ABSTRACT
Septic pulmonary embolization is an uncommon condition in which the clot or fibrin matrix, contaminated with micro-organisms, lodge in the pulmonary arterial tree, leading to infarction, suppuration and other complications. The septic emboli reach the lung from a variety of sources, including acute suppurative pelvic thrombophlebitis, infective endocarditis involving tricuspid and pulmonary valve, osteomyelitis, suppurative lesions of the neck, infected venous catheters or pacemaker wires and sepsis. Early clinical detection, along with prompt administration of broad- spectrum antibiotics, is an important factor in the prognosis of patients, but the initial clinical diagnosis is often difficult because of nonspecific findings in clinical and laboratory data. Recently, the characteristic appearance of septic emboli by chest computed tomography (CT) has been described, and chest CT is an important modality for confirming the presence of septic pulmonary emboli. We experienced a case of septic pulmonary embolism in a 14-day-old neonate with cough, fever dyspnea. Initial conventional chest radiogaphs revealed bilateral infilterate, but chest CT revealed the presence of multiple peripheral nodules, cavitation of nodules and a distinct vessel leading to a pulmonary nodule which is referred to as a feeding vessel sign, which diagnosis suggests. Coagulase negative staphylococcus was cultured in the blood stream and clinical and radiologic improvement was achieved after adminstration of antibiotics.
Subject(s)
Humans , Infant, Newborn , Anti-Bacterial Agents , Catheters , Coagulase , Cough , Diagnosis , Dyspnea , Endocarditis , Fever , Fibrin , Infarction , Lung , Neck , Osteomyelitis , Prognosis , Pulmonary Embolism , Pulmonary Valve , Rivers , Sepsis , Staphylococcus , Suppuration , Thorax , Thrombophlebitis , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: It has been known that a brief ischemic insult followed by reperfusion ('preconditioning') shows a protective effect on subsequent ischemic insult. The mechanism of this preconditioning was not fully understood, but oxygen free radicals, such as superoxide, hydrogen peroxide, which are released at the time of cardiac ischemia and reperfusion, were thought to have an important role in cardiac damage. We investigated the mechanism of preconditioning by examining the effects of oxidants on contractile function of isolated heart and the expression of cytokines and antioxidative genes. METHODS: Isolated perfused rat hearts were exposed to a 5 minutes ischemia (1 x PC) and to four times of 5 minutes ischemia, each seperated by 10 min (4 x PC). Both 1 x PC and 4 x PC groups were reperfused for 60 minutes. Control experiments were performed by perfusiong the hearts with buffer using the same time frame without ischemia-reperfusion. The effects of oxidants in contractile function of isolated rat heart were observed. The induction of the expression of two cytokines (TNF-alpha and interleukin-1) and two antioxidative enzyme genes (Mn-superoxide dismutase and catalase) were examined in control, 1 x PC and 4 x PC hearts by RT-PCR. RESULTS: In the control group, hydrogen peroxide or t-BHP inhibited contractile function of isolated heart as a dose-dependent manner, and IC50 were 36.3 micrometer or 0.34 mM, respectively. In 4 x PC hearts, inhibitory action of hydrogen peroxide on contractile function was diminished significantly, but the t-BHP action was not. In 4 x PC hearts TNF-alpha, interleukin-1alpha and catalase gene expression was significantly increased compared to both 1 x PC and control values. CONCLUSION: Repeated ischemia and reperfusion caused the induction of inflammatory and catalase genes, which may contribute to relative resistance of hydrogen peroxide in 4 x PC hearts.
Subject(s)
Animals , Rats , Catalase , Cytokines , Free Radicals , Gene Expression , Heart , Hydrogen Peroxide , Inhibitory Concentration 50 , Interleukin-1alpha , Ischemia , Ischemic Preconditioning , Oxidants , Oxygen , Reactive Oxygen Species , Reperfusion , Superoxides , Tumor Necrosis Factor-alphaABSTRACT
Congenital lobar emphysema has the clinical features of an air block' syndrome with- out the evidence of pulmonary infection or intrabronchial foreign body. The hyperinflated lung causes a compression of uninvolved lobes creating respiratory distress, cyanosis within the first weeks of life. We experienced a case of congenital lobar emphysema diagnosed incidentally by chest reontgenogram in an infant with frequent upper respiratory infection within a few weeks of life. Chest X-ray revealed extensive emphysematous changes in the left upper lobe, shifting of heart and medistinum to the right and compression of the right lung. Respiratory distress, cyanosis and chest wall retraction ensued and left upper lobe Lobectomy was performed successfully.