Gram-negative sepsis is the most common setting in which the constellation of abnormalities in lung function, is clinically called the adult respiratory distress syndrome(ARDS). There is a considerable clinical interest in measuring pulmonary microvascular filtration pressure in patients with acute respiratory failure. Pulmonary capillary pressure(Pc) influences the rate of edema formation in the injured lung, and an understanding of how Pc is altered by the disease is important to improve our treatment of acute respiratory failure, We infuesd E. Coli endotox-in, 3 mg/kg, intravenously into anesthetized dogs and measured the hemodynamics and pulmonary capillary pressure, which was derived from the pressure transient recorded while the pulmonary artery catheter was rapidly wedged. Dogs were given fluids to restore cardiac filling pressure to baseline levels. This resulted in a low resistance shock in all animals. 3 hours after the endotxin infusion experimental ARDS developed. The data report that mean pulomanary artery pressure, pulmonary capillary pressure, and pulmonary vascular resistance(PVR) are increased in experimental ARDS(P<0.1), and there is uneuqal, variable partitoning of the PVR. The Gaar estimation of Pc and measured Pc were highly correlated(r=0.915). These data suggest that measuring Pc will alow the clinician to learn if vasoactive agents infused in the management of acute respiratory failure can reduce the microvascular filtration pressure. In this manner, clinicians may directly reduce the rate of edema formation in the acutely injured lung.
Adult ; Animals ; Arteries ; Capillaries* ; Catheters ; Dogs ; Edema ; Filtration ; Hemodynamics* ; Humans ; Lung ; Pulmonary Artery ; Respiratory Insufficiency ; Sepsis ; Shock ; Shock, Septic

Gram-negative sepsis is the most common setting in which the constellation of abnormalities in lung function, is clinically called the adult respiratory distress syndrome(ARDS). There is a considerable clinical interest in measuring pulmonary microvascular filtration pressure in patients with acute respiratory failure. Pulmonary capillary pressure(Pc) influences the rate of edema formation in the injured lung, and an understanding of how Pc is altered by the disease is important to improve our treatment of acute respiratory failure, We infuesd E. Coli endotox-in, 3 mg/kg, intravenously into anesthetized dogs and measured the hemodynamics and pulmonary capillary pressure, which was derived from the pressure transient recorded while the pulmonary artery catheter was rapidly wedged. Dogs were given fluids to restore cardiac filling pressure to baseline levels. This resulted in a low resistance shock in all animals. 3 hours after the endotxin infusion experimental ARDS developed. The data report that mean pulomanary artery pressure, pulmonary capillary pressure, and pulmonary vascular resistance(PVR) are increased in experimental ARDS(P<0.1), and there is uneuqal, variable partitoning of the PVR. The Gaar estimation of Pc and measured Pc were highly correlated(r=0.915). These data suggest that measuring Pc will alow the clinician to learn if vasoactive agents infused in the management of acute respiratory failure can reduce the microvascular filtration pressure. In this manner, clinicians may directly reduce the rate of edema formation in the acutely injured lung.
Adult ; Animals ; Arteries ; Capillaries* ; Catheters ; Dogs ; Edema ; Filtration ; Hemodynamics* ; Humans ; Lung ; Pulmonary Artery ; Respiratory Insufficiency ; Sepsis ; Shock ; Shock, Septic

A case of low-grade endometrial stromal sarcoma resembling ovarian sex-cord tumor in the uterus of a 43-year-old woman is described. This tumor belongs to the group II category of uterine tumors resembling ovarian sex-cord tumor described by Clement and Scully, and the epithelial-like elements show prominent smooth muscle differentiation, proved by immunoreactivity for desmin and actin. The patient did not receive any adjuvant therapy; she is alive and well without recurrence 8 months postoperatively.
Female ; Humans

No abstract available.
Chemoradiotherapy* ; Humans ; Risk Factors* ; Treatment Failure* ; Uterine Cervical Neoplasms*

No abstract available.
Autopsy* ; Endocarditis* ; Thromboembolism

No abstract available.
Apolipoproteins* ; Blood Pressure* ; Child* ; Cholesterol* ; Humans ; Hyperlipidemias ; Hypertension ; Obesity* ; Potassium* ; Sodium* ; Statistics as Topic*

Metabolic encephalopathy is a critical condition that can be challenging to diagnose. Imaging provides early clues to confirm clinical suspicions and plays an important role in the diagnosis, assessment of the response to therapy, and prognosis prediction. Diffusion-weighted imaging is a sensitive technique used to evaluate metabolic encephalopathy at an early stage.Metabolic encephalopathies often involve the deep regions of the gray matter because they have high energy requirements and are susceptible to metabolic disturbances. Understanding the imaging patterns of various metabolic encephalopathies can help narrow the differential diagnosis and improve the prognosis of patients by initiating proper treatment regimen early.

BACKGROUND: Pulmonary complications following bonemarrow transplantation(BMT) are common and associated with a high mortality rate, We investigated the yield, safety, and impact of fiberoptic bronchoscopy(FOB) for diagnosis of postBMT pneumoniae. METHODS: From May 1997 to April 2000, 56 FOBs were performed in 52 post BMT patients for clinical pneumoniae. BMT patients with repiratory symptoms and/or pulmonary infiltrates had a thoracic HRCT(high resolution computed tomography) and bronchoscopic examination including BAL(bronchoalveolar lavage), TBLB(transbronchial lung biopsy), PSB(protected specimen brush). RESULTS: The characteristics of the subjects were as follows:37 males, 15 females, mean age of 31.3 years(17-45), 35 sibling donor allogenic BMTs, 15 nonrelated donor allogenic BMTs, and 2 autologous BMTs. Fiftynine percent of FOBs (33 FOBs, 31 patients) were diagnostic. Isolated pathogens included the following:12 cytomegalovirus(CMV) (21.4%), 7 pneumocystis carinii(PC) (12.5%), 11 CMV with PC (19.6%), 2 Mycobacaterium tuberculosis (3.6%), and 1 streptococcus (1.8%). Most of the radiographic findings were diffuse interstitial lesions. CMV pneumoniae had mainly diffuse interstitial nodular lesion, and PC pneumoniae had diffuse, interstitial ground glass opacity(GGO). When CMV was accompanied by PC, a combined pattern of nodular and GGO was present. Of the 56 cases(23.2%), 13 died of CMV pneumoniae(n=2), PCP(n=2), mixed infection with CMV and PC(n=3), underlying GVHD(n=1), underlying leukemia progression(n=1), or respiratory failure of unknown origin(n=4). There was no major complication by bronchoscopy. Only 3 cases developed minor bleedig and 1 episode temporary hypoxemia. CONCLUSION: Based on our findings, CMV and PC are the major causes of postBMT pneumoniae. In addition, BAL can be considered a safe and accurate procedure for the evaluation of pulmonary complications after BMT.
Anoxia ; Bone Marrow Transplantation* ; Bone Marrow* ; Bronchoscopy* ; Coinfection ; Diagnosis* ; Female ; Glass ; Humans ; Leukemia ; Lung ; Male ; Mortality ; Pneumocystis ; Pneumonia* ; Respiratory Insufficiency ; Siblings ; Streptococcus ; Tissue Donors ; Tuberculosis