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Revue Des Maladies Respiratoires Feb 2006The diagnosis of diffuse intra-alveolar haemorrhage (DAH) is suggested by the combination of haemoptysis, anaemia and pulmonary infiltrates. Broncho-alveolar lavage... (Review)
Review
INTRODUCTION
The diagnosis of diffuse intra-alveolar haemorrhage (DAH) is suggested by the combination of haemoptysis, anaemia and pulmonary infiltrates. Broncho-alveolar lavage produces macroscopically haemorrhagic fluid and/or haemosiderin laden macrophages. The diagnostic approach should allow distinction between immune mediated and other causes on account of the therapeutic implications.
BACKGROUND
The main immunological causes are small and medium vessel vasculitis (Wegener's granulomatosis, microscopic polyangeitis), lupus and Goodpasture's syndrome. Other immune disorders are only rarely involved. The association of DAH with an acute glomerulonephritis, indicating the pulmonary-renal syndrome, extra-thoracic involvement and immunological abnormalities suggest an immune aetiology. Immunosuppressant treatment should be started as soon as possible with corticosteroids often combined with intravenous cyclophosphamide. Plasmapharesis is indicated for Goodpasture's syndrome and poorly responding lupus. Aggravating factors such as hypervolaemia and disorders of haemostasis should be searched for and treated. Hospital mortality is close to 20%.
VIEWPOINT AND CONCLUSION
Immune mediated DAH is a disorder whose rarity justifies the establishment of a national registry with the aim of developing standardised diagnostic and therapeutic strategies.
Topics: Adult; Hemorrhage; Humans; Lung Diseases; Prognosis; Pulmonary Alveoli
PubMed: 16604015
DOI: No ID Found -
BMJ Case Reports May 2018
Topics: Aortic Dissection; Aortic Aneurysm; Back Pain; Diagnosis, Differential; Hematoma; Humans; Male; Middle Aged; Pulmonary Artery; Tomography, X-Ray Computed
PubMed: 29776945
DOI: 10.1136/bcr-2018-224853 -
Kyobu Geka. the Japanese Journal of... Jun 2023A 59-year-old woman was transferred to our hospital because of a sudden onset of chest and back pain. Computed tomography (CT) demonstrated Stanford type A acute aortic...
A 59-year-old woman was transferred to our hospital because of a sudden onset of chest and back pain. Computed tomography (CT) demonstrated Stanford type A acute aortic dissection with cardiac tamponade and right airway bleeding. Hemorrhage from ruptured false lumen extended along the pulmonary artery (PA), compression of the right PA were recognized due to hematoma surrounding the PA. An emergency operation was performed. The primary tear was located at the distal aortic arch, and total arch replacement with frozen elephant trunk was performed. During the operation, she had airway bleeding. The bleeding was thought to be due to the hematoma extending along the pulmonary artery. She was extubated 7th postopratively. She was discharged 44 days after the operation.
Topics: Female; Humans; Middle Aged; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Aortic Dissection; Aorta, Thoracic; Hemorrhage; Hematoma; Lung
PubMed: 37258030
DOI: No ID Found -
Clinical Neurology and Neurosurgery Apr 2020Current guidelines paid little attention to a unique severe disease about intracranial hematoma owing to aneurysm rupture. We attempted to explore the predictive factors...
OBJECTIVES
Current guidelines paid little attention to a unique severe disease about intracranial hematoma owing to aneurysm rupture. We attempted to explore the predictive factors for prognosis in these poor patient population.
PATIENTS AND METHODS
One hundred twenty-one aneurysmal subarachnoid hemorrhage combined with intracerebral hematoma patients discharged between 2013 and 2016 were reviewed in this retrospective study. Unfavorable outcome was defined as a modified Rankin Scale (mRS) score of 3, 4, 5, or 6 at 6 months. Multivariable logistic regression was performed to evaluate the association of unfavorable outcome with preoperative and postoperative clinical characteristics.
