1/14. The treatment of severe pulmonary edema induced by beta adrenergic agonist tocolytic therapy with continuous positive airway pressure delivered by face mask.IMPLICATIONS: We report the case of a pregnant patient who developed severe pulmonary edema secondary to beta-adrenergic agonist tocolytic therapy (salbutamol) and was successfully treated with mask-delivered continuous positive airway pressure ventilation.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/14. intracranial pressure changes during intermittent CSF drainage.Premature very-low-birth-weight infants with posthemorrhagic hydrocephalus are often managed with intermittent cerebrospinal fluid drainage from a ventricular reservoir. There are little data regarding intracranial pressure changes during intermittent drainage to determine the amount and frequency of cerebrospinal fluid removal or to determine the correct resistance of future programmable shunts. The objective of this study was to determine the feasibility of using a commercially available intracranial pressure transducer to measure changes in pressure associated with this procedure. Continuous intracranial pressure was measured in three infants with a transducer placed at the time of ventricular reservoir insertion. Daily reservoir taps began 48 hours after placement and intracranial pressure was monitored for 7 days. intracranial pressure before the initial tap was comparable to levels previously reported as normal. The daily removal of 10 cc/kg of cerebrospinal fluid was sufficient to lower intracranial pressure below baseline, however it was associated with wide swings in pressure and, in one patient, sustained negative pressure. The use of direct intracranial pressure monitoring may be useful in determining the optimal amount and frequency of cerebrospinal drainage from infants with posthemorrhagic hydrocephalus managed with a ventricular reservoir, as well as determining resistance settings of subsequent programmable shunts.- - - - - - - - - - ranking = 2.8keywords = pressure (Clic here for more details about this article) |
3/14. Successful pregnancy, achieved by ovulation induction using a human menopausal gonadotropin low-dose step-up protocol in an infertile patient with Kallmann's syndrome.A 25-year-old woman, diagnosed with Kallmann's syndrome and wanting to become pregnant, visited our hospital. Because her serum gonadotropin levels indicated hypogonadotropic hypogonadism, a main symptom of Kallmann's syndrome, we attempted to induce ovulation using a low-dose human menopausal gonadotropin (hMG) step-up protocol. In this protocol, 75 IU of hMG was used as an initial dose and this was continued for the first 14 days because adequate follicular development was not achieved. The dose of hMG was subsequently increased to 150 IU for the next 7 days. After 22 days from the start of stimulation, two follicles had developed, and were ovulated using an injection of human chorionic gonadotropin. She became pregnant, and her pregnancy was uneventful during the first trimester; however, in the second trimester both uterine contractions and blood pressure could not be controlled, and at 27 weeks' gestation she delivered a male infant weighing 830 g by cesarean section.- - - - - - - - - - ranking = 0.2keywords = pressure (Clic here for more details about this article) |
4/14. Antagonism of antihypertensive drug therapy in pregnancy by indomethacin?Two women with preeclampsia treated with pindolol and propranolol became profoundly hypertensive when indomethacin was added because of premature contractions. The interaction of nonsteroidal antiinflammatory agents and beta-blockers and their role in the control of blood pressure in obstetrics are discussed. indomethacin should not be given to pregnant patients with hypertension treated with beta-blockers.- - - - - - - - - - ranking = 0.2keywords = pressure (Clic here for more details about this article) |
5/14. High permeability pulmonary edema (ARDS) during tocolytic therapy--a case report.A 26 year old previously healthy woman who was treated with fenoterol for premature labor at 30 gestational weeks developed pulmonary edema requiring intubation and mechanical ventilation. Vaginal delivery was accomplished with forceps after tocolytic therapy had been stopped. Right heart catheterization with measurement of pulmonary wedge pressure did not reveal left ventricular failure. Protein determination in lung edema fluid provided evidence of increased pulmonary capillary permeability. Recovery was rapid and ventilatory support was stopped after 36 hours. It is suggested that the infusion of beta-sympathomimetic drugs may alter the permeability of the alveolar-capillary membranes which together with triggering factors such as fluid overload might lead to clinically manifest pulmonary edema.- - - - - - - - - - ranking = 0.2keywords = pressure (Clic here for more details about this article) |
