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Respiratory Distress (respiratory + distress)

Distribution by Scientific Domains

Medical Sciences	98%

Distribution within Medical Sciences

Pediatrics	27%
Anesthesia & Pain Management	10%
Obstetrics & Gynecology	6%
General & Introductory Veterinary Medicine	5%
Hematology	2%
16 Other Subdomains	42%

Kinds of Respiratory Distress

acute respiratory distress

neonatal respiratory distress

severe respiratory distress

Terms modified by Respiratory Distress

respiratory distress syndrome

Selected Abstracts

Additives in intravenous anesthesia modulates pulmonary inflammation in a model of LPS-induced respiratory distress

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2009
J. J. HAITSMA
Background: It has been suggested that propofol with ethylenediaminetetraacetic acid (EDTA) can modulate the systemic inflammatory response. Prolonged higher levels of pulmonary inflammation are associated with poor outcome of patients with acute lung injury. In the present study, we hypothesized that pulmonary inflammation could be modulated by propofol with EDTA compared with propofol with sulfite. Methods: Respiratory distress was induced in rats (n=25) by intratracheal nebulization of lipopolysaccharide (LPS). After 24 h, animals were randomized to either propofol with EDTA (PropofolEDTA), propofol with sulfite (Propofolsulfite) or ketamine/midazolam (Ket/Mid); control animals received saline (n=30). Animals were ventilated for 4 h and blood gases were measured hourly. Bronchoalveolar lavage (BAL) was performed for cytokine analysis of: tumor necrosis factor (TNF), interleukin (IL)-6 and macrophage inflammatory protein (MIP)-2. Results: LPS led to increased pulmonary inflammation in all groups compared with the control groups. Gas exchange deteriorated over time only in the LPS Propofolsulfite group and was significantly lower than the Ket/Mid group. Only IL-6 was significantly higher in the LPS Propofolsulfite group compared with both the Ket/Mid group and the PropofolEDTA group. Conclusion: Pulmonary IL-6 can be modulated by additives in systemic anesthesia. Implication Statement: This study demonstrates that pulmonary inflammation caused by direct lung injury can be modulated by intravenous anesthesia used in critically ill patients. [source]

Raised intracranial pressure in a neonate presenting as stridor

PEDIATRIC ANESTHESIA, Issue 8 2006
KATE SOLAN FRCA
Summary Neonatal stridor is an important sign of upper airway obstruction. This is most commonly secondary to laryngeal pathology and investigated by otolaryngologists. However neurological causes of stridor, secondary to vocal cord paralysis also occur for a variety of reasons (1). In cases of meningomyelocele up to 20% of infants may develop stridor (2). Respiratory distress may be severe and require prompt surgical and medical intervention. We describe a neonate born with a meningomyelocele, who developed stridor secondary to evolving hydrocephalus after surgical repair of the meningomyelocele. This was treated acutely by direct tapping of cerebrospinal fluid from the right coronal horn via the coronal suture with immediate symptomatic improvement prior to a definitive shunt procedure. [source]

Clinical features of neonatal sepsis caused by resistant Gram-negative bacteria

PEDIATRICS INTERNATIONAL, Issue 3 2009
Mohammad Khassawneh
Abstract Background:, Clinical features and outcomes of neonatal sepsis caused by resistant Gram-negative bacteria are not well described in Jordan. The aim of the present study was therefore to describe microbiology and clinical features, laboratory findings and outcomes of early- and late-onset Gram-negative neonatal sepsis. Methods:, All patients with Gram-negative bacteremia between July 2003 and June 2005 were retrospectively included. Resistance profiles, clinical features and outcomes of early and late-onset neonatal sepsis were compared. Results:, A total of 79 patients (after excluding all nine cases of Gram-positive bloodstream infection (BSI) were identified as having Gram-negative BSI (25 had early-onset and 54 had late-onset neonatal sepsis). Respiratory distress, metabolic acidosis and requirement of ventilation were found in 74.7%, 40.5%, and 58.2%, respectively. Hypotension was found in 22.9% of patients. Klebsiella pneumoniae was responsible for 43 cases (54.4.2%). Klebsiella pneumoniae resistance rates to ampicillin and ceftazidime were 100% and 50%, respectively. Mortality rate was 30.9%. Forty-eight percent of deaths occurred within 3 days of sepsis. Meningitis was diagnosed in five cases. Elevated C-reactive protein (CRP) and thrombocytopenia were seen in 28% and 24% of infants with early-onset sepsis, respectively, and in 79.6%, 59.3% of infants with late-onset sepsis respectively. Conclusion:, Both early- and late-onset neonatal sepsis are caused by highly resistant Gram-negative bacteria. Mortality of sepsis is high. Elevated CRP and thrombocytopenia is seen more commonly in late-onset neonatal sepsis. [source]

