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 47,337 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Eighty-six of 452 patients (19%) with chronic bifascicular block were found to have no clinically apparent associated organic heart disease (OHD) and were defined as having primary conduction disease (PCD). Comparison of patients with PCD and OHD revealed a significantly lower incidence of the following clinical variables in the PCD patients (p less than 0.001): exertional angina, dyspnea, congestive heart failure, cardiomegaly, functional class I (all by study design), left bundle branch block and premature ventricular contractions. Both mean AH and HV intervals were significantly shorter in patients with PCD (p less than 0.01). The incidence of HV prolongation was 21% in PCD and 41% in OHD patients (p less than 0.001). All patients were prospectively followed for 21-2998 days with a mean +/- SEM of 1209 +/- 66 days for PCD and 1172 +/- 36 days for OHD. Atrioventricular (AV) block developed in three patients from the PCD group and 26 from the OHD group (NS), with spontaneous block occurring in one (1%) PCD patient and 19 (5%) OHD patients (p less than 0.05). Annual mortality due to sudden death as well as total cardiovascular mortality (including sudden death) for the 5-year follow-up was significantly lower in patients with PCD. Patients with PCD have significantly lower incidence of electrophysiologic abnormalities and subsequent spontaneous AV block as well as cardiovascular and sudden death mortality. The diagnosis of PCD based on clinical criteria probably underestimates the presence of underlying OHD, as suggested by a small but definite risk of cardiovascular mortality.
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PMID:Significance of chronic bifascicular block without apparent organic heart disease. 44 30

We studied the effect of 30 mg of prednisolone on 29 Japanese patients with chronic obstructive pulmonary disease (COPD). The mean value of the baseline forced expiratory volume in one second (FEV1; mean +/- SEM) was 1.14 +/- 0.12 l (46.9 +/- 3.9% pred) and the FEV1 following the steroid trial was 1.30 +/- 0.12 l (53.7 +/- 4.3% pred). Post-trial FEV1--baseline FEV1/predicted FEV1 was 6.8 +/- 1.9%. Five patients (17%) had more than a 15% increase in FEV1 as a percentage of predicted FEV1. Post-trial FEV1/baseline FEV1 was 117.3 +/- 4.3%, and 12 patients (41%) had more than a 20% increase in FEV1 after the trial. Acute bronchodilator response to beta-agonist correlated positively with the response to corticosteroid. Baseline spirometries, blood eosinophil counts, serum IgE levels, sputum eosinophil counts, family history of asthma, and history of paroxysmal dyspnea did not vary across responders and non-responders. Patients with severe COPD should be treated to achieve the best possible pulmonary functions indicated by a steroid trial within the limit of acceptable levels of adverse effects.
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PMID:Response to oral corticosteroid in patients with chronic obstructive pulmonary disease. 128 23

1. To investigate the role of mast cells and eosinophils in the pathogenesis of nocturnal asthma, the plasma methylhistamine concentration, serum eosinophil cationic protein level and peak expiratory flow rate were measured 2-hourly for 24 h in 10 patients with nocturnal asthma and in 10 healthy control subjects. Nocturnal asthma was defined as at least one nocturnal awakening per week due to cough, wheeze or breathlessness with an average overnight fall in peak expiratory flow rate of at least 15% during a 2-week run-in period. 2. The lowest peak expiratory flow rate occurred at 02.00-04.00 hours in the group with nocturnal asthma, whose overnight fall in peak expiratory flow rate was 29 +/- 5% in comparison with 5 +/- 1% (means +/- SEM) in the normal subjects. 3. Plasma methylhistamine levels at night (0.200-04.00 hours) were lower than during the day (10.00-20.00 hours) in both asthmatic patients and normal subjects (asthmatic patients: day, median 0.22 ng/ml, 95% confidence intervals 0.18-0.34 ng/ml; night, 0.17 ng/ml, 0.13-0.24 ng/ml; P < 0.01; normal subjects: day, 0.31 ng/ml, 0.24-0.41 ng/ml; night, 0.24 ng/ml, 0.21-0.33 ng/ml; P < 0.01). 4. The serum eosinophil cationic protein level was higher by day (30 ng/ml, 8-47 ng/ml) than by night (21 ng/ml, 5-34 ng/ml; P < 0.04) in the group with nocturnal asthma, but did not change significantly with the time of day in the normal subjects (day: 8 ng/ml, 4-14 ng/ml; night: 8 ng/ml, 5-21 ng/ml).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Circulating histamine and eosinophil cationic protein levels in nocturnal asthma. 132 39

