Cases reported "Anoxia"

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1/22. Drowning and near-drowning--some lessons learnt.

    Over a period of sixteen months, 17 cases of submersion injury (encompassing victims of drowning and near-drowning) were attended to at our Accident and Emergency Department at Changi General Hospital. Most of the victims were inexperienced recreational swimmers, and in 6 of them, early bystander cardiopulmonary resuscitation enabled them to recover without severe morbidity. Non-cardiogenic pulmonary oedema with resulting chest infection was the commonest complication in survivors. Most of the episodes occurred in an urban setting in swimming pools without supervision by lifeguards. About two-thirds of the cases were adults over the age of fifteen years. In addition, there were patients in whom submersion injury was associated with more sinister conditions (fits, traumatic cervical spine injury, dysbarism, intoxication from alcohol or drugs), some of which were unsuspected by the doctors initially. Apart from the immediate threats of hypoxia and pulmonary injury, active search for any possible precipitating causes and associated occult injury should be made. In this study, the determinants of survival from near-drowning were early institution of cardiopulmonary resuscitation, presence of pupil reactivity, and presence of a palpable pulse and cardiac sinus rhythm.
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2/22. Low-dose inhaled nitric oxide in term and near-term infants with hypoxic respiratory failure: a Malaysian experience.

    Inhaled nitric oxide (iNO) improves oxygenation in term and near-term infants with persistent pulmonary hypertension of the newborn (PPHN) and decreases the need for treatment with extracorporeal membrane oxygenation (ECMO). This mode of treatment is currently being introduced in malaysia. We report our preliminary experience using low dose inhaled nitric oxide (20 parts per million) in three newborn infants (meconium aspiration syndrome, primary PPHN and congenital diaphragmatic hernia) with severe PPHN who fulfilled criteria for ECMO with a mean oxygenation index (OI) of 40. Two of the infants showed rapid and sustained improvement in oxygenation with a reduction in oxygenation index (OI) over 24 hours. The infant with diaphragmatic hernia showed an initial improvement in OI, which was unsustained and subsequently died. All three infants did not show significant elevation of methemoglobin or nitrogen dioxide (NO2). Inhaled nitric oxide is an effective and safe treatment for severe PPHN that can be used in a developing country like malaysia.
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3/22. Elevation of serum cholesterol at high altitude and its relationship to hematocrit.

    The positive relationship between hematocrit and serum cholesterol may be due to dilution. Accordingly, high hematocrits would yield reduced serum pools for dilution of cholesterol, thus producing higher levels. To test this effect, the relationships between hematocrit and cholesterol were evaluated at low-altitude and high-altitude clinics. Retrospective chart reviews were conducted at Madison, WI (264 m) and Leadville, CO (3105 m) to identify family practice patients who underwent hematocrit and serum cholesterol determinations on the same day. We excluded patients with medical conditions or on medications that affect cholesterol, patients with high glucose and triglyceride levels, and patients with extreme cholesterol levels. Remaining patients (153 in each altitude group) were matched by age and sex. The mean hematocrits and cholesterol levels were compared using analysis of variance. The linear relationships between hematocrit and cholesterol were compared using analysis of covariance. The mean hematocrit was significantly higher at high altitude (47.5% versus 41.3%; p < 0.0005) as were the mean serum cholesterol (190 mg/dL versus 177 mg/dL; p < 0.002) and the low-density lipoprotein:high-density lipoprotein ratio (2.80 versus 2.27; p < 0.05). Whereas a significant, positive relationship existed between hematocrit and cholesterol at low altitude (2.15 mg/dL per %; p < 0.002), no such relationship was found at high altitude. hematocrit and serum cholesterol were elevated for family practice patients living at high altitudes. Differences exist between altitudes in the relationship between hematocrit and cholesterol. acclimatization to high altitude and its resultant erythropoiesis may increase serum cholesterol levels. Consequently, relocation to a high altitude may increase the risk of arteriosclerotic cardiovascular disease.
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4/22. Drowning: another plunge.

    Hypoxia, pulmonary edema, acidosis, and aspiration compose the syndrome of near drowning. A review of 20 cases of near drowning indicated that the initial chest roentgenogram bears little weight in assessing the present or future clinical status. In some cases a 24 to 48 hour delay occurred before roentgenographic evidence for pulmonary edema was noted. The composition of fluid aspirated does not affect the outcome. The results of this report suggest that patients with a history of near drowning should be followed closely for at least 48 hours despite an initial normal chest roentgenogram.
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5/22. Relative hypoxia of the extremities in fabry disease.

