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At least 19 recordsLinked to original sources

Panic Disorder and Chest Pain: Mechanisms, Morbidity, and Management.

Approximately one quarter of patients who present to physicians for treatment of chest pain have panic disorder. Panic disorder frequently goes unrecognized and untreated among patients with chest pain, leading to frequent return visits and substantial morbidity. Panic attacks may lead to chest pain through a variety of mechanisms, both cardiac and noncardiac in nature, and multiple processes may cause chest pain in the same patient. Panic disorder is associated with elevated rates of cardiovascular diseases, including hypertension, cardiomyopathy, and, possibly, sudden cardiac death. Furthermore, patients with panic disorder and chest pain have high rates of functional disability and medical service utilization. Fortunately, panic disorder is treatable; selective serotonin reuptake inhibitors, benzodiazepines, and cognitive-behavioral psychotherapy all effectively reduce symptoms. Preliminary studies have also found that treatment of patients who have panic disorder and chest pain with benzodiazepines results in reduction of chest pain as well as relief of anxiety.

Journal Article↗

High frequency-low morbidity mechanical complications of tube feeding: a prospective study.

Because of preferential use of the enteral route for nutritional support, a prospective study of mechanical complications was done in 109 consecutive patients. One hundred seventy-two nasogastric tubes were placed in 60 patients, 42 esophagostomies in 28 patients, 32 gastrostomies in 22 patients and 9 jejunostomies in 8 patients. Data show that the use of enteral feeding tubes is not without complications. The complications fell into two major categories. There were 15 low frequency mechanical complications, of which four (2 carotid artery blowouts, 1 gastrointestinal perforation, and 1 aspiration) were of high morbidity and 11 of low morbidity. There were 132 high frequency-low morbidity complications with the use of 255 tubes. These consisted mainly of unplanned and untimely removal of feeding tubes with interruption of feedings and necessitating tube replacement. Data indicate that the main problems related to the use of enteral nutrition are not the dramatic complications which create notoriety but those related to the ordinary mechanical complications occurring daily and which command little attention because of their low mortality. These can assume importance because of their high frequency and as such are characterized as high frequency-low morbidity complications.

Journal Article↗

Expiratory flow limitation in morbidly obese postoperative mechanically ventilated patients.

Although obesity promotes tidal expiratory flow limitation (EFL), with concurrent dynamic hyperinflation (DH), intrinsic PEEP (PEEPi) and risk of low lung volume injury, the prevalence and magnitude of EFL, DH and PEEPi have not yet been studied in mechanically ventilated morbidly obese subjects. In 15 postoperative mechanically ventilated morbidly obese subjects, we assessed the prevalence of EFL [using the negative expiratory pressure (NEP) technique], PEEPi, DH, respiratory mechanics, arterial oxygenation and PEEPi inequality index as well as the levels of PEEP required to abolish EFL. In supine position at zero PEEP, 10 patients exhibited EFL with a significantly higher PEEPi and DH and a significantly lower PEEPi inequality index than found in the five non-EFL (NEFL) subjects. Impaired gas exchange was found in all cases without significant differences between the EFL and NEFL subjects. Application of 7.5 +/- 2.5 cm H2O of PEEP (range: 4-16) abolished EFL with a reduction of PEEPi and DH and an increase in FRC and the PEEPi inequality index but no significant effect on gas exchange. The present study indicates that: (a) on zero PEEP, EFL is present in most postoperative mechanically ventilated morbidly obese subjects; (b) EFL (and concurrent risk of low lung volume injury) is abolished with appropriate levels of PEEP; and (c) impaired gas exchange is common in these patients, probably mainly due to atelectasis.

Adult↗

Respiratory mechanics in morbid obese patients with chronic obstructive pulmonary disease and hypertension during pneumoperitoneum.