Oxygen (O2) has been reported to improve exercise tolerance in some patients with chronic obstructive pulmonary disease (COPD) despite only mild resting hypoxemia (PaO2 greater than 60 mm Hg). To confirm these prior studies and evaluate potential mechanisms of benefit, we measured dyspnea scores by numeric rating scale during cycle ergometry endurance testing and correlated the severity of dyspnea with right ventricular systolic pressure (RVSP) measured by Doppler echocardiography during a separate supine incremental exercise test. Both sets of exercise were performed according to a randomized double-blind crossover protocol in which patients breathed compressed air or 40% O2. We studied 12 patients with severe COPD (FEV1 0.89 +/- 0.09 L [mean +/- SEM], FEV1/FVC 37 +/- 2%, DLCO 9.8 +/- 1.5 ml/min/mm Hg[47% of predicted], PaO2 71 +/- 2.6 mm Hg). With endurance testing on compressed air, PaO2 did not change significantly in the group as whole (postexercise PaO2 63 +/- 5.1 mm Hg, p = NS), but did fall to less than 55 mm Hg in four patients from this group. Duration of exercise increased on 40% O2 from 10.3 +/- 1.6 to 14.2 +/- 1.5 min (p = 0.005), and the rise in dyspnea scores was delayed. Oxygen delayed the rise in RVSP with incremental exercise in all patients and lowered the mean RVSP at maximum exercise from 71 +/- 8 to 64 +/- 7 mm Hg (p less than 0.03). Improvement in duration of exercise correlated with decrease in dyspnea (r2 = 0.66, p = 0.001) but not with decreases in heart rate, minute ventilation, or RVSP.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Oxygen may improve dyspnea and endurance in patients with chronic obstructive pulmonary disease and only mild hypoxemia. 141 22

Clentiazem, 8-chloro diltiazem, is a calcium channel blocker currently undergoing evaluation for the treatment of stable angina and hypertension. As patients with ischaemic disorders often present some degree of heart failure, the aim of this study was to investigate the effect of congestive heart failure on clentiazem (200 micrograms kg-1, i.v. bolus) pharmacokinetics in a canine model. Congestive heart failure was induced in six dogs by rapid ventricular pacing (240 beats min-1) for 3-5 weeks. Clentiazem pharmacokinetics was studied in each dog under the control condition and after the development of clinical signs of heart failure (ascites, dyspnea, fatigue). Blood samples were collected up to 480 min post-dose. Clentiazem plasma concentrations were determined by high performance liquid chromatography. The area under the plasma concentration versus time curves (AUC0-infinity) was significantly increased in congestive heart failure dogs (8.8 +/- 1.6 vs 21.8 +/- 1.4 micrograms min ml-1) (mean +/- SEM). These changes were related to a reduction of the volume of distribution of the central compartment (0.9 +/- 0.1 vs 0.2 +/- 0.11 kg-1) and total body clearance (1.9 +/- 0.4 vs 0.7 +/- 0.21 h-1 kg-1). It is concluded that, in our model, congestive heart failure significantly modifies clentiazem disposition. These results suggest that caution should be exercised when clentiazem is given to patients with a low ejection fraction and a compromised cardiac function. Reduced loading and maintenance doses might be recommended in patients with severe congestive heart failure.
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PMID:Effect of congestive heart failure on clentiazem pharmacokinetics in a dog model. 148 42