Role of natriuretic hormones in the diagnosis of patent ductus arteriosus in newborn infants

ACTA PAEDIATRICA, Issue 4 2001
E Pesonen
Haemodynamically significant patent ductus arteriosus worsens respiratory distress by initiating pulmonary congestion and inactivating of surfactant. Excepting size of the ductus, several factors influence ductal flow. Conclusion: Atrial natriuretic hormones provide clinically useful data, especially in serial follow-up of the patient. [source]

Randomized trial comparing natural and synthetic surfactant: increased infection rate after natural surfactant?

ACTA PAEDIATRICA, Issue 5 2000
AK Kukkonen
The efficacy of a natural porcine surfactant and a synthetic surfactant were compared in a randomized trial. In three neonatal intensive care units, 228 neonates with respiratory distress and a ratio of arterial to alveolar partial pressure of oxygen <0.22 were randomly assigned to receive either Curosurf 100mgkg,1 or Exosurf Neonatal 5 ml kg,1. After Curosurf, the fraction of inspired oxygen was lower from 15min (0.45 ± 0.22 vs 0.70 ± 0.22, p = 0.0001) to 6 h (0.48 ± 0.26 vs 0.64 ± 0.23,p= 0.0001) and the mean airway pressure was lower at 1 h (8.3 3.2 mmH2O vs 9.4 ± 3.1 mmH2O ,= 0.01). Thereafter the respiratory parameters were similar. The duration of mechanical ventilation (median 6 vs 5 d) and the duration of oxygen supplementation (median 5 vs 4 d) were similar for Curosurf and Exosurf After Curosurf, C-reactive protein value over 40 mg r1 occurred in 45% (vs 12%; RR 3.62, 95%CI 2.12-6.17, p = 0.001), leukopenia in 52% (vs 28%; RR 1.85, 95%CI 1.31-2.61, ,= 0.001) and bacteraemia in 11% (vs 4%; RR3.17, 95%CI 1.05-9.52, p < 0.05). We conclude that when given as rescue therapy Curosurf had no advantage compared with Exosurf in addition to the more effective initial response. Curosurf may increase the risk of infection. [source]

Neonatal Congestive Heart Failure Due to a Subclavian Artery to Subclavian Vein Fistula Diagnosed by Noninvasive Procedures

CONGENITAL HEART DISEASE, Issue 3 2006
Gregory H. Tatum MD
ABSTRACT Congestive heart failure in the neonate is usually due to intracardiac anomalies or cardiac dysfunction. Extracardiac causes are rare. Patient., We report a newborn infant who presented with respiratory distress and cardiomegaly. Result., Echocardiography identified a dilated right subclavian artery and vein and superior vena cava. Magnetic resonance imaging confirmed a subclavian artery to subclavian vein fistula that was treated with surgical ligation. The infant recovered fully. This case underscores the need for clinical suspicion of fistulous connection in unusual locations in the face of unexplained heart failure in the neonate. Conclusion., Echocardiographic and magnetic resonance imaging are effective noninvasive modalities to confirm the diagnosis prior to surgical intervention. [source]

A register study of the impact of stopping third trimester selective serotonin reuptake inhibitor exposure on neonatal health

ACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2010
W. Warburton
Warburton W, Hertzman C, Oberlander TF. A register study of the impact of stopping third trimester selective serotonin reuptake inhibitor exposure on neonatal health. Objective:, To determine whether risk for adverse neonatal outcomes are reduced by stopping SSRI use before the end of pregnancy. Method:, Using population health data, maternal health and prenatal SSRI prescriptions were linked to neonatal birth records (N = 119 547) (1998,2001). Neonates SSRI-exposed in the last 14 days (L14) of gestation were compared with infants who had gestational exposure, but not during the last 14 days (NL14). Propensity score matching was used to control for potential confounders (total exposure, maternal health characteristics). Results:, Increased risk for neonatal respiratory distress was present where L14 exposure occurred compared with risk where exposure stopped before L14. However, controlling for potential maternal and neonatal confounders, differences disappeared. Conclusion:, Controlling for maternal illness severity, reducing exposure to SSRI's at the end of pregnancy had no significant clinical effect on improving neonatal health. These findings raise the possibility that some adverse neonatal outcomes may not be an acute pharmacological condition such as toxicity or withdrawal. [source]

