Pulmonary Hypertension (PH) is a rare and potentially fatal complication of hematopoietic stem cell transplantation (HSCT). PH arises from increased pulmonary vascular resistance leading to increased right ventricular pressure, right heart failure, and death. PH is often difficult to diagnose as symptoms can be nonspecific, including shortness of breath, fatigue, dizziness, weakness, and hypoxemia, and may also result in death if left untreated.1, 2
Bronchiolitis obliterans (BO) is a significant cause of morbidity and mortality in post-lung transplant and HSCT patients3. BO is a non-reversible obstructive lung disease in which bronchioles are compressed and narrowed by fibrosis and/or inflammation. This compression leads to persistent hypoxia.
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Although BO may be causative of PH, the treatment strategies for each are vastly different. We believe this case series may provide insight into PH and BO and act as a bridge to further study of possible treatment options.
Methods
We conducted a retrospective review of 291 consecutive allogeneic HSCT patients treated at Cincinnati Children’s Hospital Medical Center (CCHMC) from January 2009 to
December 2012. Clinical observations of patients’ symptoms at the time of diagnosis included shortness of breath, fatigue, dizziness, weakness, and hypoxemia. This research was performed with the approval of the institutional review board.
All patients with a clinical diagnosis of BO were identified, clinical records reviewed, and data extracted. Data collected included patient demographics, laboratory data, results of radiologic studies, pathology results, photographs of skin lesions, medical history, physical examination findings, treatment plan, and treatment outcome. All patients diagnosed with BO met standard diagnostic criteria for BO, including evidence of air trapping on high-resolution computed tomography
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Four patients (1.4%) were diagnosed with BO (Table 1). The median patient age was
7.9 years (range, 0.6 to 17.4), and 2 of the patients (50%) diagnosed with BO were male. Three received bone marrow grafts (75%), and the other graft was peripheral blood stem cells. BO was diagnosed in the four patients at a median of 196 days (range
131-305 days) after HSCT. Three of the four patients (75%) were diagnosed with PH after the diagnosis of BO at a median of 46 days (range 2-89 days). The three patients diagnosed with PH and BO were administered myeloablative conditioning regimens, while the one patient without PH was administered a reduced intensity conditioning regimen. All four patients had a history of graft-versus-host disease (GVHD). (Table 1)
The diagnosis of BO was made in all 4 patients by high-resolution CT demonstrating air trapping. Two patients received pulmonary function tests (PFT) showing decreased forced expiratory volume in one second (FEV1). PFTs were not completed in the
Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.
weak bases). After ranking the pH of these solutions, you will then test your predictions in the laboratory.
Accordingly, to this information of COPD: Coping with COPD from PubMed Health, this article provides the early stages, progression, coping and emergency plan and this disease affects family and friends. It is written answering the question, what to expect from COPD and how to manage this lung disease? A team of health care professionals, scientists and editors, and experts (Chronic obstructive pulmonary disease (COPD), 2015), provides education of how this disease may affect daily lives, how to live with this disease and what causes
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must be above 8.5 and below 6.5. If the pH is too acidic, then the
Vitamin D deficiency. The patient never did take his vitamin D supplement as prescribed. I did once again give him a prescription for vitamin D 50,000 international units every week x6 weeks then follow with vitamin D3 2000 international units per day.
Pulmonary Fibrosis is a condition where the lung tissue becomes thick and scarred, but it is more serious than just thinking you have scarring on your lungs. The thickening and scarring of the lungs makes it hard for the oxygen supply to be delivered throughout the body. This disease can develop slowly or quickly and can stay the same for years. Pulmonary fibrosis occurs in a variety of clinical settings, is a major cause of mortality, and represents an enormous medical need. However, the disease is heterogeneous and the failure to distinguish different types of fibrosing lung diseases can lead to inaccurate treatments. Pulmonary fibrosis occurs in the context of connective tissue diseases that are often characterized by a distinct pattern
The human body is a very complex organism composed of different types of systems and functions. All the functions that each system has, is what makes possible for the body to obtain life. One of the most important systems in one’s body is the circulatory system, where the heart, the lungs, and the blood vessels work together to form the circle part of the circulatory system. The pumping of the heart forces the blood on its journey. The body’s circulatory system really has three parts: pulmonary circulation, coronary circulation, and systemic circulation. Each part must be working independently in order for them to all work together. However, when one of the parts of the circulatory system does not
There are many ways that they can diagnose PPHN, but I want to start off by informing you about the laboratory testing that they use. Starting with Arterial blood gas levels also known as ABG. ABG tests are used to measure the levels of carbon dioxide and oxygen in the blood from an artery. The blood is always taken from an artery. It must be used from an artery due to the fact that in veins the oxygen has already been used up and carbon dioxide is present (Lung Disease & Respiratory Health center, 2012). Next diagnosis could possibly be done by blood count with differential. This test is done to test if an extreme infection or illness is the cause of the PPHN. Some of the infections and illnesses listed in the causes section can be
Pulmonary Arterial Hypertension (PAH) belong to group 1 in the classification of Pulmonary Hypertension (PH). It is a chronic progressive disease caused by narrowing of the minor pulmonary arteries due to vascular proliferation and remodeling.
Pulmonary edema is very similar to pneumonia. It is the alveoli in the lungs, that start to contain fluid. Pulmonary edema can be cause by two factors. The most common, and reasonable cause is from the heart. If your heart is weak, instead of filling with air it fills with pressure and fluids.
Pulmonary hypertension is a group of disorders that is known to increase blood pressure.1 According to the World Health Organization (WHO), there are five pulmonary hypertension groups. Pulmonary arterial hypertension (PAH) is classified as Group 1, with a mean artery pressure of 25 mmHg or greater while at rest or left ventricular end-diastolic pressure of 15 mmHg or less by cardiac catheterization. One of the medications, sildenafil, is used to treat pulmonary arterial hypertension and erectile dysfunction.2
Radiographic features with heart failure will demonstrate changes in cardiac output and pulmonary venous pressure, evident in dilated pulmonary vessels, interstitial, pleural and alveolar fluid leakage, and increased systemic venous pressure with chronic disease (Cremers, Bradshaw & Herfkens, 2010). Based on the pathophysiological process present with Mrs. Smith, some of the following features might be noticeable: Redistributed pulmonary blood flow will be appreciated through an increased (normal 1-2 mm) artery-to-bronchus ratio at the hilar level in the upper and middle lobes; since gravity and positioning (supine versus erect and decubitus) will have an impact, comparison with serial or old films if existing will be helpful (Cremers et al.,
blockage of the air passages, the lungs can hyperinflate or collapse (Ward et al., 2016, p. 737). The pulmonary surfactant that allows for alveolar re- expansion is also affected by the inhalation of meconium, leading to respiratory failure. El Shahed, Dargaville, Ohlsson, & Soll (2014) pointed out that “Meconium inhibits the surface tension-lowering properties of surfactant.” MAS is the most common cause of persistent pulmonary hypertension of the newborn (PPHN). It occurs when fetal circulation remains after birth due to vascular resistance in the pulmonary system, causing failure of transition to normal adult- type circulation (Ward et al., 2016, p. 738). Systematic reviews have been conducted to test the effectiveness of the interventions of MAS, leading to better clinical outcomes.
2. Following solutions are added to the tubes and the pH of each tube is determined: