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Query: UMLS:C0042373 (vascular disease)
 17,070 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This flow cytometric study was designed to identify, characterize and quantify alveolar monocyte-like cells in healthy volunteers and in patients with chronic inflammatory lung disease. Cells were obtained by bronchoalveolar lavage (BAL) from 19 patients with sarcoidosis, 29 with idiopathic pulmonary fibrosis, 10 with extrinsic allergic alveolitis, 19 with collagen vascular disease, and from 10 healthy volunteers. By taking advantage of the distinct electro-optical features of alveolar macrophages (AMs) and monocyte-like cells, the numbers of alveolar monocyte-like cells were counted, the cell dimensions calculated, and the densities of antigens on the surface of alveolar monocyte-like cells and AMs were compared. By using a panel of monoclonal antibodies detecting CD11b, CD14, CD16, and human leucocyte antigen-DR (HLA-DR), the immunophenotypes of these cells were selectively characterized. In the BAL fluid of patients with chronic inflammatory lung disease, significantly increased numbers of alveolar monocyte-like cells were detected that exhibited an immunophenotype intermediate between blood monocytes and mature AMs. Positive correlations were found between numbers of monocyte-like cells and expression of the monocyte-associated surface antigens CD11b and CD14 on total AMs; in contrast, an inverse relationship existed between monocyte numbers and expression of the macrophage-associated surface antigens CD16 and HLA-DR. When the patients were assigned to two groups according to the percentage of BAL monocyte-like cells being lower or higher than 13% (= mean value of the controls +2SD), it could be demonstrated that a high percentage of BAL monocyte-like cells was associated with significantly reduced lung function parameters. In summary, our flow cytometric data strongly support the view that considerable numbers of blood monocytes are recruited to the bronchoalveolar space in patients with chronic inflammatory lung disease.
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PMID:Characterization and quantification of alveolar monocyte-like cells in human chronic inflammatory lung disease. 879 61

As the practice of lung transplantation in children evolves, the indications are expanding. The major diagnostic groups for which transplantation is offered are similar to those used in adult lung transplantation with the notable absence of obstructive lung disease. Of all children under the age of 18 years undergoing lung transplantation, cystic fibrosis accounts for approximately 35%, pulmonary vascular disease, with or without associated congenital heart disease, accounts for 25-30%, and interstitial lung diseases comprise about 10%. The other categories included retransplantation and a variety of diagnoses which by themselves describe an unusual form of end-stage pulmonary disease. The selection of candidates with transplantable diagnoses is crucial, and as this specialty evolves the contraindications have as well. Colonization of the airway with resistant bacterial or fungal organisms, history of multiple prior thoracic procedures, need for mechanical ventilation, diabetes mellitus, and the presence of other organ failure constitute some relative contraindications for transplantation. Retransplantation is a controversial issue that has not yet been resolved.
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PMID:Pediatric lung transplantation: indications and contraindications. 884 20

The modern era of lung transplantation was ushered in on the wings of discoveries in new immunosuppressive agents and surgical technique. It has allowed those with end-stage organ disease to have a second chance at life. Even though still in its youth relative to other solid organ transplants, it is gaining momentum and promises to be a continuing area of growth and development. Although over 2,700 lung transplants have been done in the last 13 years worldwide, the lack of availability of donor organs is the major factor slowing the rapid expansion of this field of endeavor. Primary care physicians may have an impact on this problem by raising the awareness for organ donation in their patients and patients' families. Although initially performed almost exclusively for those with pulmonary vascular disease, indications have now expanded to include interstitial disease, septic lung disease, and emphysema, with the latter being the major reason for transplantation today. Unfortunately, at experienced institutions with long waiting lists, 20% or more of candidates do not survive to transplantation. With proper care and selection of transplant candidates it is hoped that more will survive to benefit from this treatment. The primary care physician will likely be assuming a greater role in the management of transplant candidates as their numbers increase. The care of transplant recipients, although often complex, is frequently rewarding. For the most part it is performed at transplant centers, but a role for the recipient's local physician in this process is also growing in the era of managed care. This chapter has also highlighted how the recipient's local physician can participate in postoperative care. Strict attention needs to be paid to any and all signs of organ rejection or infection because both can have devastating consequences. Awareness of the medications used in this population, their side effects, and drug interactions is essential. Despite the recent advances in pharmacologic therapy, organ rejection continues to be problematic. This is especially the case with the entity of chronic rejection because it frequently fails to respond long-term to therapy and accounts for a significant percentage of late mortality. Although infections continue to be the primary cause of both early and late mortality in these recipients, proper care and postoperative prophylaxis can lessen the incidence. Likewise, early and aggressive treatment of infections in recipients can be lifesaving. Despite all the potential problems, patients receiving lung transplants are living longer and return to productive lives. Between 50% and 60% are now living between 3 and 4 years, and one can only anticipate that this will continue to climb as our understanding of infections, medications, and the body's immunoregulatory system improves. As techniques for donor organ allocation and organ preservation improve, it is hoped that all those with end-stage lung disorders may have the opportunity to benefit from this expanding technology.
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PMID:Lung transplantation: implications for the general internist. 890 97

