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Wang Y, Bu C, Zhang M, Wang J, Jiang K, Ding M, Su H, Long X, Jia M, Li Y, Cao Y. Pulmonary vascular stenosis scoring in fibrosing mediastinitis. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2024; 2:qyae034. [PMID: 39045195 PMCID: PMC11195784 DOI: 10.1093/ehjimp/qyae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/23/2024] [Indexed: 07/25/2024]
Abstract
Aims This study aims to develop a scoring system for evaluating the degree of pulmonary vascular stenosis in fibrosing mediastinitis (FM). Methods and results A retrospective single-centre study was conducted on 56 patients with FM in China between April 2014 and August 2021. The involvement of pulmonary vessels in patients with FM was assessed using dual-phase computed tomography pulmonary angiography, and we found that 85.7% of the patients had both pulmonary artery (PA) and vein (PV) involvement. PA involvement was mainly located proximal to both the upper PA and the bilateral basal trunk levels in the lower lungs. The involvement of the superior PV was more common than that of the inferior PV, and the right inferior PV was the least involved. Most of these lesions exhibited moderate or severe stenosis. Additionally, a scoring system for evaluating the degree of pulmonary vascular stenosis was developed. A correlation analysis revealed a negative correlation between the final pulmonary vascular score and the pulmonary arterial pressure, pulmonary vascular resistance, and maximum tricuspid regurgitation velocity. The calculated score of 17.1 was the best cut-off value for the diagnosis of mild and severe pulmonary hypertension (PH). Conclusion We successfully developed a scoring system for pulmonary vascular stenosis that can be used to evaluate the severity of pulmonary vessel involvement and PH. This scoring system may be relevant in the future development of target-based strategies for percutaneous interventions.
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Affiliation(s)
- Yangyang Wang
- School of Clinical Medicine, Ningxia Medical University, No. 1160, Shengli Street, Yinchuan 750004, China
- Department of Cardiology, Pulmonary Vascular Disease Center (PVDC), Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou 730000, China
| | - Chao Bu
- Department of Radiology, The Seventh Affiliated Hospital of Sun Yat-sen University, No. 628, Zhenyuan Road, Xinhu Street, Shenzhen 518107, China
| | - Mengdi Zhang
- Department of Radiology, The Seventh Affiliated Hospital of Sun Yat-sen University, No. 628, Zhenyuan Road, Xinhu Street, Shenzhen 518107, China
| | - Juan Wang
- School of Clinical Medicine, Ningxia Medical University, No. 1160, Shengli Street, Yinchuan 750004, China
- Department of Cardiology, Pulmonary Vascular Disease Center (PVDC), Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou 730000, China
| | - Kaiyu Jiang
- Department of Cardiology, Pulmonary Vascular Disease Center (PVDC), Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou 730000, China
| | - Mingwang Ding
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), No. 35, Dingxi East Road, Lanzhou 730000, China
| | - Hongling Su
- Department of Cardiology, Pulmonary Vascular Disease Center (PVDC), Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou 730000, China
| | - Xiaozhou Long
- Department of Radiology, Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou 730000, China
| | - Mengfei Jia
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), No. 35, Dingxi East Road, Lanzhou 730000, China
| | - Yu Li
- Department of Radiology, The Seventh Affiliated Hospital of Sun Yat-sen University, No. 628, Zhenyuan Road, Xinhu Street, Shenzhen 518107, China
| | - Yunshan Cao
- Department of Cardiology, Pulmonary Vascular Disease Center (PVDC), Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou 730000, China
- Heart, Lung and Vessels Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, No. 32, West Second Section, Yihuan Road, Qingyang District, Chengdu 610072, China
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Ramadori GP. SARS-CoV-2-Infection (COVID-19): Clinical Course, Viral Acute Respiratory Distress Syndrome (ARDS) and Cause(s) of Death. Med Sci (Basel) 2022; 10:58. [PMID: 36278528 PMCID: PMC9590085 DOI: 10.3390/medsci10040058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/26/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
SARS-CoV-2-infected symptomatic patients often suffer from high fever and loss of appetite which are responsible for the deficit of fluids and of protein intake. Many patients admitted to the emergency room are, therefore, hypovolemic and hypoproteinemic and often suffer from respiratory distress accompanied by ground glass opacities in the CT scan of the lungs. Ischemic damage in the lung capillaries is responsible for the microscopic hallmark, diffuse alveolar damage (DAD) characterized by hyaline membrane formation, fluid invasion of the alveoli, and progressive arrest of blood flow in the pulmonary vessels. The consequences are progressive congestion, increase in lung weight, and progressive hypoxia (progressive severity of ARDS). Sequestration of blood in the lungs worsens hypovolemia and ischemia in different organs. This is most probably responsible for the recruitment of inflammatory cells into the ischemic peripheral tissues, the release of acute-phase mediators, and for the persistence of elevated serum levels of positive acute-phase markers and of hypoalbuminemia. Autopsy studies have been performed mostly in patients who died in the ICU after SARS-CoV-2 infection because of progressive acute respiratory distress syndrome (ARDS). In the death certification charts, after respiratory insufficiency, hypovolemic heart failure should be mentioned as the main cause of death.