RESULTS
Of 121 patients with intact follow-up data, 34 (28.10 %) had an unfavorable prognosis. The preoperative prognostic model included patients' age, respiratory rate, Hunt-Hess scale, red cell distribution width, and serum sodium at admission. The postoperative prognostic model included patients' age, respiratory rate, red cell distribution width, serum sodium, postoperative delayed cerebral ischemia, and pulmonary infection. Both preoperative and postoperative prognostic models had excellent discrimination with Area Under The Curve (AUC) of 0.864 (P < .001) and 0.898 (P < .001), respectively.
CONCLUSION
In clinical practice, we should pay more attention to those old patients with worse admission Hunt-Hess score, presenting deep-slow respiratory and lower serum sodium. Reduction of postoperative delayed cerebral ischemia and pulmonary infection might improve outcomes after aneurysmal SAH with intracerebral hematoma.
Topics: Adult; Age Factors; Aged; Aneurysm, Ruptured; Brain Ischemia; Cerebral Hemorrhage; Decompressive Craniectomy; Drainage; Erythrocyte Indices; Female; Functional Status; Hematoma; Humans; Intracranial Aneurysm; Intracranial Pressure; Male; Middle Aged; Monitoring, Physiologic; Pneumonia; Postoperative Complications; Prognosis; Respiratory Rate; Retrospective Studies; Rupture, Spontaneous; Sodium; Subarachnoid Hemorrhage
PubMed: 31986364
DOI: 10.1016/j.clineuro.2020.105691 -
Anesthesiology Clinics Sep 2012Spinal and epidural anesthesia and analgesia, and the combination of the two techniques, have been excellent choices for the management of certain surgical procedures... (Review)
Review
Spinal and epidural anesthesia and analgesia, and the combination of the two techniques, have been excellent choices for the management of certain surgical procedures and continue to grow in popularity. The demand for increased patient mobility and quicker discharge for both inpatients and outpatients lends itself to the benefits of regional anesthesia. A neuraxial block is indicated for any surgical procedure in which the appropriate sensory level can be accomplished without any adverse outcome. This article outlines the indications and contraindications for these techniques.
Topics: Back Pain; Blood Coagulation Disorders; Body Temperature; Central Nervous System; Gastrointestinal Diseases; Hematoma; Hemodynamics; Humans; Lung; Nerve Block; Nervous System Diseases; Neurosecretory Systems; Pain Management; Patient Discharge; Postoperative Care; Postoperative Complications; Urologic Diseases
PubMed: 22989587
DOI: 10.1016/j.anclin.2012.07.005 -
Medicine Dec 2023A large number of clinical studies suggested that surgery might be a better choice than conservative treatment for treating hypertensive intracerebral hemorrhage in the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
A large number of clinical studies suggested that surgery might be a better choice than conservative treatment for treating hypertensive intracerebral hemorrhage in the middle-aged and elderly. Stereotactic puncture can reduce the mass effect caused by hematoma, reduce the intervention of body homeostasis, reduce brain tissue damage, and improve the prognosis of patients with cerebral hemorrhage. This meta-analysis aims to evaluate the efficacy of stereotactic puncture and craniotomy in elderly patients with hypertensive intracerebral hemorrhage.
METHODS
A search strategy was designed to search in databases, including PubMed, Embase, Cochrane Central Register of Controlled Trials, CNKI, Wanfang database and relevant references. Literature on the efficacy and safety of different surgical methods for hypertensive cerebral hemorrhage in the middle-aged and elderly were retrieved. The search time was until August 17, 2022. Keywords included "hypertensive intracerebral hemorrhage," "stereotactic hematoma removal," "craniotomy." After the literature search, 2 researchers independently conducted literature screening, quality evaluation of included trials and data extraction. RevMan5.4 software was used to perform a Meta-analysis on the operation time, hospital stay, postoperative Glasgow Coma Scale (GCS) score, postoperative daily activity ability, postoperative complications and neurological prognosis scores included in the included studies.
