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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The relation of shortness of breath to left ventricular end diastolic pressure and the severity of coronary artery disease was evaluated in 146 patients with normal segmental and global left ventricular systolic performance. None had chronic lung disease, cardiomyopathy, previous myocardial infarction, uncontrolled hypertension or unstable angina pectoris. A strong relationship was found between shortness of breath and elevated left ventricular end diastolic pressure, and a borderline relationship with the severity of coronary disease. Shortness of breath as a clinical symptom indicates diastolic dysfunction in this selected group of patients.
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PMID:Relation between shortness of breath, left ventricular end diastolic pressure and severity of coronary artery disease. 874 75

Lung transplantation is now an accepted modality for treating end-stage lung disease. To better understand the factors limiting the survival of these patients, we reviewed the autopsy findings in 37 patients who received lung transplants. Between 1986 and 1995, 131 patients have undergone lung transplantation at our institution, including 4 patients with repeat transplantations. Of these, 48 (36.6%) died, 37 (77%) of whom had an autopsy. The autopsied patients were divided into three groups on the basis of post-transplantation interval: early (< 30 d), intermediate (31-365 d), and late (> 365 d). Of the 12 patients in the early group, 6 died of intra- and postoperative complications and 6 of bacterial infection with pneumonia in the transplanted lung. There were 18 patients in the intermediate group, of whom 11 died of infection (5 of cytomegalovirus, 5 of nonviral infections of the transplanted lung, and 1 of encephalomyelitis), 3 of post-transplantation lymphoproliferative disorder, 3 of chronic airway rejection, and one of unrelated cause. Of the seven patients in the late group, four died of chronic airway rejection, two of unrelated causes, and one of bacterial infection. Native lungs examined in 23 patients showed, in addition to the primary disease, bacterial pneumonia in 5, post-transplantation lymphoproliferative disorder in 3, cytomegalovirus in 2, and aspergillosis in 1. In this series of 37 autopsied patients, chronic rejection was the cause of death in 7 and was concomitantly seen in 3 patients (27%). In summary, the most common cause of death was infection (48%), followed by chronic rejection (19%), surgical complications (19%), post-transplantation lymphoproliferative disorder (7%), and unrelated causes (7%); rejection was not a major cause of death in the early and intermediate post-transplantation periods; in 30% of native lungs, significant pathologic findings were present in addition to the primary disease; and in the intermediate post-transplantation period, significant left ventricular hypertrophy occurred, which may be attributable to cyclosporine-induced hypertension but which needs to be further studied.
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PMID:Postmortem findings in lung transplant recipients. 883 58

We examined the relationship between a family history of asthma (FHA), neonatal chronic lung disease (CLD), and oxygen dependency in an inception cohort study of all 24- to 30-week gestation infants admitted to the sole tertiary perinatal center in Western Australia. One hundred and forty-four infants were admitted during the study period; 116 had data analyzed, 112 of whom survived to discharge. Respiratory morbidity was common and the prevalence increased with decreasing gestation. Hyaline membrane disease (HMD) occurred in 92 (79%) and CLD (oxygen dependency at 28 days) in 62 (53%); 35 (30%) were oxygen dependent at 36 weeks corrected age, and 16 (14%) were oxygen dependent at term. Thirty-two infants had an FHA which was equally distributed between those infants with and without CLD. Infants with an FHA were more likely to be oxygen dependent at term (relative risk 4.4; 95% Cl 1.7,11.1). Thirty-eight percent of mothers smoked; 68% of their infants developed HMD compared to 89% of those whose mothers did not smoke. Logistic regression identified GA<28 weeks (OR 7.3; 95% Cl 1.4,39), severe HMD (OR 4.8; 95% Cl 1.1,22), and FHA (OR 11.0; 95% Cl 2.3,53) as the only factors associated with an increased risk of being oxygen dependent at term. The duration of supplemental oxygen in infants with CLD was significantly related to decreasing gestation, greater degree of barotrauma, presence of HMD, pregnancy-induced hypertension in the mother, duration of patent ductus arteriosus, and an FHA. An FHA may worsen chronic lung disease in the neonate, but is not involved as a causal factor. Clinicians should be aware of its influence on duration of oxygen supplementation when counselling parents of very preterm infants.
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PMID:Neonatal chronic lung disease, oxygen dependency, and a family history of asthma. 890 97

