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BMJ Case Reports Jan 2020Leptospirosisis a zoonosis caused by spirochaetes from the species The more severe form of leptospirosis, known as Weil's disease, is characterised by the triad of...
Leptospirosisis a zoonosis caused by spirochaetes from the species The more severe form of leptospirosis, known as Weil's disease, is characterised by the triad of jaundice, renal impairment and haemorrhages. Pulmonary involvement occurs in 20%-70% of the patients, with severity ranging from non-productive cough to respiratory failure mainly due to pulmonary haemorrhage. Recognition of Weil's disease in patients presenting with pulmonary symptoms can be difficult. This case illustrates a classic case of pulmonary haemorrhagic involvement in Weil's disease.
Topics: Adult; Diagnosis, Differential; Hematologic Tests; Hemorrhage; Humans; Lung Diseases; Male; Tomography, X-Ray Computed; Weil Disease
PubMed: 31996379
DOI: 10.1136/bcr-2018-227570 -
British Journal of Haematology Nov 2015Hereditary haemorrhagic telangiectasia is a rare systemic autosomal dominantly inherited disorder of the fibrovascular tissue with a wide variety of clinical... (Review)
Review
Hereditary haemorrhagic telangiectasia is a rare systemic autosomal dominantly inherited disorder of the fibrovascular tissue with a wide variety of clinical manifestations. Diagnosis is based on the clinical Curaçao criteria or molecular genetic testing. Dilated vessels can develop into telangiectases or larger vascular malformations in various organs, calling for an interdisciplinary approach. Epistaxis and gastrointestinal bleeding can result from these vascular defects. Various conservative and interventional treatments have been described for these conditions. However, no optimal therapy exists. Treatment can become especially difficult due to progressive anaemia or when anticoagulant or anti-thrombotic therapy becomes necessary. Screening for pulmonary arteriovenous malformations (PAVM) should be performed in all confirmed and suspected patients. Treatment by percutaneous transcatheter embolotherapy and antibiotic prophylaxis is normally effective for PAVM. Cerebral or hepatic vascular malformations and rare manifestations need to be evaluated on a case-by-case basis to determine the best course of action for treatment.
Topics: Anemia, Iron-Deficiency; Antibiotic Prophylaxis; Anticoagulants; Arteriovenous Malformations; Disease Management; Embolization, Therapeutic; Epistaxis; Fibrinolytic Agents; Gastrointestinal Hemorrhage; Hemostatics; Humans; Hypertension, Pulmonary; Intracranial Arteriovenous Malformations; Liver; Lung; Neovascularization, Pathologic; Signal Transduction; Telangiectasia, Hereditary Hemorrhagic; Thrombophilia; Transforming Growth Factor beta
PubMed: 26205234
DOI: 10.1111/bjh.13606 -
The Journal of Surgical Research Aug 2011Alternative experimental models of hemorrhage mimic particular conditions of clinical settings and provide advantages to analyze novel resuscitation treatments. Here, we...
BACKGROUND
Alternative experimental models of hemorrhage mimic particular conditions of clinical settings and provide advantages to analyze novel resuscitation treatments. Here, we compared alternative models of hemorrhage and analyzed the effects of resuscitation with Hextend.
METHODS
Adult male Sprague-Dawley rats underwent alternative models of hemorrhage: anesthetized without trauma, anesthetized with trauma, or conscious (unanesthetized) hemorrhage. Each model of hemorrhage includes three experimental groups: (C) control without hemorrhage or resuscitation treatment; (NR) animals with hemorrhage but without resuscitation; and (HX) animals with hemorrhage and resuscitation treatment with Hextend.
RESULTS
Conscious animals required the highest hemorrhagic volume, whereas hemorrhage with trauma required the lowest blood volume withdrawal to achieve the same arterial pressure. Conscious hemorrhage exhibited the fastest mortality, but anesthetized animals with or without trauma had similar mortality kinetic. These survival rates did not correlate with blood chemistry, hemodynamic responses, or serum TNF and HMGB1 levels. Hemorrhage in conscious animals or anesthetized animals with trauma increased serum TNF levels by approximately 2-fold compared with hemorrhage in anesthetized animals without trauma. Animals in conscious hemorrhage had similar TNF increases in all the organs, but trauma induced a specific TNF overproduction in the spleen. Resuscitation with Hextend improved survival in all the experimental models, yet its survival benefits were statistically greater in anesthetized animals with trauma. The only two markers similar to the survival benefits of Hextend were the TNF levels in the lung and liver. Hextend significantly improved survival and inhibited pulmonary and hepatic TNF levels in all the experimental models.
CONCLUSIONS
The survival benefits of resuscitation with Hextend depended on the experimental models and did not correlate with blood chemistry, hemodynamic, or serum cytokine levels. However, resuscitation with Hextend inhibited TNF levels in the lung and the liver with a pattern that resembled the survival benefits.
