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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

First prophylactic and therapeutic possibilities in cor pulmonale are shown on the basis of its pathogenesis. Our own results illustrate the effect of therapy of the underlying lung disease and of the concomitant respiratory insufficiency on the pulmonary arterial hypertension. The relationship between pulmonary artery pressure (PAp), arterial oxygen tension, forced expiratory volume of 1 second (FEV1%VC) and slow inspired viral capacity (VC) is analysed. In obstructive respiratory disorders the PAp rises when FEV1 falls below 40% of VC, in restrictive disorders when VC falls below 70% of predicted rate. 27 patients with chronic obstructive lung disease were treated with bronchodilator aerosols by intermittent positive pressure breathing (IPPB) during 2 years after a control period of 2 years: VC and FEV1 improved, the increase of total lung capacity and the deterioration of arterial blood gases came to a halt. The elevated PAp was always significantly reduced by oxygen therapy or IPPB or the combination of both. Finally, the rationale for avoiding physical stress in established cor pulmonale is illustrated: in healthy men PAp increases by less than 20% when cardiac output is doubled. In patients with cor pulmonale PAp rises to three times the initial value under the same conditions.
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PMID:[Prevention and therapy of chronic cor pulmonale (author's transl)]. 2 May 29

Persiting pulmonary arterial hypertension, whether secondary to known lung disease or apparently idiopathic, may induce refractory hypoxaemia in the newborn. Tolazoline, pulmonary vasodilator of choice here, was used to treat this syndrome in 13 newborns. Therapeutic indications, precautions and possible side-effects are discussed.
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PMID:[Refractory hypoxemia in the newborn. Treatment with tolazoline]. 54 38

This study was undertaken in 79 patients with retinal vein occlusion to assess the different systemic mechanisms contributing to the occlusion, namely, intrinsic vessel disease and abnormalities of the blood constituents and blood viscosity. In 55 patients older than 50 years of age, important associations were hypertension, abnormal results on glucose tolerance test, hyperlipidemia, chronic lung disease, and elevated serum IgA levels. In the 24 patients younger than 50 years of age, male incidence was high and important associations were head injuries, hyperlipidemia, and the use of estrogen-containing preparations. Hyperviscosity and cryofibrinogenemia were prominent in both groups. The pathogenesis of retinal venous occlusion is complex involving interaction between the vessel wall and blood constituents.
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PMID:Systemic factors contributory to retinal vein occlusion. 62 51

Circumstances under which the use of oxygen-therapy in lung disease can be effective and harmless, depend upon a careful evaluation of its indications: they are suggested by the clinical need of correction of hypoxaemia as well as by the awareness of factors determining respiratory failure and of problems concerning O(2) transport and supply to tissues in health and disease. Blood gases monitoring enables to control the effects of treatment on arterial O2 and CO2 tensions thus giving all the useful data for oxygen administering particularly as far as components of hyperoxygenated mixtures, flow rate, duration, use of very effective low-risk devices (Venturi masks) are concerned. Correction of hypoxaemia involves the reduction of hypertension of the pulmonary circulation and hyperglobulia, improvement of tolerance of exertion, and attention to the metabolic compensation of respiratory acidosis. These results are influenced by the nature of the pathogenetic factors behind broncho-obstructive disease, which may lead to either a primarily "bronchitis" or a primarily "emphysematous" syndrome. An interesting feature relates to prognosis in the case of patients making home use of hyperoxygenated mixtures as part of a rehabilitation program, or to improve their quality of life. The cost and benifits of such treatment should be carefully weighed. Lastly, in the event of protracted treatment, attention must be paid to the possibility of toxicity and the means to be adopted for its prevention.
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PMID:[Oxygen therapy in pneumology]. 101 8

