Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020440 (hypercapnia)
 7,939 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 38-year-old patient with effort dyspnea, somnolence, cianosis and cor pulmonale is presented. Chest roentgenograms and lung function studies suggested the diagnosis of pulmonary fibrosis. The patient showed also severe hypercapnia with normal resting ventilation and ventilatory response to exercise lower than usual for this condition. Autopsy confirmed the clinical diagnosis. This subject may belong to the growing group of patients where CO2 retention is not explained by their pulmonary pathology.
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PMID:Idiopathic interstitial pulmonary fibrosis with hypercapnia. 117 39

This study reports clinical and neuropathological findings in six premature infants dying after prolonged assisted ventilation (IPPB and CPPB) due to pulmonary insufficiency (gestational age: 26.--32. week; birth weight 820--1400 Gm; respirator therapy 41--143 days; survival 104--263 days). During the rspirator therapy the children developed marked extensor rigidity of the trunc and spasticity of the extremities. Postmortem examination revealed cor pulmonale and right ventricular failure. Signs of marked perinatal brain damage were missed. The slightly atrophic brains showed predominant damage to the telencephalic white matter of varying intensity ranging from focal necroses to gliosis and retarded myelination. Constant findings were increased vascularisation and transformation of the premyelinating glia into astrocytes in the deep and subcortical white matter. This form of telencephalic leucoencephalopathy indicates the particular vulnerability of the developing white matter in conditions with chronic hypoxia, hypercapnia, acidosis and vascular congestion. The varying intensity of the lesions suggests that, in principle, minor lesions are either reversible or may be compensated in surviving children.
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PMID:Telencephalic leucoencephalopathy in premature infants dying after prolonged artificial respiration. Report on 6 cases. 124 20

The Medical Research Council and the Nocturnal Oxygen Therapy Trial studies clearly demonstrated that long-term oxygen therapy (LTOT) for more than 15 h/day improved mortality and morbidity in a well-defined group of patients with chronic obstructive pulmonary disease. There are no similar randomised control studies in patients with other hypoxaemic lung diseases such as pulmonary fibrosis and pneumoconiosis. The prescription of oxygen for other restrictive lung disorders is complicated by hypoventilation requiring mechanical support as well as oxygen and should be restricted to special centres. The clearest indications for LTOT are for patients with cor pulmonale, hypoxic chronic bronchitis and emphysema, and in terminally ill patients who require palliation. Before LTOT is considered, the patient must be clinically stable and on appropriate optimum therapy such as antibiotics, bronchodilators, physiotherapy and having stopped smoking tobacco. Many patients first present for LTOT with profound hypoxaemia and hypercapnia during an infective, often oedematous exacerbation of their lung disease. Assessments should occur during convalescence when the patient is clinically stable. They should be shown to have a PaO2 less than 7.3 kPa and/or a PaCO2 greater than 6 kPa on two occasions at least 3 weeks apart. FEV1 should be less than 1.5 litres, and there should be a less than 15% improvement in FEV1 after bronchodilators. All patients should be assessed by an experienced chest physician. Patients with a PaO2 between 7.3 and 8 kPa who have polycythaemia, right heart failure or pulmonary hypertension may gain benefit from LTOT but this is still to be clearly proven.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Indications for long-term oxygen therapy. 151 74

As more women with cystic fibrosis (CF) live to childbearing age, more become pregnant and deliver healthy infants. A 1980 review shows 129 pregnancies in 100 CF women. 80% were full term. The perinatal mortality rate was 8.5% (almost all deaths were premature infants). 18% of the mothers dies within 2 years of delivery, but none died during pregnancy. This mortality rate matched the expected rate for nonpregnant CF women at the same age. If CF women are in sound health and want to have children, physicians should encourage them to do so. Despite rumors to the contrary and theoretical problems with dehydrated cervical mucus, women with mild CF have little difficulty conceiving. Overall contraception issues are the same for both CF women and non-CF women. A few differences do exist, however. CF women should prevent unwanted pregnancy because an abortion poses special risks for them and the child adds more demands on a woman who often needs hospital care. Unpredictable absorption in the intestines makes oral contraceptives unreliable for CF women. A CF woman must consider timing, family support, and genetics of the father when planning a pregnancy. Pregnancy may not affect lung function greatly because lung volume in CF women depends on the condition of the airways rather than the size of the thoracic cage. In pregnant women with severe CF, minute ventilation cannot rise enough so hypercapnia occurs, and blood volume and cardiac output may increase 50% in the 3rd trimester. All these changes could trigger cor pulmonale in these women. Pregnancy is contraindicated for CF women with raised PaCO2, and SaO2 of 90%, and cor pulmonale. Physicians should manage pregnant CF women the same as they would other women, but increase emphasis on controlling pulmonary infection and adequate nutrition. They should also avoid teratogenic drugs and drugs with no proven record.
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PMID:Cystic fibrosis and pregnancy. 159 39

Laparoscopic cholecystectomy uses carbon dioxide, a highly diffusable gas, for insufflation. With extended periods of insufflation, patient arterial carbon dioxide levels may be adversely altered. Patients were selected for laparoscopic cholecystectomy using the same criteria as for open cholecystectomy. Twenty patients (group 1) had normal preoperative cardiopulmonary status (American Society of Anesthesiologists class I), while 10 patients (group 2) had previously diagnosed cardiac or pulmonary disease (class II or III). Demographic, hemodynamic, arterial blood gas, and ventilatory data were collected before peritoneal insufflation and at intervals during surgery. Patients with preoperative cardiopulmonary disease demonstrated significant increases in arterial carbon dioxide levels and decreases in pH during carbon dioxide insufflation compared with patients without underlying disease. Results of concurrent noninvasive methods of assessing changes in partial arterial pressures of carbon dioxide (end-tidal carbon dioxide measured with mass spectrographic techniques) may be misleading and misinterpreted because changes in partial arterial pressures of carbon dioxide are typically much smaller than changes in arterial blood levels and, unlike arterial gas measurements, do not indicate the true level of arterial hypercarbia. During laparoscopic cholecystectomy, patients with chronic cardiopulmonary disease may require careful intraoperative arterial blood gas monitoring of absorbed carbon dioxide.
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PMID:Analysis of the hemodynamic and ventilatory effects of laparoscopic cholecystectomy. 183 Jul 38

