ABSTRACT
An unusual case of a 62-year-old patient is presented with multiple coronary arteriovenous fistulas originating from both coronary arteries going into the pulmonary trunk.
Subject(s)
Arterio-Arterial Fistula/pathology , Coronary Vessel Anomalies/pathology , Pulmonary Artery/abnormalities , Coronary Angiography , Female , Humans , Middle Aged , Pulmonary Artery/pathologyABSTRACT
In this study a model of acute respiratory failure due to viral pneumonia in rats, closely resembling ARDS, is presented. Severe respiratory failure with lethal outcome in four days was induced by infection concentrated Sendai virus aerosol. This model permits evaluation of different therapeutical approaches for improving gas exchange during ARDS. Furthermore, preliminary results of surfactant substitution therapy in this model are presented.
Subject(s)
Parainfluenza Virus 1, Human/pathogenicity , Paramyxoviridae Infections/etiology , Pneumonia, Viral/etiology , Respiratory Distress Syndrome/etiology , Respiratory Insufficiency/etiology , Animals , Disease Models, Animal , Male , Pulmonary Gas Exchange/drug effects , Pulmonary Surfactants/therapeutic use , Rats , Rats, Sprague-Dawley , Respiratory Distress Syndrome/drug therapy , Respiratory Distress Syndrome/physiopathology , Respiratory Insufficiency/drug therapy , Respiratory Insufficiency/physiopathologyABSTRACT
The effect of intratracheal surfactant administration was studied in rats with adult respiratory distress syndrome associated with infection with nebulized Sendai virus. Thirty-six hours after infection, animals (n = 7) showed severely impaired gas exchange and acidosis during artificial ventilation (PaO2 = 152.2 +/- 18.7, PaCO2 = 65.3 +/- 19.2, pH = 7.26 +/- 0.11) with a pressure-controlled mode, standard frequency of 35/min, peak airway pressure of 15 cm H2O (15/0), inspiratory/expiratory ratio of 1:2, and F1O2 = 1. Gas exchange improved (P = 0.02) with increased ventilator pressures with PEEP (25/4). Forty-eight hours after infection, blood gas tensions could no longer be significantly improved by these same ventilator settings (PaO2 = 123.8 +/- 31.0, PaCO2 = 95.1 +/- 43.6, pH = 7.12 +/- 0.16, n = 9). At this time, surfactant replacement dramatically increased arterial oxygenation within 5 min (PaO2 = 389.4 +/- 79.9) and resulted in a fourfold increase in PaO2 within 2 h. It is concluded that intratracheal surfactant administration is a promising approach in the treatment of respiratory failure during adult respiratory distress syndrome associated with viral pneumonia.
