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

A study of the effects of dopamine, dobutamine and of isoprenaline was carried out in 20 patients with chronic respiratory insufficiency, 16 of whom had pulmonary arterial hypertension (PAP: 22 mmHg). The following findings emerged: --absence of any significant effect of dobutamine on heart rate,--increase in systolic and mean PAP, after infusion of dobutamine,--increase in systolic and mean PAP, after infusion of dopamine,--decrease in BP after administration of infusion of dobutamine,--decrease in pulmonary arterial resistances under the influence of isoprenaline,--decrease in total systemic resistances after the administration of dobutamine,--increase in ventricular, systolic work after the infusion of dopamine.
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PMID:[Hemodynamic effects of dopamine, dobutamine and isoproterenol in chronic respiratory insufficiency]. 3 62

The authors placed Swan-Ganz catheters in 11 preterm and 2 term infants with severe cardiopulmonary distress. The infants ranged in weight from 1100-4000 g. The procedure was performed in the neonatal ICU by jugular venous cutdown. Intracardiac pressures and oxygen saturations were measured in each chamber entered. The authors also evaluated the presence of right to left shunting through the patent ductus arteriosus and assessed the degree of pulmonary arterial hypertension. In 5 hypoxemic infants, the authors found a patent ductus arteriosus with pulmonary hypertension. Intermittent measurement of PAP served as a guide to further therapy. In 2 infants, the unexpected diagnosis of cyanotic congenital heart disease was made. The placement of flow directed pulmonary arterial catheters in critically ill infants can be performed safely at the bedside and can provide useful diagnostic and therapeutic information.
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PMID:Swan-Ganz catheterization in the critically ill newborn. 45 10

A new radiologic index indicative of pulmonary artery hypertension is presented. It was obtained by measuring the horizontal distances from the midline to the first divisions of the right and left pulmonary arteris, and dividing the sum of these distances by the maximum transverse diameter of the thorax. The index was significantly different in groups with and without pulmonary hypertension and was abnormal (above 38 percent in 111 of 150 patients with cardiovascular disease and pulmonary arterial hypertension (PAH). None of the cases with increased pulmonary flow from cardiac shunts but normal PAP had an anbormal index. Thus, an abnormal index suggested PAH but correlated poorly with the extent of hypertension.
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PMID:A radiologic index of pulmonary arterial hypertension. 114 25

Hypertension is a common phenomenon in patients undergoing aortocoronary bypass grafting. This hypertension increases myocardial oxygen consumption and can be prevented by application of vasodilators. A possible cause is activation of the renin angiotensin system. Magnesium is a potent vasodilator and has a beneficial effect after myocardial ischaemia. The study was performed to analyse the influence of magnesium infusion on the haemodynamic status and plasma renin activity in patients undergoing aortocoronary bypass grafting. METHODS. Eighteen patients (NYHA classification II-III) undergoing bypass surgery were divided into two groups, a magnesium and a control group. The magnesium group (n = 9) received 0.8 mEq/kg per h magnesium aspartate as an infusion for 15 min while still awake. After induction of anaesthesia, the magnesium infusion was reduced to 0.2 mEq/kg per h and stopped after aortic cannulation was completed. Plasma magnesium levels and concentrations within erythrocytes were measured. Anaesthesia was induced by flunitrazepam (0.01 mg/kg), fentanyl (0.005 mg/kg) and pancuronium (0.1 mg/kg). After intubation, patients were normoventilated with N2O/O2 = 1:1 and isoflurane (0.5-1.0 vol%). Additional doses of fentanyl (0.0025 mg/kg) were injected before the incision and before sternotomy. Mean arterial pressure, heart rate, cardiac index, total peripheral resistance, pulmonary vascular resistance, mean pulmonary arterial pressure, pulmonary capillary wedge pressure, left ventricular stroke work index, right ventricular stroke work index, intrapulmonary shunt and plasma renin activity were evaluated at five predefined points: (1) prior to magnesium infusion; (2) after magnesium infusion; (3) 10 min following induction of anaesthesia under steady-state conditions; (4) after sternotomy; (5) after aortic cannulation. RESULTS. Concerning the haemodynamic parameters (MAP, RAP, PAP, PCWP) no significant difference between the two groups could be demonstrated. In the control group peripheral resistance (TPR) was higher following sternotomy and aortic cannulation than in the magnesium group. Magnesium prevented decrease of the cardiac index (CI) under steady-state conditions, during sternotomy and following aortic cannulation. Left and right ventricular stroke work indexes (LVSWI and RVSWI) were higher in the magnesium group. Plasma renin levels were not significantly different between the two groups. CONCLUSION. Patients undergoing cardiac surgery benefit from magnesium administration in the pre-bypass phase. Due to its vasodilating effect, magnesium lowers the output impedance of the left ventricle and improves cardiac pumping function. It opposes detrimental cardiovascular responses to sternotomy and following aortic cannulation. Also of importance is the advantageous effect of magnesium on cardiac arrest elicited by cardioplegia and for reactivation of the ischaemic myocardium.
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PMID:[Hemodynamics of coronary surgery patients following magnesium aspartate infusion]. 148 73