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Fadlilah U, Hasmono D, Wibisono YA, Melinda M. ANTIBIOGRAM STUDY AND ANTIBIOTIC USE EVALUATION USING GYSSEN METHOD IN PATIENTS WITH DIABETIC FOOT. FOLIA MEDICA INDONESIANA 2017. [DOI: 10.20473/fmi.v52i3.5452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Foot infection is a common and serious problem in people with diabetes, which require proper management (diagnostic and therapeutic approaches) that can be cured. Empiric antibiotic regimen should be based on clinical data and bacteria pattern that are available, but definitive therapy should be based on the results of the infected tissue culture. The selection of initial antibiotic therapy was difficult and unwise use can lead to antibiotic-resistant. Evaluation is needed for using antibiotics to benefit wisely. The aim of this research is to analyzed the pattern of bacteria in diabetic foot and to its sensitivity test to antibiotics, analyze empiric antibiotics that can be recommended, and analyzed the use of antibiotics by Gyssen method. Data was analyzed with observational studies (descriptive non-experimental), retrospectively and prospectively in patients diabetic foot infection that met inclusion criteria. Retrospective data are used to analyzed bacteria pattern and its sensitivity test, while prospective data are used to evaluated the use of antibiotics based on bacteria pattern, during the period of late March-early August 2015 at Mardi Waluyo Hospital. Evaluation was conducted by Gyssen method. The results, retrospective data samples obtained 30 infection bacteria during August 2014-March 2015. The prevalence of gram-negative bacteria as 53.33% with most types of bacteria E.coli and Klebsiella oxytoca (13.33%), and gram-positive bacteria as 46.67% with the highest bacteria are Staphylococcus spp. and Streptococcus spp. From the prospective data in inclusion criteria, 13 patients with the highest prevalence of gram-negative bacteria are Klebsiella oxytoca (28.57%), and most gram-positive Staphylococcus auerus (35.71%). While the qualitative analysis of antibiotic use was conducted on 50 types of antibiotics. The results of the qualitative analysis using Gyssens method obtained category as 62%, 2%, 14%, 2B category as 26%, 3A category as 10%, 4A category 52%, 4B category as 6%, 4C category as 8% and there are no use of antibiotics in the category V and VI. Conclusions, Gyessen method can show that the use of antibiotics in diabetic foot patients in Mardi Waluyo hospital is dominated by inaccuracy in choice of antibiotic, and inaccuracies in the interval antibiotics.
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Hussain A, Suleiman MS, George SJ, Loubani M, Morice A. Hypoxic Pulmonary Vasoconstriction in Humans: Tale or Myth. Open Cardiovasc Med J 2017; 11:1-13. [PMID: 28217180 PMCID: PMC5301302 DOI: 10.2174/1874192401711010001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/02/2016] [Accepted: 12/09/2016] [Indexed: 12/13/2022] Open
Abstract
Hypoxic Pulmonary vasoconstriction (HPV) describes the physiological adaptive process of lungs to preserves systemic oxygenation. It has clinical implications in the development of pulmonary hypertension which impacts on outcomes of patients undergoing cardiothoracic surgery. This review examines both acute and chronic hypoxic vasoconstriction focusing on the distinct clinical implications and highlights the role of calcium and mitochondria in acute versus the role of reactive oxygen species and Rho GTPases in chronic HPV. Furthermore it identifies gaps of knowledge and need for further research in humans to clearly define this phenomenon and the underlying mechanism.
