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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The inner city population of the Los Angeles county has rapidly become largely Latino. The 3.3 million Latinos living in the county in 1990 had much higher poverty rates and lower educational attainment rates than Anglo (non-Hispanic white) or blacks. The health indicators of the three groups are compared for 1990. In birth outcome, although Latinos were the least likely to receive care in the first trimester, Latinos and Anglos had identical rates of low birth weight babies, and lower rates than blacks. Latino infant mortality was the lowest of the three. The age-adjusted death rates showed that Latinos have a lower overall death rate than Anglos or blacks, and lower specific rates for heart disease, cancer, AIDS and stroke. Latinos did have higher death rates than Anglos for accidents, homicides, cirrhosis and diabetes. Latinos had incidence rates of gonorrhoea and syphilis similar to Anglos and lower than blacks. The communicable disease rates for Latinos was many times higher than Anglos or blacks, including those for measles, shigellosis, giardiasis and hepatitis A. Implications for family medicine are discussed.
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PMID:Latino health in Los Angeles: family medicine in a changing minority context. 784 24

Nitric oxide was identified as the relaxing factor derived from the endothelium in 1987. Nitric oxide synthesis allows the vascular system to maintain a state of vasodilation, thereby regulating arterial pressure. Nitric oxide is also found in platelets, where it inhibits adhesion and aggregation; in the immune system, where it is responsible for the cytotoxic action of macrophages; and in the nervous system, where it acts as neurotransmitter. A deficit in endogenous synthesis of nitric oxide contributes to such conditions as essential arterial hypertension, pulmonary hypertension and heart disease. An excess of nitrous oxide induced by endotoxins and cytokinins, meanwhile, is believed to be responsible for hypotension in septic shock and for hyperdynamic circulatory state in cirrhosis of the liver. Nitric oxide has also been implicated in the rejection of transplanted organs and in cell damage after reperfusion. Inhaled nitrous oxide gas reduces pulmonary hypertension without triggering systemic hypotension in both experimental and clinical conditions. It also produces selective vasodilation when used to ventilate specific pulmonary areas, thereby improving the ventilation/perfusion ratio and, hence, oxygenation. Nitric oxide inhalation is effective in pulmonary hypertension-coincident with chronic obstructive lung disease, in persistent neonatal pulmonary hypertension and in pulmonary hypertension with congenital or acquired heart disease. Likewise, it reduces intrapulmonary shunt in acute respiratory failure and improves gas exchange. Under experimental conditions nitric oxide acts as a bronchodilator, although it seems to be less effective for this purpose in clinical use.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Nitric oxide]. 789 26

The mortality profile of female nurses and teachers in British Columbia (BC) was examined using age-standardized proportional mortality ratios (PMRs) calculated for the period 1950-1984. Lowered overall mortality among nurses was seen for degenerative heart disease and for cerebrovascular accidents. Significantly elevated PMR values were observed for cancer of the breast and ovary in nurses of age 20-65 years. PMRs were significantly elevated for cancer of the pancreas and leukemia among those age 20 years and older. Elevated values were also observed for motor vehicle accidents and suicide among nurses in both age groups. Lower than expected mortality from degenerative heart disease and cerebrovascular accidents was seen in working age teachers (age 20-65 years). However, elevated PMRs were detected for carcinoma of the colon, breast, endometrium, brain, and melanoma. Among those 20 years and over, significantly elevated PMRs were also observed for cancers of the ovary and other digestive organs. Elevated PMRs were found for motor vehicle and aircraft accidents. Mortality from cirrhosis of the liver was lower than anticipated in both teachers and nurses. A number of significant PMRs declined when deaths of "homemakers" were withdrawn from the comparison group used to generate PMR values, suggesting that risk of death from various causes among women working outside the home differ from those seen in women who are predominantly in the home.
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PMID:Mortality among female registered nurses and school teachers in British Columbia. 807 20

