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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thirty one cases of congestive cardiomyopathy previously diagnosed as "idiopathic" were retrospectively studied in order to determine the prevalence of the following pathologic myocardial factors (MFs): severe alcoholism (A), systemic arterial hypertension (SAH) and obstructive coronariopathy (OC). Sixteen (51%), 14(45%) and 9(29%) cases had an association with A, SAH and OC, respectively. Any of these MFs was present in 48% of cases, 2 of them in 19% and 3 in 13% of cases. Some peculiarities of the clinical findings, a particular interpretation of such findings by the attending physician and a modification of the psychological status of some patients were the main causes which prevented the recognition of these MFs. Besides, 67% of the cases had at least one of the following "minor" factors which contributed to the myocardial damage: mitral insufficiency, pulmonary embolism, atrial-ventricular block and diabetes mellitus. A careful investigation of these MFs should be done before a diagnosis of idiopathic congestive cardiomyopathy is considered. In some cases there is more than one pathogenic factor.
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PMID:[Importance of various myocardial factors in "primary" congestive cardiomyopathies]. 651 41

Three hundred patients with acute myocardial infarction (AMI) were studied. Half of them received anticoagulant treatment with heparin and acenocoumarin (Group I) The other 150 patients did not have anticoagulant therapy (Group II) Both groups were similar in age, sex, prior history of diabetes, arterial hypertension or smoking habits. The incidence of persistent angina, arrhythmias, pulmonary embolism and re-infarction was not different for both groups. The mortality was slightly higher in group II. Of the patients who died, the autopsy demonstrated fresh thrombi in all cases of both groups; in addition, most of the patients of group II hemorrhage of the coronary artery wall was found.
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PMID:[Hospital course of acute myocardial infarction treated with or without anticoagulants]. 651 43

Thrombus formation depends on adherence of blood-formed elements to the intimal surface through platelet-vessel surface interaction, platelet release phenomena and aggregation, formation of fibrin, and the enmeshing of blood cells. Arterial thrombi involve platelet aggregation, whereas venous thrombi found in low flow or during stasis have greater proportions of erythrocytes and fibrin. It is not known if or how abnormalities of flow resistance, platelet thrombus formation, or endothelial and dynamic parameters affect the microcirculation, largely due to the difficulty of obtaining comprehensive data from these systems. Increases of fibrinogen observed in many disorders may result in minor changes in blood viscosity without known physiologic consequence, but in most disorders in which thrombosis is observed, the pathophysiologic mechanisms are multifactorial and abnormal blood viscosity is presumed to be a significant but not limiting component. Therapeutic approaches in thrombotic disorders should recognize which elements of the thrombotic triad predominate. In arterial disorders focus should be on platelet activity, and the objectives of venous thrombosis treatment include prevention of morbidity and death from pulmonary embolism, reduction of morbidity resulting from the acute thrombotic episode, and prevention of the postphlebitic syndrome. Pathology, mechanism, and treatment for specific thrombogenic disorders are described. Treatments suggested for hyperviscosity involve giving antibiotics during crises. Also discussed are thalassemia, paroxysomal nocturnal hemoglobinuria, polycythemia, cryoglobulinemia, paraproteinemia, diabetes mellitus, and disseminated intravascular coagulation. Studies have established a relationship between thromboembolic disease and oral contraceptives (OCs). The risk is only increased while the patient is taking OCs but is compounded in women undergoing surgery or who have a disorder which predisposes to venous disease. The risk for myocardial infarction or stroke is significantly increased when OCs are taken over age 35 and when there is hypertension, smoking, type-II hyperlipoproteinemia, and diabetes mellitus. The risk appears to be a function of estrogen dosage, causing a 25% mean increase in calf venous volume and 30% decrease in vein velocity of venous blood compared to controls. Low flow rates may contribute to venous thromboembolism. OCs may alter precisely regulated systems of coagulation and fibrinolysis and recent studies confirm abnormalities in the hemostatic system attributed to OCs. 16% of women taking OCs have a 60% or greater reduction in antithrombin III activity. The multiple effects of OCs often result in low-grade activation of the hemostatic system, potentially lowering the threshold to precipitate thrombus formation and possibly explaining the increased incidence of thromboembolic disease. Heparin appears to reverse many of these problems.
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PMID:Blood viscosity and thrombosis: clinical considerations. 676 12