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Affiliation(s)
- A Hussain
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Castle Road, Cottingham, HU16 5JQ, UK
| | - M S Suleiman
- School of Clinical Sciences, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK
| | - S J George
- School of Clinical Sciences, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK
| | - M Loubani
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Castle Road, Cottingham, HU16 5JQ, UK
| | - A Morice
- Department of Respiratory Medicine, Castle Hill Hospital, Castle Road, Cottingham, HU16 5JQ, UK
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Hussain A, Bennett RT, Chaudhry MA, Qadri SS, Cowen M, Morice AH, Loubani M. Characterization of optimal resting tension in human pulmonary arteries. World J Cardiol 2016; 8:553-558. [PMID: 27721938 PMCID: PMC5039357 DOI: 10.4330/wjc.v8.i9.553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/15/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To determine the optimum resting tension (ORT) for in vitro human pulmonary artery (PA) ring preparations.
METHODS Pulmonary arteries were dissected from disease free sections of the resected lung in the operating theatre and tissue samples were directly sent to the laboratory in Krebs-Henseleit solution (Krebs). The pulmonary arteries were then cut into 2 mm long rings. PA rings were mounted in 25 mL organ baths or 8 mL myograph chambers containing Krebs compound (37 °C, bubbled with 21% O2: 5% CO2) to measure changes in isometric tension. The resting tension was set at 1-gram force (gf) with vessels being left static to equilibrate for duration of one hour. Baseline contractile reactions to 40 mmol/L KCl were obtained from a resting tension of 1 gf. Contractile reactions to 40 mmol/L KCl were then obtained from stepwise increases in resting tension (1.2, 1.4, 1.6, 1.8 and 2.0 gf).
RESULTS Twenty PA rings of internal diameter between 2-4 mm were prepared from 4 patients. In human PA rings incrementing the tension during rest stance by 0.6 gf, up to 1.6 gf significantly augmented the 40 mmol/L KCl stimulated tension. Further enhancement of active tension by 0.4 gf, up to 2.0 gf mitigate the 40 mmol/L KCl stimulated reaction. Both Myograph and the organ bath demonstrated identical conclusions, supporting that the radial optimal resting tension for human PA ring was 1.61 g.
CONCLUSION The radial optimal resting tension in our experiment is 1.61 gf (15.78 mN) for human PA rings.
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Palla A, Marconi L, Bigazzi F, Pistolesi M. Lung scintigraphy in the diagnosis of pulmonary embolism: pathophysiological and practical evidence. Clin Transl Imaging 2014. [DOI: 10.1007/s40336-014-0083-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lavorini F, Di Bello V, De Rimini ML, Lucignani G, Marconi L, Palareti G, Pesavento R, Prisco D, Santini M, Sverzellati N, Palla A, Pistolesi M. Diagnosis and treatment of pulmonary embolism: a multidisciplinary approach. Multidiscip Respir Med 2013; 8:75. [PMID: 24354912 PMCID: PMC3878229 DOI: 10.1186/2049-6958-8-75] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 12/13/2013] [Indexed: 02/02/2023] Open
Abstract
The diagnosis of pulmonary embolism (PE) is frequently considered in patients presenting to the emergency department or when hospitalized. Although early treatment is highly effective, PE is underdiagnosed and, therefore, the disease remains a major health problem. Since symptoms and signs are non specific and the consequences of anticoagulant treatment are considerable, objective tests to either establish or refute the diagnosis have become a standard of care. Diagnostic strategy should be based on clinical evaluation of the probability of PE. The accuracy of diagnostic tests for PE are high when the results are concordant with the clinical assessment. Additional testing is necessary when the test results are inconsistent with clinical probability. The present review article represents the consensus-based recommendations of the Interdisciplinary Association for Research in Lung Disease (AIMAR) multidisciplinary Task Force for diagnosis and treatment of PE. The aim of this review is to provide clinicians a practical diagnostic and therapeutic management approach using evidence from the literature.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Massimo Pistolesi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Florence 50134, Italy.
