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Biomedical subjects

E Weitzenblum

Publications and source records attributed to E Weitzenblum.

At least 145 records · Page 8Linked to original sources
PubMed1984

Long-term course of pulmonary arterial pressure in chronic obstructive pulmonary disease.

Ninety-three patients with severe chronic obstructive pulmonary disease (COPD) of the bronchitic (n = 74) or emphysematous type (n = 19), who all had arterial hypoxemia, underwent 2 right cardiac catheterizations in a clinical steady state, with a delay of 5 yr or more between the first and the last catheterization. No patients received long-term O2 therapy or pulmonary vasodilator drugs. Patients were divided into 2 groups according to the initial level of mean pulmonary artery pressure (Pap). Group 1 included 61 patients without initial pulmonary arterial hypertension (PAH), Pap being less than 20 mmHg; the average delay between the 2 catheterizations was 93.4 +/- 26.8 months. Group 2 included 32 patients with initial PAH (Pap greater than or equal to 20 mmHg), and the average delay was 85.0 +/- 26.0 months. The changes in Pap were small. They ranged from 15.5 +/- 2.4 to 19.6 +/- 7.0 mmHg in Group 1 (p less than 0.001) and from 25.8 +/- 5.6 to 27.8 +/- 9.5 mmHg in Group 2 (NS). The average increase in Pap was 0.65 mmHg/yr in Group 1 and 0.39 mmHg/yr in Group 2 (no statistical difference between the 2 groups). The other hemodynamic parameters (pulmonary capillary wedge pressure, right ventricle filling pressure, cardiac output) did not change. Hemodynamic "worsening," which was defined by an increase in Pap by greater than or equal to 5 mm Hg, was observed in 29% of the patients (n = 27). In these patients, there was a marked worsening of hypoxemia, which was not observed in the remaining 66 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Detection of right ventricular pressure overloading by thallium-201 myocardial scintigraphy. Results in 57 patients with chronic respiratory diseases.

The diagnostic value of thallium 201 (201Tl) myocardial imaging was studied in 57 patients with chronic respiratory diseases, most with COPD (n = 46), by comparing the results to hemodynamic findings. In healthy subjects, the right ventricle (RV) is not visualized; therefore, any recorded activity of the RV was considered as indicating RV hypertrophy due to RV pressure overloading (RVPO). RV activity was graded from 0 (no activity) to 3 (activity greater than or equal to that of the left ventricle). Patients were divided into three groups according to the level of the pulmonary artery mean pressure (PPA): PPA less than or equal to 20 mm Hg (no pulmonary arterial hypertension [PAH] ) = group 1, n = 20; PPA ranging from 21 to 30 mm Hg (mild to moderate PAH) = group 2, n = 20; PPA greater than 30 mm Hg (marked PAH) = group 3, n = 17. RV was visualized in 14 patients in group 3 (82 percent) and in 13 patients in group 2 (65 percent). For all patients with PAH (2 + 3) the sensitivity of 201Tl imaging for the diagnosis of RVPO was of 73 percent, higher than that of ECG and echocardiography (both 51 percent). The sensitivity of 201Tl, even if moderate (65 percent) was better than that of ECG (30 percent) or echo (40 percent) in patients with mild-to-moderate PAH (group 2). A high RV activity (grade 3) was observed in only three patients. The specificity of this method (obtained from results in group 1) was of 80 percent vs 89 percent for echo and 100 percent for ECG. These results suggest that 201Tl myocardial imaging is a rather sensitive method and could be of interest for the noninvasive diagnosis of RVPO in COPD patients.

Adult↗
PubMed1984

[Training respiratory muscles in subjects with chronic obstructive bronchopneumopathy].

Ten subjects with chronic bronchitis with relatively severe bronchial obstruction and, in most cases, severe distension underwent strengthening of their respiratory muscles at home by an additional respiratory resistance load for 10 minutes 3 times a day for one month. All of these subjects obtained an increased endurance of the respiratory muscles without any concomitant increase in the inspiratory muscular force. For the group as a whole, the diameter of the orifice of maximal tolerated inspiratory resistance decreased from 3.15 to 2.40 mm (p less than 0.001) and the time of endurance increased from 7 to 15 minutes 34 seconds (p less than 0.001) while the maximal inspiratory muscular pressure remained virtually unchanged. This benefit was not associated with an increase in the VO2 max SL measured during maximal effort nor with any modification of the VO2, the VE or the heart rate during sub-maximal effort; the objective benefit therefore appears to be very limited.

Aged↗
PubMed1984

Evolution of pulmonary hypertension in chronic obstructive pulmonary diseases.