6/14. pulmonary edema associated with the use of betamimetic agents in preterm labor.A case report of pulmonary edema associated with the use of a betamimetic agent in preterm labor is reported. A 31-year-old, black multigravida woman, 28 weeks pregnant, was admitted to the hospital with dysuria, vaginal bleeding, and uterine contractions. She had experienced premature labor in her previous pregnancies, and she had a history of kidney stones, confirmed by pyelography, and repeated urinary tract infections. Eighteen hours after admission, the contractions were occurring every five minutes. terbutaline sulfate constant infusion (10-20 micrograms/min) was started. By hospital day 2, the uterine contractions were occurring every 1-2 minutes and lasting 50 seconds. The terbutaline therapy was discontinued, and isoxsuprine hydrochloride infusion was started at 240 micrograms/min and gradually increased to 800 micrograms/min. The patient complained of smothering and became tachypneic after one hour and 40 minutes of therapy. The shortness of breath and tachypnea continued in spite of the administration of oxygen and positional changes. The isoxsuprine was discontinued. The diagnosis of pulmonary edema was confirmed by abnormal findings in the chest roentgenogram, bilateral rales, and a decrease in arterial blood oxygen pressure. A literature review of pulmonary edema associated with the administration of beta sympathomimetic drugs is presented, which suggests this adverse effect is multifactorial in origin. precipitating factors may include corticosteroids, fluid overload, low levels of serum potassium, twin gestations, a sustained tachycardia greater than 140 beats per minute, undiagnosed cardiopulmonary disease, or catecholamine-induced cardiac injury. patients requiring betamimetics for the delay of premature labor should be monitored closely to obviate this complication.- - - - - - - - - - ranking = 0.2keywords = pressure (Clic here for more details about this article) |
7/14. pulmonary edema associated with ritodrine and dexamethasone treatment of threatened premature labor. A case report.pulmonary edema occurred in association with the use of ritodrine and steroids to treat threatened premature labor. Twin gestation, intravenous ritodrine infusion longer than 24 hours and excessive fluid administration appear to be risk factors for the development of pulmonary edema. Careful case selection, scrupulous attention to the principles of fluid and electrolyte management and central venous pressure monitoring may help to diminish the incidence and severity of this complication of pregnancy.- - - - - - - - - - ranking = 0.2keywords = pressure (Clic here for more details about this article) |
8/14. Hemodynamic observations on pulmonary edema associated with a beta-mimetic agent. A report of two cases.pulmonary edema associated with the use of beta agonists in the treatment of preterm labor is a major risk of tocolytic therapy. The data obtained from echocardiographic and hemodynamic evaluation in one such case and echocardiography in another differ markedly from those in two previously published reports. Specifically, the pulmonary capillary wedge pressure became elevated, and both patients failed to improve with oxygen therapy and positional changes only. Left ventricular dysfunction was ruled out as the possible cause since the left ventricular structure and function were normal on echocardiography. The heart failure was probably the result of increased preload, giving rise to increased end diastolic pressure and hence pulmonary edema. Diuretic therapy is very important in this situation.- - - - - - - - - - ranking = 0.4keywords = pressure (Clic here for more details about this article) |
9/14. Maternal pulmonary edema during premature labor inhibition.Three cases of pulmonary edema after treatment with terbutaline are reported. In 1 patient invasive hemodynamic monitoring shortly after the onset of pulmonary edema showed normal pressures and pulmonary vascular resistance with augmented systemic blood flow. These findings suggest that this syndrome might arise on a noncardiogenic basis.- - - - - - - - - - ranking = 0.2keywords = pressure (Clic here for more details about this article) |
10/14. death of one twin followed by extremely variable flow velocity waveforms in the surviving fetus.Intrauterine death of one fetus after the second trimester in a twin pregnancy, with continuation of the pregnancy is a rare complication. The risks of morbidity and mortality for the surviving fetus are high. A 32-year-old woman was admitted to the antenatal ward at 27 weeks gestation because of intrauterine death of one twin. During the first 24 h after the death of one twin, Doppler ultrasound assessment showed a remarkable variability in flow velocity waveforms in the umbilical artery of the surviving fetus. Changes from reversed to normal end-diastolic flow velocities were recorded within 6 min. These findings are explained by twin-to-twin transfusion due to intravascular blood pressure changes, or by release of vasoactive substances by the dead fetus.- - - - - - - - - - ranking = 0.2keywords = pressure (Clic here for more details about this article) |
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