Clinical observations over the past two decades have pointed to the relationship between heart disease and alcohol abuse, usually without evident malnutrition or cirrhosis. While the prevalence of heart failure in the alcoholic population is now known, subclinical abnormalities of left ventricular function in noncardiac alcoholics who were normotensive have a high prevalence with or without some degree of ventricular hypertrophy by echocardiogram. This is frequently a diastolic rather than systolic abnormality. Congestive cardiomyopathy is not infrequently associated with high diastolic arterial blood pressures. Intoxication itself may contribute to blood pressure elevation. Angina pectoris in the absence of significant coronary disease is another presentation. Although the history may not be readily obtained, the major diagnostic feature in this entity is the history of ethanol ingestion in intoxicating amounts for at least 10 years, often marked by periods of spree drinking. While the course of congestive cardiomyopathy may be progressively downhill in individuals who continue to be actively alcoholic after the onset of heart failure, in one series one third of the patients became abstinent. These patients had a 4 year mortality that was persistently one-sixth of the alcoholic group. Management of heart failure is traditional in these patients. Atrial arrhythmias have been shown to occur during the early ethanol withdrawal phase in patients without other clinical evidence of heart disease. Sudden death in a segment of the alcoholic population is considered arrhythmia related and is commonly associated with cigarette use. Identification of the addicted individual is the essential element to management.
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PMID:Alcoholic cardiomyopathy. 808 32

In recent years health professionals have been concerned about the health of aborigines which has been neglected for a long time. Health disparities are known to exist among aborigines and non-aborigines in the United States or other countries. In Taiwan, there are nine main aboriginal tribes consisting of approximately 330,000 people. In general, their health status, evaluated by life expectancy, mortality rates and the prevalence and incidence of various diseases amongst them, is worse than amongst the rest of the Taiwanese (general) population. Current investigations indicate that life expectancy for aborigines is on average 10 years less than that of the general population; 12.5 years less for men, 6 years less for women; approaching a standardized mortality ratio of 2 fold, that is 2.1 fold in men, 1.7 fold in women. Accidental injures, suicide, tuberculosis, liver cirrhosis, alcoholism, pneumonia, bronchitis, parasite infections are the most important sources of diseases. Hypertension, heart disease, some selected sites of cancer, nutrition and lack of adaptation are gradually becoming important new sources of disorders. Although aboriginal health has improved over the decades, the author estimates that their overall health status is 25-30 years behind that of the general population or of off-shore islanders. The extent of their development varies with tribes. It is necessary to study the cause of why aborigines die so young. It may be due to insufficient medical care for heart disease whose prevalence is relatively low among aborigines but resultant mortality is nevertheless high. However, insufficient medical care cannot explain the high incidence of a number of cancers and resultant mortality. All factors relating to the environment, agents, hosts and diseases should be taken into consideration, such culture, transportation, life style, health behavior etc, and compared to those of non-aborigines. A series of studies are proposed to address the specific, multi-dimensional health demands of the aborigines. The author suggests the development of prevention and intervention strategies designed to overcome difficulties and barriers to eliminate these disparities among the people of Taiwan.
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PMID:[Issues on aboriginal health in Taiwan]. 808 70

The ablation of cardiac arrhythmias by radiofrequency has changed radically the treatment of arrhythmias. We present the case of a woman with cirrhosis and no structural heart disease, who was severely limited in her activities because of drug-refractory paroxysmal supraventricular tachyarrhythmias. She underwent an atrio-ventricular node ablation by radiofrequency. She was discharged with no antiarrhythmic drugs and on a permanent cardiac pacing. She showed obvious improvement in her quality of life.
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PMID:[Ablation of the atrioventricular node using radiofrequency in a cirrhosis patient]. 852 32

