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

Reduction of pulmonary vascular resistance by a high inspired oxygen concentration is a common, but not universal phenomenon in patients with pulmonary vascular disease of varying etiology that may determine their response to long-term domiciliary oxygen therapy. We therefore determined changes in PVR during oxygen therapy in two patient populations not previously studied: systemic sclerosis (n = 8, mean age +/- SEM, 44.5 +/- 5.4 years) and primary pulmonary hypertension (n = 7, mean age +/- SEM 38 +/- 7.8 years). All patients were hypoxemic (arterial oxygen tension, on air 9.5 +/- 1.2 kPa for SSc and 8.3 +/- 0.6 kPa for PPH, p greater than 0.05). Right atrial pressure, pulmonary artery pressure, pulmonary artery occlusion pressure, systemic arterial pressure, PaO2 and cardiac output by thermodilution were measured at three, 20-min intervals while inspiring air and again after inspiring 60 percent oxygen for 30 min. The PVR fell significantly with oxygen in patients with SSc from 797.6 +/- 179.2 to 610 +/- 151.6 dynes/s/cm-5 (p less than 0.01), and this fall correlated with baseline PAP and PaO2 prior to oxygen therapy (r = 0.86, p less than 0.025; r = 0.77, p less than 0.05, respectively). In patients with PPH, there was no significant fall in PVR with oxygen (from 969 +/- 80.2 to 851.9 +/- 91.2 dynes/s/cm-5, p greater than 0.05) and no predictor of a vasodilator response in individual patients. In SSc, hypoxic pulmonary vasoconstriction contributes more consistently to elevated PVR than in patients with PPH.
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PMID:Hypoxic pulmonary vasoconstriction in systemic sclerosis and primary pulmonary hypertension. 189 17

We used positron emission tomography and magnetic resonance imaging to evaluate 16 patients with transient ischemic attacks or minor strokes and unilateral internal carotid occlusive disease, five with stenosis, and 11 with occlusion. Cerebral blood flow, cerebral metabolic rate of oxygen, oxygen extraction fraction, cerebral blood volume, and T2-weighted magnetic resonance images obtained at 1.5-T were analyzed. Irrespective of vascular disease, patients with a confluent high-intensity area in the middle centrum semiovale had substantially decreased cerebral blood flow and ratio of cerebral blood flow to blood volume in the middle cerebral artery distribution of the cortex, with a substantially increased oxygen extraction fraction. We concluded that the confluent high-intensity area in the deep white matter region indicates hemodynamic compromise in the affected hemisphere in internal carotid artery occlusive disease.
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PMID:High-intensity area in the deep white matter indicating hemodynamic compromise in internal carotid artery occlusive disorders. 192 99

Between December 1983 and April 1989, 222 combined heart and lung transplant operations were performed for treatment of pulmonary vascular disease and parenchymal lung disease at Harefield Hospital. Seventeen of these patients had emphysema, and 11 of them were followed up for a minimum of 1 year. There were nine male and two female patients. Their mean age was 39 (range, 32 to 54) years. Seven had alpha 1-antitrypsin deficiency. Six patients were receiving continuous oxygen therapy, and two patients were dependent on a ventilator. Postoperatively, the patients' lungs were ventilated for a median of 3 days (range, 24 hours to 2 weeks). Two patients subsequently required further periods of ventilation. Immunosuppression consisted of azathioprine and cyclosporine. Three patients also received low-dose oral steroids. There was one early death, which occurred on the second postoperative day. The remaining patients were followed up for 12 to 53 (mean, 22) months. One patient had cytomegalovirus pneumonitis 6 weeks postoperatively that responded to treatment. There was one late death at 14 months after reoperation for treatment of obliterative bronchiolitis. The overall survival was 91% at 1 year. All survivors achieved an excellent level of rehabilitation. It is concluded that the medium-term results of heart and lung transplantation for treatment of emphysema are good and that patients with alpha 1-antitrypsin deficiency may undergo transplant procedures without substitution therapy.
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PMID:Medium-term results of combined heart and lung transplantation for emphysema. 200 66

