Vascular purpura revealing a severe dilated cardiomyopathy with left ventricular apical thrombus.

We present a case of vascular purpura revealing an intra-cardiac left-sided thrombus complicating an end-stage dilated cardiomyopathy. Vascular purpura main etiologies encompass the wide specturm of vasculitides and microvascular-occlusion syndromes. Among them, cardiac embolism represents an unusal but potentially severe etology.

Modeling 18F-FDG kinetics during acute lung injury: experimental data and estimation errors.

Background: There is increasing interest in Positron Emission Tomography (PET) of 2-deoxy-2-[18F]flouro-D-glucose ((18)F-FDG) to evaluate pulmonary inflammation during acute lung injury (ALI). We assessed the effect of extra-vascular lung water on estimates of (18)F-FDG-kinetics parameters in experimental and simulated data using the Patlak and Sokoloff methods, and our recently proposed four-compartment model.

Methodology/principal Findings: Eleven sheep underwent unilateral lung lavage and 4 h mechanical ventilation.

How to prevent ventilator-induced lung injury?

The experimental evidence that ventilator could injure lungs through the application of excessive end-inspiratory volumes and transpulmonary pressures has led to major changes in the clinical management of patients suffering from the acute respiratory distress syndrome (ARDS). The prevention of ventilator-induced lung injury has become one of the main goals of current ventilator strategies for patients with ARDS as well as for patients with normal lungs that require mechanical ventilation. Tidal volume reduction allowed for a reduction in mortality that confirmed the clinical relevance of ventilator-induced lung injury.

Micro-autoradiographic assessment of cell types contributing to 2-deoxy-2-[(18)F]fluoro-D-glucose uptake during ventilator-induced and endotoxemic lung injury.

Purpose: The aim of the study was to use micro-autoradiography to investigate the lung cell types responsible for 2-deoxy-2-[(18)F]fluoro-D-glucose (FDG) uptake in murine models of acute lung injury (ALI).

Procedures: C57/BL6 mice were studied in three groups: controls, ventilator-induced lung injury (VILI), and endotoxin. VILI was produced by high tidal volumes and zero end-expiratory pressure and endotoxin ALI, by intranasal administration.

Diffuse alveolar hemorrhage in immunocompetent patients: etiologies and prognosis revisited.

Background: Diffuse alveolar hemorrhage (DAH) represents a diagnostic challenge of acute respiratory failure. Prompt identification of the underlying cause of DAH and initiation of appropriate treatment are required in order to prevent acute respiratory failure and irreversible loss of renal function. More than 100 causes of DAH have been reported.

18F-FDG uptake rate is a biomarker of eosinophilic inflammation and airway response in asthma.

Unlabelled: In asthma, the relationship among airway inflammation, airway hyperresponsiveness, and lung function is poorly understood. Methods to noninvasively assess these relationships in human subjects are needed. We sought to determine whether (18)F-FDG uptake rate (K(i), min(-1)) could serve as a biomarker of eosinophilic inflammation and local lung function.

Ventilator-induced lung injury: historical perspectives and clinical implications.

Mechanical ventilation can produce lung physiological and morphological alterations termed ventilator-induced lung injury (VILI). Early experimental studies demonstrated that the main determinant of VILI is lung end-inspiratory volume. The clinical relevance of these experimental findings received resounding confirmation with the results of the acute respiratory distress syndrome (ARDS) Network study, which showed a 22% reduction in mortality in patients with the acute respiratory distress syndrome through a simple reduction in tidal volume.

Effects of surfactant depletion on regional pulmonary metabolic activity during mechanical ventilation.

Inflammation during mechanical ventilation is thought to depend on regional mechanical stress. This can be produced by concentration of stresses and cyclic recruitment in low-aeration dependent lung. Positron emission tomography (PET) with (18)F-fluorodeoxyglucose ((18)F-FDG) allows for noninvasive assessment of regional metabolic activity, an index of neutrophilic inflammation.

Changes in cysteinyl leukotrienes during and after cardiac surgery with cardiopulmonary bypass in patients with and without chronic obstructive pulmonary disease.

Objective: Pulmonary function frequently deteriorates after cardiopulmonary bypass (CPB). Chronic obstructive pulmonary disease (COPD) increases risk of respiratory complications after CPB. Cysteinyl leukotrienes are important mediators of respiratory dysfunction.

Assessment of lung inflammation with 18F-FDG PET during acute lung injury.

