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

Neonatal cyanosis due to pulmonary atresia is seen in one-third of all cyanotic neonates with congenital malformation of the heart. In both types of this disorder survival is dependent on patency of the ductus arteriosus. Consequently the first days of life most often show dramatic changes in clinical status, sometimes similar to that in patients with transposition of the great arteries. Intensive care treatment of the baby, rapid diagnostic management and early operative intervention may improve the poor prognosis. Because of the numerous cardiopulmonary and diagnostic complications, only 50 percent of patients will reach 4 weeks of age if not operated. We describe an unusual case of type 2 pulmonary atresia with intact ventricular septum in which pulmonary complications led to irreversible cardiac failure. Aneurysmatic enlargement of the right atrium caused compression atelectasis of nearly all parts of the lungs, followed by a unilateral pneumothorax after postnatal emergency ventilation. Clinical and circulatory status deteriorated. Successful pharmacological or operative therapy was impossible at this point. We want to stress upon the fact that - despite the hopeless situation of our patient - we were able to establish diagnosis by improvised procedures, which can be performed in every ICU.
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PMID:[Compression of both lungs by severe right heart dilatation in congenital pulmonary atresia]. 296 76

Phrenic nerve palsy (PNP) is seen in infants and young children usually resulting from operative trauma or birth injury. Spontaneous recovery usually occurs, but occasionally surgical plication is necessary. Twenty-three cases of PNP over a 10-year period were managed surgically. Patient ages ranged from 1 day to 30 months (median, 4 months), 18 were male and five female. Cause was operative trauma in 18 (17 cardiac surgery, one neuroblastoma), birth trauma in two, and idiopathic in three. The right side was involved in 14, the left in eight, and both in one. Indications for plication were inability to wean from the ventilator (group 1, 16 patients), recurrent pneumonia (group 2, four patients), and respiratory distress (group 3, three patients). The 16 patients in group 1 were intubated for a median of 18.5 days from onset of PNP to plication. Postoperatively, three had continuing congestive heart failure (one died at 16 days of age, one was still chronically ventilated at 22 months, one was extubated at nine days); the other 13 were extubated at a median of two days postoperatively. All the patients in groups 2 and 3 were extubated within two days of surgery. Twelve plications were transthoracic and 11 were transabdominal. Postoperative complications included pneumonia (2), wound infection (1), pneumothorax (2), and mucous plug with pulmonary collapse (1). One patient died of cardiac failure at 16 days. One patient in group 3 developed recurrent respiratory distress 4 months postoperatively; he had a recurrent elevated hemidiaphragm requiring a second plication.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Plication of the diaphragm for infants and young children with phrenic nerve palsy. 317 45

The clinical course of 13 cystic fibrosis patients with a total of 24 episodes of pneumothorax was analysed. The study is based on 488 (273/215) patients seen over 20 respectively 10 years at the University Children's Hospitals Frankfurt/Main and Essen. A pneumothorax was observed with a frequency of 2.7% mainly in adolescents of young adults with advanced pulmonary disease (mean age 17.4 years). It was not seen before the age of 10 years. Thus among 255 patients at risk above 10 years a pneumothorax occurred in 5.1%. Presenting symptoms were acute chest pain (n = 17), dyspnea (n = 17) and irritating cough (n = 8). In two patients pneumothorax was an incidental diagnosis. A tension pneumothorax was seen in 7 (= 30%; 3 initial, 4 recurrences of which 3 were ipsilateral). Out of 11 recurrences (n = 6, ipsi- and n = 5, contralateral) 4 occurred only once, one twice and in one patient five times. Two patients died as a consequence of the event (one initially due to tension pneumothorax, one due to heart failure). The therapeutic approach was conservative. Without specific treatment pneumothorax resolved in 12 cases. Ten patients were treated by chest tube drainage and only one patient by pleurodesis with a sclerosing agent. Though the therapeutic results were favorable in the patients presented, the authors suggest more aggressive treatment in view of the high ipsilateral recurrence rate. Detailed recommendations are given.
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PMID:[Spontaneous pneumothorax in cystic fibrosis]. 340 26

An experimental model was constructed to simulate a persistent ductus arteriosus (PDA) in infants. In 21 beagles (mean weight, 8.2 kg), a piece of subclavian artery was interposed between the main pulmonary artery and the aorta, thereby creating a large left-to-right shunt across the short, straight arterial pathway. There were no intraoperative complications. Three animals died postoperatively of stenosing tracheitis, pneumothorax, or bronchopneumonia. The model proved suitable for the serial testing of a new transvenous catheter closure procedure. Occlusion of the shunt was mandatory within a day after placement or severe heart failure would occur. Twelve animals with a released silicone double-balloon plug inside the vascular connection had a long-term follow-up of up to three years. Autopsy findings after the death of the animals at specified intervals revealed smooth ingrowth of the anastomoses and occlusion, by endothelialized fibrous tissue, of the pulmonary and aortic sides of the plugged experimental PDA within a month.
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PMID:The experimental production of a persistent ductus arteriosus for testing catheter closure devices. 399 44

The present study concerns the morphological and biochemical lesional picture of the myocardium in cases of acute heart failure induced by various experimental models: ligature of the coronary artery, direct electric stimulation of the heart by catheterism, lethal hemorrhage, pneumothorax, beta-adrenergic shock. Worthy of note was the similitude of the lesional myocardium pictures characterized electron microscopically by a wide range of lesions, from reversible to focal cytolysis, and biochemically by decrease of mitochondrial enzymes, ATP, Mg2-1 X K+ and increase of Na+ X H2O, Ca2+. Problems linked to the pathogenesis, reversibility of the lesions and efficiency of certain therapeutical means are discussed.
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PMID:Myocardial lesions in experimental acute heart failure. 623

