1/24. Delivery of an hypoxic gas mixture due to a defective rubber seal of a flowmeter control tube.The delivery of an hypoxic gas mixture to a patient during general anaesthesia is a rare event due to contemporary standards of monitoring, equipment design and alarm features. An incident is described where a split occurred in a rubber seal round the top of a flowmeter control tube. This resulted in a downstream oxygen leak and the delivery of an hypoxic gas mixture to the patient. The bobbin on the oxygen flowmeter did not accurately reflect the amount of oxygen being delivered. A paramagnetic oxygen analyser and a fuel cell oxygen electrode indicated that the inspired oxygen concentration was lower than intended. The anaesthetic machine was exchanged, and the operation continued uneventfully. The faulty anaesthetic machine subsequently passed a formal pressure test by the hospital engineers and also close examination of the flowmeter control valves. The importance of monitoring equipment and the interpretation of the information that they provide is emphasized.- - - - - - - - - - ranking = 1keywords = liver (Clic here for more details about this article) |
2/24. Mechanisms of hypoxemia.The definitions of hypoxemia and hypoxia, and basic pulmonary anatomy and oxygen delivery are reviewed. Low ambient oxygen, hypoventilation, ventilation-perfusion mismatch, and right-to-left shunt, the four basic mechanisms of hypoxemia are described in detail with patient examples. For the sake of completion, a fifth mechanism of hypoxemia that is rarely seen in human disease is described. Because getting oxygen into the blood stream is only half the story, mechanisms of tissue hypoxia in the setting of adequate oxygen exchange from the lungs to the blood are discussed. An algorithm is proposed for diagnosing patients who present with hypoxia.- - - - - - - - - - ranking = 0.14285714285714keywords = liver (Clic here for more details about this article) |
3/24. Mechanical ventilation during pregnancy using a helium-oxygen mixture in a patient with respiratory failure due to status asthmaticus.The authors present a 15-year-old with a second trimester intrauterine pregnancy who developed respiratory failure as the result of status asthmaticus and the development of the adult respiratory distress syndrome. Mechanical ventilation was provided with a combination of oxygen and helium to facilitate gas exchange and limit peak inflating pressures. The physiologic basis for helium's potential beneficial effects on gas exchange are reviewed. Previous reports concerning the use of helium during mechanical ventilation as well as the techniques of delivery are discussed.- - - - - - - - - - ranking = 0.14285714285714keywords = liver (Clic here for more details about this article) |
4/24. Ancient remedies revisited: does allium sativum (garlic) palliate the hepatopulmonary syndrome?Hypoxia in the setting of liver disease is often multifactorial. Obstructive or restrictive lung disease, pleural effusions, and tense ascites are common underlying disorders. Less often observed and frequently unrecognized is hypoxia related to diffuse intrapulmonary shunting--the hepatopulmonary syndrome. Its etiology is unknown but may result from disordered gut peptide metabolism. Symptoms may be ameliorated by somatostatin and reversed by successful liver transplantation. Here we report a patient with severe hepatopulmonary syndrome who failed somatostatin therapy and declined liver transplantation. On her own the patient took large daily doses of powdered garlic (allium sativum). She has experienced partial palliation of her symptoms and some objective signs of improvement over 18 months of continuous self-medication. The possible effects of garlic's main physiologically active compound, allicin, on gut peptide metabolism and pulmonary vasculature are unknown. This innocuous compound may deserve further investigation given the limited therapeutic options for this disorder.- - - - - - - - - - ranking = 0.42857142857143keywords = liver (Clic here for more details about this article) |
5/24. Three cases of sudden death due to butane or propane gas inhalation: analysis of tissues for gas components.We report three cases of sudden death due to inhalation of portable cooking stove fuel (case 1), cigarette lighter fuel (case 2), and liquefied petroleum gas (LPG) (case 3). Specimens of blood, urine, stomach contents, brain, heart, lung, liver, kidney, and fat were collected and analyzed for propylene, propane, isobutane, and n-butane by headspace gas chromatography. n-Butane was the major substance among the volatiles found in the tissues of cases 1 and 2, and propane was the major substance in case 3. A combination of the autopsy findings and the gas analysis results revealed that the cause of death was ventricular fibrillation induced by hard muscle exercise after gas inhalation in cases 1 and 2, and that the cause of death in case 3 might be hypoxia. It is possible that the victim in case 3 was under anesthetic toxicity of accumulated isobutane which is a minor component of liquefied petroleum gas.- - - - - - - - - - ranking = 0.14285714285714keywords = liver (Clic here for more details about this article) |