Topics: Animals; HMGB1 Protein; Hemorrhage; Inflammation; Liver; Lung; Male; Models, Animal; Plasma Substitutes; Rats; Rats, Sprague-Dawley; Resuscitation; Survival; Tumor Necrosis Factor-alpha; Unconsciousness; Wounds and Injuries
PubMed: 20189589
DOI: 10.1016/j.jss.2009.11.712 -
The Journal of Thoracic and... Nov 2018
Topics: Endarterectomy; Hematoma, Subdural; Humans
PubMed: 30057187
DOI: 10.1016/j.jtcvs.2018.06.029 -
Ultrasound in Medicine & Biology Nov 2019The occurrence of the pulmonary capillary hemorrhage (PCH) bioeffect of diagnostic ultrasound in rats was investigated for a SuperSonic Imagine shear wave elastography...
The occurrence of the pulmonary capillary hemorrhage (PCH) bioeffect of diagnostic ultrasound in rats was investigated for a SuperSonic Imagine shear wave elastography system (Aixplorer, Supersonic Imagine, Aix-en-Provence, France). The elastography imaging repeated at 1 Hz and consisted of widely spaced B-mode image pulses, supersonic push (SSP) pulses and shear wave imaging (SWI) pulses. Groups of rats anesthetized with ketamine and xylazine, or with ketamine only, were imaged on their right side in a warm water bath for one frame, 30 s and 300 s. The image focus and region of interest were adjusted to give exposure only with the background B-mode imaging, or primarily with the SSP and SWI pulses. A sham group had only low power aiming scans. The lungs were removed 5 min after exposure and evaluated for PCH area and volume. The B mode was notably ineffective and produced significant PCH only at the maximum 0 dB output. The SSP pulses together with the SWI pulses produced significant PCH for 300 s, 30 s and even single image exposures. Peak rarefactional pressure amplitude PCH thresholds for 300 s exposure were the same with or without the B-mode pulses at 1.5 MPa (in situ mechanical index, MI = 0.67). A 30 s duration resulted in a slightly increased threshold of 1.7 MPa (MI = 0.76). The omission of xylazine from the anesthetic, which reduces the sensitivity of rat lung to PCH occurrence, resulted in an increased threshold of 2.1 MPa (MI = 0.94). The unique SSP pulses were much more effective than the B mode, but thresholds were comparable to previous results with other diagnostic ultrasound modes on other systems.
Topics: Animals; Capillaries; Elasticity Imaging Techniques; Female; Hemorrhage; Lung; Lung Diseases; Rats; Rats, Sprague-Dawley
PubMed: 31412979
DOI: 10.1016/j.ultrasmedbio.2019.07.007 -
Journal of Ultrasound in Medicine :... Apr 2021Lung ultrasound (LUS) exposure can induce pulmonary capillary hemorrhage (PCH), depending on biological and physical exposure parameters. This study was designed to...
OBJECTIVES
Lung ultrasound (LUS) exposure can induce pulmonary capillary hemorrhage (PCH), depending on biological and physical exposure parameters. This study was designed to investigate the variation in the LUS induction of PCH due to hemorrhagic shock, which itself can engender pulmonary injury.
METHODS
Male rats were anesthetized with isoflurane in air. Shock was induced by withdrawal of 40% of the blood volume and assessed by the blood pressure detected by a femoral artery catheter and by blood glucose tests. B-mode ultrasound was delivered at 7.3 MHz with a low output (-20 dB) for aiming and with the maximal output (0 dB) for exposure. Pulmonary capillary hemorrhage was quantified by an assessment of comet tail artifacts in the LUS images and by measurement of PCH areas on the surface of fresh lung samples.
RESULTS
Tests without shock or catheterization surgery gave results for PCH similar to those of previous studies using different methods. Exposure before hemorrhagic shock gave a mean PCH area ± SE of 24.8 ± 9.2 mm on the ultrasound scan plane, whereas exposure after shock gave 0 PCH (P < .001; n = 7).
CONCLUSIONS
The presence of hemorrhagic shock significantly reduces the occurrence of LUS-induced PCH.
Topics: Animals; Disease Models, Animal; Hemorrhage; Lung; Male; Rats; Rats, Sprague-Dawley; Shock, Hemorrhagic
PubMed: 32856724
DOI: 10.1002/jum.15463 -
Tissue factor deficiency increases alveolar hemorrhage and death in influenza A virus-infected mice.Journal of Thrombosis and Haemostasis :... Jun 2016Essentials H1N1 Influenza A virus (IAV) infection is a hemostatic challenge for the lung. Tissue factor (TF) on lung epithelial cells maintains lung hemostasis after IAV...