In 1096 cases of death (autopsy rate 63.8%) the accuracy of clinical diagnoses was investigated by comparing clinical diagnoses with recorded autopsy findings. -- In 81.3% of the cases the primary disease had been determined correctly. In more than half of these cases the immediate cause of death or an additional disease contributing to death had not been correctly identified. In 16% of the cases the diagnosis proved to be inadequate. -- In 2.6% of all cases the primary disease, cause of death and accompanying illnesses were misdiagnosed. Most of these patients had stayed in the hospital for a much shorter time than the rest of the patients. -- Among conditions clinically diagnosed as cirrhosis of the liver, pulmonary embolism, myocardial infarction, cerebral hemorrhage, and malignant tumors -- pulmonary embolism was by far the most frequent condition to go unrecognized, i.e. in 50% of th cases in which it was present. Primary liver cell carcinoma proved to be the malignant tumor most frequently not identified by clinical studies. -- Four clinical diagnoses (shock, septicemia, diabetes mellitus and uremia) were often unsupported by morphological findings. Yet there were 13 clinically undiagnosed cases of septicemia in which findings at post mortem examination revealed this condition. These cases also underline the importance of autopsies.
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PMID:Autopsy and clinical diagnosis. 1879 61

Review of twenty cases of live-donor kidney transplants in Kenya for a period of 5 years (1985-1989) and the follow up study results revealed that there were both high graft losses, high morbidity and mortality due to various complications pertaining to surgery and immunosuppression. The most serious complications were intercurrent infections, acute or chronic rejection, pulmonary embolism, steroid induced diabetes, pneumonia, and myocardial infarction. At the end of the first year follow up, there were only twelve graft patients alive. Magnetic Resonance Imaging (MRI) was not available for assessing the anatomical and functional behaviour of the transplanted kidneys. This would have assisted in early diagnosis of the degree and onset of rejection for appropriate treatment before the death of the allografts. It would also assist in differentiating perfusional problems from rejection.
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PMID:Surgical aspects of live donor kidney transplants in Kenya. 803 72

Atrial fibrillation (AF) is associated with a higher morbidity and mortality because of the risk of systemic or pulmonary embolism as well as the negative impact on cardiac function. The authors investigate in the submitted paper factors influencing the vulnerability of atria during transoesophageal atrial stimulation (TESP). The group comprised 68 patients with a sinus rhythm, mean age 56.9 +/- 17.9 years. Depending on the response to rapid atrial stimulation, the patients were divided into three groups. In group I (small disposition to AF) they revealed a significantly lower age, the relative thickness of the left ventricular wall assessed by echocardiography and the dimension of the left atrium, as compared with groups with a medium increased (II) and high disposition (III) for AF. In group III hypertonic changes on the fundus were found more frequently, as well as anamnestic data on hypertension, diabetes and pathological values of the recovery period of the sinoatrial node. At the same time significantly lower values of the rate of the E wave were observed and of the ratio of amplitudes and E/A integrals from the Doppler record of the mitral valve. The weight of the left ventricle and its index by groups increased, however the changes did not attain statistical significance. Indicators of left ventricular systolic function did not differ. The authors conclude that the main independent factors which determine the response to provoked AF by the TESP method are the diastolic left ventricular function documented by the Doppler method, the diameter of the left atrium, the automation of the SA node. Less important factors are left ventricular hypertrophy and age.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Factors affecting the vulnerability of the left atrium during rapid transesophageal atrial stimulation]. 814 Jul 47

The aim of this study was to evaluate the action of trandolapril on blood glucose control and microalbuminuria in mild to moderate hypertensive in patients with non-insulin-dependent diabetes. Sixty-seven patients, aged between 33 and 79, were enrolled. After a two week placebo run-in period, treatment with trandolapril as monotherapy was given for 3 months. The dose of trandolapril was adjusted between 1 and 4 mg/day according to antihypertensive response. Patients were assessed clinically and by laboratory investigations each month. Two patients were excluded from efficacy analysis because of major protocol deviations. Mean DBP fell, under the influence of treatment, from 101 +/- 5 mmHg to 82 +/- 7 mmHg (p < 0.0001) and mean SBP from 171 +/- 9 mmHg tp 147 +/- 11 mmHG (p < 0.0001). At three months, 54 patients (84%) had a DBP < or = 90 mmHg. Microalbuminuria decreased significantly (p = 0.03) during treatment. Microalbuminuria returned to normal in 11 of the 13 patients in whom the baseline value was above 21 micrograms/min and increased to above normal in 2 of the 26 patients who had a normal baseline value. Blood glycosylated hemoglobin, fructosamine, glucose and creatinine, and creatinine clearance remained stable. Plasma potassium rose slightly in 7 patients. Six adverse events were reported (4 coughs, 1 peripheral edema, 1 plantar mal perforans). One patient died from pulmonary embolism. In conclusion, trandolapril is an effective antihypertensive agent in hypertensive diabetics. Trandolapril causes a significant decrease in microalbuminuria and does not interfere with blood glucose control in these patients.
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PMID:[Action of trandolapril on the blood glucose balance and microalbuminuria in hypertensive diabetics]. 817 83