Pulmonary arterial hypertension develops in acute respiratory failure and mostly an enhanced PADd-PCWP gradient has an important effect on the outcome of that complication. Considering that this critical state of septic burned patients may last for weeks, the long-term direct monitoring of pulmonary arterial blood pressure with indwelling Swan-Ganz catheter is impossible because of the high risk of endocarditis. Therefore, the aim of this study was to elaborate a noninvasive method to estimate the pulmonary arterial hypertension. Determination of cardiac index and pulmonary arterial blood pressure was carried out with Swan-Ganz catheter, P32 Statham transducer, cardiac output computers (Gould IM 1000, Marquette 7010). Extended systolic time interval measurements (with Medicor 661 polygraph completed by PC program package) were performed simultaneously in 7 burned patients (av. age 38.7 ys, means of TBS 38%) with acute respiratory failure at 38 occasions. The values of cardiac indices with the two methods were practically the same CI t = 3.4 +/- 1.21 1/min/m2 CI s = 3.1 +/- 1.10 1/min/m2; regression equation: CI s = 0.874 CIt + 0.135, r = 0.98, n = 38. Close correlations have been found between PAPm and PO2/FiO2 (r = 0.75), as well as between PAP values and some noninvasively measured hemodynamic data. Using these interrelations: 1) regression equations for PAPs., PAPm, PAPd, PCWP, PVRI were elaborated (r values: 0.855, 0.869, 0.681, 0.644, 0.817 respectively); 2) discriminant analysis with noninvasive parameters correctly classified the cases at critical PAPd-PCWP gradient (greater than 4 mm/Hg) in 84%. These results suggest that a continuous noninvasive hemodynamic and blood gas monitoring completed with a periodic bedside computer analysis of the PC-processed data for calculation of the pulmonary arterial pressure may be enough for the therapy during the long-term critical periods.
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PMID:Noninvasive estimation of pulmonary arterial blood pressure in burned patients with acute respiratory failure. 176 49

