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)

In a Zurich autopsy study comprising 7947 adults (over 20-year-olds), cor pulmonale was diagnosed in 8.9% (709 cases). In more than half of the cases the cor pulmonale was caused by lung diseases associated with chronic bronchitis and emphysema or with fibrosis of the lung. In 7 cases recurrent thromboembolism was the sole cause of cor pulmonale, whereas in 103 cases additional lung diseases were involved. 7 cases could be attributed to primary pulmonary hypertension. Cor pulmonale is, as a rule, the result of multiple lung conditions. The lesions of pulmonary vessels in cor pulmonale are produced either by parenchymatous lung changes (such as pneumoconiosis, sarcoidosis, etc.) or by pulmonary hypertension.
 ...
PMID:[Pathologic anatomy of cor pulmonale. Results of autopsies]. 85 27

1. In 1991 there were 2,127 heart, 402 lung, and 51 heart-lung transplants performed in the United States. These numbers reflect increases of 27% for heart, over 1000% for lung, and a decrease of 31% for heart-lung transplants since 1988. 2. The number of programs performing heart transplants has increased by 16% since 1988, whereas the number of programs performing lung transplants has tripled over that time. 3. The most frequent primary indications for thoracic transplantation were: cardiomyopathy (45%) and coronary artery disease (41%) for heart; primary pulmonary hypertension (43%) and congenital/Eisenmenger's for heart-lung; and emphysema/chronic obstructive pulmonary disease (28%) and Alpha-1 antitrypsin deficiency (20%) for lung. 4. Average cold ischemic time increased gradually between 1988 and 1991: 2.7 hours for hearts transplanted in 1991 compared with 3.3 hours for heart-lungs, and 4.3 for lungs. 5. Between 1988 and December 1991, the following percentages increased significantly: pediatric heart and lung transplantations; non-White thoracic transplant recipients and donors; the use of thoracic organs from younger (< or = 5 yrs) as well as older (> or = 45 yrs) donors; and local utilization of thoracic organs. 6. For the entire period covered by this report, 1-year recipient survival rates were: heart 81.6%, heart-lung 55.4%, and lung 67.2%. Patient survival was significantly lower in heart retransplants or when the primary indication for transplantation was the treatment of congenital disease. Between 1988 and 1991, 1-year survival appeared to have increased significantly for heart-lung and lung recipients.
 ...
PMID:Thoracic organ transplants in the United States from October 1987 through December 1991: a report from the UNOS Scientific Registry for Organ Transplants. 130 9

Advances in immunosuppression and operative techniques have allowed single lung transplantation to become a viable treatment option at selected medical centers. We describe eight patients, all from the southeastern United States, who had single lung transplantation at Vanderbilt University Medical Center from March 1990 to June 1991. Their diagnoses represent a diverse set of diseases including idiopathic pulmonary fibrosis, primary pulmonary hypertension, emphysema, and pulmonary veno-occlusive disease. After thorough evaluation, the average waiting period to transplantation was 165 days. The posttransplantation periods were conspicuous for rejection, infection, and other complications. All of these recipients have either returned to an active life or are actively recuperating; this center's first single lung recipient has now survived 15 months. Our initial experience with single lung transplantation is encouraging, yet broader application requires that the paucity of donor organ availability be rectified.
 ...
PMID:Single lung transplantation: replacement therapy for end-stage lung disease. 152 48

The techniques and indications for lung transplantation have evolved significantly in the past 6 years. We initially restricted single-lung transplantation to patients with pulmonary fibrosis and developed the double-lung transplantation procedure for patients with emphysema or cystic fibrosis. However, with the double-lung procedure, a 25% mortality rate resulted from ischemic complications at the tracheal anastomosis. The technique was altered to incorporate bilateral bronchial anastomosis, with a resulting reduction in airway complications. The double-lung transplantation procedure continued to have significant drawbacks, including intraoperative and postoperative hemorrhage, and cardiac complications due to prolonged cardiopulmonary bypass, ischemic cardiac arrest, and extensive manipulation of the heart. These problems recently have been addressed with a much simplified procedure incorporating a bilateral transverse thoracosternotomy, replacement of the right lung without cardiopulmonary bypass, and replacement of the left lung with or without a short period of partial bypass. This procedure has been successfully used for emphysema and for cystic fibrosis. The technique of single-lung transplantation also has been simplified and indications have been expanded to include selected patients with emphysema and with primary pulmonary hypertension. With single-lung transplantation, each of the lungs from a donor has been successfully used for a separate recipient on several occasions, improving the supply of available donor organs.
 ...
PMID:The evolution of techniques and indications for lung transplantation. 220 16

