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

Case histories of the last nine fatalities (1969-1984), in which the cause of death on the State of Arizona Certificate of Death was snakebite, were reviewed. Six males and three females ranged in age from 2 to 77 years, and were bitten between 0800-2100 hours from April to September. Bites in three adult males were "illegitimate" and of these, two were by captive Mojave rattlesnakes, Crotalus s. scutulatus. The latter two victims had been bitten previously and remained at home, refusing treatment. In the other seven victims, the snakes involved were not identified. However, all localities where bites occurred were within the geographical and altitudinal range for Crotalus atrox and C. s. scutulatus. The apparent cause of death was prolonged hypotension with major organ system failure in five, intestinal hemorrhage in one, and was unknown in three. Major organs were involved as follows: cardiac failure (two); noncardiac pulmonary edema (two); renal failure (two); unconsciousness with airway obstruction and brain damage (two); and coagulopathy with multiple hemorrhage sites (one). Seven of the nine deaths appeared to be preventable. Four delayed going to a medical facility and six did not have hypotension corrected. Antivenin was not administered early (first four hours) or in adequate amounts (10 vials or more) because of delayed arrival in five or physician's decision in four. Pre-existing cardiac disease contributed to death of two victims. Rattlesnake bite victims should not delay travel to a medical facility and hypotension must be treated aggressively and appropriately.
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PMID:Fatal rattlesnake envenomation in Arizona: 1969-1984. 370 4

The importance of eosinophilia in patients with severe polyarteritis causing myocardial ischaemia is discussed in connection with a case history. A 20 year old man complaining of recurrent episodes of dyspnoea was found to have a very high eosinophil count, and no allergy as assessed by prick test, RAST and histamine liberation test. The eosinophilia responded to steroid treatment. The patient died 2 years later, at which time his eosinophilia had recurred, of heart failure, with pericardial and pleural effusions and a congested liver. Post-mortem examination showed severe ischaemic changes in the myocardium and chronic inflammatory changes in the small branches of the coronary arteries. The pathologic diagnosis was polyarteritis (in some degree of remission) confined to the heart. Since the clinical and electrocardiographic diagnosis of myocardial ischaemia and cardiomyopathy in patients with polyarteritis and/or eosinophilia can be difficult, other non-invasive investigations are indicated when there is a suspicion that the heart may be affected. Echocardiography, and possibly endomyocardial biopsy may be used at an early stage to assess the response to immunosuppressive treatment. Prophylactic treatment of any associated clotting disorder should be considered. The aetiology and pathogenesis of polyarteritis is unknown, but endothelial damage caused by eosinophilia early in the disease process may be important. Adequate treatment should therefore be given in order to reduce the eosinophil count and a close follow-up is essential in order to diagnose a relapse of the eosinophilia early and thereby possibly prevent fatal cardiac complications.
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PMID:Eosinophilia and myocardial ischemia secondary to polyarteritis. A discussion of pathogenesis on the basis of a case history. 613 21

Five cases of recurrent cervical carcinoma with sites of recurrence restricted to the pelvis were treated by intra-arterial infusion of oncostatics via the bilateral internal iliac arteries. One tip of the catheter was positioned in the internal iliac artery, proximal and close to the superior glutea artery, through the arteria glutea superior or inferior with ligations of both arteria glutea superior and inferior so as to give high concentration of drugs in the lesion. The other tip of the catheter was introduced subcutaneously up to the subclavian fossa of the anterior chest and was secured to the skin. Several chemotherapeutic agents (cisplatin, adriamycin, pepleomycin, mitomycin C and 5-fluorouracil) were infused repeatedly through the catheter, once or twice a week. The clinical efficacy according to Karnovsky's criteria was 0-C in one case, 1-A in one case and 1-B in three cases. The overall response rate of 1-B or higher was 60%. Two patients died, one from inflammation in the pelvic dead space and disseminated intravascular coagulopathy, the other from myocarditis and heart failure. The other three are alive and being treated by weekly intra-arterial infusion of chemotherapeutic agents at our outpatient clinic. No problems, such as spontaneous removal of the catheter, inflammation around the catheter or bleeding, have been encountered. The toxicity of the oncostatics in case of intra-arterial infusion was less pronounced than in the case of intra-venous administration of the same dose.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Recurrent cervical cancer in the pelvis--intra-arterial infusion of oncostatics. 619

