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Circulatory regulation in response to postural changes follows mechanical rules, whereby the shifts in volume in the various organs of the body play an essential role. The change from the horizontal to the vertical position is accompanied by a decrease in pressure above the hydrostatic neutral point, i.e. in the cephalic vessels, whereas the capacious vessels in the caudal region are dilated and the venous return becomes sluggish. As a consequence of the different time courses followed by the various circulatory parameters in the wake of counter-regulatory measures, a distinction can be made between an early orthostatic instant regulatory response and a late orthostatic response. Prominent clinical features do not necessarily always consist of non-systemic dizziness, tinnitus, pallor cold sweat and, finally, orthostatic collapse, but general subjective symptoms such as deafness and tingling of the extremities, a chilly sensation and cardiac symptoms may frequently predominante. In the case of development of an autonomic neurotic symptom complex, psychoautonomic symptoms such as general sleep disturbance are observed. Apart from investigations carried out on a surgical tilting table in general practice, other procedures such as the Valsalva manoeuvre, the squatting test and, in most cases, the erect test are performed. Broadly speaking four different reaction types can be distinguished amongst cases of postural hypotension. Drugs with different therapeutic actions are selectively administered according to the pathophysiological characteristics of the individual patient and the sympathetic adrenal counter-regulatory response. Medico-mechanical measures and physical training should not be neglected.
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PMID:[Postural hypotension: pathophysiology and clinical features (author's transl)]. 1 41

Portuguese man-of-war and jellyfish stings are common occurrence in the coastal waters of the southern United States. Signs and symptoms of Portuguese man-of-war envenomation usually appear immediately following a sting but may be delayed for several hours. Reactions are commonly localized and comprise pain, paresthesia, and intense burning with a linear, red, papular eruption or urticaria at the contact site. Systemic signs may include nausea, myalgia, headache, chills, or pallor. Cardiovascular collapse and death have been reported. Venom can be inactivated with dilute acetic acid (vinegar), proteolytic meat tenderizer, or baking soda. Tentacle debris should be removed. Resolution of symptoms usually occurs within 72 hours, without sequelae.
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PMID:Portuguese man-of-war envenomation. 135 Dec 83

We report the case of a three week old newborn who developed bilateral adrenal hemorrhage. This is an extraordinary case because of the late presentation of the hemorrhage as well as the excessive amount of blood involved. The newborn was the product of a normally evolved to full-term pregnancy, with a prolonged and traumatic delivery. The child had severe neonatal hypoxia and encephalopathy which required intensive care. The child was discharged in good conditions a week later. A week after that, the child is readmitted due to circulatory collapse, extreme paleness and a hemoglobin count of 3 g/dL. The newborn was treated for hypovolemic shock and improved substantially. The bilateral intraabdominal mass was detected and using an intravenous pyelography, ultrasonography and a CAT scan, a severe bilateral adrenal hemorrhage was seen. Adrenal failure was excluded and the child's care allowed for him to be discharged a week later in excellent conditions an followed as an outpatient until the hematomas subsided. This problem should be suspected in hypoxic newborns for which they should be submitted to abdominal ultrasonography before being discharged.
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PMID:[Massive neonatal hemorrhage of the adrenal glands]. 227 50

