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Revue Des Maladies Respiratoires Apr 2024In France, even though it occurs only exceptionally in cases of hemopathy, severe hemoptysis in cancer is the leading cause of hemoptysis. Without adequate treatment,... (Review)
Review
In France, even though it occurs only exceptionally in cases of hemopathy, severe hemoptysis in cancer is the leading cause of hemoptysis. Without adequate treatment, in-hospital mortality exceeds 60%, even reaching 100% at 6 months. The management of severe hemoptysis should be discussed with the oncologist. Aside from situations of threatening hemoptysis, in which bronchoscopy should be performed immediately, CT angiography is an essential means of localizing the bleeding and determining the causes and the vascular mechanisms involved. In more than 90% of cases, hemoptysis is linked to systemic bronchial or non-bronchial hypervascularization, whereas in fewer than 5%, it is associated with pulmonary arterial origin or, exceptionally, with damage to the alveolar-capillary barrier. The most severely ill patients must be treated in intensive care in centers equipped with interventional radiology, thoracic surgery and, ideally, with interventional bronchoscopy. Interventional radiology is the first-line symptomatic treatment. In over 80% of cases, bronchial arteriography with embolization allows immediate control. Emergency surgery should be avoided, as it is associated with significant mortality. Appropriate and adequate care reduces hospital mortality to 30%, enabling patients to benefit from the most recent, survival-prolonging treatments.
Topics: Humans; Hemoptysis; Embolization, Therapeutic; Bronchoscopy; Bronchi; Hematology
PubMed: 38155073
DOI: 10.1016/j.rmr.2023.11.004 -
A&A Practice Apr 2024Pulmonary embolism is a common complication after intracranial hemorrhage. As thrombolysis is contraindicated in this situation, surgical pulmonary embolectomy may be...
Pulmonary embolism is a common complication after intracranial hemorrhage. As thrombolysis is contraindicated in this situation, surgical pulmonary embolectomy may be indicated in case of high-risk pulmonary embolism but requires transient anticoagulation with heparin during cardiopulmonary bypass. We report the case of a patient with a history of heparin-induced thrombocytopenia who presented with a high-risk pulmonary embolism 10 days after the spontaneous onset of a voluminous intracerebral hematoma. Despite high doses of heparin required to run the cardiopulmonary bypass and subsequent anticoagulation by danaparoid sodium, the brain hematoma remained stable and the patient was discharged without complications 30 days after surgery.
Topics: Humans; Anticoagulants; Cardiopulmonary Bypass; Heparin; Thrombocytopenia; Pulmonary Embolism; Intracranial Hemorrhages; Cerebral Hemorrhage; Embolectomy; Hematoma
PubMed: 38578015
DOI: 10.1213/XAA.0000000000001767 -
Basic Research in Cardiology 1975Standardized bone trauma by means of open osteotomy is performed on both hind legs of 16 out of 24 anaesthetised mongrels. During the following 6 hours the most...
Standardized bone trauma by means of open osteotomy is performed on both hind legs of 16 out of 24 anaesthetised mongrels. During the following 6 hours the most important parameters of blood coagulation and the serum lipids are estimated at regular intervals. Subsequently in a number of the animals 50% of the total blood volume is withdrawn continuously over a period of one hour. All animals without the preceding trauma survive the hemorrhage. The animals in the trauma group die on the average 42 minutes after the beginning of the hemorrhage. The trauma causes an acute decrease in total platelet count (GTZ) to 40% of the pretraumatic value. During an initial phase of hypercoagulability there is a formation of reversible microaggregations containing platelets and fibrin, caused by an increased turnover of coagulation factors. Secondary fibrinolysis develops in the traumatised animals. A further increase in coagulation is caused by the following hemorrhage. In combination with decreased and inhibited fibrinolysis, a disseminated intravascular coagulation state is found and results in irreversible pulmonary microthrombosis. Massive pulmonary fat deposits cannot be found histologically in spite of an increase in serum triglycerid levels to 35% above the pretraumatic values. In dogs great amounts of fat are filtered by the glomeruli and are demonstrable in the tubular epithelium. Histological examinations show a marked disseminated pulmonary microthrombosis of platelets, fibrin and fat in those animals with trauma and hemorrhage. Only the accompanying hypovolemia produces the characteristic histologic changes of the so-called Pulmonary Microembolism Syndrome.
