Men's Health News - Part 4

03 Feb

Organ Interactions in the Adult Respiratory Distress Syndrome during Sepsis

Organ Interactions in the Adult Respiratory Distress Syndrome during SepsisRole of the Liver in Host Defense
Respite increasing sophistication in antimicrobial therapy and intensive care support of failing organs, mortality in critically ill patients with the adult respiratory distress syndrome (ARDS) and progressive multiple systems organ failure accompanying Gram-negative bacterial sepsis still exceeds 60 percent and shows no sign of decreasing, However, the pathophysiologic conception of ARDS mediated by blood-borne factors has evolved significantly from a selfcontained intrapulmonary process consisting of permeability edema, complicated by ensuing extra-pulmonary organ system failures. At present, sepsis-induced ARDS may appropriately be viewed as the pulmonary expression of a pansystemic disorder. We propose that preexisting and acquired impairments of systemic host defenses lead to early generalized endothelial cell injury that simultaneously affects multiple organs. The resultant pulmonary dysfunction is manifest dramatically because changes in lung micro-vascular permeability lead to alveolar flooding, overt disturbances in gas exchange, and abnormal pulmonary mechanics. In contrast, early markers of extra-pulmonary organ dysfunction are scarce because alterations in endothelial permeability are less functionally apparent. Ultimately, evolution of severely deranged host inflammatory responses owing to uncontrolled infection amplify tissue damage and lead to clinically overt dysfunction in all organs. whitening gel Continue Reading »

02 Feb

Complex Mass at Right Lung Base: Diagnosis

Intralobar sequestrations lie contiguous to normal lung parenchyma and within the same visceral pleura. Venous drainage is usually via the pulmonary veins. There is a slight left-sided predominance with the posterior basal segments most often involved. Most patients with intralobar sequestration present with recurrent respiratory infections. In about 15 percent of the patients, other congenital abnormalities are identified. These include esophagobronchial diverticulum, diaphragmatic hernia, skeletal deformities, and cardiac abnormalities. Extralobar sequestrations are enveloped by a separate pleural covering and usually have systemic venous drainage. They are related to the left hemidiaphragm in 80 percent of the cases. In 75 percent of cases, the sequestration is located between the diaphragm and the lower lobe. It may also be within or below the diaphragm. It is frequently (about 50 percent) associated with congenital abnormalities. The most common of these include diaphragmatic hernias, diaphragmatic defects, and other lung anomalies. natural breast enlargement cream Continue Reading »

01 Feb

Complex Mass at Right Lung Base

Complex Mass at Right Lung BaseA 43-year-old nonsmoking man was admitted for evaluation of two masses at the right lung base. A mass was first noted on a routine chest radiograph 14 years previously (Fig 1). The patient underwent bronchoscopic examination at that time, which was reported as unremarkable. In view of the patients age and lack of symptoms, it was decided to follow the lesion with annual chest radiographs. The right lower lobe mass remained stable in size and appearance for nine years. avandia online Continue Reading »

30 Jan

Pneumocephalus Associated with Nasal Continuous Positive Airway Pressure in a Patient with Sleep Apnea Syndrome: Discussion

Pneumocephalus Associated with Nasal Continuous Positive Airway Pressure in a Patient with Sleep Apnea Syndrome: DiscussionPneumocephalus has been reported to occur as a complication of mask-CPAP or manually operated oxygen powered resuscitator applied via face mask in head trauma victims, and in a young previously healthy male scuba diver while ascending to the water surface. Air within the cranium usually implies a connection with the atmosphere, directly or via air containing structures. Positive pressure in the upper airway achieved with nasal CPAP is assumed to have forced air into the skull through a weak spot in the cranial structure, most likely the cribriform plate. Congenital fistulas across the cribriform plate are often implicated in spontaneous CSF leaks that occur typically in adult women. website Continue Reading »

29 Jan

Pneumocephalus Associated with Nasal Continuous Positive Airway Pressure in a Patient with Sleep Apnea Syndrome: Case Report

Polysomnography revealed severe obstructive sleep apnea syndrome with apnea/hypopnea index of 63 episodes per hour of sleep and severe oxygen desaturation. Sleep pattern was marked by virtual absence of stages 3 and 4 of NREM sleep, and numerous brief awakenings associated with the abnormal respiratory events. A repeat polysomnography study was done on nasal CPAP, which demonstrated its efficacy in resolving obstructive apneas at pressure level of 12.5 cm H*0, with dramatic improvement in sleep pattern; however, persistence of significant 02 desaturation (80 percent) required the addition of a continuous flow of oxygen at 1 L/min. Continue Reading »

28 Jan

Pneumocephalus Associated with Nasal Continuous Positive Airway Pressure in a Patient with Sleep Apnea Syndrome