Left heart diseases, in particular mitral stenosis, are often associated with anatomic and functional alterations of the lung. According to the pulmonary structures involved they could be named chronic secondary intersticial and vascular lung diseases. Congenital heart diseases with pre- or post-tricuspid shunts are also often associated with anatomic and functional alterations of the lung. This condition also constitutes a chronic secondary vascular lung disease (atrial septal defect) or a chronic primary vascular lung disease ( ventricular septal defect, patent ductus arteriosus). Primary lung diseases (interstitial pulmonary fibrosis, pulmonary emphysema, recurrent pulmonary embolism) are often associated with right ventricular hypertrophy with or without dilation, a condition commonly named chronic cor pulmonale. On the whole the interrelationships between heart and lung diseases are as follows: a) anatomic and functional alterations of the lung due to left heart diseases are mediated through pulmonary venous hypertension; b) anatomic and functional alterations of the lung due to congenital heart diseases are mediated through the increased pulmonary blood flow with or without transmission of the systemic blood pressure to the pulmonary vasculature, and c) anatomic and functional alterations of the right ventricle due to primary or secondary lung diseases are mediated through arterial pulmonary hypertension. In summary, the interrelationships between heart and lung diseases are mainly mediated through the pulmonary venous or pulmonary arterial hypertension.
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PMID:Cardiac and pulmonary diseases. A pathophysiologic interelationship. 113 Sep 7

Experience with 1000 cases of aorto-(bi)femoral bypass is presented evaluating factors influencing the overall patency rate and late survival, over a period of 25 years. There were 820 cases with bilateral and 180 with a unilateral bypass. Mortality was 3.3% and death rate 39.4%. Re-do procedures have been excluded. Operative indications were for stage I disease (moderate claudication) (17.6%), stage II (advanced claudication) (53.2%), stage III (rest pain and/or pregangrenous changes) (22.7%) and stage IV (gangrenous tissue loss (6.5%). Myocardial infarction was the predominant cause of late death in 192 cases (48.7%), followed by cancer in 48 (13%), cerebrovascular disease in 43 (11%), chronic lung disease with cor pulmonale in 15 (3.8%) and miscellaneous causes in 52 (13.2%) of patients. The cause of death was unknown in 31 (7.8%) cases. Co-existent peripheral arteriopathy (PAD) noted in 377 (37.7%) patients, was found to be a major determinant of late graft patency. Carotid artery disease and renovascular hypertension were corrected surgically, prior to aorto-femoral bypass in the 5.6% and concomitantly in 4.2%. Coronary artery disease in 273 (27.3%) patients and hypertension in 269 (26.9%), had a great influence on late survival as did age and smoking habits. Endarterectomy together with profundaplasty was carried out in 162 (16.2%) instances. It was our policy to extend the graft limb over the profunda femoris and in cases with co-existent superficial femoral artery disease 208 (20.8%). In 630 (63%) instances, the distal anastomosis was performed at the level of common femoral artery. Immediate graft patency was obtained in 99.3% of the cases. Late patency rate for stages I and II at 5, 10 and 15 years was 82%, 76% and 72% respectively. Following secondary operation for graft occlusion, the 15 year patency was increased to 71%. Co-existent superficial femoral disease can be alleviated by appropriate concomitant profundaplasty. Amputation rates were 0.8% for stage II, 1.5% for stage III and 2.4% for stage IV disease. Twenty year life table analysis showed a reduced survival (54%), in comparison with normal population (77%).
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PMID:Aorto-femoral bypass and determinants of early success and late favourable outcome. Experience with 1000 consecutive cases. 128 3

The aim of this study was to assess if, in the neonatal period, there were differences in the blood pressure (BP) level of infants who did and did not develop chronic lung disease. If such differences were demonstrated to exist, we also hoped to determine influencing factors. Forty infants, consecutively admitted to our unit and who remained there throughout the neonatal period were studied. Twenty infants, median gestational age 29 weeks (range 27-32), did not develop CLD (non-CLD group) and 20 infants, median gestational age 26 weeks (range 24-32), developed CLD. Systolic BP was assessed using a non-invasive Doppler technique on day one and subsequently at weekly intervals. After day one and throughout the neonatal period BP levels, corrected for birthweight, were higher in the CLD group compared to the non-CLD group, by a mean of 5 mmHg. There was no significant difference between the numbers of infants in each group receiving theophylline or pancuronium. Significantly more infants in the CLD group had an umbilical catheter inserted and their catheters remained in situ significantly longer, a median of 8 days compared to a median of one day in the non-CLD group. We conclude that even in the neonatal period infants who develop CLD may have a modest elevation of BP, this is associated with prolonged umbilical arterial catheterisation. Our results, however, suggest that significant hypertension in infants who develop CLD, occurs after the neonatal period.
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PMID:Neonatal blood pressure levels of preterm infants who did and did not develop chronic lung disease. 129 21

