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

Increased numbers of cardiac transplantations are being performed as a therapeutic option for end-stage cardiac disease. Immunosuppressive therapy combining multiple drugs to prevent rejection is essential to the success of this procedure. Although the patient's primary problem of heart failure is alleviated by a successful transplant, the secondary effect of immunosuppression causes many potential problems for this patient population. Infection from common pathogens or opportunistic microorganisms is the primary complication causing death in the post-transplant patient. Bacterial, viral, fungal, or parasitic infection may ensue during the postoperative period. Life-long immunosuppressive therapy places the patient at continuous risk for the development of infection. Nurses play an important role in the management of the cardiac transplant patient. A thorough knowledge of normal immune system function and the specific actions of each immunosuppressive drug on the immune system function is a prerequisite for providing care for these patients. Continuous monitoring of the patient to detect the signs and symptoms of infection or other side effects of the drugs is part of the nurse's role in caring for these patients. Maintenance of the patient's nonspecific host defenses is supported by specific nursing actions. In preparation for the life-long effects of the drugs, education of the patient and family regarding the implications of therapy with immunosuppressive agents is a crucial nursing function for the successful management of the cardiac transplant patient.
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PMID:Complications after cardiac transplantation. The role of immunosuppression. 269 23

The case histories of the 49 patients who died in a series of 165 patients admitted to the Medical Unit between 1958 and 1984 with polyarteritis nodosa (PAN) were reviewed. The causes of death of the 29 men and 20 women, mean age 51.44 +/- 7.4 years, were classified into 6 groups. Infection accounted for 26.5% (13/49) of deaths, the initial site of infection being pulmonary, complicated by septicaemia in 6 cases. Cardiovascular events were responsible for death in 24.4% (11/49): terminal cardiac failure (4 cases), myocardial infarction (1 case), ventricular tachycardia (1 case), stroke (1 case), pulmonary embolism (2 cases), fulminant hemoptysis (1 case). Gastrointestinal complications were the cause of death in 16.3% (8/49): ischemic necrosis (5 cases), acute pancreatitis (2 cases), oesophageal ulceration (1 case). Renal failure was observed in 10.2% (5/49), all occurring before 1972: acute renal failure (3 cases), chronic renal failure (2 cases). Cancer was the cause of death in 10.2% (5/49): primary bronchial carcinoma (2 cases), laryngeal carcinoma (1 case), carcinoma of the vulva (1 case), bone metastases (1 case). Finally, 14.2% (7/49) could not be classified in the preceding groups. Sudden death occurred in 3 patients, shock in 1 patient, multivisceral PAN in 2 patients and anaphylactic shock in 1 patient. Three of the 12 patients who had post-mortem studies had signs of progressive vasculitis. The results are compared with other reports in the literature and the pathogenic mechanisms are discussed. The infections and cardiovascular deaths occurred early or late and were not related to the state of the activity of the vasculitis. Immunosuppressive treatment seems to play an important role in their pathogenesis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Causes of death in systemic vasculitis of polyarteritis nodosa. Analysis of a series of 165 patients]. 290 28

Acute and therapeutically uncontrollable cardiac insufficiency in a case of chronic heart disease with acute risk of rejection and with a record of previous transplantation or during a heart operation should be considered as an indication for implantation of an artificial heart or a ventricle-supporting system, if a donor heart is not available. Two results are expected from such an approach, restoration of adequate circulation and improvement of organ functionally providing a chance for later transplantation. Attention should be given, according to the authors' own experience, to effective surgical haemostasis. Infections have quite often proved to be incurable after implantation of an artificial heart and, consequently, provide a clear-cut contraindication to implantation.
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PMID:[Current status of use of the artificial heart in combination with heart transplantation]. 305 51

Microbiological features, diagnostic investigations, treatment, and complication rate in 53 cases of infective endocarditis were reviewed in this study. Infection occurred both on prosthetic (47%) and native valves (38%), while in 15% of the cases no prior valvular disease was known. Streptococcal (38%) and staphylococcal (30%) infections were predominant. In 17% of the cases apparent negative blood cultures were obtained. The most frequent portal of entry was dental infection or manipulation (45%), however in 28% of the patients etiology remained obscure. Major clinical signs and symptoms included heart murmurs (96%), fever (91%), dyspnoea (32%), and splenomegaly (30%). Echocardiography revealed vegetations in 78%, aortic and mitral valve being nearly equally affected. All patients were medically treated and 53% received antibiotics prior to blood cultures. Associations of ampicillin or penicillin with an aminoglycoside (43%) and penicillinase-resistant antibiotics (30%) were most frequently administered. In 28% of the patients, it was necessary to insert a prosthetic (aortic or mitral) valve. During follow-up, heart failure (28%), embolization (11%), and infections (11%) were the major complications.
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PMID:A six years review on 53 cases of infective endocarditis: clinical, microbiological and therapeutical features. 325 78

The group B streptococcus has been shown to be a major cause of meningitis in the newborn and an occasional cause of endocarditis and sepsis in postpartum women. Little attention has been devoted to this organism as a cause of bacterial endocarditis. Twelve patients with group B streptococcal endocarditis were seen at The Presbyterian Hospital, New York, NY, between 1974 and 1985. There were seven women, five men. Ages ranged from 32 to 81 years. Serious underlying disease was present in all - diabetes mellitus in seven, carcinoma in three (bladder in two, and breast in one), alcoholism in three, malnutrition in two, heroin addiction in one, tuberculosis in one, serious prior valvular heart disease in two. The aortic valve was affected in four patients - mitral in two, mitral and aortic in one, tricuspid in four, unknown in one. The presentation was acute in seven patients. Metastatic infection occurred in seven, heart failure in six, major emboli in four, septic pericarditis in one, myocardial abscess in one. The group B streptococcus should be considered as a pathogen capable of causing acute endocarditis in certain patients with defects of host defense, particularly patients with diabetes mellitus, carcinoma or alcoholism. Cardiac surgery may be necessary in these patients due to the rapid destruction of the valves which occurs, in spite of the fact that the organisms are usually highly susceptible to penicillin.
Infection
PMID:Streptococcus agalactiae (group B) endocarditis--a description of twelve cases and review of the literature. 330 82