Long-term outcome was studied in 233 patients who had undergone renal artery revascularization (51 with balloon angioplasty, 182 with surgery) between 1976 and 1992. Patients (excluding renal transplants) were treated for renal vascular hypertension without or with renal insufficiency (serum creatinine > 1.6 mg/dl. All patients still alive (n = 188) were contacted to determine current blood pressure, medications, serum creatinine, and subsequent significant medical events. In patients who had died the cause of death was determined and renal function status at the time of death noted from medical records. Some follow-up information was obtained on all 233 patients; follow-up serum creatinine data were obtained in 193 (82.8%) patients. Some 24 patients (10.3%) became dialysis-dependent. Using a multiple logistic regression analysis only, preoperative creatinine maintained significance (P < 0.001) for increased dialysis risk. There was no statistically significant association of dialysis for type of revascularization (percutaneous transluminal angioplasty, autogenous artery, saphenous vein, endarterectomy or synthetic material), simultaneous or previous aortic or other vascular surgery (carotid endarterectomy, femoropopliteal bypass, etc.), pathology (atherosclerosis or fibromuscular dysplasia), number of renal arteries stenosed or treated, length of follow-up, age, coronary artery disease, congestive heart failure, stroke, chronic lung disease or type II diabetes. It is concluded that, in patients with renal artery stenosis, the timing of renal artery revascularization relative to the level of renal function is the most important determinant for long-term renal salvage.
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PMID:Late renal function in patients undergoing renal revascularization for control of hypertension and/or renal preservation. 890 17

The use of corticosteroids as a treatment for chronic lung disease is increasing in newborn intensive care units. The anti-inflammatory mechanism of steroids suppresses the pulmonary inflammatory response, leading to improved pulmonary compliance and often a successful extubation. However, side effects, including sepsis, hypertension, glucosuria, and heme positive stools, have been reported. Caregivers must appreciate the multisystem biochemical effects of corticosteroids and anticipate the potential side effects when administering this medication. The article reviews the biochemical processes of dexamethasone, a synthetic corticosteroid, and presents a case study of an infant receiving dexamethasone. A question-and-answer format is interpolated throughout the case study and is intended to challenge the reader's knowledge of the pathophysiology of chronic lung disease and the biochemical actions of corticosteroids. Implications for nursing assessment and management of infants receiving this medication are reviewed.
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PMID:Bronchopulmonary dysplasia and corticosteroid therapy: a case review. 893 70

The association between alpha1-antitrypsin (A1AT) deficiency and glomerulonephritis has only sporadically been reported, and mostly based upon autopsy findings, as opposed to the more frequent linkage between A1AT deficiency and lung emphysema with or without hepatic cirrhosis. The present case report describes a 30-year-old man with A1AT deficiency, without evidence of lung disease, who developed hepatic cirrhosis in early childhood and IgA glomerulonephritis and hypertension in adult life. The IgA nephritis followed an unusual course, with a sudden deterioration of the renal function, possibly induced by uncontrolled hypertension or the possible occurrence of vasculitis. After 6 months of hemodialysis, the patient successfully underwent living-related-donor kidney transplantation.
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PMID:Alpha-1-antitrypsin deficiency associated with hepatic cirrhosis and IgA nephritis. 934 92

beta-Adrenoceptor antagonists (beta-blockers) reduce mortality and recurrent myocardial infarction (MI) in older patients after both Q-wave MI and non-Q-wave MI. The effects of beta-blockers are to: (i) reduce complex ventricular arrhythmias, including ventricular tachycardia; (ii) increase the ventricular fibrillation threshold; (iii) reduce myocardial ischaemia; (iv) decrease sympathetic tone; (v) markedly attenuate the circadian variation of complex ventricular arrhythmias: (vi) abolish the circadian variation of myocardial ischaemia; and (vii) abolish the circadian variation of sudden cardiac death or MI. beta-Blockers reduce mortality in patients with MI and complex ventricular arrhythmias. In addition, they are excellent antianginal agents. Older persons with hypertension who have had an MI should be treated initially with a beta-blocker. beta-Blockers reduce mortality in patients with: (i) diabetes mellitus who have had an MI; (ii) MI and congestive heart failure with an abnormal or normal left ventricular ejection fraction; and (iii) MI and an asymptomatic abnormal left ventricular ejection fraction. Severe congestive heart failure, severe peripheral arterial disease with threatening gangrene, greater than first degree atrioventricular block, hypotension, bradycardia, lung disease with bronchospasm, and bronchial asthma are contraindications to treatment with beta-blockers.
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PMID:Postinfarction use of beta-blockers in elderly patients. 941

