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)

Twenty cases of sonographically visualized thickening of the gallbladder wall were reviewed and the clinical diagnoses compiled. In only eight of these patients was cholecystitis considered responsible for the finding. The rest had hepatitis, alcoholic liver disease with hypoproteinemia, heart failure, renal disease, and multiple myeloma; however, all lacked clinical evidence of gallbladder disease. Because of these findings, caution is urged in making the diagnosis of cholecystitis on the basis of wall thickening alone.
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PMID:Sonography of the thickened gallbladder wall: a nonspecific finding. 678 Dec 56

To quantify prognosis in patients with end-stage renal disease, we evaluated pretreatment clinical state and ascertained the outcome of all 220 patients who began therapy at two hospitals from 1970 to 1975. Each of three pretreatment characteristics made a statistically significant independent contribution to the relative risk of death: age (relative risk for 10-year increments = 2.2, p less than 0.001); duration of diabetes (relative risk for 10-year increments = 2.2, p less than 0.001); and left-sided heart failure (relative risk = 2.0, p less than 0.001). We combined the effects of these factors in an age-equivalence index that showed a strong gradient in survival rates from lower to higher values; the 5-year survival rate differed between 92% in patients with a score of 30 or less and 6% in patients with a score over 70. This index, which is simple to use, should prove helpful in patient care and can improve the scientific validity of therapeutic comparisons in patients with end-stage renal disease by identifying and adjusting for the selection biases that occur in the allocation of different treatments.
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PMID:Predicting survival in adults with end-stage renal disease: an age equivalence index. 703 43

Despite many years of using digitalis to treat congestive heart failure, the problem of intoxication has remained unchanged. In nine prospective studies on patients under a maintenance treatment with digoxin the intoxication rate ranged from 15.2% to 27.5%. Other studies have also shown that renal insufficiency was present in 70% of intoxicated patients. In contrast the digitoxin toxicity rate, as shown in two prospective studies from Norway and France on 649 and 2120 patients respectively, resulted in an intoxication rate of 5.8% and 3.2% respectively. The explanation for the discrepancy between the two glycosides seems to be predominantly the influence of renal function on drug elimination. Digoxin is mainly excreted through the kidneys; an impairment of the renal function will therefore lead to a reduced elimination of this drug. In these cases a dose reduction of digoxin is necessary. Digitoxin on the other hand is excreted both through the kidneys and the bile. Impairment of the renal function does, therefore, not lead to any decrease in digitoxin elimination whether in renal disease, during heart failure or in old age. In contrast to digoxin, no dose reduction is necessary with digitoxin when renal function is reduced. Digitoxin is therefore easier to handle in the long term management of cardiac patients with and without renal impairment.
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PMID:[Prospective examinations of digitalis poisoning]. 727 39

M. mode echocardiography was performed on 16 chronic hemodialysis patients (12 men, 4 women, average use of 21, hematocrit around 24 +/- 5%) with a normal blood pressure and no clinical or roentgenographic signs of heart failure, 18 to 22 hours after the end of a dialysis. Renal diseases due to hypertension, diabetes or amyloidosis were excluded from the study. 8 normal subjects of similar age, heart rate and blood pressure were used as a test group. On these 24 persons, and diastolic time diameter index (DTDI) and end systolic time diameter index (STDI), ejection time (ET), mean velocity of circumferential fiber shortening (VCF) and ejection fraction were calculated. DTDI of hemodialysis patients (31 mm/m(2) +/- 2) is greater than DTDI of the control subjects, and STDI and ET are the same. This explains the increase of VCF (1,69 +/- 0,10 c/s) and EF (0,78 +/- 0,05). After a three minute compression of the fistulas the differences disappear. These results suggest that the previous exam conditions permit a better determination of the true contractile state of the left ventricule of hemodialyzed patients if one disregards the load changes due to the fistula, anemia and the intermittent volume expansion.
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PMID:[Does echocardiography Tm permit to determine the true contractile state of the left ventricle of hemodialysis patients? (author's transl)]. 729 Mar 3

