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1.
Arch. argent. pediatr ; 120(1): e17-e20, feb 2022. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1353739

ABSTRACT

La hipertensión portopulmonar (HTPP) es una complicación infrecuente de la hipertensión portal, que sigue un curso progresivo con un pronóstico sombrío. Los reportes en pacientes pediátricos son escasos y con períodos de seguimiento cortos. Se describe una paciente con cirrosis descompensada que desarrolló HTPP resuelta mediante trasplante hepático, que permanece asintomática tras diez años de seguimiento.


Portopulmonary hypertension is an uncommon complication of portal hypertension, running a progressive course with a negative prognosis. Reports in pediatric patients are scarce with short follow up. We describe the case of decompensated cirrhosis who developed PoPH and resolved with liver transplantation, remaining asymptomatic after ten years of follow up.


Subject(s)
Humans , Female , Child , Liver Transplantation , Hepatitis, Autoimmune/complications , Hypertension, Portal/complications , Hypertension, Pulmonary/etiology , Liver Cirrhosis/complications
5.
Medicina (B.Aires) ; 81(1): 91-95, mar. 2021. graf
Article in Spanish | LILACS | ID: biblio-1287245

ABSTRACT

Resumen La enfermedad de Whipple es una enfermedad multisistémica crónica, causada por la bacteria Tropherima whipplei. Se han descripto aproximadamente 1200 casos en la literatura. La incidencia mundial se estima en 9.8 casos por millón de personas. Los datos provenientes de Sudamérica y Europa muestran que afecta a varones de mediana edad. Se cree que los factores inmunológicos del huésped son los que influyen en el curso de la infección y no el genotipo del agente. Dado que las características clínicas no suelen ser específicas y el espectro de manifestaciones en órganos individuales puede ser subestimado, el diagnóstico sigue siendo muy difícil. Presentamos un caso confirmado por histopatología con compromiso multisistémico. Consideramos importante su difusión dados los escasos casos documentados en Sudamérica y la relevancia de tener presente la sospecha diagnóstica para el abordaje terapéutico precoz que mejora el pronóstico de esta rara enfermedad.


Abstract Whipple's disease is a chronic mutisystem disease caused by the bacteria Tropherima whipplei. Approximately 1200 cases have been described in the literature. The worldwide incidence is estimated at 9.8 cases per million people. Data from South America and Europe show that it affects middle-aged males. It is believed that host immunological factors rather than agent genotypic traits influence the course of the infection. Since the clinical characteristics are usually nonspecific and the wide spectrum of manifestations in individual organs may be underestimated, the diagnosis remains challenging. We present a case with multisystem compromise confirmed by histopathology. We consider its publication important given the few cases documented in South America and the relevance of bearing in mind the importance of an early diagnosis for a prompt treatment that improves the prognosis of this rare disease.


Subject(s)
Humans , Male , Middle Aged , Aged , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/etiology , Whipple Disease/complications , Whipple Disease/diagnosis , Whipple Disease/drug therapy , Europe , Tropheryma , Anti-Bacterial Agents/therapeutic use
6.
Article in Chinese | WPRIM | ID: wpr-879817

ABSTRACT

OBJECTIVE@#To study the role of vascular endothelial growth factor-A (VEGF-A) in pulmonary vascular remodeling in neonatal rats with hypoxic pulmonary hypertension (HPH) by regulating survivin (SVV).@*METHODS@#A total of 96 neonatal rats were randomly divided into three groups: HPH+VEGF-A group, HPH group, and control group. Each group was further randomly divided into 3-, 7-, 10-, and 14-day subgroups (@*RESULTS@#The HPH group had a significantly higher mean RVSP than the control and HPH+VEGF-A groups at each time point (@*CONCLUSIONS@#Prophylactic intratracheal administration of exogenous VEGF-A in neonatal rats with HPH can inhibit pulmonary vascular remodeling and reduce pulmonary arterial pressure by upregulating the expression of SVV in the early stage of hypoxia. This provides a basis for the interventional treatment of pulmonary vascular remodeling in neonatal HPH.