Sickle cell disease is the most common inherited disease in the African American population. Multiorgan pathologic features with a predilection for thoracic organs predominate. Acute cardiopulmonary diseases include acute chest syndrome, pneumonia, and left ventricular failure. Cardiomegaly, pleural effusions, pulmonary consolidation, pulmonary edema on chest radiographs, and ground-glass opacities on computed tomographs are characteristic. Chronic changes include sickle cell lung disease with lung fibrosis, pulmonary arterial hypertension, hyperkinetic circulation related to severe anemia, and thoracic skeletal abnormalities; the latter are H-shaped vertebrae, rib infarction, and extramedullary hematopoesis.
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PMID:Thoracic manifestations of sickle cell disease. 955 90

To characterize the factors affecting the decision to withdraw from dialysis, the authors compared patients withdrawing from dialysis (n=62) with patients dying from all other causes (n=242) over 21 years (1976-1996) in a single dialysis unit. Compared with those who died from other causes, patients who withdrew were older (67+/-11 vs 61+/-11 years); were more likely to have severe physical impairment (87% vs 62%) and severe restriction of activities of daily living (77% vs 46%); and had higher frequencies of congestive heart failure (81 % vs 62%), myocardial infarction (60% vs 42%), peripheral vascular disease (71 % vs 40%), and diabetes mellitus (66% vs 36%) (p < or = 0.014). Dialysis modality; duration of dialysis; the degree of family support; index of disease severity; the use of tobacco, alcohol, or illicit drugs; and the frequency of ischemic heart disease, dysrhythmia, pericarditis, cardiac arrest, cerebrovascular accident, hypertension, obstructive lung disease, cancer, and human immunodeficiency virus did not differ between the two groups. Stepwise logistic regression showed that dialysis during 1990-1996, severe limitation of activities of daily living, and diabetes mellitus were independent risk factors for withdrawal. During 1990-1996, 44% of the deaths were caused by withdrawal from treatment. In addition to other factors, dialysis in the 1990s is a strong predictor of withdrawal from dialysis. The reasons for the increased rate of withdrawal from dialysis in recent years, and the effect of this increased rate of withdrawal on mortality, need further evaluation.
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PMID:Twenty-one year mortality in a dialysis unit: changing effect of withdrawal from dialysis. 961 51

A review of the records of all live-born neonates with a birth weight below 1000 g born in 1993-96 at National Taiwan University Hospital was conducted, with emphasis on outcomes and risk factors for mortality. There were 81 extremely-low-birth-weight infants (0.59%) among the 13,835 live births recorded during the 3-year study period and, after exclusion of infants with major anomalies, 73 cases were enrolled for study. The mean gestational age was 27.2 weeks (range, 24-34 weeks). The most common complications of pregnancy leading to premature delivery were antepartum hemorrhage (44%) and pregnancy-induced hypertension. Respiratory distress syndrome occurred in 64%; exogenous surfactant therapy was provided to 47% and 85% received intermittent mandatory ventilation. Symptomatic patent ductus arteriosus occurred in 34% of infants, septicemia in 30%, chronic lung disease in 48%, grade III-IV intraventricular hemorrhage in 27%, stage III-V retinopathy of prematurity in 33%, and necrotizing enterocolitis in 8%. 54 infants (74%) survived the neonatal period and 44 (60.3%) survived until discharge. The survival rate was 40% for infants with a birth weight of 501-750 g and 68% for those weighing 751-999 g. Survival was 27% for infants with a gestational age under 26 weeks compared with 75% for those with a gestational age of 26 weeks and above. Cox regression analysis of survival indicated that Apgar scores at 1 minute, pulmonary hypertension, and severe intraventricular hemorrhage were the most significant contributing factors to mortality.
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PMID:Early outcome of extremely low birth weight infants in Taiwan. 970 Feb 44


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