Respiratory system syndrome

The third condition, late respiratory systemic syndrome, is characterized by cough, mucus production, occasional wheezing, and systemic symptoms of malaise, chills, fever, and aching muscles and joints, occurring 4—12 hours alter exposure. This syndrome also has been termed TMA flu and clinically resembles hypersensitivity pneumonitis with visible chest X-ray infiltrates. High levels of IgG serum antibody and total serum antibody directed against trimellityl-human protein conjugates accompany the syndrome, and a latent period of exposure before the onset of symptoms is typical. 

A follow-up study of 29 workers with TMAN-induced immunologic lung disease who had been moved to low-exposure jobs for more than 1 year revealed that workers with late asthma or late respiratory systemic syndrome had improved symptoms, improved pulmonary functions, and lower total antibody against TMAN-HSA. In contrast, 7 of 12 workers with asthma rhinitis continued to have moderate to severe symptoms, abnormal pulmonary functions, and elevated IgE against TMAN-HSA. Elevated IgE against TMAN-HSA appears to be a marker for the subpopulation of workers with asthma rhinitis that does not improve. 

For the treatment of lung surfactant deficiency in premature human infants suffering from respiratory distress syndrome, limited clinical trials were performed showing that liposomes in the lung-instilled intratracheally either as an aerosolized mist (Ivey et al., 1977) or as a suspension via an endotracheal tube (Fujiwara et al., 1980)—rapidly improved lung function. No adverse effects were observed as a result of the supplementation with surfactant-like material. It appears, therefore, that liposomes are a suitable system for the delivery of major phospholipid components of endogenous lung surfactant. 

AMS acute myocardial syndrome ANC absolute neutrophil count ANS autonomic nervous system APACHE Acute Physiologic and Chronic Health Evaluation ICU illness severity scoring system APAP acetaminophen [N-acetyl-p-aminof enol] aPTT activated partial thromboplastin time ARB angiotensin 11 receptor blocker ARDS adult respiratory distress syndrome... 

Complications included acute respiratory distress syndrome, renal failure, and multi-organ failure. Evidence that the clinical spectrum of human H5N1 infections is not restricted to pulmonary symptoms was provided by a reported case of possible central nervous system involvement in a Vietnamese boy who presented with diarrhea, followed by coma and death. Influenza H5N1 virus was isolated from throat, rectal, blood, and cerebrospinal fluid specimens, suggesting widely disseminated viral replication. 

Unlabeled Uses Cardiopulmonary bypass surgery hemodialysis pulmonary hypertension associated with acute respiratory distress syndrome, systemic lupus erythematosus, or congenital heart disease refractory CHF severe community-acquired pneumonia... 

Systemic inflammation Acute respiratory distress syndrome (sustained therapy with moderate dosage accelerates recovery and decreases mortality)... 

R13. Romaschin, A. D., De Majo, W. C., Winton, T., D Costa, M., Chang, G., Rubin, B., Gamliel, Z., and Walker, P. M., Systemic phospholipase a2 and cachectin levels in adult respiratory distress syndrome and multiple-organ failure. Clin. Biochem. 25,55—60 (1992). 

There are also several examples of natural surfactants and foams in the human body. The understanding of the pulmonary surfactant system, although discovered in 1929, has only been applied clinically since about 1990 for the treatment of respiratory distress syndrome. Surfactant replacement therapy may also be used in treating other forms of lung disease, such as meconium aspiration syndrome, neonatal pneumonia and congenital diaphragmatic hernia [881]. Lung surfactant, composed of phospholipids and proteins [882,883], is necessary to maintain a low surface tension at the alveolar air-liquid interface. When there is a deficiency of surfac-... 

The disease appeared after a latent period of at least one to two weeks, longer in some cases, and an apparent relationship between the extent of use of the oil and the effect (a dose-response relationship) was noted in one report. The syndrome had an initial phase lasting one to two months, with effects mainly on the respiratory system and the accumulation of fluid in the lungs. There were many deaths at this early stage from respiratory failure. In the next phase (two to four months) there was muscle pain and liver damage. In the final phase there was muscle wasting and weight loss and the skin was affected (see box). 

System improvements may improve the quality of prescribing by standardizing to an expert level. Morris (51) described the development, testing, and use of computerized protocols for management of intravenous fluid and hemodynamic factors in patients with acute respiratory distress syndrome. Evans et al. (52) used a computerized anti-infectives management... 

In a double-blind, randomized pilot study of the efficacy and adverse effects of inhaled fluticasone in 25 newborn preterm infants who required mechanical ventilation for treatment of respiratory distress syndrome, the infants were randomized to receive inhaled fluticasone 1000 micrograms/day or placebo (47). The hypothalamic-pituitary-adrenal axis was assessed by the response to corticotropin-releasing factor. AU basal and post-stimulation plasma corticotropin and serum cortisol concentrations were significantly less with inhaled fluticasone than placebo. Cumulative high-dose inhaled glucocorticoids caused moderately severe suppression of both the pituitary and the adrenal glands. This systemic activity is probably associated with pulmonary vascular absorption that avoids hepatic first-pass metabolism. 

Buratti T, Joannidis M, Pechlaner C, Wiedermann CJ. Systemic hypotension on withdrawal from inhaled nitric oxide in an adult patient with acute respiratory distress syndrome. Grit Care Med 1999 27(2) 441. 

Furfural can cause skin sensitization and has been shown to cause irritant dermatitis which may become eczematous. It can be absorbed through the skin or by inhalation and it is an irritant to the eyes, skin, and respiratory system. No throat or eye irritation was noted in humans exposed to 10 ppm for 8h or 20 ppm for 4h. No data are available relative to reproductive or developmental effects in humans exposed to furfural. When air concentrations reach from 2 to 14 ppm, headaches, itching of the throat, and red/weeping eyes occurred in exposed humans. If exposures are severe, respiratory tract irritation can progress to acute respiratory distress syndrome, which may be delayed in its onset by up to 72 h. The National Institute for Occupational Safety and Flealth has indicated that 100 ppm in air is a concentration immediately dangerous to life or health. 

Formaldehyde is a major contributor to many cases of sick building syndrome. It is a very toxic chemical that is corrosive to the skin, eyes, and the respiratory system. Acute or chronic exposure can result in difficulty breathing and even brief exposures can induce asthmatic reactions in sensitized individuals. 13 Exposures to mixtures of formaldehyde and lipophilic chemicals can result in unanticipated toxic effects. 14 Formaldehyde is an animal carcinogen, a suspected human nasal cancer carcinogen 29 and suspected human leukemogen. 3°1... 

The delivery of aerosol powders by generation with minimal formulation has been an attractive prospect to many researchers. The early use of a dry powder artificial phospholipid in the treatment of neonatal respiratory distress syndrome proved very successful [181]. Because no delivery system was available to facilitate this treatment, a simple system was devised. A Laerdal neonatal resuscitation bag was modified to hold a capsule containing the artificial surfactant, as shown schematically in Fig. 11. However, where MDIs of the prescribed medication are available, both physicians and patients prefer their use. The powders themselves have to be prepared in the same way as those used in MDIs, by milling. Often, excipients are added to carry the fine powder. Lactose has been used in both cromolyn sodium and albuterol formulations. As a consequence of the interest in dry powders, a number of products have been... 

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