Edematous Group Research Articles

Factors Predicting the Development of Necrosis in Patients Presenting With Edematous Acute Pancreatitis.

There is no marker that can accurately predict the development of pancreatic necrosis in edematous acute pancreatitis (AP). This study aimed to investigate the factors associated with necrosis development in cases of edematous AP and to create an easy-to-use scoring system. We retrospectively reviewed patients diagnosed with edematous AP between 2010 and 2021. Among the patients, those who were found to have developed necrosis during follow-up were categorized as the necrotizing group, whereas the others constituted the edematous group. With multivariate analysis, white blood cell, hematocrit, lactate dehydrogenase, and C-reactive protein levels at the 48th hour were revealed to be independent risk factors for necrosis. Using these 4 independent predictors, the Necrosis Development Score 48 (NDS-48) was derived. While the cutoff value was 2.5, the sensitivity and specificity of the NDS-48 for necrosis were 92.5% and 85.9%, respectively. The area under the curve value of the NDS-48 for necrosis was 0.949 (95% confidence interval, 0.920-0.977). White blood cell, hematocrit, lactate dehydrogenase, and C-reactive protein levels at the 48th hour are independent predictors of necrosis development. The NDS-48, a new scoring system created with these 4 predictors, satisfactorily predicted the development of necrosis.

The safety of iloprost in systemic sclerosis in a real-life experience.

Iloprost (ILO) is employed intravenously for the treatment of severe Raynaud phenomenon (RP) and digital ulcers (DU) in systemic sclerosis (SSc). The aim of this study was to evaluate the safety and tolerability of the intravenous treatment with ILO in different phases of SSc. Eighty-one consecutive non-selected SSc patients, all on nifedipine, with moderate RP, treated with ILO infusion, were retrospectively evaluated. Patients were sub classified according to the edematous or fibrotic/atrophic cutaneous phase of the disease. ILO was infused with a progressive increase of the dosage up to the achievement of patient's tolerance, 1day/week. In cases of slower infusion regimen due to adverse events (AE) at the beginning of the administration, patients received a lower dose of the drug (not possible to quantify precisely the final cumulative dosage). 16/81 SSc patients presented digital edema, 5 developed diarrhea, and 9 developed transient hypotension during the infusion at 20ml/h that ameliorated when the drug was withdrawn. Moreover, 10/16 edematous patients experienced significant and painful digital swelling, unlike patients in the fibrotic group (p < 0.0001); 11/16 patients reported flushing and 7/16 headache, always controlled with dose tapering below 10ml/h. In the atrophic/fibrotic phase patients (65/81), 10 developed diarrhea and 24 hypotension at infusion rate of 20ml/h that led to temporary withdrawal of the drug. When ILO was restarted and kept below 10ml/h, no side effects were experienced. 23/65 patients experienced flushing and 8/65 headache, all controlled with infusion reduction below 10ml/h. In these patients, adverse events were significantly less frequent than in the edematous group (p = 0.023 and p = 0.008, respectively). Our data suggest that calcium channel blockers should be transitorily stopped while using ILO and that a pre-treatment approach might reduce or control adverse events. In patients with digital edema, ILO infusion should be carefully employed after the evaluation of patient's drug tolerance.

Effect of peripheral edema on oscillometric blood pressure measurement.

Introduction: Blood pressure (BP) measurement is essential for epidemiological studies and clinical decisions. It seems that tissue characteristics can affect BP results and we try to find edema effect on BP results taken by different methods. Methods: BP of 55 children before open heart surgery were measured and compared according to three methods: Arterial as standard and reference, oscillometric and auscultatory methods. Peripheral edema as a tissue characteristic was defined in higher than +2 as marked edema and in equal or lower than +2 as no edema. Statistical analyses: data was expressed as Mean and 95% of confidence interval (CI 95%). Comparison of two groups was performed by T independent test and of more than two groups by ANOVA test. Mann–Whitney U and paired T-test were used for serially comparisons of changes. P less than 0.05 was considered significant. Results: Fifty five children aged 29.4±3.9 months were divided into two groups: 10 children with peripheral edema beyond +2 and 45 cases without edema. Oscillometric method overestimated systolic BP and the Mean (CI 95%) difference of oscillometric to arterial was 4.8 (8/-1, P=0.02) in edematous and 4.2 (7/1, p=0.004) in non edematous. Oscillometric method underestimated diastolic BP as -9 (-1.8/-16.5, P=0.03) in edematous group and 2.6 (-0.7/+5, P= 0.2) in non edematous compared to arterial method. Conclusion: Oscillometric device standards cannot cover all specific clinical conditions. It underestimates diastolic BP significantly in edematous children, which was 9.2 mmHg in average beyond the acceptable standards.

