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

Red blood cells (RBC) normally lose their nuclei before appearing in peripheral blood. After having undergone differentiation in bone marrow, blood cells must cross the blood-marrow barrier to enter the bloodstream. Erythroblasts, or nucleated red blood cells (NRBC), do not distort easily, so they cannot escape this barrier. Therefore, with the exception of the neonatal period, the presence of NRBCs in peripheral blood is always a pathologic finding. NRBCs may be found in the course of severe diseases and are associated with poor prognosis and higher mortality. The underlying pathophysiology of NRBCs in peripheral blood is not fully understood. It is hypothesized that their appearance could be provoked by either increased erythropoiesis or bone marrow micro-architectural damage mostly caused by inflammation and/or decreased tissue oxygenation. In addition, it is known that the mortality is higher in NRBC-positive patients as compared with NRBC-negative patients. Hereby we present a patient admitted to the hospital with the symptoms of cardiac failure and decompensated liver cirrhosis. The patient was already known to have liver cirrhosis of ethylic etiology, cardiac decompensation caused by hypertensive heart disease with permanent atrial fibrillation, chronic obstructive pulmonary disease, diabetes mellitus type 2, and cholelithiasis. During hospital stay, the patient developed acute pancreatitis and, soon after that, a stroke with left hemiparesis followed by cardiopulmonary arrest. Then he was transferred to the intensive care unit. Despite appropriate therapy, intensive care treatment and cardiopulmonary support, the patient's general state worsened, he developed multiple organ failure and died on day 10 of intensive care unit stay. Three days earlier, NRBCs were detected in peripheral blood and their concentration increased during the next two days before death. NRBCs are known to appear 1-3 weeks before death, but their appearance does not seem to be related to one particular cause of death. Still, detection of NRBCs is an independent risk of poor outcome, where the mortality increases with the increasing NRBC concentration. Detection of NRBCs in blood is a relatively early phenomenon prior to death, so screening for NRBCs may aid in the early identification of patients at high risk, and in making duly decision for NRBC-positive patients to obtain ongoing intensive care treatment.
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PMID:[Erythroblasts in the peripheral blood of adult patient as an adverse prognostic sign--a case report]. 2312 50

A 72-year-old male with heart failure was admitted to our hospital. Treatment with dabigatran (220 mg per day) was initiated because of atrial fibrillation. On the third day, the patient developed left-sided hemiparesis and dysarthria at 4.5 hr after the last dose of dabigatran. The activated partial thromboplastin time (APTT) was 39.1 sec, and the NIHSS (NIH Stroke Scale) was 11. An intravenous infusion of rt-PA was administered at 160 min after the onset of hemiparesis (at 7 hr after the last dose of dabigatran). Although diffusion weighted MRI revealed a minor infarction in the right lower frontal gyrus, the patient was discharged without hemorrhage (NIHSS 0), and the score on the modified Rankin scale assessed 3 months later was 0. The outcomes have been good in 8 out of 9 reported cases, including the present case; the remaining severe case developed complicating intracranial hemorrhage. Thrombolytic therapy could be safe, if it is performed more than 7 hr after the last dose of dabigatran and the APTT is less than 40 sec.
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PMID:[Successful thrombolysis without hemorrhage in a patient with cardioembolic stroke under dabigatran treatment-a case report and review of literature]. 2470 41

A 36-year-old woman with a 4 year history of lower legs edema, hypermenorrhea and melena without medical treatment was admitted to our hospital. At 18 days before admission, anasarca and general fatigue appeared and she was admitted to another hospital. Her hemoglobin concentration was 1.4 g/dl and chest X-ray showed cardiomegaly. Heart failure with severe chronic anemia was diagnosed, and blood transfusion was performed. Her hemoglobin concentration increased to 10 g/dl and the anasarca disappeared. The day after discharge, she was referred to our hospital with generalized convulsion. We diagnosed posterior reversible encephalopathy syndrome (PRES) from the typical MRI imaging. We started treatment and her consciousness recovered steadily. At a week after admission, left hemiparesis appeared. Her brain imaging revealed multiple intracranial hemorrhages. In addition, her visual disturbance revealed vitamin A and vitamin K deficiency. PRES sometimes occur secondary to blood transfusion, but secondary brain hemorrhage is rare. Her fat-soluble vitamin deficiency, which resulted from a peculiar eating habit, may have contributed to the brain hemorrhage.
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PMID:[Case of post-transfusion posterior reversible encephalopathy syndrome with cerebral hemorrhage that may be associated with fat-soluble vitamin deficiency]. 2499 Aug 39