Subject(s)
Animals , Animals, Newborn , Hypertension, Pulmonary/etiology , Hypoxia , Pulmonary Artery , Rats , Rats, Wistar , Vascular Endothelial Growth Factor A , Vascular Remodeling
7.
Ann. afr. méd. (En ligne) ; 13(4): 3829-3839, 2020. tab
Article in French | AIM, AIM | ID: biblio-1259096

ABSTRACT

Contexte et objectif. L'hypertension pulmonaire (HTP) entraîne des symptômes qui altèrent la qualité de vie des patients. En plus, le diagnostic tardif et le traitement inefficace de l'HTP réduisent considérablement la durée de vie des malades. Peu d'études sur cette maladie ont été publié en Afrique subsaharienne et pratiquement aucune en république démocratique du Congo. Le présent travail a pour objectif de déterminer la prévalence et les étiologies de l'HTP à l'hôpital provincial Général de Référence de Bukavu (HPGRB) dans le Sud-Kivu, une province de l'Est de la République Démocratique du Congo (RD Congo). Méthodes. La présente étude mono centrique s'est déroulée dans le Département de Médecine interne de l'HPGRB. C'est une étude de descriptive rétrospective qui s'est réalisée entre le 1er octobre 2014 et le 1er octobre 2019. La population de la présente étude était constituée de tout patient reçus dans le département de Médecine interne et chez qui il a été diagnostiqué une hypertension pulmonaire. Il s'agissait d'un échantillonnage exhaustif. Résultats. La prévalence de l'hypertension pulmonaire était de 3,7 %. Le sexe féminin est majoritaire avec un sex ratio de 1,49 : 1. Dans notre étude, la majorité des patients (61,3 %) avait une hypertension pulmonaire due à des cardiopathies gauches. L'hypertension pulmonaire des maladies respiratoires concernait un quart des patients (25,5 %). L'hypertension pulmonaire post embolique chronique était retrouvée chez 10,2 % des patients. Conclusion. L'hypertension pulmonaire est une pathologie assez fréquente au Sud-Kivu. Son diagnostic est possible à Bukavu et sa prise en charge demande un suivi spécialisé


Subject(s)
Democratic Republic of the Congo , Disease Management , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/therapy , Quality of Life
8.
Clinics ; 75: e1373, 2020. tab, graf
Article in English | LILACS | ID: biblio-1055875

ABSTRACT

OBJECTIVES: Chronic thromboembolic pulmonary hypertension (CTEPH) is a unique form of pulmonary hypertension (PH) that arises from obstruction of the pulmonary vessels by recanalized thromboembolic material. CTEPH has a wide range of radiologic presentations. Commonly, it presents as main pulmonary artery enlargement, peripheral vascular obstructions, bronchial artery dilations, and mosaic attenuation patterns. Nevertheless, other uncommon presentations have been described, such as lung cavities. These lesions may be solely related to chronic lung parenchyma ischemia but may also be a consequence of concomitant chronic infectious conditions. The objective of this study was to evaluate the different etiologies that cause lung cavities in CTEPH patients. METHODS: A retrospective data analysis of the medical records of CTEPH patients in a single reference PH center that contained or mentioned lung cavities was conducted between 2013 and 2016. RESULTS: Seven CTEPH patients with lung cavities were identified. The cavities had different sizes, locations, and wall thicknesses. In two patients, the cavities were attributed to pulmonary infarction; in 5 patients, an infectious etiology was identified. CONCLUSION: Despite the possibility of being solely associated with chronic lung parenchyma ischemia, most cases of lung cavities in CTEPH patients were associated with chronic granulomatous diseases, reinforcing the need for active investigation of infectious agents in this setting.


Subject(s)
Humans , Male , Female , Pulmonary Embolism/diagnosis , Thromboembolism/etiology , Granulomatous Disease, Chronic/pathology , Hypertension, Pulmonary/diagnosis , Pulmonary Embolism/complications , Pulmonary Embolism/therapy , Angiography/methods , Tomography, X-Ray Computed/methods , Chronic Disease , Retrospective Studies , Treatment Outcome , Perfusion Imaging , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/therapy , Lung/blood supply , Anticoagulants/therapeutic use
9.
Arq. bras. cardiol ; 113(3): 419-428, Sept. 2019. tab, graf
Article in English | LILACS | ID: biblio-1038559

ABSTRACT

Abstract The finding of pulmonary hypertension (PH) by echocardiography is common and of concern. However, echocardiography is just a suggestive and non-diagnostic assessment of PH. When direct involvement of pulmonary circulation is suspected, invasive hemodynamic monitoring is recommended to establish the diagnosis. This assessent provides, in addition to the diagnostic confirmation, the correct identification of the vascular territory predominantly involved (arterial pulmonary or postcapillary). Treatment with specific medication for PH (phosphodiesterase type 5 inhibitors, endothelin receptor antagonists and prostacyclin analogues) has been proven effective in patients with pulmonary arterial hypertension, but its use in patients with PH due to left heart disease can even be damaging. In this review, we discuss the diagnosis criteria, how etiological investigation should be carried out, the clinical classification and, finally, the therapeutic recommendations for PH.