We studied length of survival and related clinical findings in 715 inpatients with collagen-vascular diseases (1984 through 1994), the diagnostic Kaplan-Meier analysis showed that patients with polymyositis/dermatomyositis and those with systemic sclerosis did not survive as long as those with other types of collagen-vascular disease. Of the patients who died 37% died of respiratory failure due to interstitial lung disease. Patients with interstitial lung disease had better outcomes than did those with idiopathic interstitial pneumonia: they were younger, had higher initial vital capacities, and fewer episodes of acute exacerbation of lung disease than did those with idiopathic interstitial pneumonia. Among patients with interstitial lung disease, those who died of polymyositis/dermatomyositis did so within 1 year, but those who died of systemic sclerosis lived longer. Interstitial lung disease is an important prognostic factor in collagen-vascular disease, and needs further evaluation.
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PMID:[Importance of interstitial lung disease in collagen vascular disease: analysis of outcome]. 897 70

Single and bilateral lung transplantation represents the most recent success in the field of organ replacement. The procedure underwent a very long period of laboratory and clinical experimentation and it is still a high-risk procedure to be performed by a few highly specialized centers. At our Department of Cardiac Surgery, the preliminary experience in lung replacement was obtained by clinically applying heart-lung transplantation in patients with both vascular and parenchymal lung disease during 1991. In the following years, the indications for isolated lung transplantation were enlarged by some centers with good results; this consideration, together with the scarce availability of integral heart-lung blocks, led us to use single and bilateral lung transplantation initially for parenchymal disease and subsequently also for vascular disease. Since February 1992, 12 single lung transplantations and 12 bilateral lung transplantations have been performed at our Center. In this report the selection criteria, the preoperative characteristics and the perioperative variables of donors and recipients are discussed. Particular emphasis is given to immunosuppression treatment, diagnosis of rejection and airways suture complications. The conclusions summarize the present indications for the different types of lung transplantations according to the different preoperative diagnosis.
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PMID:[Lung transplantation in Pavia. Clinical experience]. 906 68

Iodine-123-metaiodobenzylguanidine [123I-MIBG] has been used to evaluate the cardiac sympathetic nervous system. We evaluated the effect of pulmonary hypertension on the sympathetic neuronal function of the left ventricle in patients with pulmonary hypertension. We studied 20 patients with either chronic lung disease or pulmonary vascular disease. The patients were divided into a pulmonary hypertensive group and a control group. Single photon emission tomography was performed in the resting state 15 min and 4 h after administration of 123I-MIBG. Regions of interest (ROI) were set in the left ventricular (LV) free wall, the interventricular septum (IVS) and outside the LV free wall on short-axis images. The washout rate and the ROI/LV uptake ratio were calculated in each ROI. The IVS:LV uptake ratio was significantly lower in the pulmonary hypertensive group than in the control group. Our results suggest that left heart sympathetic neuronal dysfunction initially occurs in the IVS before it involves the LV free wall subsequently.
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PMID:Iodine-123 metaiodobenzylguanidine myocardial imaging in patients with pulmonary hypertension. 910 Jan 59

