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

We report a case of essential thrombocythemia (ET) that climaxed in acute myeloid leukemia after developing into refractory anemia. The male patient had ET that was stable for 8 years on carboquone therapy. However, at the age of 72 years he developed an acute terminal illness that was characterized by severe pancytopenia, circulating myeloblasts, extensive bone marrow infiltration by myeloblasts, and an abnormal karyotype [46, XY, t(8q-; 20q+)]. He subsequently died of severe bilateral pneumonia and heart failure. This case suggests that ET may be similar to polycythemia vera; progression to leukemia is unusual except after chemotherapy. Therefore, treatment of patients with asymptomatic ET may not be advisable.
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PMID:Essential thrombocythemia developing into refractory anemia and complicated by acute myeloid leukemia. 128 33

Natural surfactant (Surfactant TA, Survanta, CLSE, SF-RI 1, Curosurf and human surfactant obtained from amniotic fluid) therapy for RDS in very premature infants has been evaluated in 17 controlled clinical trials. Uniformly intratracheal surfactant administration caused a decreased intensity of mechanical ventilation during the first hours (reduced inspiratory pressure, reduced oxygen requirements) as an immediate effect of surfactant administration. Metanalysis reveals barotraumatic pulmonary complications mainly, pneumothorax and pulmonary interstitial emphysema to occur less frequently in surfactant-treated infants in virtually all trials; an increased incidence of survival without bronchopulmonary dysplasia following surfactant treatment was observed in 10 controlled clinical trials. The incidence of other complications of prematurity (intracranial hemorrhage, patent ductus arteriosus and necrotizing enterocolitis) was unchanged following natural surfactant treatment. Dosing of natural surfactant is still under investigation, however recent data indicate that the initial dose should not be less than 100 mg/kg b.w. and retreatment should be given to infants with unsatisfactory response (i.e. fraction of inspired oxygen (FiO2) > 40%). Timing of surfactant treatment still remains controversial. Prophylactic treatment shortly following birth has been compared with rescue-treatment, i.e. surfactant administration to infants suffering from manifest RDS in most studies 4-8 h after birth. Conflicting data from 5 controlled trials may be interpreted as follows: prophylactic treatment seems to be favourable for extremely premature infants (GA < or = 26 weeks) and rescue treatment seems to be adequate for infants of 27-30 weeks of gestation. Intratracheal surfactant instillation in very premature infants did not result in an improved lung function for 24 h to 48 h in all patients. Ten--25% of study infants were reported to be "non-responders", i.e. infants without sustained decrease in oxygen requirements (i.e. FiO2 > 40%). Various factors may be operative including congenital bacterial infections (sepsis or pneumonia), lung hypoplasia and cardiac failure. Inactivation of surface properties of natural surfactant caused by a leakage of proteins across the alveolar-capillary membrane was observed in experimental and clinical studies. Current investigations focus on a combination of postnatal steroids and surfactant treatment to improve lung function and outcome in "non-responders". As long as any controlled clinical studies are being published, this approach remains experimental. Up to now, any controlled clinical trials have been performed to assess different modes of artificial ventilation (e.g. high frequency oscillating ventilation versus conventional ventilation) combined with surfactant therapy. Data obtained from premature animals given natural surfactant indicate any advantage with respect to gas exchange and lung histology to result from high frequency ventilation.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Natural surfactant for neonatal respiratory distress syndrome in very premature infants: a 1992 update. 129 66

Sixty-eight infants with clinical evidence of a large ventricular septal defect (VSD), refractory to conventional medical treatment, underwent surgical closure within the first 12 months of life from August 1987 to June 1991. There were 43 males and 25 females. The ages of the patients ranged from two to 12 months, with a mean age of 6.6 months. The mean body weight of the patients was 5.4 kg (range, 2.3-10 kg). Surgery was performed because of intractable heart failure in 27 infants (39.7%), failure to thrive in 40 (58.8%), repeated pneumonia in 43 (63.2%) and prolonged endotracheal intubation in nine (13.2%). There were 21 patients with a supracristal VSD (30.9%) and 47 patients with perimembranous VSD (69.1%). Nine patients (13.2%) had preoperative cardiac catheterization. Transatrial repair of perimembranous VSDs and transpulmonary repair of supracristal VSDs was used exclusively without ventriculotomy. Surgically induced heart blocks did not occur in any of the patients. Only two patients (2.9%) died during the early postoperative period. Diagnosis in most cases was confirmed by the present advanced integrated color Doppler echocardiographic technology which is widely used by pediatric cardiologists. There was no need to perform cardiac catheterization in most patients with VSDs. The morbidity and mortality were very low. We strongly suggest that for infants with a large VSD, primary repair should be the procedure of choice.
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PMID:Surgical repair of ventricular septal defect without ventriculotomy in the first 12 months of life. 135 8

