Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A group of 102 patients (66 males, age 62 +/- 11 years) surviving an acute myocardial infarction was followed for 6 to 48 months. Survival was analyzed by the method of Kaplan Meier and Cox analysis was used to identify prognostic factors. Thirteen patients died during follow up: 3 had sudden death, 3 a stroke, 3 died from heart failure, 3 had reinfarction and cardiogenic shock and 1 died from cholangitis. Most deaths occurred in the first few months of follow up. Survival was 92% at 6 months, 90% at 1 year, 88% at 2 years and 86% at 3 years after infarction. Single variable analysis disclosed a 2 to 3 fold late mortality risk associated to the presence of age over 60 years, old myocardial infarction, hypertension, diabetes mellitus and ventricular tachycardia or fibrillation during the acute phase. Greater than 3 fold risk was seen for patients developing heart failure or shock during myocardial infarction. Heart failure was the only statistically significant risk factor identified by multivariate analysis.
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PMID:[Prognosis after myocardial infarction]. 213 24

Intra-arterial hepatic chemotherapy (IAHC) with adriamycin (ADM) has not increased its therapeutic index. For our preclinical studies, we selected pirarubicin (THP), an ADM derivative with faster cellular uptake. In rabbits with VX2 tumor in the liver we compared plasmatic and cellular pharmacokinetics of ADM and THP after i.v. and IAH therapy. For ADM, there were no differences in plasma and heart concentrations, with only a slight increase in tumoral levels after IAH compared to i.v. administration; on the other hand, with IAH THP, there was important reduction in systemic exposure with a major increase in tumoral drug distribution. In the phase I study, involving nine patients with implanted catheters, the starting dose of THP was 30 mg/m2 with a 10 mg/m2 intrapatient escalation every 3 weeks in the absence of toxicity. Pharmacokinetics were compared for i.v. and IAH administration in seven patients. The limiting toxicity was neutropenia and the maximal tolerated dose (MTD) ranged from 50 to 110 mg/m2. Moderate nausea-vomiting (grade 1-2) and alopecia (grade 1) occurred at the MTD. No arterial occlusion, gastroduodenal ulcer, hepatitis, or sclerosing cholangitis were seen. In the phase II study, in colorectal cancer patients (CRC) with metastasis confined to the liver, patients were enrolled until June 1990. THP (40 min infusion every 3 weeks) was initiated at 60 mg/m2 with 10 mg/m2 increment until grade 2 hematotoxicity. The median MTD was 85 mg/m2 (range of 60-120 mg/m2), and the median number of cycles was 7 (range of 2-11) with cumulated doses from 180 to 1,030 mg/m2. Grade 2-4 neutropenia was reached in 15 patients. Other toxicities included two arterial occlusions, one episode of gastritis, but no hepatic toxicity and no heart failure. Antitumor effect (in 18 patients) included 1 CR, 5 PR, 3 MR, 6 NC, and 3 PD. The median survival was 18+ months and 1-year survival was 73% +/- 12%. Seven patients had extrahepatic progression at this time. In conclusion, besides 5-FU or Fudr, THP is active in IAHC (probably in relation with high local extraction) on CRC liver metastases usually unresponsive to ADM. It can be given in an outpatient setting with minimal toxicity.
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PMID:Intra-arterial hepatic chemotherapy with pirarubicin. Preclinical and clinical studies. 229 52

The purpose of this study was to determine the incidence of death as the initial manifestation of cholelithiasis. Records of patients who died or underwent cholecystectomy for gallstone-related disease at Duke University Medical Center between 1976 and 1985 were reviewed. Thirty patients died, six of whom (20%) had previous episodes of biliary pain and stone documentation. Twenty-four (80%) were asymptomatic (three with previous incidental diagnosis of cholelithiasis). Reason for admission included acute cholecystitis (nine), pancreatitis (eight), biliary pain (six), cholangitis (four), jaundice (one), and endocarditis (one). Three patients died of gallstone complications without surgical intervention; one patient had renal failure and two had septicemia. Other causes of death were: sepsis (seven patients), cardiac failure (six), pulmonary complications (four), renal failure (three), cerebrovascular accident (three), liver failure (two), pancreatitis (one), and gastrointestinal bleeding (one). During this period, 1731 cholecystectomies were performed without mortality. In this group, the patients were younger (50 +/- 8 years vs. 64 +/- 13 years, p less than 0.001), and had a lower incidence of cirrhosis (p less than 0.001) and diabetes (p less than 0.002). The sex ratio was inverted (p less than 0.001). This study demonstrates that death from gallstones is uncommon (three cases per year), as is death from their initial clinical manifestation (1.2%). The risk of death is two- and ninefold higher in patients with acute cholecystitis or acute pancreatitis. Age, cirrhosis, and diabetes are important determinants of outcome.
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PMID:Deaths from gallstones. Incidence and associated clinical factors. 291 58

