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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 review the pathophysiological mechanisms of general clinical symptoms during the treatment of severe burn injuries (hypovolemia, katabolism, anemia, coagulation disorders, hyperbilirubinemia, hypoxia, cardiac insufficiency and bone disorders) are analysed with special reference to specific therapeutical measures.
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PMID:[General symptoms in severe burn injuries (author's transl)]. 79 73

To distinguish high-risk patients prior to implantation of a Jarvik-7 artificial heart as a bridge to transplantation, our 37 attempts were reviewed retrospectively. Arbitrary scores of 1 to 4 were given for nine preoperative factors on the basis of results obtained by uni- and multivariate analyses between successful cases and failed attempts; transplant rejection (scored 4: S4) or postoperative heart failure (S3) as the indication, recipient height less than 175 cm (S3), body surface area less than 1.8 m2 (S3), hyperbilirubinemia greater than 24 microM/l (S2), preoperative renal failure requiring dialysis (S2), weight less than 60 kg (S2), and age greater than 40 years (S1). All except one of the 16 patients with successful bridge had a total score of less than 4, with an average score of 1.3 in contrast to 6.6 in the 21 failed cases (p less than 0.001). Among the 17 patients who scored less than 4, 15 received transplants (specificity 90%), while only one qualified for transplantation among 20 patients who scored 4 or more (sensitivity 94%). The two unpredicted failures resulted from mediastinitis and pulmonary infarction, both attributable to postoperative management. Multiple preoperative factors in combination could have successfully predicted the outcome of mechanical support in our experience. These results underscore the importance of patient selection to achieve successful and effective use of the Jarvik-7 as a bridge to heart transplantation.
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PMID:Preoperative risk analysis in patients receiving Jarvik-7 artificial heart as a bridge to transplantation. 175 42

Application of isolated ultrafiltration (IUF) of blood in 70 out of 100 patients with refractory heart failure (HF) made it possible, acting on some mechanisms of water excretion disorders, to attain the compensation for the HF signs. At the same time the correction of the manifestations of secondary hyperaldosteronism, hypoproteinemia, hyperbilirubinemia, and azotemia was attained only thanks to the presence of the functional reserves of the liver and kidneys. In 35 patients with cachectic HF, IUF failure was determined by marked cardial liver cirrhosis together with depletion of the functional reserves of the cardiovascular system. The lack of sufficient diuresis, hyponatremia, hypoproteinemia, and hyperbilirubinemia may be unfavourable prognostic signs despite the reduction of HF intensity consequent on IUF.
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PMID:[The efficacy of isolated ultrafiltration of the blood in patients with refractory heart failure]. 276 1

Two adolescent patients referred for evaluation of severe "hepatitis" were found to have clinically unsuspected cardiac failure. Clinical profiles were characterized by anorexia, malaise, right upper quadrant pain, mild jaundice, initially predominantly indirect hyperbilirubinemia, profound elevations of transaminases, and prolonged prothrombin time. Left ventricular failure and low cardiac output were documented by clinical examination, echocardiography, and measurements of pulmonary capillary wedge pressure and cardiac index. Acute and chronic intrinsic liver disease was ruled out by appropriate tests. At autopsy, pathologic lesions of centrilobular necrosis characteristic of hepatic hypoxia were noted, and there was evidence of marked myocardial degeneration. These two cases emphasize the need for careful cardiac examination when evaluating acute hepatitis.
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PMID:Severe cardiomyopathy simulating hepatitis in adolescence. 369 46

