Gene/Protein Disease Symptom Drug Enzyme Compound
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 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinical and physiologic effects of bronchopulmonary lavage of both lungs at separate times in 14 patients with alveolar proteinosis proved by biopsy were followed for 2 to 96 months. Before lavage, all patients had moderate to severe dyspnea on exertion. Twelve had a nonproductive cough, and 2 had a productive cough; both were smokers. Nine had generalized fatigue, and 4 had weight loss. Twelve of 14 had fine inspiratory rales. All of the patients had abnormal chest roentgenograms, and 13 of 14 had an increased lactate dehydrogenase concentration. After lavage, all patients had loss of fatigue and improved exercise tolerance, with most returning to normal activity. Cough cleared in 12 of 14 and remained only in the cigarette smokers. Inspiratory rales cleared completely in most patients (11 of 12) and partially in one. The rales usually returned during exacerbations. Physiologic measurements that changed significantly after bilateral lavage included: vital capacity, total lung capacity, resting room air PO2, exercise PO2, PO2 while breathing 100 per cent O2, and DLCO. Because all measurements were made within 5 days of the second lavage, one must attribute the acute improvement to the removal of proteinaceous material from the alveoli. The long-term effects varied; some patients required annual or semiannual lavages, wherease others remained in remission after lavage for 36 to 96 months. Exacerbations were accompanied by increased dyspnea, reappearance of rales, and deterioration of the gas-exchange parameters noted previously. Repeat lavage reversed the clinical symptoms and physiologic abnormalities in patients who had recurrences.
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PMID:Physiologic effects of bronchopulmonary lavage in alveolar proteinosis. 69 76

Preliminary results of this retrospective-prospective analysis of renal hypertension in 110 children indicate that hypertension may be secondary to a wide variety of acute progresive, and chronic renal diseases which may be either congenital or acquired. Affected children may be detected at any time from infancy through adolescence. Symptoms usually associated with acute glomerulonephritis (i.e., headache, swelling, nausea, vomiting, anorexia, fatigue, dizziness, and fever) occur in both acute and chronic renal diseases associated with hypertension. Headache and swelling are the most common symptoms in this series. Peripheral edema, rales, and increased heart size were found in between 10 and 25% of these children. Differential diagnosis may be approached by a consideration of causes of acute and chronic hypertension. The child with chronic renal disease usually presents with a long history of fatigability, poor growth, and pallor, and laboratory tests reveal elevation of the creatinine and BUN along with anemia, hypocalcemia, and hyperphosphatemia. In contrast, the child with acute renal disease and hypertension presents with a history of prior good health followed by the abrupt onset of signs and symptoms of renal disease; laboratory tests usually reveal modest elevations of creatinine and BUN, anemia is unusual, an abnormal urinalysis is common, and serum calcium and phosphorous levels are usually normal. Renovascular and asymmetric renal parenchymal disease represent uncommon but important conditions because surgery may be curative. Treatment may be surgical, medical, or combined. Surgical conditions include renal trauma, hydronephrosis, asymmetric renal disease, and renal arterial disease. Adequate blood pressure control without medication can be expected following surgery in instances of unilateral involvement with a normal contralateral kidney. Meticulous assessment of the contralateral kidney is needed to determine that it is normal. If surgery is unsuccessful or is not indicated, pharmacologic therapy is initiated with a stepwise regimen starting with the mildest agent (e.g., thiazides) and then adding additional antihypertensive drugs when adequate blood pressure control has not yet been achieved. The goal of therapy is the lowest, safest, tolerated blood pressure levels. Long-term, carefully designed studies of antihypertensive agents for children with renal hypertension are not available. The need for collection and critical analysis of data concerning the clinical course of children with renal hypertension is evident from a review of the literature and from the preliminary data presented in this series. The presentation of such information and a critique of outcome variables will provide a basis for program planning for affected children and improvement in patient care where indicated.
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PMID:Renal hypertension in children. 99 44