6/24. Partial hepatic vein diversion in pulmonary arteriovenous malformations in congenital heart disease.The late appearance of pulmonary arteriovenous malformations after operations for complex congenital cardiac conditions may be explained in many ways. The necessity of hepatic blood flow to the lungs is now generally accepted for carrying some labile substance that is secreted by the liver and that has not yet been identified. Rerouting of hepatic blood to the lungs in cardiac patients can be accomplished with different methods, most of which are predisposed to thrombosis because of the slow flow in the tunnel. My colleagues and I describe a case of partial diversion of hepatic blood into the pulmonary circulation and suggest a strategy to decrease the likelihood of conduit thrombosis and to treat pulmonary arteriovenous malformations.- - - - - - - - - - ranking = 0.39018891410506keywords = liver, hepatic (Clic here for more details about this article) |
7/24. Therapeutic benefits of helium-oxygen delivery to infants via nasal cannula.OBJECTIVE: The benefits of helium-oxygen (heliox) administration for pediatric upper and lower respiratory disorders have been well described. However, while most studies advocate delivery via a sealed or semisealed facemask system, such systems may not be tolerated in the young child. This report describes the successful and efficacious delivery of heliox via nasal cannula to 5 infants. methods: A mixture of 80% helium/20% oxygen was blended with 100% oxygen from a wall source and delivered via nasal cannula to 5 spontaneously breathing infants with respiratory distress at flow rates of 2 to 3 liters per minute. Treatment efficacy was retrospectively extracted from nursing, respiratory therapist, and physician entries in the medical record, specifically focusing on changes in respiratory rate, work of breathing, and oxygenation and/or ventilation parameters. RESULTS: All 5 infants tolerated the nasal cannula well. In 2, nasal cannulae were used after attempts to use a facemask system were not tolerated. All patients demonstrated rapid improvements in respiratory parameters including a decreased work of breathing (n = 5), respiratory rate (n = 4), transcutaneous CO2 (n = 2), and stridor (n = 2), or improved oxygenation (n = 1). In 1 patient, the recurrence of distress shortly after discontinuing heliox was rapidly reversed with heliox reinstitution. CONCLUSIONS: In infants with respiratory distress who do not tolerate a facemask, the use of nasal cannula represents a viable and efficacious alternative for heliox delivery.- - - - - - - - - - ranking = 1.1428571428571keywords = liver (Clic here for more details about this article) |
8/24. Hypoxia and cyanosis in alpha-1-antitrypsin deficiency. Cirrhosis as an unusual etiologic factor.A patient with type PiZZ alpha-1-antitrypsin deficiency was found to have severe hypoxia despite normal pulmonary function testing and a normal chest radiograph. A nuclear medicine ventilation-perfusion study revealed a right-to-left shunt. Computed tomography showed minimal bleb formation, no diffuse changes, and hepatic changes of cirrhosis with portal hypertension. No nodular pulmonary masses or enlarged peripheral pulmonary vessels were found. The diagnosis of diffuse intrapulmonic arteriovenous shunts ("pulmonary spiders of cirrhosis") was suggested and then confirmed with a dynamic radionuclide flow study.- - - - - - - - - - ranking = 7.2292408861744keywords = cirrhosis, hepatic (Clic here for more details about this article) |
9/24. Acardius anceps: report of 3 cases.Acardius anceps is an uncommon but serious consequence of multiple pregnancy, usually in monozygotic twins. There are great variations in gross appearance and pathologic features. Recently we have encountered 3 cases of acardius anceps in 3 sets of twin pregnancy. The subcutaneous edema was so extensive and severe that no facial structures could be recognized; however, the skull bones could be detected by prenatal ultrasound examination and confirmed by postnatal radiography. The hearts were all severely malformed and many of the visceral organs were also defective. Prenatal blood gas analysis in 2 affected fetuses showed severe hypoxemia. All 3 pregnancies were terminated before the normal co-twin reached viability. One set of the twins was delivered by hysterotomy because of the potential dystocia caused by bulky fetal mass due to severe hydropic change. Prenatal ultrasound examination is a very useful tool in the diagnosis and management of this anomaly.- - - - - - - - - - ranking = 0.14285714285714keywords = liver (Clic here for more details about this article) |
10/24. Alpha1-antitrypsin deficiency. Severe obstructive lung disease and pregnancy.The case of a 37-year-old primigravida with severe obstructive lung disease and alpha1-antitrypsin deficiency is reported. Serial pulmonary function studies and arterial blood gases were obtained during the antenatal and postpartum periods. Intrauterine fetal growth was monitored with serial ultrasonic fetal biparietal diameter determinations. Serial oxytocin challenge tests were used to monitor uteroplacental function. Aggressive chest physiotherapy was used to maintain good maternal bronchopulmonary hygiene. A normal female infant was delivered vaginally at 38 weeks' gestation following an uneventful labor. The available obstetric literature regarding the outcome of pregnancy in patients with obstructive lung disease and cystic fibrosis is reviewed. This literature suggests that pregnancy in a patient with severe obstructive lung disease should be considered a medical indication for therapeutic abortion. Successful delivery of this patient with severe obstructive lung disease and alpha1-antitrypsin deficiency suggests that these conditions are not a contraindication to successful outcome of preganncy for both mother and child.- - - - - - - - - - ranking = 0.28571428571429keywords = liver (Clic here for more details about this article) |
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