Using cyclosporine A (CyA), long-term results after heart-lung transplantation became possible. Since 1981, 761 clinical heart lung transplantations have been registered at the International Society for Heart Transplantation. Candidates for this operation reveal signs of irreversible heart and lung diseases which are caused by cardiac lesions (e.g. valvular disease, Eisenmenger reaction due to congenital malformation) or pulmonary disorders (e.g. primary pulmonary hypertension, emphysema, fibrosis). The standard surgical procedure necessitates three anastomoses which combine donor and recipient tracheae, right atria and aortae. Immunosuppression consists of CyA (blood levels of 300-500 ng/ml), azathioprine (1-2 mg/kg/d) and rabbit antithymocyte globuline (RATG) (IgG: 2-4 mg/kg/d). After the first 2 postoperative weeks, RATG is replaced by low dose methylprednisolone (0.3-0.1 mg/kg/d). As an alternative, RATG may be omitted completely. Postoperatively, a variety of complications may evolve. Early problems (within the first month) comprise acute pulmonary rejection, bacterial pneumoniae, and multiorgan failure. Diagnosis of acute lung rejection proves difficult; it includes clinical signs, chest radiographic appearances and cytoimmunological monitoring of the peripheral blood. Transbronchial lung biopsies are for precise diagnosis of similar value to endomyocardial biopsies after heart transplantation. Late postoperative complications comprise viral, bacterial, fungal, and protozoal infections and chronic obliterative bronchiolitis. With increasing experience, the 30 day mortality fell to below 20% according to the International Society for Heart Transplantation. The one-year survival rate between 1986 und 1988 was reported to be 61%. The results of some individual groups are even better.
 ...
PMID:Heart-lung transplantation in 1990--indications, surgical technique, postoperative complications and outcome. 226 34

Lung transplants have been attempted since 1963 but with little success. After fundamental work by the Toronto group with improved surgical techniques and after the introduction of cyclosporin that group was able to present convincing results. Of 16 unilaterally transplanted patients with pulmonary fibrosis in the final stage, 10 are still living, one of them for now 5 years. With bilateral lung transplantation the indication was extended to cover further pulmonary diseases in the final stage, such as emphysema, bronchiectases, eosinophilic granuloma, primary pulmonary hypertension and bronchiolitis obliterans. The unilateral lung transplantation performed by us failed after initially excellent functioning, on the 9th postoperative day because of a Pseudomonas infection that had been transferred with the donor organ.
 ...
PMID:[Unilateral lung transplantation--an initial report of experiences]. 236 95

Using cyclosporin A, long-term survival after heart-lung transplantation became possible. The drug blocks the immune system more selectively and leaves the tracheal wound healing unimpaired. Since 1981, 501 clinical cases have been collected by the registry of the International Society for Heart Transplantation. Candidates for heart-lung transplantation reveal signs of irreversible heart and lung diseases that may have been caused by cardiac lesions (valvular diseases, Eisenmenger reaction due to congenital malformations) or by pulmonic disorders (primary pulmonary hypertension, emphysema, fibrosis). The standard surgical procedure, which combines donor and recipient tracheas, right atria, and aortas, makes three anastomoses necessary. Immunosuppressive regimen includes cyclosporin A (blood trough levels of 300 to 500 ng/mL), azathioprine (1 to 2 mg/kg), and rabbit antithymocyte globulin (1 to 4 mg immunoglobulin G/kg). After the first two postoperative weeks, rabbit antithymocyte globulin is replaced by methylprednisolone (0.3 to 0.1 mg/kg; 500 mg are given intravenously after opening the aortic cross-clamp; 3 x 125 mg on postoperative day 1). After heart-lung transplantation an extreme variety of problems may evolve. Early postoperative complications (within the first postoperative month) comprise acute isolated lung rejection, multiorgan failure, and bacterial pneumonia. Diagnosis of acute lung rejection proves difficult; it includes clinical signs, chest radiographic appearances, and cytoimmunological monitoring. Transbronchial lung biopsies are of similar value for precise diagnosis as are endomyocardial specimens after heart transplantation. Late postoperative complications (after 1 postoperative month) comprise viral pneumonia, fungal infection, tuberculosis, and chronic obliterative bronchiolitis.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Surgical management of heart-lung transplantation. 240 7