Penetrating injury at the thoracic inlet in a Paint-Arab mare

EQUINE VETERINARY EDUCATION, Issue 12 2009
Y. R. Rojman
Summary A 12-year-old Paint-Arab mare was admitted for evaluation of a penetrating chest laceration at the thoracic inlet. The left brachiocephalic muscle was transected and the recurrent laryngeal nerve was traumatised. Subsequent to the injury, the horse developed Horner's syndrome on the left side of the neck and face, Grade IV left laryngeal hemiplegia, dysphagia, cough and subcutaneous emphysema. The defect was closed in multiple layers. Antimicrobial and antiinflammatory therapy was instituted along with local wound care. The mare remained bright and responsive and the wound healed normally. The mare showed no signs of respiratory distress. Dysphagia and ptosis persisted at 30 days post trauma. [source]

Acute cardiorespiratory collapse from heparin: a consequence of heparin-induced thrombocytopenia

EUROPEAN JOURNAL OF HAEMATOLOGY, Issue 5 2004
Martha P. Mims
Abstract: Background:, Heparin has rarely been reported to cause acute cardiorespiratory reactions or collapse. Some reports relate this to underlying heparin-induced thrombocytopenia. Objective:, To confirm and increase awareness of acute life-threatening cardiopulmonary events when patients with heparin-induced thrombocytopenia are re-exposed to heparin. Design:, Retrospective observational case series. Patients/setting:, Four cardiovascular surgery patients were identified in two adjacent large urban hospitals over a 2-yr-period who experienced eight episodes of cardiorespiratory collapse immediately following heparin administration. All had underlying heparin-induced thrombocytopenia. Results:, Intravenous boluses of unfractionated heparin were given to four patients with known or previously unrecognized heparin-induced thrombocytopenia. Two patients experienced severe respiratory distress within 15 min for which they required endotracheal intubation. Two other patients experienced cardiac arrest or a lethal arrhythmia within minutes of receiving intravenous heparin. Serologic tests for heparin-induced antibodies were positive in all patients. In three cases, the platelet count was normal or near normal but fell dramatically (71%) immediately following the heparin bolus. Three cases had prior diagnoses of heparin-induced thrombocytopenia, but health care workers administered heparin either unaware of the diagnosis or ignorant of its significance. No patients died, but all required some form of cardiopulmonary resuscitation and subsequent intensive care. Conclusions:, Heparin administration to patients with heparin-induced antibodies can result in life-threatening pulmonary or cardiac events. Appreciation of this phenomenon can unmask cases of heparin-induced thrombocytopenia and strengthens the mandate to avoid any heparin exposure in affected patients. Recognition is crucial to avoiding disastrous outcomes. [source]

Torticollis as a sign of cervico-thoracic epidural haematoma in an infant with severe haemophilia A

HAEMOPHILIA, Issue 6 2006
G. D. E. CUVELIER
Summary., We describe the case of a spinal epidural haematoma in an infant with severe haemophilia A. Initial signs and symptoms were non-specific resulting in delay of the diagnosis and more definitive therapy. The patient eventually developed torticollis, acute flaccid paralysis of the upper extremities, and respiratory distress, prompting radiological examination of the spinal cord. The patient was treated with recombinant FactorVIII and laminectomy. Neurological recovery was complete 3 months following the event. We hypothesize that infants with haemophilia may be at higher risk for this rare complication because of their increasing mobility, frequent falls while cruising furniture, and lack of prophylactic factor replacement. Non-specific signs such as irritability without a focus should alert the clinician to this diagnostic possibility. Torticollis should prompt rapid radiological evaluation of the cervical spine with magnetic resonance imaging to avoid delay in diagnosis. [source]

Application of unsedated transnasal esophagogastroduodenoscopy in the diagnosis of hypopharyngeal cancer

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 2 2009
Cheng-Ping Wang MD
Abstract Background This study evaluates the efficacy of unsedated transnasal esophagogastroduodenoscopy (EGD) in the diagnosis of hypopharyngeal cancer and screening of esophageal lesions. Methods Twenty-seven patients with newly diagnosed hypopharyngeal cancer were evaluated by transnasal EGD without conscious sedation. Results Twenty-two hypopharyngeal cancers arose from the pyriform sinus, and the other 5 tumors were from the posterior hypopharyngeal wall. Seventeen tumors were classified as T3-T4. Twenty-four hypopharyngeal tumors were pathologically proved malignancy by this technique. Regarding simultaneous esophageal lesions, esophageal dysplasia was noted in 4 patients and esophageal cancer occurred in 6 patients. The procedures were performed without difficulty except in 1 patient with huge posterior wall tumor. The mean procedure time was 22 minutes. All patients tolerated the procedure well, without significant bleeding or respiratory distress during examination. Conclusion Unsedated transnasal EGD is a safe, tolerable, and accurate endoscopic technique for diagnosis of hypopharyngeal cancer and screening of simultaneous esophageal cancer. © 2008 Wiley Periodicals, Inc. Head Neck, 2009 [source]

