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ardiogenic pulmonary edema, which is a common complication of acute myocardial infarction, remains a serious clinical problem. 1 If pulmonary edema results in hypoxemia, mechanical ventilation with positive end-expiratory pressure (PEEP) is required. Mechanical ventilation, however, has associated morbidity. The potential benefits of continuous positive airway pressure (CPAP) ventilation include an improvement in oxygenation, a decrease in respiratory work, and a decrease in left ventricular afterload. [2][3][4][5] If CPAP using a mask is utilized in patients with cardiogenic pulmonary edema, the number of patients that later require mechanical ventilation by means of endotracheal intubation can be reduced, while oxygenation and respiratory rate are improved. 6 Further, we have reported that nasal CPAP led to an early decrease in plasma endothelin-1 (ET-1) concentrations in patients with severe cardiogenic pulmonary edema. 7 In practice, however, there are no generally accepted criteria for the initiation of mechanical ventilation in patients with pulmonary edema in the setting of acute myocardial infarction. Accordingly, the primary goal of the present study was to determine the effects of different methods of respiratory management on the hemodynamics, oxygenation, and outcome in patients who developed respiratory failure due to severe cardiogenic pulmonary edema after acute myocardial infarction. Patients and MethodsThis study was approved by the Committee on Human Patients. Because of the severity of cardiogenic pulmonary edema, no patient was able to give valid informed consent at entry into the study. Therefore, information was provided to the patient's next of kin and their consent was obtained prior to study entry. During the 1-year study period, we prospectively studied 31 of 147 patients with acute myocardial infarction admitted to the coronary care unit (CCU) of our hospital. Of these, one patient with left ventricular free wall rupture and another with ventricular septal perforation were excluded. The remaining patients consisted of 29 adults with respiratory failure due to severe cardiogenic pulmonary edema. All patients with cardiogenic pulmonary edema who had clinical evidence of respiratory distress and a PaO2 below 80 mmHg while receiving 50% oxygen by tight-fitting mask were enrolled.Cardiogenic pulmonary edema was diagnosed if a patient had dyspnea of sudden onset, typical findings on Effect of Nasal Continuous Positive Airway Pressure on Pulmonary Edema Complicating Acute Myocardial InfarctionJpn Circ J 1998; 62: 553 -558 Shinhiro Takeda, MD; Jun Nejima, MD; Teruo Takano, MD; Kazuhiro Nakanishi, MD; Morimasa Takayama, MD; Atsuhiro Sakamoto, MD*; Ryo Ogawa, MD* Cardiogenic pulmonary edema is a frequent cause of reparatory failure. We investigated the effects of nasal continuous positive airway pressure (CPAP) in patients with severe pulmonary edema associated with acute myocardial infarction. Twenty-nine consecutive patients were divided into 3 groups: firstly, 7 intubated patients who rece...

This prospective study showed that embolic events occurred during total knee arthroplasty, even while a tourniquet was inflated. An inflated tourniquet does not completely prevent pulmonary emboli.

Proinflammatory cytokines have been implicated in mediating respiratory failure associated with major surgery. We investigated the effect of giving glucocorticoids preoperatively for the prophylaxis of surgical stress and the association of cytokine levels, such as interleukin-6 (IL-6) and interleukin-8 (IL-8), with oxygenation after esophagectomy. We studied 17 patients who underwent subtotal esophagectomy. Seven patients (steroid group) were chosen at random to be given methylprednisolone (10 mg/kg) and 10 patients (control group) to be given saline intravenously before operation. Plasma and bronchoalveolar lavage fluid (BALF) IL-8 levels in the control group were significantly higher than those in the steroid group. In both groups, plasma IL-6 levels were significantly higher than those in BALF, but in contrast, BALF IL-8 levels were significantly higher than plasma levels of IL-8 postoperatively. The PaO(2)/FiO(2) ratio was significantly reduced in the control group. The PaO(2)/FiO(2) ratio of the control group had significantly lower values than that of the steroid group. There was significant correlation between BALF IL-8 levels and the PaO(2)/FiO(2) ratio postoperatively. We conclude that preoperative administration of methylprednisolone may attenuate postoperative reduction of arterial oxygen saturation by suppressing the release of cytokines.

Vitamin K deficiency is associated with malnutrition in some complications, such as hyperemesis gravidarum, active gastrointestinal diseases, and psychological disorders. Maternal vitamin K deficiency can cause fetal bleeding, in particular, fetal intracranial hemorrhage. Although fetal hemorrhage is uncommon, severe damage to the fetus may be inevitable. We describe a pregnant woman with vitamin K deficiency possibly due to hyperemesis gravidarum. The patient was treated for the deficiency, and no fetal or neonatal hemorrhagic diseases were manifested. (J Nippon Med Sch 2015; 82: 54 58)

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BackgroundLandiolol hydrochloride is a new β-adrenergic blocker with a pharmacological profile that suggests it can be administered safely to patients who have sinus tachycardia or tachyarrhythmia and who require heart rate reduction. This study aimed to investigate whether intraoperative administration of landiolol could reduce the incidence of atrial fibrillation (AF) after cardiac surgery.MethodsOf the 200 consecutive patients whose records could be retrieved between October 2006 and September 2007, we retrospectively reviewed a total of 105 patients who met the inclusion criteria: no previous permanent/persistent AF, no permanent pacemaker, no renal insufficiency requiring dialysis, and no reactive airway disease, etc. Landiolol infusion was started after surgery had commenced, at an infusion rate of 1 μg/kg/min, titrated upward in 3–5 μg/kg/min increments. The patients were divided into 2 groups: those who received intraoperative β-blocker therapy with landiolol (landiolol group) and those who did not receive any β-blockers during surgery (control group). An unpaired t test and Fisher’s exact test were used to compare between-group differences in mean values and categorical data, respectively.ResultsSeventeen of the 105 patients (16.2%) developed postoperative atrial fibrillation: 5/57 (8.8%) in the landiolol group and 12/48 (25%) in the control group. There was a significant difference between the two groups (P=0.03). The incidence of AF after valve surgery and off-pump coronary artery bypass grafting was lower in the landiolol group, although the difference between the groups was not statistically significant.ConclusionsOur retrospective review demonstrated a marked reduction of postoperative AF in those who received landiolol intraoperatively. A prospective study of intraoperative landiolol for preventing postoperative atrial fibrillation is warranted.

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