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

The efficacies and side effects of disopyramide and mexiletine used alone and in combination were assessed in 29 patients with chronic ventricular arrhythmias. In combination therapy, one half or two thirds of the conventional doses of each drug were administered. Each patient underwent Holter electrocardiographic monitoring during 4 different periods: baseline, disopyramide alone, mexiletine alone and combination of the two drugs. The mean baseline number of ventricular premature complex per hour was 783 +/- 521 (mean +/- SD), which was significantly reduced with all three therapies. Disopyramide alone significantly reduced the ventricular premature complex frequency in patients with organic heart disease (P less than 0.05), but did not significantly reduce the ventricular premature complex frequency in patients with no apparent heart disease. In contrast, mexiletine alone significantly decreased the ventricular premature complex frequency in no apparent heart disease patients (P less than 0.05), but did not significantly reduce the ventricular premature complex frequency in organic heart disease patients. With disopyramide alone, patients having a significant reduction in ventricular premature complexes (greater than or equal to 83% reduction in ventricular premature complexes) or elimination of ventricular tachycardias tended to be more frequently found in organic heart disease than in no apparent heart disease. The opposite was observed with mexiletine alone. QTc interval with disopyramide alone was significantly prolonged, and the prematurity index of ventricular premature complexes was significantly lowered as compared to mexiletine alone or combination therapy (P less than 0.01 for disopyramide versus mexiletine; P less than 0.05 for disopyramide versus combination therapy). During combination therapy, no patients withdrew from the study due to side effects. However, 3 patients receiving single drug therapy withdrew from the study due to severe side effects. Consequently, disopyramide is suggested to be more effective on ventricular premature complexes in organic heart disease than in no apparent heart disease patients, whereas the opposite was true for mexiletine. A combination of disopyramide and mexiletine in smaller doses may provide almost the same or enhanced antiarrhythmic effects, no aggravation of electrocardiographical parameters and less incidence of side effects when compared to the conventional dose of each drug alone.
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PMID:Evaluation of disopyramide and mexiletine used alone and in combination for ventricular arrhythmias in patients with and without overt heart disease. 172 33

To determine observer agreement for a clinical score and oximetry in lower respiratory infection in children less than 2 yr of age, a convenience sample of 56 infants hospitalized with bronchiolitis or pneumonia was assessed independently by two observers. A total of 12 infants had chronic lung disease of prematurity or congenital heart disease. Infants in whom oxygen supplementation could not be discontinued for at least 5 min were excluded. A severity score was assigned for each of four categories (respiratory rate, retractions, wheeze, and general appearance). A total for each patient was obtained by summing the score for each category. Oxygen saturation was measured using a Nellcor oximeter. Agreement beyond chance was measured using the kappa statistic. The relationship between observers for total score and oximetry and the mean total score and mean oximetry value for each patient was expressed as a Pearson correlation coefficient. A total of 56 infants and children were studied: 2 had pneumonia, 11 had an exacerbation of pulmonary signs and symptoms with their underlying cardiac or pulmonary disease, and 43 had bronchiolitis. Kappa was 0.48 for general assessment, 0.38 for respiratory rate, 0.31 for wheeze, and 0.25 for retractions. All values were statistically significantly greater than 0 at p less than 0.01. Correlations for total score and for oximetry were 0.68 and 0.88, respectively. The median difference between oximetry readings was 1. The correlation coefficient between total score and oximetry was -0.04. The limited agreement for clinical signs makes comparison of patient illness severity between studies difficult.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Observer agreement for respiratory signs and oximetry in infants hospitalized with lower respiratory infections. 173 71

Mortality from cancer and other diseases from 1964 to 1984 and their contributions in 1984 to premature mortality in Bombay, India, were studied. Cancer was the ninth and tenth cause of death in boys and girls younger than 15 years of age, respectively, in 1984. Prematurity and infectious diseases contributed most to years of potential life lost by children younger than 5 years of age in 1984; cancer, heart disease, and accidents-injury became important in children older than 5 years. When currently high mortality rates in infants and children younger than 5 years of age are reduced, cancer may become a greater childhood health problem. Approximately 5% of male and 3% of female patients with cancer in six hospital and three population-based cancer registries in India were children younger than 15 years of age. Cancer mortality declined from the rate during 1964 to 1972 to the rate during 1973 to 1984 by about 40% in children younger than 5 years old and in girls of 10 to 14 years of age and by 7.5% and 14% in the 5 to 9-year-old boys and girls, respectively. It increased by 12% in the 10 to 14-year-old boys. Early diagnosis and treatment of cancer in children older than 5 years of age may yield increased productive person-years of life.
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PMID:Cancer and other causes of childhood mortality in Bombay, India. 191 32