Pendred's syndrome with goiter and enlarged vestibular aqueducts diagnosed by PDS gene mutation,

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 7 2002
Hajime Ishinaga MD
Abstract Background Pendred's syndrome (PS) is an autosomal recessive disorder characterized by goiter and congenital sensorineural hearing loss. Recent advances in molecular biology revealed the gene responsible for PS (PDS) and provided an important aid for the diagnosis of this condition. Methods A case of PS with huge goiter and congenital hearing impairment was diagnosed by mutational analysis of the PDS gene. Results Physical examination and computer tomography CT revealed a diffuse swelling of the thyroid gland. Thyroid function tests were normal, and the perchlorate discharge test was negative. Audiologic examination confirmed sensorineural hearing loss, and temporal bone CT revealed bilateral enlarged vestibular aqueducts. The mutational analysis revealed that the patient was homozygous for His 723 Arg (2168A,G) in exon 19, a missense mutation. Conclusions The results of thyroid function tests in PS patients are usually normal, and the positive perchlorate discharge test has been used for the diagnosis. However, this is a nonspecific test and is not sensitive enough for PS. In our case, despite a negative perchlorate test, the patient was diagnosed by mutational analysis and received total thyroidectomy to relieve respiratory distress caused by thyroid enlargement. This is the first report of a mutation detected in the thyroid tissue and clearly shows that the mutation caused histopathologic change in that gland. © 2002 Wiley Periodicals, Inc. [source]

Prenatal and perinatal risk factors for neuroblastoma,

INTERNATIONAL JOURNAL OF CANCER, Issue 12 2008
Elizabeth Bluhm
Abstract Neuroblastoma is a rare embryonal tumor of childhood for which risk factors are not well known. Using a nested case,control design, we investigated prenatal, perinatal and neonatal risk factors in detail by linking 245 pediatric neuroblastoma cases identified in the Swedish Cancer Register diagnosed in the year 1973,1995 with the Swedish Medical Birth Register. Five living controls per case were randomly selected from the birth registry, matched by gender and age. Increased risks were associated with maternal anemia during pregnancy (odds ratio (OR) = 2.95, 95% confidence interval (CI): 1.53, 5.69), neonatal respiratory distress (OR = 3.61, 95% CI: 1.41, 9.24) and low (below or equal to 7) 1-min Apgar score (OR = 2.23, 95% CI: 1.41, 3.52). Increased risks were limited to cases diagnosed before 1 year of age. Markers of prenatal, perinatal and neonatal distress may be associated with neuroblastoma in infancy, but not with diagnoses at 1 year or above. Published 2008 Wiley-Liss, Inc. [source]

Dyspnoea after antiplatelet agents: the AZD6140 controversy

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 3 2007
V. L. Serebruany
Summary Recent randomised studies suggest that experimental oral reversible platelet P2Y12 receptor inhibitor, AZD6140, causes dyspnoea. This also raises similar concerns about the parent compound, and another adenosine triphosphate (ATP) analogue (AR-69931MX or cangrelor), which is currently in Phase 3 trial in patients undergoing coronary interventions. We analysed package inserts, and available clinical trials safety data for antiplatelet agents with regard to the incidence of dyspnoea. We found that dyspnoea is a very rare complication of the presently approved platelet inhibitors, mostly caused by underlying disease, rather than antiplatelet therapy per se. The main reasons for respiratory distress after oral (AZD6140), and intravenous (cangrelor) agents may be the development of mild asymptomatic thrombotic thrombocytopenic purpura, fluid retention and dyspnoea because of the reversible nature of these drugs. Also, these agents are ATP analogues, which rapidly metabolise to adenosine, a well-known bronchoprovocator causing dyspnoea as well. In summary, dyspnoea is seldom considered, there are no treatment algorithms when it does occur, plausible mechanisms exist and despite these plausible mechanisms, the true cause of dyspnoea in these exposed individuals is unknown. Additional pulmonary function testing, immunological investigations and platelet receptor studies are urgently needed to determine the cause of dyspnoea after AZD6140, and to point out how such serious adverse reactions can be prevented, or at least minimised, raising potential concerns about this drug. [source]