Pediatric lung transplantation is becoming more common, and with increasing experience there is increasing success. The most common indications for considering lung transplantation are cystic fibrosis, pulmonary vascular disease (usually due to congenital heart disease), and fibrotic lung disease. The contraindications and complications are similar to adult transplant patients, although post-transplant lymphoproliferative disease and airway complications may occur more frequently. The patients with cystic fibrosis face additional obstacles to the success of transplantation: airway colonization with Gram-negative organisms, pancreatic insufficiency, glucose intolerance, and osteoporosis. The survival for children is comparable to adults, reaching about 65% at 1 year, and 69% at 2 years.
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PMID:Pediatric lung transplantation. 918 31

Obliterative or constrictive bronchiolitis is characterized by narrowing of the small airways, due to submucosal and peribronchiolar fibrosis, with chronic obstruction. The vast majority of cases of bronchiolitis obliterans are associated with other diseases and only few cases are idiopathic. We report on the main computed tomography (CT) methods used study obliterative bronchiolitis, the CT findings and the differential diagnosis with other diseases. The dynamic study of alveolar ventilation with CT uses inspiratory and expiratory CT or high-resolution CT (HRCT), spiral dynamic CT or HRCT with advanced image display, ultrafast CT. In abnormal cases HRCT shows direct and indirect signs of small airways disease. The most common (> 80%) sign of obliterative bronchiolitis is the so-called mosaic oligohemia, with low attenuating lobules, caused by air trapping and best seen on expiratory CT, associated with blood flow redistribution to more normal lobules; this finding simulates the ground-glass pattern from infiltrative lung disease. Differential diagnosis is more difficult in the presence of true ground-glass patterns associated with diffuse bronchiolar obstruction and also with mosaic oligohemia due to pulmonary vascular disease and pulmonary emphysema. HRCT can distinguish these diseases and dynamic CT is more sensitive than functional tests in detecting regional abnormalities and air trapping. The combination of HRCT, rapid volumetric scanning and advanced image display is a powerful tool study the normal and abnormal features of bronchiolar function and alveolar ventilation.
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PMID:[Dynamic computed tomography in the study of bronchiolitis obliterans]. 946 35

Pulmonary disease is a complication of Gaucher disease (GD), a lysosomal disorder due to the deficiency of glucocerebrosidase. Lung involvement was investigated through chest radiography, high-resolution computed tomography of the chest, pulmonary function tests (PFT), and oxygen saturation (SaO2) at 21% FI(O2) in 13 Italian GD patients, six homoallelic for the L444P mutation (Group A), seven with various genotypes (Group B). Echocardiography and transcutaneous oxygen tension measurement at room air and after breathing 100% oxygen were performed to exclude pulmonary hypertension and/or intrapulmonary shunts. A score index (SI) including lung involvement evaluated the severity of GD. In three Group A patients with respiratory symptoms and in an asymptomatic male interstitial involvement was demonstrated; one child died of aspiration pneumonia. Group B patients had no signs of lung damage; PFT were normal in all cases but one. SaO2 was normal in both groups. Pulmonary vascular disease was ruled out in three cases with respiratory symptoms. In Groups A and B the median SI were 22 and 13, respectively (p < 0.01). L444P homozygotes appear at major risk for developing pulmonary disease, even at earlier ages. A comprehensive evaluation of lung involvement is recommended primarily in these subjects.
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PMID:Pulmonary manifestations of Gaucher disease: an increased risk for L444P homozygotes? 951 21

We evaluated arterial and mixed venous oxygen desaturation during symptom-limited exercise in patients with chronic pulmonary disease. Patients were divided into five groups according to disease: [chronic pulmonary emphysema (CPE), chronic bronchitis (CB), pulmonary tuberculosis sequalae (TB-seq), fibrosing lung disease (FLD), and pulmonary vascular disease (PVD)]. There were no significant difference in the values of arterial (PaO2) and mixed venous (PvO2) oxygen tension before and at the end of exercise among the five groups, whereas absolute decreases in PvO2 were significantly larger in PVD and FLD. The changes in PvO2 were similar to the changes in the coefficient of oxygen delivery (COD) which is equal to oxygen transport divided by oxygen consumption. These results suggest that the relative decrease in oxygen transport during exercise due to the high ratio of oxygen extraction by tissues is an important factor to determine decreases in PvO2 in pulmonary hypertensive disease and fibrosing lung disease.
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PMID:Arterial and mixed venous oxygen desaturation during incremental exercise in patients with chronic pulmonary disease. 961 63


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