Topics: Animals; Blood Coagulation Factors; Blood Platelets; Blood Pressure; Cardiac Output; Dogs; Female; Hemodynamics; Hemorrhage; Kidney; Lung; Male; Platelet Aggregation; Pulmonary Circulation; Pulmonary Embolism; Triglycerides; Wounds and Injuries
PubMed: 1191208
DOI: 10.1007/BF01914337 -
Fa Yi Xue Za Zhi Jun 2018Due to the concealment and incidence higher than reported statistics, infanticide should attract the attention of legal medical experts. The infanticide process has... (Review)
Review
Due to the concealment and incidence higher than reported statistics, infanticide should attract the attention of legal medical experts. The infanticide process has common behavioral characteristics. The perpetrators are most frequently biological mothers who are unmarried, with inferior education, and lack of routine pregnancy tests. Medicolegal identification of infanticide cases includes identification of live births and causes of death. Besides the classical lung floating test, there are other methods to identify live births such as pulmonary interstitial emphysema, CT imaging examination, immunohistochemical examination of umbilical cord vitality markers. Neonatal line measurement is the only way to identify live births in corpse with severe decomposition. The main causes of death in infanticide are mechanic asphyxia and fatal head trauma. Shaken baby syndrome, as a common abusive head trauma, is pathologically characterized by the triad of encephalopathy, subdural haemorrhage (SDH) and retinal haemorrhage (RH). During the autopsy of suspected shaking baby syndrome, in addition to carefully examining cervical cord, the possibility of pathological temporal lobe hemorrhage should also be ruled out.
Topics: Craniocerebral Trauma; Forensic Medicine; Hematoma, Subdural; Humans; Infant; Infanticide; Retinal Hemorrhage; Shaken Baby Syndrome
PubMed: 30896108
DOI: 10.12116/j.issn.1004-5619.2018.06.018 -
Lymphology Sep 1979The effects of hemorrhage on pulmonary hemodynamics and lung transvascular fluid dynamics were studied in sheep. We found that 2 hr of hemorrhage caused a fall in lung...
The effects of hemorrhage on pulmonary hemodynamics and lung transvascular fluid dynamics were studied in sheep. We found that 2 hr of hemorrhage caused a fall in lung lymph flow (p less than 0.05) and no significant change in lymph protein concentration. The fall in lymph flow was not due to decreased vascular surface area since the regional distribution of pulmonary perfusion was not altered during hemorrhage; however, the decrease in lymph flow was associated with decrease (p less than 0.05) in the calculated pulmonary microvascular pressure. The extravascular lung water lung content per g bloodless dry lung was increased (p less than 0.05) in the hemorrhaged sheep from the control values. Pulmonary edema was not due to increased lung vascular endothelial permeability since the net transvascular protein flux was not increased. The finding that pulmonary edema occurred despite the consistent decreases in lymph flow suggests that edema may be due to hemorrhage-induced lymphatic "failure" or that edema fluid is sequestered in spaces (e.g., endothelial cells) where if cannot be drained by the lymphatics.
Topics: Animals; Blood Proteins; Blood Volume; Hemorrhage; Lung; Lymph; Proteins; Pulmonary Circulation; Regional Blood Flow; Serum Albumin; Sheep
PubMed: 542020
DOI: No ID Found -
Radiology Jul 1987
Topics: Aortic Rupture; Hematoma; Hemorrhage; Humans; Lung Diseases; Mediastinal Diseases
PubMed: 3588923
DOI: 10.1148/radiology.164.1.286-b -
Brain Injury 2017Pulmonary oedema is accumulation of fluid in the lung air spaces and interstitia. Neurogenic pulmonary oedema (NPE) is a potentially life-threatening condition which has... (Review)
Review
INTRODUCTION
Pulmonary oedema is accumulation of fluid in the lung air spaces and interstitia. Neurogenic pulmonary oedema (NPE) is a potentially life-threatening condition which has been noted in head injury, subarachnoid haemorrhage (SAH), intracerebral haemorrhage (ICH) and others. Timely management is crucial to achieve good outcome; however, no specific guidelines have been defined.
METHODS
A 33-year female involved in a motor vehicular accident had a GCS of 14/15 and CT scan showed a moderate-sized unilateral posterior fossa extradural haematoma (PFEDH). She had sudden deterioration in her haemodynamic status with drop in sensorium 2 hours after admission. There was a copious amount of frothy secretions noted on intubation and she was diagnosed as having NPE.
RESULTS
Sub-occiptial craneictomy (SOC) with haematoma evacuation was performed and was managed with PEEP mechanical ventilation post-operatively. Excellent outcome was obtained and was discharged with a GOS of 5.