BACKGROUND AND OBJECTIVE: To evaluate the effects of pneumoperitoneum and the reverse Trendelenburg position on respiratory mechanics and blood-gases in morbid obese patients with chronic obstructive pulmonary disease and hypertension. METHODS: Sixteen morbid obese patients with chronic obstructive pulmonary disease and hypertension were studied. Mean arterial pressure, heart rate, respiratory resistance, dynamic respiratory compliance and peak inspiratory pressures were measured at four time points: 5 min after induction of anaesthesia (T1), 5 min after insufflation of the peritoneum (T2), 5 min after adoption of a 20 degrees reverse Trendelenburg position (T3), and 5 min after deflation of the peritoneum (T4). Arterial blood-gas status was measured at the same measuring points. RESULTS: Respiratory compliance was 40 +/- 12, 28 +/- 8, 32 +/- 8 and 37 +/- 11 mL cm H2O(-1) in T1, T2, T3 and T4, respectively. The changes were significant at T2, T3 and T4. Airway resistance and peak inspiratory pressures showed comparable changes throughout the study with that of respiratory compliance. Haemodynamic measurements showed no clinically significant changes in this study. CONCLUSIONS: In morbid obese patients with chronic obstructive pulmonary disease and hypertension, a 20 degrees reverse Trendelenburg position improved respiratory mechanics and oxygenation without any apparent adverse effects on haemodynamics during laparoscopic gastric banding surgery.

Analysis of Variance↗

Risk factors for morbidity in mechanically ventilated patients with acute severe asthma.

Acute severe asthma is associated with significant morbidity and mortality. We retrospectively quantified hypotension, pulmonary barotrauma, and cardiac arrhythmias in all patients with severe asthma admitted to the intensive care unit (ICU) and prospectively evaluated the predictive value of a measurement of dynamic hyperinflation (DHI) in those patients who required mechanical ventilation. In the first study, 88 ICU admissions for severe asthma over 5 yr (73 patients, 40 +/- 18 yr, 36 men, 37 women) were evaluated. Fifty-one admissions were mechanically ventilated, 29 were not, and 8 previously ventilated patients remained briefly intubated but were not ventilated in the ICU. Hypotension (18/88, 20%), pulmonary barotrauma (12/88, 14%), and arrhythmias (9/88, 10%) were entirely confined to patients who had been mechanically ventilated. There were no significant differences in ventilatory parameters, airway pressures, or blood gases between mechanically ventilated patients with and without complications. Two patients with previous severe hypoxic cerebral damage died from this complication after ICU discharge. In the second study, the end-inspiratory lung volume (VEI) (1) was compared with standard ventilatory parameters in 22 patients. There were no ICU deaths, but high incidences of pulmonary barotrauma (27%) and hypotension (41%) were found. Both minute ventilation (VE and VEI) were significantly higher in patients who developed complications (VE 13.7 +/- 3.0 versus 11.2 +/- 2.5 L/min, VEI 26.1 +/- 4.7 versus 20.0 +/- 7.4 ml/kg, p less than 0.05) but only VEI had a threshold value significantly predictive of complications. For VEI less than 1.4 L, 0/5 (0%) patients had complications; for VEI greater than or equal to 1.4 L, 11/17 (65%) had complications (p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

Mechanisms of morbidity and mortality from exposure to ambient air particles.