Resumo O achado de hipertensão pulmonar (HP) em avaliação ecocardiográfica é frequente e preocupante. No entanto, o ecocardiograma é apenas um exame sugestivo e não diagnóstico de HP. Quando se suspeita de acometimento direto da circulação pulmonar, está indicada medida hemodinâmica invasiva para estabelecer o diagnóstico. Essa avaliação permite, além da confirmação diagnóstica, a correta identificação do território vascular predominantemente acometido (arterial pulmonar ou pós-capilar). O tratamento com as medicações específicas de HP (inibidores da fosfodiestarese 5, antagonistas do receptor de endotelina, análogos da prostaciclina e estimulador da guanilil ciclase solúvel) é comprovadamente eficaz para pacientes com hipertensão arterial pulmonar, mas seu uso em pacientes com HP decorrente de doença cardíaca de câmaras esquerdas pode até mesmo ser prejudicial. Discutiremos nesta revisão o critério diagnóstico, a maneira de proceder a investigação etiológica, a classificação clínica e, finalmente, as recomendações terapêuticas na HP.


Subject(s)
Humans , Hypertension, Pulmonary/diagnostic imaging , Echocardiography , Pulmonary Circulation , Risk Assessment , Pulmonary Disease, Chronic Obstructive/complications , Heart Diseases/complications , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/physiopathology , Hypertension, Pulmonary/therapy
10.
Arch. Health Sci. (Online) ; 26(1): 76-79, 28/08/2019.
Article in Portuguese | LILACS | ID: biblio-1046133

ABSTRACT

Introdução: A Hipertensão Arterial Pulmonar está associada a uma ampla gama de doenças, sendo comum nas doenças do tecido conjuntivo. Porém, um dos maiores desafios diagnósticos em relação à Hipertensão Arterial Pulmonar inclui doenças do tecido conjuntivo clinicamente não identificadas ou tardiamente evidenciadas, principalmente Esclerose Sistêmica. Objetivos: Relatar casos de Hipertensão Arterial Pulmonar secundária à Esclerose Sistêmica que inicialmente foi classificada como Idiopática. Materiais e métodos: Estudo observacional analítico transversal no qual sete pacientes com diagnóstico de Hipertensão Arterial Pulmonar Idiopática foram avaliados quanto ao quadro clínico, exame físico, pesquisa de autoanticorpos e capilaroscopia periungueal na busca de critérios que os classificassem como Esclerose Sistêmica. Resultados: Todos os pacientes preencheram os Critérios Classificatórios para Esclerose Sistêmica ACR/EULAR 2013, sendo que Fenômeno de Raynaud, telangiectasias e positividade de autoanticorpos estiveram presentes em 100% dos casos. A maioria dos pacientes apresentava Esclerose Sistêmica forma cutânea limitada. Conclusões: A determinação do diagnóstico de Hipertensão Arterial Pulmonar secundária à Esclerose Sistêmica é fundamental, pois tais pacientes têm menor sobrevida quando comparados aos casos Idiopáticos. A presença de Fenômeno de Raynaud tem grande relevância no diagnóstico dos pacientes com Hipertensão Arterial Pulmonar associada à Esclerose Sistêmica.


