Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: 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)

A prospective study of staphylococcal lower respiratory infection in 31 children aged 1-48 months has shown that radiologically, patchy consolidation was the single most common lesion, followed by pleural effusion with or without pneumothorax. Although the mean respiratory rate was 65/minute, it was below 50/minute in 8 cases. Complications include heart failure in 9 cases and severe anaemia necessitating blood transfusion in 9 others, seven (78%) of whom had pleural effusion. Finally diagnoses were bronchopneumonia alone in 16 (52%) cases, pyopneumothorax alone in 6 (19%), pyopneumothorax plus pneumonia in 5 (16%), pleural effusion in 2 (6%) cases and one case each of lobar pneumonia alone and a combination of lobar and bronchopneumonia. Staphylococcus aureus was isolated from the blood in 8 (62%) of 13 children with pleural effusion, indicating a need to consider parenteral antibiotic administration in the initial management of children with staphylococcal pleural effusion. Three (9.7%) patients died; they were all malnourished children who did not receive antibiotics prior to presentation; they all had bronchopneumonia, positive blood cultures and respiratory rates of 60/minute.
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PMID:Staphylococcal lower respiratory infection in children. 808 Aug 38

Esophagectomy without opening the thoracic cavity--transhiatal esophagectomy--(THE) were performed in 47 patients with malignant tumors localized at various levels of the esophagus. Pulmonary function studies were performed in all patients and they are categorized as low, moderate, or high risk for probable postoperative pulmonary complications according to the risk category system. Nine of these patients were classified as high risk, seven as moderate risk, and the rest as low risk. In all patients but four, reconstruction was accomplished by using their stomachs as a substitute. In the remaining patient, intestinal continuity was established by a left and right colonic interposition. Three patients were lost in the early postoperative period. Two patients categorized as low risk died from pulmonary thromboembolism and cardiac failure, respectively. One patient categorized in the high risk group died of coronary thrombosis. Postoperative complications included transient hoarseness due to recurrent laryngeal nerve paresis in one patient, right pleural effusion in one patient, pneumothorax in two patients, and thrombophlebitis in one patient. In the high risk patient group, there were no pulmonary complications. This clinical study demonstrated the protective effect of THE in patients with serious pulmonary problems.
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PMID:Transhiatal esophagectomy for esophageal carcinoma in Turkey: with special reference to respiratory function. 829 63

The so-called percutaneous dilatational tracheostomy-essentially a minimally invasive puncture method-inserting the tracheal cannula by a modified Seldinger-technique is an alternative method to the conventional operative tracheostomy. The percutaneous dilatational tracheostomy was evaluated in a prospective trial (June 92-January 93) on 50 consecutive surgical (n = 36), medical (n = 10), and neurological-neurosurgical (n = 4) critically ill patients (29 m, 21 f; age 14-87 years) with need for prolonged mechanical ventilation. After an average duration of endotracheal intubation of 6 (0-22) days, the procedure was endoscopically guided and controlled via the endotracheal tube. An 8 mm cannula was inserted in each case. Eight patients had severe thrombocytopenia (< or = 50,000 Plt./microL). The percutaneous tracheostomy was always performed with success. The average procedure duration was 8 (5-15) minutes. The perioperative complications were: one patient died of acute cardiac failure independent from the method of tracheostomy, one sustained a temporary subcutaneous emphysema and one a minor bleeding. During a mean duration of cannulation of 21 (0-113) days only one bleeding from the skin margin was observed postoperatively. Infection of stoma site, misplacement of cannula, rupture of the tube cuff, and pneumothorax were not noticed. On 13 decannulated patients stenosis of the trachea was not found in a period of 6-8 weeks following the tracheostomy. As a bedside procedure the percutaneous dilatational tracheostomy is safe and quick and should therefore be the method of choice for critically ill patients who require a tracheostomy.
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PMID:[Puncture tracheostomy in intensive care patients. Technique and results of a minimally invasive method]. 837 22

The occurrence of complications in course of thoracoscopic vegetative denervation has been found low in the author's analysis of his 2679 cases. There arose several small lung lesions with consecutive pneumothorax or tension pneumothorax, furthermore some events of emphysema of the skin, one bleeding of an intercostal artery, which was stopped under thoracotomy, one division of the thoracic duct, one thrombosis of the anterior spinal artery, one cardiac failure. On the other hand there could be avoided air embolism, Horner's syndrome, lesions of recurrent and phrenic nerve, damage on trachea, bronchial tree, oesophagus and big vessels.
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PMID:[Possible complications of transpleural neurotomy]. 837 56