To date, more than 200 human heart-lung transplantations (HLT) have been performed in USA and Europe. The main indications are still primary pulmonary hypertension and Eisenmenger's syndrome but the intervention has also been employed in cases of parenchymatous pulmonary disease. At operation, the thoracic organ is replaced. The recipient's heart can frequently be donated. Recent reviews suggest acceptable two-year survival following HLT of approximately 60%. The direct economical costs of transplantation have been stated to be approximately 17,000 pounds but to this must be added the expenses for life-long immunosuppressive treatment and follow up control together with hospitalization during the time waiting for a suitable donor. The annual requirement for transplantation in Denmark is estimated at present to be approximately ten patients. The immediate requirement for transplantation will probably be covered by referral to the European centres via national or provincial hospitals and with the permission of the Danish Board of Health. The case reports of the first two Danes (both with emphysema secondary to alpha-1-antitrypsin deficiency) who underwent successful heart-lung transplantations in England are presented. In the long run, it will prove necessary to utilize Danish donors which necessitates alterations in the criteria of death.
 ...
PMID:[Heart-lung transplantation]. 249 70

We have achieved repeated success with unilateral lung transplantation for pulmonary fibrosis and have developed an en bloc, double-lung transplant procedure for patients with advanced lung disease of an obstructive or infective nature. Six such procedures have now been performed for end-stage emphysema, and all recipients are alive and well 5 to 15 months later. A seventh transplant for primary pulmonary hypertension was unsuccessful. All recipients were judged to have a life expectancy of 12 to 18 months on the basis of the degree of disability and the documented rate of disease progression. We feel the double-lung procedure is more appropriate than the combined heart-lung transplant for patients requiring replacement of both lungs when right heart function is adequate or deemed recoverable. With this procedure, the recipient is able to retain his or her own heart, avoiding the liabilities associated with cardiac transplantation. Furthermore, the donor heart is available for a separate recipient, and this sharing of the heart and lungs greatly increases the supply of transplantable lungs for patients with end-stage lung disease. Ischemia of the donor airway has been a source of complication, including the one death to date, but this appears to be a surmountable problem.
 ...
PMID:Double-lung transplant for advanced chronic obstructive lung disease. 264 98

First-pass lung uptake of propranolol was studied in 10 patients with normal lungs, 8 patients with severe pulmonary emphysema, and 1 patient with primary pulmonary hypertension. Propranolol uptake was measured by comparing the ratio of [14C]propranolol (0.5 mg) to indocyanine green (5 mg) injected into the right atrium with the ratio of their concentrations in arterial blood collected over the duration of the first-pass dye outflow curve. Mean uptake was 69 +/- 4% (n = 18) in patients with normal lungs; 55 +/- 7% (n = 13) in patients with emphysema (p less than 0.001), and 51% in the patient with primary pulmonary hypertension. Cardiac index in the normal group (2.78 +/- 0.48 L/min/M2, n = 16) was not significantly different from the group with emphysema (2.90 +/- 0.48, n = 12). There was no correlation between lung uptake and conventional lung function indexes in patients with emphysema. We conclude that propranolol uptake is reduced when the pulmonary vascular bed is damaged. This may have pharmacologic consequences, and it is possible that other pharmacokinetic functions of the lung may similarly be impaired in pulmonary disease. The method is relatively simple, and may be suitable for assessing pulmonary endothelial function in patients with lung disease.
 ...
PMID:Impaired lung uptake of propranolol in human pulmonary emphysema. 706 22


1 2 3 4 5 6 Next >>