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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors report a case of massive haemolytic anaemia with acute mitral valve regurgitation and left cardiac failure, which occurred one year after surgical reconstruction of the mitral valve for rupture of smaller leaflet chordae. Anaemia, mitral regurgitation and cardiac failure disappeared after mitral valve replacement, using a Carpentier Edwards No. 29 valve. Haemolytic anaemia following mitral valve reconstruction is exceptional. It seems to be due to the suture material lying in a turbulent regurgitation stream when mitral incompetence develops again.
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PMID:[Massive hemolysis and acute mitral insufficiency one year following mitral valve repair. Apropos of a case]. 311 59

There were 37 maternal deaths among the 109,221 livebirths registered during the period 1977-86 in Bahrain, Arabian Gulf. The maternal mortality rate was 33.9/100,000 for the 10-year study period; however, disaggregation reveals a decline in this rate from 42.3/100,000 in 1977-81 to 26.9/100,000 in 1982-86. This decline presumably reflects streamlining of the Ministry of Health's maternity services, including a central maternity hospital with all modern facilities that serves as a referral center for all of Bahrain, 2 peripheral hospitals with provision for blood transfusion and surgical deliveries, and 3 maternity units managed by fully qualified midwives. About 80% of deliveries are covered by these maternity services; only 2.5% of deliveries occur in the home. Despite this highly developed maternity care system, 18 of the maternal deaths were due to direct obstetric cause: hemorrhage, 7; pre-eclampsia and eclampsia, 5; abortion septicemia, 2; bowel perforation during cesarean section, 1; thromboembolism, 2; and amniotic fluid embolism, 1. The causes of the 19 indirect maternal deaths were: pulmonary embolism, 5; infection, 7; cardiac failure, 2; cerebrovascular accident, 2; pulmonary hypertension, 1; and uncertain, 2. Of interest is the finding that sickle cell disease was the underlying cause of maternal death in 12 of the 37 deaths in this series. Sickle cell disease was implicated in 3 of the deaths from hemorrhage, all 5 deaths from pulmonary embolism, 2 deaths from septicemia, and the 2 cases of cardiac failure. In this series, 50% of the patients with sickle cell disease had thromboembolic crises following treatment of anemia with packed cell transfusion. Blood transfusion, especially of packed cells, should be given with caution to these patients since it may precipitate vaso-occlusive crisis by increasing blood viscosity. Since sickle cell disease represents a high risk during pregnancy in this Arab population, such patients should have frequent prenatal check-ups and deliver in a well-equipped hospital.
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PMID:Maternal mortality in Bahrain with special reference to sickle cell disease. 321 81

In a case of fetal anaemia due to pure red cell anaemia (Blackfan-Diamond syndrome), two-dimensional fetal Doppler echocardiography revealed an altered blood flow velocity pattern with entire incorporation of the atrial contraction component in the early passive filling phase of the right ventricle. Intracardiac blood velocities were increased, whereas cardiac output was only moderately increased. The fetal heart rate was normal. It is concluded that in fetal anaemia the compensatory mechanisms are limited and restricted to an increase in stroke volume. The hypothesis that chronic fetal anaemia is associated with 'high output cardiac failure' corresponds well with the present findings. The technique described may prove to be useful in the early diagnosis of fetal anaemia.
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PMID:Altered fetal cardiac flow patterns in pure red cell anaemia (the Blackfan-Diamond syndrome). 322 19

Two-dimensional Doppler echocardiography was used to diagnose congestive heart failure in a fetus with a large sacrococcygeal teratoma. Ultrasound performed for size-date inconsistency revealed a 27.5-week fetus with hydrops and a large solid and cystic mass in the sacral region. Fetal echocardiography showed dilated ventricles and a pericardial effusion; Doppler ultrasound demonstrated increased velocities and volume flows, along with tricuspid and mitral regurgitation. At delivery, the mass was bleeding actively, the amniotic fluid was markedly bloody, and the neonatal hematocrit was 10%. We postulate that intrauterine hemorrhage from the teratoma led to anemia and high-output cardiac failure confirmed by Doppler echocardiography, and suggest that all fetuses with sacrococcygeal teratomas be evaluated by two-dimensional Doppler echocardiography to detect the presence of congestive heart failure, in order to allow well-timed therapeutic interventions.
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PMID:Prenatal diagnosis of congestive heart failure in a fetus with a sacrococcygeal teratoma. 328 52