Eight years' experience with the brachiocephalic fistula for vascular access are reported. Eighty one fistulae were created in 77 patients. Forty one fistulae were created by an end to side anastomosis and 40 using a side to side technique. Overall patency was 70% at 1 year; 57% at 2 years; 50% at 3 years, which compares well with other secondary access procedures. Anastomotic configuration did not significantly affect fistula survival. Cardiac failure and arterial steal syndrome were significant problems with the side to side fistula. Two patients died from fistula complications; one exsanguinated at home from a cannulation site and another succumbed to high output cardiac failure. Infection was rare. The end to side brachiocephalic fistula is recommended as the secondary vascular access procedure of choice. It is a simple, reliable procedure which does not require graft implantation and preserves the saphenous vein, should tertiary access be required.
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PMID:Vascular access: experience with the brachiocephalic fistula. 378 6

Over a period of 6 years, only twelve cases of dilated cardiomyopathy were clinically diagnosed in Nigerians between the ages of 11-30 years at the University College Hospital, Ibadan, Nigeria. Eleven presented with heart failure, while the twelfth patient presented with a cerebrovascular accident. Two other patients also had a cerebrovascular accident. A history of febrile illness was obtained in seven, but in only three was fever unresponsive to antimalarials, documented on admission. Antistreptolysin-O titre was normal and erythrocyte sedimentation rates elevated in each of the patients. Leucocytosis was present in six, three had a four-fold rise or fall in antibody titres against Coxsackie-B viruses and one, a four-fold rise or fall against Toxoplasma gondii. Histological evidences of myopericarditis were found in three of the six patients who died. It is concluded that dilated cardiomyopathy is rare in young adult Nigerians, and that constitutional upset is common, as in children, but prognosis is poorer. Infections by Coxsackie-B viruses, T. gondii and possibly other viruses appear to be of major aetiological factors
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PMID:Dilated cardiomyopathy in young adult Africans: a sequel to infections? 629 52

175 patients with histological evidence of chronic diffuse liver disease, 67 patients with heart failure, diabetes and atherosclerosis, and 118 healthy adults under 30 years of age engaged in sports were studied for the prevalence of hepatitis A virus antibody (anti-HAV) by radioimmunoassay using a HAVAB (Abbott)-kit. Infection with hepatitis-A virus is highly prevalent in Hungary, anti-HAV having been demonstrated in a very high proportion of controls as well as of patients. Over the age of 40 the incidence is 100% in controls and 98% in patients with chronic liver disease. Infection with hepatitis-A virus must have been asymptomatic in the majority, since no more than 11.4% of the subjects had a history of acute hepatitis. The prevalence of acquired anti-HAV increases with age until it attains 100% in advanced age. The present results lend no support to the possibility that hepatitis-A virus infection might be involved in the production of chronic diffuse liver disease.
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PMID:Hepatitis a virus antibody in chronic diffuse liver disease. 666 44

The surgical technique recommended for vaginal extirpation of the uterus from patients with corpus carcinoma differs from methods suggested for any other indications, including inadequately controllable metrorrhagia, uterus myomatosus, in situ carcinoma, Stage Ia carcinoma of the cervix, and positional abnormality. Reported are 1,052 cases of hysterectomy for which these indications had been valid. More than 25 per cent of the patients concerned had been above 60 years of age. There had been complications of two types, intra-operative and postoperative. Infections of the urinary tract ranked on top of the list and accounted for 5.6 per cent of all complications. They were followed by intra-operative bleeding in 2.6 per cent of the cases and postoperative bleeding in 1.6 per cent. There were also two cases of ileus, one of them fatal. Another death occurred due to cardiac insufficiency.
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PMID:[Indications for vaginal hysterectomy]. 713 61

The results have been reviewed of 41 patients with end stage polycystic kidney disease on maintenance hemodialysis. The patients ranged in age from 34 to 83 years with an average age of 55 years and 25 patients were male, 16 were female. The duration of maintenance hemodialysis in the patients was from 1 to 200 months with an average time of 69 months. Infection of the cysts and pyelonephitis occurred 22 times in 13 patients (32%) and hemorrhage into the cysts occurred 15 times in 13 patients (32%). To control the infection, bilateral nephrectomy was required in 10 patients and 1 patient was undergone unilateral nephrectomy. Of 13 patients with the hemorrhagic cysts, 5 were undergone bilateral nephrectomy and 2 were undergone unilateral nephrectomy. Six patients died during follow up and the cause of death were 1) cardiac failure, 2) cerebral hemorrhage, 3) cardiac infarction, 4) pneumonia after nephrectomy, 5) massive bleeding after second operation for adhesive ileus due to first nephrectomy, 6) unknown. Fourteen patients but one undergone bilateral nephrectomy were followed for an average time of 70 months after nephrectomy. Such as complication due to bilateral nephrectomy, anemia occurred in 13 patients (93%) and hypotension occurred in 5 patients (33%). Bilateral nephrectomy was effective procedure in safety for end stage polycystic kidney patients with the infection and the hemorrhagic cysts because anemia and hypotension which occurred usually after bilateral nephrectomy now can be controlled goodly.
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PMID:[End stage polycystic kidney disease: the study for upper urinary tract infection & hemorrhage into the cysts]. 780 76


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