The sudden development of diffuse pulmonary infiltration in a patient with SLE presents difficult diagnostic and therapeutic problems to the clinician. In the past ten years, we have seen eight patients with this problem. Neither roentgenograms nor clinical findings were specific. In six patients, pulmonary hemorrhage was found, but in only two of them did it exist alone. In the other four, heart failure, uremia, and coagulopathy complicated the findings. In one patient, P carinii was the cause; in one congestive heart failure, which was not obvious clinically or radiologically, was the cause. Three patients died: one of uncomplicated pulmonary hemorrhage, one with pulmonary hemorrhage occurring during the treatment of pneumonia due to L bozemanii, and one with pulmonary hemorrhage and multiple complications including sepsis due to Candida. On the basis of this experience, we have recommended a plan of action for physicians facing this problem.
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PMID:Severe, acute pulmonary disease in patients with systemic lupus erythematosus: ten years of experience at the National Institutes of Health. 648 76

In the operating room, 66 preterm infants weighing between 710 and 2,700 gm (23 less than 1,000 gm) underwent ligation of a patent ductus arteriosus (PDA). Respiratory distress syndrome was present in 53 patients; the rest had apnea-bradycardia syndrome. PDA ligation was indicated for intractable congestive heart failure in 52 patients or progressive respiratory failure in 14. There were no intraoperative deaths. Fifteen infants died 1 to 120 days postoperatively. Seven deaths resulted from intracranial bleeding, 3 from diffuse coagulopathy, and 1 from respiratory failure. The condition of patients with heart failure improved postoperatively, with the mean left atrium to aorta ratio reduced from 1.56 to 1.02 (p = 0.05). Respiratory function improved in 25 patients extubated by the third postoperative day. Late follow-up (one to five years) of the 51 survivors showed 1 late death. Seventeen survivors had roentgenographic evidence of bronchopulmonary dysplasia. Infants with bronchopulmonary dysplasia required longer postoperative ventilation (mean, 21.5 days compared with 4.75 days). Twenty-four infants were normal. Ligation of PDA in preterm infants has low intraoperative risk and improves the condition of those with heart and respiratory failure. Late follow-up showed good recovery of nearly two-thirds of the patients.
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PMID:Ligation of patent ductus arteriosus in premature infants. 725 56

The case of an obese patient who developed massive centrilobular liver cell necrosis, severe coagulopathy, acute renal failure, and encephalopathy is presented. Hypovolemia and heart failure were absent, but the acute liver disease was associated with severe arterial hypoxemia due to obstructive sleep apnea that was shown by the nocturnal blood oxygen desaturation, the results of the polysomnographic study, and normal baseline pulmonary function tests. In this obese patient, liver cell necrosis was caused by severe liver cell hypoxia secondary to severe arterial hypoxemia as a consequence of obstructive sleep apnea associated with a Pickwickian syndrome. This observation is consistent with the hypothesis that liver ischemia was directly related to severe arterial hypoxemia.
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PMID:Ischemic hepatitis due to obstructive sleep apnea. 755 54

Eighteen patients with an acute thrombosis of the splanchnic veins were reviewed. Most of apparently idiopathic cases of splanchnic vein thrombosis are related to an increased coagulation related to a congenital or acquired defect of haemostasis. The aim of this study was to assess the effects of a new and effective treatment. Nine male and 9 female patients (range of age: 19 to 81 years) experienced a mesenteric venous thrombosis. There were 14 mesenteric vein thromboses with infarction, two transient mesenteric venous ischaemias without bowel infarction and two acute thromboses of the splanchnic veins without bowel ischaemia. A coagulopathy was detected in seven patients: oral contraception, protein C (PC) or antithrombin III (AT III) congenital deficiencies, acquired deficiency of AT III, PC and protein S (PS), polycythaemia in the post-partum period and primary myeloproliferative disorder. No coagulopathy was associated with thrombosis in eight cases: mesenteric haematoma, splenomegaly, cirrhosis, appendicectomy, cholescytectomy, chronic heart failure, treatment with beta-adrenergic receptor antagonist and digitalis, stenosis of the portal anastomosis after liver transplantation. Twelve patients required surgery: eight intestinal bowel resections with immediate anastomosis, four resections without immediate anastomosis. Only one patient underwent a second look for a repeat bowel resection. No death occurred in the early postoperative period and 17 out of 18 patients were alive after 12 years. An oral anticoagulant therapy was undertaken from two months to seven years. However, three patients suffered a recurrent thrombosis. Two of them required a long-term anticoagulation. Six patients experienced a portal hypertension and oral anticoagulants were discontinued in three of them because of bleeding oesophageal varices. Six patients were treated only by unfractionated heparin (UFH) or low molecular weight heparin (LMWH) followed by oral anticoagulants. After laparotomy, two were only treated with UFH without any bowel resection, as mesenteric venous ischaemia was too extensive. These observations suggest that the choice between an appropriate medical or surgical treatment is important and must be discussed. Since 1989, the therapeutic choice has been modified by ultrasonography and contrast enhanced computed tomographic scan which confirms diagnosis, allows to follow up and check the effects of anticoagulation and to choose the time for surgery. When the diagnosis is established and the patient's risk is low, the IU . kg(-1) . d(-1) to obtain an antifactor Xa activity between 0.3 and 0.6 antiXa IU mL(-1). When the diagnosis is uncertain and the patient's risk if high a laparotomy is required.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Mesentric venous thrombosis. Risk factors, treatment and outcome. An analysis of 18 cases]. 781 2