Intravascular ultrasound-guided central vein angioplasty and stenting without the use of radiographic contrast agents

JOURNAL OF CLINICAL ULTRASOUND, Issue 4 2008
Ray Matthews MD
Abstract Patients with contraindications to iodinated radiographic contrast agents present a significant challenge during endovascular intervention. A 46-year-old man with end-stage renal disease and a normally functioning left upper extremity arteriovenous fistula presented with severe left arm edema. The patient's history included repeated severe anaphylactoid reactions with severe respiratory distress upon exposure to iodinated contrast. In an attempt to avoid the use of iodinated contrast, angioplasty and stent placement of a severe central venous stenosis were performed using only fluoroscopy and intravascular sonography. In patients unable to receive iodinated contrast secondary to anaphylactoid reactions, intravascular sonography can be used to guide angioplasty and stenting of central venous stenosis. © 2008 Wiley Periodicals, Inc. J Clin Ultrasound, 2008. [source]

Additives in intravenous anesthesia modulates pulmonary inflammation in a model of LPS-induced respiratory distress

Practice variation in initial management and transfer thresholds for infants with respiratory distress in Australian hospitals.

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 6 2007
Who should write the guidelines?
Aim: In Australian hospitals: (i) to identify current practices in the initial oxygen management of infants with respiratory distress; (ii) to identify factors important in deciding to transfer an infant; and (iii) to identify thresholds for transfer. Methods: All Australian hospitals with: >200 registered deliveries, a special care unit (SCU) or neonatal intensive care unit (NICU), and at least one paediatrician were surveyed in 2004 (n = 176). The questionnaire sought information on the initial oxygen management and factors important in deciding to transfer. Three scenarios were also used to identify thresholds for pH, carbon dioxide and oxygen levels at which transfer should occur. Responses from SCU were compared with those from NICU. Results: 15/19 (79%) NICUs and 118/157 (75%) SCUs responded. Initial oxygen management varies widely among SCUs and NICUs. NICUs set significantly lower saturation (SaO2) targets in two of the three scenarios. NICUs are statistically significantly more likely to regard ,Medical Staff Experience' and ,Time to Nearest NICU' as important compared with SCUs (P < 0.05). NICUs would ,Probably' and ,Definitely Transfer' infants at significantly lower oxygen levels in all three cases (P < 0.05). SCUs are significantly less likely to transfer babies with pH of <7.25 compared with NICUs. There was no difference between the centres for CO2 level. Conclusion: The wide variation that exists between nurseries in the initial management of infants with respiratory distress and in the thresholds for transfer strongly suggests the need for the development of practice guidelines. [source]

Mycoplasma pneumoniae infections in Australian children

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 12 2005
N Othman
Objectives: To describe the epidemiology, clinical features and outcome of Mycoplasma pneumoniae infection in children presenting to a tertiary children's hospital. Methods: Sixty-three month retrospective review of serologically diagnosed M. pneumoniae infections. Results: There were 76 children, 42 boys and 34 girls, mean age 6.3 ± 3.5 years. The age group most commonly affected was 5,9 years, followed by children 1,5 years. More than half of the patients had failed to respond to antibiotics before referral. The commonest presentation was with cough and fever. Coryza, diarrhoea, vomiting, tachypnoea and recession were significantly more common in children less than 5 years than in children 5,15 years. Hospitalized patients were more likely than non-hospitalized patients to have respiratory distress with recession and wheeze. Radiographic findings were non-specific. Thrombocytosis was found in 29 (41.4%) of 70 children studied. Conclusion: The clinical features of M. pneumoniae infection were different in children less than 5 years than in children aged 5,9 years. The presence of thrombocytosis in 40% of the cases has not previously been reported in children. [source]

Pneumothorax in cats with a clinical diagnosis of feline asthma: 5 cases (1990,2000)

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 2 2003
Edward S. Cooper VMD
Abstract Objective: This paper characterizes the clinical findings in 5 cats with feline asthma complicated by concurrent pneumothorax. Design: Retrospective study. Medical records of cats with concurrent diagnoses of asthma and pneumothorax that were presented to the Veterinary Hospital of the University of Pennsylvania from 1990 to 2000 were reviewed. Results: Of 421 cases of feline asthma, 5 cats fulfilled the inclusion criteria (1.2%). All 5 had respiratory distress at presentation. One cat was panting, and the other 4 cats had respiratory rates of 28, 52, 58 and 120 breaths per minute (bpm), respectively (mean RR 65±39 bpm). Historical findings included untreated chronic cough (n=3), previously treated asthma (n=1), and no previous illness (n=1). Thoracocentesis was performed in 4/5 cats, and 3 of those cats required thoracostomy tubes. Four cats required immediate oxygen supplementation, and 1 of those cats required ventilation. All 5 cats had evidence of pneumothorax on initial radiographs. Follow-up radiographs revealed partial or complete resolution of pneumothorax in 4 cats which were discharged alive with total hospitalization of 2,7 days, but were then lost to follow-up. One cat was euthanized because it could not be weaned off mechanical ventilation, and necropsy confirmed end-stage feline asthma and emphysema. Conclusion: Small airway obstruction can predispose asthma patients to increased alveolar pressure, emphysema, and spontaneous pneumothorax, which can lead to dyspnea in affected cats. The short-term outcome in these cats was good despite the severity of dyspnea at presentation. [source]

