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

Arteriovenous fistulas between the common iliac vessels resulting from spontaneous rupture of aneurysms are rare, with only 31 cases having been reported since 1971. Clinical diagnosis is possible when a unique set of findings is present, namely high-output cardiac failure, a pulsatile abdominal mass associated with a bruit or thrill, and unilateral arterial insufficiency or venous engorgement. Recently, with advancements in diagnostic techniques, the number of cases in which an arteriovenous fistula is found between the common iliac vessels has increased. Diagnosis can be difficult, however, as in the case of one of our patients in whom the predominant sign was acute renal failure. Other reports of renal failure or impairment in the presence of a common iliac fistula have also appeared. Awareness of this phenomenon can help the physician to establish the diagnosis when one or more of the classic signs are absent. Prompt diagnosis and surgical management have contributed to the high incidence of survival in patients with arteriovenous fistulas between the common iliac vessels.
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PMID:Spontaneous common iliac arteriovenous fistula manifested by acute renal failure: a case report. 206 62

There have been only a few investigations that have considered renal disease or any disturbance of renal function in the calculation of risk in cardiac surgery. Risks of cardiac surgery have to be considered for renal disease without direct connection to heart disease (e.g., infections of the kidney and of the urinary tract, primary and secondary glomerulonephritis, parenchymal renal disease, and impaired renal function of unknown origin), as well as in renal disease with concomitant influence on heart and kidney (e.g., infective endocarditis, arterial hypertension, systemic disease of heart and kidney such as with diabetes mellitus, disturbance of kidney function or electrolyte balance due to heart failure). In most cases, the problem is solved by therapeutic intervention and postponement of cardiac surgery. A limited or negative operative indication is found with untreatable infection of the kidney or urinary tract, with untreatable nephrotic syndrome, in advanced renal disease with heart transplantation, as well as in case of severe arterial hypertension with possible organ complications, and in advanced diabetes mellitus with ESRD and multiorgan involvement. After cardiac surgery, acute renal failure represents a critically important complication. Primary therapeutic procedures must include prophylaxis of hemodynamic unstable situations, as well as prophylaxis of infectious complications. Cardiac surgery in dialysis patients and post-transplant patients is basically possible and only has a slightly increased risk compared to patients with normal renal function. Seventy-seven dialysis patients were operated (49 aorto-coronary bypass operations, 19 single-valve and multiple-valve replacements, five patients with valve replacement and aorto-coronary bypass, and four other cardiac surgical operations). Only in valve replacement, was mortality significantly higher than in renal healthy persons, the main causes of death being cerebrovascular complications and septicemia.
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PMID:[Extracardiac risk factors in heart surgery--the kidney]. 208 10

The survival of a patient with irreversible cardiac failure on the cardiac transplantation waiting list was assured for 38 days by circulatory assistance with heterotopic Pierce Donachy prosthetic ventricles and followed by successful cardiac transplantation. This method of circulatory assistance is relatively simple to install from the technical point of view and provides a satisfactory haemodynamic result whilst waiting for a compatible donor organ. Several complications, some of them serious, were observed. Some were related to the patient's poor preoperative condition: acute renal failure, disorders of coagulation. These regressed slowly when the patient's haemodynamic status improved. On the other hand, septic problems and local haemorrhage were inherent to this technique. These are the commonest complications reported by other authors. Although the mortality rate during the period of circulatory assistance may appear to be high, this technique remains a valuable method of survival for selected patients and does not affect the chances of success of ulterior cardiac transplantation.
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PMID:[Successful cardiac transplantation after 38 days of circulatory assistance with a heterotopic artificial heart]. 210 98