This paper discusses the possible pathogenesis of the cerebral atrophy (CA) observed in a large percentage of uraemic patients, taking the form of prevalently cortical damage (cortical atrophy) and/or subcortical enlargement of ventricular cavities (subcortical atrophy). This central nervous system pathology seems to share very little either with the better known 'dialysis encephalopathy' or with the 'acute encephalopathy syndrome', even though sporadic cases of both these forms have shown concomitant CA. Histopathologically it offers the picture of loss of neurons and nerve fibres and can thus be compared with uraemic peripheral nervous system damage. CA is unquestionably important because of its implications in terms of impairment of superior cortical functions, just as in CA of non-uraemic aetiology. A first aetiopathogenic hypothesis might include endogenous uraemic intoxication to the nerve tissue, believed responsible for peripheral uraemic neuropathy, but other possibilities merit consideration: vascular calcification secondary to hyperparathyroidism, blood lipid disorders, and systemic hypertension--factors that contribute to impairing the brain vasculature, with cascade effects on brain tissue oxygenation, neuronal metabolism, and energy exchanges. Tissue oxygenation is already jeopardized in the uraemic patient by the concomitant chronic anaemia and by cardiac insufficiency in cases with hypertensive heart disease. In dialysis patients with volume-dependent hypertension the brain may be further damaged by abrupt pressure changes produced by dialytic ultrafiltration; these constitute a severe challenge to cerebral blood flow autoregulation. Cyclic variations of brain tissue hydration connected with regular dialysis treatment may have adverse effects on neurotransmitter functions, particularly those mediated by neuropeptidergic systems. Chronic intoxication may result from oral Al(OH)3 of phosphorus-chelating agents: in animal studies and clinical observations in non-uraemic populations the neurotoxic potential of Al is indicated by a significant correlation between histological neuronal damage, impaired function, and Al concentration in brain tissues. In addition, a concausal role of malnutrition in central nervous system damage in the uraemic patient cannot be overlooked, since malnutrition is known to give rise to functional and structural alterations in non-uraemic human pathology. In the light of these clinical observations and experimental findings, it would appear that the prevention of CA in uraemia is today feasible.
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PMID:Pathogenesis of cerebral atrophy in uraemia. State of the art. 328 91

Cardiovascular instability is the cause of almost 50% of postoperative complications and raises postoperative mortality far above that intraoperatively. The aged patient with pre-existing heart disease represents a high postoperative risk. These patients are very susceptible to hypoxia, anemia, hypovolemia, the negative inotropic effects of certain anesthetics, and increased oxygen consumption due to shivering. The reversal of anesthetic agents is also rather debatable in these cases. Hypertension and arrhythmias are common phenomena in the recovery room. They may be aggravated by a number of factors such as metabolic and respiratory imbalances, incorrect fluid substitution, pain, or excitation. The frequency of postoperative myocardial infarction (MI) depends upon pre-existing coronary artery disease and hypertension. A medical history of heart failure or previous MI also plays an important role hemodynamic course as do the surgical procedure and the intraoperative. Postoperative hemodynamic monitoring should be performed according to the standards suggested by the American Society of Anesthesiologists. Medical treatment basically consists of symptomatic therapy and the avoidance of risk factors. Specific treatment is rarely required.
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PMID:[Postoperative disorders of cardiovascular function]. 329 48