UNLABELLED
Essentials H1N1 Influenza A virus (IAV) infection is a hemostatic challenge for the lung. Tissue factor (TF) on lung epithelial cells maintains lung hemostasis after IAV infection. Reduced TF-dependent activation of coagulation leads to alveolar hemorrhage. Anticoagulation might increase the risk for hemorrhages into the lung during severe IAV infection.
SUMMARY
Background Influenza A virus (IAV) infection is a common respiratory tract infection that causes considerable morbidity and mortality worldwide. Objective To investigate the effect of genetic deficiency of tissue factor (TF) in a mouse model of IAV infection. Methods Wild-type mice, low-TF (LTF) mice and mice with the TF gene deleted in different cell types were infected with a mouse-adapted A/Puerto Rico/8/34 H1N1 strain of IAV. TF expression was measured in the lungs, and bronchoalveolar lavage fluid (BALF) was collected to measure extracellular vesicle TF, activation of coagulation, alveolar hemorrhage, and inflammation. Results IAV infection of wild-type mice increased lung TF expression, activation of coagulation and inflammation in BALF, but also led to alveolar hemorrhage. LTF mice and mice with selective deficiency of TF in lung epithelial cells had low basal levels of TF and failed to increase TF expression after infection; these two strains of mice had more alveolar hemorrhage and death than controls. In contrast, deletion of TF in either myeloid cells or endothelial cells and hematopoietic cells did not increase alveolar hemorrhage or death after IAV infection. These results indicate that TF expression in the lung, particularly in epithelial cells, is required to maintain alveolar hemostasis after IAV infection. Conclusion Our study indicates that TF-dependent activation of coagulation is required to limit alveolar hemorrhage and death after IAV infection.
Topics: Animals; Anticoagulants; Blood Coagulation; Bronchoalveolar Lavage Fluid; Epithelial Cells; Gene Deletion; Hemorrhage; Hemostasis; Inflammation; Influenza A Virus, H1N1 Subtype; Integrases; Lung; Male; Mice; Mice, Inbred C57BL; Orthomyxoviridae Infections; Pulmonary Alveoli; Thromboplastin
PubMed: 26947929
DOI: 10.1111/jth.13307 -
Computational and Mathematical Methods... 2022This study is aimed at investigating the efficacy and safety of multislice spiral CT-guided transthoracic lung biopsy in the diagnosis of pulmonary nodules of different...
OBJECTIVE
This study is aimed at investigating the efficacy and safety of multislice spiral CT-guided transthoracic lung biopsy in the diagnosis of pulmonary nodules of different sizes.
METHODS
Data of 78 patients with pulmonary nodules who underwent CT-guided transthoracic lung biopsy in our hospital from January 2020 to December 2021 were retrospectively analyzed, and they were divided into the small nodules group ( = 12), medium nodules group ( = 35), and large nodules group ( = 31) according to the diameter of pulmonary nodules. The results of puncture biopsy and final diagnosis of pulmonary nodules of different sizes were compared. The incidence of complications in patients with pulmonary nodules of different sizes was compared. Univariate analysis was used to compare the incidence of complications in 78 patients. Logistic multiple regression analysis was used to analyze the independent risk factors of pneumothorax in patients with pulmonary nodule puncture. Logistic multiple regression analysis was used to analyze the independent risk factors of pulmonary hemorrhage in patients with pulmonary nodule puncture.
RESULTS
The diagnostic accuracy, sensitivity, and specificity were 83.33%, 100.00%, and 77.78% in small nodules group. The diagnostic accuracy, sensitivity, and specificity of medium nodules group were 85.71%, 100.00%, and 73.68%, respectively. The diagnostic accuracy, sensitivity, and specificity of large nodules group were 93.55%, 100.00%, and 33.33%, respectively. There was no significant difference in the incidence of pneumothorax among the three groups ( > 0.05). The incidence of pulmonary hemorrhage in small nodule group was higher than that in the medium nodule group and large nodule group, and the difference was statistically significant ( < 0.05). There was no significant difference in the incidence of total complications among the three groups ( > 0.05). There were statistically significant differences in clinical data such as the needle tract length, the puncture position, and the distance of the puncture needle passing through the lung tissue in patients with or without pneumothorax ( < 0.05). There were statistically significant differences in needle tract length, distance of puncture needle passing through lung tissue, and size of pulmonary nodules in patients with or without pulmonary hemorrhage ( > 0.05). Logistic multivariate analysis showed that needle tract length ≤ 50 mm, lateral decubitus position, and the distance of puncture needle passing through lung tissue ≥ 14 mm were independent risk factors for pneumothorax after puncture in patients with pulmonary nodules ( < 0.05). The needle tract length > 50 mm, the distance of puncture needle passing through lung tissue ≥ 14 mm, and small nodules (pulmonary nodules diameter ≤ 10 mm) were independent risk factors for pulmonary hemorrhage after puncture in patients with pulmonary nodules ( < 0.05).
