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

Setting out from the components of respiratory function, i.e., ventilation, distribution, diffusion, circulation, respiratory mechanics, and regulation of breathing, the pathogenic mechanisms leading to respiratory failure are discussed. In every case, the vital capacity is decreased by 4 factors, namely loss of ventilated lung parenchyma, diminished compliance of lungs, thorax or both, airway obstruction, and insufficient respiratory airflow. With few exceptions, these alterations can be attributed to the two general groups of obstructive and restrictive disturbances of ventilation. Essential for the understanding of airway obstruction from the viewpoint of mechanical ventilation is the dependence of the airway caliber on lung volume, thoracic pressure, and bronchial gas flow. The functional differentiation of restrictive disorders between forms with lung retraction(fibrosis, scarring) and with lung fettering (pleural thickening) is important for adequate correction of complications during the intensive care phase. Respiratory failure is the consequence of these alterations which usually impede pulmonary gas exchange. Hypoxemia results in most situations through disturbance of ventilation/perfusion ratio, especially increase of anatomical or functional pulmonary right-to-left shunting. Disturbance of diffusion or alveolar hypoventilation are far less frequently leading mechanisms for hypoxemia. The differential diagnosis of these hypoxemic mechanisms is generally by arterial blood gas analysis under resting conditions breathing air and 100% oxygen, and during exercise. Respiratory failure often leads to hypertension in the lesser circulation. Pulmonary arterial hypertension must be subdivided into the active, the passive and the hyperdynamic forms, of which only the active component is important for the evaluation of pulmonary insufficiency since only this kind of elevated pressure in the pulmonary circulation is connected with increased vascular resistance due to thoracopulmonary disease. By restoration of normoxic conditions, the functional variant of active pulmonary hypertension can be efficiently improved by correction of respiratory disease or directly by treatment with oxygen and by mechanical ventilation. Finally, disturbances of gas transport in the blood may have an essential bearing on respiratory failure, but are often overlooked in diagnostic and therapeutic considerations. Shifting of the oxygen-dissociation curve to the left may, by increased oxygen affinity of hemoglobin, create a lack of oxygen in the peripheral tissue, while right wardshifting impedes oxygenation of hemoglobin in the lung. Thus, the correction of acidosis and elevated body temperature may become an important factor in the treatment of respiratory failure.
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PMID:[Basis of respiratory insufficiency]. 52 97

A case of papilloedema secondary to respiratory failure is reported which caused considerable diagnostic difficulty and led to extensive neurological investigation. Neurological complaints of headache and visual impairment overshadowed respiratory symptoms and were associated with gross haemorrhagic papilloedema. The case is compared with previous reports and the pathogenesis of papilloedema in respiratory failure is reviewed briefly. The similarity between the pathogenesis of this condition and benign intracranial hypertension is discussed.
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PMID:Papilloedema associated with respiratory failure. 59 98

High frequency electrocardiograms were studied in 19 patients with chronic neumopathies, pulmonary arterial hypertension and respiratory failure in the great majority. Studies were made of: a) the significance of conduction disorders in the right ventricle either at the fasciculary branch or within the mass of the ventricle with regard to the time of appearance and the length of the intrinsicoid deflection and its components. b) The duration of the electrical sistole of each ventricle in relation with hyperatrophy that results in sistolic over loading. c) An attempt was made to correlate the number of high frequency deflections (discontinuity of activity) with the prognosis.
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PMID:[Electrocardiography of high frequency and pneumopathies]. 69 52

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

Injection of ibotenic acid (IA), a glutamate agonist, into the ventral medullary raphe (VMR; especially the nucleus raphe magnus) of the rat produced respiratory failure and death following a predictable course of events. The response to the IA injection was characterized initially by increased respiratory frequency and was followed by pulmonary arterial hypertension, systemic arterial hypoxemia, acidosis, and hypothermia. Within 90 min apnea occurred as a terminal event in all animals. Gravimetric, bronchoalveolar lavage protein, and histological analyses revealed no evidence of pulmonary edema. Intracerebral (VMR) pretreatment with PPP, a sigma receptor agonist, or scopolamine, a muscarinic cholinergic antagonist, prevented pulmonary failure and death even though postmortem histological analysis showed VMR cell loss and gliosis consequent to the cytotoxic IA injection. Based on the results of the study, it is suggested that the VMR has a role in regulation of pulmonary blood flow. Preliminary pharmacological studies suggested that a disruption of glutamatergic and cholinergic mechanisms mediates the lethal pulmonary phenomenon.
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PMID:Respiratory failure without pulmonary edema following injection of a glutamate agonist into the ventral medullary raphe of the rat. 137 23