The evolutive patterns, actuarial survival and causes of death of idiopathic myelofibrosis were analysed in a series of 60 patients. The median age of the patients was 64 years; 41 were males and 19 females. In the initial bone-marrow biopsy studies 25 patients were in stage MF/C, 17 in MF/O- and 18 in MF/O+. When performing this analysis, 32 patients were dead, 19 were still alive and 9 had been lost after a median follow-up of 6 months. The median survival of the whole series was 57 months. Four major evolutive patterns were recorded: 1) blastic crisis (7 cases), 2) portal vein hypertension (4 cases), 3) liver insufficiency due to massive myeloid metaplasia of the liver without signs of portal vein hypertension (5 cases); in 2 of them this pattern followed splenectomy), and 4) heart failure ascribable, at least partially, to post-transfusion haemochromatosis (3 cases). The blastic crisis appearing in 7 patients presented after a median follow-up of 19 months, and 6 of these patients have died after a median of 5 months since the diagnosis of the blastic crisis. In the 16 patients who died without any characteristic evolutive pattern, the following causes of death could be registered: septic shock (6 cases), intracranial haemorrhage, haemoperitoneum and acute renal failure (1 case each), whereas the cause of the deceased was unclear in the remaining 7 patients.
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PMID:[Idiopathic myelofibrosis: clinical course, survival, and causes of death in a series of 60 patients]. 219 99

Until recently acute renal failure (ARF) in critically ill patients has been known to have a very poor prognosis, particularly when associated with multiple organ failure (MOF). Mortality rates for ARF in combination with at least two other failing organ systems have ranged over 90%. Despite the use of intermittent hemodialysis no better outcome was possible until continuous arteriovenous hemofiltration (CAVH) was introduced by Kramer in 1977. From several extracorporeal clearance methods we chose to evaluate the pump-driven intermittent venovenous hemofiltration (HF) system in the ICU and its effect on mortality in MOF. PATIENTS and METHODS. Over a period of 39 months we evaluated 63 patients, 58 of them with MOF undergoing altogether 532 sessions of HF. The reason for the development of ARF was prerenal in 47% (circulatory shock, hypovolemia), renal in 43% (septic) and other problems in 10% (ARDS, cardiac failure). After special optimizing therapy for patients with ARF (10), HF was required for treatment as defined by a serum creatinine greater than 3 mg/dl (BUN greater than 150 mg/dl), oliguria of less than 30 ml/h or a creatinine clearance of less than 20 ml/min. Vascular access was obtained by a double lumen venous cannula inserted into the subclavian vein. HF was performed by a machine equipped with 3 roller pumps and an electronic fluid equilibration system using a hollow fiber filter running for 6-8 h. The average flow of ultrafiltrate was 74 ml/min. RESULTS. The average decrease per hemofiltration of creatinine levels was 1.97 +/- 0.77 mg/dl, of BUN 73.5 +/- 28.3 mg/dl. Moreover, we noticed decreasing platelet counts, fibrinogen and osmolarity levels, as well as a slight increase in pH values. Mortality was 37%. DISCUSSION. When comparing HF with other clearance methods such as hemodialysis there are some remarkable advantages: easier handling of the fluid and electrolyte balance; the possibility of total i.v. alimentation in septic, hypercatabolic patients, safe and precise administration of antibiotics, glycosides and sedatives because of their highly predictable and steady elimination rates throughout HF; last but not least, the removal of renal and vasoactive toxins. There was practically no impairment of the cardiovascular system during HF. Our experiences in the ICU show that HF has been successfully used with decreasing mortality. This kind of treatment improved the fate of the critically ill patient with ARF alone or combined with MOF to the extent that the patient's prognosis was excellent if the main surgical problems could be solved.
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PMID:[Hemofiltration in acute kidney failure. Experiences of a surgical intensive care station]. 227 75

After ingestion of an unknown amount of formalin with suicidal intent, a 55-year-old female and a 34-year-old male were admitted to the hospital with extensive gastrointestinal corrosive damage, circulatory shock, metabolic acidosis, respiratory insufficiency and impairment of renal function, which rapidly progressed to acute renal failure. Metabolic acidosis was in part due to high plasma levels of formic acid, the main metabolite of formaldehyde, and hyperlactatemia. Both patients underwent hemodialysis and hemofiltration treatment. In the male patient, a gastrectomy had to be performed. The further clinical course in the patients was characterized by sepsis and protracted pulmonary complications. Both patients died after developing adult respiratory distress syndrome and global cardiac insufficiency. In vitro experiments on formaldehyde reactivity to proteins yielded evidence for almost complete but reversible binding to plasma and blood. Formaldehyde probably exerts systemic toxicity in the form of its labile Schiff's base with proteins, but not as free formaldehyde.
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PMID:Suicidal ingestion of formalin with fatal complications. 235 82