The studies reported here assessed pathophysiologic mechanisms that result from exposure to concentrated ambient particles (CAPs) in animals with and without cardiopulmonary compromise. These studies were carried out to determine the biologic plausibility of epidemiologic observations of increases in particulate air pollution associated with increases in human morbidity and mortality. Dogs were exposed two at a time to CAPs or filtered air via tracheostomy for six hours per day on three consecutive days. The electrocardiogram (ECG) and breathing pattern were recorded continuously, and indicators of inflammation were also assessed. In one experimental design, normal dogs were exposed in pairs to CAPs and subsequently to filtered air or to filtered air and subsequently CAPs (the double CAPs/double sham design). Comparisons were made between the CAPs measurements and each dog's own sham responses. In another design, one dog was exposed to CAPs while the chambermate received a sham exposure; these experiments were followed by crossover of the protocol the subsequent week (the crossover design). Comparisons were made between the CAPs exposure and both the chambermate's sham and each dog's own sham responses. The crossover experiments were conducted in normal animals and in animals who had undergone balloon occlusion of the left anterior descending (LAD) coronary artery to induce myocardial compromise. The effects of CAPs in animals with induced chronic bronchitis were part of the original specific aims; because these studies were not fully pursued, the results are presented only in Appendix A. In normal dogs, analyses of all double CAPs and crossover studies revealed low frequency (LF) and high frequency (HF) powers for heart rate variability (HRV) that were significantly higher for CAPs exposure compared to sham exposure. Variation in day-to-day exposure concentrations, aerosol composition, and pathophysiologic responses were also found. The crossover design, continuous measures of aerosol mass, and biologic responses were incorporated in the development of a statistical model that allowed isolation of changes associated with CAPs from changes due to animal variations. Comparison of individual exposures with this model revealed a range from no response in any measured parameter to statistically significant changes in cardiac autonomic balance, pulmonary air flow, and breathing pattern. On days in which dogs showed statistically significant changes in responses, the findings were consistent in both cardiac and respiratory parameters. Days associated with significant increases in LF and HF HRV, LF/ HF HRV ratio, and heart rate standard deviation (HR SD) were also associated with decreases in average heart rate. These same days had decreases in respiratory frequency, tidal volume, minute volume, and peak flows with corresponding increases in respiratory cycle times and enhanced pause (Pauenh), a measure of bronchoconstriction. These cardiac and respiratory changes suggest an effect mediated via both the sympathetic nervous system and the vagus nerve. Alternatively, days associated with increased heart rate had decreases in the HR SD; decreases or no change in HF and LF HRV; increases in respiratory flows and volumes; and decreases in breathing cycle times, all suggesting only sympathetic nervous system mediation. When all data from the crossover design experiments were assessed with this model, the heart rate and respiratory rate were significantly decreased in relation to both cumulative and actual exposure and the LF HRV, LF/HF HRV ratio, HR SD, and all other respiratory parameters were significantly increased (p < 0.0001 for all). When cardiac data were grouped by days in which the air mass trajectory came from the north or northwest (versus west, south, east, or northeast), significant increases in HR SD and HF HRV and significant decreases in average heart rate were associated with the northwest trajectory. (ABSTRACT TRUNCATED)

Air Pollutants↗

[Morbidity: terminology, mechanisms of formation and classification].

In the 70-ies of the last century the evolution of the epidemic process doctrine resulted in developing population approach to morbidity analysis, in addition to the traditional focal approach. On the one hand, this led to the discussion on the possibility of applying such notion to non-infectious diseases and, on the other hand, to the discussion on the mechanisms of the development and formation of different manifestations in infectious diseases. In both cases the discussion was centered on the phenomenon of morbidity. The present article deals with the nature of morbidity as a phenomenon and the acceptability of general scientific approaches in the interpretation of seasonal and cyclic character of morbidity from the viewpoint of the wave process in an open system. On the basis of the data presented in this work the terms used in epidemiology in considering manifestations of the epidemic process are discussed. The improved classification of morbidity by qualitative and quantitative signs for infectious diseases is proposed.

Bacteria↗

Pulmonary ventilation and mechanics in morbidly obese Zucker rats.

The obese Zucker rat, an autosomally genetic model of obesity, represents a good model of relatively early onset human obesity. Although factors associated with the control of metabolism and thermoregulation have been studied extensively in these animals, pulmonary mechanics and ventilation have not been documented and form the basis of this investigation. Studies were carried out in 16 obese and 18 lean female littermates (698 +/- 79 versus 304 +/- 24 g, p < 0.001). Pulmonary function, including lung volumes and respiratory system compliance, was evaluated in supine anesthetized animals. With the exception of residual volume, all other lung volumes, including function residual capacity, total lung capacity, expiratory reserve volume, and inspiratory capacity, were significantly reduced (p < 0.05 or better) in the obese phenotype compared with volumes in the lean littermates. Pressure-volume relationships of the intact respiratory system and the excised lung were also determined. Although lung compliance was similar between the phenotypes, respiratory system compliance was significantly lower (0.85 +/- 0.06 versus 0.67 +/- 0.09 ml/cm H2O, p < 0.01) in the obese rats. Oxygen consumption and ventilatory parameters (including respiratory rate, tidal volume, minute ventilation, inspiratory time, and expiratory time) were similar between phenotypes breathing room air, and the minute ventilation in response to hypoxia was similar in both groups. In marked contrast, obese animals exhibited a blunted ventilatory response to hypercapnia (221 +/- 38 versus 135 +/- 44 ml/min, p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

[Pathophysiology and morbidity of mechanical ileus].

