Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0034067 (emphysema)
 11,506 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Three patients with pulmonary interstitial emphysema are presented in whom the course was similar and progressive. Eventually all three infants developed respiratory insufficiency and chronic dependence on mechanical ventilation, cardiovascular complications of patent ductus arteriosus with congestive heart failure, and seizures probably secondary to intermittent periods of asphyxia and hypoxemia. All infants underwent lobectomy and recovered rapidly. Follow-up examinations have shown some residual pulmonary abnormalities. All three infants are progressing within the normal range for motor development.
 ...
PMID:Surgical resection for pulmonary interstitial emphysema in the newborn infant. 70 47

Objective documentation of pulmonary embolism is an essential prerequisite for appropriate treatment (Figure 7). A chest film, as well as measurement of arterial blood gases, should be obtained immediately, and if the lung fields are essentially normal, a lung scan should then be performed. If the scan shows a definite perfusion defect characteristic of embolism, this provides sufficient evidence to establish a diagnosis of pulmonary embolism. The presence of hypoxemia with a low arterial pO2, further confirms the suspicion of a ventilation-perfusion abnormality, and anticoagulant therapy with heparin should be initiated immediately. Should the chest film show abnormalities in the same anatomic areas in which perfusion defects are present on the scan, further investigation by pulmonary arteriography is required to substantiate the diagnosis. The use of pulmonary angiography for documentation of pulmonary embolism is also indicated at the outset when certain specific disorders that confuse scan interpretation are also present-chronic obstructive lung disease, emphysema, asthma, congestive cardiac failure. Assessment of the arterial blood oxygenation simultaneously with the estimated occlusion and the hemodynamic data can be used as a prognostic index as therapy progresses.
 ...
PMID:The diagnosis of pulmonary embolism. 100 Sep 26

To determine the prevalence of "nonobstructive" (impairment of gas transfer) emphysema in a select population of smokers with dyspnea, a retrospective study of patients with emphysema evident at high-resolution computed tomography (HRCT) was undertaken. Four hundred seventy HRCT studies were reviewed. In 47 cases, centrilobular emphysema was the dominant or sole parenchymal abnormality. Concomitant chest radiographs were available in 41 of these cases; 16 of the 41 lacked radiographic findings of emphysema. Among these 16 patients, pulmonary function testing revealed 10 to have normal flow rates (ratio of forced expiratory volume in 1 second to forced vital capacity and forced expiratory volume in 1 second greater than 80% predicted) and impaired gas transfer (single-breath carbon monoxide diffusing capacity [DLCOSB] less than 80% predicted). With the exclusion of one patient with congestive heart failure from the group of 10, the severity of emphysema at HRCT correlated inversely with DLCOSB (r = -.643). These results indicate that HRCT allows detection of emphysema in symptomatic patients when chest radiographs and pulmonary function tests are nondiagnostic.
 ...
PMID:High-resolution CT diagnosis of emphysema in symptomatic patients with normal chest radiographs and isolated low diffusing capacity. 153

Imaging of the respiratory system developed with exceptional rapidity in North America during the spring of 1896, after Roentgen's discovery of X-rays in November 1895, largely because of the efforts of a unique physicians, Francis H. Williams. With great zeal, this pioneer used fluoroscopy for early detection of tuberculosis and other life-threatening chest disorders. By the summer of 1896, he had accumulated more than 100 volumes containing tracings of clinical chest fluoroscopy. As a result of his extensive clinical experience, his dedication to patients' welfare, and his sense of scientific inquiry, several inventions and many landmark clinical observations were made in the first few years after the discovery of the X-ray. These included (1) the invention of a "densitometer" for standardized measurements of relative X-ray attenuation of the lung, (2) the invention of a "seehear" device to correlate auscultative findings and fluoroscopic observations, (3) the recognition that fluoroscopy was more accurate than percussion for estimating mediastinal displacement, (4) the discovery that clinically occult tuberculosis and congestive heart failure could be detected with fluoroscopy, (5) the documentation that unilateral chest disease caused decreased ipsilateral ventilatory compliance and increased contralateral ventilation, (6) the identification of the classical imaging characteristics of tuberculosis, pneumonia, pneumothorax, tension pneumothorax, pleural effusion, hydropneumothorax, emphysema, congestive heart failure, and air trapping. In April 1896, Dr. Williams described the "air bronchogram" in a radiograph of a patient with pneumonia.
 ...
PMID:Fleischner Lecture. Imaging the respiratory system in the first few years after discovery of the X-ray: contributions of Francis H. Williams, M.D. 160 79