A four - month old boy with Salmonella Typhimurium meningitis is presented. This patient was admitted to the hospital with a diagnosis of staphylococcal pneumonia, pyo-pneumothorax, cardiac failure and anemia. He has been treated for 18 days and he was discharged in good condition. Two days after discharge patient was readmitted with a fever, vomiting and feeding problem. In physical examination, stiff neck and bulging of the fontanel were remarkable. Examination of cerebrospinal fluid (CSF) has revealed meningitis and cultures of blood and CSF specimens were positive for S. typhimurium. It was sensitive only to trimethoprim sulphamethoxazole and netilmicin. Trimethoprim sulphamethoxazole (IM) and netilmicin (IV) were given. At the fifth day of this treatment patient expired. Postmortem examination has revealed the same agent in both meninges tissue and CSF cultures.
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PMID:[Salmonella meningitis]. 636 87

The authors report a case of bilateral hilar lymphoma of sarcoid origin associated with a pleural effusion. With the exception of pneumothorax, the pleural manifestations in the course of sarcoidosis amount to 115 published cases, including 49 with histopathological proof enabling us to speak of a pleural sarcoidosis. When the histopathological diagnosis is missing, it is preferable to speak of sarcoidotic pleurisy: the aetiopathogenesis in this case is venous obstruction and/or lymphatic obstruction by sarcoid involved lymph nodes. Exceptionally, it could be due to heart failure due to the fibrotic stage of sarcoidosis or to an autonomous sarcoidotic myocarditis.
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PMID:[Pleurisy and sarcoidosis. Apropos of a case]. 665 55

The most important and consistent symptom of acute PE is the sudden onset of dyspnoea unexplained by pneumonia, heart failure, pneumothorax, or exacerbation of airway obstruction. The features commonly remembered such as haemoptysis and pleural rub may be absent in up to two thirds of patients. With previous cardiorespiratory disease the signs and symptoms become nonspecific and a relatively minor PE can produce clinical features more suggestive of a large embolus. Hypoxia and a raised respiratory rate are also suggestive but cannot be relied upon if there is pre-existing cardiorespiratory disease or in the elderly. Although the radiological appearance of an infarct shadow may be recognized, the chest X-ray is frequently nonspecific or normal. A negative perfusion scan excludes any significant emboli and an abnormal perfusion scan is suggestive of PE but not diagnostic; its specificity can be increased considerably if facilities are available for a concurrent ventilation scan. A deep venous thrombosis when present is also indicative of PE, although its absence does not preclude the diagnosis. Factors predisposing to deep venous thrombosis are usually present in the patient with PE. No single diagnostic aid can be relied upon in the diagnosis of PE. As with many illnesses much of the evidence begins with a careful consideration of the presenting history and physical signs. Further help can be obtained from various investigations, but results must be interpreted with consideration of the patient's age and pre-existing health. The final diagnosis may need to be established by pulmonary angiography.
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PMID:Diagnostic criteria for pulmonary embolism. 701 62

A retrospective review was carried out of the radiographic features of 1016 adults admitted to hospital with acute asthma over a 4-year time period. The radiographic features were classified into five groups: (I) normal, 536 patients (52.9%); (II) features compatible with obstructive lung disease, 323 patients (31.8%); (III) complications of asthma including infection, segmental or greater atelectasis, one case of pneumomediastinum and one case of pneumothorax, 83 patients (8.2%); (IV) unimportant incidental findings, six cases (0.6%); and (V) important incidental findings including tuberulosis, heart failure, and bronchial neoplasm, 68 cases (6.7%). We conclude that in this large series of patients presenting with asthma symptoms severe enough to merit admission there is an incidence of clinically significant radiographic abnormalities of approximately 15%. Admission chest radiography is therefore indicated in adults who are hospitalized with acute asthma.
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PMID:Radiographic features in 1016 adults admitted to hospital with acute asthma. 789 9

The abdominal pressure is a hydrostatic one, which can be measured in the bladder, the rectum and the stomach. In physiologic conditions, the abdominal pressure is variable, with peaks as high as 100 to 200 mmHg at the time of defecation, cough. The increase in abdominal pressure elicited by abdominal distension or compression acts directly on the abdominal compartment, indirectly on the thoracic compartment, and modifies the circulation and the ventilation. Venous return is decreased as the inferior vena cava is compressed. The systemic resistances are also increased as the abdominal vessels are compressed. Therefore the circulation is mainly distributed to the superior part of the body. Although the cardiac output is decreased, the usual haemodynamic parameters remain in the normal range: arterial pressure is increased, heart rate is unchanged, central venous pressure is increased, cardiac failure is unusual. The abdominal distension is also responsible for a restrictive respiratory syndrome, mainly due to the ascension of the diaphragm. The compression of the abdominal content explains renal effects and the decreased diuresis. A sustained increase in abdominal pressure occurs in several clinical conditions. During coelioscopy, abdominal pressure is a under control and the cardiovascular effects are minor. Insufflation with CO2 carries the risk of hypercapnia, gas embolism and pneumothorax. During abdominal tamponade, anuria is directly related to the level of pressures. At an abdominal pressure over 25 mmHg, anuria is common and decompression becomes essential. The G suit increases arterial pressure either by elevating vascular resistances or increasing blood content in the upper part of the body. Therefore cardiac tolerance can be decreased especially in cardiac patients. The adverse effects of abdominal pressure can also be observed in case of peritoneal dialysis and ascites. The risk of regurgitation associated with an increased abdominal pressure must also be kept in mind. The abdominal pressure plays an important role in anaesthesia as well as in surgery. Therefore its measurement, which is easy, should become a routine.
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PMID:[Intra-abdominal pressure]. 799 45


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