Nine patients who had developed pulmonary artery hypertension during the adult respiratory distress syndrome (ARDS) were treated with an infusion of prostacyclin (PGI2) (12.5-35.0 ng.kg-1.min-1). Whether PGI2 might decrease the pulmonary capillary pressure (PCP) obtained by analysis of the pulmonary artery occlusion pressure decay curve and improve systemic oxygen delivery was examined. Gas exchange alterations induced by PGI2 were analyzed by using the multiple inert gas elimination technique. PGI2 reduced the pulmonary artery pressure from 35.6 to 28.8 mmHg (P less than 0.001) and the PCP from 22.9 to 19.7 mmHg (P less than 0.01) without changing the contribution of the pulmonary venous resistance to the total pulmonary vascular resistance. The cardiac index increased from 4.2 to 5.7 1.min-1.m-2 (P less than 0.001) due to both increased stroke volume and heart rate. Despite a marked deterioration of ventilation-perfusion (VA/Q) matching with increased true intrapulmonary shunt flow from 28.6% to 38.6% (P less than 0.01) of the cardiac output, the PaO2 was unchanged due to increased mixed venous oxygen content indicated by an augmented mixed venous PO2 (from 37.0 to 41.9 mmHg, P less than 0.01). This caused a 35% (P less than 0.001) increase of the systemic oxygen delivery rate. Thus, short-term infusions of PGI2 reduced PAP and PCP without deleterious effects on arterial oxygenation in patients with ARDS. Hence, PGI2 may be useful to lower pulmonary vascular pressures in patients with ARDS.
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PMID:Prostacyclin for the treatment of pulmonary hypertension in the adult respiratory distress syndrome: effects on pulmonary capillary pressure and ventilation-perfusion distributions. 211 82

In order to evaluate the hemodynamic effects of INPV, eight patients with COPD (FEV1/FVC, 54 +/- 6 percent; mean +/- SD), respiratory failure (PaO2, 52 +/- 6 mm Hg; PaCO2, 56 +/- 4 mm Hg), and clinical signs of inspiratory muscle fatigue underwent right cardiac catheterization while performing 20 minutes of INPV by a cuirass ventilator at a pressure (-20 to -40 cm H2O) able to reduce the diaphragmatic electromyographic activity. Patients showed a mild basal pulmonary artery hypertension. During INPV, no changes in the mean values of HR (from 79 +/- 20 to 80 +/- 18 beats per minute), systolic BP (141 +/- 19 to 139 +/- 16 mm Hg), CO (5.2 +/- 0.8 to 5.1 +/- 1.3 L/min), mean PAP (23.8 +/- 3.8 to 23.9 +/- 4.4 mm Hg), RAP (4.3 +/- 2.6 to 5.5 +/- 2.5 mm Hg), PWP (10.3 +/- 4.5 to 9.4 +/- 2.9 mm Hg), TPR (369 +/- 76 to 392 +/- 124 dynes.s.cm-5), and PVR (199 +/- 51 to 233 +/- 94 dynes.s.cm-5) were observed. Direct systemic BP monitoring could be performed in six patients. During INPV, three patients showed "pulsus paradoxus," as assessed by an inspiratory fall in systolic BP of 11, 13, and 20 mm Hg, respectively. We conclude that INPV by cuirass ventilator does not induce adverse hemodynamic effects in patients with COPD who have pulmonary artery hypertension.
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PMID:Hemodynamic effects of negative-pressure ventilation in patients with COPD. 218 97

Soskin, in his 1946 textbook, stated that insulin may be regarded as the dominant instrument in the symphony of endocrine action that results in normal carbohydrate metabolism. After almost half a century, great progress in the medical field has revealed that insulin plays more than even he described. Some aspects of important actions of insulin in our field as investigated in our laboratory are summarized below. 1. Role of insulin in reproductive endocrinology. (1) Correlation of insulin and testosterone in normal young women and patients with polycystic ovary syndrome (PCO). The sum of serum insulin values during 75g OGTT and serum testosterone values were positively correlated in normal women and patients with PCO. Glucose transport activities in isolated adipocytes from a typical PCO patient were decreased, but insulin binding activities were not, which indicates that insulin resistance in this patients is due to some post-receptor defects. (2) Insulin may be a risk factor of endometrial carcinoma. It is well-recognized that several diseases associate with hyperinsulinemia, such as obesity, PCO, diabetes mellitus, and hypertension are risk factors for endometrial carcinoma. The sum of the insulin values during OGTT was significantly higher in patients with endometrial carcinoma than in those without. 2. Role of insulin in perinatal medicine. (1) Increase in insulin secretion during pregnancy. High serum insulin concentration during OGTT, increased secretion of urinary C-peptide, and enhanced staining of insulin in B cells by the PAP method suggest that insulin secretion is enhanced during pregnancy. (2) Insulin resistance during pregnancy. Glucose utilization rate in both pregnant and progesterone-treated rats, as assessed by a glucose clamp technique, is significantly decreased as compared to nonpregnant rats. The technique of 2-deoxyglucose injection revealed that whole body insulin resistance is due to insulin resistance in individual insulin-sensitive tissues. The activities of 3-0-methyl-D-glucose transport in isolated rat skeletal muscle and human adipocytes were found to decrease during late pregnancy, but insulin binding activities were not. These results suggest that insulin resistance during pregnancy is due to some post-receptor mechanisms. (3) Physiological meaning of insulin in fetal growth.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[The role of insulin in reproductive endocrinology and perinatal medicine]. 223 Apr 12