A large-scale, prospective, 8-week, office-based study was conducted to evaluate the effects of adding captopril to a therapeutic regimen of diuretic and digoxin or diuretic alone in the management of patients with mild to moderate congestive heart failure (CHF). A total of 2218 primary care physicians evaluated 6669 patients over the study period for efficacy parameters, which included changes in a modified New York Heart Association (NYHA) functional classification, symptomatology, and daily activity levels. Overall, 63.8% of evaluated patients improved with regard to functional ability, with 19% improving two or more modified NYHA classes. Symptoms of CHF, including dyspnea on exertion, fatigue, and orthopnea and signs, including rales and peripheral edema, were reduced in 86% of these patients: 41.5% demonstrated mild improvement; 30.0%, moderate improvement; and 14.5%, marked improvement. Three parameters, with which patients reported having difficulty at study entry, were assessed serially to evaluate changes in functional capacity; 78.5% of patients reported an increased walking distance, 72.3% had increased capacity for climbing stairs, and 60.2% had improved capacity for individual recreational activities. Adverse experiences were reported in 18.1% of all patients; 4.9% of patients withdrew from the study because of an adverse effect. Combination therapy with captopril and diuretic for CHF was shown to be safe and effective regardless of patient age (less than 70 years vs. greater than or equal to 70 years), duration of heart failure (less than 1 year vs. greater than 1 year), presence of digoxin treatment, or the dosing schedule employed.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A large-scale trial of captopril for mild to moderate heart failure in the primary care setting. 191 72

This is a review of the effects of E on the symptoms of CHF which affect patients' (pts) quality of life and the signs associated with pts' prognosis. The review is based on clinical studies which were included in the New Drug Application for Vasotec (enalapril maleate, MSD) in the United States. There were 3 open-label (242 pts) and 4 double-blind, placebo (P)-controlled (661 pts) studies of at least 1 month and up to about 2 years duration. One of these, the CONSENSUS Trial evaluated mortality in 253 pts with class IV CHF. Dyspnea and fatigue are considered the most disabling symptoms causing pts' functional impairment and thus reducing the quality of life. Left ventricular gallop, pulmonary rales, cardiomegaly, and ejection fractions are known to adversely effect pts' prognosis. Evaluations of these signs, symptoms, and scores related to these symptoms were included in most, but not all, studies. The pts' NYHA cardiac status was evaluated in all studies. E alleviated the signs and symptoms of CHF and improved various scores in significant number of pts. Pts' quality of life improved as indicated by the number of pts "feeling better" after Rx with E (p less than 0.01 vs P) in a multinational study of 256 pts; reductions of cardiomegaly and increases in ejection fraction were significantly greater in E than in P treated pts; and in severe CHF (CONSENSUS Trial) the mortality was significantly reduced (p less than 0.003 vs P).
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PMID:Enalapril in the treatment of congestive heart failure: effects on signs, symptoms and mortality. 204 70

We describe the clinical characteristics and actuarial survival of a consecutive cohort of 41 patients with rheumatoid arthritis and clinical pericarditis who were seen at the Mayo Clinic between 1970 and 1987 and followed up until death or through 1987. The survivors were followed up for a median of 5.1 years. Approximately three-fourths of our patients had acute pericarditis, the remainder having recurrent acute pericarditis, chronic pericarditis with effusion, or chronic constrictive pericarditis. Most patients had symmetrical joint swelling, morning stiffness, subcutaneous nodules, rheumatoid factor, and classic radiographic changes of rheumatoid arthritis. Common extra-articular features included fatigue, loss of weight, and fever. Dyspnea or orthopnea, typical pericardial pain, peripheral edema, tachycardia, tachypnea, a diminished mean blood pressure, a pericardial friction rub, jugular venous distension, rales, radiographic evidence of cardiomegaly and pleural effusions, and abnormal echocardiograms were the most common cardiac manifestations. An elevated erythrocyte sedimentation rate and anemia were other common laboratory findings. Our cohort demonstrated decreased survival in comparison with an age- and sex-matched North Central white population (from the upper midwestern United States), especially during the first year after diagnosis. Increasing age, the presence of other heart disease, an increasing total number of other extra-articular manifestations of rheumatoid arthritis, jugular venous distention, and a lower mean blood pressure were associated with decreased survival.
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PMID:Rheumatoid pericarditis: clinical features and survival. 231 40

