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PubMedDate not supplied

[The comparative evaluation of the action of naniprus and perlinganit on the central and cerebral hemodynamics of patients with a myocardial infarct and pulmonary edema].

A study is presented of 59 patients with macrofocal and transmural myocardial infarction and symptoms of pulmonary edema. It was found that in patients with myocardial infarction complicated by acute left ventricular failure, reduced reserves of autoregulation naniprus is the drug of choice for control of pulmonary edema, particularly, in case of hypokinetic type of cerebral hemodynamics.

Adult↗
PubMed1989

[Surgical treatment of a right atrial myxoma with pulmonary embolism].

We report on an 18-year-old man with a right atrial myxoma complicated by widespread pulmonary infarction. Under cardiopulmonary bypass, a typical gelatin-like myxoma of 65 g in weight and the segments of pulmonary infarction were simultaneously removed. From the excised lung specimens, pulmonary tissue infarction caused by myxoma acting as a blocker was recognized. This was a very rare case of myxoma complicated by pulmonary infarction, and we report here the successful removal of the right myxoma and partial pneumonectomy.

Adolescent↗
PubMed2006

[An integral approach for cyanotic congenital heart disease with major aortopulmonary collateral arteries].

OBJECTIVE: To demonstrate the feasibility of combined collateral embolization with surgical repair for tetralogy of Fallot or pulmonary atresia with major aorta pulmonary collateral arteries. METHODS: The clinical, catheterization and surgical data of 15 such patients from November 1992 to September 2003 were analyzed retrospectively. RESULTS: All 15 patients underwent combined therapy of major-aorto pulmonary collateral arteries (MAPCAs) occlusion and complete repair with a mortality of 26.7%. Of the 46 collateral arteries, 35 were occluded with a successful rate of 90.6%. Embolization was performed before corrective surgery in 12 patients. The causes of early death in three patients were low cardiac output syndrome, pulmonary hemorrhage, and pulmonary infarction respectively. Complications included extensive pulmonary infiltration in 1 patient and right ventricular dysfunction in another patient. The other 7 patients recovered smoothly with the arterial oxygen saturation greater than 97% at discharge. Embolization was performed after corrective surgery in 3 patients with postoperative congestive heart failure. One patient died of congestive heart failure. The symptoms and signs of heart failure was significently relieved in the other two cases. CONCLUSIONS: In selective group of patients with dual pulmonary blood supply by both MAPCA and native pulmonary arteries, this combined therapy of collateral embolization and surgical repair simplifies complete surgical operation and enhances surgical results. It is necessary to minimize the error in distinguish sole pulmonary blood supply from dual pulmonary blood supply to avoid postoperative pulmonary infarction. Embolization after surgical correction is an important rescue measurement to congestive heart failure.

Adolescent↗
PubMed1991

Bolus, front-loaded, and accelerated thrombolytic infusions for myocardial infarction and pulmonary embolism.

Thrombolytic therapy decreases mortality in patients with acute myocardial infarction and is now widely used in such patients. The choice of which thrombolytic agent to use in such patients, either streptokinase or recombinant tissue plasminogen activator (rt-PA), is based on regional preferences. The standard dose of streptokinase is 1.5 million units over 60 min, and the dose of rt-PA that is commonly used is 100 mg over 3 h. Experiments in animals have demonstrated that rt-PA produces continuing thrombolysis after it is cleared from the circulation and that thrombolysis is both increased and accelerated and bleeding is reduced when rt-PA is administered over a short time period. Based on these studies, there have been a number of recent trials examining alternative dosage regimens for rt-PA (bolus, front-loaded, and accelerated) in patients with myocardial infarction. To date, there is no convincing evidence that such regimens are superior to the more traditional rt-PA regimen. Future randomized trials will determine whether attempts to optimize rt-PA regimens will result in more efficacious treatment regimens. Interest in the use of thrombolytic therapy for patients with acute pulmonary embolism has been rekindled. The traditional 12- to 24-h regimens of streptokinase and urokinase are not optimal because of their logistic complexity and associated hemorrhagic complications. Clinical studies have demonstrated that rt-PA, 100 mg over 2 h, is an effective thrombolytic agent in patients with acute pulmonary embolism. In a recent double-blind trial in patients with acute pulmonary embolism, rt-PA, 0.6 mg/kg infused over 2 min, improved pulmonary perfusion. This bolus regimen is attractive because it is simple to administer. Future studies will compare the relative efficacy and safety of these two rt-PA regimens in patients with acute pulmonary embolism.