Oxygen tension measurements are presented for the first time for the vitreous body of the rat eye. Oxygen-sensitive microelectrodes were used to measure vitreal PO2 profiles for two breathing conditions: 20 and 100% O2. Results show that for ventilation with 20% O2 most of the vitreous body has a constant PO2 (mid vitreous PO2 of 22.6 +/- 1.9 mmHg (+/- S.E.; n = 6), except for a layer about 200 microns thick at the retinal surface where significant PO2 gradients exist, especially in the region of retinal arteries. Midvitreous PO2 is similar to the PO2 at retinal veins. All vitreal PO2 values increase if ventilatory oxygen is raised to 100% O2. After equilibration, the main body of the vitreous again has an almost constant PO2, a factor of 3.75 +/- 0.40 (n = 10), higher than for 20% O2 ventilation except for a region about 400 microns thick adjacent to the internal limiting membrane where the local geometry of the retinal circulation dictates PO2 distribution. When the electrode was oriented to make contact with the retina at different distances from the optic disk, venous PO2 was observed to decrease in more peripheral locations. This work opens the possibility of investigating the role of hypoxia in rat models of retinal vascular disease.
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PMID:Vitreal oxygen tension measurements in the rat eye. 201 58

Sixty patients with congenital heart disease (CHD), age range 3 months-45 years (median 2 years), underwent lung biopsy to exclude pulmonary vascular disease (PVD): 25 had an atrioventricular (AV) septal defect, 14 a ventricular septal defect (VSD), 7 a complete transposition of the great arteries (TGA) + VSD, 3 an atrial septal defect, and 2 a patent ductus arteriosus; 9 had other malformations. Scoring of histological section (0-4) according to a modified Heath-Edwards classification disclosed that 30 patients had severe "irreversible" PVD (greater than or equal to grade 3) (11 AV septal defect, 8 VSD, 6 TGA + VSD and 5 others); 8 patients were younger than 1 year. Pulmonary vascular resistance (PVR) was calculated in 51 patients and exceeded 7 U/m2 in 1 of 2 patients with grade 0, in 9 of 18 with grade 1, in 1 of 4 with grade 2, in 11 of 18 with grade 3, and in 8 of 9 with grade 4. PVR was also calculated after 100% oxygen administration in 19 patients, 14 of whom had a resting PVR greater than or equal to 7 U/m2. PVR persisted greater than or equal to 7 U/m2 in 5 patients: 4 had PVD greater than or equal to grade 3 and died after surgery. PVR fell to under 7 U/m2 in 14 patients, 3 of whom had PVD greater than or equal to grade 3:1 patient with grade 4 was not operated upon and 2 with grade 3 were operated upon: all are alive. Follow-up in discharged living patients was 100%, with a mean of 50 months. Fifty-five patients underwent surgery with 10 early and 2 late deaths. Among the 12 subjects with a fatal outcome, 10 had irreversible lesions. The 5 non-operated patients all had irreversible lesions at biopsy, and are still alive.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Is lung biopsy useful for surgical decision making in congenital heart disease? 202 37

Near-infrared spectroscopy has been performed on the calf muscles of 38 subjects, 21 normal controls without vascular disease and 17 patients with peripheral vascular disease. Oxygen consumption was measured in the calf by calculating the rate of conversion of oxyhaemoglobin to deoxyhaemoglobin during a period of tourniquet-induced ischaemia. Postischaemic reoxygenation was also measured. Median oxygen consumption in patients with peripheral vascular disease was 0.10 ml 100 g tissue-1 min-1, while in the control group it was 0.20 ml 100 g tissue-1 min-1 (P less than 0.03, Mann-Whitney U test). The median time taken to reach maximum oxyhaemoglobin levels after ischaemia was 40 s in patients with peripheral vascular disease and 20 s in controls (P less than 0.02). The results indicate that oxygen consumption is reduced in peripheral vascular disease. Near infrared spectroscopy is a non-invasive method for assessing metabolic improvement resulting from surgical or pharmacological treatment.
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PMID:Near-infrared spectroscopy in peripheral vascular disease. 203 98