We studied five men with chronic obstructive pulmonary disease (COPD) (mean age, 65 +/- SEM 2 yr; FEV1, 0.68 +/- 0.08 L; and FEV1/FVC, 38 +/- 2%) to determine the relationship between ventilatory muscle endurance (VME) and ventilatory muscle rest (VMR) elicited by negative-pressure ventilation (NPV). VME was measured as the maximal sustainable ventilation (MSVC) that the subjects could maintain for 12 min. Prior to therapy, MSVC for the subjects was 25.0 +/- 3.6 L/min. During the therapy phase, subjects received 4 wk of daily "in-hospital-supervised" NPV therapy (4 h/day). While subjects received therapy, we quantified VMR by (1) the percentage of breaths that were "in synchrony" and by (2) the percentage of breaths showing "turn-off" of the diaphragmatic EMG signal (EMGdl). During the therapy sessions, 93 +/- 2% of breaths were in synchrony, whereas 66 +/- 11% showed EMGdl turn-off. During post-therapy testing, an increase in MSVC was noted in each of the subjects; the mean increase was 4.0 +/- 1.3 L/min (p less than 0.05), which represented an increase of 16 +/- 4% over pretherapy values. Increases in MSVC were highly correlated with both the percentage of in-synchrony breaths (r = 0.96, p less than 0.01) and the percentage of breaths showing EMGdl turn-off (r = 0.92, p less than 0.02). However, NPV therapy elicited no other improvements in either clinical or laboratory measurements. Moreover, patients exhibited marked dyspnea with initiation and termination of daily NPV therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effect of negative pressure ventilation on ventilatory muscle endurance in patients with severe chronic obstructive pulmonary disease. 151 53

We developed a technique to isolate and lavage a segment of a large human airway in vivo. Airway lavage and BAL were performed without significant complications 18 times on 17 normal volunteers. The mean +/- SEM volume of instillate used on all subjects totaled 31.3 +/- 2.7 ml with 47.1 +/- 3.8% of the fluid recovered. A total of 1.5 +/- 0.3 x 10(6) cells were retrieved. Cell viability averaged 71.3 +/- 4.6%. The majority of the cells were macrophages, 27.9 +/- 2.7%, and neutrophils, 28.4 +/- 6.0%. A descriptive comparison of airway macrophages using transmission electron microscopy with those retrieved from paired bronchoalveolar lavage (BAL) samples revealed that airway macrophages possessed more vacuoles (p less than 0.0001), fewer long microvilli (p less than 0.0001), and more membrane undulations (p less than 0.0001). In contrast, macrophages from both lavage locations demonstrated similar staining characteristics when stained with a panel of monoclonal antibodies. During lavage, all subjects experienced mild dyspnea that was relieved when the lavage was completed. One of three subjects tested during the procedure revealed O2 desaturation that was prevented by the inhalation of O2. We conclude that viable macrophages can be retrieved safely from airways of normal subjects and that, compared with macrophages present in BAL, these cells bear both similarities and dissimilarities that may portend differing functional capabilities.
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PMID:Human airway macrophages. A technique for their retrieval and a descriptive comparison with alveolar macrophages. 155 22

The purpose of this study was to demonstrate that clinical ratings of dyspnea and physiologic function are separate dimensions underlying the pathophysiology of chronic obstructive pulmonary disease (COPD). We used principal-components factor analysis to confirm these dimensions using data collected prospectively in 86 symptomatic patients with COPD. Three different instruments were used to rate dyspnea: a modified Medical Research Council (MRC) scale, the oxygen cost diagram (OCD), and the baseline dyspnea index (BDI). Measures of physiologic function included standard spirometric measures (forced vital capacity [FVC] and forced expiratory volume in one second [FEV1]) and maximal inspiratory (PImax) and expiratory (PEmax) mouth pressures. Age of the 65 male and 21 female subjects was 62.9 +/- 1.2 yr (mean +/- SEM). All three clinical scales were significantly correlated with physiologic function (range of r values, 0.32 to 0.45; p less than 0.05), except for the relationship between the MRC scale and PEmax (r = -0.14; p = NS). The factor analysis yielded three factors that accounted for 71.9% of the total variance of the data: clinical ratings of dyspnea (MRC scale, OCD, and BDI) loaded on the first factor; maximal respiratory pressures and gender loaded on the second factor; and lung function and age loaded on the third factor. Additional post hoc factor analysis provided similar results when the sample was divided into two subgroups by randomization, by severity of dyspnea ratings, or by severity of airflow obstruction. We conclude that dyspnea ratings, maximal respiratory pressures, and lung function are separate factors or quantities that independently characterize the condition of patients with COPD.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A factor analysis of dyspnea ratings, respiratory muscle strength, and lung function in patients with chronic obstructive pulmonary disease. 173 59