Pulmonary epithelioid hemangioendothelioma is an uncommon lung malignancy of endothelial origin. Besides demonstrating unpredictable presentation features and prognosis, the paucity of established treatment guidelines remains a challenge in managing these patients. We present two patients. The first patient presented with chronic productive cough over 1-year duration. He was initially diagnosed and showed partial response to treatment for cardiac failure. A persistent right upper zone consolidation on chest radiograph prompted further investigations which revealed the diagnosis of pulmonary epithelioid hemangioendothelioma. The second patient presented with right-sided hemiparesis for 1-month duration. Initial computer tomography scan of the brain showed findings of distant metastatic foci. Subsequent investigations revealed pulmonary epithelioid hemangioendothelioma as the primary lesion. Both patients succumbed without any treatment due to rapid progression of the disease. We believe that pulmonary epithelioid hemangioendothelioma is undoubtedly rarely reported in south-east Asia region. In these two case reports, the patients were diagnosed in west and east Malaysia, respectively, in the same year (2015). Both cases highlight the increasing prevalence of pulmonary epithelioid hemangioendothelioma. We postulate that this could possibly be secondary to the advancement in diagnostic capabilities and improved healthcare facilities available in this region. Late presentation of pulmonary epithelioid hemangioendothelioma generally results in grave prognosis. Further investigations are required to elucidate the nature of progression and therapeutic options for patients with pulmonary epithelioid hemangioendothelioma.
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PMID:Ambiguous presentations of pulmonary epithelioid hemangioendothelioma: Two case reports of a rare pulmonary malignancy. 2748 19

Henrik Ibsen (1828-1906) is a Norwegian playwright and poet who is known as the father of modern drama. Ibsen was in good health when he announced at his 70th birthday celebration that he intended to continue writing. His last play, When We Dead Awaken, was published in 1899. Why did Ibsen's dramatic writing come to an end? This chapter presents a medical account of Ibsen's health condition during the last 6 years of his life. It is based on a review of a document written by one of his doctors, Edvard Bull (1845-1925), letters, biographic information, and Ibsen's death certificate. The historical material suggests that he suffered from arteriosclerosis and cerebrovascular disease, and that he suffered several strokes, in 1900, 1901, and 1903. He suffered a paresis in his left foot, expressive aphasia, and a right hemiparesis, and he lost the ability to write. There is no evidence that Ibsen was hospitalised. He received medical treatment and care at his home and at a recreational spa. His health condition was unstable, and it is likely that he suffered from a series of smaller strokes in the last years of his life. Ibsen developed signs of heart failure, and he died peacefully from "paralysis cordis" at his home on May 23rd, 1906.
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PMID:Henrik Ibsen's Battle with Cerebrovascular Disease. 3033 61

A 64-year-old woman with recurrent mitral valve stenosis was hospitalized 30 years after open commissurotomy. Severe right cerebral embolism occurred at age 58, with left hemiparesis. She was debilitated with cardiac cachexia. Based on symptomatic valvular disease findings, surgery was considered, but deemed too high risk due to the combined insufficiencies. She refused this surgical operation and requested conservative therapy. Optimized medication and cardiac rehabilitation improved her general condition allowing transfer to another hospital. We explained the short life expectancy both to her and to her family. They decided to transfer to a hospice at a chronic care hospital and she was given best supportive care. Eventually, her urine output decreased and respiration deteriorated. She and her family refused resuscitation in the event of cardiopulmonary arrest, requesting only suffering reduction. Thus, continuous intravenous infusion of morphine was started. The optimized doses for pain alleviation were determined in consultation with palliative care specialists and maximized her consciousness level for the last four days. "Heart-failure hospice" is potentially a place to die for end-of-life patients, attended by their families and healthcare providers. They need prognostic information and options for end-stage. Our experience confirms results about palliative care from previous studies conducted overseas demonstrating the effectiveness of opioids relieving end-stage symptoms. <Learning objective: Perform an appropriate end-of-life assessment for patients with irreversible severe heart failure. Formulate appropriate plans for further evaluation and management, including referral and consultation to palliative care specialists when necessary. Develop an appropriate regional cooperation, with consideration given to the less common optional treatment for cardiac dysfunction, "heart-failure hospice.">.
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PMID:Cooperation between Heart Failure Center of Hiroshima University Hospital and a regional medical facility: Option for an end-of-life heart failure patient receiving palliative care. 3053 1