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Diagnosing pulmonary embolism: clinical problem or methodological issue? Eur J Nucl Med Mol Imaging 2009; 36:522-8. [PMID: 19137291 DOI: 10.1007/s00259-008-1059-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Is the lung scan alive and well? Facts and controversies in defining the role of lung scintigraphy for the diagnosis of pulmonary embolism in the era of MDCT. Eur J Nucl Med Mol Imaging 2009; 36:505-21. [DOI: 10.1007/s00259-008-1014-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Accepted: 11/07/2008] [Indexed: 11/26/2022]
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Miniati M, Sostman HD, Gottschalk A, Monti S, Pistolesi M. Perfusion Lung Scintigraphy for the Diagnosis of Pulmonary Embolism: A Reappraisal and Review of the Prospective Investigative Study of Acute Pulmonary Embolism Diagnosis Methods. Semin Nucl Med 2008; 38:450-61. [DOI: 10.1053/j.semnuclmed.2008.06.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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11
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Milne ENC. Comment on Chest Radiograph as a Triage Tool. AJR Am J Roentgenol 2006; 186:1198. [PMID: 16554608 DOI: 10.2214/ajr.06.5024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Hogg K, Dawson D, Tabor T, Tabor B, Mackway-Jones K. Respiratory Dead Space Measurement in the Investigation of Pulmonary Embolism in Outpatients With Pleuritic Chest Pain. Chest 2005; 128:2195-202. [PMID: 16236874 DOI: 10.1378/chest.128.4.2195] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Pleuritic chest pain is a common presenting condition in the emergency department. A noninvasive bedside rule out test for pulmonary embolism would aid investigating this patient group. Our study aimed to compare the clinical utility of three methods for calculating respiratory dead space in the diagnosis of pulmonary embolism in outpatients with pleuritic chest pain. DESIGN Prospective diagnostic study. SETTING Large city-center emergency department. PATIENTS Between February 2002 and June 2003, 425 patients presenting to the emergency department with pleuritic chest pain were prospectively recruited. INTERVENTION Data collection for respiratory dead space was performed in the emergency department by two researchers. The respiratory dead space fraction was calculated independently using three different methods. All patients underwent an independent reference standard diagnostic algorithm to establish the presence or absence of pulmonary embolism. Those with a low modified Wells clinical probability and a normal quantitative d-dimer finding were discharged home. All others followed a reference standard protocol using Prospective Investigation of Pulmonary Embolism Diagnosis-interpreted ventilation/perfusion scanning, CT pulmonary angiography, and digital subtraction pulmonary angiography. All patients were followed up clinically for 3 months. MEASUREMENTS AND RESULTS For the Bohr calculation, the area under the receiver operating characteristic curve was 0.62 (95% confidence interval [CI], 0.51 to 0.73), the Enghoff calculation was 0.66 (95% CI, 0.55 to 0.77), and the capillary sample Enghoff was 0.62 (95% CI, 0.49 to 0.65). The optimum Bohr cutoff value gave 100.0% sensitivity (95% CI, 84.5 to 100%) but a low specificity of 22.7% (95% CI, 18.8 to 27.2%). The optimum cutoff points for Enghoff and capillary Enghoff calculations gave sensitivities of 95.3% (95% CI, 77.3 to 99.2%) and 94.4% (95% CI, 74.2 to 99.0%), respectively, with poor specificity. CONCLUSIONS Respiratory dead space analysis does not perform well as a stand-alone diagnostic test for pulmonary embolism in outpatients presenting with pleuritic chest pain.
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Affiliation(s)
- Kerstin Hogg
- Emergency Medicine Research Group, Emergency Department, Manchester Royal Infirmary, Oxford Rd, Manchester, M13 9WL UK.