Birth weights of 843 children with congenital heart disease (CHD) were compared to the respective data of a normal West German population. On average, the CHD group had significantly lower birth weights, but the weight deficit was far less pronounced than in previous studies. The decrease in birth weight was distinct only in children with tetralogy of Fallot and atrial septal defect. Compared to normal newborns, patients with CHD were more often small for gestational age (15.0%) or had a low (less than 2500 g) birth weight (8.6%). The prevalence of prematurity was not increased. Extracardiac malformations were not significantly more common in CHD patients, who were small for gestational age, than in CHD patients with normal birth weight.
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PMID:Birth weight of children with congenital heart disease. 222 45

The sensitivity and specificity of a new protocol of programmed ventricular stimulation were evaluated in 71 consecutive patients who were divided into 2 groups: group 1 included 41 patients, of whom 25 had sustained ventricular tachycardia (VT) not associated with cardiac arrest and 16 had ventricular fibrillation (VF) not precipitated by any obvious factor; group 2 included 30 patients without demonstrable heart disease and no suspected or documented sustained ventricular tachyarrhythmias. The study consisted of a standard protocol (up to 2 extrastimuli given only once for each extrastimulus prematurity, 2 right ventricular sites and 3 basic pacing cycle lengths, as well as rapid ventricular pacing) in which double extrastimulation at the shortest coupling intervals that allowed ventricular capture was repeated 10 times. A stimulus current of 3 mA was used. Sustained ventricular tachyarrhythmias were induced in 23 of 25 (92%) patients who presented with sustained VT, 14 of 16 (88%) patients who presented with VF and 2 of 30 (7%) group 2 patients. Eighteen of 25 (72%) patients with sustained VT but only 4 of 16 (25%) with VF had arrhythmias inducible at "immediate" trials of single or double extrastimulation (p less than 0.01). Repetition of double extrastimulation increased the yield of inducible sustained ventricular tachyarrhythmia to 92% in patients with sustained VT (+20%, p = 0.14) and 75% (+50%, p = 0.013) in patients with VF. Rapid right ventricular pacing added a 13% increase in the overall yield in patients with VF. This new protocol of programmed ventricular stimulation has both high sensitivity (90%) and specificity (93%) for induction of sustained VT.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Programmed ventricular stimulation using up to two extrastimuli and repetition of double extrastimulation for induction of ventricular tachycardia: a new highly sensitive and specific protocol. 230 31

From 1978 to 1987, 350 infants and children had silicone central catheters placed for long-term venous access. Real time echocardiography showed a catheter tip thrombus in 16 patients, including 12 premature infants and four children. Catheters had been in place for eight to 560 days. Thirteen patients were receiving total parenteral nutrition (TPN) at the time thrombus was identified, and one patient had received TPN 2 weeks previously. Indications for echocardiography included sepsis (7), respiratory insufficiency (6), evaluation of heart disease (3), and catheter malfunction (1); several patients had multiple indications. Treatment was individualized and included atriotomy (2), systemic heparin and thrombolytic agents with or without catheter removal (8), catheter removal only (3), and observation (3). Four of eight patients treated with thrombolysis had complete clot lysis and four had partial dissolution. Two patients managed expectantly had resolution of the thrombus. None of the patients suffered further complications or died as a result of the thrombus, but ten of the 16 died 1 to 12 weeks later from their underlying disease. Forty-seven asymptomatic patients were studied by echocardiography to assess the incidence of unsuspected right atrial thrombus. Their catheters had been in place for a mean of 200 days and only 11 had been used for TPN. None of these patients had identifiable thrombus at the catheter tip. The incidence of catheter tip thrombus, which is higher than previously suspected, is related to prematurity, TPN, and continuous catheter use, but not duration of catheterization. The incidence is low in asymptomatic patients. Treatment regimen must be individualized and this series reflects a trend toward more conservative management.
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PMID:Thrombus associated with central venous catheters in infants and children. 249 18

The medical records of 114 infants with abdominal wall defects, including 35 infants examined at autopsy, were reviewed to determine if giant (liver-containing) defects are associated with a narrow thoracic cage deformity and pulmonary hypoplasia. The study included 48 infants with gastroschisis, 60 with omphalocele, two with a lower midline syndrome (cloacal exstrophy) and four with an upper midline syndrome (Cantrell's pentalogy). A giant abdominal wall defect was present in 33 infants, including one with gastroschisis, 27 with omphalocele, two with a lower midline syndrome, and three with an upper midline syndrome. A thoracic cage deformity, characterized by a narrow chest and down-slanting ribs, was identified radiographically in 42% (14 of 33) of infants with giant abdominal wall defects. Among the 35 infants examined at autopsy, 14 infants with giant omphaloceles had mean chest circumference to occipital frontal circumference ratio and lung weight to body weight ratios that were significantly below the means for infants with gastroschisis or small omphalocele. Lung weight to body weight ratios indicated marked pulmonary hypoplasia in three of 12 (25%) of infants who had a narrow thoracic cage deformity, and radial alveolar counts indicated mild pulmonary hypoplasia in four additional infants. Prematurity (four infants), diaphragmatic abnormalities (seven infants), and congenital heart disease (four infants) potentially contributed to the respiratory distress experienced by these 12 infants. Infants with giant abdominal wall defects and narrow thoracic cages are at increased risk for pulmonary hypoplasia and respiratory distress.
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PMID:Pulmonary hypoplasia in infants with giant abdominal wall defects. 271 98