Endoscopic sphincterotomy is an available nonoperative alternative treatment for recurrent or residual common bile duct stones. Nevertheless, immediate, intraoperative and definitive treatment is needed in patients with common duct stones and other pathologies that are prone to develop into such complications, which is important especially in aged high-risk patients during recurrent operations and nonoperative instrumental interventions. To evaluate the safety of choledochoduodenostomy in elderly patients, we reviewed our experience with 55 patients over the age of 70 years with benign biliary tract diseases. Even though the majority of patients (69%) had obstructive jaundice and were operated on urgently, there was one death (1.8%) due to cardiac failure, and nine (16.3%) early postoperative complications including subphrenic abscess, disruption of wound and pneumonia (one case of each), wound infection (three cases) and urinary tract infections (three cases). There were no complications related to the procedure itself. In a follow-up period of one to 12 years, neither cholangitis nor sump syndrome were documented.
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PMID:Choledochoduodenostomy for benign biliary tract disease in the elderly. 368 62

Cardiovascular anomalies such as absent inferior vena cava and preduodenal portal vein are reported in cases of biliary atresia and make hepatic portoenterostomy a technical challenge. The authors present the case of a severe cardiac anomaly that significantly altered the functional outcome of a Kasai procedure. Baby M., an 8-week-old boy born with total anomalous pulmonary venous return (TAPVR), underwent hepatic portoenterostomy for biliary atresia. Over the next 3 months he remained icteric and febrile, and failed to gain weight. After multiple antibiotic treatments for suspected cholangitis, he underwent reexploration of the portoenterostomy, with no improvement in his overall condition. His prognosis was considered dismal because correction of the cardiac anomaly is associated with a high mortality rate (> 90%). The cardiac surgeon agreed to attempt a cure of the TAPVR, provided liver transplantation is contemplated if the patient survived. Within 48 hours postoperatively, his hepatic function had improved drastically. He became afebrile, had an improved appetite and weight gain, and was finally discharged 203 days after admission. One year later, he is thriving and remains anicteric. The exact reason for this drastic improvement is not well understood, but the right-sided cardiac failure caused by the TAPVR had a significant effect on the functional outcome of the portoenterostomy.
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PMID:Total anomalous pulmonary venous return complicating portoenterostomy for biliary atresia. 780 57

Eleven cases of hepatic injury attributed to the intake of flucloxacillin were reported to the Netherlands Center for Monitoring of Adverse Reactions to Drugs between 1982 and 1992. They concerned four men and seven women, with a mean age of 57 years, treated for 2-28 days with an oral dose varying from 1500-4000 mg per day. Symptoms mostly appeared 10 to 30 days after starting treatment with flucloxacillin. Biochemically, the pattern was compatible with cholestatic hepatitis in seven cases, with a mixed cholestatic-hepatocellular type of injury in one case, a hepatocellular pattern in two cases, and mild liver enzyme elevations in one patient. Two patients died, one due to fatal bleeding from the liver after biopsy, and the second patient to a combination of hepatic and cardiac failure. The other patients recovered, on average 72 days after peaking of serum aminotransferase values. Histology in seven cases showed cholestatic hepatitis in five, with cholangitis or cholangiolitis in four of these patients. In the other two patients, there was centrilobular cholestasis with extensive bridging fibrosis and portal-central bridging necrosis, respectively.
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PMID:Flucloxacillin-associated hepatic injury. 799 79