    A purine degradation study, thermography and near infrared spectroscopy of the extremities were performed on 2 young males with fabry disease and 2 healthy controls. Two-minute semi-ischemic forearm exercise caused a distinct increase in lactate in all subjects, but venous hypoxanthine and ammonia were greatly increased only in the Fabry patients, suggesting a relatively hypoxic state of the extremities. Limb thermograms of the patients revealed glove and stocking type disturbance at rest. Poor recovery of the skin temperature of the hands and forearms after exercise was observed in the patients, but the sharp increase in oxygenated hemoglobin after total ischemia was found to be normal or near infrared spectroscopy. Neurotropin showed an analgesic effect, i.e. a strong and selective heat-productive action on the painful lesions, and suppressed the hypoxanthine level after exercise in 1 patient. Although the pathophysiology of the pain in fabry disease has not been clearly elucidated, a relatively hypoxic state with peripheral hypothermia might play an important role in triggering of a painful attack or chronic burning paresthesia.
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6/22. Congenital lobar emphysema: an otolaryngologic perspective.

    Congenital lobar emphysema (CLE) is an uncommon but potentially life threatening pulmonary abnormality affecting infants. patients often present within the first 6 months of life with recurrent respiratory distress as a result of hyperinflation of the affected pulmonary lobe, and resultant near total collapse of normal lung parenchyma. We present a case of a 2-month-old infant with recurrent admissions for respiratory distress.
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7/22. nitric oxide in pulmonary arteriovenous malformations and fontan procedure.

    Pulmonary arteriovenous malformations are a well documented complication of superior cavopulmonary (Glenn) connections. We report the successful management of a case of severe hypoxemia in the early postoperative period of a patient who underwent the Fontan operation. The patient had previously been diagnosed with pulmonary arteriovenous malformations; the use of inhaled nitric oxide was followed up with reversal of life-threatening hypoxemia. At 6-month postoperative follow-up, the patient was asymptomatic with near normal aortic saturation.
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8/22. Multifocal electroretinography changes in the macula at high altitude: a report of three cases.

    BACKGROUND: To evaluate the short- and long-term effects of high-altitude hypobaric hypoxia on macula morphology and function during ascents, acclimatizations, and descents between 500 m and 5,650 m, macula function was evaluated in three healthy climbers of a trekking expedition. methods: Macula physiology was tested with multifocal electroretinography (MF ERG), near and farvisual acuity, and Amsler grid tests. Macula morphology was tested with optical coherence tomography (OCT) and with stereoscopic fundoscopy obtained 1 week before ascent, as well as 1 week and 2 weeks after high-altitude exposure. The following physiological parameters indicative of acclimatization were compared daily during the expedition at altitudes between 500 m and 5,050 m: hemoglobin, oxygen saturation, resting heart rate, retinal findings, and the Lake Louise score of acclimatization. RESULTS: The central macula MF ERG responses were significantly reduced 1 week after high-altitude exposure, and had recovered by the follow-up examination performed during the following week. Near visual acuity and Amsler grid tests remained unaffected at both follow-up examinations. No significant changes were found in the follow-up OCT and daily fundoscopy examinations in all three well-acclimatized climbers. CONCLUSIONS: High-altitude hypobaric hypoxia affects the function of the highly sensitive macula region. This suggests that the exposure of persons with macula diseases such as age-related macula degeneration, tapetoretinal degeneration, or diabetic retinopathy to high altitudes may influence the disease progression. For this reason, this population should avoid prolonged and unnecessary high-altitude exposure without proper acclimatization.
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9/22. Recurrent high-altitude illness associated with right pulmonary artery occlusion from granulomatous mediastinitis.

    While travelling across the intermountain West at an altitude of approximately 2,300 m, a 35-year-old man developed symptoms of HAPE. Delay in diagnosis and treatment was nearly lethal. Subsequent evaluation demonstrated unilateral pulmonary artery occlusion, presumably resulting from antecedent granulomatous mediastinitis. This case report supports the concept of evaluating anyone developing HAPE at relatively low altitude for an underlying predisposition.
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10/22. Hypoxic pulmonary vasoconstriction and high altitude pulmonary edema.

    The pulmonary hemodynamic response to an acute normobaric inspiratory hypoxia, a fraction of inspired O2 of 0.125 and the balance nitrogen for 10 min, was investigated in a 51-year-old man 11 months before and again 3 wk after he experienced an episode of pulmonary edema while mountaineering near the summit of the Chimborazo (ecuador) at an altitude of about 5,700 m. Pulmonary vascular resistance increased by 72 and 70 dyne . s . cm-5 . m2 in the presence of decreased arterial PO2 to 40 and 43 mmHg, respectively, which is in the average of previously reported changes in normal volunteers in identical experimental conditions. These results suggest that susceptibility to high altitude pulmonary edema cannot be reliably detected by pulmonary vasoreactivity testing to hypoxia at sea level.
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