We analyzed 17 cases of multicystic dysplastic kidney (MCDK) to document the natural history of MCDK and its management. One patient was nephrectomied for respiratory failure associated with MCDK. Follow-up studies of 14 kidneys revealed that 5 kidneys (36%) did not change in size, 7 kidneys (50%) decreased in size. Two kidneys (14%) increased in size during the follow up periods and were nephrectomized. Hypertension and malignancy was not observed in our cases. Evaluations for the contralateral kidney and urinary tract system were performed in 15 patients and 5 (33%) revealed abnormalities--two patients with VUR, 1 with PUJ stenosis, 1 with ureteral stricture and 1 with ectopic ureterocele. In our hospital, the management for MCDK is conservative in most cases. Nephrectomy is indicated when there are complications resulting from the size of MCDK, or when the kidney continues to increase in size after the second year of life.
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PMID:[Management of multicystic dysplastic kidney detected in perinatal periods]. 143 65

In the early period up to 1986, our treatment of acute type III dissection was anti-hypertension drug therapy as a rule, and Collins operations were performed in two cases of progressive hemothorax. Among 21 patients receiving medical therapy, five died of rupture, and three operated cases died of multiple organ ischemia, and then the hospital mortality was 40%. Since 1987, we have selected hypotensive treatment of strictly maintaining blood pressure less than 120mmHg for the completely thrombosed type of the dissected lumen, and the emergency operation of ringed intraluminal graft insertion (RIG operation) for the blood-flow type and aneurysm formation type of the dissected lumen, diagnosed by the emergency cine-angiography. As the result, among 51 cases having hypotensive therapy, one died of respiratory failure. In the 23 operated cases, in which RIG operation and/or arterial reconstruction was performed, four died of multiple organ ischemia. The hospital mortality was 8%, which was significantly improved compared with that of the early period.
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PMID:[Combined medical and surgical treatment of 74 cases of acute type III aortic dissection]. 147 Jan 10

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

The clinical outcome of 99 patients who underwent combined single-stage carotid thromboendarterectomy and coronary artery bypass grafts in three different hospitals over a 15-year period was analyzed. Coronary revascularization was elective in 16 patients, urgent in 46 and emergent in 37 patients. Asymptomatic carotid artery stenosis of greater than or equal to 80% was detected in 79% of patients. Sequential reconstruction of the carotid artery circulation followed by restoration of the coronary circulation was performed in all patients by two separate surgical teams. The population included 79 men and 20 women, with a mean age of 67 +/- 6 years, of whom 53% had a previous myocardial infarction, 59% had hypertension and 49% had a history of smoking. Three or more coronary arteries were revascularized in 90% of patients. The overall major neurological complication rate was 25%, with an 11% stroke rate ipsilateral to the operated carotid. Other major complications included respiratory failure (5%), multisystem failure (8%), and myocardial infarction (8%). The overall mortality was 12%. Ten of the 12 deaths were directly related to the cardiac operation, and 2 died as a result of stroke. We conclude that a combined carotid and coronary artery operation results in a high morbidity and mortality in institutions with excellent records for each operation when performed separately. Whenever possible, these high risk patients should be carefully assessed regarding the need for both procedures, since prophylactic carotid endarterectomy has not been shown to significantly reduce the neurologic risk of coronary bypass.
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PMID:Combined carotid endarterectomy and coronary artery revascularization: a sobering review. 173 95

Several approaches to non-respiratory management of adult respiratory distress syndrome (ARDS) are discussed. (1) Diagnosis and therapy of the underlying disease is a primary goal in order to avoid the ongoing process of lung injury. (2) Specific pharmacologic therapy for primary lung injury is not available even after 25 years of immunologic research, because no specific mediator has yet been identified as a primary pathogenic factor in ARDS, which is a heterogenous clinical syndrome. (3) Supportive therapy (i.e. improving right ventricular dysfunction and treating pulmonary arterial hypertension) should be emphasized. (4) The most important approach is to optimize prophylactic management to avoid nosocomial infection by eliminating unnecessary invasive techniques, changing the patients' positioning and conserving organ function. So far the latter approach seems to be the only way to improve survival in respiratory failure.
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PMID:[Non-respiratory therapy of adult respiratory distress syndrome]. 194 50


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