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Thorvaldson J, Ilebekk A, Leraand S, Kiil F. Determinants of pulmonary blood volume. Effects of acute changes in pulmonary vascular pressures and flow. ACTA PHYSIOLOGICA SCANDINAVICA 1984; 121:45-56. [PMID: 6741579 DOI: 10.1111/j.1748-1716.1984.tb10456.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
To examine the effects of pulmonary vascular pressures and flow on pulmonary blood volume (PBV), experiments were performed at constant heart rate and zone 3 conditions (mean left atrial pressure (LAP) above airway pressure) in six anesthetized, open-chest dogs. PBV was calculated as the product of electromagnetic aortic flow and pulmonary mean transit time for ascorbate, obtained without blood withdrawal by polarographic recording of aortic ascorbate changes. In three series of experiments LAP was raised similarly in three steps, from 4.5 to 14.8 mmHg: by mitral constriction which reduced pulmonary blood flow, by blood volume expansion which more than doubled pulmonary blood flow, or by a combination of the two procedures which kept pulmonary blood flow constant. In all three series, LAP and mean pulmonary arterial pressure (PAP) rose in proportion, but PBV was better correlated to PAP (r = 0.87 +/- 0.02) than to LAP (r = 0.66 +/- 0.09). These experiments suggest that PAP is the most important factor in determining PBV under zone 3 conditions, whether PAP is raised by increasing pulmonary blood flow or by mitral constriction.
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Abstract
The anatomy and physiology of the pulmonary vasculature has been described with emphasis on several types of pulmonary hypertension and their pathophysiology. Treatment of pulmonary hypertension may be successful, especially when disease is related to emboli which respond to anticoagulant therapy. Relief of mitral valve obstruction is usually beneficial. Patients with abnormalities of blood PO2 and pH (especially in chronic obstructive lung disease) may be spared increased pulmonary pressure or may reverse existing pulmonary hypertension by giving up smoking, learning more efficient ventilatory methods, and when indicated, using supplemental oxygen, bronchodilators, digitalis, diuretics, or a combination of these.
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Benoit PR, Hampson LG, Burgess JH. Value of arterial hypoxemia in the diagnosis of pulmonary fat embolism. Ann Surg 1972; 175:128-37. [PMID: 5060851 PMCID: PMC1355167 DOI: 10.1097/00000658-197201000-00019] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Holloway R, Adams EB, Desai SD, Thambiran AK. Effect of chest physiotherapy on blood gases of neonates treated by intermittent positive pressure respiration. Thorax 1969; 24:421-6. [PMID: 4894052 PMCID: PMC472005 DOI: 10.1136/thx.24.4.421] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The effect of standardized chest physiotherapy and hyperinflation on the blood gases of neonates being treated for tetanus by intermittent positive pressure respiration was investigated. It was found that physiotherapy and suction to remove secretions did not improve oxygen pressures but produced a small drop in both Paco2 and Pao2. This was associated with a widening of the alveolar to arterial gradient for oxygen. During the hour that followed, blood oxygen pressure slowly returned to pre-physiotherapy levels. This could be hastened by hyperinflation (increasing the pressure delivered to the baby) after physiotherapy. Although hyperinflation restored blood oxygen pressures, it did so by a mechanism which left alveolar to arterial oxygen gradients unchanged. Moderate hyperinflation without physiotherapy produced small increases in blood oxygen tension, but also failed to restore completely arterial oxygen pressures of neonates on I.P.P.R. The results are discussed.
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Gifford RW, Groves LK. Limitations in the feasibility of pulmonary embolectomy. A clinicopathologic study of 101 cases of massive pulmonary embolism. Circulation 1969; 39:523-30. [PMID: 5778253 DOI: 10.1161/01.cir.39.4.523] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Of 101 patients who had major pulmonary emboli confirmed at autopsy, 44 died within 1 hour of the onset of symptoms; 26 had no abrupt change in the clinical course to indicate the presence of emboli; and three died while they were under anesthesia. Of the 28 patients who survived for more than 1 hour after onset of symptoms, seven had incurable malignant lesions, four were unconscious with irreversible brain damage, six were too ill from other diseases to undergo embolectomy, and the diagnosis was not suspected for five. Consequently, of the 101 patients only six would have been selected to undergo pulmonary embolectomy. Only by increasing our diagnostic acumen and by obtaining pulmonary angiograms as soon as possible after onset of symptoms can this salvage rate be improved.