Hypersensitivity pneumonitis (extrinsic allergic alveolitis) represents a spectrum of granulomatous, interstitial, and alveolar-filling lung disorders of which farmer's lung is a classic example. A major source of offending antigens in these diseases are thermophilic actinomycetes growing in moldy vegetable matter especially Micropolyspora faeni, and members of the Thermoactinomyces genus. Acutely, hypersensitivity pneumonitis presents as cough, dyspnea and fever, with crepitant rales, leucocytosis, diffuse interstitial and alveolar pulmonary infiltrates and a restrictive-type pulmonary functional deficit. Symptoms usually begin 4 to 6 hr after exposure to large quantities of causative organic dust. Chronically, these diseases may present with the gradual onset of cough, dyspnea on exertion, fatigue, anorexia, and weight loss which may progress to pulmonary fibrosis or severe pulmonary insufficiency. While early ideas on the pathogenesis of hypersensitivity pneumonitis support the role of Type III immune complex hypersensitivity, more recent evidence attests to the important and integral role of Type IV or delayed-type hypersensitivity. It is the purpose of this review, therefore, to describe those immune mechanisms relevant to the pathogenesis of hypersensitivity pneumonitis and stress the importance of "local" pulmonary immune responsiveness.
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PMID:Immunology of hypersensitivity pneumonitis. 676 Oct 66

Hypertension is associated with the remodeling of left ventricular geometry and abnormalities of function that may precede geometric changes. Rather than a specific disease, "hypertensive heart failure" is a spectrum of disorders that result from left ventricular geometric changes and comorbid conditions. Heart failure may present as abnormalities of diastolic or systolic function, although symptoms (dyspnea, fatigue) and physical findings (edema, rales) may be similar.
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PMID:Hypertensive heart disease and heart failure. 749 52

Near infrared spectroscopy (NIRS) is a noninvasive technique of monitoring tissue oxygen saturation by detecting changes in tissue absorbance of two wavelengths (850 and 760 nm) reflecting the relative oxygenation of hemoglobin and myoglobin. Aim of the present study was to determine whether changes in skeletal muscle oxygen saturation during incremental exercise detected by NIRS can reflect an impared oxygen delivery and an early onset of anaerobic metabolism in patients with chronic heart failure (CHF). We studied 19 subjects (mean age 43 +/- 16 years). Seven patients had a history of CHF with a diagnosis of ischemic cardiomyopathy (Group A) and 12 were healthy sedentary (Group B). All patients had a history of dyspnea on exertion (NY-HA II), peripheral edema, pulmonary rales and cardiac gallop sounds over the last 6 months. They were in sinus rhythm and stable clinical condition in the last 3 months. They were well matched regarding age, sex and body surface area. All subjects performed an incremental work rate test in a ramp pattern on a upright cycle ergometer until volitional fatigue. Gas exchange was measured breath by breath with a metabolic chart. Muscle oxygenation was determined, transcutaneously, during the exercise test over the vastus lateralis muscle with NIRS. At peak exercise, work rate, VO2, anaerobic threshold (LAT), heart rate and systolic blood pressure were significantly lower in Group A compared to Group B (92 +/- 28 vs 232 +/- 17 watts; 14 +/- 2 vs 21 +/- 2 ml/kg/min; 868 +/- 225 vs 1317 +/- 354 ml/min; 149 +/- 7 vs 172 +/- 18 b/min; 145 +/- 18 vs 195 +/- 21 mm Hg, respectively; p < 0.0001 for all). In both groups, as work rate increased, tissue oxygenation initially either remained constant near resting levels or decreased. In both groups, muscle oxygenation decreased more steeply near the work rate where lactic acidosis (LAT) was detected. However, patients with CHF had an earlier acceleration in muscle deoxygenation compared to the other group, indicating a premature onset of anaerobic metabolism. Moreover, Group A had a flatter increase in both heart rate and systolic blood pressure and a steeper slope of oxygenation profile at all matched workloads compared to normals (Group A: -0.13 +/- 0.03 ml/min; Group B: -0.06 +/- 0.015 ml/min; p < 0.0001). The LAT correlated with the work rate at which the rate of tissue O2 desaturation accelerated (r = 0.94; p < 0.0001).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Near infrared spectroscopy and changes in skeletal muscle oxygenation during incremental exercise in chronic heart failure: a comparison with healthy subjects. 764 20