A 26-year-old man, in daily contact with pigs was admitted to hospital with septic shock which appeared to be caused by Streptococcus suis type 2 infection. Despite immediate antibiotic therapy a multiple organ failure developed, with ARDS, cardiac failure, disseminated intravascular coagulation and acute renal failure. Streptococcus suis infection is a zoonosis. The bacterium can be isolated from the tonsils of a significant part of the Dutch pig population. Mainly people who are in close contact with pigs or pork become infected. Usually meningitis develops. Sepsis, as this case, is rare and often fatal.
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PMID:[Fulminant sepsis caused by Streptococcus suis]. 238 12

All major types of human interferons (IFNs) have been purified and clinically administered as antitumor agents. We summarize here experience to date with toxicity of IFNs in cancer patients. The acute syndrome consists of fever, chills, myalgias, arthralgias, and headache, with some variation according to type of IFN, route of administration, schedule, and dose. Fatigue, perhaps reflecting CNS toxicity, is the most prevalent nonacute symptom. At high doses, IFNs are neurotoxic; the abnormalities seen by EEG resemble those in diffuse encephalitis. Hematologic toxicity consists mainly of leukopenia, but anemia and thrombocytopenia occur in some patients. Nausea, vomiting, and diarrhea are the main gastrointestinal symptoms. Elevation of serum transaminases seems to reflect liver toxicity. Renal function is well preserved, except for rare instances of acute renal failure. Cardiac toxicity remains questionable, although heart failure and arrhythmias have been associated with the administration of IFNs. Most, if not all, of these effects are reversible or can be ameliorated. With IFN alpha, the type most widely used in clinical studies, doses of 1 million to 9 million units (MU) are generally well tolerated, but doses greater than or equal to 18 MU yield moderate to severe toxicity. Doses greater than or equal to 36 MU can induce severe toxicity and significantly alter the performance status of the patient.
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PMID:Clinical toxicity of interferons in cancer patients: a review. 241 69

We evaluated the results of hemodialysis performed with 106 double lumen catheters in 87 patients (mean age 52, range 10-82). 46 patients had chronic and 38 acute renal failure; 2 had respiratory distress syndrome and one refractory heart failure. Catheter flow ranged from 100 to 250 ml/min (mean 207) and effective clearance from 64 to 171 ml/min (mean 125). Only one catheter was used in 75 patients (86%), 2 in 7 and more than 2 in 5. Causes of failure included inadequate flow (9), coagulation (6) and displacement (4). In nine instances, severe complications developed: sepsis (3), local infection (4), hematoma (1) and vagal reaction (1). Three patient with catheters located in the subclavian vein developed vein stenosis, requiring angioplasty in 2 and graft in 1. Thus, double lumen catheter is easy to place and helps preserve future vascular sites in chronic hemodialysis.
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PMID:[Hemodialysis: vascular access with double lumen catheter]. 251 82

A 24-year-old woman was admitted to our hospital with acute paracetamol poisoning, and severe hepatic injury. The peak blood level of GOT, GPT and LDH were 32,600 U, 119,200 U and 36,500 U respectively. Glucagon-insulin and glutathione were administered to save the liver function. On the third hospital day, hemodialysis was administered to treat acute renal failure. On the 16th hospital day, when the liver and renal functions recovered, severe pulmonary congestion occurred and right heart catheterization revealed high pulmonary pressure. Echocardiography showed left ventricular enlargement accompanied by a severe diffuse impairment of left ventricular wall motion. Multi-focal ventricular arrhythmia was frequent during this period. Hemodialysis and artificial respiration were carried out for the treatment of heart failure. Three months after admission, myocardial perfusion scintigram showed patchy reduction in the uptake of Tl-201 throughout the myocardium, and left ventriculography showed mild diffuse impairment of the LV wall motion (ejection fraction: 49%). In this case, acute heart failure appeared approximately 2 weeks after the severe hepatic injury. Apparently myocardial damage following paracetamol overdosage is caused not only by direct toxicity but by severe metabolic derangement.
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PMID:A case of myocardial damage following acute paracetamol poisoning. 252 40


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