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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The pharmacokinetic and clinical characteristics of a once-daily formulation of diltiazem are described. In a 20 subject, 5 day, steady-state pharmacokinetic study, 120 and 240 mg of once-daily diltiazem were bioequivalent on a dose-adjusted basis and were bioequivalent to a conventional reference product administered four times daily. The conventional formulation showed marked diurnal variation in its pharmacokinetics. Plasma concentrations following its administration at 2100 and 0300 h were significantly lower than following administration at 0900 and 1500 h. One hundred forty-four hypertensive patients completed a 16 week placebo-controlled, dose-titrated study examining the effects of once-daily diltiazem at doses of 120, 240, and 360 mg. Blood pressure was measured manually and (in 121 patients) by ambulatory evaluation. Following dose titration, diltiazem given once daily reduced blood pressure with significant effects present at 24 h following drug administration. Ambulatory blood pressures were lower than those measured manually and data from the manual measurements demonstrated a placebo effect suggested to result primarily from investigator bias. The placebo-adjusted reduction in blood pressure 24 h following a dose of diltiazem was approximately 5 mm Hg and was comparable for manual (supine and standing) and ambulatory measurements. Diltiazem was well tolerated. The only significant findings were of tiredness/dizziness (9 patients of 144) or oedema (also 9 of 144). The incidence of headache was not different than placebo. On both pharmacokinetic and pharmacodynamic grounds, the results indicate that diltiazem can be formulated in a manner suitable for once-daily antihypertensive use.
J Cardiovasc Pharmacol 1991 Jun
PMID:Pharmacokinetic properties and antihypertensive efficacy of once-daily diltiazem. 171 21

In this study of the efficacy and safety of isradipine as first-line therapy in hypertension, 1,647 patients enrolled; 1,472 completed the 4-week placebo run-in period and began treatment with isradipine at 2.5 mg twice daily for 4 weeks. During placebo, 11% (n = 175) of the 1,647 patients withdrew because of normalization of blood pressure, side effects, noncompliance, violation of the study protocol, side effects from concomitant therapy, or other reasons. During isradipine therapy (n = 1,376), blood pressure decreased from 168 +/- 18/102 +/- 8 mm Hg at the end of the placebo period to 155 +/- 17/94 +/- 9 mm Hg after 2 weeks (p less than 0.001) and 151 +/- 16/92 +/- 9 mm Hg after 4 weeks (p less than 0.001). During active treatment, 6.4% (n = 94) were withdrawn because of flushing, headache, edema, palpitations, gastrointestinal side effects, skin rashes, or other side effects, and two patients because of lack of efficacy. The side effect score in the remaining patients worsened for flushing, remained unchanged for edema, but significantly improved for palpitations, fatigue, dizziness, headache, and nervousness. After 4 weeks, 60% of patients had diastolic blood pressures of less than or equal to 90 mm Hg. Thus, isradipine is effective and safe as first-line therapy in patients with primary hypertension as seen in general practice.
J Cardiovasc Pharmacol 1991
PMID:Calcium antagonists as first-line therapy in hypertension: results of the Swiss Isradipine Study. Swiss Hypertension Society. 172 Apr 76

Fourteen patients with pulmonary vascular disease, either primary pulmonary hypertension or the result of cardiac defects, underwent balloon atrial septostomy (BAS) over the period of July 1981 to June 1988 because of symptoms of syncope, fatigue, right heart failure, and cardiac arrest. Ages ranged from 4 mo to 50 yr. Two moribund patients died within 24 h of the septostomy due to severe hypoxemia and unrelieved low cardiac output; three others died 2 wk to 35 mo later; the remaining 9 patients have improved symptomatically and are alive 11 to 96 mo after septostomy. One received a heart and lung transplant 19 mo later. We conclude that, in patients with symptomatic cor pulmonale secondary to pulmonary vascular disease, atrial septostomy can improve symptoms and may serve as a palliative bridge to heart and/or lung transplantation.
Cathet Cardiovasc Diagn 1991 Nov
PMID:Effects of atrial septostomy in patients with terminal cor pulmonale due to pulmonary vascular disease. 172 34

A 48-yr-old woman presented with a loud continuous precordial murmur and symptoms of fatigue. Color-flow doppler imaging and nuclear magnetic resonance imaging failed to show the cause of the murmur. Diagnostic catheterization showed a large left anterior descending coronary artery to pulmonary artery fistula with impaired left ventricular wall motion. Two detachable balloons were deployed in the fistula with complete abolition of flow in the main fistula channel. A small parallel channel of the fistula, previously not appreciated due to vessel overlap, remained patent but had trivial flow as assessed by green-dye and oximetric techniques. The patient had immediate resolution of her symptoms and return of normal ventricular wall motion.
Cathet Cardiovasc Diagn 1991 May
PMID:Successful percutaneous closure of a complex coronary-to-pulmonary artery fistula using a detachable balloon: benefits of intra-procedural physiologic and angiographic assessment. 186 56