Bowel obstruction by adhesion and tumor is the most common cause of mechanical ileus. The major alteration of obstructed bowels is distention. Microcirculation is hampered by raising the intraluminar pressure to 30 mm Hg. The high losses of water and electrolytes are not only due to lower resorption but also to secretion of liquid caused by enterotoxin. Therefore, perioperative antibiotics are necessary in addition to other therapeutic steps like decompression, parenteral nutrition and early operative intervention.

Enterotoxins↗

Chest mechanics in morbidly obese non-hypoventilated patients.

Seventy-seven patients with morbid obesity, body mass index (BMI) 40-69.9 kg m(-2), who were candidates for gastroplasty, were studied in our laboratory as part of a pre-operative survey. They had no complaints other than obesity and were not cyanotic. A group of 28 lean subjects (BMI 20-29.8 kg m(-2)) who were candidates for abdominal surgery, without any respiratory complaint, were included as controls. For each patient a pulmonary function test was performed, measuring slow vital capacity with expiratory residual volume (ERV), forced vital capacity (flow/volume) and maximal voluntary ventilation (MVV). In obese patients the MVV is reduced as BMI increases. This results in the reduction of expiratory flows and volumes. Forced expiratory volume in 1 sec (FEV1) is reduced in proportion to the FVC reduction and is related to MVV. It is suggested that the main consequence of the burden of the chest wall by increased adipose mass is a reduction in its compliance, making inspiration increasingly difficult, and resulting in lower static volumes and flows.

Adult↗

Therapeutic and genetic prospects of an atypical affective disorder.

The utility of bipolar type II affective disorder subgrouping is discussed. There is low diagnostic agreement among clinicians for this putative condition. However, the clustering of cases in families and the poor response to standard treatments suggest that it is a distinct subgroup. The clinical features of the depressive phase of this condition including chronicity, intermittency, hyperphagia, hypersomnia, and reactivity relate it to the constructs of "hysteroid dysphoria," atypical depression, and seasonal affective disorder. Its association to several abnormal motivated behaviors such as alcoholism and eating disorders allows the speculation that a distinct morbid mechanism involving serotonin may underlie it and that new serotonin reuptake blocking drugs may be useful in treating it. Finally, the genetic identity of this subgroup in all likelihood will be established or rejected by genetic linkage studies utilizing the restriction fragment length polymorphism map of the genome.

Genetic Markers↗

Traumatic chylothorax: a case report.

A case of traumatic chylothorax following a motor vehicle accident is presented. This is a rare injury following thoracic trauma and is associated with a high mortality and morbidity. Mechanisms of injury to the thoracic duct are described. A management strategy is suggested, which initially entails a trial of conservative therapy of adequate drainage, total parenteral nutrition (TPN) and total gut rest. If significant chyle losses persist after 2 weeks, surgery is indicated, as immunological factors may complicate recovery. The recommended surgical technique is transthoracic duct ligation directly or at the hiatus.

Accidents, Traffic↗

Treatment of chronic renal failure with "serial recipes for renal failure": a report of 64 cases.

The "Serial Recipes for Renal Failure" (SRRF), are 11 recipes formulated in accordance with the morbid mechanisms of deficiency, stagnation, dampness and reverse in chronic renal failure (CRF), for the purposes of replenishing deficiency, and activating blood stagnation as an etiological approach and eliminating dampness and suppressing reverse flow as an symptomatic approach. In the treatment of 64 cases of CRF, the total effective rate of SRRF was 84.4%, and the markedly effective rate 51.6%. The author holds that blood stagnation is the main point in the pathogenic mechanism and recommends comprehensive therapeutic measures.

Administration, Rectal↗

[Analysis of inconstancy of epidemic outbreaks within the dynamics of seasonal rise in mortality].