Long-term survival of biliary atresia patients after Kasai hepatoportoenterostomy is being increasingly reported. Favorable prognostic factors are: 1) Young age at operation (max. 60 days). 2) Few incidents of postoperative cholangitis. Jaundice-free long-term survival is achieved in one-fourth to one-third of patients undergoing Kasai hepatoportoenterostomy. Without treatment the average life span is 19 months. Twenty infants with biliary atresia were treated with the Kasai operation between 1976 and 1992. Nine children are alive 11 months to 16 years postoperatively, two after a liver replacement, one at ten months and one at two and a half years old. A tenth child had a well functioning anastomosis but died of heart failure. Eight children with a well functioning anastomosis were all younger than 60 days at the operation. Only one child older than 60 days survived without a liver transplantation. Our results confirm that early diagnosis and treatment of biliary atresia, before 60 days of age, is necessary.
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PMID:[Biliary tract atresia. Hepatoportoenteric anastomosis and/or liver transplantation]. 832 49

Captopril, a competitive inhibitor of angiotensin-converting enzyme, is widely used in the treatment of hypertension and heart failure. Captopril is known to be associated with dermatologic, hematologic, and pulmonary adverse effects. However, hepatotoxicity is extremely rare. A patient with severe cholestatic jaundice induced by captopril is presented. On admission to the hospital, the patient was diagnosed and treated as having cholangitis. Review of the literature showed similar occurrences in other patients. Patients treated with captopril who develop "atypical cholangitis" should be suspected of having captopril-associated liver damage.
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PMID:Captopril-associated "pseudocholangitis'. A case report and review of the literature. 864 78

To assess the longevity of the liver, arterialized, orthotopic liver grafts were performed using syngeneic male BN/BiRij rats. Young (5-month-old) livers were transplanted into 5-month-old recipients (group I, n = 27), and old (28-month-old) livers were transplanted into 5-month-old rats (group II, n = 28). Recipient survival after transplantation was similar in both groups. The average age of the livers at the time of death was 16.7 months in group I and 39.1 months in group II. Four of the livers in group II survived for more than 4 years (48.1 to 52.4 months). Early deaths (less than 1 year) after transplantation were most commonly caused by biliary obstruction and cholangitis in both groups. Late deaths (more than 1 year) after grafting were mainly from heart failure or tumors. None of the animals died of liver failure or liver disease. Weight gain in the rats, total serum protein levels, and alanine transaminase levels after transplantation did not differ significantly between the two groups. There was a trend for the histological features of aging of the liver-fibrosis, bile duct proliferation, and pigment deposition-to become more prevalent as the livers became very old (mean age, 46 months). Nevertheless, typical aging changes, as individual findings, were absent in nearly half of the oldest organs. The alterations in morphology had no apparent effect on the ability of the livers to sustain the lives of the recipients. The liver of the BN/BiRij rat was capable of surviving far beyond the maximum life span of BN/BiRij rats, and rats in general. It did not become diseased in the process.
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PMID:Assessment of the longevity of the liver using a rat transplant model. 902 57

An autopsy case of ancient sarcoidosis with severe fibrosis in the liver and heart was reported. The patient was a 61-year-old female when she died, 12 years after the onset of sarcoidosis. Cervical lymph node biopsy at 49 years demonstrated non-necrotizing sarcoid granuloma, and laboratory data were compatible with sarcoidosis. Liver and heart failure were observed clinically, and because of heart failure a pacemaker was implanted. She died of septic shock at 61 years. At autopsy, the liver demonstrated cirrhotic severe fibrosis, cholestasis, and acute cholangitis without mechanical bile duct obstruction. In the heart, severe fibrosis was observed, and infectious foci of candida infection were observed on the cardiac valves. Although both liver and heart did not show typical sarcoid granuloma, fibrosis was thought to be due to sarcoidosis because no other causes of liver and heart fibrosis were identified clinically or pathologically. There were systemic foci of candida infection, and she died of sepsis due to candida infection. It was speculated that immunological impairment induced candida infection. This case seems to be a rare and important case of ancient sarcoidosis.
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PMID:An autopsy case of ancient sarcoidosis associated with severe fibrosis in the liver and heart. 970 Oct 16


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