Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0729233 (Thoracic)
 6,478 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diagnostic delay in patients suffering massive pulmonary embolism (PE) on chronic thromboembolic pulmonary hypertension (CTEPH) has inevitably fatal consequences. Indications to pulmonary thromboendarterectomy (PTE) and extracorporeal membrane oxygenation (ECMO) are limited by severe comorbid conditions, some of which, as neurologic disease, absolutely contraindicate these procedures. We reported the clinical course of a severely diseased patient with a history of meningitis, psychosis and epilepsy, experiencing acute massive pulmonary embolism complicated by acute respiratory failure, successfully treated by ECMO and PTE. A 51-year-old woman with massive PE complicating a misdiagnosed CTEPH needed mechanical ventilation because of acute respiratory insufficiency. Thoracic computed tomography (CT) scan demonstrated PE, and brain CT showed multiple cerebral and cerebellar ischemic lesions. Veno-venous ECMO assistance was instituted despite CT imaging. She recovered from acute respiratory insufficiency by means of veno-venous ECMO. Weaning from ECMO was however impossible until surgical exploration demonstrated an underlying chronic CTEPH, which was successfully addressed by PTE, switching the ECMO system to a standard cardiopulmonary bypass. Postoperative course was uneventful and the patient was discharged home in healthy condition. Despite the fact that the cost-effective ratio should always be considered in advanced life support, expanding the commonly accepted selection criteria for expensive procedures might be advisable in selected acute life-threatening cases, in view of the possibility to unexpectedly save lives.
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PMID:Veno-venous extracorporeal membrane oxygenation as a bridge to and support for pulmonary thromboendarterectomy in misdiagnosed chronic thromboembolic pulmonary hypertension. 2149 95

BACKGROUND AND AIMS: Assessment of respiration is important in medicine and physical therapy. As respiration is multifaceted, we need several specific examination methods. The purpose of this study was to develop a method for examination of visible respiratory movements, by extracting from two examinations the items with best ability to discriminate among healthy controls, patients with pain disorders and patients with psychotic disorders. METHODS: Two physiotherapists independently examined 132 individuals (34 healthy persons, 32 with localized pain, 32 with widespread pain and 34 with psychoses). Items were assigned to subscales by explorative factor analysis. Internal consistency of subscales was examined with Cronbach's alpha. To examine validity, one-way analysis of variance and the area under the curve (AUC) were used. RESULTS: WE IDENTIFIED FOUR SUBSCALES: Tension, Position of Thorax, Basal respiration and Thoracic movements. Cronbach's alpha ranged from 0.75 to 0.86. The subscales' discriminating ability was excellent between healthy controls and patients, and fair between patients with localized pain and the two other patient groups. CONCLUSIONS: The respiration domain of the new Global Body Examination has 21 items, which comprise four subscales with high internal consistency and good ability to discriminate between healthy persons and patients with pain disorders or psychosis.
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PMID:The Global Body Examination (GBE). A useful instrument for evaluation of respiration. 2324 89

A 32-year-old woman was referred to our hospital because of severe psychosis and was found to have an ectopic ACTH-producing thymic neuroendocrine tumor. Laboratory data revealed an elevated serum cortisol and plasma ACTH level, hypokalemia, and metabolic alkalosis. Chest computed tomography (CT) revealed an anterior mediastinal mass and multiple pulmonary nodules. As the patient was unable to communicate because of her consciousness disturbance, she was managed with artificial ventilation and deep sedation. Metyrapone and potassium supplementation were administered, and steroid psychosis gradually improved. Thoracic surgery was performed and the histopathological diagnosis was thymic neuroendocrine tumor with positive anti-ACTH immunohistochemical staining. Here we present details of the case and review the literature.
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PMID:ACTH-producing thymic neuroendocrine tumor initially presenting as psychosis: A case report and literature review. 3118 63