The possible cause of inconstancy appear against a background rhythmical repeated the seasonal raising of morbidity epidemic outbreak is studied by mathematical modeling. Results of the research are applied to influenza epidemics outbreaks against a background of seasonal raising of respiratory morbidity. Mechanism of outgrowing of seasonal raising to epidemic outbreak is explained as a change of the stable equilibrium by temporary unstable one.

Disease Outbreaks↗

Vascular endothelium in sepsis and endotoxemia.

Since septic or endotoxin shock was high mortality and morbidity, mechanisms for cardiovascular collapse have been intensely investigated. The vascular response to catecholamines and other agonists is greatly attenuated. The mechanisms are considered to be related to changes in endothelium function. The endothelium releases vasoconstrictor and vasodilator compounds. These autocoids normally interact with systemic and other local vascular controls, but during endotoxemia this balance is severely altered. Large artery endothelia are destroyed whereas the microvessels remain intact and functional. The release of nitric oxide, prostacyclin and endothelin is greatly enhanced. The cytokines from endotoxin seem, however, to be the major causal agents of the syndrome and affect the endothelial or receptors on the endothelia differentially, dependent on tissue location.

Bacterial Infections↗

Chest physiotherapy for preventing morbidity in babies being extubated from mechanical ventilation.

BACKGROUND: This section is under preparation and will be included in the next issue. OBJECTIVES: To assess the effects of active chest physiotherapy on babies being extubated from mechanical ventilation for neonatal respiratory failure. SEARCH STRATEGY: The standard search strategy for the Neonatal Review Group was used as outlined in the Cochrane Handbook in the Cochrane Library. SELECTION CRITERIA: All trials utilising random or quasi-random patient allocation, in which active chest physiotherapy was compared with non-active techniques (eg positioning and suction alone) or no intervention in the periextubation period. The methodological quality of each trial was assessed by two independent authors. DATA COLLECTION AND ANALYSIS: Data were extracted independently by two authors. The data were analysed from 3 trials. Subgroup analysis was performed on different treatment frequencies. MAIN RESULTS: In this review of 3 small trials, 2 of which were carried out 10 & 20 years ago, no clear benefit of periextubation active chest physiotherapy can be seen. Active chest physiotherapy did not significantly reduce the rate of postextubation lobar collapse (RR 0.69;0.33,1.45), though a reduction in the use of reintubation was shown in the overall analysis (RR 0.24;0.08,0.75). Subgroup analysis of different treatment frequencies showed the same effect with more frequent treatment (1 & 2 hourly) but showed a trend to increased lobar collapse, and no reduction in the use of reintubation, with less frequent treatment (4 hourly). There is insufficient information to assess other important short and long term outcomes, including adverse effects. REVIEWER'S CONCLUSIONS: The results of this review do not allow development of clear guidelines for clinical practice. Caution is required when interpreting the possible positive effects of chest physiotherapy of a reduction in the use of reintubation and the trend for decreased post-extubation atelectasis as the numbers of babies studied are small, the results are not consistent across trials, data on safety are insufficient, and applicability to current practice may be limited.

Humans↗

The clinical spectrum of chronic metabolic acidosis: homeostatic mechanisms produce significant morbidity.

Chronic metabolic acidosis is a process whereby an excess nonvolatile acid load is chronically placed on the body due to excess acid generation or diminished acid removal by normal homeostatic mechanisms. Two common, often-overlooked clinical conditions associated with chronic metabolic acidosis are aging and excessive meat ingestion. Because the body's homeostatic response to these pathologic processes is very efficient, the serum HCO3- and blood pH are frequently maintained within the "normal" range. Nevertheless, these homeostatic responses engender pathologic consequences, such as nephrolithiasis, bone demineralization, muscle protein breakdown, and renal growth. Based on this, the concept of eubicarbonatemic metabolic acidosis is introduced. Even in patients with a normal serum HCO3- and blood pH, it is important to treat the acid load and prevent pathologic homeostatic responses. These homeostatic responses, as well as the mechanisms responsible for their initiation, are reviewed.

Acid-Base Equilibrium↗