Fractional dextran clearances (theta D) were used to ascertain whether the albuminuria accompanying cardiac failure (CF) has a hemodynamic basis. In 17 patients with grade-IV CF in whom GFR and effective renal plasma flow (ERPF) were depressed to 58 +/- 7 and 215 +/- 20 ml/min/1.73 m2, respectively, theta D was elevated relative to normal control subjects over the Stokes-Einstein radius (r) interval of 28 to 46 Angstrom. For dextran of equivalent size to albumin (r = 36 Angstrom), the rate of urinary excretion (UD36V) was not increased because elevated theta D36 was offset by the depressed GFR. In contrast, urinary albumin excretion (UalbV) was increased to 82 +/- 35 microgram/min. Thus, for albuminuria in CF to have the hemodynamic basis suggested by elevation of theta D requires that (I) the fractional clearance for anionic albumin be disproportionately enhanced relative to uncharged dextran by reduced glomerular plasma flow and/or (2) that glomerular electrostatic barrier function be impaired in CF. In seven patients with minimal change nephropathy, UD36V was similar to that in CF, but UalbV was 40 times greater than that in CF. Thus, if glomerular electrostatic barrier function is impaired in CF, such dysfunction is trivial by comparison with minimal change nephropathy.
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PMID:Albuminuria and the permselective properties of the glomerulus in cardiac failure. 739 24

The use of ACE-inhibitors has increased greatly during the last years. They were first used in treating hypertension, but nowadays cardiac diseases, mainly cardiac failure, are common indications. This means that the drugs are used in the treatment of more elderly patients who often have generalised atherosclerosis. This means that the patients must be controlled more often after initiation of treatment, especially concerning kidney function, since treatment with ACE-inhibitors can cause pronounced changes in renal haemodynamics and kidney function. This review focuses on the effects of ACE-inhibitors on renal haemodynamics and kidney function, which may be positive, with preservation of kidney function in diabetic and other chronic nephropathy, or negative, for example in cases with atherosclerotic stenosis of large or small renal arteries. It is concluded, that in cases of diabetic nephropathy an ACE-inhibitor is the "drug of choice" for treatment of hypertension. Furthermore the ACE-inhibitors seem to reduce the rate of deterioration of renal function and proteinuria in other kidney diseases. It is emphasized, that during treatment with ACE-inhibitors kidney function must be controlled before and following one to two weeks of treatment, if the dose is changed and in all cases following two to three months of treatment. Special attention should be given to patients with atherosclerotic manifestations e.g. angina.
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PMID:[Renal function during treatment with angiotensin converting enzyme inhibitors]. 748 49

In chronic uremia, cardiomyopathy manifests itself as systolic dysfunction, concentric left ventricular (LV) hypertrophy, or LV dilatation. To determine the impact of renal transplantation on uremic cardiomyopathy, all dialysis patients participating in a long-term cohort study who received a successful renal transplant were followed with echocardiography. The transplanted group comprised 102 of 433 (24%) endstage renal disease (ESRD) patients. They were significantly younger and, on starting ESRD therapy, had significantly less ischemic heart disease and cardiac failure than the overall ESRD cohort. During followup, ischemic heart disease developed in only 1 patient and none experienced cardiac failure. In the 12% (n = 12) of patients with systolic dysfunction before renal transplant, fractional shortening normalized in all patients, increasing from 21.5 +/- 4.6% to 33.5 +/- 5.6% after transplantation. In the 41% (n = 41) with concentric LV hypertrophy before transplantation, the LV mass index improved from 158 +/- 39 g/m2 to 132 +/- 39 g/m2. LV dilatation was present in 32% (n = 32) of patients before transplantation. After transplantation, LV volume fell from 116 +/- 3.1 ml/m2 to 89 +/- 21 ml/m2, and LV mass index in this group fell from 166 +/- 55 g/m2 to 135 +/- 37 g/m2. It was not possible to associate risk factors characteristic of the uremic state with the improvement in cardiac structure and function, although the fall in LV mass was significantly associated with fall in blood pressure. We conclude that correction of the uremic state by renal transplantation leads to normalization of LV contractility in systolic dysfunction, regression of hypertrophy in concentric LV hypertrophy, and improvement of cavity volume in LV dilatation. The degree of improvement suggests that dialysis patients with uremic cardiomyopathy would benefit from renal transplantation.
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PMID:Impact of renal transplantation on uremic cardiomyopathy. 749 92

