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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Percutaneous transhepatic catheterization of the portal venous system and pressure readings were performed in nineteen patients with cirrhosis of the liver and bleeding varices. Portal pressures were recorded in awake and mobile patients in supine, sitting and standing position, during sleep, ingestion of food, Valsalva manoeuvre and coughing. No significant differences were recorded in the different postures, during sleep or food intake. Four patients with hepatofugal portal blood flow had, however, lowest pressure in standing position. During Valsalva manoeuvre portal pressure was doubled, and it became fourfold during coughing. Elevations of this magnitude have not previously been reported. A relationship was found between portal pressure and size of varices.
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PMID:The influence of posture, Valsalva manoeuvre and coughing on portal hypertension in cirrhosis. 55 37

The number of patients with postthrombotic syndrome subsequent to venous thrombosis is continuously increasing. The risk of venous thrombosis is increased by the increasing age of the population, through increasingly-extensive surgical intervention, through hormonal contraception and through prolonged airline flights and the risk appears diminished by modern thrombosis prophylaxis. The course of the disease can be divided into an acute phase of thrombosis with a duration of about one week, the subacute phase lasting from the second to the fourth week and the phase of the postthrombotic syndrome. Pathophysiology Thrombotic occlusion can be compensated for by recanalization and collateralization. Concomitant with the generation of the blood clot, fibrinolytic factors are activated which can serve to lyse the thrombus. After organization of the remaining clot, blood flow can be re-established. The extent of recanalization can be quantified radiologically. In 35.5% of the patients there is complete recanalization, in 53.4% partial and in 11.1% no recanalization. At nearly all sites of venous occlusion preformed collaterals can be found. A hemodynamically meaningful occlusion causes an increase in the peripheral venous pressure. On use of Doppler ultrasound examination, there is absence of respiratory modulation as well as a high-frequency continuous signal which disappears as soon as collateral function is optimal. As the venous circulation adapts, there is dilatation in the collateral vessels, initially with preserved coaptation of the valve leaflets. This stage is designated as compensatory phlebectasia; phlebography of the great saphenous vein shows the typical findings. If the venous valves are incompetent, under some conditions the direction of flow may be reversed. An example of secondary varicosities in the region of the great and lesser saphenous vein is shown in Figure 3. The most frequent causes of valve damage are over-extension of the valve ring through recoil pressure and volume waves during standing, coughing and pressing in addition to local thrombus formation and inflammatory processes. In association with thrombosis in the femoropopliteal region with compensatory phlebectasia of the great saphenous vein, respiratory modulation in this vein can be detected with Doppler ultrasound examination. With secondary varicosities, which have to be differentiated from compensatory phlebectasia, on use of the Valsalva test or calf compression test there is pathologic, persistent retrograde blood flow, the calf compression test shows diminished A-sounds. In contrast to primary varicosities, with secondary varicosities of the great saphenous vein the distal dilatation is more marked than that seen proximally. Retrograde blood flow can extend to the foot with no obstacles.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Evaluation and management of post-thrombotic syndrome]. 268 Aug 52

An accidental rupture of the pulmonary artery in a 77 year old female patient is reported. She was admitted for total mastectomy, but her past medical history revealed an old myocardial infarct, treated arterial hypertension and asthma. She was under heparin as well for her varicose veins. Her clinical examination revealed a patient in mild chronic heart failure. It was therefore decided to carry out invasive monitoring during surgery and the recovery period. A Swan-Ganz catheter was put up. Its progression was controlled by looking at the pressure curves. Several attempts were made to obtain a wedge pressure, with no success. During these attempts, the patient developed a cough followed by massive haemoptysis. Despite adequate resuscitative measures, the patient died before a surgical procedure could be attempted. Postmortem examination showed the rupture to be 9 cm away from the origin of the pulmonary artery. This unfortunate accident confirmed that the following three factors, all present in this patient, should call for extreme care in the setting-up of Swan-Ganz catheters: age greater than 60 years, pulmonary arterial hypertension and anticoagulant therapy.
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PMID:[Perforation of the pulmonary artery during the insertion of a Swan-Ganz catheter]. 320 33

The portal venous-esophageal luminal pressure gradient may be more important than the absolute portal venous pressure in explaining hemorrhages caused by esophageal varices. A continuous recording of portal venous pressure and the esophageal luminal pressure enabled the authors to study the gradient between these pressures in 12 cirrhotic patients with varices of different size and under different circumstances, in particular inspiration, expiration, coughing and a Valsalva maneuver. A significant increase of portal venous pressure occurred during inspiration (+15%), coughing (+77%) and Valsalva maneuver (+157%). The value of portal venous-esophageal luminal pressure gradient increased during inspiration (+38%), coughing (+90%) and Valsalva maneuver (+69%) while it decreased during expiration (-14%).
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PMID:Portal venous-esophageal luminal pressure gradient in cirrhosis. 348 15

Pressure in oesophageal varices was measured endoscopically in 52 patients, in 16 of them central portal-vein pressure additionally by percutaneously introduced transhepatic portal-vein catheter. Only in the region of the cardia occlusion segment was the portal-vein pressure the same as that in the oesophageal varices. The larger the varices the higher the average variceal pressure. Depending on the time interval since a meal there were marked pressure variations during the day in portal-vein pressure. Intra-abdominal pressure rise (e.g. on coughing, choking or vomiting) induces a sudden and marked pressure rise in the portal vein as well as the oesophageal varices. The larger the varices the greater the danger of rupture when these pressure rises occur. Gastro-oesophageal reflux plays no role in the pathogenesis of bleeding from oesophageal varices.
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PMID:[Pathogenesis of bleeding esophageal varices]. 348 19

