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

Geriatric patients are preferentially involved in ischemic bowel disease. The sudden occlusion of the large mesenteric arteries (a. mesenterica superior (more frequently) and inferior) is followed by intestinal gangrene and peritonitis with a poor prognosis and a high letality (greater than 90%). In chronic intestinal ischemia the leading clinical symptom is postprandial pain ('claudicatio intestinalis'). In some cases of acute mesenteric artery occlusion no embolus or thrombus will be found. In these cases the circulation in the arteriosclerotic vessels falls below a critical value due to cardiac insufficiency, shock, digitalis overdose and others. In less severe ischemia the mucosa is involved being most sensitive to O2 deprivation. It usually regenerates within a few days. This form is found more frequently in the colon than in other parts of the gut (about 40%): ischemic colitis. The therapy - if possible in acute, fulminant ischemia or if necessary in chronic intestinal ischemia - is surgical consisting in reconstructive procedures of the mesenteric circulation.
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PMID:[Ischemic bowel disease (author's transl)]. 1 31

An extremely rare case of hypereosinophilic syndrome is reported. The patient had congestive heart failure due to left ventricular obliteration by a giant thrombus in the apex. Arteriosclerosis obliterans resulted in serious lower extremity gangrene. Combination therapy with a corticosteroid and hydroxyurea caused a marked reduction in eosinophil count, and heart failure recovered in stages. Although the patient was discharged, he returned to our hospital 3 months later with acute myeloblastic leukemia and subsequently died of respiratory failure with pneumonia.
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PMID:Hypereosinophilic syndrome associated with obliterative left ventricular chamber and systemic obliterative arteriosclerosis. 177 33

An analysis of 4 cases of the thrombotic thrombocytopenia in children of 4 to 10 years of age is performed. The disease was characterized by fever, purpura, headache and abdominal pains, arterial hypertension, microangiopathic haemolytic anemia, thrombocytopenia, increase of blood urea and serum creatinine, micro-haematuria and proteinuria. The duration of the disease was from 4 days to 7 months. Anuria, gangrene of the ears, scrotum, penis and soft tissues of legs and feet were registered in a 5-year-old patient with a fulminant disease. The cause of death of other patients was heart failure with acute lung oedema, brain haemorrhages and haemorrhagic pancreonecrosis. The diagnosis of the thrombotic thrombocytopenia was confirmed by the finding in the autopsy material of thrombotic microangiopathy of small arteries, veins, arterioles, venules and capillaries in kidneys and other organs and tissues. Kidney damage in fulminant disease is complicated by segmentary cortical necrosis, in a more prolonged disease--by glomerulosclerosis or mesangio-capillary glomerulonephritis.
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PMID:[Thrombotic thrombocytopenic purpura in children]. 180 69

Gangrene of the left upper limb was found to complicate severe mitral stenosis presenting with heart failure in a sixty-eight-year-old woman with a documented left atrial thrombus. Arterial obstruction as the cause of gangrene was excluded by Doppler-assisted assessment of the peripheral pulses. Venous gangrene can complicate severe mitral stenosis and must be distinguished from arterial embolization, in which urgent surgical treatment is imperative.
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PMID:Venous gangrene (phlegmasia caerulea dolens) complicating heart failure from severe mitral stenosis--a case history. 189 41