Atrial fibrillation and atrial flutter are common arrhythmias after coronary artery bypass grafting. Although the consequences of the arrhythmia are generally not life-threatening, it constitutes a major clinical problem often requiring conversion to sinus rhythm. Atrial fibrillation or flutter can result in hypotension, heart failure, pneumonia, and stroke. This article reviews the literature on epidemiology, electrophysiology, risk factors, and preventive trials. The major conclusions are: (1) In patients undergoing coronary artery bypass surgery, the incidence of postoperative atrial fibrillation or flutter is 20-30%, the peak incidence being on the second or third postoperative day. (2) The strongest independent preoperative predictor for atrial fibrillation or flutter is the patients' age. (3) Intra-atrial conduction delay recorded pre and peroperatively may predict development of atrial fibrillation. (4) Peroperative inducibility of atrial fibrillation by pacing the right atrium may identify patients at risk for postoperative atrial fibrillation. (5) Development of postoperative atrial fibrillation or flutter has not been associated with peroperative or postoperative events. (6) The specificity and sensitivity of age and other possible relevant factors for prediction of atrial fibrillation or flutter after coronary artery bypass grafting is low. (7) No effective prophylactic regimen has yet been established.
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PMID:Atrial fibrillation and flutter after coronary artery bypass surgery: epidemiology, risk factors and preventive trials. 135 29

A survey by parent questionnaire and interview was carried out to determine the frequency of health problems in 204 children with Down syndrome. Seventy-two children (35.3%) had a congenital heart defect. Refraction had been performed on 196 and 68 (34.6%) of these had a refractive error. A diagnosis of 'glue ear' had been made in 112 (54.9%) and in 12 (11%) of these permanent hearing loss was present. Significant ill-health over the previous 12 months consisted of cardiac failure (two children), more than three upper respiratory tract infections (24 children), bronchitis (eight children), pneumonia (two children) and asthma (seven children). A neck X-ray had been performed in 172 (84.3%) and had demonstrated the presence of atlanto-axial instability in 12 (7%) of these. One hundred and thirty-two (64.7%) of the children had been tested for hypothyroidism in the previous 18 months and this had been found in four (3%) of these children. The implications of these and other findings are discussed in relation to parental counselling and planning of routine health checks.
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PMID:Health problems and health checks in school-aged children with Down syndrome. 138 51

Overall 302 infants with acute pneumonia were examined for gas, acid-base and electrolyte homeostasis, central and cerebral hemodynamics. In interpreting the data obtained use was made of a basically new approach to estimation of central and peripheral hemodynamics, resting on an analysis of gas, acid-base and electrolyte homeostasis, reflecting external respiratory function, blood transport system, redox processes in tissues, and so forth. Based on the data obtained the author has devised the classification of acute respiratory and heart failure as well as rapid index in order to differentiate acute heart and vascular failure in infants with acute pneumonia.
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PMID:[Working classification of acute respiratory and cardiac insufficiency in young children with pneumonia]. 140 67

We report the case of an 80-year-old man affected by hypertensive cardiomyopathy and already admitted to our Division for recurrent episodes of heart failure. He was eventually hospitalized for septic shock secondary to disseminated pneumonia with concomitant left pleural effusion. At 2D-echo examination, a highly echo-reflectant mass was detected in the retrocardiac space. As the patient died notwithstanding the intensive pharmacological care, an autoptic procedure was performed which showed a massive thrombosis of the right atrial appendage. We discuss the 2D-echo imaging and advance a pathogenetic hypothesis after a review of the current literature.
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PMID:[Thrombosis of the right atrial appendage. The two-dimensional echocardiographic aspect and the autopsy finding]. 148 40