CONCLUSIONS
NPE is a poorly understood and uncommon complication of acute CNS injury and should be considered in any patient with acute respiratory distress in the setting of CNS injury. Reduction in ICP and supportive mechanical ventilation form the mainstay of management. Diagnosis of NPE remains challenging and more reliable diagnostic criteria need to be defined to identify such cases with greater frequency.
Topics: Accidents, Traffic; Adult; Female; Hematoma, Epidural, Cranial; Humans; Pulmonary Edema; Tomography, X-Ray Computed
PubMed: 27880060
DOI: 10.1080/02699052.2016.1219388 -
Annual Review of Medicine 1972
Review
Topics: Albumins; Blood Transfusion; Capillaries; Erythrocytes; Humans; Lung; Lung Compliance; Membranes; Microscopy, Electron; Oxygen Consumption; Plasma Substitutes; Pulmonary Alveoli; Pulmonary Edema; Respiratory Dead Space; Resuscitation; Shock, Hemorrhagic; Sodium Chloride; Spirometry; Wounds and Injuries
PubMed: 4577379
DOI: 10.1146/annurev.me.23.020172.001221 -
British Medical Journal Apr 1975Through gleeding into the lung parenchyma is responsible for morbidity and mortality in patients with leukaemia pulmonary haemorrhage is seldom diagnosed during life. We...
Through gleeding into the lung parenchyma is responsible for morbidity and mortality in patients with leukaemia pulmonary haemorrhage is seldom diagnosed during life. We diagnosed occult pulmonary haemorrhage in five leukaemic patients with unexplained infiltrates on chest roetgenograms by examining alveolar macrophages retrieved by bronchopulmonary lavage. Macrophage haemosiderin content was greatly increased in the patients with pulmonary haemorrhage as compared to normal and thrombocytopenic control subjects. Haemoglobin and intact erythrocytes in alveolar macrophages were taken as evidence of recent haemorrhage. Intrapulmonary bleeding may occur often in patients with leukaemia, and bronchopulmonary lavage offers a safe approach to diagnosis and allows for concomitant identification of pulmonary infection.
Topics: Autopsy; Child; Erythrocytes; Female; Hemorrhage; Hemosiderin; Humans; Leukemia; Lung; Lung Diseases; Macrophages; Male; Middle Aged; Radiography; Therapeutic Irrigation
PubMed: 1125726
DOI: 10.1136/bmj.2.5964.166 -
Journal of Neurosurgery Sep 2023Subdural hemorrhage (SDH) has been reported to be the most frequent intracranial hemorrhagic complication following open heart surgery; however, its clinical features...
OBJECTIVE
Subdural hemorrhage (SDH) has been reported to be the most frequent intracranial hemorrhagic complication following open heart surgery; however, its clinical features and pathophysiology remain unclear. The aim of this retrospective study was to elucidate the incidence, clinical course, and factors associated with the development of symptomatic SDH following heart valve surgery.
METHODS
A retrospective review of medical records on the development of symptomatic SDH after heart valve surgery involving cardiopulmonary bypass (CPB) from April 2011 to March 2016 was performed. Patients who had undergone preoperative cranial computed tomography (CT) or brain magnetic resonance imaging (MRI) were included in this study, and factors associated with SDH following heart valve surgery were analyzed. When neurological symptoms developed after heart valve surgery, cranial CT or brain MRI was performed.
RESULTS
A total of 556 patients who had undergone heart valve surgery were analyzed. Among these patients, symptomatic SDH occurred in 11 (2.0%). The mean duration of symptomatic onset was 10.1 days (range 2-37 days). Ten of 11 patients (90.9%) developed SDH in the posterior fossa or occipital convexity. Logistic regression analysis revealed longer aortic clamp time (95% CI 1.00-1.10, p = 0.04), higher dose of heparin after surgery (95% CI 1.00-1.02, p = 0.001), and higher pulmonary artery pressure (PAP) just before disconnection of the CPB (95% CI 1.01-1.37, p = 0.04) as significantly associated with the development of SDH.
CONCLUSIONS
The incidence of symptomatic SDH following heart valve surgery was 2.0%. Symptoms due to SDH usually developed a few days to 1 month after surgery. Surprisingly, most SDHs developed in the posterior fossa or occipital convexity following heart valve surgery. A longer aortic clamp time, higher dose of heparin after surgery, and higher PAP just before disconnection of the CPB were related to the development of symptomatic SDH following heart valve surgery.
Topics: Humans; Retrospective Studies; Hematoma, Subdural; Cardiac Surgical Procedures; Heparin; Heart Valves
PubMed: 36789990
DOI: 10.3171/2023.1.JNS222059