Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A diffuse interstitial pulmonary fibrosis associated with an idiopathic hepatic cirrhosis occurred in a 79 years old man treated during five years with cyclothiazide and triamterene for a mild systemic hypertension. The outcome was fatal. A provocation test was positive with BAL lymphocytic reaction. Cyclothiazide induced fibrosis is likely.
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PMID:[Fibrosing pneumopathy induced by cyclothiazide. Apropos of a case]. 156 34

Single lung transplantation was performed in several steps: laparotomy to prepare an omentopexy, followed by pneumonectomy and implantation of a pulmonary graft, both by postero-lateral thoracotomy. The patients suffered from lymphangiomyomatosis (1), panacinar emphysema (2) and idiopathic pulmonary fibrosis (1). Immunosuppressive treatment was started before surgery. Anaesthesia was induced and maintained with alfentanil, midazolam and vecuronium. The patients were intubated with a Carlens endotracheal tube. Ventilation was carried out using an oxygen-air mixture, without any nitrous oxide or halogenated anaesthetic agent. Besides the usual parameters, expired CO2 concentrations, and oxygen saturation in the pulmonary artery were monitored. Partial femoro-femoral cardiopulmonary bypass was not required. Three major problems were encountered: hypoxia, hypercapnia, and pulmonary arterial hypertension. Hypoxia first occurred during the period of one-lung ventilation, during pneumonectomy, and again after unclamping of the graft vessels before the bronchus had been anastomosed. It was treated either by increasing the FiO2, inflating the lungs with pure oxygen, or partial clamping of the homolateral pulmonary artery. Hypercapnia occurred in three of the four patients until the graft was ventilated again. Except in one patient with preoperative pulmonary hypertension, the increase in pulmonary vascular resistances remained moderate after clamping of the pulmonary artery. Sufficient oxygen delivery, with more than 50% venous oxygen saturation, was maintained at this time by the infusion of dopamine and dobutamine. Two other specific problems were encountered in the emphysematous patients: severe hypotension following the start of artificial ventilation and after placing the patient in lateral position; thoracic asymetry with overdistension of the emphysematous lung, and mediastinal shift.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Anesthesia in unilateral pulmonary transplantation]. 185 49

Certain system diseases which include vascular involvement may be accompanied by pulmonary artery hypertension (PAHT). This chiefly concerns connective tissue disorders, notably scleroderma, CREST syndrome and mixed connective tissue disease and, to a lesser extent, systemic lupus erythematosus. The onset of PAHT in relation to vasculitis of the great vessels or necrosing angeitis is rare. It may result from pulmonary artery vasoconstriction of hypoxic origin during diffuse interstitial pulmonary fibrosis, a thrombo-embolic mechanism, a vasomotor phenomenon equivalent at pulmonary level to Raynaud's syndrome, and above all from pulmonary vasculitis, the commonest mechanism. The incidence of PAHT is such connective tissue disease is probably underestimated since it is a complication often unrecognised clinically. It is a major cause of death in such conditions, certain of which nevertheless enjoy a benign reputation. With the exception of rare cases of favourable outcomes under the influence of corticosteroids and immunosuppressants in cases of mixed connective tissue disease, no treatment has in fact been shown to be effective in terms of survival.
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PMID:[Pulmonary arterial hypertension and systemic diseases]. 205 30