Retrospective Evaluation of Sildenafil Citrate as a Therapy for Pulmonary Hypertension in Dogs

JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 5 2006
Jonathan F. Bach DACVIM (SA-IM)
Pulmonary arterial hypertension (PH) is a pathologic condition in dogs characterized by abnormally high pressures in the pulmonary circulation and has been associated with a poor outcome. Sildenafil is a type V phosphodiesterase inhibitor that produces nitric oxide-mediated vasodilatation. Sildenafil treatment decreases pulmonary arterial pressure and pulmonary vascular resistance in people with PH. The purpose of this study was to describe the clinical characteristics and outcome of dogs with PH treated with sildenafil. The cardiology database was searched for dogs with PH treated with sildenafil. PH was defined as systolic pulmonary arterial pressure (PAPS) 25 mmHg at rest. Medical records were reviewed for the following information: signalment, duration and type of clinical signs before treatment, underlying disease, estimated or measured PAPS, dosage and dosing interval of sildenafil, and the effect of treatment on clinical signs and pulmonary arterial pressure and survival time. Thirteen affected dogs were identified. Clinical signs included collapse, syncope, respiratory distress, and cough. Duration of clinical signs before presentation ranged from 3 days to 5 months. An underlying cause was identified in 8 dogs. The median sildenafil dosage was 1.9 mg/kg. Ten dogs received concurrent medications. Median PAPS was 90 mmHg; 8 dogs were reevaluated after therapy, and the median decrease in PAPS was 16.5 mmHg. The median survival time of all dogs was 91 days. Sildenafil appeared to be well tolerated in dogs with PH and was associated with decreased PAPS and amelioration of clinical signs in most. Sildenafil represents a reasonable treatment option for dogs with pulmonary hypertension. [source]

Third-Degree Atrioventricular Block in 21 Cats (1997,2004)

JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2006
H.B. Kellum
The effect of 3rd-degree atrioventricular block on long-term outcome in cats is unknown. Clinical findings and long-term outcome of 21 cats with 3rd-degree atrioventricular block were studied retrospectively. Median age of cats studied was 14 years (range 7,19 years). Presenting signs included respiratory distress or collapse, but 6 cats had no clinical signs of disease. Eight cats had congestive heart failure (CHF) at the time that 3rd-degree atrioventricular block was detected. Heart rates ranged from 80 to 140 beats per minute (bpm; median 120 bpm) with no difference in heart rate between cats with and those without CHF. Eleven of 18 cats that had echocardiograms had structural cardiac disease, and 6 cats had cardiac changes consistent with concurrent systemic disease. No atrioventricular nodal lesions were detected by echocardiography. One cat had atrioventricular nodal lesions detected on histologic examination. Median survival of 14 cats that died or were euthanized was 386 days (range 1,2,013 days). Survival did not differ between cats with or without CHF or between cats with or without structural cardiac disease. Thirteen cats with 3rd-degree atrioventricular block survived >1 year after diagnosis, regardless of presenting signs or underlying cardiac disease. Third-degree heart block in cats is often not immediately life threatening. Survival was not affected by the presence of underlying heart disease or congestive heart failure at the time of presentation. Even cats with collapse might survive >1 year without pacemaker implantation. [source]

B-type natriuretic peptide (BNP) and N-terminal-proBNP for heart failure diagnosis in shock or acute respiratory distress