CONCLUSION
Multislice spiral CT-guided transthoracic lung biopsy is effective in diagnosing pulmonary nodules of different sizes.
Topics: Biopsy, Needle; Hemorrhage; Humans; Lung; Multiple Pulmonary Nodules; Pneumothorax; Retrospective Studies; Solitary Pulmonary Nodule; Tomography, Spiral Computed
PubMed: 36060660
DOI: 10.1155/2022/8192832 -
Journal of Applied Physiology... May 2021Airway management is important in trauma and critically ill patients. Prolonged mechanical ventilation results in overventilation-induced lung barotrauma, but few...
Airway management is important in trauma and critically ill patients. Prolonged mechanical ventilation results in overventilation-induced lung barotrauma, but few studies have examined the consequence of acute (1 h or less) overventilation. We hypothesized that acute hyperventilation, as might inadvertently be performed in prehospital settings, would elevate systemic inflammation and cause lung damage. Female Yorkshire pigs (40-50 kg, = 10/group) were anesthetized, instrumented for hemodynamic measurements and blood sampling, and underwent a 25% controlled hemorrhage followed by 1 h of ) spontaneous breathing, ) "normal" bag ventilation (4.8 L·min volume, ∼400 mL tidal volume, 12 breaths/minute), ) bag hyperventilation (9 L·min volume, ∼750 mL tidal volume, 12 breaths/minute), ) maximum hyperventilation (15 L·min volume, ∼750 mL tidal volume, 20 breaths/minute), or ) mechanical ventilation. Pigs then regained consciousness and recovered for 24 h, followed by euthanasia and collection of blood and tissue samples. No level of manual ventilation had any significant impact on hemodynamic variables. Blood markers of tissue damage and plasma cytokines were not statistically different between groups with the exception of a transient increase in IL-1β; all values returned to baseline by 24 h. On pathological review, severity and distribution of lung edema or other gross pathologies were not significantly different between groups. These data indicate hyperventilation causes no adverse effects, to include inflammation and tissue damage, and that acute overventilation, as could be seen in the prehospital phase of trauma care, does not produce evidence of adverse effects on the lungs following moderate hemorrhage. Appropriate airway management is essential in trauma and critically ill patients. Prolonged mechanical ventilation can result in overventilation-induced lung barotrauma, but few studies have examined the consequence of acute overventilation. We investigated the outcome of hemorrhage followed by 1 h of overventilation in swine. We found that acute overventilation, as could be seen in the prehospital phase of trauma care, does not produce evidence of adverse effects on otherwise healthy lungs following moderate hemorrhage.
Topics: Animals; Female; Hemodynamics; Hemorrhage; Humans; Lung; Respiration, Artificial; Swine; Tidal Volume
PubMed: 33734830
DOI: 10.1152/japplphysiol.01048.2020 -
The American Journal of Pathology Mar 2004Human patients suffering from leptospirosis present with a diverse array of clinical manifestations, including the more severe and often fatal pulmonary form of the...
Human patients suffering from leptospirosis present with a diverse array of clinical manifestations, including the more severe and often fatal pulmonary form of the disease. The etiology of pulmonary hemorrhage is unclear. Isolates of Leptospira acquired from patients suffering from pulmonary hemorrhage were used to develop a guinea pig model of pulmonary hemorrhage. Gross findings post-infection confirmed extensive hemorrhage in the lungs and on peritoneal surfaces as the likely cause of death. Immunohistochemistry confirmed the presence of large numbers of leptospires in kidney, liver, intestinal tissues, and spleen, but few inflammatory cells were seen. In marked contrast, few leptospires were detected in infected hemorrhagic lung tissue. Blood chemistries and hematology did not reveal the etiology of the hemorrhage observed. There was no chemical or microscopic evidence for disseminated intravascular coagulation. To ascertain an immunopathologic role during disease, immunofluorescence was performed on infected lung tissues and confirmed the presence of IgM, IgG, IgA, and C3 along the alveolar basement membrane. This suggests that an autoimmune process may be the etiology of fatal pulmonary hemorrhage in leptospirosis.
Topics: Animals; Autoimmune Diseases; Complement System Proteins; Disease Models, Animal; Guinea Pigs; Hemorrhage; Immunoglobulins; Immunohistochemistry; Intestines; Kidney; Leptospira; Leptospirosis; Liver; Lung Diseases; Male; Microscopy, Electron; Pulmonary Alveoli; Spleen
PubMed: 14982864
DOI: 10.1016/S0002-9440(10)63198-7