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

Assisted circulation is now used in the treatment of severe forms of heart failure which complicate the course of many diseases. Application of one method of assisted circulation--intra-aortic counterpulsation by a balloon pump in cardiogenic shock--was successful: prolonged survival (over 1 year) was obtained in 18% of the patients. A further decrease in the mortality rate is dependent on the rational organization of treatment for these patients. This poses two major problems: the organization of treatment of patients in cardiogenic shock and postoperative heart failure in large cardiologic and heart surgery centers, and treatment of heart failure in patients in whom it has occurred secondarily. We developed a method of organizing the treatment of these patients beginning in the prehospital stage and continuing in a specialized hospital. In addition to methods of assisted circulation, various intensive care methods and hemosorption (in poisoning by liver toxins), hemodialysis (in anuria), etc., are used. Although this type of organization complicates therapy, the results are significantly improved.
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PMID:Organization of treatment of patients with cardiac insufficiency of different origin. 683 2

Anuria resulting from obstruction of the renal arteries to both Kidneys or to a solitary kidney is unusual. The tolerance of the kidney to this ischemia is largely dependent upon the presence of collaterals, stimulated by pre-existing arterial disease. Our experience with six patients with anuria caused by renal artery occlusion supports the role of revascularization in the recovery of significant renal function. Four of these patients had hypertension, impaired renal function, and the existence of collateral circulation to an ischemic kidney, prior to occlusion, while two patients had normal renal function (serum creatinine = 0.5 and 0.9 mg/dl) before occlusion. The intervals of anuria for the two previously normal kidneys were six hours and five days, and 2 to 14 days in the four patients with vascular disease. Isotope scanning suggested renal artery occlusion in two patients, but arteriograms confirmed the diagnosis in all six. A thrombectomy restored blood flow through the two previously normal renal arteries. Grafts from the aorta or celiax axis were used for three patients and the splenic artery was used for the sixth patient. Urine flow began during or soon after operation in all patients. Dialysis was necessary for 30 and 45 days in the two patients with normal kidneys, but in only one of the four patients with previous disease (for ten days). Serum creatinine decreased to <2.0 mg/dl after operation, except in the man with a solitary kidney, who five years later has a creatinine of 3 mg/dl. All four patients with previous arterial disease died from cardiac failure within 1 to 30 months after operation. Therefore, anuria of acute onset should be evaluated by renal scan and arteriogram to detect those patients with proximal renal artery occlusion in preparation for revascularization.
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PMID:Successful surgical treatment of anuria caused by renal artery occlusion. 705 45

The authors report a case of a forty-years-old woman who died nineteen hours after ingestion of a massive dose of Paraquat (about 125 ml of Gramoxone, 52 g of Paraquat) with vomitings, anuria and cardiac arrest. Early autopsy (less than two hours after death) showed necrotizing esophagitis, ulcerative gastritis, tubular nephritis, congestion of lung, interstitial myocarditis which could explain the heart failure. The ultrastructural study of lung showed interstitial edema associated with minimal endothelial changes but important epithelial cell necrosis of both pneumocytes. These findings are very similar to experimental studies of massive Paraquat poisoning emphasizing the early involvement of pneumocyte II.
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PMID:[Massive poisoning by paraquat with early death (19 hours). Apropos of a case with ultrastructure study]. 715 7

Over a period of 5 years, 1975-1979, 418 infants and children were operated on for congenital cardiac malformations using cardiopulmonary bypass. Fifteen patients (4 with transposition, 4 with Fallot's tetralogy, 1 with pulmonary atresia and 6 with complex composite malformations) developed acute renal failure with anuria, which did not respond to volume load, afterload reduction, low dose dopamine, diuretics and controlled ventilation. Continuous peritoneal dialysis was started within a few hours of anuria. During dialysis the patients remained sedated, intubated and on controlled normocapnic ventilation. No complications occurred caused by the dialysis per se. Ten patients recovered and had normal serum creatinine when discharged from hospital (mean duration of dialysis: 6 days). Complex cardiac malformations were overrepresented in the 5 patients who died early in the postoperative period due to myocardial failure (mean duration of dialysis: 3 days).
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PMID:Peritoneal dialysis in infants and children after open heart surgery. 717 Jun 11

Nine days following ingestion of 5 to 10 gm of thallium nitrate, a young man died with severe cranial and peripheral neuropathy, anuria, and heart failure. Ultrastructural examination of nerves obtained on days 7 and 9 demonstrated axonal degeneration with secondary myelin loss. Axons were swollen and contained distended mitochondria and vacuoles. Thallium levels in more than twenty organs and body fluids ranged from below 1.0 to 178 microgram/gm; concentrations in twenty areas of the nervous system ranged from 29 to 140 microgram/gm. The highest brain levels of thallium were found in gray matter. In the thalamus, 87% of the thallium was present in cell sap. Tissue concentrations of thallium did not parallel those reported for potassium, suggesting that thallium distribution differs from potassium distribution in human beings.
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PMID:Acute thallium poisoning: toxicological and morphological studies of the nervous system. 727 Dec 31

The results of surgical treatment of 209 ruptured abdominal aortic aneurysms are reviewed. The mortality over the first period of ten years was 37.8% and over the second ten years 44.9%. An attempt was made to analyse the reasons for this somewhat disappointing experience, shared by other authors. The broader indications for surgical treatment and the rise in the average age of our patients at presentation may be partially responsible. This elderly aged group had a greater incidence of coexistent disease leading to increased postoperative complications. The duration of preoperative shock had a direct inverse relationship to mortality. It is stressed that, apart from close collaboration between surgeon and internist with early detection of many postoperative complications such as gastrointestinal bleeding, anuria or heart failure, correct and early diagnosis of the ruptured aneurysm offers the best chance for the improvement in the survival rate of these patients.
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PMID:Twenty years' experience of surgical treatment of the ruptured atherosclerotic aneurysm of the abdominal aorta. 730 Nov 57