To determine if spirometric changes reflect early high-altitude pulmonary edema (HAPE) formation, we measured the FVC, FEV1, and FEF25-75 serially during the short-term period following simulated altitude exposure (4,400 m) in eight male subjects, four with a history of HAPE and four control subjects who had never experienced HAPE. Three of the four HAPE-susceptible subjects developed acute mountain sickness (AMS), based on their positive Environmental Symptom Questionnaire (AMS-C) scores. Clinical signs and symptoms of mild pulmonary edema developed in two of the three subjects with AMS after 4 h of exposure, which prompted their removal from the chamber. Their spirometry showed small decreases in FVC and greater decreases in FEV1 and FEF25-75 after arrival at high altitude in the presence of rales or wheezing on clinical examination and normal chest radiographs. One of the two subjects had desaturation (59 percent) and tachycardia during mild exercise, and excessive fatigue and inability to complete the exercise protocol developed in the other at 4 h. The six other subjects had minimal changes in spirometry and did not develop signs of lung edema. Further, we measured each subject's ventilatory response to hypoxia (HVR) prior to decompression to determine whether the HVR would predict the development of altitude illness in susceptible subjects. In contrast to anticipated results, high ventilatory responses to acute hypoxia, supported by increased ventilation during exposure to high altitude, occurred in the two subjects in whom symptoms of HAPE developed. The results confirm that HAPE can occur in susceptible individuals despite the presence of a normal or high ventilatory response to hypoxia.
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PMID:Pulmonary function and hypoxic ventilatory response in subjects susceptible to high-altitude pulmonary edema. 841 62

Unclear pulmonary infiltrates with eosinophilia, a problem of differential diagnosis. HISTORY AND ADMISSION FINDINGS: A 60-year-old woman was admitted for the diagnosis of pulmonary infiltrates. A year before she had been exposed to tuberculosis when working as a doctor in Manila, the Philippines. Ten days before admission she had spent 10 days in Sao Paulo, Brazil. On admission she complained of fatigue, dry cough and nocturnal sweating. Her body temperature was 37.8; C. At auscultation of the chest fine rales were heard with diminished percussion sounds over both lungs. INVESTIGATIONS: The chest radiogram showed bilateral apical infiltrates. Blood count indicated normal white and red cells, but platelets were raised to 606 x 10 9/l. The differential blood count revealed an eosinophilia of 30%, ESR was raised at 91 mm/h and C-reactive protein increased to 103 mg/l. Angiotensin-converting enzyme, IgG, IgA, IgM, IgE, C3 and C4, paraproteins, antinuclear antibodies and double-strand DNA antibodies were all within normal limits. There was no direct or indirect evidence of tuberculosis and no parasites were found in sputum, stool, urine and blood. DIAGNOSIS, TREATMENT AND COURSE: After bronchoscopy with bronchial biopsy had failed to establish a diagnosis, an open lung biopsy with partial lung resection was performed. This revealed histologically an eosinophilic pneumonia with intra-alveolar protein precipitation and multinucleated giant cells, as well as interstitial fibroblast proliferation without demonstrable mincroorganisms. Under cortisone administration there was striking improvement of symptoms within a few days, and C-reactive proteins fell to 3 mg/l, ESR to 25 mm/h and the eosino-philia to 2%. CONCLUSION: Eosinophilic pneumonia should be included in the differential diagnosis of unclear pulmonary infiltrations with eosinophilia, once parasitological and malignant diseases, tuberculosis and allergic pulmonary aspergillosis have been excluded.
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PMID:[Unclear pulmonary infiltrates with eosinophilia, a problem of differential diagnosis] 1275 Oct 17


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