Toxic manifestations of digitalis are one of the most prevalent adverse drug reactions encountered in clinical practice. The estimated incidence is about 20% in hospitalized patients in the USA. The authors describe a rare case of myocardial "catecholamine necrosis" (anteroseptal myocardial infarction) during accidental digitalis intoxication. A male patient, 75 years old, suffering from cirrhosis and ascites, take on by mistake a tablet of digoxin 0.25 mg. four times at day for eleven days. He hadn't heart disease in the past. At the eleventh day the patient showed a deep tiredness and so he was submitted to a clinical examination and electrocardiogram. The ECG demonstrated an anteroseptal myocardial infarction in the second-third electrical stage. The patient was hospitalized. The successive examination revealed: very high plasma digitalis concentrations; an increase of the serum levels of CPK and LDH; a significant increase of plasmatic and urinary catecholamine levels which return to normal values after fifteen days; apical akinesia at the echocardiographic examination; no signs of residual myocardial ischemia to the echo-dypiridamole stress test; normal coronary artery to the coronary arteriography and absence of coronary artery spasm to the ergonovine test. Furthermore the abdominal echography and the abdominal computerized tomography didn't reveal surrenal disease but showed an important liver disease. The patient was free from other cardiac events in the follow-up. Generally, during the digitalis intoxication we observe various rhythm and conduction disturbances. Instead in this case no serious arrhythmias were registered and the main expression of the drug toxicity was an anteroseptal myocardial infarction with undamaged coronary artery. Also the usual extracardiac symptoms and signs of the digitalis intoxication were absent in this case. All these observations can be explained with the pathological increase of the cathecholamine levels, indirectly induced by digitalis; with the direct toxic effect of the drug at the myocardic level; with the contemporary absence of ionic disturbances; with the concomitant liver disease. The direct toxic effect of the digitalis produced an increase in calcium ions availability for the electromechanical coupling and an increase of the intramyocardial pressure; the increase of the adrenergic activity determined contemporary an increase in the oxygen consumption of the myocardial cells, a rise of vascular tone and coronary artery tone and a reduction of the duration of the diastole. All these factors provoked a "primary and secondary" ischemia which evolved toward a real "cathecholamine necrosis" and produced a myocardial infarction. This hypothesis explains the myocardial infarction in absence of injury at the coronary arteriography and without coronary spasm at the ergonovine test; moreover it explains the transient increase in cathecholamine plasma levels observed in the acute phases an normalized after fifteen days. The "cathecholamine necrosis" is an anatomical definition, nevertheless in our opinion it gives account of the rare clinical situation observed.
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PMID:[An unusual case of "catecholamine necrosis" caused by accidental digitalis poisoning]. 855 67

Our objective was to analyze the survival of diabetic patients on renal replacement therapy and to compare their survival on extracorporeal and on peritoneal dialysis. All data regarding diabetic patients admitted to dialysis between 1 January 1983 and 31 December 1993 were collected by means of individual patient questionnaires sent to all of the 44 regional Renal Units (100% answers) of Lombardy, Italy. Cox proportional hazards model, stepwise procedure, was applied in order to select the covariates significantly associated with survival. Age (at baseline), sex, type of diabetes, initial modality of treatment (hemodialysis or peritoneal dialysis), and initial clinical risk factors (malignancies, serious heart disease, vascular disease, cirrhosis of the liver, cachexia) were considered. Descriptive analysis of survival was performed using the Kaplan-Meier technique. The survival of all diabetic patients (895) was 86.5% at one year, 52% at three years, and 34% at five years. The main causes of the 488 deaths of diabetic patients were cardiovascular diseases (56%), cachexia (18%), and infections (11%). The relative death risk of patients on peritoneal dialysis versus those on hemodialysis, after taking into account the main comorbid conditions, did not significantly differ from 1, as estimated by the Cox proportional hazards regression model. Five-year survival of diabetic patients was 34%, and no differences were found between peritoneal dialysis and hemodialysis as far as mortality is concerned.
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PMID:Survival of diabetic patients on peritoneal dialysis or hemodialysis. 872 8

