Cases reported "Hypertension, Pulmonary"

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1/4. In utero development of hypertensive necrotizing pulmonary arterial lesions: report of a case associated with premature closure of the ductus arteriosus and pulmonary hypoplasia.

    Premature closure of the ductus arteriosus (PCDA) is an uncommon defect in which pulmonary hypertension (PH) has been documented by echocardiography in patients and by direct measurement after experimental PCDA in animals. The pulmonary vascular histology in human cases has received little attention but in the few recorded observations the vessels were either normal or showed increased muscularity. We report the case of a 31 week hydropic female stillborn monozygotic twin in whom postmortem examination disclosed PCDA and hypoplasia of the lungs. Atypical plexiform lesions with necrotizing pulmonary arteritis were present. These lesions represent vascular consequences of severe pulmonary hypertension produced by greatly enhanced blood flow through a restricted vascular bed resulting from the combined effects of these two abnormalities. The findings in this case of PCDA with presumed severe PH indicate that severe pulmonary vascular changes can develop in utero and that the interval of time needed for development of such chances in secondary PH is relatively short.
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ranking = 1
keywords = animal
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2/4. Sildenafil in the management of primary pulmonary hypertension.

    Primary pulmonary hypertension is a rare disorder of unknown etiology with a poor prognosis. There is no cure, and drug therapy is effective in only a few patients. calcium-channel antagonists and anticoagulants are the mainstay of therapy. Prostacyclin therapy leads to significant clinical improvement but its use is restricted due to high cost and complex drug delivery systems. Sildenafil is a selective vasodilator and has been shown to be effective in decreasing pulmonary vascular resistance in animal models of pulmonary hypertension. We report the use of sildenafil in two patients of primary pulmonary hypertension who were refractory to conventional drug therapy.
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ranking = 1
keywords = animal
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3/4. Acute respiratory failure after sodium morrhuate esophageal sclerotherapy.

    Two of 30 patients with esophageal varices had respiratory distress develop within 8-24 h of esophageal sclerotherapy. Evidence of aspiration and sepsis were absent in these two patients with the clinical picture of adult respiratory distress syndrome. To investigate the possible etiologic role of sodium morrhuate in this syndrome, a sheep model was established and pulmonary hemodynamics, lung lymph flow, and albumin concentration were measured before and after the intravenous injection of 2.5-15.0 cm3 of sodium morrhuate. In all 8 animals studied, mean pulmonary artery pressures increased from 11.6 /- 2.8 to 32.8 /- 4.9 mmHg (p less than 0.01) 30 s after injection. These pressures returned to baseline values over 120 min. lymph flow increased from 0.91 /- 0.89 to 2.8 /- 1.5 ml/30 min at 90 min postinjection (p less than 0.05) and returned to baseline values in animals monitored for 6-8 h. The lymph/plasma albumin ratio decreased from 0.856 /- 0.08 to 0.74 /- 0.01 (p less than 0.05) 120 min postinjection. pulmonary edema was not evident histologically or gravimetrically (wet/dry weight ratio was 3.65 /- 0.3 and not different from normal). It was concluded that sodium morrhuate injection in sheep causes marked but transient pulmonary hypertension associated with an increased lymph flow of relatively protein-poor lymph. sodium morrhuate esophageal sclerotherapy may affect pulmonary hemodynamics and contribute to respiratory difficulties in patients.
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ranking = 2
keywords = animal
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4/4. Pathophysiologic alterations in endotoxemia. Similarities to an animal model.

    The validity of animal models of human sepsis has been questioned. We describe a patient who experienced a short episode of endotoxemia (? bacteremia) with resultant pulmonary hypertension, pulmonary edema from increased alveolar capillary membrane permeability, hypoxemia, hypotension, and relative leukopenia, which mimics the pathophysiologic changes noted following infusion of pseudomonas bacteria into awake sheep. The similarity of abnormalities and their resolution suggests that pseudomonas infusion in sheep is a valid experimental model of human septic shock.
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ranking = 5
keywords = animal
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