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2006
L. Bal
Background:, Plasma B-type natriuretic peptide (BNP) assay is recommended as a diagnostic tool in emergency-room patients with acute dyspnea. In the intensive care unit (ICU), the utility of this peptide remains a matter of debate. The objectives of this study were to determine whether cut-off values for BNP and N-terminal-proBNP (NT-proBNP) reliably diagnosed right and/or left ventricular failure in patients with shock or acute respiratory distress, and whether non-cardiac factors led to an increase in these markers. Methods:, Plasma BNP and NT-proBNP levels and echocardiographic parameters of cardiac dysfunction were determined in 41 patients within 24 h of the onset of shock or acute respiratory distress. Results:, BNP and NT-proBNP levels were higher in the 25 patients with heart failure than in the other 16 patients: 491.7 ± 418 pg/ml vs. 144.3 ± 128 pg/ml and 2874.4 ± 2929 pg/ml vs. 762.7 ± 1128 pg/ml, respectively (P < 0.05). In the diagnosis of cardiac dysfunction, BNP > 221 pg/ml and NT-proBNP > 443 pg/ml had 68% and 84% sensitivity, respectively, and 88% and 75% specificity, respectively, but there was a substantial overlap of BNP and NT-proBNP values between patients with and without heart failure. BNP and NT-proBNP were elevated, but not significantly, in patients with isolated right ventricular dysfunction. Patients with renal dysfunction and normal heart function had significantly higher levels of BNP (258.6 ± 144 pg/ml vs. 92.4 ± 84 pg/ml) and NT-proBNP (2049 ± 1320 pg/ml vs. 118 ± 104 pg/ml) than patients without renal dysfunction. Conclusion:, Both BNP and NT-proBNP can help in the diagnosis of cardiac dysfunction in ICU patients, but cannot replace echocardiography. An elevated BNP or NT-proBNP level merely indicates the presence of a ,cardiorenal distress' and should prompt further investigation. [source]

Living liver donor death related to complications of myeloma

LIVER TRANSPLANTATION, Issue 3 2009
Emmanuel Melloul
We report a donor death after right hepatectomy for living donor transplantation due to an undiagnosed myeloma. The 47-year-old donor, who was the 147th case performed in our department, was in excellent health without any abnormalities in the preoperative investigations. Despite an uneventful right hepatectomy without transfusion, the patient developed a partial thrombus of the inferior vena cava with a right proximal pulmonary trunk embolism on postoperative day 6. Subsequently, he developed multiorgan dysfunction leading to a coagulopathy, respiratory distress, and renal failure requiring hemodialysis and mechanical ventilation. This clinical scenario led us to suspect a hematological disorder. Immune electrophoresis showed a monoclonal peak of immunoglobulin G (8.7 g/L), a myelogram revealed an abnormally high level of dystrophic plasmocytes (more than 7%), and biopsies of salivary glands confirmed the diagnosis of immunoglobulin G kappa myeloma. The patient progressively deteriorated because of simultaneous hemorrhagic and infectious pulmonary complications resulting in septic shock. Despite an adequate combination of antimicrobial therapy and pleural drainage, the donor died on postoperative day 57 from multiple organ failure. This unusual cause of donor death after right hepatectomy reinforces the need for an extensive preoperative assessment. We advocate the addition of urinary protein loss and electrophoresis to the standard donor assessment protocol. Liver Transpl 15:326,329, 2009. © 2009 AASLD. [source]

The effects of specific educational preparation on emergency nurses' clinical decisions regarding supplemental oxygen administration

NURSING & HEALTH SCIENCES, Issue 2 2006
Julie Considine rn, certacutecarensg(emerg), frcna, graddipnsg(acute care)
Abstract, The use of supplemental oxygen by emergency nurses has important implications for patient outcomes, yet there is significant variability in oxygen administration practises. Specific education related to oxygen administration increases factual knowledge in this domain; however, the impact of knowledge acquisition on nurses' clinical decisions is poorly understood. This study aimed to examine the effect of educational preparation on 20 emergency nurses' decisions regarding the assessment of oxygenation and the use of supplemental oxygen. A pre-test/post-test, quasi-experimental design was used. The intervention was a written, self-directed learning package. The major effects of the completion of the learning package included no change in the number or types of parameters used by nurses to assess oxygenation, a significant decrease in the selection of simple masks, a significant increase in the selection of air entrainment masks, fewer hypothetical outcomes of unresolved respiratory distress and more hypothetical outcomes of decreased respiratory distress. As many nursing education programs are aimed at increasing factual knowledge, while experience remains relatively constant, a greater understanding of the relationship between factual knowledge and clinical decisions is needed if educational interventions are to improve patient outcomes. [source]

Benign thymic hyperplasia: an unexpected cause of respiratory distress during inhalatory induction of anesthesia

PEDIATRIC ANESTHESIA, Issue 12 2008
Pascale Piednoir
No abstract is available for this article. [source]