The prognostic value of the presence and degree of pulmonary arterial hypertension in chronic obstructive pulmonary diseases has been well established, but the natural history of the course of pulmonary artery mean pressure was relatively obscure until recent years. The first studies showed a modest increase in pulmonary artery mean pressure after an average delay of 3-5 years. More recently, studying a group of 35 patients with chronic bronchitis, most of them exhibiting pulmonary arterial hypertension followed-up for a mean period of 3 years, Schrijen et al. did not observe a significant change in pulmonary artery mean pressure in patients with or without initial pulmonary arterial hypertension; a marked decrease in systemic arterial pressure occurred in one third of the patients. In 1979 studying a series of 85 chronic obstructive pulmonary diseases patients, we noticed that pulmonary artery mean pressure slightly increased in patients with or without initial pulmonary arterial hypertension, but the average increase, after five years, for the group taken as a whole was only 0.6 mmHg/year. When putting together the data of Boushy and North, Schrijen et al. and Weitzenblum et al. which concern a relatively homogeneous group of 163 patients with severe chronic obstructive pulmonary diseases, it appears that changes in pulmonary artery mean pressure, after an average follow-up period of 4 years, were rather small, from 21.4 to 23.6 mmHg (0.5-0.6 mmHg/year). These results have been confirmed by a very recent study of our group concerning 93 chronic obstructive pulmonary diseases with patients followed-up for 5-12 years (mean = 90 months).

Blood Pressure↗
PubMed1984

[Diffuse interstitial pneumopathy related to tungsten carbide, confirmed by bronchoalveolar lavage, and responding to corticotherapy].

The authors report a case of severe diffuse interstitial hard metal lung disease responding to corticosteroid therapy. They point out that the course of this disease may be regressive and emphasise that analysis of broncho-alveolar washings showed no abnormality in the differential cell count. Mineralogical study of the same material confirmed exposure.

Adrenal Cortex Hormones↗
PubMed1984

[Value of the measurement of the alveolo-arterial PO2 difference in moderate hyperoxia (FIO2 = 0.40) in chronic respiratory insufficiency].

Alveolo-arterial difference in PO2 (AaDO2) during moderate hyperoxia (FIO2 = 0.40) and shunt-effect (Qs/Qt) were measured in 219 patients with chronic lung disease of various aetiologies. In particular, the series included 79 chronic bronchitics, 35 cases of "primary" emphysema, 40 cases of sarcoidosis and 36 cases of diffuse interstitial pulmonary fibrosis ( DIPF ). Alveolar PO2 was calculated from the equation of alveolar air. Ventilatory parameters were measured under stable conditions using a Fleisch metabograph . Shunt-effect (in moderate hyperoxia) was calculated from the classical equation. AaDO2 in chronic bronchitis was on average 118.3 +/- 30.7 mmHg, significantly higher (p less than 0.005) than in the emphysema patients: 99.2 +/- 22.3 mmHg. The same difference between the two groups was found for shunt-effect (p less than 0.005). In sarcoidosis, AaDO2 and Qs/Qt were only slightly raised on average: 83.6 +/- 22.0 mmHg and 7.2 +/- 3.7% respectively. By contrast, in DIPF , AaDO2 was very high (124.9 +/- 35.7 mmHg) as was Qs/Qt (14.8 +/- 6.9%). The measurement (in moderate hyperoxia) of AaDO2 and Qs/Qt, which are fairly representative of ventilation-perfusion inequalities, may thus make a contribution to the physiopathological differentiation between chronic bronchitis and emphysema. The frank increase in AaDO2 and Qs/Qt in DIPF emphasises the importance of ventilation-perfusion inequalities in the development of hypoxaemia in such patients. For all the cases studied, there was a very satisfactory correlation between AaDO2 in moderate hyperoxia and PaO2 at rest in ordinary air (r = -0.64, p less than 0.001). Similarly, there was a satisfactory correlation between Qs/Qt in moderate hyperoxia and PaO2 at rest in ordinary air (r = -0.53, p less than 0.01).

Blood Pressure↗
PubMed1984

[Home oxygen therapy of chronic bronchitis patients. Clinical, functional and pulmonary hemodynamic results. Apropos of 17 cases].

UNLABELLED: Seventeen subjects (16 male, 1 female) with a mean age of 60 +/- 7 years were studied. INCLUSION CRITERIA: severe chronic bronchitis (mean FEV1 = 960 ml with frank hypoxaemia (PaO2 less than 60 mmHg); past history of right heart failure or electrical signs of right ventricular hypertrophy or pulmonary hypertension (PAP greater than 20 mmHg); oxygen therapy at home for greater than 10/24 hours (most often greater than or equal to 12 hours) for more than a year; interval of more than 6 months between the first haemodynamic investigation (before the start of O2) and the last, this period being on average 23.9 +/- 18.6 months. From a clinical standpoint, there were 5 deaths occurring 11 to 30 months after the start of O2. Effort dyspnoea was stable or worsened but hospitalisations for cardiorespiratory decompensation were less frequent than before the start of O2. There were no significant changes in arterial blood gases: PaO2 rose from 51.9 +/- 8.1 to 52.5 +/- 7.0 mmHg. PAP improved in 12 cases out of 17, and for the group as a whole the difference was not statistically significant. However in the sub-group where the daily duration of administration was greater than 12/24 hours (n = 7), PAP improved in all the individual cases and fell on average from 26.4 +/- 6.8 to 19.9 +/- 3.4 mmHg (p less than 0.02) whilst in the 10-12 hours sub-group there was no mean change in PAP.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1983

