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PubMed2006

Severe pneumonia with pneumatoceles and patent foramen ovale in an infant: optimal ventilation strategy?

We discuss a case of severe pneumonia with pneumatoceles in a 2-month old infant. Despite peak and plateau airway pressures kept below 30 and 25 cmH(2)O, respectively, the infant developed bilateral pneumothorax and pneumomediastinum caused by pneumatocele rupture, necessitating bilateral intercostal drainage. Application of positive end-expiratory pressure (PEEP) of 10 cmH(2)O at FIO(2) of 0.7 worsened oxygenation, and transthoracic echocardiography showed right-to-left shunting of blood through the patent foramen ovale. Therefore, PEEP had to be tapered to 6 cmH(2)O, and ventilation carried out at FIO(2) of 1 until the lung condition improved. The open lung strategy of higher increments of PEEP and lower FIO(2) for lung protective ventilation actually proved deleterious to our patient. We conclude that a subset of patients with acute respiratory distress syndrome with refractory hypoxaemia may have right-to-left shunting of blood through a patent foramen ovale. This can be detected by echocardiography, and these patients may benefit from a ventilation strategy aimed at lowering pulmonary vascular resistance.

Echocardiography↗

PubMed2006

[Thrombophilia and patent foramen ovale in young stroke patients].

INTRODUCTION: Patent foramen ovale (PFO) is a vascular risk factor in young stroke patients. OBJECTIVE: [corrected] We sought to analyze the prevalence of thrombophilia in young stroke patients with patent foramen ovale (PFO). METHODS: Prospective study; a total of 130 consecutive young stroke patients (female: 58.5 %; mean age: 34; range: 15-45 years) consecutively admitted to the hospital during 2002-2003. All patients underwent a diagnostic protocol including echocardiogram, carotid echodoppler, transcranial doppler with bubble test, brain tomography scan or magnetic resonance imaging. Thrombophilia studies included fasting plasma levels of protein C, protein S, antithrombin III, lupus anticoagulant, anticardiolipin antibodies, lupus anticoagulant, antinuclear antibodies, and genetic testing for the factor V Leiden and C677T methylene tetrahydrofolate reductase mutations. Stroke subtype classification was done according to TOAST criteria. RESULTS: Etiology of stroke was: cryptogenic (67 %), cardioembolism (14.6 %), large artery atherosclerosis (8.5 %), small vessel occlusion (3.8 %) and other causes (5.4 %). 42 patients (32.3 %) had a PFO; 41 % of cryptogenic stroke patients had a PFO while 14.3 % of known cause stroke patients had a positive PFO (p = 0.003; OR: 4.15; IC 95%: 1.47-12.29). 23.8 % of positive PFO patients (10/42) had migraine, while 9.1 % negative PFO patients suffered migraine (OR: 3.13; CI 95 %: 1.02- 9.69; p=0.023). Prevalence of thrombophilia in positive and negative PFO patients, in young with cryptogenic stroke and stroke patients with known etiology, and in cryptogenic stroke patients with and without PFO was similar. CONCLUSIONS: Thrombophilia does not seem to be an additional factor to the excess of risk observed in young patients with cryptogenic stroke and PFO.

Adolescent↗

PubMed1991

[Patent urachus associated with abdominal abscess: report of a case].

A case of the patent urachus associated with abdominal abscess was reported. A 44-year-old woman was consulted to our clinic with the complaints of bladder irritability and discharge from the navel on October 27, 1987. A fist-sized tumor around the umbilicus was pointed out and the cystography from the umbilicus demonstrated that the contrast medium reached to the urinary bladder. The cystoscopy showed the protruded lesion on the dome of the bladder. The pre-operative diagnosis was patent urachus. She received resection of the urachus on November 11, 1987. The pathological finding was pyogenic granuloma of the urachus due to chronic inflammation.