Polymyositis-dermatomyositis (PM-DM) is an inflammatory disease of muscle and skin mediated by autoimmune and cellular events. Most typically, muscle weakness is the usual presentation. This review emphasizes that often the systemic components of this disease may mask the usual presentation and actually may be the presenting and only manifestations; more often than not they are the causes of increased morbidity and mortality. In particular, the cardiopulmonary manifestations may dominate the disease course. Cardiac complications include congestive heart failure resulting from a primary cardiomyopathy, disrhythmias and atrioventricular conduction disturbances, sick sinus syndrome, and cor pulmonale either secondary to interstitial lung disease (ILD) or primary pulmonary artery hypertension. Recurrent aspiration pneumonia results from pharyngeal muscle involvement by the myositic process. Several histologic patterns of ILD can emerge with varying outcomes and responses to immunosuppresive therapy. Involvement of the muscles of respiration can lead to hypercapnic respiratory failure, diaphragmatic dysfunction, hypostatic pneumonia, and restrictive lung disease.
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PMID:Pulmonary and cardiac manifestations of polymyositis-dermatomyositis. 157 25

Lung transplantation began to expand in 1983, after the advent of cyclosporin and the publication of the Toronto lung transplant group study. Single lung transplantation was first performed in patients with interstitial pneumopathy to be extended later to pulmonary emphysema, then to primary or secondary pulmonary arterial hypertension. Double lung transplantation provides patients suffering from chronic lung infection (e.g. cystic fibrosis) with a useful alternative to their ordinary treatment. The experience acquired throughout these years has resulted in wider criteria for patients' inclusion. More than acute rejection, bacterial infections directly condition the immediate prognosis. The frequency and severity of cytomegalovirus lung diseases lead to a discussion on the possibility of prophylactic and curative antiviral therapy. The occurrence of obliterative broncholitis, which reflects chronic lung rejection, jeopardizes the long-term results of transplantation. The functional results of the various types of lung grafting are analysed, and the position of lung transplantation in thoracic surgery is reassessed.
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PMID:[Lung transplantation]. 179 34

Although there is increasing evidence that mineral dust exposure will produce obstructive lung disease, there is little information on the effects of mineral dust on the pulmonary vascular system. To examine whether exposure to amosite asbestos would affect the pulmonary vasculature and produce pulmonary hypertension, we instilled 5 mg amosite asbestor intratracheally into guinea pigs. After periods of 3 and 6 months, we examined their pulmonary and pulmonary vascular function, and compared these data to those obtained from groups of control animals. We found that, at both time periods, there was pulmonary arterial hypertension, with alteration of the vascular pressure-flow relationships. This was accompanied by abnormalities in the structure of the small pulmonary arterioles. The animals also showed airflow obstruction, with air trapping and an upward shift of the pressure-volume curve. There was evidence of emphysema, and the animals were moderately hypoxic. We found no consistent increase in inflammatory cells either in lavage or peripheral blood, and the histamine dose-response curves were similar in control and asbestos-exposed animals at 6 months. We conclude that intratracheal instillation of asbestos in the guinea pig produces pulmonary hypertension associated with modest hypoxia, emphysema, and airflow obstruction. Whether pulmonary hypertension reflects emphysema-induced hypoxia and loss of vascular bed, or is related to the brief but intense inflammatory infiltrate induced by asbestos, is unclear.
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PMID:Pulmonary hypertension induced by amosite asbestos: a physiological and morphologic study in the guinea pig. 184 13


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