Contrast echocardiography was used to detect atrial right-to-left shunts in 20 term infants; there were 10 cyanosed infants who had severe respiratory distress and signs of cardiac failure but no apparent congenital heart disease and 10 noncyanosed infants with no respiratory distress and no signs of cardiac failure who underwent exchange transfusion for hyperbilirubinemia. All of the venous contrast echocardiograms in the cyanosed infants showed an atrial right-to-left shunt with a dense contrast effect in the left atrium and aorta but little in the right ventricle. A sparse effect in the left atrium and a dense one in the right ventricle were recorded in infants with resolving respiratory distress and in three infants from the control group. The other seven infants in the control group showed no right-to-left shunt. Conventional M-mode echocardiograms showed no evidence of congenital heart disease in any of the 20 infants. This contrast echocardiographic technique was useful for demonstrating an atrial right-to-left shunt in cyanosed term infants with neonatal respiratory problems and signs of congestive failure but no apparent congenital heart disease.
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PMID:Atrial right-to-left shunt in infants with respiratory and cardiac distress but without congenital heart disease. Demonstration by contrast echocardiography. 706 22

A 64-year-old man developed severe hyperbilirubinemia of predominantly conjugated fraction in 1978, eight years after a myocardial infarction and development of congestive heart failure. In 1975, he was admitted elsewhere for symptoms suggestive of chronic hepatitis, but liver biopsy revealed replacement of hepatocytes by red blood cells which was interpreted as a result of left-sided cardiac failure. In 1978, liver biopsy showed congestive liver disease with cardiac sclerosis. Despite initial improvement, his condition deteriorated, he became encephalopathic, and died in a coma. This case is reported to illustrate that chronic congestive heart failure can present with severe jaundice and terminate in hepatic coma.
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PMID:Severe hyperbilirubinemia and coma in chronic congestive heart failure. 707 14

Hepatobiliary dysfunctions (TPN-HBD) occur during parenteral nutrition. In older children these are usually reversible whereas in newborns and infants these hepatobiliary abnormalities play a significant role in the morbidity. Cholestasis is a commonly occurring TPN-HBD. It correlates directly with the decreasing gestational age, low birth weight and increasing duration of TPN therapy. The pathogenesis of cholestasis of TPN is multifactorial and predisposed by necrotising enterocolitis, sepsis, cardiac failure, shock, and hypotension. Diagnosis is made with exclusion of other causes of direct hyperbilirubinemia. Most TPN-HBD appear within 4 weeks of starting of TPN but severe complications manifest usually after the 16th week. Histologically there is intralobular cholestasis. In few cases there may be severe portal fibrosis followed by development of micronodular biliary cirrhosis. Enteral starvation, defective bile acid carriers, hypercaloric TPN are the major factors responsible for TPN-HBD, including cholestasis. Biliary complications of TPN-HBD are acalculous, cholecystitis, and cholelithiasis. Bile stasis is a major pathological factor for these. If the calories are provided only by glucose or glucose-containing electrolyte solutions it may lead to cholestasis and other TPN-HBD. Even small oral alimentation (continuous or bolus) during TPN, prevent TPN-HBD. Choleretic agents have been useful in the prevention and management of cholestasis and other parenteral nutrition induced hepatobiliary abnormalities.
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PMID:Hepatobiliary abnormalities and parenteral nutrition. 1102 27

This study was a retrospective investigation about the indication and efficacy of artifical liver support for liver transplant recipients. Apheresis was performed in 16 of 41 patients subjected to living related liver transplantation (LRLTx) as articial liver support, including plasmapheresis (PP) in 13 cases, continuous hemodiafiltration (CHDF) in 7 cases, and plasma adsorption (PA) in 2 cases. One patient with cryptogenic liver cirrhosis was subjected to PP before the LRLTx, and the result was satisfactory. On the contrary, the results of PP and CHDF for graft, respiratory, or cardiac failure were not acceptable. Only 1 patient survived despite multiple organ failure. Both PP and PA for patients with hyperbilirubinemia were effective and improved their critical conditions. We conclude that apheresis for liver transplant patients is effective to treat hyperbilirubinemia, but it is not indicated for respiratory and cardiac failure nor for hepatic failure.
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PMID:Experience with artificial liver support in 16 living related liver transplant recipients. 1125 16