Abdominal Muscles↗

PubMed1990

[Assay of bilirubin of ox gallstone in Chinese patent medicines by differential spectrophotometry].

This paper describes that the absorption spectrum of bilirubin solution was changed obviously by photo-oxidation. The absorbance was measured at 453 nm before and after light irradiation. The contents of bilirubin of ox gallstone in Liuying pills, Liushen pills and Niuhuang Xiaoyan pills were determined by differential absorbance (delta A). Calibration graph was linear in the range of 1.6-8.0 micrograms/ml for delta A. The average recoveries for three Chinese patent medicines were over 93%. Determinations of bilirubin in Chinese patent medicines were not affected by other components.

Animals↗

PubMed1989

[Right-left auricular shunt caused by patent foramen ovale at a multi-purpose intensive care unit. Apropos of 3 cases].

Three cases of symptomatic right-to-left interatrial shunt through a patent foramen ovale were detected in the course of a case of paradoxical embolism related to a massive pulmonary embolism, a case of refractory hypoxemia after cardiopulmonary bypass and a case of refractory hypoxemia in a patient with tricuspid endocarditis. According to anatomic studies, the incidence of patent foramen ovale is 25-30% in healthy people. In that case any pathological event generating an increase in the right atrial pressure higher than the left atrial pressure may induce a right-to-left shunt with systemic arterial desaturation and possible paradoxical embolization. The reported cases emphasize the advantage of ultrasonic examinations (contrast sonocardiography, pulsated or coloured Doppler) to show the right-to-left atrial shunt. The demonstration of this acquired shunt requires appropriate measures in order to reverse the atrial gradient. Sometimes a specific therapy is required such as caval filter insertion in case of pulmonary embolization or surgical closure of foramen ovale in some patients.

Adult↗

PubMed1986

Sonographic patent umbilical vein: lack of specificity for portal hypertension.

The sonographically patent umbilical vein is commonly considered a sign of portal hypertension and is held to be specific by some authors. We found sonographically patent umbilical veins in 11 patients with hepatic cirrhosis and esophageal varices, and in three subjects without liver disease and without esophageal varices. All subjects were submitted to Doppler flowmetry, which, with the investigation of the direction of venous flow, proved to be a simple discriminatory test.

Adolescent↗

PubMed1988

Diagnosis and surgical correction of patent ductus venosus in a calf.

Patent ductus venosus was diagnosed in a 10-week-old Holstein heifer with acute onset of collapse and marked tenesmus. Additional clinical signs observed during the course of hospitalization included depression, anorexia, hind limb ataxia, bruxism, and poor growth. Clinicopathologic test results included high blood ammonia concentration, prolonged sulfobromophthalein half-life, and high serum bile acid concentration. Liver biopsy revealed mild periportal fibrosis, but no appreciable hepatocyte atrophy. Mesenteric portography and percutaneous ultrasonography confirmed the patent ductus venosus. An atrial septal defect prosthesis was placed in the ductus venosus, using a catheterization technique. After surgery, however, clinicopathologic test results were unchanged. Ultrasonography revealed that the prosthesis had pulled away from one side of the vessel. When the calf was 10.5 months old, surgical correction was achieved by a transhepatic ligation technique. Ultrasonography confirmed closure of the ductus venosus during and after surgery. Blood ammonia and serum bile acid concentrations and sulfobromophthalein half-life were normal 3 weeks after surgery. The calf had no further episodes of hepatoencephalopathy and was successfully bred at 18 months of age.

Animals↗

PubMed1988

In vitro response of Haemonchus contortus larvae harvested during different times of the patent period to anthelmintics.

Three commercially available ruminant anthelmintics and an investigational drug were evaluated for effects on the motor function/motility of third stage (ensheathed) Haemonchus contortus. Helminth ova were collected at one, five, nine and 13 weeks during the patent period, cultured to the third larval stage and assayed for sensitivity to four different drugs. All four drugs (100 and 10 micrograms ml-1) significantly affected the motility of third stage H contortus larvae cultured from eggs passed at each of the times examined. However, the investigational drug (p-toluoyl chloride phenylhydrazone, 10 micrograms ml-1) had a significantly greater effect on the motility of larvae harvested at 13 weeks than those cultured at nine weeks (32 per cent difference). No other significant differences in the motility response during the patent period were observed.