65 patients with interstitial lung diseases were subdivided into two groups: idiopathic pulmonary fibrosis (IPF) and other interstitial pulmonary diseases (OIP) according to histopathological, immunological and follow-up findings. Arterial blood gases and pulmonary hemodynamics at rest and during steady-state exercise were compared in these two groups (IPF = 31 patients, OIP = 34 patients). The resting PaO2 was significantly lower in the IPF group (p less than 0.001) and regularly worsened during exercise in this group (from 69.6 +/- 11.6 to 56.0 +/- 9.4 mm Hg, p less than 0.001) whereas it did not vary significantly in the OIP group (from 79.2 +/- 13.1 to 75.3 +/- 14.1 mm Hg, NS). Pulmonary artery mean pressure (PPA) was higher in the IPF group (p less than 0.001) as were all indices of pulmonary vascular resistance (PVR). During exercise, PPA markedly increased in the IPF group (from 21.7 +/- 7.8 to 45.3 +/- 16.2 mm Hg) but modestly in the OIP group (from 15.5 +/- 3.7 to 28.3 +/- 9.8 mm Hg). The best relationships were found between PPA, PVR and PaO2, which suggests that pulmonary arterial hypertension in these diseases is not only due to anatomical factors but also to alveolar and arterial hypoxia. Arterial blood gases and pulmonary hemodynamics at rest and during exercise may be of interest for the discrimination of 'true' interstitial fibrosis (IPF) from other interstitial lung diseases (OIP).
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PMID:Pulmonary hemodynamics in idiopathic pulmonary fibrosis and other interstitial pulmonary diseases. 683 87

Respiratory disorders in homozygous drepanocytosis and double SC heterozygosis are mainly dependent on two factors : repeated infections with, more particularly, pneumococcus or mycoplasma, and epidoses of occlusion of the pulmonary circulation. Mutual reinforcement of these two factors occurs, in so far as the relative hypoxia of an infected lung increases the risk of falciform and thrombosis formation in the pulmonary arterioles. The particular physical and chemical properties of the drepanocyte red cell, and the anaemia, themselves lead to parallel disturbances in pulmonary circulation function and gas exchanges. Possible development of respiratory insufficiency is generally, therefore, the result of chronic pulmonary arterial hypertension. However, the results of respiratory function tests are often fairly analogous to those observed in moderate interstitial fibrosis : reduction in vital capacity, alveolo-capillary block, reduction in CO diffusion space, a shunt effect, and diminished pulmonary compliance. This problem is discussed in relation to findings of diffuse interstitial fibrosis in a 34-year-old man with double SC heterozygosis, who had numerous episodes of bone, abdominal, and pulmonary microinfarcts. The presence of a diffuse interstitial pulmonary fibrosis, evoked by radiological criteria and respiratory function tests and confirmed by transbronchial biopsy, no other aetiology being established, raises the question of the possible genesis of the fibrosis from repeated episodes of microvascular occlusion. Many factors may therefore be involved in the formation of fibrosis of this type, not only the pulmonary artery obstruction from the microthrombi but also the macrophagic perivascular inflammatory response related to the presence of foci of infarction and precipitation of pathological intravascular material.
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PMID:[Drepanocytosis and diffuse interstitial pulmonary fibrosis (author's transl)]. 733 30

The authors report the results of the study performed with high resolution CT (HRCT) in a group of 29 patients affected with idiopathic pulmonary fibrosis (IPF). Each patient underwent HRCT at the beginning of the study and after one year. A complete clinico-functional assessment was available in 20 cases and functional CT correlation was made in these patients; 15/20 subjects underwent immunosuppressive therapy with corticosteroids and cyclophosphamide. Disease severity was assessed with chest radiography and HRCT. On the basis of CT findings the patients were classified into three groups, according to Wells classification: predominant ground-glass pattern, mixed pattern and predominant reticular disease with honeycombing. Furthermore, a visual score was assigned to total disease extent and a different score to ground-glass and reticular opacities. Our data confirm the poor accuracy of chest radiography in assessing disease type and overall severity, versus the outstanding diagnostic accuracy of HRCT. We also found a high incidence of mediastinal adenopathies (37.9% of the patients) and signs of pulmonary arterial hypertension (62%), together with low extent of pulmonary emphysema (65.5% of the patients; mean extent: 5.4%). Ground-glass attenuation is an early sign of IPF and might suggest alveolitis activity. In our series, however, the patients with grade I disease were rare (6.8%), but likely to benefit from therapy. Different from Wells, we found no significant difference in the evolution of the patients with grade II versus grade III disease. Wells grading was useful in early disease assessment, but the visual score of total disease extent and the score of ground-glass and reticular opacities were much more useful in the follow-up because they can assess disease progression. Furthermore, in the few patients with predominant alveolitis, who improve after therapy, the relative prevalence of the reticular pattern might allocate the patient in a higher Wells group with a "paradoxical" worsening, if the visual score of the extent of the primary lesion is not used.
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PMID:[The assessment of the activity of idiopathic pulmonary fibrosis by high-resolution computed tomography]. 862 37