The records of 56 patients operated upon for ampullary tumors were reviewed in order to determine the best way to diagnose and treat these tumors. Thirty six males and 20 females, 30 to 89 years old, were operated upon between October 1970 and October 1985. Eighty six p. 100 had jaundice and 21 p. 100, anemia. In recent years, ultrasonography, duodenoscopy and ERCP appeared to be the most useful tests for diagnosis. Mean size of the tumors was 2.3 cm (0.5 to 5 cm). Five tumors were benign (8.9 p. 100) and 51 were malignant. According to the classification of Martin, 5 were grade I: 10, grade II: 18, grade III: and 18, grade IV. The correct histologic diagnosis was obtained on biopsy specimens taken during endoscopy in 7 of 12 patients. Nine patients underwent palliative choledocoduodenostomies: only one is alive at 3 years; 47 underwent resection of the tumor: 3 local excisions associated with sphincterotomy for small benign tumors, 6 ampullectomies (followed in 3 by a Whipple procedure for recurrence) and 41 Whipple procedures. After pancreatic resection, 3 patients died during hospital stay and 12 had reversible complications; overall 5 year survival was 41 p. 100. It was 75 p. 100 in grade I, 50 p. 100 in grade II, 40 p. 100 in grade III and 10 p. 100 in grade IV. Patients who received an ampullectomy were alive with a follow up of 1, 2, and 3 years. All patients operated upon for a benign tumor were alive except one who died of cardiac failure.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Surgical treatment of Oddi's sphincter tumors. Apropos of 56 cases]. 337 96

A 10-year-old patient with severe autoimmune hemolytic anemia (AIHA) presented with heart failure. Hemoglobin levels remained dangerously low despite multiple blood transfusions and corticosteroid therapy. A two-volume exchange transfusion promptly restored and maintained satisfactory hemoglobin levels. An exchange transfusion should be considered in selected patients with AIHA when severe hemolysis results in life-threatening anemia, and repeated blood transfusions are unsuccessful in maintaining safe hemoglobin levels. Such an approach may be especially applicable in children in whom plasma-pheresis may not be suitable because of technical limitations.
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PMID:Exchange transfusion for severe autoimmune hemolytic anemia. 343 79

Serum erythropoietin levels were measured by radioimmunoassay in 146 children and young adults with congenital heart disease to assess the relationship between erythropoietin and clinical factors (heart failure, anemia, cyanosis) and hemodynamic variables affecting oxygen delivery and utilization. Erythropoietin values were in the normal range (10 to 30 microU/mL) in 73% (58 of 80) of the patients with and 82% (54 of 66) of those without cyanosis. Elevated erythropoietin values in cyanotic patients were associated with lower mixed venous oxygen saturation and tension than in cyanotic patients with normal erythropoietin levels, even though the degree of polycythemia was similar. In contrast, most of the acyanotic patients who had elevated erythropoietin levels were anemic. Of the blood oxygen measurements, mixed venous oxygen saturation and tension had the closest inverse correlation with erythropoietin values. The normal erythropoietin values in most patients are in accord with other observations that show that an elevation in erythropoietin level in response to hypoxia will be transient if it results in a rise in hemoglobin concentration "appropriate" to the degree of hypoxia. Persistent elevation of erythropoietin in patients with congenital heart disease may indicate harmful impairment of hemoglobin production that is potentially correctable.
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PMID:Serum erythropoietin levels in patients with congenital heart disease. 355 1

Sixteen patients with advanced evaluable urothelial cancer were treated with a chemotherapy regimen of cyclophosphamide, adriamycin and cisplatin (CAP). Cisplatin 50 mg/m2 and adriamycin 30 mg/m2 were given on the first day and cyclophosphamide 200 mg/m2 was given from the second to the fifth day. This course was repeated every 3 weeks. The objective response rate was 25% (4 of 16 patients), with 1 patient achieving complete remission. The survival time of responders was longer than that of nonresponders, although the difference was not significant (generalized Wilcoxon method). As side effects, nausea with vomiting (43.8%), renal dysfunction (6.3%), anemia (12.5%), leucopenia (12.5%), thrombocytopenia (25.0%), alopecia (68.8%), heart failure (6.3%) and peripheral neuropathy (6.3%) were noticed. One patient died of sepsis due to agranulocytosis and another died suddenly of heart failure.
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PMID:[Combination chemotherapy of cyclophosphamide, adriamycin and cisplatin in advanced urothelial cancer]. 367 92


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