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

Between March 1981 and March 1986, 200 orthotopic heart transplantations were performed at the University of Pittsburgh. Fourteen of those procedures were carried out in children 2 to 16 years of age. Two children received combined liver and heart transplants; one because of familial hypercholesterolemia with associated ischemic heart disease, and the other because of dilated cardiomyopathy associated with intrahepatic biliary atresia. Eight patients had dilated cardiomyopathy, and two had myocarditis. Two had heart transplantations for congenital heart disease: one had multiple muscular ventricular septal defects repaired in infancy and had an associated cardiomyopathy, and the other developed a cardiomyopathic ventricle from a congenital right coronary artery to right atrial fistula. Chronic immune suppression consisted 0.2 to 0.5 mg/kg/d of prednisone and 5 to 50 mg/kg/d cyclosporine, with the addition of antithymocyte globulin for unresolved moderate or severe acute rejection. There were three early postoperative deaths: one from intracranial bleeding, one from Pseudomonas mediastinitis, and one from ischemic injury to transplanted organs. Early postoperative complications included reversible renal failure, hypertension, and seizures. Late problems were related to allograft rejection and side effects of cyclosporine and corticosteroids. Significant rejection episodes occurred in all patients surviving longer than 2 weeks, with seven requiring antithymocyte globulin. Two patients died 8 months following transplantation of severe acute and chronic rejection; another patient required retransplantation for ischemic cardiomyopathy resulting from chronic rejection but subsequently died of recurring rejection 3 months after the second transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Experience with heart transplantation in children. 354 Aug 34

This report describes the case of a 50-year-old male with end-stage renal failure accompanied with congenital heart disease and polycythemia. After he had received continuous ambulatory peritoneal dialysis for 1 year, he still remained polycythemic and his serum erythropoietin titer, assayed using fetal mouse liver cells, was markedly increased. An inhibitory effect on erythropoiesis was not detected by this method. Bone marrow examination showed erythroid hyperplasia. These phenomena could be explained by an overproduction of erythropoietin by the remnant kidneys or extrarenal organs, such as the liver, in response to persisting hypoxia. The patient's bone marrow was still responsive to erythropoietin.
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PMID:Polycythemia of end-stage renal failure: no inhibition of erythropoiesis by uremic serum and markedly increased serum erythropoietin level. 360 Sep 10

Low-dose streptokinase infusions have been used in 8 of our patients. Five of these were newborns who had major vessel occlusion. Four babies had extensive aortic thrombosis and hypertension producing congestive aortic thrombosis and hypertension producing congestive heart failure. One baby had caval and renal vein thrombosis and was in renal failure. Two infants with cyanotic heart disease and 1 with arteritis had occluded prosthetic grafts, which were reopened completely. Two grafts were between the subclavian and pulmonary arteries (Blalock-Taussig shunt), and one was between the abdominal aorta and right renal artery. In each patient, the thrombolytic agent was delivered directly to the area of thrombosis by three or four percutaneously inserted French catheters. The dose of streptokinase used was between 50 and 100 U/kg/hr. Therapy lasted for 2 to 11 days. Major bleeding was anticipated, and it occurred in 1 patient. Low-dose streptokinase infusion is a safe and effective treatment for a variety of thrombotic problems in infants and children.
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PMID:Treatment of grafts and major vessel thrombosis with low-dose streptokinase in children. 371 40

The occurrence of heart disease in uraemic patients was evaluated from study of 94 autopsied cases of chronic renal failure. The most common autopsy-ascertained causes of death were congestive heart failure (37%), acute myocardial infarction (13%) and tamponading pericarditis (8%). Death from congestive heart failure was significantly more common among the patients aged 60 or more than in the younger group. Hypertension was recorded in 59% of the patients, including all those with fatal myocardial infarction. Coronary arteriosclerosis was graded as absent to mild in about 40% of the patients. More severe grades occurred predominantly in the older patients. Tamponading pericarditis almost exclusively affected patients in haemodialysis. The authors conclude that most deaths among patients with end-stage renal failure were due to congestive heart failure. Ischaemic heart disease did not seem to be a more common cause of death than in the general population.
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PMID:Occurrence and significance of heart disease in uraemia. An autopsy study. 381 61