The use of long term domiciliary oxygen therapy in the Sheffield area from June to August 1987 has been surveyed. Of the 74 patients prescribed long term domiciliary oxygen therapy, 64 were visited at home. These had arterial blood gas tensions or oxygen saturation measured (while breathing oxygen and air), and the indications for long term domiciliary oxygen therapy were examined retrospectively. Fifty two patients had chronic bronchitis and emphysema, the remainder having pneumoconiosis, bronchiectasis, fibrosing alveolitis, and congestive cardiac failure. Of the 54 cases where indications for treatment could be compared with the Department of Health and Social Security (DHSS) guidelines, only 23 (43%) met the full DHSS criteria before the start of treatment. The median length of treatment was 16 months. At follow up 51 patients had an arterial oxygen tension (PaO2) greater than 8.0 kPa when breathing oxygen. They had a significantly higher PaO2 when breathing air than before long term oxygen therapy (6.7 (SD 1.2) kPa before oxygen treatment, 7.6 (1.4) kPa on reassessment). A similar change was seen in the 23 patients assessed as recommended by the DHSS (6.1 (0.8) kPa; 7.2 (1.2]. PaO2 during the breathing of air was less than 7.3 kPa at reassessment in only 21 (33%) patients. Thirteen patients had carboxyhaemoglobin concentrations above 2.5%, the 95th centile of the distribution in nonsmokers in the laboratory.
 ...
PMID:Long term domiciliary oxygen treatment for chronic respiratory failure reviewed. 210 1

The increasing interest in geriatric medicine demands an understanding of aging in human tissues. The changes in the human heart are an important aspect of this understanding because cardiovascular diseases are a leading medical problem in the elderly. The published data about age-related changes in the human myocardium remain incomplete and occasionally are controversial. An ongoing study of the hearts of people aged 80 years and older is being conducted at our institution. Various aspects of morphologic changes in these hearts were studied. In this report, we discuss the presence and extent of myocardial fibrosis, namely, the interstitial type. Two types of fibrosis are recognized: (1) scarring, the fibrotic replacement of lost myocardium, usually of vascular origin; and (2) interstitial, in which a delicate fibrotic net encircles single myocardial fibers. The morphologic findings were correlated with the following clinical findings: hypertension, congestive heart failure, emphysema, cor pulmonale, and coronary artery disease. The results support the hypothesis that interstitial fibrosis develops independently of the above-mentioned clinical conditions and may be considered as a true aging process.
 ...
PMID:Myocardial fibrosis in the elderly. 239 10

The fifth leading cause of death in the United States, chronic obstructive respiratory conditions, cannot be cured but can be considerably ameliorated by appropriate management. Many patients with COPD have a combination of chronic bronchitis, asthma, and emphysema. While the damage due to emphysema is permanent, many of the pathophysiologic changes of asthma and bronchitis can be reversed to some extent, and such reversal should be a goal of therapy. Smoking cessation will help the patient more than any other medical treatment. Bronchodilator therapy is best given by inhalation from a metered dose inhaler and on a maintenance basis. Be sure to check inhaler technique. An anticholinergic agent, eg, ipratropium bromide, is probably most effective, but many patients prefer a beta 2-selective adrenergic agent. Xanthines are currently third choice but are very useful to cover nocturnal dyspnea. Corticosteroids are usually only used in acute exacerbations and then only for short courses. If prolonged use is required, however, the inhalation route minimizes side effects to which these patients are particularly prone. Antibiotics are also usually only used in exacerbations, but one can be liberal with them. Use the less expensive broad-spectrum options for ten days. Some clinicians believe that hydration is an effective expectorant. Mucolytic therapy is extensively used outside the United States. The appropriate role of mucolytic therapy in the treatment of bronchitis remains to be more fully explored. Low-flow oxygen is only used in the prevention or treatment of cor pulmonale when the PaO2 is persistently at or below 55, or with a rising hematocrit and right-sided cardiac changes. If used, oxygen is helpful only when given long term for at least 18 h per day, not on a prn basis. Cardiac glycosides are probably of little benefit, but diuretics have an important role in treatment of fluid retention. Pulmonary vasodilator therapy is still experimental, as is almitrine. Prophylaxis with pneumococcal vaccine and annual influenza vaccine is rational but has not been proven to be of value. Exercise and activity should be encouraged for all except those with frank congestive heart failure. The role of "breathing exercises" is currently being reevaluated. Surgery has almost no place in the management of COPD. Anesthesia often results in postoperative complications in this disease. Avoid all sedatives and tranquilizers.
 ...
PMID:Chronic obstructive pulmonary disease. Current concepts and therapeutic approaches. 240 8