Animals↗
PubMed1978

Computed tomographic patterns of pulmonary thromboembolism and infarction.

A wedge shaped pulmonary density with its broad base against a peripheral pleural surface and with its tip pointing to the parahilar area is suggestive of pulmonary infarction. This pattern can be shown more often with computed tomography (CT) scanning than in plain chest X-ray films. In 16 patients with clinical evidence of pulmonary thromboembolism, often corroborated by diagnostic procedures other than CT, a variety of CT patterns of increased attenuation were noted. In seven (44%) of these cases, a distinct wedge shaped appearance was observed.

Adult↗
PubMed1985

[Combined acute myocardial infarct and pulmonary thromboembolism with fatal outcome].

A retrospective clinical and pathologicoanatomic analysis was made of 37 patients with the combination of acute myocardial infarction (AMI) and pulmonary thromboembolism (PTE), that had a lethal end. The following facts were established: The combination of AMI with PTE is established in 7.89% in AMI. All patients have several preconditioning factors for PTE, advanced age including. PTE advances usually in extensive anterior and anterior-posterior myocardial infarction, complicated with cardiac insufficiency. In rare cases, a reverse succession is likely--massive PTE with a following, most frequently posterior-inferior AMI. The percentage of the undistinguished PTE in case of AMI is high--46%. The diagnosis of PTE in AMI is made, with a high probability, in acutely advancing respiratory distress, tachycardia (tachyarrhythmia, pulmonary hypertension, loading of right ventricle, arterial hypotension, phlebothrombosis in the absence of data for extension of the myocardial infarction. ECG, roentgenography, laboratory investigations do not essentially improve the possibilities of making the diagnosis of PTE in AMI.

Aged↗
PubMed1984

Current status of pulmonary thromboembolism--incidence, diagnosis, classification, pathogenesis, and treatment.

The incidence of pulmonary thromboembolism in the total autopsied cases and the actual reported cases of pulmonary thromboembolism in Japan has gradually increased. Since there is no part of the history, physical examination or noninvasive laboratory findings that is specific, a tentative criteria for diagnosis of pulmonary thromboembolism is proposed based a scoring system. Pulmonary thromboembolism can be classified into 5 different types: (1) massive pulmonary thromboembolism, (2) recurrent or occult pulmonary thromboembolism, (3) diffuse pulmonary microthromboembolism, (4) submassive pulmonary thromboembolism, (5) pulmonary infarction. We have carried out a series of model experiments in order to clarify the mechanism of the development of pulmonary microthromboembolism and the production of pulmonary infarction. On the basis of this data, we suspect that hyperfibrinolysis, endothelial damages and activated permeability factors lead to the interstitial and alveolar edema in pulmonary microthromboembolism or severe hemorrhage in pulmonary infarction. The combination therapy of UK (480,000 units) and DS (3,000 mg) had two advantages: (1) inhibition of shortening of APTT, (2) economy of UK dosage. Laboratory monitoring for effective UK therapy showed a markedly reduced alpha 2PI to under 50% of normal levels and fibrinolysis associated with fibrinogenolysis. The therapeutic effects of heparin were assessed by prolonged APTT (45-250 sec) and elevated Anti-FXa activity (0.2-1.2 u/ml of plasma heparin concentration) as an indicator for the evaluation of anticoagulation activity and by normalized FPA, Fbg, FDP, Plg and AT III as an indicator for evaluation of antithrombolic activity.

Adult↗
PubMedDate not supplied

Early, aggressive open lung biopsy in heart transplant recipients.