Forty percent of patients with insulin-dependent diabetes will develop nephropathy during the course of their disease, thus being the most important single disorder leading to end-stage renal failure (ESRF). Intensive metabolic control delays onset of diabetic nephropathy, the first omen of which is appearance of subclinical albuminuria, also termed microalbuminuria. Moreover, it is now established that intensive treatment of hypertension reduces rate of decline in GFR and thus postpones ESRF. When uremia eventually sets in, a range of biochemical and endocrine abnormalities can be included among those characteristics of diabetes mellitus per se. These include elevated plasma levels of growth hormone, glucagon and free fatty acids, which may participate in the uremic insulin resistance superimposed on the preexisting diabetic carbohydrate intolerance. Hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) are two established modalities of renal replacement therapy in diabetes mellitus. Controlled clinical trials for comparison of CAPD versus HD treatment of diabetics are, however, still needed. The survival rate is approximately 80 and 65-95% in insulin-dependent diabetic patients at 1 year during treatment with HD and CAPD, respectively. However, it is general experience that diabetics on CAPD exhibit a glycemic control, superior to that attained during HD. It has not been proved that patient survival after cadaveric renal transplantation is better than on dialysis. The degree of vascular heart disease seems to be the major determinant for survival of kidney-transplanted diabetic patients.
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PMID:End-state renal failure in diabetic nephropathy: pathophysiology and treatment. 391 47

Graft inclusion and vessel reattachment to openings made in the graft were employed in the treatment of 605 patients with thoracoabdominal aortic aneurysms. These patients were divided into four groups on the basis of the extent of aneurysm. Group I consisted of those patients with involvement of most of the descending thoracic and upper abdominal aorta; group II involved most of the descending thoracic aorta and most or all of the abdominal aorta; group III involved the distal descending thoracic aorta and varying segments of abdominal aorta; and group IV involved most or all of the abdominal aorta including the segment from which the visceral vessels arose. The cause of aneurysm formation was medial degenerative disease in 80%, and dissection in 17%; other causes were responsible in the remaining 3%. The median age was 65 years and associated diseases including aneurysms involving other segments, atherosclerotic occlusive disease, heart disease, chronic obstructive pulmonary disease (COPD), hypertension, and renal insufficiency were frequent. The aneurysm was symptomatic in 70% of cases and rupture had occurred in 4% of cases. There were 54 (8.9%) early (30-day) deaths and 151 late deaths; 400 (66%) patients were still alive 3 months to 20 years after operation, including 60% at 5 years. Statistically significant pre- and intraoperative variables by univariate analysis that were predictive of increased risk of early death were advancing age, associated diseases that included COPD, renal artery occlusive disease, atherosclerotic heart disease, renal insufficiency, and long aortic clamp time. Three of these (age, clamp time, and the presence of COPD) retained significance by multivariate analysis. Variables predictive of risk of late death were age, dissection, extent of aneurysm, rupture, heart disease, cerebrovascular disease, COPD, hypertension, and poor renal function. Age, rupture, renal dysfunction, extent of aneurysm, and dissection retained their significance by multivariate analysis. Variables predictive of neurologic disturbances of the lower extremities included rupture, reattachment of intercostal and lumbar arteries, clamp time, dissection, extent and age. Rupture, reattachment of vessels, dissection, and extent of aneurysm retained significance by multivariate analysis. Thus, the risk of this complication was greatest in patients with extensive lesions (group II) with aortic dissection. The greatest risk of renal failure after operation that required dialysis was in patients who had impaired renal function before operation. Methods employed did not prevent these complications.
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PMID:Thoracoabdominal aortic aneurysms: preoperative and intraoperative factors determining immediate and long-term results of operations in 605 patients. 395 Oct 25

An estimated 60 million Americans have high blood pressure that increases their risk of illness and premature death. Of these persons approximately 35 million need some form of continuing treatment, while the remaining 25 million have borderline high blood pressure that requires medical surveillance. Untreated hypertension is the largest single contributor to stroke and a major contributor to heart disease and kidney failure. The National High Blood Pressure Education Program, started in 1972, has helped to improve hypertension control in the Nation. With providers and the public better informed about hypertension, patient visits and medication prescriptions for hypertension have increased, as has the number of persons whose hypertension is well controlled. Associated deaths, especially from stroke, have declined rapidly and dramatically. There is much room for improvement. Provider interest in and attention to long-term regimen adherence needs more emphasis. Large segments of the population, especially ethnic and racial minority groups, continue to face access problems. Awareness and attempted application of patient management technologies have improved, but stronger efforts are needed to address care delivery system management issues.
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PMID:Preventive health services: High blood pressure control. 641 21

