The American journal of the medical sciences
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Case Reports
An unusual case of unilateral pulmonary edema with contralateral bronchial obstruction.
A 61 year-old man presented with progressive shortness of breath. Computed tomography scan of the chest showed diffuse ground glass infiltrates and dilated pulmonary vessels in the right lung in addition to bilateral pulmonary masses with obstruction of the left main pulmonary bronchus. ⋯ We hypothesize that the patient developed right pulmonary edema secondary to hypoxic vasoconstriction of the left lung. This case suggests a rare mechanism of unilateral pulmonary edema and supports inclusion of pulmonary edema in the differential diagnosis of unilateral pulmonary infiltrates in the setting of contralateral bronchial obstruction.
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Observational Study
Renal Dysfunction and hsCRP Predict Long-term Outcomes of Percutaneous Coronary Intervention in Acute Myocardial Infarction.
This study assessed the combined utility of estimated glomerular filtration rate (eGFR) and serum high-sensitivity C-reactive protein (hsCRP) levels to predict long-term mortality and cardiovascular outcomes of patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Elevated CRP levels and renal dysfunction have both been shown to independently and jointly predict mortality and cardiovascular outcomes after PCI in the short term. However, long-term results in patients with acute STEMI undergoing PCI have not been reported. ⋯ Renal dysfunction and elevated hsCRP predict a high long-term incidence of MACE in patients with acute STEMI undergoing primary PCI, with the combination being of prognostic significance for long-term mortality and MI in these patients.
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The FloTrac®/Vigileo device uses arterial pressure waveform analysis to calculate stroke volume and cardiac output; it does not require calibration against an independent measurement of cardiac output. Consequently, it provides a method to determine hemodynamic status, changes in the clinical course and responses to therapeutic interventions in patients who have arterial catheters in place. These devices perform relatively well in stable patients undergoing surgery and having an acceptable percentage error in differences between the FloTrac® device and invasive monitoring using pulmonary catheters. ⋯ There is a moderate correlation with changes in cardiac output after fluid administration, but a poor correlation with changes in cardiac output after increases or decreases in norepinephrine administration. The bias between measurements increases as the systemic vascular resistance decreases. Consequently, cardiac output measurements using the FloTrac® device are not accurate enough for use in patients with septic shock, advanced liver disease and other medical conditions associated with decreased vascular tone.