In the South-Western part of Norway, lambs of the Old Norwegian short tailed breed (Spael) and crosses with the Dala breed sometimes develop an Acute Respiratory Distress Syndrome (ARDS) shortly after they have been moved onto lush aftermath grazings from mountain pastures. This article covers the symptoms and pathoanatomical findings in lambs affected with ARDS (Table I). The lambs acquired ARDS 18-72 hours after change of pasture. Heavy dysphne, frothing at the mouth, elevated temperature (greater than 41 degrees C), tachycardia, urination and ruminal atony were striking symptoms (Table II). In the early phase of the disease the lambs were often in a tranquil state, depressed, sometimes atactic, and it seemed that they went into the overt dysphneic phase on exposure to physical stress. Morbidity was 1.4%, mortality 36%. Post mortem findings included frothy contents in the airways, heavy congestion and oedema in the lungs which also had emphysematous areas, subepicardial petechiae, varying degree of mottling of the myocardium, and also varying degree of paleness and spottyness of renal cortices. The lungs showed extensive focal alveolar and interstitial emphysema, septal congestion, alveolar oedema, partial collapse, and accumulations of polymorphonuclear leucocytes in vascular beds. Later, fibrillar material was found in the alveoli, alveolar macrophages accumulated, and interalveolar septa thickened because of increased fibromuscular tissue and mononuclear cells (Fig. 1, A-D). Alveolar epithelial hyperplasia was not seen in any stage. Four lambs were moderately infected with lungworms (D. filaria), three in the prepatent, one in the patent phase. Histopathological changes in other organs included granular degenerations of myocardial threads, and development of a glomerulonephritis and focal interstitial nephritis (Fig. 1, E-F). This disease entity (ARDS) in lambs seems to be unknown in literature. The disease is compared with other known diseases in ruminants. Etiology is so far unknown. Possibilities of sudden ruminal histamine formation coinciding with a hypersensitivity reaction is discussed.
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PMID:Acute respiratory distress syndrome (ARDS) in lambs. Clinical and pathoanatomical investigations. 656 10

This thesis presents the results of a study of 384 eyes of 192 patients with a mean age of 39.1 years who presented with typical retinitis pigmentosa. The major findings are outlined below, together with suggested hypotheses: Cataract was found in 46.4% of the eyes. Among these, 93.6% showed posterior subcapsular opacification. The incidence of cataract increased with age. The vitreous degeneration that is characteristic of the RP syndrome and begins in childhood was described as showing dust-like, particulate matter throughout the gel; posterior vitreous separation; formation of a posterior matrix of coarse, white, interconnected strands and opacities; and final collapse of the residual gel. Ultrastructural studies of vitreous material from eight eyes revealed that the particles were isolated pigment granules and the coarse strands were composed of condensed collagen fibers. Notwithstanding the vitreous degeneration and prevalence of myopia in RP, neurosensory retinal breaks and/or rhegmatogenous detachment were found in only 7 (1.8%) of the 384 eyes studied. Premature separation of the vitreous from the retina, absence of lattice retinal degeneration, and perhaps a stronger than normal RPE-neurosensory retinal bond are thought to be possible protective factors. Rather than searching for a "toxin," elaborated by diseased retina, that causes vitreous degeneration and cataract formation, it is suggested that the ocular media be studied for an absence of moieties that are normally produced by healthy retina for vitreous and lens maintenance. The classic criteria for diagnosis of RP were met by 96.3% of eyes that showed retinal vascular attenuation and by 52.0% that showed pallor of the optic disc. Less frequent manifestations included solitary retinal hemorrhage, peripheral microaneurysms, telangiectasia, and fluorescein leakage at the macula and disc. Seven additional cases with a Coats'-like retinal detachment were added to the 14 already presented in the literature. Two of the seven had autosomal dominant RP, the first such cases reported. The vascular malformations and detachments were most often inferior. Unlike typical Coats' syndrome, the condition was usually bilateral, showed no sex preference, and appeared to affect older individuals.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Retinitis pigmentosa: clinical observations and correlations. 667 82