Introduction: Pulmonary Arterial Hypertension is associated with a wide range of diseases. It is common in connective tissue diseases. However, one of the major diagnostic challenges in relation to Pulmonary Arterial Hypertension includes clinically unidentified or late-onset diseases of the connective tissue, mainly Systemic Sclerosis. Objectives: To report cases of Pulmonary Arterial Hypertension secondary to Systemic Sclerosis, which was initially classified as Idiopathic. Patients and methods: We carried out a cross-sectional observational study in which seven patients with a diagnosis of Idiopathic Pulmonary Arterial Hypertension was evaluated for clinical examination, physical examination, autoantibody and nailfold capillaroscopy examination in search of criteria that reclassified them as Systemic Sclerosis. Results: All patients met the Classification Criteria for Systemic Sclerosis ACR/EULAR 2013, with Raynaud's Phenomenon, telangiectasia and autoantibody positivity being present in 100% of the cases. The majority of patients presented limited cutaneous Systemic Sclerosis. Conclusions: The diagnosis of Pulmonary Arterial Hypertension secondary to Systemic Sclerosis is essential, considering the association with lower survival when compared to the idiopathic cases. The presence of Raynaud's Phenomenon has an important relevance in the diagnosis of patients with Pulmonary Arterial Hypertension associated with Systemic Sclerosis.


Subject(s)
Humans , Male , Female , Aged , Scleroderma, Systemic/diagnosis , Connective Tissue/physiopathology , Hypertension, Pulmonary/etiology
11.
Braz. j. med. biol. res ; 52(8): e8513, 2019. tab, graf
Article in English | LILACS | ID: biblio-1011602

ABSTRACT

Phenotypic differences have been described between patients with systemic sclerosis (SSc)-associated interstitial lung disease (ILD) and SSc-associated pulmonary hypertension, including performance differences in the 6-min walk test (6MWT). Moreover, the correlations between the 6MWT and traditional pulmonary function tests (PFTs) are weak, indicating the need to search for new parameters that explain exercise performance. Thus, our objective was to evaluate the impact of ventilation distribution heterogeneity assessed by the nitrogen single-breath washout (N2SBW) test and peripheral muscle dysfunction on the exercise capacity in patients with SSc-ILD and limited involvement of the pulmonary parenchyma. In this cross-sectional study, 20 women with SSc-ILD and 20 matched controls underwent PFTs (including spirometry, diffusing capacity for carbon monoxide (DLco), and the N2SBW test) and performed the 6MWT and knee isometric dynamometry. The 6-min walking distance (6MWD, % predicted) was strongly correlated with the phase III slope of the single-breath nitrogen washout (phase III slopeN2SBW) (r=−0.753, P<0.0001) and reasonably correlated with the forced vital capacity (FVC) (r=0.466, P=0.008) and DLco (r=0.398, P=0.011). The peripheral oxygen saturation (SpO2) during exercise was not significantly correlated with any of the pulmonary or muscle function parameters. The phase III slopeN2SBW was the only predictive variable for the 6MWD, whereas quadriceps strength and FVC/DLco were predictive variables for SpO2. Ventilation distribution heterogeneity is one factor that contributes to a lower 6MWD in SSc-ILD patients. In addition, muscle dysfunction and abnormal lung diffusion at least partly explain the decreased SpO2 of these patients.


Subject(s)
Humans , Female , Adult , Middle Aged , Respiratory Function Tests/methods , Scleroderma, Systemic/complications , Exercise Tolerance/physiology , Lung Diseases, Interstitial/physiopathology , Hypertension, Pulmonary/physiopathology , Lung/physiology , Raynaud Disease/complications , Tomography, X-Ray Computed/methods , Case-Control Studies , Vital Capacity/physiology , Lung Diseases, Interstitial/etiology , Pulmonary Ventilation , Walk Test/methods , Hypertension, Pulmonary/etiology , Lung/physiopathology , Lung Volume Measurements/methods
12.
Medicina (B.Aires) ; 78(6): 443-446, Dec. 2018. ilus, tab
Article in Spanish | LILACS | ID: biblio-976144

ABSTRACT

El mieloma múltiple es una enfermedad oncohematológica, que representa el 15% de las enfermedades hematológicas malignas. La edad media de aparición es entre los 65-70 años, siendo muy poco frecuente en pacientes jóvenes; 2% son menores de 40 años. Presentamos el caso de una mujer de 36 años con antecedente de tabaquismo de 20 paquetes año. Consultó por disnea asociada a signos de insuficiencia cardíaca derecha, anemia, proteinuria, elevación de reactantes de fase aguda y patrón sugestivo de restricción moderadamente grave en la espirometría y caída de la capacidad de difusión de monóxido de carbono (DLco). El ecocardiograma doppler evidenció dilatación de cavidades derechas y signos de hipertensión pulmonar que se confirmó con cateterismo cardiaco derecho. En busca de la etiología se arribó al diagnóstico de mieloma múltiple.