Tracheal agenesis: management of the first 10 months of life

PEDIATRIC ANESTHESIA, Issue 9 2004
S. Baroncini-Cornea MD
Summary Tracheal agenesis is a potentially lethal congenital anomaly, appearing only at birth. We describe a newborn preterm infant who presented with immediate respiratory distress and no audible cry. There was almost complete tracheal agenesis with a very short segment of distal trachea (only two tracheal rings) arising from the anterior wall of the esophagus, before dividing into the mainstem bronchi. The anomaly was unsuspected prenatally, as the scan showed pyloric atresia and complex congenital cardiac disease. Despite the patient's difficult course, with correction of the rare-associated malformations (cardiac and gastrointestinal tract anomalies), the fact that the child is lively and neurologically normal for her age, requires that we now consider the patency of the airway and the possibility of surgical correction, in accordance with a good quality of life. [source]

Life threatening subcutaneous emphysema following surgical repair of tracheocutaneous fistula

PEDIATRIC ANESTHESIA, Issue 4 2003
Virender Kumar Mohan MD
Summary A 9-year-old male child posted for closure of tracheocutaneous fistula developed extensive subcutaneous emphysema resulting in acute respiratory distress immediately after transfer to recovery room. The clinical management, precautions and other complications of closure of tracheocutaneous fistula are discussed. [source]

Acute pulmonary toxicity following intralesional administration of bleomycin for a lymphovenous malformation

PEDIATRIC PULMONOLOGY, Issue 2 2010
Khalid Atwa MD
Abstract Objective To describe the clinical course and treatment of an infant with acute pulmonary toxicity following intralesional administration of bleomycin for a lymphovenous malformation. Design Case report. Setting A tertiary care University-affiliated hospital. Patient, Intervention, and Results An 8-month-old girl developed acute respiratory distress with profound hypoxemia complicated by pneumothorax and pneumomediastinum 1 day following intralesional administration of bleomycin. She was treated with bilateral chest tube insertion, systemic corticosteroids, pentoxifylline, and supportive care. At the most recent follow-up 5 months after the onset of the respiratory event, the patient is active, walks, and talks without any evidence of pulmonary diseases clinically. This is the youngest infant reported, to date, with acute bleomycin pulmonary toxicity following intralesional administration of bleomycin resulting in acute respiratory insufficiency followed by complete recovery. Conclusions This case illustrates the importance of early recognition and aggressive treatment of acute bleomycin toxicity resulting from intralesional administration of this medication for lymphovenous malformations. Pediatr Pulmonol. 2010; 45:192,196. © 2009 Wiley-Liss, Inc. [source]

Mediastinal gastroenteric cyst in a neonate containing respiratory-type epithelium and pancreatic tissue

PEDIATRIC PULMONOLOGY, Issue 12 2009
Eleftherios Anagnostou MD
Abstract Mediastinal gastroenteric cyst is an uncommon congenital malformation and a distinct histopathological entity within the family of foregut duplication cysts. This lesion is mainly encountered in neonates and infants. Histologically, it is characterized by double-layered smooth muscle wall and gastric lining mucosa. We report on a case of a 2-day-old girl, with a posterior mediastinal cystic mass associated with T3,T4 hemivertebrae, presenting with severe respiratory distress. The cyst was multilocular, surgically removed, and histopathologic analysis revealed that it was of gastroenteric type. However, in numerous areas of the lesion, respiratory-type epithelium was observed, as well as pancreatic tissue. After removal of the lesion the patient made an uneventful recovery and shows no signs of long-term pulmonary sequelae. We failed to demonstrate in the available literature the presence of this variable epithelial lining within a single mediastinal foregut cyst. In addition, pancreatic tissue within an intrathoracic enteric cyst has been reported only twice. Pediatr Pulmonol. 2009; 44:1240,1243. © 2009 Wiley-Liss, Inc. [source]

Lymphoid bronchiolitis presenting at birth in an immunocompetent child: Chronic interstitial lung disease of unknown aetiology

PEDIATRIC PULMONOLOGY, Issue 6 2009
Malcolm Brodlie MB ChB
Abstract A female infant presented at birth with respiratory distress, which was subsequently shown to be secondary to lymphoid bronchiolitis, an exceptionally rare condition in childhood. Over the following 13 years there has been a slow progressive deterioration in her respiratory status with forced expiratory volume in 1 sec currently 40% predicted. Tests for connective tissue disease, infection, or immunodeficiency have all been negative and in the absence of any other explanation we postulate that this severe problem may have occurred as a consequence of an unrecognized intrauterine infection. Pediatr Pulmonol. 2009; 44:622,624. © 2009 Wiley-Liss, Inc. [source]