Category Archives: Pulmonary

My Canadian Pharmacy Shares the Facts about Mortality From Acute Pulmonary Embolism According to Season

pulmonary embolism Varying observations have been reported on seasonal differences of mortality from acute pulmonary embolism (PE). Several investigators reported peak mortality rates in the first quarter of the year, sometimes with overlap in the last quarter, and sometimes with second peaks in the third quarter. Others reported peak mortality rates in the second quarter, sometimes with second peaks in the third and fourth quarter, or fourth quarter alone. And still others reported peaks only in the third and fourth quarters. More frequent fatal PE during “fine weather phases” of the year and “at the beginning of fine weather” has been reported. No reported quarterly variation has also been reported. Many of these investigations were based on observations in < 200 patients. The largest investigation included < 1,500 patients. We report data from the US National Center for Health Statistics, which includes an order of magnitude more data than has previously been published.

Materials and Methods

The number of deaths each year from PE, based on death certificates, was obtained from the US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, Multiple Cause-of-Death Files. Data were available from 1980 through 1998. During those years, deaths were coded with the International Classification of Diseases, Ninth Revision, Clinical Modification, for identification of patients with PE (codes 415.1, 634.6, 635.6, 636.6, 637.6, 638.6, and 673.2).

A SO-Year-Old Man With Skin Lesions and Multiple Pulmonary Nodules: Conclusion

Our case patient met each of the Coleman criteria. His rash, lymphadenopathy, and constitutional symptoms of fevers, chills, night sweats, and weight loss were all well-described clinical manifestations of secondary syphilis. Serologic testing, including positive rapid plasma reagin and fluorescent treponemal antibody absorption test results, confirmed the disease. Chest imaging revealed multiple bilateral basilar nodules, and other possible etiologies (including Wegener granulomatosis, lymphoma, and tuberculosis) were excluded. Consistent with secondary syphilis, a Jarisch-Herxheimer reaction developed after the first infusion of penicillin, manifested by hypotension, tachycardia, fever as high as 39.4°C, rigors, myalgias, headache, and nausea. Two months after completing therapy, a follow-up CT scan of the chest revealed near-complete resolution of the pulmonary nodules (Fig 4).

A SO-Year-Old Man With Skin Lesions and Multiple Pulmonary Nodules: Patients

A SO-Year-Old Man With Skin Lesions and Multiple Pulmonary Nodules: PatientsAmong the protean clinical manifestations of syphilis, pulmonary involvement is unusual. While nodular (or gummatous) and fibrotic lesions of the lung (usually with pleural involvement) are well established yet uncommon complications of tertiary syph-ilis, pulmonary involvement in secondary syphilis is extremely rare.
Though it may be argued that cases of pulmonary involvement in secondary syphilis potentially are missed because radiography is not routinely performed, evidence points to the contrary. In a study conducted at Bellevue hospital between the years 1939 and 1944, 1,500 patients with secondary syphilis were screened for pathologic findings in the chest prior to arsenic treatment; none of these patients showed radiographic evidence of pulmonary involvement (S. Landry, quoted in Biro et al).

A SO-Year-Old Man With Skin Lesions and Multiple Pulmonary Nodules: Diagnosis

Subsequent laboratory evaluation included the following: erythrocyte sedimentation rate, 49 mm/h; HIV by enzyme-linked immunosorbent assay, negative; viral hepatitis panel, negative; urine and blood cultures, no growth; skin biopsy fungal culture, no growth; antinuclear antibody, titer of 1:80 in a speckled pattern; rheumatoid factor, negative; and antineutrophil cytoplasmic antibody panel, negative. A purified protein derivative skin test was placed, and the result was negative.

A SO-Year-Old Man With Skin Lesions and Multiple Pulmonary Nodules

A SO-Year-Old Man With Skin Lesions and Multiple Pulmonary NodulesA50-year-old heterosexual man presented to the emergency department for evaluation of a diffuse rash that started 10 weeks prior to hospital admission. He reported that the lesions began as small (0.3 cm), pink papules on his upper extremities, which progressed into large (3 cm), red, annular, plaque-like lesions that developed a thin scale within several days of onset. Subsequently, the lesions spread to his scalp, face, trunk, genitals, and lower extremities. He reported subjective fevers, chills, occasional drenching night sweats, and a 10-lb weight loss. Simultaneous with the onset of the skin lesions, he had an intermittent nonproductive cough, without dyspnea. Six weeks prior to presentation, he described the onset of sinus congestion with occasional epistaxis and left eye conjunctivitis, at which time he received a course of antibiotics. He denied any significant medical history. He also denied tobacco use, animal exposures, or recent travel. He worked as a cartographer in Colorado.