The effects of two pharmacologically distinct histamine H2 receptor antagonists were studied in combination with ibuprofen (I) and diphenhydramine (D) in a porcine model of septic ARDS. Cimetidine (C) is reported as having direct oxygen radical scavenging abilities and is an inhibitor of cytochrome P-450, whereas ranitidine (R) acts solely by H2 receptor blockade. Four groups were studied: Group Ps (n = 8) received a continuous infusion of live Pseudomonas aeruginosa 5 x 10(8) CFU/ml at 0.3 ml/20kg/min, Group C (n = 6) received a control saline infusion, and the treatment groups received I (12.5 mg/kg) and D (10 mg/kg) in combination with either C (150 mg, CID, n = 6) or R (25 mg, RID, n = 5) given at 20 and 120 minutes after the onset of Ps. Pulmonary (PAP) and systemic (SAP) arterial pressures, cardiac index (CI), PaO2, thermal cardiogreen extravascular lung water (EVLW) and scintigraphically determined pulmonary albumin flux (slope index, SI) were measured. Ps infusion produced significant (p less than 0.05) cardiovascular collapse, hypoxemia and increased EVLW and SI. Both CID and RID temporarily reversed pulmonary arterial hypertension and maintained PaO2, EVLW, SAP and CI at control levels throughout the study, and significantly improved SI at 180 min. These results suggest that cimetidine and ranitidine act in this combination therapy primarily as H2 receptor antagonists.
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PMID:Ranitidine compared to cimetidine in multiagent pharmacological treatment of porcine Pseudomonas ARDS. 231 Dec 2

The aim of this study was to establish a stable and reproducible model of pulmonary artery hypertension with concomitant ARDS-like changes of lung function and lung morphology. In eight anesthetized and ventilated dogs, 0.01 ml/kg oleic acid (OA) was given i.v. followed by repetitive injections of 100 microns glass beads (GB) into the right atrium until a mean pulmonary artery pressure of 35-40 mmHg was reached. Mean right ventricular (RVP) and pulmonary artery (PAP) pressures, pulmonary vascular resistance (PVR), lung compliance and resistance, PaO2, intrapulmonary shunt and colloidosmotic pressure (COP) were closely monitored for 150 min. PAP, RVP, and PVR considerably increased subsequent to OA/GB injection, and stabilized at a high level within 70 min, showing only a minimal decrease (PAP, RVP) or no change (PVR) during the following 80 min. A significant decrease of PaO2 and pulmonary compliance as well as an increase of resistance and intrapulmonary shunt were found as early as 30 min after the last embolization and they remained unchanged for 120 min. Reduction of COP suggested transcapillary leakage of macromolecules. Histology revealed an interstitial and intraalveolar edema. We conclude that the combined injection of oleic acid and glass beads provokes microvascular lung injury and results in stable pulmonary artery hypertension with concomitant ARDS-like changes of lung function. Thus, an acute model is provided in the dog allowing for the study of cardiac function in ARDS complicated by pulmonary artery hypertension.
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PMID:A new experimental model of ARDS and pulmonary hypertension in the dog. 248 70


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