Patients with renal failure have characteristic systemic and oral conditions that require special precautions during dental treatment. Drugs must be administered with caution and patients undergoing hemodialysis must receive special consideration. Both hemodialysis and transplant patients must be protected against infection. This is achieved by early, aggressive, and thorough dental treatment. Use of antibiotics during dental treatment is essential in transplant patients and is often necessary in hemodialysis patients to protect them against bacteremia. Bacterial endocarditis is a concern in patients with renal failure and with heart disease and, in these patients, antibiotic prophylaxis is essential. Hepatitis is often present in patients with renal failure, and precautions should be taken against its spread. Before dental treatment of patients with renal failure is begun, the dentist should consult the patient's physician regarding specific precautions. A treatment plan should be constructed which best restores the patient's dentition and protects from potentially severe infection of dental origin.
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PMID:Dental care for patients with renal failure and renal transplants. 646 52

A saphenous vein allograft was used to create an aortopulmonary communication in 16 infants with cyanotic congenital heart disease and ductus-dependent pulmonary blood flow. These grafts measured from 3 to 8 mm in diameter and were placed between the aorta and main pulmonary artery in eight patients, between aorta and right pulmonary artery in eight, and between aorta and left pulmonary artery in one (one child had two grafts). Before heparin was used, early in the series, four of these grafts occluded and three of the four infants died during attempted revision. Another infant died early from renal failure. Late mortality has claimed four: one from cerebral hemorrhage, two from hypoxia, and one at open-heart surgery for repair. There are eight late survivors (50%). Most of the allografts were used before small diameter Gore-Tex was available; in more recent patients, 4- to 6-mm Gore-Tex grafts have been used. In our most recent patient, however, the attempt to place a Gore-Tex graft was unsuccessful, but the more pliable saphenous vein graft was readily placed and an adequate shunt obtained. Both the saphenous vein graft and the Gore-Tex have the advantage of providing pulmonary flow without the higher risk of congestive failure or pulmonary hypertension seen in patients with a Waterston or Potts anastomosis. They are easier to perform, require less anesthesia time than the Blalock-Taussig shunt, last as long as the Blalock-Taussig when done under similar conditions, and are easy to take down at the time of total repair.
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PMID:Use of saphenous vein allografts for aortopulmonary artery anastomoses in neonates with complex cyanotic congenital heart disease. 646 24

This multicenter regional study analyzes survival of a large group of patients who began chronic dialysis or received their first renal transplant during the 5 1/2-year period that ended in June 1983. Survival was determined from the onset of renal replacement therapy, irrespective of changes in treatment modality. Univariate life-table analysis was used to examine more than 35 risk factors. Age of patients at entry into the therapeutic program significantly affected survival. General survival rates were lower for patients with diabetes than for nondiabetics, irrespective of treatment modality, with the exception of those older than 60 years of age. Five-year graft survival was lower for diabetics than for nondiabetics in all age groups, irrespective of source. Patients with systemic lupus erythematosus, focal glomerulosclerosis, or glomerulonephritis had the highest survival rates, whereas those with primary renal malignant lesions, primary hypertensive disease, or diabetes mellitus as the cause of renal failure had the lowest. Concurrent morbid conditions that adversely affected survival included arteriosclerotic heart disease, peripheral vascular disease, noncutaneous malignant lesions, chronic pulmonary disease, and multiple coexisting morbid conditions. Although the objective of this study was to analyze survival for single patient characteristics, irrespective of treatment modality, analyses of survival rates by treatment modality for a control group indicated that minimal differences were evident by the third year among the four treatment groups: in-center hemodialysis, home hemodialysis, living related donor transplantation, and cadaver transplantation; however, recipients of cadaver grafts had lower survival rates than all other groups, even those maintained by in-center hemodialysis (P = 0.025).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Survival rates of 2,728 patients with end-stage renal disease. 649 73


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