Multiple myeloma is a hematologic disease, which accounts for 15% of hematologic malignancies. The average age of onset is between 65-70 years and is very rare in young patients, as 2% are under 40 years old. We present a case of 36-year-old women with history of 20 pack years (p/y) smoking, who complaints of dyspnea associated with signs of right cardiac overload, anemia, proteinuria, elevated acute phase reactants and spirometry pattern suggestive of moderately-severe restriction and severe drop in diffusing capacity for carbon monoxide (DLCO). Echocardiogram evidence dilated right heart cavities and signs of pulmonary hypertension which is confirmed by right heart catheterization. In search of the etiology we arrive to the diagnosis of multiple myeloma.


Subject(s)
Humans , Female , Adult , Hypertension, Pulmonary/etiology , Multiple Myeloma/complications , Biopsy , Cardiac Catheterization , Radiography, Thoracic , Hypertension, Pulmonary/physiopathology , Hypertension, Pulmonary/pathology , Multiple Myeloma/physiopathology , Multiple Myeloma/pathology
13.
Arch. cardiol. Méx ; 88(5): 503-506, dic. 2018. graf
Article in Spanish | LILACS | ID: biblio-1142162

ABSTRACT

Resumen El desarrollo de hipertensión arterial pulmonar asociada al virus de inmunodeficiencia humana reduce la probabilidad de sobrevivencia en el paciente afectado en comparación con el que no presenta esta alteración cardiopulmonar. La fisiopatogenia aún es incierta. Existen varias líneas de investigación para asociar las diferentes proteínas del virus en la lesión endo- telial. Desde el punto de vista terapéutico, existen modalidades de tratamiento que permiten una expectativa de vida aceptable.


Abstract The development of pulmonary arterial hypertension associated with human immunodeficiency virus reduces the probability of survival in the patient affected compared to those without cardiopulmonary disease. The pathophysiology is uncertain. There are several lines of research to associate the different proteins of the virus in the endothelial lesion. From a therapeutic point of view there are treatment modalities that allow an acceptable life expectancy.


Subject(s)
Humans , Viral Proteins/metabolism , HIV Infections/complications , Hypertension, Pulmonary/etiology , HIV Infections/mortality , Life Expectancy , Hypertension, Pulmonary/physiopathology , Hypertension, Pulmonary/therapy
14.
Rev. chil. pediatr ; 88(6): 699-706, dic. 2017. graf
Article in Spanish | LILACS | ID: biblio-1042711

ABSTRACT

Resumen Hace 50 años Northway describió la Displasia Broncopulmonar (DBP), en nacidos de pretérmino expuestos a ventilación mecánica. Desde entonces, ha aumentado la sobrevida de ellos; sin embar go, ha aparecido una "nueva DBP" y la incidencia de esta no ha disminuido. Una de las caracte rísticas de esta patología es la remodelación vascular anómala, que en su expresión más severa se conoce como Hipertensión Pulmonar (HP); con una incidencia de 17%, que es proporcional a la severidad de la DBP (33% en DBP severa); y como un factor de mortalidad (hasta un 48% mortali dad a 2 años con HP por DBP). Debido a esto resulta importante conocer los métodos diagnósticos y alternativas terapéuticas, tema que se discute en esta revisión. Considerando la alta mortalidad de la asociación HP-DBP, adquiere importancia una estrategia de tamizaje en la población de riesgo. El gold standard para el diagnóstico de HP es el cateterismo cardíaco, sin embargo, el ecocardio-grama transtorácico es una herramienta útil para el tamizaje y diagnóstico de HP en pacientes dis-plásicos, con mediciones cuantitativas y cambios cualitativos en la evaluación diagnóstica. A nivel sanguíneo el péptido natriurético tipo B (BNP), ha mostrado ser útil en el seguimiento; en cuanto a imágenes, la tomografía computarizada se utiliza en casos severos. En cuanto a las terapias, se han propuesto el óxido nítrico inhalado como vasodilatador pulmonar, los inhibidores de la fosfodies-terasas -sildenafil-, los antagonistas de la endotelina -bosentán- y los análogos de prostaciclinas -iloprost-. Aún no se cuenta con evidencia de alta calidad para su uso, dosis y duración del trata miento, pero hay variadas experiencias clínicas. Además, es relevante el cuidado interdisciplinario, destacando optimizar la nutrición. El desafío es lograr una prevención efectiva de la DBP y de sus complicaciones. Un protocolo de tamizaje de HP debe asociarse a una estratificación de riesgo y directrices de tratamiento.


