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)

In this case report, the patient had been delivered by Caesarean section and weighed only 4 pounds at birth. The mother was O negative, the father A positive, and the infant A positive. Initial red cell count was 2.85 million/cu mm; white cell count, 19,200/cu mm; and hemoglobin 70% of normal. At 3 months of age hemoglobin was 10% of normal. Bone marrow examination revealed marked erythroid hyperplasia. A diagnosis of Blackfan-Diamond syndrome was made. He received blood transfusions every 2 or 3 weeks for the first 4 years of his life. During his lifetime he received 433 units of packed cells for the treatment of congenital hypoplastic anemia. Vitamin-B12, folic acid, and iron were given without benefit. At 8 years of age a spelectomy was done. 20 months after surgery he recovered from pneumonococcal meningitis without sequelae. Progressive signs of hemochromatosis developed and finally progressive signs of heart failure with edema. At 24 years of age severe epigastric pain developed. An open liver biopsy disclosed multiple liver nodules which proved to be hepatoma. Severe ascites followed the surgery. Pulmonary metastases of the liver tumor developed and heart failure. He died at age 25. This patient had received no androgen. He was consistently hepatitis antigen negative. He was prepubertal at the age of 25 and had almost no endogenous androgens. Alpha-fetoglobin was present. This test may be useful as a screening test for hepatoma.
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PMID:Hepatocellular carcinoma, transfusion-induced hemochromatosis and congenital hypoplastic anemia (Blackfan-Diamond syndrome). 18 Aug 2

Overt liver disease caused by left-sided heart failure is seldom recognized unless there is obvious hypotension. We now report 4 patients whose initial diagnosis was hepatitis but who were later shown to have central hepatic necrosis associated with left ventricular failure. Signs of right-sided heart failure were absent. Hepatitis was initially suspected in 3 patients because of striking transaminase elevations and in 1 patient because of jaundice and symptoms compatible with hepatitis. Liver biopsies performed on all patients revealed central hepatic necrosis without evidence of acute or chronic hepatitis. Left ventricular failure was documented in all 4 patients. One patient had coronary artery disease, and the other three patients had valvular heart disease. Liver function tests became normal or improved in all cases as the underlying heart disease was treated. We believe that liver dysfunction secondary to left ventricular failure is not uncommon and can be seen in the absence of right-sided heart failure or hypotension.
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PMID:Left-sided heart failure presenting as hepatitis. 63 89

Multiple organ failure (MOF) appeared during the course of nine cases with fulminant hepatitis, and it was compared with that of seven cirrhotic patients with post-operative hepatic failure. The number of organs failed was 4.9 and 3.6 on average in fulminant hepatitis and post-operative cirrhosis, respectively. All the patients died in less than nine days following the occurrence of MOF. Gastrointestinal bleeding was more frequently observed in fulminant hepatitis cases than in cirrhotic patients. In post-operative cirrhotics, hepatic failure occurred later and the elevation of serum total bilirubin was mild and slow. Renal failure and/or gastrointestinal bleeding was observed prior to death in fulminant hepatitis cases, and cardiac failure and hepatic failure in post-operative cirrhotics. These organ failures resulted in death, although extensive and multimodal treatments were carried out in both groups of patients.
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PMID:Multiple organ failure in patients with fulminant hepatitis and in post-operative patients with liver cirrhosis. 151 19

We present a patient with left ventricular thrombus diagnosed by two-dimensional echocardiography. Thrombosis was due to acquired transient protein C deficiency which was caused by impaired liver function due to hepatitis, sepsis and heart failure. With proper treatment the thrombus disappeared on the fourth day. Eighteen weeks later the protein C level returned to normal. We recommend echocardiographic evaluation and follow-up of suspected cases for intracardiac thrombus. The measurement of protein C level in such cases is proposed. This is the first case with left-sided cardiac thrombus associated with protein C deficiency in the medical literature.
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PMID:Left ventricular thrombosis due to acquired protein C deficiency diagnosed by two-dimensional echocardiography. 159 53

Ischemic hepatitis is not an uncommon complication of reversible severe hypotension or cardiac failure. The prognosis usually is determined by the cause of the initial hypotension or cardiac failure, rather than the subsequent hepatic dysfunction. We report a retrospective analysis of nine patients with ischemic hepatitis in which previously unreported clinical and biochemical abnormalities are noted. The clinical and biochemical course of the patients were reviewed until recovery or death from ischemic hepatitis. All the patients had a rapid striking elevation of aspartate aminotransferase, and lactic dehydrogenase, with an equally rapid resolution of these parameters. Abnormal serum glucose levels occurred in six patients (none of whom had a prior carbohydrate intolerance). Insulin therapy was given to three patients for a limited period. Renal impairment was manifest in all nine patients, and it resolved spontaneously within 10 days. Altered mental status was detected in six patients; the changes reverted to normal within 7 days of their onset. A preexisting anemia (hemoglobin less than 11.0 g/dl) was noted on admission in four patients, and it did not appear to potentiate the manifestations of the hepatic ischemia. We conclude that ischemic hepatitis should be anticipated in all patients with a recent history of systemic hypotension. It should be considered in the differential diagnosis of patients with unexplained hepatitis; the early massive rise in lactic dehydrogenase, the rapid fall in transaminases, and the early mild/moderate renal failure strongly suggest ischemic hepatitis. Patients with ischemic hepatitis can manifest reversible renal failure, mental confusion, and hyperglycemia which may require insulin for its control.
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PMID:Ischemic hepatitis: widening horizons. 848 Jul 56