Albendazole↗

PubMed1988

Patent blue V encapsulation in liposomes: potential applicability to endolympatic therapy and preoperative chromolymphography.

The water soluble dark blue stain Patent Blue V was incorporated into liposomes to increase its depot properties. Experiments with intraperitoneal and intramuscular application in rats and with intralymphatic injections in rabbits showed a substantial difference between the pharmacokinetics of aqueous and liposomal solutions. Independent of the route of administration, the dye-stain remained much longer in the tissues using liposomes. Most notably, retroperitoneal lymph nodes in rabbits remained dark blue up to 28 days after hindlimb endolymphatic instillation of liposomal patent blue. This vastly superior depot effect may be clinically adaptable for endolymphatic therapy with cytostatic drugs to enhance nodal drug retention and concentration or for preoperative chromolymphography to facilitate nodal visualization at laparotomy.

Animals↗

PubMed1987

[Tricuspid endocarditis with right-left auricular shunt through a patent foramen ovale].

The authors report the case of a tricuspid endocarditis secondary to Streptococcus bovis with important regurgitation and severe hypoxemia secondary to a right-left atrial shunt through a patent foramen ovale, requiring a surgical treatment which included the replacement of the tricuspid valve and closure of the dehiscence in the inter-atrial septum. The presence of a patent foramen ovale in the course of a tricuspid endocarditis has been exceptionally reported. This diagnosis deserves to be evoked in case of an unexplained hypoxic condition or a systemic embolism complicating a tricuspid endocarditis. The report emphasizes the advantage of ultrasonic examinations (contrast sonocardiography, pulsated Doppler) in order to demonstrate this right-left atrial shunt in addition to the data collected about the tricuspid valve.

Adult↗

PubMed1987

Changes in LC50 in an in vitro egg development assay during the patent period of Haemonchus contortus in sheep.

Using an in vitro egg development assay with thiabendazole as anthelmintic the LC50 of eggs produced by two sheep infected with either a susceptible or a resistant strain of Haemonchus contortus was followed during the patent period from 22 days to 77 days after infection. In both sheep the LC50 followed the same pattern. At the start of the patent period the average values for the susceptible and the resistant strain were, respectively, 0.05 and 0.21 micrograms ml-1 thiabendazole, after 40 to 60 days 0.09 and 0.35 micrograms ml-1, while after 77 days 0.07 and 0.24 micrograms ml-1 were recorded.

Animals↗

PubMed1986

Left hepatic vein attenuation for treatment of patent ductus venosus in a dog.

Patent ductus venosus was identified in a young dog. Surgical attenuation of the anomalous vessel was performed by partial ligation of the left hepatic vein. Clinical signs resolved after surgery, and laboratory values returned to normal. Jejunal venous portography, performed 8 weeks after surgery, revealed complete occlusion of the patent ductus venosus, with normal portal vasculature to the right and central divisions of the liver. Atrophy of the left hepatic division resulted.

Animals↗

PubMed1983

[Paradoxical embolism through a patent foramen ovale. 4 cases].

