We compared the effect of crystalloid to colloid fluid infusion on extravascular lung water (EVLW) in hypoproteinemic dogs. Plasmapheresis was used to decrease plasma colloid osmotic pressure (COP) to less than 40% of its base-line level. Five animals were then infused with 0.9% sodium chloride (saline), five with 5% human serum albumin (albumin), and five with 6% hydroxyethyl starch (hetastarch) to increase the pulmonary arterial occlusive pressure by 10 Torr in comparison to the postplasmapheresis level for a 5-h study interval. On completion of the procedure, the lungs were harvested and EVLW measured by the blood-free gravimetric technique. Three to six times the volume of saline compared with albumin or hetastarch (P less than 0.001) was infused. In the saline animals, COP was decreased to 3.3 +/- 1.3 Torr, whereas COP was increased to 18.1 +/- 1.4 Torr in albumin animals (P less than 0.001) and 20.1 +/- 1.6 Torr in the hetastarch group (P less than 0.001). The saline-treated dogs developed gross signs of systemic edema. The EVLW was 8.1 +/- 0.9 ml/kg in saline animals compared with 5.3 +/- 2.1 ml/kg in the albumin (P less than 0.05) and 4.1 +/- 1.4 ml/kg in the hetastarch (P less than 0.01) groups. These data indicate that crystalloid fluid infusion during hypoproteinemia is associated with the development of both systemic and pulmonary edema.
Acute infective inflammation of the epiglottis and supraglottic tissues in the adult is an uncommon but life-threatening condition. 1•4 The incidence of adult cases may even be on the increase. 5 However, epiglottitis in association with infection of a pre-existing epiglottic cyst is unusual. CASE REPORT In January 1988 a 62-year-old man presented with several hours history of sore throat, dysphagia and pyrexia. A cyst on the left side of his epiglottis had previously been noted in May 1985 during the course of an anaesthetic laryngoscopy. The epiglottic cyst had been asymptomatic and had required no treatment at that time. On admission to hospital his axillary temperature was 37.5°C. There was a cellulitis of the skin overlying the anterior aspect of his neck and sternum. The patient had a muffled voice and was unable to swallow his saliva. However, he had no stridor in the sitting position at rest and had no palpable lymph nodes. Humidified oxygen therapy was administered to the patient in the sitting position. Throat swabs, blood cultures, a full blood count and a lateral soft tissue X-ray of neck were obtained. The lateral X-ray of neck demonstrated the extended cervical spine typical of upper airways obstruction, widening of the prevertebral soft tissue •F.F.A.R.C.S .. Senior Registrar in Anaesthesia.
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