Correlates of the size of infarcts, the time from stroke to death, and the mechanisms of death were studied in 77 consecutive patients who died from infarction in the middle cerebral artery territory. The area of infarcts was assessed by planimetry on schemas of representative brain levels and the results were expressed as a ratio of infarcted area on the whole MCA territory. No clear relationship was found between the size of infarcts in the MCA territory, and any of the characteristics of the patients, but extensive infarcts were more frequent when the internal carotid artery was occluded. No evidence was found of an adverse effect of age, diabetes or initial hyperglycemia on the size of infarcts. The mechanisms of death were not linked to sex, age, high blood pressure, diabetes, blood glucose level at admission, presence and location of an arterial occlusion, or etiology of the infarct. On the contrary, they varied as a function of interval from stroke to death. Transtentorial herniation, the main cerebral cause of death, occurred mainly in the first week and was related to the large size of infarcts. Rare recurrences of stroke and frequent extracerebral mechanisms of death (mainly pneumonia, pulmonary embolism and cardiopathy) occurred later on.
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PMID:Infarcts in the middle cerebral artery territory. Pathological study of the mechanisms of death. 833 39

Carotid endarterectomy (TEA) has proven to be beneficial for symptomatic patients. Anticoagulation (AC) and antiplatelet therapy (ASA) have been shown to prolong life following vascular surgery in patients with occlusive arterial disease (PAOD). To determine whether ASA or AC prolong life after TEA, retrospective analysis was undertaken, since cerebral haemorrhage is associated with the use of both drugs, especially AC. Between 1979-1986, 328 patients with stenotic lesions of the carotid bifurcation were operated upon electively. Patient survival and causes of death were the primary end points of the analysis. Recent data were obtained from the Austrian Central Bureau of Statistics. Cumulative survival rates were calculated by Kaplan-Meier estimation and differences determined by Breslow and Mantel tests. 36 patients were on AC, 157 on ASA and 135 remained without medication (0-group). Since the common risk factors in PAOD were unevenly distributed between groups, a stepwise Cox regression model was applied which revealed age (p < 0.01), cardiac pathology (p < 0.01) and diabetes (p < 0.05) as relevant for survival. Therefore, ASA patients and 0-group patients were selected and matched, employing the aforementioned prognostic criteria, and compared to the patients on long-term AC for various indications (vein bypass surgery, myocardial infarction, pulmonary embolism; i.e. data-matching). The median postoperative survival was 7.72 years for ASA and 8.48 years for AC, compared to 6.07 years for the 0-group (p = 0.0095 Breslow, p = 0.477 Mantel). There was no significant difference between AC and ASA treated patients. Irrespective of medication, the causes of death were well balanced, and no higher incidence of intracerebral haemorrhage was detected.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Anticoagulants, antiaggregants or nothing following carotid endarterectomy? 835 90

The incidence of pulmonary embolism (PE) in osteoarthritic patients prophylaxed with low-dose coumadin after cemented total knee arthroplasty (TKA) was investigated prospectively. Each patient had a preoperative perfusion scan and a ventilation-perfusion scan on the seventh postoperative day. Pulmonary embolism was diagnosed by a high probability ventilation-perfusion scan or positive arteriogram. Patients with a moderate probability scan had an arteriogram to rule out PE. Pulmonary embolus was identified in 48 (5.6%) of 852 TKAs in 755 patients. Of these, six (0.7%) were symptomatic, and no fatal PE was identified. Age, gender, and weight did not show statistical differences comparing the PE and non-PE groups, nor did the incidences of previous PE, contralateral phlebitis, malignancy, and diabetes. A history of ipsilateral phlebitis increased the risk of PE from 5.2% to 13%, and a history of cardiac disease decreased the risk from 7.8% to 4.2%. Type of anesthesia, blood loss, tourniquet time, and prosthesis type were not significant factors. With the exception of previous contralateral phlebitis, traditional risk factors for PE were not found to increase risk of PE with low-dose coumadin prophylaxis. Spinal anesthesia that has been shown to be protective in total hip surgery was not a significant factor in this study.
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PMID:Incidence of pulmonary embolism after total knee arthroplasty with low-dose coumadin prophylaxis. 842 57


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