Four cases of paradoxical embolism through a patent foramen ovale associated with massive pulmonary embolism are reported. In two cases, patency of the foramen ovale was demonstrated by a new technique: cross-sectional contrast echocardiography potentiated by coughing. The conventional surgical treatment included arterial embolectomy followed by insertion of a caval filter. Embolism recurred on three occasions under mechanical ventilation prior to insertion of the filter. A new sequence of investigations to facilitate detection of paradoxical embolism in patients with unexplained arterial embolism is suggested: (1) blood gas measurements, which reveal associated pulmonary embolism; (2) cough-potentiated cross-sectional contrast echocardiography, which demonstrates a patent foramen ovale and excludes emboligenic cardiopathies; (3) phlebography and pulmonary angiography which complete the diagnosis. To reduce the risk of recurrent embolism, it is recommended to begin treatment by blocking the vena cava without mechanical ventilation. This can be done by inserting a filter through the jugular vein under local anaesthesia. Arterial embolism can then be treated at lesser risk under mechanical ventilation.

Echocardiography↗

PubMed1984

Reoperation in patients with patent atherosclerotic coronary vein grafts. A different approach to a different disease.

Atherosclerotic changes are often noted in vein grafts at angiography 8 to 10 years after coronary artery grafting. Reoperation in these patients is hazardous, as manipulation of the grafts may loosen atheromatous debris and cause coronary embolization and myocardial infarction. A technique is described to avoid embolization of atheromatous material during reoperation in patients with patent atherosclerotic coronary vein grafts. This technique was carried out in six patients and compared to the standard technique of reoperation in similar patients. The incidence of complicated perioperative myocardial infarction (0/6 versus 5/12) and perioperative death (zero versus three) was lower when our new technique was used. This approach consists of minimal dissection for access to the right atrium and ascending aorta for cannulation, prompt ligation of all patent grafts at the start of cardiopulmonary bypass, cardioplegic infusion through the ascending aorta and subsequently also through newly inserted grafts using larger infusions until myocardial temperatures reach less than or equal to 15 degrees C, and single aortic clamping for distal and proximal anastomoses.

Aged↗

PubMed1981

Patent median artery as a cause of carpal tunnel syndrome.

Persistent median artery should be considered in the evaluation of patients with carpal tunnel syndrome. We present 5 instances of carpal tunnel syndrome caused by pressure from patent median arteries. The arteries caused bilateral carpal tunnel syndrome in 1 patient. Neuropraxia can be so severe that thenar muscle atrophy and complete loss of sensation occur. We review the embryonic development of the median nerve vascular supply and the reported incidence of persistent median artery. The use of Doppler examination is stressed in evaluating whether a median artery is present, and if it is essential to digital blood supply. In each instance, the neuropraxia resolved after the patent median artery was resected.

Adult↗

PubMed1981

Patent foramen ovale and hypoxemia in chronic obstructive pulmonary disease.

In an obese 50 year-old heavy cigarette smoker with finger clubbing, persistent hypoxemia following an episode of right heart failure proved to be caused in part by a 12% right-to-left shunt through a patent foramen ovale. In this case report, we review the mechanisms of hypoxemia in patients with such a combination of diseases and suggest that the functional opening of a patent foramen ovale is likely to occur in some 25% of patients with right heart failure.

Heart Failure↗

PubMed1995

[Treatment of refractory hypoxemia due to right-to-left interatrial shunt complicating right ventricular infarction: successful short-term percutaneous catheter closure of the patent foramen ovale].

Refractory hypoxemia as a complication of right ventricular infarction is rare. A 74-year-old man developed persistent hypoxemia due to right-to-left interatrial shunting through a patent foramen ovale during the acute phase of right ventricular infarction. Short-term percutaneous transvenous closure of the patent foramen ovale with a large balloon occlusion catheter was life-saving.

Aged↗

PubMedDate not supplied

Diagnosis of patent foramen ovale with transesophageal echocardiography in a patient supported with a left ventricular assist device.

Intracardiac right-to-left shunting through a patent foramen ovale is a known cause of arterial hypoxemia. We present a case report of a patient supported with a left ventricular assist device who had significant right-to-left shunting as visualized with transesophageal echocardiography. When the device was turned off, no further shunting occurred and arterial hypoxemia resolved. Our report is the first visual representation of the anatomy of a patent foramen ovale in a patient supported with a left ventricular assist device.

Adult↗