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Hyun Choi, Dinesh Krishnamoorthy
BACKGROUND: Pulmonary embolism (PE) during pregnancy remains one of the leading causes of maternal morbidity and mortality in the developed world. However, there is a paucity of high-quality evidence resulting in a lack of consensus in managing this group of patients. The aims of the study were to address the diagnostic utility of D-dimer for suspected PE in pregnant and post-partum patients and to identify any clinical presentation variables that are predictors of PE in this group of patients...
March 5, 2018: International Journal of Emergency Medicine
Nancy Glober, Christopher R Tainter, Jesse Brennan, Mark Darocki, Morgan Klingfus, Michelle Choi, Brenna Derksen, Frances Rudolf, Gabriel Wardi, Edward Castillo, Theodore Chan
BACKGROUND: Assessment for pulmonary embolism (PE) in the emergency department (ED) remains complex, involving clinical decision tools, blood tests, and imaging. OBJECTIVE: Our objective was to examine the test characteristics of the high-sensitivity d-dimer for the diagnosis of PE at our institution and evaluate use of the d-dimer and factors associated with a falsely elevated d-dimer. METHODS: We retrospectively collected data on adult patients evaluated with a d-dimer and computed tomography (CT) pulmonary angiogram or ventilation perfusion scan at two EDs between June 4, 2012 and March 30, 2016...
March 1, 2018: Journal of Emergency Medicine
Jonas Munch Nielsen, Jann Mortensen
The diagnosis of pulmonary embolism (PE) relies on clinical assessment, D-dimer test and diagnostic imaging. Modern CT pulmonary angiography (CTPA), ventilation/perfusion  single-photon emission computed tomography (SPECT) and SPECT/CT are rather equal in terms of sensitivity, specificity and inconclusive results for the diagnosis of PE, outper-forming planar lung scintigraphy. Furthermore, SPECT/CT and CTPA can both provide important information regarding differential diagnoses. Thus, the choice of primary diag-nostic modality relies on local expertise, availability and special circumstances like radiation dose, contraindications and the clinical urgency...
February 19, 2018: Ugeskrift for Laeger
Ben Korman, Ranjan K Dash, Philip J Peyton
BACKGROUND: Recent clinical studies suggest that the magnitude of the second gas effect is considerably greater on arterial blood partial pressures of volatile agents than on end-expired partial pressures, and a significant second gas effect on blood partial pressures of oxygen and volatile agents occurs even at relatively low rates of nitrous oxide uptake. We set out to further investigate the mechanism of this phenomenon with the help of mathematical modeling. METHODS: Log-normal distributions of ventilation and blood flow were generated representing the range of ventilation-perfusion scatter seen in patients during general anesthesia...
February 26, 2018: Anesthesiology
John B West, Daniel R Crouch, Janelle M Fine, Dipen Makadia, Daniel L Wang, G Kim Prisk
BACKGROUND: It would be valuable to have a noninvasive method of measuring impaired pulmonary gas exchange in patients with lung disease and so reduce the need for repeated arterial punctures. Here we report the results of using a new test in a group of outpatients attending a pulmonary clinic. METHODS: Inspired and expired P O2 and P CO2 are continually measured by small, rapidly responding analyzers. The arterial P O2 is calculated from the oximeter Sp O2 and the oxygen dissociation curve...
February 13, 2018: Chest
Geak Poh Tan, John Arputhan Abisheganaden, Soon Keng Goh, Akash Verma
Bronchial stenosis is known to complicate endobronchial tuberculosis despite medical therapy. It is often associated with dyspnoea. In severe cases, bronchial stenosis results in airflow obstruction, impaired secretion clearance, and can lead to respiratory failure. We present an unusual observation of platypnoea-orthodeoxia syndrome in a young woman with acute atelectasis due to post-tuberculosis bronchial stricture. Imaging revealed complete middle and right lower lobe atelectasis with a partially aerated right upper lobe...
April 2018: Respirology Case Reports
Gisela M B Meyer, Fernanda B Spilimbergo, Stephan Atmayer, Gabriel S Pacini, Matheus Zanon, Guilherme Watte, Edson Marchiori, Bruno Hochhegger
INTRODUCTION: Our goal was to assess the diagnostic performance of magnetic resonance imaging (MRI) as a single method to diagnose pulmonary hypertension (PH) compared to right heart catheterization (RHC), computed tomography (CT), and ventilation/perfusion (V/Q) scintigraphy. METHODS: We identified 35 patients diagnosed with PH by RHC in our institution who have also undergone a CT, a scintigraphy, and an MRI within a month. All cases were discussed in multidisciplinary meetings...