Cardiodynamic studies using a non-invasive computerised thoracic electrical bioimpedance (TEB) equipment were performed in 35 patients presenting with acute lower limb ischaemia of presumed embolic origin, and in 36 age-matched control patients without emboli. Patients who presented with imminent gangrene were promptly operated upon, whereas those who had less severe ischaemia were treated initially with heparin only. In the former group, cardiac output and myocardial contractility were very low on admission, while systemic vascular resistance was high. Cardiac output was further decreased when measured immediately after revascularisation, whereas it had become normal 2 days later. In patients with less severe acute ischaemia, cardiac output and myocardial contractility values on admission were similar to those of control patients, and no changes were observed after 2 days of conservative treatment. Overall, cardiac output on admission was significantly related to the simultaneously observed severity of the limb ischaemia. A low cardiac output (less than 1.7 l/min m2) on admission was found to predict severe cardiac complications (60% mortality within 10 days), whereas clinical assessment of cardiac failure on admission was poorly related to outcome. We conclude that patients with acute lower limb ischaemia of presumed embolic origin often have unrecognised poor cardiac function, which is related to the severity of the limb ischaemia and to outcome. By routine non-invasive TEB cardiodynamic measurements, high risk patients can rapidly be identified and proper treatment regimes be instituted in each individual patient.
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PMID:Cardiac output in patients with acute lower limb ischaemia of presumed embolic origin--a predictor of severity and outcome? 239 78

Medical calcification of arteries is common in chronic renal failure. We report on a patient with extensive calcification of the arterial media who developed symmetrical acral gangrene and severe cardiac failure shortly after cadaveric renal transplantation. At necropsy, the medial calcification was found to be accompanied by extensive intimal proliferation and multiple antemortem fractures, some healing by callus formation. Such medial calcification, which is similar to Monckeberg's sclerosis, affected all systemic arteries except the aorta, pulmonary artery and transplanted renal artery. Six years before this terminal illness he had undergone total parathyroidectomy for osteitis fibrosa associated with ruptured tendons. We review previous reports of patients with the syndrome of acral gangrene in azotaemic renal failure and discuss the histopathological features and pathogenesis in relation to the unusual features of our patient.
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PMID:Symmetric gangrene of the extremities in late renal failure: a case report and review of the literature. 306 Aug 94

Thirty-four neonates (weights 0.97-4.47 kg) were operated on for coarctation of the aorta. They included five premature infants with birth weight less than or equal to 2.1 kg. All 34 were symptomatic, 31 severely so. Coarctation was "simple" in 12 cases and "complex" in 22; 12 with ventricular septal defect and 10 with more complex malformations. The mean age at operation was 11 days. Subclavian flap aortoplasty was used in 27 cases, a lusoric artery in two, and combined end-to-end anastomosis and flap repair in five. The main pulmonary artery was banded in 13 of the 22 complex coarctation syndromes. Absorbable suture was used in the last 22 cases. There was one early postoperative death. Serious ischaemic complications (bowel or limb gangrene) arose in four patients who were in severe heart failure preoperatively. During follow-up averaging 1.9 years there were two recurrences of coarctation. Resection with end-to-end anastomosis combined with subclavian flap aortoplasty when there is bulging ductal tissue or long, narrow isthmus and use of absorbable vascular suture may further lower the incidence of recurrent coarctation.
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PMID:Neonatal surgery for coarctation of the aorta. The Gothenburg experience. 312 1

CSAD provides a challenge for the vascular surgeon. Patients are older, sicker, and at greater risk than are patients with unisegmental disease. Similarly, symptoms are more severe and limb loss is more frequent. A multitude of different reconstructive techniques are available, but their injudicious or untimely use can not only fail to improve the patient but can also cause limb loss or death. Their use must be predicated by a differentiation of which arterial segments are hemodynamically involved, yet this determination may not be possible even after extensive noninvasive and invasive investigation. To optimize the approach to these patients, the following principles should be employed. First, incapacitating claudication is a valid indication for a suprainguinal inflow procedure in a good-risk patient. However, indications for surgery should usually be limited to limb salvage, especially if an infrainguinal procedure is contemplated. Medical conditions such as heart failure and diabetes should be improved before arteriography. The latter should delineate the entire infrarenal arterial system, with special attention to the iliac, deep femoral, and pedal arteries. Oblique views may be of critical importance. Noninvasive hemodynamic tests should be used to confirm the need for arterial reconstruction and help delineate areas of functional stenosis. Direct pull-through pressure measurements may be required for ultimate confirmation. If proximal disease is thus defined, as proximal inflow operation should usually be sufficient unless there is extensive gangrene of the foot, in which case synchronous distal grafts may be required. If the proximal graft alone is performed, the patient must be followed closely since approximately 10% of patients may need subsequent distal reconstructions. The role of the "runoff" segments such as the deep femoral artery, popliteal trifurcation, and pedal arteries may be critical. Every effort should be made to ensure flow through these vessels. Profundoplasty alone is seldom indicated but is often a valuable adjunct to other reconstructive procedures. Lumbar sympathectomy is seldom required. PTA is becoming a valuable adjunct to treatment of CSAD, and intraoperative dilatation also has potential attributes. If such an approach is followed, lasting limb salvage with minimal morbidity should be achieved in most patients with CSAD.
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PMID:Combined segment arterial disease. 315 27