It may be difficult to decide if respiratory/ventilatory failure in patients with emphysema has resulted from a reversible process, such as pneumonia, acute on chronic bronchitis or cardiac decompensation. Therefore, we favour early institution of mechanical ventilation. Intermittent mandatory ventilation (IMV), continuous positive airway pressure (CPAP) and the new modes of pressure support (PS) help the patient to recover the strength of his musculature. Measures for bronchodilatation, antibiotics and optimal nutrition (including fat calories) allow to successfully wean most patients from the respirator. The prognosis for survival, however, is very uncertain and in general not very promising.
 ...
PMID:[Ventilation problems in emphysema patients]. 264 29

The most common causes of hypoxic cor pulmonale are chronic bronchitis and emphysema. Although the clinical situation in some patients is characterized early by hypoxemia, oedema is rare in patients with an arterial pO2 above 60 mm Hg. The presence of oedema can be regarded as an unfavorable prognostic indicator. For many years, peripheral oedema had been considered an expression of congestive cardiac failure; it may be assumed, however, that neither right nor left ventricular failure is prerequisite to the development of oedema. Oedema formation can be attributed to excessive retention of salt and water or a redistribution of body water into the extracellular compartment. Hypercapnia and acidosis affect direct stimulation of renal hydrogen ion secretion. The resulting electrochemical imbalance is compensated by reabsorption of sodium. Hypercapnia and, in acute phases possibly, hypoxia lead to a fall in renal blood flow mediated by alpha-adrenergic stimulation through activation of the renin-angiotensin-aldosterone system. An increase in plasma ADH may also contribute to development of oedema. The development of cor pulmonale or respiratory insufficiency can be enhanced by nocturnal hypoventilation and hypoxia during sleep as well as by sleep apnoea. Nocturnal hypoxia, smoking and reduced oxygen tension in the relevant kidney cells responsible for erythropoietin release promote the occurrence of secondary polycythaemia. For treatment of acute exacerbations in cor pulmonale associated with infections bronchitis antibiotics such as amoxycillin and cotrimoxacol are drugs of first choice. While the use of digoxin is of doubtful value, the cautious administration of diuretics may bring symptomatic relief. In addition to physiotherapy, beta-2-selective bronchodilators and nebulized bronchodilator therapy can be useful; theophyllines dilate airways and increase cardiac output but they can cause arrhythmias and a deterioration of arterial blood gases in hypoxic patients. If the patient has been treated chronically with corticosteroids, the dosage will have to be incremented; if asthma is suspected, corticosteroid treatment is essential. Controlled oxygen therapy is the most important single therapy aimed at relief of severe arterial hypoxaemia. Oxygen should be titrated initially (for the first one or two days) to achieve an arterial tension of at least 48 mm Hg. Thereafter, the oxygen flow should be increased to yield an arterial tension in excess of 60 mm Hg during continued treatment for two to three weeks.(ABSTRACT TRUNCATED AT 400 WORDS)
 ...
PMID:Hypoxic cor pulmonale: a review. 294 54

We describe the electrical signs due to the positional changes of the heart and those related to hypertrophy and dilatation of the right heart chambers in subjects with chronic cor pulmonale. The positional changes mainly reflect the vertical position of the heart, which is almost constantly associated with some degree of clockwise rotation, because of the descent of the diaphragm and increase of lung volume owing to chronic emphysema. The electrovectorcardiographic alterations observed in right ventricular hypertrophy owing to permanent pulmonary arterial hypertension differ depending on the type of hypertrophy: global or segmentary. The first is generally observed in the chronic hypertensive pulmonary cardiopathy of vascular origin and produces an increase in the magnitude and manifestation of all the principal vectors of right ventricular activation. The second is frequently present in the chronic hypertensive pulmonary cardiopathy of bronchial origin and increases only the magnitude and manifestation of the right basal vector. The progressive dilatation of the right heart chambers evident during the evolution of the chronic hypertensive pulmonary cardiopathy toward the congestive heart failure produces SAQRS rotation to the right, downward and forward or backward. During acute intercurrent bronchopulmonary infection or embolia, transient electrical signs of right cardiac chambers dilatation are present.
 ...
PMID:[Electro-vectorcardiographic examination in cardiopathy of pulmonary origin]. 295 64


1 2 3 4 5 Next >>