Back to Basics: Pitting Edema and the Optimization of Hypertension Treatment in Incident Peritoneal Dialysis Patients (BRAZPD)

Systemic arterial hypertension is an important risk factor for cardiovascular disease that is frequently observed in populations with declining renal function. Initiation of renal replacement therapy at least partially decreases signs of fluid overload; however, high blood pressure levels persist in the majority of patients after dialysis initiation. Hypervolemia due to water retention predisposes peritoneal dialysis (PD) patients to hypertension and can clinically manifest in several forms, including peripheral edema. The approaches to detect edema, which include methods such as bioimpedance, inferior vena cava diameter and biomarkers, are not always available to physicians worldwide. For clinical examinations, the presence of pitting located in the lower extremities and/or over the sacrum to diagnose the presence of peripheral edema in their patients are frequently utulized. We evaluated the impact of edema on the control of blood pressure of incident PD patients during the first year of dialysis treatment. Patients were recruited from 114 Brazilian dialysis centers that were participating in the BRAZPD study for a total of 1089 incident patients. Peripheral edema was diagnosed by the presence of pitting after finger pressure was applied to the edematous area. Patients were divided into 2 groups: those with and without edema according to the monthly medical evaluation. Blood arterial pressure, body mass index, the number of antihypertensive drugs and comorbidities were analyzed. We observed an initial BP reduction in the first five months and a stabilization of blood pressure levels from five to twelve months. The edematous group exhibited higher blood pressure levels than the group without edema during the follow-up. The results strongly indicate that the presence of a simple and easily detectable clinical sign of peripheral edema is a very relevant tool that could be used to re-evaluate not only the patient's clinical hypertensive status but also the PD prescription and patient compliance.

Dietary cysteine is used more efficiently by children with severe acute malnutrition with edema compared with those without edema

Children with edematous severe acute malnutrition (SAM) produce less cysteine than do their nonedematous counterparts. They also have marked glutathione (GSH) depletion, hair loss, skin erosion, gut mucosal atrophy, and depletion of mucins. Because GSH, skin, hair, mucosal, and mucin proteins are rich in cysteine, we hypothesized that splanchnic extraction and the efficiency of cysteine utilization would be greater in edematous than in nonedematous SAM. We aimed to measure cysteine kinetics in childhood edematous and nonedematous SAM. Cysteine flux, oxidation, balance, and splanchnic uptake (SPU) were measured in 2 groups of children with edematous (n = 9) and nonedematous (n = 10) SAM at 4.4 ± 1.1 d after admission (stage 1) and at 20.5 ± 1.6 d after admission (stage 2) when they had replenished 50% of their weight deficit. In comparison with the nonedematous group, the edematous group had slower cysteine flux at stage 1 but not at stage 2; furthermore, they oxidized less cysteine at both stages, resulting in better cysteine balance and therefore better efficiency of utilization of dietary cysteine. Cysteine SPU was not different between groups but was ∼45% in both groups at the 2 stages. These findings suggest that children with edematous SAM may have a greater requirement for cysteine during early and mid-nutritional rehabilitation because they used dietary cysteine more efficiently than did their nonedematous counterparts and because the splanchnic tissues of all children with SAM have a relatively high requirement for cysteine. This trial was registered at clinicaltrials.gov as NCT00069134.

Reversal of Lower Limb Edema by Calf Muscle Pump Stimulation

Peripheral edema (PE) is commonly coupled with heart failure, restrictive cardiomyopathy, nephrotic syndrome, renal failure, and hypoproteinemia. Diuretics and/or limb elevation, although commonly prescribed to treat PE, are often insufficient to remove sufficient fluid to prevent complications. We assessed the ability of the calf muscle pump (CMP) stimulation to reverse PE. Fluid volume was evaluated by air plethysmography in the right legs of 54 adult women (mean age 46.7 +/- 1.5 years) following venous status assessment. Change in calf volume was assessed during 30 minutes of quiet sitting, followed by 30 minutes of sitting with CMP stimulation via micromechanical stimulation of the plantar surface. Leg volume changes demonstrated a bimodal distribution. Leg volume decreased during quiet sitting in 56% of the study group, whereas in 44% of the group, significant lower leg fluid pooling was evident (increase in calf volume of 14.0 +/- 0.3 mL/h). CMP stimulation reversed the fluid pooling in the edematous group (-2.7 +/- 0.1 mL/h) and was able to accelerate fluid removal in the nonedematous group. Approximately two fifths of adult women experience substantial pooling when their lower limbs are maintained in a dependent position. Lower-extremity edema exhibited by these women may primarily be due to inadequate calf muscle tone because exogenous stimulation of the CMP was sufficient to halt and reverse fluid pooling. Whether CMP stimulation would provide a means to treat PE in individuals with edema-related health complications, such as congestive heart failure, merits further investigation.