Between January 1986 October 1987, extended profundaplasty was performed on 11 severely ischemic limbs of eight patients with extended arteriosclerotic occlusions, associated with surgery for improvement in inflow. The subjects were all males, and ages ranged from 62 to 84 years (mean: 72.8 years). Symptoms were disabling claudication in one limb (1 case), rest pain in 5 (4 cases), and gangrene of the foot or ulcer of the toes in 5 (3 cases). Preoperative ankle pressure index (API) was 0 in 7 limbs (5 cases), and between 0.11 and 0.27 in the remaining 4 limbs (3 cases). Thrombectomy was performed in two cases, axillo-bifemoral bypass in 5, femoro-femoral bypass in one, and aorto-bifemoral bypass in one, as surgery for improvement in inflow. Although postoperative API remained 0 in 4 limbs, it increased between 0.36 and 0.56 in the remaining limbs. One subject died of heart failure on the 22nd postoperative day, and two limbs required below-knee amputation. Limb salvage rate was 81.8%. Extended profundaplasty seems to be a worthwhile choice of treatment as a limb salvage operation for severely ischemic limbs due to extended arteriosclerotic occlusions involving not only aorto-iliac but also femoro-popliteal or crural segment.
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PMID:[A clinical study of extended profundaplasty for severely ischemic limbs]. 323 Dec 10

Colonic pseudo-obstruction (Ogilvie's syndrome) may occur in surgical patients, particularly those who have had orthopedic or blunt trauma, have uremia or diabetes, have complex metabolic or cardiac failure, have metastatic cancer involving the lymph nodes and neural tissue, or are addicted to narcotics. Although a single true cause has not been identified by fulfilling Koch's postulates, the clinical pattern has been recognized in a variety of surgical patients, and this pattern must be distinguished from true obstruction of the colon. Tumor or internal hernia may constitute an obstruction, but the important differential diagnosis of cecal volvulus must be excluded. Ischemic colitis may be confused with Ogilvie's syndrome or may follow it. Gangrene, infarction, and perforation may ensue as colon diameter increases and particularly if cecal distention reaches above 14 cm. This arbitrary number for cecal dilatation should not be awaited before treatment is instituted if signs of devitalization of the gut or peritoneal signs have developed in the patient. Treatment has changed recently with the widespread application of colonoscopy. Endoscopy is helpful in relieving distention but may also be dangerous in the patient with a massively distended colon, particularly at the level of the thin-walled cecum. Colonoscopy also appears to be associated with a high rate of treatment failure and recurrence. Surgical decompression may take the form of cecostomy or may require exteriorization or resection of the colon if infarction has occurred. A series of 12 patients has been presented. The patients were all referred to a single surgeon in a university medical center over a 4 1/2 year period with clinical patterns not suggestive of a common cause but a similar clinical evolution of Ogilvie's syndrome. The prognosis for such patients in whom the complication is recognized early and in whom decompression is performed endoscopically or surgically is encouraging. If recognition is late and particularly if perforation and gangrene result, mortality is nearly 50 percent.
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PMID:Colonic pseudo-obstruction in surgical patients. 397 Mar 26


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