Pulmonary hemodynamics in idiopathic pulmonary fibrosis and other interstitial pulmonary diseases.

65 patients with interstitial lung diseases were subdivided into two groups: idiopathic pulmonary fibrosis (IPF) and other interstitial pulmonary diseases (OIP) according to histopathological, immunological and follow-up findings. Arterial blood gases and pulmonary hemodynamics at rest and during steady-state exercise were compared in these two groups (IPF = 31 patients, OIP = 34 patients). The resting PaO2 was significantly lower in the IPF group (p less than 0.001) and regularly worsened during exercise in this group (from 69.6 +/- 11.6 to 56.0 +/- 9.4 mm Hg, p less than 0.001) whereas it did not vary significantly in the OIP group (from 79.2 +/- 13.1 to 75.3 +/- 14.1 mm Hg, NS). Pulmonary artery mean pressure (PPA) was higher in the IPF group (p less than 0.001) as were all indices of pulmonary vascular resistance (PVR). During exercise, PPA markedly increased in the IPF group (from 21.7 +/- 7.8 to 45.3 +/- 16.2 mm Hg) but modestly in the OIP group (from 15.5 +/- 3.7 to 28.3 +/- 9.8 mm Hg). The best relationships were found between PPA, PVR and PaO2, which suggests that pulmonary arterial hypertension in these diseases is not only due to anatomical factors but also to alveolar and arterial hypoxia. Arterial blood gases and pulmonary hemodynamics at rest and during exercise may be of interest for the discrimination of 'true' interstitial fibrosis (IPF) from other interstitial lung diseases (OIP).

Adolescent↗
PubMed1983

[5-year survival of resected bronchial cancer. Multifactorial analysis of its prognosis].

Prognosis in patients having undergone surgery for a bronchial carcinoma (oat cell. carcinoma excluded) was studied by comparing, with two statistical methods, a group of 178 patients surviving five years and more (group I) and a group of 178 patients who died within five years (group II). The two groups had undergone treatment during the same period. Comparison of the two groups suggested that the following factors were indicators of a good prognosis: ratio weight-height within normal limits without recent weight loss, fortuitous detection of the carcinoma; normal aspect on bronchoscopy; T1 N0 type without vascular extension, limited exeresis. Recurrences of the carcinoma were generally observed in group II but could be present in group I. The differential prognosis between pulmonary metastases and a "new" bronchial carcinoma was difficult. Survival was finally determined by the frequency of recurrences and metastases. By a correspondences factorial analysis it was possible to separate and to define the main characteristics of the patients with a good prognosis and a long survival and of those with a poor prognosis and a short survival. However this proved to be exact in only 30% of the individual cases because occurrence of metastases was generally unforeseable. From these data it appears that surgery alone is indicated in only one kind of tumours; T1 N0 carcinomas detected by routine examinations.

Aged↗
PubMed1982

[Nocturnal changes in blood gases and pulmonary arterial pressure in chronic bronchitis patients with respiratory insufficiency (author's transl)].

Fourteen male patients with chronic bronchitis and respiratory insufficiency were monitored during nocturnal sleep by conventional polygraphy (EEG, EOG and EMG of the chin) associated with continuous recording of the mean pulmonary arterial pressure (PAP) and, in 50% of the cases, continuous measurement of O2 saturation. Six subjects were able to sleep long enough for oxygen saturation, blood gases and PAP values to be correlated with the various phases of sleep. Frequent, significant and sometimes abrupt peaks of hypoxaemia were observed; they usually, though not necessarily, occurred during paradoxical sleep. The most pronounced nocturnal changes in SaO2 were encountered in those patients who had the most severe hypoxaemia during daytime. Nocturnal fluctuations in PAP were also pronounced (with increases of more than 20 mmHg) and often paralleled changes in SaO2. Correlation between SaO2 and PAP was good in some patients ("responders") but poor or even lacking in others ("poor-or non-responders"). This preliminary study indicates that patients with chronic bronchitis may have severe exacerbations of pulmonary arterial hypertension during nocturnal sleep and warrant nocturnal oxygen therapy.