Arginine flux and intravascular nitric oxide synthesis in severe childhood undernutrition

Background: Although nutritionally dispensable amino acids are not essential in the diet, adequate synthesis is necessary for maintenance of good health. Whereas children with edematous severe childhood undernutrition (SCU) can maintain production rates of glycine and serine despite a slower body protein breakdown rate, it is unknown whether the same is true for the semidispensable amino acid arginine.Objective: We aimed to measure arginine flux and intravascular nitric oxide synthesis in children with SCU.Design: Arginine flux and the fractional and absolute synthesis rates of plasma nitrite plus nitrate were measured postabsorptively by using a 6-h infusion of [15N2]-arginine in 2 groups of children with edematous (n = 14) or nonedematous (n = 7) SCU when they were infected and malnourished (postadmission day ≈3; clinical phase 1), when they were no longer infected (postadmission day ≈15; clinical phase 2), and when they were recovered (postadmission day ≈55; clinical phase 3).Results: Arginine flux was slower (P < 0.01) and plasma arginine concentrations were lower in the edematous group than in the nonedematous group at clinical phase 1. At clinical phase 2, flux doubled to a value that was not significantly different from the value at clinical phase 3. There were no significant differences in the plasma concentration or fractional or absolute synthesis rate of plasma nitrite plus nitrate between the groups at any clinical phase and among clinical phases within each group.Conclusion: Whereas children with nonedematous SCU can maintain arginine flux at the same rate as when recovered, children with edematous SCU cannot. The slower arginine flux was not, however, associated with slower nitric oxide synthesis.

Protein kinetic differences between children with edematous and nonedematous severe childhood undernutrition in the fed and postabsorptive states

Pathogenic factors that cause a child to develop the edematous instead of the nonedematous form of severe childhood undernutrition (SCU) during food deprivation are not clear. It was hypothesized that, in edematous but not nonedematous SCU, impaired protein breakdown leading to inadequate amino acids for maintenance of important organ systems was a factor. We measured protein kinetics in children with edematous and nonedematous SCU. Endogenous leucine flux, an index of whole-body protein breakdown rate, was determined in 4 groups of children with edematous or nonedematous SCU in the malnourished and recovered states. Two groups were studied in the postabsorptive state, and 2 groups were studied in the fed state. In the postabsorptive state, leucine flux was slower (P < 0.01) in the edematous group than in the nonedematous group in the malnourished state, but in the recovered state, it was faster (P < 0.05) in the children who previously had edematous SCU. When compared with the malnourished state value, leucine flux at recovery doubled in the group that previously had edematous SCU, but it did not change in the other group. In the fed state, leucine flux was slower (P < 0.01) in the edematous group than in the nonedematous group in the malnourished state but not in the recovered state. In the recovered state, enteral leucine extraction by splanchnic tissues trended higher in the group that previously had edematous SCU than in the nonedematous group. These findings indicate different protein breakdown responses to food deprivation between children with edematous and nonedematous SCU and inherent differences in protein metabolism when they have recovered.

Relationship between pancreatic enzymes and pathological changes in the pancreas in acute pancreatitis

To clarify the relationship between changes in serum pancreatic enzymes and pathological changes in pancreatic parenchyma, this study was performed by using rat models with acute pancreatitis. The models were rats with edematous and necrotizing pancreatitis. Amylase, lipase, ribonuclease (RNase), and deoxyribonuclease (DNase I, II) in the serum were determined for 48 h after the development of pancreatitis. Amylase and lipase levels rose directly in both pancreatitis groups. These enzymes in the necrotizing pancreatitis group were higher than those in the edematous pancreatitis group, but there was no significant difference. RNase levels also rose markedly, but there was no obvious difference between either of the pancreatitis groups. On the other hand, DNase levels were high in the necrotizing pancreatitis group but low in the edematous pancreatitis group, with significant differences between the two groups, especially in the DNase II levels over a 36-h period (p less than 0.05-0.01). Therefore, these results suggest that serum DNase levels reveal the necrotizing changes in pancreatic parenchyma.

Plasma prolactin levels in full-term newborn infants with idiopathic edema: response to furosemide.

In an attempt to explore the possible role of prolactin (PRL) in the control of neonatal electrolyte homeostasis, this study has been carried out to compare plasma electrolyte concentrations, urine volume and urinary electrolyte excretion as well as plasma PRL levels in healthy full-term neonates with idiopathic edema prior to and after furosemide treatment. No differences in plasma sodium and potassium were demonstrated, edematous neonates, however, had less urine volume and sodium excretion than neonates without edema. Plasma PRL proved to be significantly higher in the edematous group (11.0 +/- 1.9 vs. 4.2 +/- 3.1 U/l, p less than 0.01) but it remained unaltered by furosemide challenge (8.5 +/- 1.5 U/l) in spite of the marked elevation of urine flow and sodium excretion. It is concluded that PRL may be involved in the control of the volume and composition of the body fluids in the neonate but further studies are needed to define the effect of changes in body composition on the neonatal PRL secretion.