Excessive release of reactive oxygen metabolites (ROM) from lung inflammatory cells has been claimed to be of major pathogenetic significance in diffuse fibrosing alveolitis. In the present study, the content of oxidized methionine residues [Met(O)] as a percentage of total methionine (Met) in BAL-derived proteins was used to assess the biologic effect of ROM. In addition, procollagen-III-peptide was measured in BAL fluid as a marker of fibroblast activation. We investigated bronchoalveolar lavage (BAL) samples from seven control patients without evidence of interstitial lung disease and from 42 patients with fibrosing alveolitis caused by idiopathic pulmonary fibrosis (IPF), n = 20, or by collagen vascular disease (CVD), n = 22. Met(O) was elevated in the patients with IPF or CVD compared with that in the control subjects (8.86 +/- 1.26 and 8.13 +/- 1.44% versus 3.36 +/- 0.49%, p less than 0.01 and p less than 0.05, respectively; mean +/- SEM). A positive correlation was found between percentage of neutrophils in BAL and Met(O) in both groups separately and combined (IPF, r = 0.84; p less than 0.001; CVD, r = 0.44; p less than 0.05; IPF and CVD, r = 0.60; p less than 0.001), whereas an inverse relationship existed between Met(O) and the percentage of alveolar macrophages in BAL (IPF, r = -0.59; p less than 0.01; CVD, r = -0.24; NS; IPF and CVD, r = -0.41; p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pathogenetic significance of reactive oxygen species in diffuse fibrosing alveolitis. 206 21

Diabetes is associated with altered blood viscosity and abnormal tissue oxygenation. Transcutaneous oxygen tension is measured in 119 diabetic and 20 normal subjects. Measurements of transcutaneous oxygen pressure (TcPO2) are made by Oxymonitor SM 361 at 45 degrees C at the dorsum of the foot. At the same time, the main microrheological parameters (plasma viscosity, albumin, fibrinogen, red cell aggregation times, disaggregation threshold and red cell aggregate structure index) are measured in diabetic patients with good and poor glycemic control, with and without angiopathy. All the diabetics have a significant reduction of TcPO2 and have rheological disturbances. TcPO2 values are related significantly with plasma viscosity and with several parameters of aggregation-disaggregation phenomenon. As for microrheological parameter abnormalities, it seems that tissue hypoxia precedes clinical signs of angiopathy and depends on the metabolic state as rheological abnormalities. TcPO2 values are the result of numerous parameters as rheological parameters. It seems that TcPO2 measurement is able to provide useful informations about microcirculation in diabetes mellitus without clinical signs of tissue hypoxia.
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PMID:Transcutaneous oxygen pressure and hemorheology in diabetes mellitus. 209 59

Hypoxic vasoconstriction has been the subject of many studies, but little is known about the interaction of hypercapnia and the pulmonary circulation. We performed two haemodynamic studies on each of three patients with pulmonary vascular disease secondary to congenital heart disease. On the first occasion ventilation was inadequate due to technical problems, and the patients were therefore hypercapnic (arterial pCO2 greater than 5.3 kPa). On the second occasion, they were normocapnic. Pulmonary vascular resistance was measured on each occasion while the patients were breathing 100% oxygen (alveolar hyperoxia) and while epoprostenol (prostacyclin) was infused at doses of 5-20 ng/kg/min. Pulmonary vascular resistance was elevated in the presence of hypercapnia and, despite oxygen and epoprostenol, could not be reduced to the levels observed in the normocapnic study. We conclude that hypercapnia causes significant vasoconstriction in infants; and that epoprostenol is a relatively ineffective pulmonary vasodilator in infants who are hypercapnic due to inadequate ventilation. Where possible, respiratory acidosis should be corrected before using oxygen or epoprostenol as a pulmonary vasodilator.
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PMID:Interactions between alveolar hypercapnia and epoprostenol on the pulmonary circulation: clinical and pharmacological implications. 213 21

Peripheral skin perfusion reflects the level of vascularity and viability of a limb and may help in planning the site of amputation or bypass surgery in patients with vascular disease. This study used peripheral pulse oximetry in 20 healthy volunteers and in 20 patients with limb ischaemia. Pulse oximetry saturation levels (Psa,O2) were compared with ankle artery Doppler pressures and transcutaneous oxygen measurements (Ptc,O2). Recordings were taken at two standard sites distally and referenced to finger and forearm to calculate an index. A significant correlation was found between Ptc,O2 and Psa,O2 in patients with ischaemia (r = 0.68, P less than 0.01). A further group of 12 patients with acute limb ischaemia was similarly assessed before and after revascularization. After revascularization mean(s.d.) Ptc,O2 increased from 38(13) to 44(1) mmHg (P greater than 0.05) and mean(s.d.) Psa,O2 increased from 86(3) to 90(4) per cent (P less than 0.01). These data suggest that pulse oximetry is a more sensitive index of peripheral perfusion than Ptc,O2 or ankle artery Doppler pressure and that, because of its accuracy and simplicity, it merits further use.
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PMID:Pulse oximetry: a new non-invasive assessment of peripheral arterial occlusive disease. 187 29


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