February 12, 2018: Lung
Yoshie Nogami, Yoshihiro Seo, Masayoshi Yamamoto, Tomoko Ishizu, Kazutaka Aonuma
Wave intensity (WI) is a novel noninvasive index of circulatory dynamics that reflects ventriculo-arterial coupling. It is calculated as the product of the first derivative of blood pressure and that of flow velocity measured by carotid echocardiography. This study aimed to clarify the clinical implications of WI and its relation with carbon dioxide production (VE/VCO 2 slope). Twenty-one healthy volunteers (control group) and 21 patients with hypertension (HT group) underwent cardiopulmonary exercise testing (CPX) and exercise stress echocardiography...
February 12, 2018: Heart and Vessels
Maurizio Turzo, Julian Vaith, Felix Lasitschka, Markus A Weigand, Cornelius J Busch
BACKGROUND: ATP-regulated potassium channels (KATP) regulate pulmonary vascular tone and are involved in hypoxic pulmonary vasoconstriction (HPV). In patients with inflammation like sepsis or ARDS, HPV is impaired, resulting in a ventilation-perfusion mismatch and hypoxia. Since increase of vascular KATP channel Kir6.1 has been reported in animal models of endotoxemia, we studied the expression and physiological effects of Kir6.1 in murine endotoxemic lungs. We hypothesized that inhibition of overexpressed Kir6...
February 13, 2018: Respiratory Research
Maria Theresa Voelker, Andreas Bergmann, Thilo Busch, Nora Jahn, Sven Laudi, Katharina Noreikat, Philipp Simon, Sven Bercker
INTRODUCTION: Hemoglobin-based oxygen carriers (HBOC) have been developed as an alternative to blood transfusions. Their nitric-oxide-scavenging properties HBOC also induce vasoconstriction. In acute lung injury, an excess of nitric oxide results in a general vasodilation, reducing oxygenation by impairing the hypoxic pulmonary vasoconstriction. Inhaled nitric oxide (iNO) is used to correct the ventilation perfusion mismatch. We hypothesized that the additional use of HBOC might increase this effect...
February 6, 2018: Pulmonary Pharmacology & Therapeutics
Patrick Tivnan, Henny H Billett, Leonard M Freeman, Linda B Haramati
Sickle cell disease, a complex disorder with known pulmonary complications, has the potential to confound the diagnosis of pulmonary embolism. We hypothesized that when the choice of imaging is guided by chest radiographic results, CT pulmonary angiography (CTPA) and Ventilation-Perfusion (V/Q) scintigraphy have comparable diagnostic performance in sickle cell disease. Methods: A retrospective cohort of adults with sickle cell disease who were imaged for suspected pulmonary embolism with either CTPA or V/Q, from 2000-2016, at our institution, was established...
February 1, 2018: Journal of Nuclear Medicine: Official Publication, Society of Nuclear Medicine
David Morland, Sofiane Guendouzen, Edmond Rust, Dimitri Papathanassiou, Nicolas Passat, Fabrice Hubelé
BACKGROUND: Ventilation/perfusion lung scan is subject to blur due to respiratory motion whether with planar acquisition or single photon emission computed tomography (SPECT). We propose a data- driven gating method for extracting different respiratory phases from lung scan list-mode or dynamic data. METHODS: The algorithm derives a surrogate respiratory signal from an automatically detected diaphragmatic region of interest. The time activity curve generated is then filtered using a Savitzky- Golay filter...
February 5, 2018: Quarterly Journal of Nuclear Medicine and Molecular Imaging
Michael A S Kreltszheim, Nick I Brown, Joseph C Lee
We present a 46-year-old female with pleuritic chest pain on a background of pulmonary embolism diagnosed on a single-photon emission computed tomography (SPECT) ventilation-perfusion (V/Q) imaging 3 years earlier. A SPECT V/Q scan detected a mismatched perfusion defect in the posterior basal segment of the right lower lobe, essentially unchanged from a defect identified 3 years earlier. Given the atypical finding, the patient went on to have a computed tomographic pulmonary angiogram. It revealed an intralobar bronchopulmonary sequestration as the cause of the right lower lobe mismatched perfusion defect...
January 2018: World Journal of Nuclear Medicine
Virginia Chamorro, Daniel Morales-Cano, Javier Milara, Bianca Barreira, Laura Moreno, María Callejo, Gema Mondejar-Parreño, Sergio Esquivel-Ruiz, Julio Cortijo, Ángel Cogolludo, Joan A Barberá, Francisco Perez-Vizcaino
INTRODUCTION: Current treatment with vasodilators for pulmonary hypertension associated with respiratory diseases is limited by their inhibitory effect on hypoxic pulmonary vasoconstriction (HPV) and uncoupling effects on ventilation-perfusion (V'/Q'). Hypoxia is also a well-known modulator of the nitric oxide (NO) pathway, and may therefore differentially affect the responses to phosphodiesterase 5 (PDE5) inhibitors and soluble guanylyl cyclase (sGC) stimulators. So far, the effects of the sGC stimulator riociguat on HPV have been poorly characterized...