It is evident that positive attitudes towards patient care are the cornerstone of risk containment during CPB. Positive attitudes are shaped by education and training, including continuing education. Mutual respect among team members can foster positive attitudes that are manifested in an orderly, quiet operating room, with those present always mindful of the patient's welfare. Vigilance is the key in preventing complacency during CPB procedures that have now become routine. Collins writes that the best airplane pilots develop a curious and suspicious attitude in the cockpit and, again, the applicability of the aviation and perfusion analogy is apparent. Monitors, standards, protocols, and safety devices can never fully replace vigilance in overcoming human frailty or error. Vigilance has been defined as "a state of clinical awareness whereby dangerous conditions are anticipated or recognized and promptly treated." Stoelting further writes that levels of vigilance may be reduced by extraneous distractions, fatigue, and stress. Gaba et al have studied anesthetic mishaps in the context of accident investigations in unrelated fields and have suggested two responsibilities in breaking the chain of accident evolution. The first is to scrutinize our own abilities and limitations ... and implement the procedures and training that can be shown to optimize patient safety, and second ... to reexamine the entire structure of our industry, attempting to steer the interacting sources of incentive and constraint towards a system that promotes patient safety. Guides to acceptability of risk include the twin tenets of reasonableness and custom of usage, prevailing professional practice, the best available practice, and the degree of necessity or benefit.(ABSTRACT TRUNCATED AT 250 WORDS)
Semin Thorac Cardiovasc Surg 1990 Oct
PMID:Risk containment during cardiopulmonary bypass. 209

The limited durability of the valve bioprostheses made from calf pericardium is partially due to the calcification of this biomaterial and to mechanical fatigue of the tissue. The object of this study is to determine the harmful effect on the pericardial membrane of cutting caused by the suture thread by showing the different elastic behaviors of the biomaterials employed. This cutting stress is established during the process of molding the valve leaflet, creating a vulnerable point from the very moment of construction, which is an important factor in the limited duration of the bioprosthesis.
J Thorac Cardiovasc Surg 1990 Oct
PMID:Is cutting stress responsible for the limited durability of heart valve bioprostheses? 221 34

This case report describes a patient with an uncommon type of mitral incompetence caused by a perivalvular communication between the left ventricle (LV) and the left atrium (LA) masked by a considerable fibrotic subvalvular aortic stenosis, endocarditis and congestive heart failure (CHF). A 64 year old farmer with a history of a systolic murmur since childhood complaining of increasing fatigue and dyspnoea, temperature over 39 degrees C, and signs of CHF was admitted and transferred to a cardiological unit. Invasive examination and continuing clinical deterioration caused urgent transfer for surgery under suspicion of a decompensated hypertrophic obstructive cardiomyopathy. Clinical investigation revealed a decompensated subvalvular aortic stenosis and a mild mitral insufficiency. At surgery the advanced fibrotic subvalvular stenosis was resected. After coming off bypass severe mitral insufficiency was detected by intraoperative analysis of the simultaneous intracavitary-pressure tracings. A midsystolic maximum of a high V-wave of the LA-pressure tracing was suggestive of an unusual reason of the mitral insufficiency. Reexploration indicated a perivalvular broad communication from the LA groove to the LV with an otherwise normal mitral valve. The communication was closed using buttressed mattress-sutures. This uncommon type of mitral incompetence via a perivalvular LA-LV communication was probably caused by endocarditis and an intramyocardial abscess in the LA-wall which subendocardially led to LV-LA communication.
Thorac Cardiovasc Surg 1990 Feb
PMID:Uncommon type of mitral insufficiency caused by perivalvular communication between left ventricle and left atrium. 230 25

Primary mediastinal tumour or cyst was surgically treated in 129 patients (including 19 younger than 12 years) during a 16-year period. All histologic specimens and smears from fine-needle aspiration biopsy were reviewed. Intrathoracic goitre, neurogenic lesions and thymomas comprised 62% of all the tumours. Fifty lesions (39%) were found at routine radiographic examination and were asymptomatic. Eight of these 50 lesions were malignant. Chest pain, fatigue, weight loss and fever were significantly more common in malignant than in benign disease. Despite extensive investigations, the diagnosis was not established preoperatively in 32% of the cases. Chest radiography, CT-scanning and fine-needle aspiration biopsy usually provide satisfactory diagnostic information, thereby substantially reducing the need for other preoperative procedures. Early operative intervention is mandatory in these cases.
Scand J Thorac Cardiovasc Surg 1990
PMID:Mediastinal tumours. A report of 129 cases. 235 80

A case report of the first single lung transplantation and closure of a patent ductus arteriosus for Eisenmenger's syndrome is presented. The operation was performed on Sept. 28, 1988. The patient was extubated on postoperative day 8, discharged from the intensive care unit on postoperative day 13, and discharged from the hospital on postoperative day 43, free of symptoms and without supplementary oxygen. Subsequent symptoms of dyspnea, presyncope, and fatigue recurred in association with subvalvular right ventricular outflow tract obstruction. Symptomatic improvement occurred gradually in association with reduction of the outflow tract obstruction. The patient is in New York Heart Association class I-II 12 months after the operation. The rationale, methods, and management of this patient are discussed, as well as the potential for application of this operation in similar settings.
J Thorac Cardiovasc Surg 1990 Jul
PMID:Single lung transplantation and closure of patent ductus arteriosus for Eisenmenger's syndrome. Toronto Lung Transplant Group. 146 29

The conventional approach to hypertension considers only the peak and trough of the pressure wave in the brachial artery (systolic and diastolic pressure). An alternate (or supplementary) approach considers mean pressure and fluctuation around this mean. Such an approach permits separation of pulsatile phenomena from steady flow phenomena; it is the basis for description of hydraulic load as vascular impedance and for application of engineering principles to the study of fatigue and degeneration of arteries; it readily explains disturbed arterial function in hypertension in terms of increased peripheral resistance and of increased arterial stiffness. The major effects of hypertension on pressure wave contour, on arterial degeneration, and on left ventricular load are consequences of arterial stiffening rather than of increased resistance. Logical therapy for hypertension should include measures to increase arterial distensibility as well as those to decrease peripheral resistance.
J Cardiovasc Pharmacol 1985
PMID:Basic concepts for the understanding of large arteries in hypertension. 240 63


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