Abstract 50 years ago, Northway described Broncopulmonary Dysplasia (BPD) in preterm infants exposed to mechanical ventilation. Since then, their survival has increased, nevertheless a "new BPD" has appeared and its incidence has not diminished. One of the characteristics of this pathology is the the abnormal vascular remodeling, which in its most severe expression is known as Pulmonary Hyper tension (PH); with an incidence of 17% in patients with BPD, which is proportional to the severity of the disease (33% in severe BPD), and as mortality factor (up to 48% 2-year mortality in PH-BPD). Thereby, it is important to know the diagnostic methods and therapeutic alternatives, topics discus sed in this review. Considering the high mortality in BPD associated PH, screening strategies in at risk population become important. The gold standard is cardiac catheterization; however, transtho-rathic echocardiography is a useful tool for the screening and diagnosis of PH in displasic patients, using cuantitive measures and cualitative changes in the evaluation. Seric type-B natriuretic peptide has shown to be useful for follow-up; regarding images, CT scan is used in severe cases. In terms of therapy; inhaled Nitric Oxide as a pulmonary vasodilator, phosphodiesterase inhibitors -sildenafil-, endotelin antagonists -bosentan-, and prostacyclin analogues -iloprost-, have been proposed. Their use, dosis and treatment lenght still lack support of high quality evidence, but diverse clinical expe riences have been described. Interdisciplinary care is also important, highlighting to optimize nu trition. Therefore, the challenge is to effectively prevent BPD and its complications. A PH screening protocol should be associated with risk stratification and treatment guidelines.


Subject(s)
Humans , Infant, Newborn , Bronchopulmonary Dysplasia/complications , Hypertension, Pulmonary/etiology , Oxygen Inhalation Therapy , Respiration, Artificial , Complementary Therapies , Bronchodilator Agents/therapeutic use , Bronchopulmonary Dysplasia/diagnosis , Bronchopulmonary Dysplasia/metabolism , Bronchopulmonary Dysplasia/therapy , Infant, Premature , Biomarkers/metabolism , Tomography, X-Ray Computed , Combined Modality Therapy , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/metabolism , Hypertension, Pulmonary/therapy , Nitric Oxide/therapeutic use
17.
Braz. j. otorhinolaryngol. (Impr.) ; 83(3): 292-298, May-June 2017. tab, graf
Article in English | LILACS | ID: biblio-889264

ABSTRACT

Abstract Introduction: Adenotonsillar hyperplasia (ATH) and allergic rhinitis (AR) are the most common causes of upper airway obstruction in children. Such diseases, by affecting the upper airways, can cause chronic alveolar hypoventilation, pulmonary vasoconstriction and pulmonary hypertension, which in some cases, are irreversible. Objective: This cross-sectional study aimed to evaluate the prevalence of pulmonary hypertension in two groups of mouth-breathing (MB) 2-12 years old children with ATH and isolated allergic rhinitis, through Doppler echocardiography. Methods: 54 patients with ATH and indications for adenoidectomy and/or tonsillectomy and 24 patients with persistent allergic rhinitis were selected and submitted to Doppler echocardiography. The Systolic Pulmonary Artery Pressure (SPAP) was determined by tricuspid regurgitation and the Mean Pulmonary Artery Pressure (MPAP) was calculated from the SPAP. Similar measurements were carried out in 25 nasal breathing (NB) individuals. Results: The mean MPAP and SPAP were higher in the MB than in the NB group (17.62 ± 2.06 [ATH] and 17.45 ± 1.25 [AR] vs. 15.20 ± 2.36 [NB] mmHg, p < 0.005, and 25.61 ± 3.38 [ATH] and 25.33 ± 2.06 [AR] vs. 21.64 ± 3.87 [NB] mmHg, p < 0.005, respectively) and the mean acceleration time of pulmonary flow trace (Act) was higher in the NB than in the MB group (127.24 ± 12.81 [RN] vs. 114.06 ± 10.63 ms [ATH] and 117.96 ± 10.28 [AR] MS [AR]; p < 0.0001). Conclusion: None of the MB children (ATH and AR) met the PH criteria, although individuals with both ATH and isolated AR showed significant evidence of increased pulmonary artery pressure by Doppler echocardiography in relation to NB individuals. No differences were observed between the ATH and AR groups.