2018: PloS One
Christopher Kelly, Chad Agy, Margaret Carlson, Jacob Steenblik, Joseph Bledsoe, Stephen Hartsell, Troy Madsen
BACKGROUND: Pulmonary embolism (PE) clinical decision rules do not consider a patient's family history of venous thromboembolism (VTE). We evaluated whether a family history of VTE predicts acute PE in the emergency department (ED). METHODS: Over a 5.5-year study period, we enrolled a prospective convenience sample of patients presenting to an academic emergency department with chest pain and/or shortness of breath. We defined a family history of VTE as a first-degree relative with previous PE or deep vein thrombosis (DVT)...
January 6, 2018: American Journal of Emergency Medicine
Valentin Coirier, Alain Lescoat, Céline Chabanne, Maxime Fournet, Guillaume Coiffier, Stéphane Jouneau, Elisabeth Polard, Patrick Jégo
Pulmonary arterial hypertension (PAH) is a rare disorder that can be drug-induced, mostly following treatment by appetite-suppressant drugs. We report four cases of patients who developed PAH following a treatment by leflunomide for rheumatoid arthritis, psoriatic arthritis or undetermined connective tissue disease. All patients described a progressive dyspnea from grade II to IV of NYHA classification; clinical examination found signs of heart failure. PAH was finally diagnosed and confirmed by right heart catheterisation...
January 9, 2018: Joint, Bone, Spine: Revue du Rhumatisme
David Buchbinder, Gina A Montealegre Sanchez, Raphaela Goldbach-Mansky, Hermine Brunner, Andrew I Shulman
A previously healthy 2-year-old Guatemalan female with an undiagnosed chronic illness characterized by fever and rash had presented with anorexia, weight loss, periorbital edema, abdominal pain and distention. A chest radiograph documented cardiomegaly. An echocardiogram demonstrated a pericardial effusion, dilated right atrium, right ventricle, and main pulmonary artery as well as diminished right ventricular systolic function and pulmonary hypertension. Right ventricular systolic pressure was estimated at 90 mmHg...
January 5, 2018: Arthritis Care & Research
Houssam Abusibah, Muntasir M Abdelaziz, Peter Standen, Praveen Bhatia, Mahir Ma Hamad
The diagnosis of pulmonary embolism can be very difficult and elusive. It depends greatly on the use of diagnostic tests, which are in turn interpreted according to a pre-test clinical probability. These include non-specific tests such as the chest X-ray and electrocardiograph, which help exclude other conditions such as pneumonia or myocardial infarction. On the other hand, more specific tests such as computed tomography or ventilation/perfusion scanning are used to confirm or exclude the diagnosis of pulmonary embolism...
January 2, 2018: British Journal of Hospital Medicine
Cécile Tromeur, Olivier Sanchez, Emilie Presles, Gilles Pernod, Laurent Bertoletti, Patrick Jego, Elisabeth Duhamel, Karine Provost, Florence Parent, Philippe Robin, Lucile Deloire, Florent Leven, Fanny Mingant, Luc Bressollette, Pierre-Yves Le Roux, Pierre-Yves Salaun, Michel Nonent, Brigitte Pan-Petesch, Benjamin Planquette, Philippe Girard, Karine Lacut, Solen Melac, Patrick Mismetti, Silvy Laporte, Guy Meyer, Dominique Mottier, Christophe Leroyer, Francis Couturaud
We aimed to identify risk factors for recurrent venous thromboembolism (VTE) after unprovoked pulmonary embolism.Analyses were based on the double-blind randomised PADIS-PE trial, which included 371 patients with a first unprovoked pulmonary embolism initially treated during 6 months who were randomised to receive an additional 18 months of warfarin or placebo and followed up for 2 years after study treatment discontinuation. All patients had ventilation/perfusion lung scan at inclusion ( i.e. at 6 months of anticoagulation)...
January 2018: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
Mariana Faria-Urbina, Rudolf K F Oliveira, Manyoo Agarwal, Aaron B Waxman
PURPOSE: Pulmonary hypertension (PH) in the setting of parenchymal lung disease adversely affects quality of life and survival. However, PH-specific drugs may result in ventilation/perfusion imbalance and currently, there are no approved PH treatments for this patient population. In the present retrospective study, data from 22 patients with PH associated with lung disease treated with inhaled treprostinil (iTre) and followed up clinically for at least 3 months are presented. METHODS: PH was defined by resting right heart catheterization as a mean pulmonary artery pressure (mPAP) ≥ 35 mmHg, or mPAP ≥ 25 mmHg associated with pulmonary vascular resistance ≥ 4 Woods Units...
December 23, 2017: Lung
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