A diffuse interstitial pulmonary fibrosis occurred in a 74-year-old woman treated for ten years with labetalol for systemic hypertension. Bronchoalveolar lavage (BAL) revealed lymphocytic and neutrophilic alveolitis. The lack of another etiologic factor and the spontaneously favorable course after withdrawal of the drug support the hypothesis of a labetalol induced pulmonary fibrosis.
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PMID:[Fibrosing pneumopathy caused by labetalol]. 873 54

There are few reports on the use of cyclosporine in idiopathic pulmonary fibrosis, in experimental animals or humans. We report three patients with advanced pulmonary fibrosis in whom steroid therapy failed and that received cyclosporine in a dose of 3 to 5 mg/kg for three to five months. One patient developed systemic hypertension that subsided reducing the dose of cyclosporine. No positive changes in dyspnea were obtained and pulmonary function tests deteriorated during the treatment period. We conclude that cyclosporine treatment had no clinical benefit in these patients with pulmonary fibrosis.
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PMID:[Evaluation of treatment with cyclosporine in three patients with pulmonary fibrosis]. 951 89

A case of advanced cryptogenic fibrosing alveolitis (CFA) with multiple bullae and extensive pulmonary fibrosis, scheduled for modified radical mastectomy for carcinoma of breast, is presented. This patient had ischemic heart disease, corticosteroid-induced hypertension, diabetes mellitus, and a difficult airway. Thoracic epidural segmental anesthesia was successfully given to this patient. Preoperative problems, perioperative management, and alternative anesthetic techniques are discussed.
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PMID:Thoracic epidural anesthesia for modified radical mastectomy in a patient with cryptogenic fibrosing alveolitis: a case report. 1077 15

Lung transplantation has become an accepted therapy for patients with end-stage lung disease. The survival rate after this operation is not, however, satisfactory, being 40-50% at 5 yrs after lung transplantation; infections and pulmonary rejection (acute and chronic) are the cause of this brief survival. Recently, it has been shown that lung transplantation is an advantageous solution only for selected pathologies. The introduction of alternatives to lung transplantation (lung volume reduction surgery in emphysema, prostacyclin therapy in primary pulmonary hypertension and pulmonary thromboendarterectomy in chronic thromboembolic hypertension) has modified the number of patients admitted to the lung transplantation waiting list. In this study, admission to the lung transplantation waiting list in the first 50 and in the following 50 months of activity of the Pulmonary Division Medical Centre of Montescano were retrospectively compared in order to verify whether experience gained has influenced admission to the lung transplantation waiting list. The mortality rate of patients with idiopathic pulmonary fibrosis (44%), chronic thromboembolic pulmonary hypertension (50%) and primary pulmonary hypertension (52%) before lung transplantation was high; the mortality after lung transplantation was low in idiopathic pulmonary fibrosis (16%), but rather high in primary pulmonary hypertension (55%) and chronic thromboembolic pulmonary hypertension (50%). In contrast, the mortality rate of patients with Eisenmenger's syndrome and emphysema was fairly low while on the lung transplantation waiting list, but rather high after lung transplantation. The trend in admission to the lung transplantation waiting list changed during the two observation periods, with a reduction in the number of patients with Eisenmenger's syndrome and emphysema, but not of those with idiopathic pulmonary fibrosis, chronic thromboembolic pulmonary hypertension and primary pulmonary hypertension. The experience gained modified the authors' approach to lung transplantation, but the "world" of lung transplantation still needs a lot more experience.
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PMID:Lung transplantation: the new point of view of an Italian centre. 1105 79


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