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19
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Morris J. Lung scanning in the diagnosis and management of pulmonary embolism. AUSTRALASIAN RADIOLOGY 1969; 13:88-92. [PMID: 5784591 DOI: 10.1111/j.1440-1673.1969.tb01214.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Steward DJ, Sloan IA. Recent upper respiratory infection and pulmonary artery clamping in the aetiology of postoperative respiratory complications. CANADIAN ANAESTHETISTS' SOCIETY JOURNAL 1969; 16:57-60. [PMID: 5764525 DOI: 10.1007/bf03005778] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Friedman WF, Braunwald E, Morrow AG. Alterations in regional pulmonary blood flow in patients with congenital heart disease studied by radioisotope scanning. Circulation 1968; 37:747-58. [PMID: 5646861 DOI: 10.1161/01.cir.37.5.747] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
External scintillation scanning of intravenously administered
131
I-labeled macro-aggregates of human serum albumin (
131
I-MAA) was employed to evaluate the distribution of pulmonary arterial blood flow in 61 normal subjects and in 100 patients with various congenital cardiovascular malformations. Intra-aortic administration of
131
I-MAA demonstrated that blood flow through subclavian-pulmonary artery anastomoses is directed principally to the lung on the side of the anastomosis; the relative concentration of
131
I-MAA in each lung after intravenous injection provided an index of the patency of the anastomosis or of the development of pulmonary atresia or pulmonary hypertension. In contrast to the findings in patients with a patent subclavian-pulmonary shunt, scans obtained from patients with a patent ductus arteriosus did not reveal a separation of the systemic arterial and systemic venous inflows to the lungs. The patency of superior vena caval-right pulmonary arterial anastomosis could be assessed after injection of
131
I-MAA into an upper-extremity vein.
Anomalies characterized by increased pulmonary blood flow or elevated pulmonary arterial pressures, or both, increased the ratio of pulmonary blood flow in the lung apices relative to that in the dependent lung zones. Anomalies characterized by elevated pulmonary venous pressure, such as cor triatriatum and mitral regurgitation, were readily detected by demonstrating both a decrease in blood flow to the lung bases as well as an increase to the apices. Thus, in patients with known pulmonary arterial hypertension (mean pressure, >30 mm Hg) the ratio of upper to lower zone blood flow was always significantly higher if the arterial hypertension was accompanied by venous hypertension. For this reason, lung scans facilitated the screening of patients with pulmonary arterial hypertension for surgically correctable lesions such as cor triatriatum and mitral stenosis.
The method described is technically simple, without risk, easily applicable to large numbers of patients, and provides clinically important information concerning many forms of congenital heart disease.
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ROGERS ROBERTM, KUHL DAVIDE. ESTIMATION AND LOCALIZATION OF PULMONARY VASCULAR ABNORMALITIES USING RADIOISOTOPE SCANNING. Radiol Clin North Am 1967. [DOI: 10.1016/s0033-8389(22)02769-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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24
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Quinn JL. Radioisotope lung scanning. Semin Roentgenol 1967. [DOI: 10.1016/0037-198x(67)90043-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Oakley CM, Goodwin JF. The current status of pulmonary embolism and pulmonary vascular disease in relation to pulmonary hypertension. Prog Cardiovasc Dis 1967; 9:495-521. [PMID: 6046731 DOI: 10.1016/s0033-0620(67)80007-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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26
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Buschmann HJ, Dissmann W, Siemon G, Sonderkamp H, Schröder R. [Arterial hypoxemia in acute myocardial infarct]. KLINISCHE WOCHENSCHRIFT 1967; 45:113-21. [PMID: 5593538 DOI: 10.1007/bf01725065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Moser KM, Tisi GM, Rhodes PG, Landis GA, Miale A. Correlation of lung photoscans with pulmonary angiography in pulmonary embolism. Am J Cardiol 1966; 18:810-20. [PMID: 5923991 DOI: 10.1016/0002-9149(66)90424-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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