Resumo Introdução: A hiperplasia adenotonsilar (HAT) e a rinite alérgica (RA) consistem nas causas mais comuns de obstrução de vias aéreas superiores em crianças. Tais afecções, ao comprometer a via aérea superior, podem ocasionar hipoventilação alveolar crônica, vasoconstrição pulmonar e hipertensão pulmonar, em alguns casos irreversível. Objetivo: Este estudo transversal objetivou avaliar a prevalência de hipertensão arterial pulmonar em dois grupos de crianças respiradoras orais (RO): com HAT e rinite alérgica isolada, de 2 a 12 anos, por meio de exame ecodopplercardiográfico. Método: Foram selecionados e submetidos à ecodopplercardiografia 54 pacientes com HAT com indicação de adenoidectomia e/ou tonsilectomia e 24 pacientes com rinite alérgica persistente. A pressão sistólica da artéria pulmonar (PSAP) foi determinada pela regurgitação tricúspide e a pressão média da artéria pulmonar (PMAP) foi calculada a partir da PSAP. Determinações similares foram feitas em 25 respiradores nasais (RN). Resultados: As médias da PMAP e da PSAP foram maiores nos grupos de RO do que nos RN (17,62 ± 2,06 [HAT] e 17,45 ± 1,25 [RA] vs. 15,20 ± 2,36 [RN] mmHg; p < 0,005; e 25,61 ± 3,38 [HAT] e 25,33 ± 2,06 [RA] vs. 21,64 ± 3,87 [RN] mmHg; p < 0,005; respectivamente) e a média do tempo de aceleração do traçado do fluxo pulmonar (TAc) foi maior nos RN que nos grupos de RO (127,24 ± 12,81 [RN] vs. 114,06 ± 10,63 ms [HAT] e 117,96 ± 10,28 [RA] MS [RA]; p < 0,0001). Conclusão: Nenhuma criança respiradora oral (HAT e RA) preencheu os critérios de HP, embora tanto os portadores de HAT quanto de RA isolada apresentaram evidências significativas de aumento da pressão arterial pulmonar pela ecodopplercardiografia em relação aos respiradores nasais. Não se observou diferença entre os grupos HAT e RA.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adenoids/pathology , Rhinitis, Allergic/complications , Hypertension, Pulmonary/etiology , Mouth Breathing/complications , Pulmonary Artery/diagnostic imaging , Syndrome , Echocardiography, Doppler , Cross-Sectional Studies , Hyperplasia/complications , Hypertension, Pulmonary/diagnostic imaging
18.
Neumol. pediátr. (En línea) ; 12(2): 71-75, abr. 2017. tab
Article in Spanish | LILACS | ID: biblio-999078

ABSTRACT

Respiratory sleep disorders in children with Down syndrome (DS) have a high prevalence and are related to anatomical and functional characteristics of this syndrome. In this children we should have a high index of suspicion of sleep breathing disorders, diagnose and treat them in order to achieve their full potential in terms of physical and cogntive health


Los trastornos respiratorios del sueño (TRS) en niños con síndrome de Down (SD) tienen una alta prevalencia y estan relacionados con características estructurales y funcionales propias de la enfermedad. En el SD se debe mantener un alto índice de sospecha de los TRS, diagnosticarlos y tratarlos con el fin que los pacientes puedan alcanzar su pleno potencial en términos de salud física y cognitiva


Subject(s)
Humans , Child , Down Syndrome/complications , Sleep Apnea, Obstructive/complications , Sleep Apnea Syndromes/complications , Thyroid Diseases/etiology , Gastroesophageal Reflux , Down Syndrome/therapy , Sleep Apnea, Obstructive/diagnosis , Sleep Apnea, Obstructive/therapy , Alzheimer Disease/etiology , Hypertension, Pulmonary/etiology
19.
Rev. Soc. Bras. Med. Trop ; 50(2): 194-198, Mar.-Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-842844