Disruption of the pancreatic anastomosis with resultant sepsis is the cause of nearly 50% of deaths following pancreaticoduodenectomy (PD). Traditionally, the pancreatic remnant is anastomosed to the jejunum. Pancreaticogastrostomy (PG) was introduced as an alternative by Waugh and Clagett in 1946 and by Park, Mackie, and Rhoads in 1967. The purpose of this retrospective review was to assess the safety of PG at a single institution. Between 1986 and 1998 a total of 102 patients underwent PG following PD. The indications for PD were periampullary carcinoma (n = 89), pancreatitis (n = 7), and miscellaneous (n = 6). Altogether, 80 patients underwent the traditional Whipple procedure and 22 the pylorus-preserving Whipple (PPW) procedure. The PG was performed by a single-layer invagination technique to the posterior gastric wall using interrupted silk sutures. Leaks from the pancreatic anastomosis were detected by measuring amylase in fluid obtained from surgically placed drains. Operative mortality was 3.9% (4/102). The cause of death was uncontrolled upper gastrointestinal hemorrhage, sepsis, pulmonary embolus, and cardiac failure secondary to myocardial infarction. The mean operating time was 6.8 hours. Blood transfusion was given in 43 patients (42%), and the mean amount of the transfusion was 2.6 units. Nonfatal complications occurred in 35 patients (34%), and included leaks from the pancreatic anastomosis in 9 (8.8%), leaks from the biliary-enteric anastomosis in 4 (3.9%), and gastric paresis 7 (6.9%). Other complications included abscess, wound infection, colitis, delirium tremens, and hyperbilirubinemia. Discharge occurred 6 to 47 days (median 12 days) postoperatively and was prolonged in patients suffering from a complication. PD is associated with significant morbidity. PG is a safe alternative to pancreaticojejunostomy for managing the pancreatic remnant.
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PMID:Pancreaticogastrostomy following pancreaticoduodenectomy: review of 102 consecutive cases. 1136 81

A phase II study was conducted to evaluate the safety and efficacy of fludarabine, cytarabine (ara-C), cyclophosphamide, cisplatin and GM-CSF (FACPGM) treatment in patients with Richter's syndrome (RS), refractory prolymphocytic leukemia (PLL) or refractory non-Hodgkin's lymphoma (NHL). Twenty-two patients with RS, refractory PLL, or refractory NHL were entered into this trial between March 1997 and February 2001. Median age was 62 years (42-74); 77% were over 60 years of age. Histologic diagnosis was large cell NHL transformation in 15 patients with CLL, immunoblastic transformation of CLL in one, refractory PLL in three, and refractory NHL in three patients. Treatment consisted of fludarabine 30mg/m2 (days 1-3), ara-C 0.5g/m2 (days 3-4), cyclophosphamide 250 mg/m2 (days 2-4), cisplatin 15 mg/m2 IV CI (days 1-4) with GM-CSF 250 microg/m2 from day 5 to recovery of neutrophils and antibiotic prophylaxis. Patients with response were to receive a maximum of six cycles of therapy. Eighteen patients were evaluable for response; one patient achieved a complete remission (5%), 12 stable disease/no response (67%) and five patients had progressive disease (28%). The median survival was 2.2 months (range, 1-19); the median failure-free survival was 1.5 months (range, 0.5-18.6). Grade III/IV toxicities were as follows: anemia in 62% of cycles; leucopoenia in 66%; granulocytopenia in 90%; thrombocytopenia in 83%; hyperbilirubinemia in 14%; hyperuricemia in 17%; hyponatremia in 17%; hypokalemia in 14%; hypophosphatemia in 10%; hypoalbulinemia in 14%; hypocalcemia in 7%; and hypercalcemia in 3%. One (3%) patient developed cardiac failure. Forty-one percent of the cycles were complicated with fever, 34% with non-neutropenic fever, and 55% cycles with infections (fungal 31%; bacterial 57%; HSV 6%; VZV 6%). FACPGM had very limited activity and significant toxicity in a cohort of patients with heavily pretreated refractory lymphoproliferative disorders.
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PMID:Phase II study of fludarabine, cytarabine (Ara-C), cyclophosphamide, cisplatin and GM-CSF (FACPGM) in patients with Richter's syndrome or refractory lymphoproliferative disorders. 1215 63


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