We studied 19 subjects with asthma (11 men and eight women, aged 20 to 66 years), 6 months to 5 years after a near-fatal (NF) episode of asthma (NF group). Mean duration of asthma was 16.3 +/- 2.4 years. On reevaluation, all subjects were using an inhaled beta 2-agonist and inhaled steroids (mean daily dose of budesonide, 1070 micrograms [N = 5], and beclomethasone, 1079 micrograms [N = 14]). Two subjects were taking prednisone, 10 and 15 mg/day. Subjects were matched for age, sex, atopic status, baseline FEV1, and medication use to a control group (C group) of subjects with asthma who had never experienced an NF asthma episode. All subjects had the following evaluation: (1) questionnaire on the characteristics of their asthma, (2) spirometry, (3) morning and evening measurements of peak expiratory flow rates (PEFR) with daily recordings of asthma symptoms for 4 weeks, and (4) psychometric evaluation with the Minnesota Multiphasic Personality Inventory. Ten subjects of the NF group and 13 of the C group had a methacholine challenge with scoring of dyspnea on a modified Borg scale. Mean percent predicted (+/- SEM), FEV1, FVC, and PEFR were similar for the NF and C groups with respective values of 63.4 (4.4), 61.3 (5.6), 81.1 (4.5), 79.1 (3.8), 61.3 (5.6), and 62.4 (6.1). Geometric mean of the provocative concentration of methacholine causing a 20% drop in FEV1 (milligrams per milliliter) was 0.61 for the NF group (N = 10) and 1.18 for the C group (N = 13).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Near-fatal asthma: clinical and physiologic features, perception of bronchoconstriction, and psychologic profile. 174 54

Human recombinant erythropoietin (r-HuEPO) improves quality of life in patients on maintenance haemodialysis, but the haemoglobin (Hb) level necessary to achieve this improvement is unknown. In this study, quality of life, functional capacity and symptoms of 28 haemodialysis patients with an initial Hb of 67 +/- 2 (mean +/- SEM) g/L were assessed after 0, 6 and 12 months of r-HuEPO, the dose of which was titrated to achieve a stable Hb of between 90 and 100 g/L. At six and 12 months Hb was 97 +/- 2 and 93 +/- 2 g/L, and mean r-HuEPO dose between three and six, and between nine and 12 months was 88 +/- 6 and 62 +/- 9 U/kg/week intravenously respectively. There was a significant improvement in level of activity and satisfaction with various aspects of life, and a reduction in fatigue, weakness, dyspnoea, angina and restless legs. Patients were able to walk 50% further in six minutes. The improvement in quality of life and function was similar to that reported from other centres whose target Hb was between 100 and 120 g/L, and where the r-HuEPO dose was 75% higher than in this study. Costs of r-HuEPO therapy were assessed. The drug itself costs +A3681/yr/patient, to which was added the estimated cost of additional dialyses and medications, bringing the total to +A5177/yr/patient. There was, however, a reduction in both hospitalisation by 8.3 days/yr/patient and medical consultation by 3.9 hours/yr/patient. Five patients commenced full-time work, one took up full-time study aimed at finding work, three transferred to home haemodialysis and six fewer patients drew social security benefits. The net cost saving from using low dose r-HuEPO was more than +A1,000/yr/patient.
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PMID:Low dose erythropoietin in maintenance haemodialysis: improvement in quality of life and reduction in true cost of haemodialysis. 175 17


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