Morphologic changes in the subendocardial myocardium that appeared to be caused by severe, chronic subendocardial ischemia were studied in patients with fatal ischemic heart disease admitted to the Specialized Center of Research for Ischemic Heart Disease at the University of Alabama in Birmingham in the period 1970--1977. Thirteen patients were selected for this report on the basis that they had the lesions in the subendocardial myocardium we believe to have been caused by subendocardial ischemia and had no evidence of acute or remote myocardial infarction or other conditions that may have contributed to their terminal illness or death. Clinical findings were unstable angina, congestive heart failure, usually no increase in plasma enzymes indicative of myocardial damage, and electrocardiographic changes consistent with subendocardial ischemia. All 13 patients had 75% or greater stenosis of the three major coronary arteries; none had acute thrombotic or embolic coronary artery occlusion. The left ventricle in all cases was hypertrophied. The subendocardial myocardium showed circumferential pallor, hyperemia, or focal fibrosis without perceptible loss of volume in papillary muscles or trabeculae carneae. Microscopically, acute lesions showed one to two layers of preserved myofibers adjacent to the endocardium, vacuolar change in the deeper fibers, and focal areas of coagulation necrosis of variable size in the myocardium external to the fibers with vacuolar change. Coagulation necrosis was extensive in some cases and usually was not associated with infiltration of neutrophils. The repair reaction involved removal of necrotic sarcoplasm by mononuclear phagocytes, resulting in a reticular-appearing tissue without evidence of stromal collapse. Granulation tissue was not seen. Collagen fibers appeared to be deposited within the area of previous sarcolemmal sheaths. The distribution and morphology of subendocardial myocardial lesions associated with severe coronary atherosclerosis are distinctive and can be distinguished from myocardial necrosis or fibrosis associated with acute total occlusion of a coronary artery.
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PMID:Subendocardial ischemic myocardial lesions associated with severe coronary atherosclerosis. 736 50

A crude, whole-body extract of female or male heartworms was injected IV into 28 dogs with and 22 dogs without heartworm (HW) infection. The female HW extract caused shock in 22 of 24 dogs with and 12 of 20 dogs without HW infection. The male HW extract induced shock in 4 of 4 dogs with and 1 of 2 dogs without HW infection. Prevalence of shock caused by female HW extract was significantly (P < 0.05) higher in dogs with than without HW infection; shock developed 5 to 30 minutes after HW injection. These signs were observed: marked decrease in blood pressure; collapse (initial collapse); paleness of mucous membranes; weak heart sounds; dyspnea; skin coldness; intestinal hyperperistalsis, and defecation; increases in RBC count, serum total protein concentration, serum osmolality, serum Na and blood glucose concentrations; and decreases in neutrophil, eosinophil, and platelet counts. Alanine transaminase, alkaline phosphatase, and lactate dehydrogenase activities increased substantially from the time of initial collapse to 24 hours after HW injection. Of 39 dogs with shock, 29 recovered from initial collapse, but 5 of the 29 subsequently collapsed again (secondary collapse), with bloody diarrhea followed by death. Of these 39 dogs, 6 died during initial collapse without bloody diarrhea, and 4 were euthanatized during initial collapse. It was confirmed that HW extract had, in fact, induced shock. These clinical, hematologic, and biochemical findings were fundamentally similar to those associated with shock resulting from administration of drugs, such as diethylcarbamazine and milbemycin D, in microfilaremic dogs with HW infection.
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PMID:Clinical, hematologic, and biochemical findings in dogs after induction of shock by injection of heartworm extract. 787 76

To evaluate the morphologic changes in the peripheral airways associated with positive pressure ventilation, fine fiberoptic bronchoscopy (1.8 mm outer diameter) was performed in 12 patients who had no history of prior pulmonary failure. In 19 examinations, the main morphologic findings were paleness and bronchial dilatation in the peripheral airways where increased secretions, pigmentation and stenosis or collapse were also observed. Patients with bronchial dilatation had longer periods of mechanical ventilation (17 +/- 8 days) compared to those without dilation (10 +/- 5 days). The structural destruction in the peripheral airways observed in patients on prolonged positive pressure mechanical ventilation suggests that barotrauma may be more widespread than previously recognized.
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PMID:[Changes of peripheral airways through mechanical ventilation in acute respiratory failure]. 827 10