Adult↗
PubMed1981

Prognostic value of pulmonary artery pressure in chronic obstructive pulmonary disease.

In 175 patients with chronic obstructive lung disease (157 chronic bronchitic and 18 emphysematous patients) exhibiting moderate to severe airway obstruction (mean FEV1/vital capacity = 40.2 +/- 11.1%), cumulative survival rates calculated by the actuarial method were compared in subgroups according to the initial level of mean pulmonary artery pressure, pulmonary volumes, and arterial blood gases. Patients were catheterised between 1968 and 1972 and were followed for at least five years. The results emphasise the high prognostic value of PAP since survival rates after four and seven years were significantly lower in the subgroup with PAP greater than 20 mmHg (2.7 kPa). Certain other parameters ("driving" pressure across the pulmonary circulation, FEV1 and Paco2) appear to be equally good at predicting survival as PAP in these obstructed patients. The effect of age should be taken into account in prognostic studies such as ours since survival rates were significantly lower in patients over 60 years of age. In 64 patients who underwent a second right heart catheterisation at least three years after the first (average delay: 5.5 +/- 2 years), the prognostic value of changes in PAP, arterial blood gases, and pulmonary volumes was studied but with the exception of Pao2 was unremarkable. Further studies are needed in this field.

Adult↗
PubMed1981

[The prognostic significance of pulmonary arterial hypertension in chronic obstructive airway disease (author's transl)].

In 175 cases of chronic obstructive airway disease (most often chronic bronchitis) with severe ventilatory deficit in the majority of cases, the prognostic value of mean pulmonary arterial pressure (PAP) and other respiratory function parameters (FEV1, blood gases) was studied by calculation of survival rates using the actuarial method. The patients were cathetherised between 1968 and 1972 and the maximum period of follow-up is 10 years. The results demonstrated the definite prognostic value of PAP : 4 and 7 year survival rates were markedly different according to whether initial PAP was above or below 20 mmHg. However other haemodynamic (motor pressure through the pulmonary circulation) and non-haemodynamic (FEV1, PaCO2) parameters also would appear to be as useful as PAP in predicting survival in such patients. The prognosis is particularly bad in patients with severe pulmonary arterial hypertension (PAP greater than 30 mmHg). In this type of study, it is essential to bear in mind the influence of age. Survival rates differed significantly according to whether the subjects were over 60 years in age initially.

Adult↗
PubMed1981

[Regional pulmonary function in unilateral sero-fibrinous pleural effusions and changes under the influence of treatment (author's transl)].

The regional distribution of ventilation (Vr), perfusion (Qr) (expressed in absolute values) and the regional distribution of ventilated lung volume, of ventilation and of perfusion (expressed as %) were studied using Xenon 133 in 13 subjects with a unilateral pleural effusion of proven or presumed tuberculous origin. The examinations were performed in a sitting position. The initial examination was carried out after as complete an evacuation as possible of the fluid effusion. Eight subjects underwent a follow-up examination after two months treatment with tuberculostatic agents combined with daily respiratory physiotherapy. The initial results emphasized the following points: - in absolute values, a deficit in ventilation on the involved side affecting the 3 regions explored without any similar change in perfusion ; a hyperventilation on the controlateral upper and middle regions ; - in relative values, a slight deficit in ventilated volume and perfusion localised at the base, whilst the deficit in ventilation was more marked and more extensive. After treatment the contribution to ventilation of the involved side increased on average by 6%. However this improvement only concerned the lower territory. The mechanisms of impairment of regional function and its improvement under the influence of treatment are discussed.

Adolescent↗
PubMed1980

[Physiopathology of diffuse and bullous emphysema (author's transl)].

In emphysema, structural modifications (alveolar distension with destruction of the walls and of the pulmonary capillary bed) contribute to the understanding of pathophysiological disorders, such as increase of the static pulmonary volumes, loss of elastic recoil, impairment in gas transfer. In panlobular emphysema, the simultaneous destruction of ventilatory and circulatory structures explains the absence of shunt effect. The loss of elastic recoil is the main cause of maximal expiratory flow limitation and of bronchial obstruction which is qualified as "extrinsic". For a same degree of bronchial expiratory obstruction, the disorders of gas exchange and pulmonary haemodynamics are less pronounced in emphysema (panlobular) than in chronic bronchitis. The effects of voluminous bullae associated with diffuse emphysema are difficult to study and to demonstrate. The bullae accentuate the altered elastic properties of the emphysematous lung and contribute therefore to the expiratory flow limitation. The bullae are usually neither ventilated nor perfused; a dead-space effect is thus rare, but should be investigated. The effects of compression by the bullae of the adjacent parenchyma (excepting the haemodynamic effects) can be evaluated only by relatively sophisticated regional exploration methods, while taking into account morphological data (X-ray, angiography).

Humans↗