Chest
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Our laboratory has focused on the increased activity of an endogenous vascular elastase in the pathobiology of pulmonary hypertension and on the mechanisms by which it is upregulated and by which it orchestrates abnormal remodeling of the vessel wall, specifically the induction of growth factors, the induction of the glycoprotein tenascin, which amplifies the proliferative response, and fibronectin, which is critical to the process of smooth muscle migration in the context of neointimal formation. We explore strategies by which targetting these processes might arrest progression or induce regression of pulmonary vascular disease associated with unexplained pulmonary hypertension.
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Elevated pulmonary vascular resistance is a risk factor in heart transplantation and reversibility of high pulmonary vascular resistance is evaluated preoperatively in potential recipients using i.v. vasodilators or inhaled nitric oxide. Prostacyclin is a potent vasodilator, which when inhaled, has selective pulmonary vasodilatory properties. The aim of this study was to compare the central hemodynamic effects of inhaled prostacyclin with those of inhaled nitric oxide in heart transplant candidates. ⋯ Inhaled prostacyclin induces a selective pulmonary vasodilation that is comparable to the effect of inhaled nitric oxide. Major advantages with inhaled prostacyclin are its lack of toxic reactions and easy administration as compared with the potentially toxic nitric oxide requiring more complicated delivery systems.
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To determine whether African-American race is independently associated with lung disease in scleroderma. ⋯ African-American race and antibodies to topoisomerase I are independent risk factors for scleroderma lung disease.
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Continuous albuterol nebulization (CAN) is a therapeutic modality available to treat status asthmaticus. Currently, CAN may be administered using a large-volume nebulizer (LVN) or a small-volume nebulizer attached to an infusion pump or refilled as needed. Few data are available regarding the reproducibility of aerosol characteristics during CAN. In this study, we determined the aerodynamic profile, drug output (DO), DO in respirable range (RD), solution output (SO), and changes in reservoir's albuterol concentration (AR) hourly during 4 hours of CAN. ⋯ The PBsj demonstrated consistent and adequate aerosol production during 4 hours of CAN. These bench data support the widespread use of a LVN for CAN.
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Aortic dissection generally is an acute catastrophe. Rapid diagnosis is critical. We hypothesized that the quality of history taking contributes to the accuracy of diagnosis in patients with dissection. ⋯ Despite important advances in diagnostic imaging, accurate diagnosis of aortic dissection requires an accurate history. In our series, the quality of initial history was associated with the accuracy of the initial clinical impression in patients with aortic dissection.