Incidence and type of postoperative complications were prospectively analyzed in 2280 patients undergoing gastrointestinal surgery. 6.6% had one or more pulmonary complications requiring therapeutic intervention (2.3% pneumonia, 1.6% drained pleural effusions, 1.2% atelectases). Based on univariate and logistic regression analyses, the following parameters constitute high-risk patients with regard to pulmonary complications: Elective surgery (4.3%, 61/1428): anemia (7.2% pulmonary complications), pathological blood gas analysis (9.8%), preoperative hospitalization greater than 1 week (6.3%), blood loss under operations greater than 1000 ml (10.5%), length of the operation greater than 3 h (9.7%); emergency surgery (10.4%, 89/852): upper gastrointestinal operation (16.2%), age greater than 75 (19.9%), ASA IV/V (28%), anemia (19.6%), chronic bronchitis (19%), pathological blood gas analysis (26.6%), diabetes (16.5%), heart failure (18.2%), blood loss under operation greater than 1000 ml (24.3%), length of the operation greater than 2 h (15.4%). These results allow to distinguish between different levels of pulmonary risk.
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PMID:[Pulmonary complications following surgical abdominal interventions. Identification of various risk groups]. 150 62

Physicians analyzed December 1982-November 1989 data on 48 2-60 month old children with empyema thoracis at the University of Calabar Teaching Hospital in southeastern Nigeria to determine the incidence and etiology of empyema thoracis in this region. The incidence rate stood at 2/1000 pediatric admissions. 3 children died (6.3%), all of heart failure. 47 children suffered from fever, cough, and breathlessness, the symptoms for pneumonia. Even though bronchopneumonia is a common complication of measles which occurs frequently in Calabar, only 3 children (6.25%) also had measles. The most frequent complication of this accumulation of pus in the thoracic cavity was congestive heart failure (16 cases). 47 patients suffered from anemia (hemoglobin levels 11 gm/dl). Hemoglobin levels of 54% of all patients decreased over time to 8 gm/dl. In fact, 2 children had hemoglobin levels of 4.4 gm/dl and they experienced cardiac failure. Laboratory personnel were only able to examine pleural aspirates from 37 patients. They did not detect any organisms in 27% of these aspirates. This may have been due to parent's widespread practice of giving medication to all the children before coming to the hospital. 45.9% of the aspirates only grew Staphylococcus aureus while another 8.1% grew it and other pathogens. About 90% of the pathogens were resistant to ampicillin and penicillin and almost 90% were sensitive to cloxacillin, gentamicin, and erythromycin. Cloxacillin was very expensive and parenteral erythromycin was unavailable. Nevertheless the pediatricians used parenteral gentamicin and cloxacillin. The parents were responsible for buying the antibiotics which tended to be costly. All the patients required emergency closed tube thoracostomy drainage within 24 hours of admission. 83.3% remained in the hospital for 2 weeks and 33.3% for 1 month. Despite the rarity of empyema, long hospitalization and expensive drugs make it an important disease in Calabar.
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PMID:Clinical and bacteriological study on childhood empyema in south eastern Nigeria. 150 92

Some lung cancer patients after surgical treatment die as a result of pneumonia or cardiac failure without recurrence of lung cancer months or years after surgery because many such patients are aged or have decreased lung function. Surgical treatment may be partly to blame for these deaths. In this article, to evaluate the contribution of surgical treatment to deaths resulting from other disease, we calculate predicted survival rates using abridged life tables and compute relative survival rates. From 1952 to 1985, a total of 1289 lung cancer patients underwent surgical resection of lung cancer in our department. We calculated some kind of survival rates according to age, stage, and operative procedure. Each case was classified according to age (5-year periods), year of operation (5-year periods), and sex. The 5-year survival rate indicated by the abridged life tables in each class was regarded as the 5-year predicted survival rate of the case. The mean of 5-year predicted survival rates of all cases in a group was regarded as being the 5-year predicted survival rate of the group. The ratio (actual survival rate of the group/predicted survival rate of the group) was also calculated. The ratio of the patients who had stage O, I, or II diseases tended to decrease according to age. This fact supposed that the number of deaths resulting from other diseases with no recurrence of lung cancer in which surgical treatment contributed to death increased in the elderly. In the other hand, this tendency did not exist in the patients who had stage IIIA diseases.
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PMID:[Re-evaluation with abridged life tables of the prognosis of lung cancer patients who underwent surgical therapy]. 150 98


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