Adverse reactions to radiopharmaceuticals are comparatively few in number. Various estimates quote an incident rate of 1 to 6 reactions per 100,000 injections. Other figures quoted are 1 in 800 for the bone-seeking radiopharmaceutical methylene diphosphonate, and 1 in 400 for the lung visualisation agent macroaggregated albumin. The very low numbers of reported adverse effects probably reflect the tiny amounts of material which are used in the formulation of radiopharmaceuticals. Adverse reactions to radiopharmaceuticals are usually mild and transient and require little or no medical treatment. A few reactions involve respiratory or circulatory collapse or loss of consciousness. Several fatalities have been reported with the liver scanning agent 99mTc (technetium 99m)-albumin colloid. Clinical manifestations may be categorised under the headings of vasomotor effects i.e. faintness, pallor, diaphoresis or hypotension, and anaphylactoid effects such as nausea, dermographism, wheezing, bronchospasm, erythema and pruritus. The most prominent group of radiopharmaceuticals that have been reported to produce adverse events are the diphosphonates, which are used for scanning the skeleton. Typical diphosphonate reactions include erythema (especially over the extremities), nausea, vomiting and malaise. The onset of reaction is usually 2 to 3 hours after injection. The second group of radiopharmaceuticals which give rise to adverse events are the colloids, which are used for liver and spleen scintigraphy. Typical colloid reactions include pallor, nausea, flush and pulse changes. Adverse events may also occur as a result of the patient's medication interfering with the disposition of the radiopharmaceutical. Although not usually hazardous or dangerous, such events may be so pronounced that a marked deviation in the expected pharmacokinetics may occur. Drug interactions can be conveniently categorised under the headings of unusual handling of the radiopharmaceutical because of pharmacological action, genuine in vivo interaction between the medication and radiopharmaceutical, drug-induced disease and interaction between the radiopharmaceutical and catheters or syringes. The most serious drug interactions are those where the patient is taking cortisone or cytotoxic agents prior to tumour scintigraphy. Other important effects occur in patients undergoing bone scanning who are receiving iron preparations. Nifedipine has been reported to produce quite severe problems in scanning, including difficulties in the radiolabelling of red cells (for cardiac scintigraphy), and other effects where the drug appears to prevent the transport of bone-seeking materials into the skeleton. Many drugs alter hormonal status and these effects may produce marked deviations from the expected biodistribution. Diethylstilbestrol (stilboestrol), digitalis, gonadotrophins, phenothiazines and cimetidine all increase estrogen levels in high doses.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Adverse reactions and drug interactions with radiopharmaceuticals. 848 Dec 15

We describe three typical consequences of chronic or subacute proximal vein obstruction: venous claudication, narrowing of the spinal canal by dilated veins that function as collaterals, and hypovolemia caused by trapping of blood in the periphery and slow return. Venous claudication is a well recognized clinical entity. We emphasize that the syndrome is often diagnosed in patients who do not remember acute thrombosis and that the signs on the skin of chronic venous insufficiency are typically absent in these patients. Venous drainage after proximal thrombosis often involves the veins of the spinal canal. Under the condition of sustained physical activity these veins become dilated and occupy space causing the syndrome of a narrow spinal canal. The clinical features differ from those encountered in other forms of a narrow spinal canal; the symptoms appear only after prolonged and strenuous exercise, do barely depend on the posture of the spine and do not disappear readily with cessation of the effort. In patients with bilateral pelvic vein occlusions we regularly found evidence for a shock-like syndrome that follows vigorous exercise. The patients experience sudden weakness and dizziness, with sweats, pallor and tachycardia and have to interrupt the effort to prevent collapse and fainting. The clinical features depend on the anatomical localisation of the obstruction as well as on the pathways of the collaterals. In patients with typical symptoms a venographic workup may be indicated to assess the possibility of recanalisation by endoluminal stenting. The presence of peripheral valve incompetence may be regarded as a contraindication to stenting since it may increase the volume overload and make the chronic venous insufficiency worse.
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PMID:[Sequelae of proximal venous stenosis]. 865 51


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