RESULTS
A total of 1988 samples were included in 9 studies. 1022 patients underwent stereotactic hematoma removal, and 968 patients underwent craniotomy hematoma removal. The orientation group had more advantages in the length of hospital stay, postoperative disability, pulmonary infection, intracranial infection and digestive tract ulcer, and the difference was statistically significant (P < .05). In addition, the length of stay (I²= 83%) of the included articles had good homogeneity (I²< 50%), and there was no significant difference between the 2 groups in operation time, postoperative GCS score, postoperative daily activity ability, and neurological prognosis score (P > .05).
CONCLUSION
The meta-analysis indicate that compared to craniotomy for hematoma removal, stereotactic hematoma removal can reduce the postoperative disability rate, intracranial infection rate, lung infection rate, and digestive tract ulcer rate in middle-aged and elderly patients with hypertensive intracerebral hemorrhage.
Topics: Aged; Middle Aged; Humans; Intracranial Hemorrhage, Hypertensive; Ulcer; Treatment Outcome; Craniotomy; Cerebral Hemorrhage; Hematoma; Retrospective Studies
PubMed: 38065865
DOI: 10.1097/MD.0000000000036533 -
The British Journal of Radiology Aug 1966
Topics: Bronchography; Hematoma; Humans; Lung Diseases; Male; Middle Aged; Radiography, Thoracic; Tomography
PubMed: 5944505
DOI: 10.1259/0007-1285-39-464-629 -
The Indian Journal of Medical Research Mar 2010Pulmonary involvement due to leptospirosis carries high case fatality rate and is the commonest cause of death due to leptospirosis. Immune mechanisms play a key role in...
BACKGROUND & OBJECTIVES
Pulmonary involvement due to leptospirosis carries high case fatality rate and is the commonest cause of death due to leptospirosis. Immune mechanisms play a key role in the pathogenesis of leptospiral pulmonary haemorrhage. As other immune pulmonary haemorrhages due to non leptospiral causes are treated with plasma exchange and cyclophosphamide we evaluated their efficacy in patient with leptospiral pulmonary haemorrhage.
METHODS
Of the 602 confirmed patients of leptospirosis, 236 (39.2%) had pulmonary haemorrhage. Of these,144 had mild haemorrhage (acute lung injury score < 2.5) and were included in the study. One hundred and fourteen patients were given two cycles of plasma exchange, 24 h apart, 25 ml/kg body weight of plasma was removed in each cycle. Cyclophosphamide (20 mg/kg body weight) was given after the first plasma exchange cycle. The remaining 30 patients were not given this treatment, and used as control.
RESULTS
In the control group only 5 (16.6%) patients survived while in the treatment group 70 (61.40%) patients survived. Thrombocytopenia was observed in 111 (77.08%) patients. Renal and hepatic involvement was seen but did not account for mortality. Minor complications were seen in group I patients after plasma exchange and cyclophosphamide treatment, but none were serious.
INTERPRETATION & CONCLUSIONS
Our findings showed that plasma exchange with immunosuppression improved survival in patients of pulmonary alveolar haemorrhage due to leptospirosis, suggesting that immune mechanisms play a key role in the pathogenesis of the disease.
Topics: Adolescent; Adult; Cyclophosphamide; Female; Hemorrhage; Humans; Immune System; Immunosuppressive Agents; Leptospirosis; Lung; Male; Middle Aged; Plasma Exchange; Pulmonary Alveoli; Time Factors; Treatment Outcome
PubMed: 20418558
DOI: No ID Found -
Emergency Medicine Journal : EMJ Aug 2006The case is presented of a 66 year old woman who attended the emergency department with severe abdominal pain subsequent to a bout of coughing, following a week's...