M-mode and two-dimensional echocardiography (2DE) allows the accurate assessment of primary tissue degeneration of bioprosthetic valves. The Doppler method permits quantitative evaluation of the pressure gradient across the prosthetic valve or detection of regurgitant flow. The present study summarized our clinical experiences of serial cases of mitral valve replacement (MVR) with bioprostheses at the mitral position, and clarified the clinical usefulness and limitations of Doppler and 2DE examinations for the early detection of primary valve dysfunction. Consecutive 65 patients undergoing single mitral valve replacement from April, 1977 to November, 1979 were listed for the study. A survey of the present clinical status was carried out from July, 1988 to July, 1990 (a follow-up period ranged from 84 to 127 months) for all patients, and the information was available from 53 patients (47 adults and six infants). Twenty-four survived patients without re-MVR were examined by Doppler and 2DE. Among the 53 patients, 34 were alive and 19 dead, and the total survival rate was 64.2%. The reasons for death in 19 patients were perioperative death in seven (including four infants with severe calcification of bioprostheses), chronic heart failure in three, cerebral infarction in two, post blood transfusion hepatitis in two, endocarditis in one, and non-cardiac death such as cancers in four. During the long-term observation of 47 adult patients, 14 cases (30%) had re-MVR (one for a stenotic lesion with massive calcification, and 13 for torn leaflets). Thickening and/or torn leaflets were noted in 13 (54%) of the 24 survived patients without re-MVR.2+ suggests that bioprosthetic valve replacement at the mitral position may not be recommended.
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PMID:[Doppler hemodynamic evaluation of bioprosthetic valve failure in the mitral position]. 188 60

The study was designed to determine the prevalence of alcoholism/problem drinking among emergency medical admissions. Of 203 emergency admissions to two medical wards, 18% were found to be problem drinkers, using the brief Michigan alcoholic screening test (MAST) questionnaire. Problem drinking was found in 31% of males and 5% of females. Most drinking was done with friends (77%) and at the "rum shop" (62%). Fifty-one per cent of problem drinkers started between the ages of sixteen and twenty years. Seventy per cent of all problem drinkers had a first degree family relative who drank compared to 28% of non-drinkers. A high prevalence of alcoholism (48%) was found among smokers. Housestaff detected just over half of male (56%) and female (60%) alcoholics who were MAST-positive. Medical diagnoses among MAST-positive patients were gastrointestinal (cirrhosis, pancreatitis and hepatitis) in 32%, neurological (delirium tremens, seizures and subdural hematoma) in 27% and cardiovascular (cardiomyopathy, heart failure and dysrhythmias) in 16%. The detected level of problem drinking is likely to cause significant morbidity, and allows an important opportunity for intervention. The use of questionnaire methods to screen for alcoholism needs further evaluation in the region.
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PMID:Questionnaire detection of problem drinkers among acute medical admissions. 189 23

The increase of serum ASTm activity might reflect the severity of damage at the subcellular level of the myocardium. 50 patients with acute myocardial infarction (AMI) were observed. The mean peak ASTm activity was 34.34 +/- 34.60 IU/L and 48 patients (96%) greater than or equal to 9 IU/L (two times median value of normal subject). The peak time (36 h) came later and the duration (120 h) was longer than that of CK-MB. ASTm/ASTt ratio in groups of AMI, non-AMI heart failure and acute ictero-hepatitis was 0.25 +/- 0.10, 0.02 +/- 0.05 and 0.05 +/- 0.02 respectively. The former was significantly greater than other two groups (P less than 0.01). The activity of ASTm in AMI cases with heart function at I, II and III + IV (Killip classification) was 21.8, 40.2 and 76.2 IU/L respectively (F = 8.407 P less than 0.01) and it was 84.9 and 24.7 IU/L in the death and surviving groups (P less than 0.01). The result showed that the estimation of serum ASTm level was helpful to the establishment of diagnosis in the patients with AMI who were sent delayed to the hospital. It held special significance in evaluating the severity of myocardial damage, heart function and in predicting the prognosis of AMI.
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PMID:[Serum mitochondrial aspartate aminotransferase (ASTm) in acute myocardial infarction]. 191 59

In order to assess the prevalence, causes, and severity of chronic liver dysfunction (LD) in heart transplant patients, 80 transplanted patients followed for 60 months (median; range, 1.5-98 months) were reviewed. Sustained liver dysfunction was found in 50 patients, occurring during the first year after heart transplantation in 42 (84%) of them. Most patients were asymptomatic (80%). Causes for the liver dysfunction included non-A, non-B hepatitis in 16 cases (32%), viral B hepatitis in 13 (26%), delta hepatitis in one (2%), drug-induced hepatitis in six (12%), and cardiac failure in seven (14%). Anti-HCV antibodies were found in 56.2% of patients with non-A, non-B hepatitis and in 22% of patients with HBV hepatitis. It was found neither in patients with drug-induced hepatitis cardiac failure nor in patients with normal liver tests. This study outlines a high prevalence of LD (62.5%) in heart transplant patients, the high frequency of viral-related chronic LD (usually of moderate severity), and high incidence of HCV and HBV hepatitis.
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PMID:Chronic liver dysfunction in heart transplant recipients, with special reference to viral B, C, and non-A, non-B, non-C hepatitis. A retrospective study in 80 patients with follow-up of 60 months. 192 44

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


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