Objective: The purpose of this review is to describe the current experimental and clinical data regarding the fundamentals and applications of (18)F-FDG PET during acute lung injury (ALI) and acute respiratory distress syndrome (ARDS).

Conclusion: Lung inflammation is a key feature of ALI. During ALI, FDG PET can be used to monitor lung neutrophils, which are essential cells in the pathophysiologic mechanisms of ALI.

Bacteremia in Stevens-Johnson syndrome and toxic epidermal necrolysis: epidemiology, risk factors, and predictive value of skin cultures.

Toxic epidermal necrolysis (TEN) is a rare drug-related life-threatening acute condition. Sepsis is the main cause of mortality. Skin colonization on top of impaired barrier function promotes bloodstream infections (BSI).

Blood cocaine and metabolite pharmacokinetics after cardiac arrest in a body-packer case.

Introduction: Cocaine body packing, the internal concealment of cocaine for transportation between countries, may expose to life-threatening intoxications. No data is currently available on the pharmacokinetics of cocaine and its metabolites when a packet rupture occurs in a body packer.

Case Report: We report the first pharmacokinetic data associated with a severe cocaine intoxication in a body packer, resulting in cardiac arrest.

Diffuse alveolar haemorrhage: factors associated with in-hospital and long-term mortality.

Diffuse alveolar haemorrhage (DAH) is a feature of several immune and nonimmune disorders. Reported prognosis is poor, with in-hospital mortality ranging from 20% to 100%. Early identification of prognostic factors may be useful in the initiation of appropriate treatment.

Fluorine-18 fluorodeoxyglucose with positron emission tomography revealed bone marrow involvement in sarcoidosis patients with anaemia.

Background: Anaemia occurs in 13-28% of sarcoidosis patients. It is associated with bone marrow infiltration by epitheliod granulomas in about 50% of cases, but its pathophysiology remains unclear.

Objectives: It was the aim of this study to describe a series of sarcoidosis patients with and without anaemia who underwent metabolic imaging with fluorine-18 fluorodeoxyglucose with positron emission tomography ((18)F-FDG PET).

Candida albicans impairs macrophage function and facilitates Pseudomonas aeruginosa pneumonia in rat.

Objective: To determine whether Candida albicans airway colonization influences Pseudomonas aeruginosa pneumonia prevalence in rats and by which mechanism.

Design: Prospective, randomized, controlled animal study.

Setting: Research laboratory of a university.

Terbutaline lessens protein fluxes across the alveolo-capillary barrier during high-volume ventilation.

Objective: To evaluate whether a beta2-adrenergic agonist may reduce acute alveolo-capillary barrier alterations during high-volume ventilation.

Design: Experimental study.

Setting: Animal research laboratory.

Glucose transport in the lung and its role in liquid movement.

Glucose concentration in the liquid present in the alveolar/airway lumen is the consequence of the balance between removal by lung epithelial cells and entry from the plasma or lung interstitium through the paracellular pathway. Glucose removal is mediated by active, Na(+) -dependent, cotransport and results in transepithelial Na(+) transport and liquid absorption in animals with significant rates of luminal glucose uptake and when luminal glucose concentration is high enough. Cotransport kinetics predicted a low luminal glucose concentration at the steady state, and foetal lung fluid and adult alveolar epithelial lining fluid glucose concentrations were indeed found lower than plasma.

Alveolar edema dispersion and alveolar protein permeability during high volume ventilation: effect of positive end-expiratory pressure.

Objectives: To evaluate whether PEEP affects intrapulmonary alveolar edema liquid movement and alveolar permeability to proteins during high volume ventilation.

Design And Setting: Experimental study in an animal research laboratory.

Subjects: 46 male Wistar rats.

Evaluation of two-way protein fluxes across the alveolo-capillary membrane by scintigraphy in rats: effect of lung inflation.

Pulmonary microvascular and alveolar epithelial permeability were evaluated in vivo by scintigraphic imaging during lung distension. A zone of alveolar flooding was made by instilling a solution containing 99mTc-albumin in a bronchus. Alveolar epithelial permeability was estimated from the rate at which this tracer left the lungs.

B-type natriuretic peptide and weaning from mechanical ventilation.

Objective: Cardiac function and volume status could play a critical role in the setting of weaning failure. B-type natriuretic peptide (BNP) is a powerful marker of cardiac dysfunction. We assessed the value of BNP during the weaning process.