ABSTRACT

Abstract INTRODUCTION: Chagas disease (CD) is progressive and incapacitating, especially when cardiopulmonary function is affected. For example, respiratory muscle weakness can cause dyspnea upon exertion and fatigue, which may be exacerbated when it is associated with pulmonary hypertension (PH). The present study aimed to evaluate respiratory musculature, quality of life, anxiety, and depression among patients with indeterminate chronic CD and symptoms of PH. METHODS: All individuals completed a clinical evaluation, spirometry, a 6-min walking test, respiratory musculature testing using maximum inspiratory pressure (PImax) and maximum expiratory pressure (PEmax), the Hospital Anxiety and Depression Scale, and the SF-36 questionnaire. RESULTS: We evaluated 107 patients who were assigned to a control group with only CD (G1, 8 patients), a group with CD and possible PH (G2, 93 patients), and a group with CD and echocardiography evidence of PH (G3, 6 patients). The three groups had similar values for PImax and PEmax. Compared to the G1 and G2 groups, the G3 group covered significantly less distance during the 6-min walking test and had a significantly shorter predicted distance (p < 0.05 vs. the G1 group). All three groups had similar values for their spirometry results, Hospital Anxiety and Depression Scale scores, and SF-36 questionnaire results. CONCLUSIONS: Patients with indeterminate chronic CD and symptoms of PH did not experience significant impairment in the studied variables, with the exception of the 6-min walking test, which suggests a low exercise tolerance.


Subject(s)
Humans , Male , Female , Adult , Aged , Quality of Life/psychology , Respiratory Muscles/physiopathology , Chagas Disease/complications , Chagas Disease/physiopathology , Depression/etiology , Hypertension, Pulmonary/etiology , Anxiety/etiology , Anxiety/psychology , Spirometry , Echocardiography , Case-Control Studies , Chronic Disease , Prospective Studies , Surveys and Questionnaires , Chagas Disease/psychology , Depression/psychology , Muscle Strength/physiology , Walk Test , Hypertension, Pulmonary/physiopathology , Middle Aged
20.
Braz. j. med. biol. res ; 50(11): e6237, 2017. tab, graf
Article in English | LILACS | ID: biblio-888952

ABSTRACT

Intrauterine growth retardation (IUGR) is associated with the development of adult-onset diseases, including pulmonary hypertension. However, the underlying mechanism of the early nutritional insult that results in pulmonary vascular dysfunction later in life is not fully understood. Here, we investigated the role of tyrosine phosphorylation of voltage-gated potassium channel 1.5 (Kv1.5) in this prenatal event that results in exaggerated adult vascular dysfunction. A rat model of chronic hypoxia (2 weeks of hypoxia at 12 weeks old) following IUGR was used to investigate the physiological and structural effect of intrauterine malnutrition on the pulmonary artery by evaluating pulmonary artery systolic pressure and vascular diameter in male rats. Kv1.5 expression and tyrosine phosphorylation in pulmonary artery smooth muscle cells (PASMCs) were determined. We found that IUGR increased mean pulmonary artery pressure and resulted in thicker pulmonary artery smooth muscle layer in 14-week-old rats after 2 weeks of hypoxia, while no difference was observed in normoxia groups. In the PASMCs of IUGR-hypoxia rats, Kv1.5 mRNA and protein expression decreased while that of tyrosine-phosphorylated Kv1.5 significantly increased. These results demonstrate that IUGR leads to exaggerated chronic hypoxia pulmonary arterial hypertension (CH-PAH) in association with decreased Kv1.5 expression in PASMCs. This phenomenon may be mediated by increased tyrosine phosphorylation of Kv1.5 in PASMCs and it provides new insight into the prevention and treatment of IUGR-related CH-PAH.


Subject(s)
Animals , Male , Female , Pregnancy , Organophosphates/metabolism , Polymers/metabolism , Kv1.5 Potassium Channel/analysis , Fetal Hypoxia/complications , Fetal Hypoxia/physiopathology , Fetal Growth Retardation/metabolism , Hypertension, Pulmonary/etiology , Muscle, Smooth, Vascular/chemistry , Phosphorylation , Prenatal Exposure Delayed Effects/metabolism , Pulmonary Artery/physiopathology , Pulmonary Artery/pathology , Time Factors , RNA, Messenger/analysis , Immunohistochemistry , Immunoblotting , Random Allocation , Up-Regulation , Fluorescent Antibody Technique , Rats, Sprague-Dawley , Malnutrition/complications , Disease Models, Animal , Fetal Growth Retardation/etiology , Real-Time Polymerase Chain Reaction , Hypertension, Pulmonary/physiopathology , Hypertension, Pulmonary/pathology , Muscle, Smooth, Vascular/pathology
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