In the mouse, nerves were located throughout the trachea and extrapulmonary bronchi in both the smooth muscle and the connective tissue. However, no nerves were found within the epithelium. In the smooth muscle there were large numbers of nonmyelinated nerves. These were usually 'en passant' elements but varicosities containing small mitochondria and vesicles were also seen; these axons sometimes appeared to be efferent to the muscle. Unilateral cervical vagotomy reduced the numbers of nerves in the muscle of the trachea and ipsilateral primary bronchus, suggesting that they were afferent. The intramuscular nerves were characterized in terms of their complement of cytoplasmic organelles; in particular nerves containing many mitochondria disappeared following vagotomy. Pretreatment of mice with 5-hydroxydopamine to accentuate the electron-opacity of catecholamine-containing granules resulted in 3.5% of the nerves within tracheal muscle showing such granules. The afferent nerves of the smooth muscle may be complex branching structures with many varicosities. The absence of epithelial nerves may be related to the absence of the cough reflex in the mouse.
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PMID:The innervation of the trachea and extrapulmonary bronchi of the mouse. 648 94

Patients with primary varicose veins were examined by a combination of the standard tourniquet test with detection of reflux by Doppler ultrasound. Results were compared with standard clinical tests: impulse or thrill at the saphenous opening on coughing, tap impulse at the groin, and the 'Trendelenburg' tourniquet test. The state of competence of the saphenofemoral junction was noted at operation. One hundred and sixty-one limbs of 105 patients were studied. The saphenofemoral junction was incompetent in 132/161 limbs (82 per cent) and was judged competent in 29/161 limbs (18 per cent). The combined Doppler and tourniquet test assessed the saphenofemoral junction correctly in 82 per cent of limbs and was more accurate than all the other tests. The test had good sensitivity (0.9) but poor specificity (0.45). Poor specificity was a feature of all the tests except for thrill which was a highly insensitive test. The combined Doppler and tourniquet test appears to be the most simple, rapid and accurate means of detecting saphenofemoral incompetence.
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PMID:The demonstration of saphenofemoral incompetence; doppler ultrasound compared with standard clinical tests. 673 23

SFV competence was investigated in 100 patients (189 legs) suffering from varicose veins. The incidence was found to depend on the method used. The simpler clinical methods such as the cough test, percussion test, Trendelenburg test, revealed SFV insufficiency to be between 15.4-21.6%. Using the Doppler ultrasound the incidence increased to 47.6%; by using the MABP, SFV insufficiency was found to be increased 20%. The SFV competence was indicated as playing an important role in the pathogenesis of varicose veins. The phlebologist's decision to carry out high ligation and stripping of the saphena magna in patients with varicose veins should be considered only for those cases where the extent of incompetence has been established beyond doubt.
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PMID:Sapheno-femoral valve insufficiency in varicose veins of the lower limb. 733 7

The most common cause of a mass in the neck appearing only during straining is a laryngocele. On the other hand, the rare jugular phlebectasia may present in a similar manner. The cause of the jugular phlebectasia remains unclear. No treatment is indicated for this benign self-limiting condition. However, surgical removal for cosmetic purposes alone consists of a unilateral excision of the internal or external jugular vein; this produces no gross side-effects. Conclusion. Every patient with a swelling in the neck that enlarges in size after the Valsalva manoeuvre, straining, coughing or sneezing should be suspected of having jugular phlebectasia.
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PMID:External jugular phlebectasia in children. 875 Aug 15

The aim of this study was to determine the accuracy of clinical tests compared to colour duplex imaging in patients with primary varicose veins using a prospective, blinded comparison study. A total of 44 patients (70 limbs) with primary, previously untreated varicose veins presenting to the vascular laboratory of a university teaching hospital were studied. The patients underwent physical examination using the cough test, the tap test, Trendelenbergs' test, Perthes' test and hand-held Doppler (HHD) assessment prior to undergoing colour duplex scanning. Reflux was detected on duplex scanning, at the sapheno-femoral junction in 39/70 limbs (54%), the long saphenous vein in 47/70 limbs (64%) and the sapheno-popliteal junction in 9/70 limbs (13%). The cough test had low sensitivity (0.59) and specificity (0.67). The tap test had low sensitivity (0.18) and high specificity (0.92). The Trendelenberg test had high sensitivity (0.91) but low specificity (0.15). Perthes' test had a high sensitivity (0.97) but low specificity (0.20). Hand-held Doppler assessment of reflux at the sapheno-femoral junction, in the long saphenous vein and at the sapheno-popliteal junction had high sensitivity (0.97, 0.82, and 0.80, respectively) and specificity (0.73, 0.92, and 0.90, respectively) of detecting reflux. Clinical tests used in the examination of patients with primary varicose veins are inaccurate. Assessment using hand-held Doppler is more accurate. Courses and clinical textbooks should be revised to replace these tests with instruction in how to use hand-held Doppler in the clinical examination of patients with varicose veins.
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PMID:Clinical examination of varicose veins--a validation study. 1132 Sep 31


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