Pneumocephalus Associated with Nasal Continuous Positive Airway Pressure in a Patient with Sleep Apnea SyndromeObstructive sleep apnea syndrome is characterized by periodic upper airway obstruction and hypoxemia during sleep with daytime hypersomnolence. In severe cases, polycythemia and cor pulmonale may develop. Nasal CPAP was introduced as a treatment for obstructive sleep apnea by Sullivan et al in 1981, and has been shown to be very effective in obviating obstructive sleep apnea in most of those who can tolerate it. During sleep the tongue and soft palate collapse against the posterior wall of the hypo-pharynx, thereby causing air flow obstruction. Application of nasal CPAP maintains a continuous positive intra-airway pressure along the upper airway, thus acting as a pneumatic splint that prevents the occlusion of the upper airway by the tongue and soft palate. The nasal CPAP unit consists of an airflow generator that blows air into a mask tighdy fitted over the nose. A release valve is added to the circuit to maintain the set pressure that has been shown to be optimal in eliminating episodes of apnea on a previous polysomnography study. Intolerance to the nasal CPAP is usually related to nasal congestion, dryness, headaches and mask discomfort. In this report, we present a new and potentially serious complication associated with the use of nasal CPAP. lumigan drops Continue Reading »

25 Jan

Yohimbine-induced Bronchospasm

Yohimbine-induced BronchospasmYohimbine is an alpha-2 blocking agent. Its peripheral autonomic effect is to decrease sympathetic activity and to increase parasympathetic activity. The increase in cholinergic activity and the decrease in adrenergic activity both can cause an increase in mucus secretion and bronchocon-striction. Following is the report of a patient with yohimbine-induced bronchospasm.
Case Report
A 60-year-old man who was two years post-heart transplant for idiopathic cardiomyopathy presented to the emergency room with a ten-day history of cough productive of large amounts of clear to white sputum, headaches and progressive shortness of breath. The coughing was complicated by gagging and occasional vomiting of large amounts of sputum. The patient denied any fever, chills, diaphoresis, sore throat or chest pain. He had been started on yohimbine, 5.4 mg orally three times a day, for impotence just prior to the onset of symptoms. The patient had no history of lung disease or infections but had a smoking history of 40 pack years before stopping three years prior to admission. Other medications included Zantac, verapamil, furosemide (Lasix), prednisone, azathioprine (Imuran) and cyclosporine. comments Continue Reading »

24 Jan

Recurrent Calcium Emboli in a Patient with Aortic Stenosis: Second Visit

Second Visit
Ten months later, the patient returned with the same symptoms as on his first visit; however, their onset was slower. About a week prior the pain had begun in his left leg on walking and progressed to the point that he experienced severe pain in his left calf after taking only a few steps. Both limbs appeared to be of normal color and were similar, except that the dorsalis pedis pulse on the left was absent. The posterior tibial artery was palpable. Using a handheld Doppler, the posterior tibial artery could be heard very well, but the dorsalis pedis and anterior tibial arteries produced no signals. The patient was admitted to the hospital and an arteriogram was obtained. It showed a typical, localized, bullet-shaped mass in the popliteal artery and the anterior tibial artery at the site where the anterior tibial is normally visualized. A duplex scan was obtained. Calcium could be observed in the popliteal artery but not clearly enough to enable the diagnosis of embolus to be made without the corroborating arteriogram. my canadian pharmacy Continue Reading »

23 Jan

Recurrent Calcium Emboli in a Patient with Aortic Stenosis

Recurrent Calcium Emboli in a Patient with Aortic StenosisLittle information regarding the natural history of calcium ¬†emboli from diseased heart valves is available and it is not known whether this complication should be considered an indication for surgical valve replacement. We report a unique case in which a patient had two calcium emboli to the same location in a period of ten months. Spontaneous calcific emboli have been considered rare; however, necroscopy examination of patients with aortic stenosis reveals an incidence of 19 percent. The majority of these emboli were to the coronary arteries. Clinically obvious cases seem to be much less common. In a series of735 embolectomies for major arterial emboli, the heart was the source of the embolus in 90 percent of the cases. Seven percent of the patients gave a history of rheumatic heart disease. The case we report is the only instance in which calcium embolic material was an operative and pathologic finding. The incidence of recurrence following a calcium embolus is not known and thus, whether to recommend valve replacement in such patients is problematic, especially if their aortic stenosis is not severe. patanol eye drop Continue Reading »

20 Jan

Prediction of Pulmonary Arterial Pressure in Chronic Obstructive Pulmonary Disease by Radionuclide Ventriculography: Conclusion

Prediction of Pulmonary Arterial Pressure in Chronic Obstructive Pulmonary Disease by Radionuclide Ventriculography: ConclusionIn contrast, Marchandise et al found a correlation between the acceleration time measured by Doppler echocardiography and PAP in patients with COPD. In our study, the time between the onset and peak pulmonary flow velocity is reflected by the difference between time to peak ejection rate and pre-ejection period. This parameter has not allowed an accurate evaluation of pulmonary arterial pressure. The discrepancies between our results and Marchandises suggest that the measurement of systolic and diastolic delays might be less accurate by the isotopic method than by the Doppler technique. This is probably due to the surimposition of the right auricle and the right ventricle. Moreover, the evaluation of mean pulmonary arterial pressure by parameters derived from a right ventricular equilibrium curve rather than the evaluation of pulmonary arterial pressure values during one heart cycle implies less precise measurements because of chest movements and a variability in duration of the heart cycles. Continue Reading »

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