Stroke involving some areas of the cerebral hemisphere, such as insula, amygdala, and lateral hypothalamus, may cause changes in autonomic control of cardiac function. A 58-year-old woman presented to the emergency department for acute onset of left facial-brachial-crural hemiparesis and dysarthria. A brain CT scan showed subacute ischemic lesion with hemorrhagic infarction in right insular-rolandic cortex. Over the next few days ECG showed severe bradycardia with elongation of QTc, significative pauses (5 seconds), runs of nonsustained ventricular tachycardia and torsades de pointes. Drug induced and other several possible causes of elongation of QT and bradycardia such as hypokalemia, a history of heart failure, and structural heart disease were ruled out. The case confirms that insular cortex plays a major role in stroke-induced cardiovascular changes.
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PMID:Cardiac Arrhythmias and Acute Cerebrovascular Events: A Case of QT Prolongation and Torsades de Pointes Early After Right Insular Stroke. 3141 60

We report a case of lung adenocarcinoma metastasizing to intracranial meningioma as a first clinical manifestation. Surgeons should be aware of this rare lesion. A 70-year-old Chinese woman was admitted to our hospital with a complaint of progressive left hemiparesis, predominantly of the upper extremity, for 20 days. Computed tomography (CT) revealed a mass on the right side of the right occipital cerebral falx. The subsequent magnetic resonance imaging (MRI) showed an oval mass with equal intensity on T1 weighted imaging (WI) and heterogeneous equal intensity on T2 WI. Within the tumor, a low T1 signal lesion was moderately enhanced after enhanced scanning with a relative boundary. Neuroimaging indicated a meningioma and the patient underwent a total mass resection. Formalin-embedded sections demonstrated two histologically distinct tumors (meningioma and adenocarcinoma) simultaneously in the same lesion without an intermediate transitional zone. Meanwhile, immunohistochemical (IHC) staining showed two distinctly different immunophenotypes in these two tumors and indicated that the component of adenocarcinoma might be a metastasis from a primary lung cancer. Therefore, a subsequent pulmonary CT scan was performed and found a mass at the tip of the upper lobe of the right lung. Fine-needle aspiration biopsy demonstrated an adenocarcinoma. The primary lung adenocarcinoma shared similar histologic morphology with that of the intracranial metastatic site. The final diagnosis waslung adenocarcinoma metastasizing to intracranial benign meningioma. The patient died of heart failure 2 weeks after surgery.
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PMID:Tumor-to-tumor metastasis: lung adenocarcinoma metastasizing to intracranial benign meningioma as a first clinical manifestation, with literature review. 3193 6

The gold standard treatment for end-stage heart failure is heart transplantation; however, the rate of transplantation remains inadequate because of the paucity of organ donation. The left ventricular assist device (LVAD) has been used as a bridge therapy before transplantation. The LVAD is being used increasingly because it reduces mortality despite the accompanying morbidities. Therefore, the anesthetic management of LVAD-related morbidities is important and requires experience and knowledge. Herein, we describe a 60-year-old male patient with an LVAD with complaints of right hemiparesis, dysphasia, and facial paralysis. We aim to present the anesthetic management of a patient with intracranial hemorrhage who underwent LVAD exchange due to thrombosis.
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PMID:Anesthetic Management of Left Ventricular Assist Device Exchange in a Patient with Intracranial Hemorrhage. 3274 90


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