Fourteen open lung biopsies were done in 13 patients out of a total of 63 heart transplant recipients. All of the patients were receiving cyclosporine and azathioprine (Imuran) and had received prophylactic antithymocyte globulin or murine antihuman mature T cell (OKT3). Eight of the patients were receiving steroids, and five of the patients had been weaned off steroids. A fever of greater than 38.5 degrees C was present in all 13 patients. Hypoxia, defined as PO2 less than 60 on room air, was present in 11 of the 13 patients. One patient had to be intubated before surgery for respiratory failure. The chest x-ray film most often revealed bilateral interstitial infiltrates. The operative approach was by a small anterior thoracotomy in 12 patients and a posterolateral thoracotomy in two patients. A definitive diagnosis was made in 11 of the 14 open lung biopsies: three patients had Legionella, one had cytomegalovirus (CMV), one had a Pseudomonas infection, three had Pneumocystis, one patient had CMV and Pneumocystis, one patient had a pulmonary infarct, and one patient had a pulmonary infarct and CMV. Specific therapy was instituted in all these patients. In the three patients in whom no specific diagnosis was made, therapy was also changed and the use of antibiotics discontinued. There was no mortality in this group. Morbidity was minimal. No patient had excessive bleeding, and none of the patients required the transfusion of blood or blood products. Three patients required mechanical ventilatory support for longer than 24 hours.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Spiral CT of acute pulmonary thromboembolism: evaluation of pleuroparenchymal abnormalities.

PURPOSE: The goal of this work was to identify and categorize the spectrum of pulmonary parenchymal and pleural abnormalities identified by CT in patients with acute pulmonary thromboembolism (PE). METHOD: A review of interpretations from 4,715 consecutive contrast-enhanced thoracic CT studies identified 41 examinations in which the diagnosis of PE was reported. Thirty-four studies were available for review, and two radiologists confirmed intraluminal defects in 31 patients. The number of emboli were counted and localized using bronchopulmonary nomenclature. Associated parenchymal and pleural abnormalities were tabulated. RESULTS: Of the 31 patients, 13 underwent confirmatory or correlative studies including angiography, radionuclide study, or autopsy. In addition, deep venous thrombosis was confirmed by ultrasound or MRI in 13 patients. An average of 7.5 emboli per patient was detected. Pleuroparenchymal findings were as follows: Nine patients (29%) had no acute pulmonary parenchymal or pleural abnormality. In the remaining 22 patients, pleural effusion was the most common abnormality, found in 14 of 31 (45%). Ten patients (32%) had peripheral wedge-shaped parenchymal opacities suggestive of pulmonary infarction. Normally enhancing lobar atelectasis was seen in nine patients (29%). Six patients (19%) demonstrated heterogeneous parenchymal enhancement within nonaerated lung, two of whom had pathologically proven pulmonary infarct. Thirteen of 31 patients underwent high resolution CT; a typical mosaic perfusion pattern was seen in only 1 patient. CONCLUSION: Twenty-nine percent of patients with acute PE had no acute lung parenchymal abnormality on CT; thus, the absence of parenchymal abnormality on CT does not exclude PE. High resolution CT mosaic perfusion was not a common feature of acute pulmonary embolism. Regions of decreased enhancement within nonaerated lung, seen in 19%, may prove to be an indicator of pulmonary infarction; however, this is a nonspecific finding.

Adolescent↗
PubMed1986

[Swimming after myocardial infarct. Oxygen saturation, pulmonary arterial and capillary pressure in underwater immersion and during swimming after myocardial infarct].

Pulmonary arterial (PA) and pulmonary capillary (PC) pressures and oxygen saturation were measured over a 5-minute period on immersion in water and during swimming in four symptom-free men (aged 52-58 years) who had sustained a transmural infarct 6-10 weeks previously. Measurements were made through an indwelling flow-guided percutaneously introduced catheter. The speed of swimming was 20-25 m/min. Static pressures on immersion up to the neck rose up to 23 mm Hg, on diving to five times as much above the resting recumbent value. Mean PC values after five minutes of swimming rose in all four subjects above those obtained after a 5-minute 100 W exercise: they were similar to the diastolic pressures. But the oxygen saturations on swimming were in all patients higher than after tread-wheel exercise. All patients felt swimming to be easier than the ergometric exercise. It is concluded that noninvasive methods, such as X-rays, ergometry and echocardiography, are not sufficient for estimating volume stress induced by immersion in water. Cardiac arrhythmias did not occur.

Exercise Test↗