This paper reports the mortality experience from 1948 to 1989 of 2,504 maintenance employees who had a minimum of one year of employment in jobs with potential exposure to asbestos at a Texas refinery and petrochemical plant. For the purposes of this study, "potential exposure" is equated with those jobs or crafts having the greatest direct potential proximity to, or which worked directly with, asbestos-containing materials, especially asbestos-containing thermal insulation. Approximately one-half of the study population had 10 years or longer potential exposure, and 80% had their first potential exposure before 1970. The total population exhibited significantly lower mortality for all causes, the standardized mortality ratio (SMR = 77); and for all cancer (SMR = 85), as compared to residents in the surrounding communities. Statistically significant deficits in mortality were also observed in a number of noncancerous diseases such as heart disease (SMR = 78; 95% CI = 69-88), nonmalignant respiratory disease (SMR = 70; 95% CI = 50-95), and cirrhosis of the liver (SMR = 44; 95% CI = 22-79). Mortality among employees who had 20 years or longer since their first potential exposure was also examined; the pattern of mortality was similar to that exhibited by the total cohort, with a slight increase in the SMR for most of the causes. The only statistically significant excess of mortality found was a fourfold increase in mesothelioma (5 observed and 1.2 expected deaths) the SMR was 428 (95% CI = 139-996) for the total cohort and was 469 (95% CI = 152-1093) for those who had 20 years or more since first potential exposure. In contrast to asbestos industry worker studies, mortality for lung cancer was substantially lower than the general population (SMR = 81; 95% CI = 63-103). The observed number of deaths for cancer of the larynx was virtually the same as expected (3 observed vs. 2.8 expected). This study also showed decreased mortality for cancers of gastrointestinal organs such as the esophagus (SMR = 78), stomach (SMR = 63), large intestine (SMR = 91), rectum (SMR = 55), or pancreas (SMR = 90)--cancers that have been reported to be elevated in studies of various industry workers directly exposed to asbestos.
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PMID:Mortality among maintenance employees potentially exposed to asbestos in a refinery and petrochemical plant. 880 46

The present study evaluated end-stage renal disease (ESRD) patient survival in Lombardy, Italy, and the United States (U.S.) using data from two registries, the Lombardy Dialysis and Transplant Registry (RLDT) and the U.S. Renal Data System (USRDS), respectively. For this purpose, 4,196 white patients (2,900 from the USRDS Case Mix Severity Study and all 1296 from RLDT) who started renal replacement therapy in 1986 and 1987 were studied. Compared to Lombardy patients, those in the USA were significantly older (mean age 59.9 +/- 16.4 vs. 55.9 +/- 14.7 years), had a lower proportion of males (53.7 vs. 62.1%), a greater proportion with diabetic nephropathy (29.9 vs. 9.7%) and a significantly greater proportion of patients with the recorded comorbid conditions (heart disease, peripheral vascular disease, cirrhosis, cachexia, malignancy). U.S. patients were less frequently treated with peritoneal dialysis (PD) by day 30 of ESRD (21.2 vs. 30.7). Survival was compared in the Cox proportional hazard regression model, using age, sex, comorbid conditions and early modality of treatment as explanatory covariates. Overall, 48% of the 4196 patients died during the 48 to 72 months follow-up to 12/31/91. Per 100 patient-years the gross death rate for USRDS patients was 28.7 compared to 13.0 of RLDT patients. The unadjusted death relative risk for RLDT was 0.439, that is, 56% lower death rate compared to USRDS patients. Age, sex, diabetic status, each of the recorded comorbid conditions and treatment modality were significantly related to survival and included in the model. The Cox cumulative survival adjusted for all these explanatory covariates survival was for U.S. patients 84.4% at one year, 67.0% at two years and 33.4% at five years, and for RLDT patients 88.3% at one year, 75.9% at two years and 45.9% at five years. The relative mortality risk (RR) for the patients treated in Lombardy adjusted for all the reported covariates was 29% lower than for US patients (RR = 0.71; P < 0.0001). This comparative risk varied significantly by age (P < 0.0001) and was 65 percent lower for Lombardy compared to U.S. patients in the age range 25 to 44 years (RR = 0.35) and about 20% lower for patients over age 65 years (RR = 0.80). This relative risk was mainly related to hemodialysis and was not statistically significant for PD patients. The observed lower mortality risk in Lombardy was less pronounced when adjusted for demographic and comorbid covariates, but was still large and therefore suggests the need for further studies regarding treatment related factors and unmeasured patient factors, particularly in hemodialysis patients.
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PMID:ESRD patient mortality with adjustment for comorbid conditions in Lombardy (Italy) versus the United States. 1297 8


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