Iron poisoning is the most common cause of overdose mortality in children under six years of age and there are no reports of survival with iron levels > 2687 mumol/L (> 15,000 micrograms/dL). A 22-month-old male was brought to the emergency department by his parents after ingesting an estimated 50 ferrous sulfate tablets (60 mg elemental iron/tablet) several hours earlier. Despite spontaneous emesis and gastric lavage his condition deteriorated and he was found to have a serum iron of 2992 mumol/L (16,706 micrograms/dL). During the first four days in the intensive care unit, he developed coma, metabolic acidosis, hypovolemic and cardiogenic shock, liver failure, coagulopathy and adult respiratory distress syndrome. He was treated with a unique deferoxamine dosage schedule (25 mg/kg/h for 12 h/d x 3 d), mechanical ventilation, Swan-Ganz catheter monitoring, dopamine/nitroprusside therapy, blood product, bicarbonate, electrolyte and volume replacement. After a prolonged hospital course complicated primarily by gastric outlet obstruction he was dismissed on full oral feedings, gaining weight, and neurologically intact. Swan-Ganz catheter monitoring guided the management of this patient's shock, iron-induced cardiac failure, and deferoxamine mesylate induced adult respiratory distress syndrome. Further experience and research is required to determine the most appropriate deferoxamine mesylate dosing schedule and our experience expands the range for possible survival after massive iron overdose.
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PMID:Survival after a severe iron poisoning treated with intermittent infusions of deferoxamine. 783 15

We experienced two patients with a prosthetic heart valve, who underwent hepatic resection for hepatoma while on anticoagulation therapy. Patients with a prosthetic heart valve have the following characteristics; an increased risk of thromboembolism due to diminished anticoagulation in the perioperative period, a greater risk of endocarditis due to the artificial material in the heart, and impaired cardiopulmonary function including possible arrhythmia and heart failure. Furthermore, when such patients also have liver cirrhosis with a hepatoma, there is an increased risk of perioperative bleeding while on anticoagulation due to coagulopathy and also a risk of infection due to decreased cellular immunity. Patients with a prosthetic heart valve therefore require special care and attention whenever they have to undergo hepatic resection. With respect to anticoagulation, a minimal level is required to prevent bleeding and thromboembolism. Warfarin being administered preoperatively may be switched to heparin while closely monitoring the activated clotting time (biomaterial valve: 130-150 sec, non-biomaterial valve: 150-180 sec); the heparin should then be changed back to warfarin immediately after starting oral intake following operation. For the prevention of infection, a broad spectrum antibiotic should be used prophylactically both intra-operatively and postoperatively. The cardiopulmonary function must also be carefully monitored. For the assessment of postoperative liver function, lecithin: cholesterol acyltransferase, serum bilirubin and albumin are useful because there is no relevance of coagulation parameters such as prothrombin time under anticoagulation.
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PMID:Major hepatic resection in patients with a prosthetic heart valve receiving anticoagulation treatment. 795 57

One-year-old boy who previously had modified Van Praagh procedure for interruption of the aortic arch (Celoria-Patton type A) and double inlet left ventricle with ventriculoarterial discordance was admitted for progressive cyanosis. He underwent reconstruction of the left pulmonary artery and additional left common carotid-left pulmonary artery shunt. During this procedure, severe hypotension of the lower extremities and heart failure occurred for unknown cause. He died on the 7 postoperative day for lung bleeding with disseminated intravascular coagulopathy. Autopsy revealed dissection of the pseudointima and obstruction of the prosthetic graft (interposed between the main pulmonary artery and the descending aorta). This complication seems very rare but a great care should be taken when a prosthetic graft is manipulated later.
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PMID:[Dissection of the pseudointima followed by lethal obstruction of the prosthetic graft--a case report]. 855 Oct 80


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