Subject(s)
Autoimmune Diseases/immunology , Immunomodulation/immunology , Neoplasms/immunology , Tryptophan/metabolism , Animals , Brain/immunology , Dietary Supplements , Disease Models, Animal , Dose-Response Relationship, Drug , Humans , Immune Tolerance/immunology , Indoleamine-Pyrrole 2,3,-Dioxygenase/physiology , Inflammation/immunology , Kynurenine/analogs & derivatives , Kynurenine/metabolism , Mice , Serotonin/metabolism , Treatment Outcome , Tryptophan/administration & dosageABSTRACT
HISTORY: 10 years ago a now 49-year-old woman with Render-Osler-Weber disease showed unspecific symptoms of nausea, and general unwellness. Pulmonary manifestation of the disease was accompanied by pulmonary hypertension. INVESTIGATION: Teleangiectasia of the tongue and pharynx as well as of the mucosa of mouth and nose were observed. Fixed-splitting of the second heart sound with accentuated pulmonary component and a 2/6 systolic murmur over the tricuspid valve were heard. In addition, a murmur was heard dorsal over the right lung's lower lobe. Apart from minor oedema of both ankles, the physical status was not remarkable. Echocardiography showed dilatation of the right ventricle and a minor regurgitation of the tricuspid valve. The computed tomography showed dilatation of the pulmonary arteries as well as an arteriovenous malformation in the right lower lobe. Right-heart catheterisation revealed elevated pulmonary pressure. THERAPY AND FOLLOW-UP: Initial treatment with a calcium channel blocker proved insufficient and was changed to inhalative, and later to oral prostanoids. Under this treatment the cardiopulmonary state was stabilised, but episodes of epistaxis were increased. Two years after readjustment of the medication to a dual endothelin receptor antagonist, the cardiopulmonary state remains stable without significant haemorrhagic complications. CONCLUSION: Prostanoid treatment in patients with Render-Osler-Weber disease and additional pulmonary hypertension can lead to an increased risk of haemorrhagic complications. Treatment with newer medications, such as endothelin receptor antagonists, seems indicated as successfully illustrated in our case.
Subject(s)
Antihypertensive Agents/therapeutic use , Endothelin Receptor Antagonists , Epoprostenol/analogs & derivatives , Hypertension, Pulmonary/etiology , Sulfonamides/therapeutic use , Telangiectasia, Hereditary Hemorrhagic/complications , Anticoagulants/therapeutic use , Bosentan , Calcium Channel Blockers/therapeutic use , Diuretics/therapeutic use , Epistaxis/chemically induced , Epoprostenol/adverse effects , Epoprostenol/therapeutic use , Female , Furosemide/therapeutic use , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/drug therapy , Iloprost/adverse effects , Iloprost/therapeutic use , Middle Aged , Nifedipine/therapeutic use , Pedigree , Phenprocoumon/therapeutic use , Pyridines/therapeutic use , Telangiectasia, Hereditary Hemorrhagic/drug therapy , Telangiectasia, Hereditary Hemorrhagic/genetics , Treatment Failure , Vasodilator Agents/adverse effects , Vasodilator Agents/therapeutic useABSTRACT
Laser-induced thermotherapy (LITT) and radiofrequency thermoablation (RFTA) are increasingly used for pulmonary interventions. Primarily patients with severe functional limitations precluding a surgical approach are selected for these procedures. In this patient group a valid preinterventional risk assessment is of paramount importance. The occurrence of a pneumothorax is one of the most important complications associated with these procedures. Therefore, the functional capacity and pulmonary reserve of these patients should allow for at least short periods of lung collapse. The periinterventional risk of these patients can be estimated from basic lung function studies when certain comorbidities are excluded.