The aim of this study was to evaluate potential indications of Magnetic Resonance Imaging (MRI) in the diagnostic workup of congenital heart disease in the newborn in comparison with two other means of investigation: Doppler-echocardiography and angiography. The imaging permitted to make the diagnosis in the 10 cases. MRI was superior than echocardiography in one newborn with a double aortic arch. MRI detected small muscular ventricular septum defects in two newborns with transposition of the great vessels. There was good agreement between MRI and angiographic images. Neither age nor prematurity proved to pose a limit on the diagnosis of MRI. MRI proved to be a good investigative tool which should be used after echocardiography, eventually making it possible to avoid angiography.
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PMID:[Contribution of magnetic resonance imaging in the neonatal diagnosis of congenital cardiopathies. Apropos of 10 cases]. 273 2

Foetal and neonatal consequences of exogenous intoxications are nowadays better apprehended especially regarding alcohol. Alcoholism during pregnancy is the cause of the syndrome of foetal alcoholism described in France by Lemoine in 1968 and then by Jones and Smith in 1973. The prevalence of the table is 1 out of 700 to 800 deliveries for the severe forms and concerns especially by not exclusively the most underprivileged sections of the population and shows in: -- a very specific dysmorphy of skull and face and other abnormalities which give to the face a singular and persistent aspect; -- various and frequent malformative abnormalities with a pronounced tendency for cardiopathy. Most of them are latent or of late discovery; -- a constant growth lateness which is also part of the table as well as prematurity and spontaneous abortion. Hypotrophy is moderate, total, and cerebral; -- effects on central nervous system: it is the third overall cause of mental lateness after trisomy and deficiency of neural canal. Other causes and themselves to alcohol to produce these effects that show themselves on badly affected children or dead in utero because of macroscopic and microscopic alterations of numerous cerebral structures. From a clinical view point, they show themselves by abnormalities of the neural canal, a decreasing of the crane perimeter, neonatal neurologic troubles due to deficiency in the first hours of life, followed during the second and third day by a table evoking a weaning syndrome. The evolution on a medium term is characterized by the persistence of the crane and skull dysmorphy modified by parents phenotype, a persistence of the growth lateness leading to dwarfism in the severe forms. In the moderate and medium form thinness and paleness are spectacular and malformations exist in 2/3 of the cases. The neurologic and behaving evolution is documented by some prospective studies. They tend to indicate the persistence for the severe forms of troubles concerning hyperactivity, lack of attention and decreasing of the crane perimeter as well as a main mental lateness in half of the cases. The study made in Roubaix shows that behaving and intellectual troubles are more pronounced when the dysmorphy is marked. The effects of alcohol lead to a syndrome of foetal alcoholism when the level of alcoholization is high which correspond to K. Sulik's experimental data in 1982. On the other hand, a relation dose-effect has not been yet demonstrated except for hypotrophy. This is the same for threshold-dose. There is no residual effects confirming that alcoholism and its intensity during pregnancy have a direct effect upon descendants. As a matter of fact after weaning and recovery children are again normal and normotroph. Pregnancy and especially delivery are privileged period for detection of maternal alcoholism and beginning of a prevention in a view to avoid. These effects during a later pregnancy.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Clinical aspects, epidemiologic progression of fetal alcoholism: a current daily problem]. 280 13

During the winter of 1986-1987, 64 children with respiratory syncytial virus (RSV) infection were admitted to our hospital. The diagnosis was made by direct immunofluorescent antibody technique. Twenty-three children (36%) needed intensive care treatment. Nearly 11 (52%) had a preexisting disease state, identified as a risk factor i.e., prematurity (n = 8), bronchopulmonary dysplasia (n = 2), congenital heart disease (n = 1). Twelve patients (50%) were intubated and ventilated. Conditions for intubation and ventilation were repetitive apnea with or without bradycardia (n = 4), clinical deterioration (n = 3) or hypercarbia (n = 5). Seventy-five percent of the patients who needed intensive care management were under three months of age compared to 34% of the children who were admitted to the clinical ward. The mean age for ventilated patients was 7.9 weeks. The mean duration of ventilation was 5.5 days. Volume controlled ventilation was initially applied to all patients. Pulmonary complications (atelectasis, pneumonia, pneumothorax or adult respiratory distress syndrome) were present in 15 (65%) IC patients. Nine (39%) of them also had symptoms of inappropriate antidiuretic hormone secretion (IADHS). Only two patients had symptoms of IADHS and two others had convulsions. Three children (5%) died as a result of respiratory insufficiency. Two of these infants belonged to the risk group.
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PMID:Respiratory syncytial virus infections in children admitted to the intensive care unit. 281 76


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