Plasma brain natriuretic peptide (BNP) levels have been reported to increase in patients with heart failure and end-stage renal disease (ESRD); however, little is known about molecular forms of plasma BNP that increase in these diseases. In the present study, we analyzed the molecular forms of plasma BNP in ESRD patients of both before (pre-) and after (post-) hemodialysis (HD) state. The plasma extract was analyzed by gel filtration on a TSK-GEL G2000 SW column followed by a RIA for both BNP and atrial natriuretic peptide (ANP). In the pre-HD patients, a 14- to 2300-fold increase in plasma level of immunoreactive (ir-) BNP was observed when compared to normal controls. A ratio of BNP-32 to g-BNP (pro BNP) in plasma from the patients was much larger than that in plasma from normal subjects, indicating that the high plasma level of ir-BNP level in the patients on HD largely results from a marked increase in BNP-32. HD significantly (P < 0.01) lowered the plasma levels of both BNP-32 and g-BNP with a greater reduction in BNP-32 than in g-BNP. Whereas, a-ANP was a main molecular form of plasma ANP in both pre- and post-HD plasma. These results suggest that plasma BNP-32 plays an important role in the sodium-fluid balance and that secretion and metabolism of BNP may differ from those of ANP in the HD patients.
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PMID:Molecular forms of human brain natriuretic peptide (BNP) in plasma of patients on hemodialysis (HD). 760 77

The overall objective with the present investigations was to study the influence of insulin-dependent diabetes mellitus (IDDM) on periodontal conditions and to identify factors that may be predictors for severe periodontal disease in individuals with IDDM. Periodontal conditions were studied in two cross-sectional studies of adult, insulin-dependent diabetics and age-and sex-matched controls. In one study 72 diabetics with short-(SD) and 82 with long-duration (LD) diabetes and 77 controls participated. In the other study 83 LD diabetics and 99 controls took part. The portion of individuals exhibiting severe periodontal disease was larger in the diabetic group than in the control group. Advanced periodontal disease appeared in earlier ages (40-49 years) in the LD diabetics compared to the SD diabetics and controls. In fact, the 40-49-year-old LD diabetics had alveolar bone loss equal to the older controls (60-69 years). LD diabetics exhibited more severe periodontitis than SD diabetics. Some salivary factors were studied in 72 SD and 82 LD diabetics and 77 controls. LD and SD diabetics had a lower stimulated salivary secretion rate and an increased glucose content compared to the controls. The reduction in flow rate, however, was moderate, and all mean values were within the normal limits. The moderately increased glucose content did not result in higher mean numbers of Candida albicans, lactobacilli, and mutans streptococci. The subgingival bacterial species currently considered to be associated with periodontitis were studied in 30 LD diabetics and 34 controls. All these bacterial species were recovered in diabetics as well as controls. More LD diabetics than controls harboured Porphyromonas gingivalis. In the control group the periopathogens were recovered more often in deep periodontal pockets. In the LD group, however, these bacterial species were recovered as often in shallow as in deep periodontal pockets. The medical status of 39 matched pairs of LD diabetics was analysed. One in each pair had severe periodontal disease while the other had no/minor symptoms of periodontal disease. Biochemical analyses and clinical variables routinely used in monitoring diabetics failed to discriminate between diabetics with severe and minor periodontal disease. Diabetics with severe periodontal disease, however, showed a higher prevalence of renal disease and cardiovascular complications such as stroke, transient ischemic attacks, angina, myocardial infarct, heart failure, and claudicatio intermittens than diabetics with only minor periodontal disease. This indicates that closer cooperation between the diabetologist and the dentist is necessary in monitoring the diabetic patient.
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PMID:Periodontal disease in adult insulin-dependent diabetics. 763 66

Patients on dialysis have an age-adjusted death rate 3.5 times that of the general population. The most common cause of death in patients on dialysis is cardiovascular disease. We prospectively followed a cohort of 433 patients in three centers for a mean of 41 months. Mean hemoglobin level at the beginning of dialysis was 8.39 (+/- 1.7) g/dL, and the mean hemoglobin level during follow-up was 8.84 (+/- 1.5) g/dL. Using Cox's regression model, we found that anemia predicted mortality independently of age, diabetes mellitus, cardiac failure, hypoalbuminemia, serum creatinine, mean arterial pressure, or echocardiographic heart disease. The independent relative risk (RR) of mortality was 1.18 per 1.0 g/dL decrease in hemoglobin level. Anemia also independently predicted the de novo occurrence of congestive heart failure when the same covariates were controlled for (RR, 1.49 per 1.0 g/dL decrease). Anemia was also independently predictive of heart failure at the start of dialysis (RR, 1.14 per 1.0 g/dL decrease) and heart failure recurrence (RR, 1.25 per 1.0 g/dL decrease). Left ventricular hypertrophy is present in 75% of patients on dialysis at the start of therapy for end-stage renal disease. It independently predicts mortality. Our prospective cohort study identified increasing age, hypertension, and anemia as risk factors for its development. One controlled study and several uncontrolled studies demonstrated improvement (but not complete regression) of elevated left ventricular mass in patients on dialysis treated with recombinant human erythropoietin (epoetin).
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PMID:Cardiac function and hematocrit level. 770 71


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