The case is presented of a 66 year old woman who attended the emergency department with severe abdominal pain subsequent to a bout of coughing, following a week's history of productive cough. She was known to have chronic obstructive pulmonary disease and was also on warfarin for recurrent deep vein thromboses. She had no history of ischaemic heart disease. She was found to have a rectus sheath haematoma and an international normalised ratio of 7.7, and admission was arranged for coagulation control and analgesia. However, a routine electrocardiograph (ECG) demonstrated an ST elevation pattern consistent with an acute inferior infarction. Subsequent ECGs showed no ST elevation, although the axis and chest lead QRS morphology remained the same throughout the first 12 hours. Over the next three days, R wave progression decreased in the chest leads. Troponin I at admission and 24 hours later were both <0.2 ng/ml. ECG changes compatible with acute myocardial infarction have been reported in association with a number of non-cardiac presentations; however, to our knowledge, it has never been reported in relation to a rectus sheath haematoma. We speculated on the possible mechanism of such "pseudo myocardial infarction" and the importance of treating the patient, not the ECG.
Topics: Aged; Electrocardiography; Emergency Medical Services; Female; Hematoma; Humans; Myocardial Infarction; Rectus Abdominis
PubMed: 16858085
DOI: 10.1136/emj.2005.032656 -
Neurocritical Care Feb 2021Stereotactic minimally invasive surgery (sMIS) has been used in the treatment of intracerebral hemorrhage (ICH) in recent years and has obtained promising results....
BACKGROUND
Stereotactic minimally invasive surgery (sMIS) has been used in the treatment of intracerebral hemorrhage (ICH) in recent years and has obtained promising results. However, the outcomes of patients are associated with many factors. The aim of the present study was to retrospectively observe the relationship between hematoma shape features and the outcome of patients with spontaneous ICH following sMIS.
METHODS
One hundred eighty-three patients with hypertensive ICH who underwent sMIS were enrolled. Based on hematoma shape features, the patients were assigned to a regular-shaped hematoma group (RSH group, including 121 patients) or an irregular-shaped hematoma group (ISH group, including 62 patients). The Glasgow Coma Scale (GCS) score and the National Institutes of Health Stroke Scale (NIHSS) score were assessed on admission and at 1 week and 2 weeks after surgery. The rates of severe pulmonary infection, cardiac complications, and postoperative rebleeding during the hospital stay were also recorded for comparison. The functional outcome assessed by using the modified Rankin scale score was determined at discharge. A multivariate logistic regression analysis was performed for predictors of good outcome in patients with ICH who underwent sMIS. A receiver operating characteristic curve was also used to confirm the results.
RESULTS
Compared to the ISH group, the RSH group showed increased median GCS scores at one week and two weeks after surgery. The RSH group showed significantly decreased NIHSS scores at one week and two weeks after surgery compared with the ISH group at the same time point. Significant differences in the GCS score and the NIHSS score at 1 week (P < 0.05) and 2 weeks (P < 0.05) after surgery were observed between the RSH group and the ISH group. The RSH group showed lower rates of severe pulmonary infection, heart failure, and postoperative rehemorrhage than the ISH group (P < 0.05). Of the total patients with good outcomes, the RSH group accounted for 84.6%, and just 15.4% were from the ISH group. The multivariate logistic regression analysis demonstrated that regular-shaped hematoma (P < 0.0001) was an independent predictor of good outcome. The postoperative residual hematoma volume (P < 0.05) predicted a poor outcome. The sensitivity, specificity, and positive and negative predictive values of regular-shaped hematomas for the prediction of a favorable outcome in patients were 0.667, 0.846, 0.917, and 0.542, respectively. Additionally, the Youden index was 0.513.
CONCLUSIONS
Patients with regular-shaped hematomas exhibited more favorable outcomes. Irregular-shaped hematomas and postoperative residual hematoma volume predicted a poor outcome in patients with ICH following sMIS.
Topics: Cerebral Hemorrhage; Glasgow Coma Scale; Hematoma; Humans; Intracranial Hemorrhage, Hypertensive; Minimally Invasive Surgical Procedures; Retrospective Studies; Treatment Outcome
PubMed: 32462410
DOI: 10.1007/s12028-020-00996-2