The abdominal pressure is a hydrostatic one, which can be measured in the bladder, the rectum and the stomach. In physiologic conditions, the abdominal pressure is variable, with peaks as high as 100 to 200 mmHg at the time of defecation, cough. The increase in abdominal pressure elicited by abdominal distension or compression acts directly on the abdominal compartment, indirectly on the thoracic compartment, and modifies the circulation and the ventilation. Venous return is decreased as the inferior vena cava is compressed. The systemic resistances are also increased as the abdominal vessels are compressed. Therefore the circulation is mainly distributed to the superior part of the body. Although the cardiac output is decreased, the usual haemodynamic parameters remain in the normal range: arterial pressure is increased, heart rate is unchanged, central venous pressure is increased, cardiac failure is unusual. The abdominal distension is also responsible for a restrictive respiratory syndrome, mainly due to the ascension of the diaphragm. The compression of the abdominal content explains renal effects and the decreased diuresis. A sustained increase in abdominal pressure occurs in several clinical conditions. During coelioscopy, abdominal pressure is a under control and the cardiovascular effects are minor. Insufflation with CO2 carries the risk of hypercapnia, gas embolism and pneumothorax. During abdominal tamponade, anuria is directly related to the level of pressures. At an abdominal pressure over 25 mmHg, anuria is common and decompression becomes essential. The G suit increases arterial pressure either by elevating vascular resistances or increasing blood content in the upper part of the body. Therefore cardiac tolerance can be decreased especially in cardiac patients. The adverse effects of abdominal pressure can also be observed in case of peritoneal dialysis and ascites. The risk of regurgitation associated with an increased abdominal pressure must also be kept in mind. The abdominal pressure plays an important role in anaesthesia as well as in surgery. Therefore its measurement, which is easy, should become a routine.
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PMID:[Intra-abdominal pressure]. 799 45

The authors report two cases of thrombosis occurring after partial interruption of the inferior vena cava. They presented as collapse and anuria with fatal outcome. Heparin induced thrombocytopenia was present in two cases and distal migration of filter in one case. Thrombo-embolic complications can follow heparin induced thrombocytopenia and justify first treatment with low molecular weight heparin and/or early treatment with oral anti-coagulant. Thrombosis, recurrent embolism or thrombosis of renal vena may occur after vena cava filter. Renal vena thrombosis especially follow filter movement and present as collapse and cardiac failure often with fatal outcome.
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PMID:[Heparin-induced thrombocytopenia and vena cava filter. Difficulties of treatment]. 812 Apr 65

In a 43-year-old patient with Ebstein's anomaly and a history of acute myocardial infarction by means of duplex ultrasonography and aortography the diagnosis of thrombotic occlusion of the a aorta was established, starting above the insertion of the renal arteries and reaching as far as the bifurcation of the aorta and the common iliac arteries. In the clinical picture dominated complete anuria with uraemia and marked hyperkaliaemia as a result of ischaemic affection of the extremities due to thrombosis of the aorta; at the onset of hospitalization also left ventricular failure with hyperhydration and later also signs of the hyperviscous syndrome. The latter developed after repeated haemofiltrations which led to a rise of the originally high haemoglobin and haemotocrit values a result of a righ-left shunt in Ebstein's anomaly. After improvement of the clinical condition local fibrinolytic treatment of the aortal thrombosis with urokinase (total dose 2,160,000 u. administered within 24 hours) was provided. The thrombus with a total length of 13.5 cm was dissolved except for a residual portion of 10 mm located in the area of insertion of the right renal artery. After dissolution of the thrombus it proved possible to restore the blood flow into the left kidney a and lower extremities, but not into the right kidney because of the residual thrombus. Seventy-two hours after terminated fibrinolysis - and after 31 days of anuria - the diuresis was restored and after a polyuric stage normalization of mineral, urea levels was restored and the creatinine value was slightly above the upper normal range. Concurrently with fibrinolytic therapy angioplasty of the aorta was carried out and a stent was placed on the left iliac artery. The clinical condition of the patient was improving, the patient started to mount stairs. Death occurred suddenly and the cause was cardiac failure due to very serious congenital heart disease.
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PMID:[Subacute thrombosis of the abdominal aorta with suprarenal involvement and successful treatment with pharmacomechanical fibrinolysis]. 855 98

The hemolytic uremic syndrome (HUS) is the end result of a variety of etiologic agents that can induce endothelial cell injury and thrombotic microangiopathy (TMA) mostly within the kidney. The typical, post-diarrheal verocytotoxin associated HUS (D + HUS) is the major cause of acute renal failure in children worldwide. In the course of HUS treatment, fluid overload is usually the result of overhydration in the context of oliguria or anuria which cause edema, hypertension, worsening of neurologic signs and cardiac failure. Appropriate and timely use of dialysis has dramatically reduced complications of renal failure and extra-renal complications are now the main causes of mortality and morbidity in D + HUS. The reasons for treatment by infusion of fresh frozen plasma and/or plasmapheresis for D + HUS are theoretical and their therapeutic effects are inconclusive. We believe that plasma administration for regular D + HUS has no value and is potentially harmful. Until new strategies become available in clinical practice, the general consensus for the moment is that careful supportive management with patience is still the most appropriate form of D + HUS therapy.
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PMID:[Advances in the treatment of hemolytic uremic syndrome (HUS)]. 908 86


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