Feasibility of Routine Pulmonary Arterial Impedance Measurements in Pulmonary Hypertension: Clinical Implications

Thus, it may be that proximal pulmonary arterial changes leading to increased Zc and RF are predominantly the passive consequences of increased mean distending pressure, and that “fixed” proximal pulmonary arterial remodeling plays a minor role in determining RV hydraulic load. Dobutamine therapy increased cardiac output and decreased PVR, without a change in the pattern of PVZ spectrum. This observation is in keeping with experimental observations that dobutamine administration up to 10 ^g/kg/min has no flow-independent pulmonary vascular effect. A dobutamine-induced decrease in PVR probably reflects the flow dependency of this composite variable rather than structural or tone-related changes in the resistive arterioles. zithromax online

Feasibility of Routine Pulmonary Arterial Impedance Measurements in Pulmonary Hypertension: Effects of Pharmacologic Interventions

Feasibility of Routine Pulmonary Arterial Impedance Measurements in Pulmonary Hypertension: Effects of Pharmacologic InterventionsHowever, PVR is known to be insufficient for the evaluation of all the forces that oppose RV ejection, which result from a dynamic interplay among resistance, elastance, and wave reflection. This information is contained in Ppa and flow waves, and can be quantified by a PVZ spectrum calculation. The method provides a measure of hydraulic load by a low-frequency impedance determination (Z1), and by an estimate of compliance and wave reflection using a high-frequency Zc determination, together with the measurement of Fmin and the frequency of phase angle zero crossing. An index of wave RF can be calculated from Z0 and Zc determinations.

Feasibility of Routine Pulmonary Arterial Impedance Measurements in Pulmonary Hypertension: Pharmacologic Interventions

Inhaled NO therapy decreased Ppa and PVR, while Q, HR, and Psa remained unaffected. Z0, Z1; and Zc decreased, while Fmin, phase indexes, and RF were unchanged (Table 2). Epoprostenol therapy decreased PVR and Psa, increased Q, while HR remained unaffected, and decreased Z0, Z1, and Zc, while Fmin, phases indexes, and RF were unchanged (Table 2). Dobutamine therapy increased Q, HR, and Ppa, did not affect Psa, and decreased PVR and Z0, while Z1, Zc, Fmin, and phase indexes remained unaffected (Table 2). Figures 1 to 3 illustrate the typical PVZ spectra modifications observed with each intervention. Source

Feasibility of Routine Pulmonary Arterial Impedance Measurements in Pulmonary Hypertension: Statistical Analysis

The dose of NO had been selected on the basis of findings from previous reports that 10 to 20 ppm allows the maximum possible pulmonary vasodilation in PAH patients. NO was supplied from a pure NO source tank (Oxhydrique; Machelen, Belgium) and was delivered through a tight facemask. The inspired fraction of NO was monitored by chemiluminescence after calibration against a standard NO concentration (42 chemi-luminescence NO-NO2-Nox analyser; Thermo Environmental Instruments Inc; Franklin, MA). The dose of epoprostenol conformed to standard practice at the initiation of long-term continuous IV epoprostenol therapy. The dose of dobutamine was selected on the basis of experimental data showing that this inotropic drug is without flow-independent pulmonary vascular effects at doses of up to 10 ^g/kg/min. natural breast enlargement cream

Feasibility of Routine Pulmonary Arterial Impedance Measurements in Pulmonary Hypertension: Protocol

Ppa and flow signals were recorded after the pulmonary catheter was then carefully withdrawn to position its tip just above the pulmonary valve, as close as possible to the pulsed Doppler pulmonary artery flow-velocity sampling site. The signals were visually checked for quality, and then were synchronized by an ECG artifact and recorded on paper at a speed of 100 mm/s using the built-in printing system of the echocardiograph. Pressure and flow-velocity tracings were scanned (Scanjet 4470c; Hewlett Packard), digitized at a sampling rate of 200 Hz, and analyzed on a personal computer. Between three and five heartbeats were used for the analysis during each data collection period. For each patient, a series of thermodilution cardiac outputs and concomitant average Doppler flow velocities were used to calculate a conversion factor for the flow-velocity tracings into volume flow. Link

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