Cor pulmonale is right ventricular enlargement secondary to pulmonary hypertension. Although most often caused by parenchymal lung disease, derangements of the ventilatory drive, the respiratory pumping mechanism, or the pulmonary vascular bed may also result in right ventricular hypertrophy and dilatation. Arterial hypoxemia (and resultant polycythemia), hypercapnia, and respiratory acidosis all contribute to the increased afterload on the right ventricle. Diagnosis is often difficult, since pulmonary vascular disease, pulmonary hypertension, and cor pulmonale have few specific manifestations, especially early in their evolution. Treatment is primarily directed at the underlying pulmonary or ventilatory disorder, rather than at the right ventricular failure per se. Supplemental oxygen is essential to avoid hypoxia; corticosteroids, anticoagulants, vasodilators, and other specific therapies are used as indicated to treat the underlying pulmonary disorders. When medical therapies fail, lung or heart-lung transplantation has become a possibility for selected patients.
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PMID:Chronic cor pulmonale. Etiology and management. 239 36

The perioperative anaesthetic management of an adult patient with central alveolar hypoventilation syndrome (CAHS), Ondine's Curse, is described for anterior resection of a carcinoma of the bowel. This rare syndrome results in alveolar hypoventilation, hypercarbia, hypoxaemia with secondary polycythaemia, pulmonary artery hypertension, and cor pulmonale. Epidural morphine was used for postoperative analgesia in an attempt to improve postoperative respiratory function. However, postoperative mechanical ventilation was required until recovery of the respiratory drive, which was ablated by anaesthetic drugs, epidural morphine and high inspired oxygen concentrations. The pathophysiology and treatment of this syndrome are reviewed.
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PMID:Anaesthesia for a patient with central alveolar hypoventilation syndrome (Ondine's Curse). 229 95

A female case of Japanese summer-type hypersensitivity pneumonitis who was a smoker developed in chronic respiratory failure several years later. Biopsy specimen on first admission showed findings of granulomatous bronchioloalveolitis distributed in the center of secondary lobules. Pulmonary function studies demonstrated restrictive disease with high RV% and low airway conductance. In spite of steroid therapy, dyspnea persisted and the same symptoms were found on next summer. Six years later symptoms of chronic respiratory failure and cor pulmonale developed. Chest X-Ray showed dilated pulmonary artery, cardiomegaly and overinflation without apparent fibrosis. Hypoxemia and hypercapnia were also seen on blood gas analysis. Pulmonary function was unchanged compared to the findings on first admission. Since then long term oxygen therapy was started. It was thought that irreversible small airway disease caused by hypersensitivity pneumonitis was attributable to cor pulmonale and chronic respiratory failure because of her smoking habit and long period of exposure to antigen. As a patient with summer type hypersensitivity pneumonitis always has a possibility of chronic disease developing after long term exposure to antigen, such as a farmer's lung, the cessation of exposure to antigen by complete cleaning up of the patient's environment or moving out were considered to be important.
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PMID:[A case of summer type hypersensitivity pneumonitis resulting in chronic respiratory failure and cor pulmonale]. 262 12

In 75 COPD patients with (group I) or without (group II) cor Pulmonale, we measured plasma renin activity (PRA), angiotensin I and II (ATI and ATII), and aldosterone (Ald) by RIA. We found that the levels of PRA, ATI, ATII, Ald in group I are all higher than those in 25 healthy subjects and in group II (P less than 0.05, P less than 0.001), The PRA, ATI, ATII, Ald also increased in patients with respiratory failure, especially accompanied by hypercapnia, and in patients with hyponatrium. In addition, the strong correlation was found between PaO2, PaCO2 and RAAS activation. These findings suggest that the activation of RAAS increased significantly in COPD patients with cor pulmonale or with respiratory failure, and the changes may involve in the pathophysiologic process in COPD patients.
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PMID:[The renin-angiotensin-aldosterone system changes in chronic obstructive pulmonary disease]. 263 30

Renal function was assessed in 89 patients with advanced chronic obstructive pulmonary disease and chronic cor pulmonale, 62 of them had respiratory failure, 18 health aged served as control. The results showed that the creatinine clearance and the free water clearance were decreased in 82.3% and 69.5% of patients with respiratory failure respectively. The renal function was impaired in case of hypoxia, PaO2 less than or equal to 6.0 kPa (45 mmHg), mean 5.33 kPa (40 mmHg). Hypercapnia was one of the most important factors that effected the renal function. There was a clinical threshold which effected the renal function, i.e. PaCO2 equals more than 8.67 kPa (65 mmHg). Renal function was greatly impaired if hypercapnia and hypoxia exist at the same time. The impairment of renal function was further marked when right heart failure and acidosis developed. The causes and effects of the abnormality of renal function were preliminarily discussed.
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PMID:[Influence of acute respiratory failure on renal function in advanced chronic obstructive pulmonary disease and chronic cor pulmonale]. 263 31


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