The most important technical improvements of implantable cardioverter-defibrillators (ICD) of the latest generation comprise more sophisticated antitachycardia pacing options, stored intracardiac electrograms and biphasic shock capabilities which virtually always allow ICD implantation without thoracotomy. The present study summarizes the first clinical experience with these new devices. In 37 consecutive symptomatic (near sudden death 17, syncope 16, pre-syncope 4) patients aged 56 +/- 10 years with refractory ventricular arrhythmias (presenting arrhythmia: ventricular fibrillation 14, ventricular tachycardia 22, not documented 1), an ICD (Jewel PCD 7219, Medtronic) was implanted. Coronary artery disease was present in 21, dilated cardiomyopathy in 5, valvular heart disease in 2 and various conditions in 8 patients; the mean left ventricular ejection fraction was 43 +/- 18%. In 29 patients (78%), the ICD was inserted in a pectoral and in 8 (22%) in an abdominal position. A non-thoracotomy lead (NTL) configuration was successfully implanted in 36/37 patients (97%) (purely transvenous systems in 30, in combination with subcutaneous patch electrode in 6). Surgical complications comprised one pneumothorax, one hemorrhage and one death due to sepsis; during a mean follow-up of 5 +/- 3 months, another patient died of heart failure and 2 revisions (5.4%) for lead problems (1 connector, 1 SQ-patch) became necessary. In 23/37 patients (62%), the ICD was activated after 74 +/- 89 days post implant. 22 of these 23 patients (96%) received one or more appropriate shocks (9 +/- 22 shocks per patient). The actuarial survival was 95% at 6 months. In the present study, an ICD of the newest generation was successfully implanted without thoracotomy in > or = 97% and with purely transvenous systems in > or = 84%. Compared to older systems, this has made the implantation procedure remarkably easier and will most likely lead to a further reduction in mortality and morbidity. Despite the relatively short follow-up, the high incidence of appropriate ICD utilization underscores the high recurrence rate of arrhythmias in this population and suggests that the ICD may be very effective in preventing unnecessary rehospitalizations.
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PMID:[Initial clinical results with a novel implantable cardioverter-defibrillator: a prospective evaluation in 3 Swiss university hospitals]. 855 30

In critical care patients requiring prolonged mechanical ventilation, tracheostomy is necessary. Alternatively to the standard surgical method, a percutaneous dilatational technique is available. From September 1993 to October 1994 38 critically ill neurosurgical patients underwent tracheostomy using the minimal invasive puncture method. The patients were aged between 20 and 92 years. The average duration of the tracheostomy was 7.5 [4-15] minutes and was performed bed sided at the ICU. The tracheostomy was controlled endoscopically through the naso- or orotracheal tube. A 8 mm cannula was inserted in each case. One patient died during the procedure of sudden fulminant pulmonary artery embolism. One procedure had to be interrupted because of cardiac failure. In this patient the tracheostomy was performed the day after under optimized conditions. There was no peri- or postoperative bleeding, no pneumothorax, no misplacement of the cannula. An infection of the stoma site was not noticed. The decannulation did not cause any complications (16 cases). The stoma was closed within a few days, only a small scar remained. The bed side procedure of percutaneous dilatational tracheostomy is a safe and quick technique. There is no need to disconnect the patient from intensive monitoring for means of transportation to the surgery room. Thus we find it the method of choice for critically ill neurosurgical patients.
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PMID:[Percutaneous puncture tracheostomy in neurosurgical intensive care patients]. 890 Aug 99

A review summarizing recent findings on the causes of the development, pathogenesis, diagnosis and treatment of acute cardiac failure. It is a condition when the heart is unable to pump blood in amounts needed for the metabolic activity of tissues. It may be the first manifestation of disease or acute deterioration of chronic heart failure. The most frequent causes of acute left-sided failure include acute myocardial infarction, arterial hypertension, valvular defects, myocarditis, toxic damage or metabolic myocardial disorders. In right-sided failure pulmonary embolism, extensive affections of the lungs and pleura, right ventricular infarction and affection of the pericardium predominate. The clinical picture of cardiac failure is due to a combination fo the basic disease, evoking causes, signs of an inadequate minute volume, transudation of fluids into the interstitium and the presence of compensating mechanisms. The diagnosis of cardiac failure is based on an analysis of subjective and objective clinical symptoms and other auxiliary examinations such as X-ray examination of the chest, electrocardiogram, echocardiography, examination of blood gases and other laboratory examinations. In right-sided insufficiency the examination is supplemented by pulmonary scintigraphy, possibly by catheterization of the right heart and pulmonary angiography. As to the differential diagnosis, we must differentiate from acute cardiac failure, asthma bronchiale, spontaneous pneumothorax, dyspnoea in neuroasthenic patients, non-cardiac pulmonary oedema. Treatment of cardiac failure involves lifestyle and dietary provisions, medicamentous treatment which has undergone great changes in recent years. Cardiac failure is controlled by reduction of the cardiac filling pressure and support of the efficiency of the cardiac pump (Inotropy) and control of excessive fluid and salt retention. Decisive for the subsequent development of the disease is diagnosis of the basic cardiac or non-cardiac disease and its aimed treatment. In uncontrolled cardiac failure mechanical support of cardiac activity and transplantation of the heart are options.
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PMID:[Clinical aspects of acute heart failure]. 892 24

Lung volume reduction (LVR) is a new surgical approach designed to relieve shortness of breath and to improve exercise tolerance in patients with severe lung emphysema. Selection of patients for LVR is based on history, clinical investigation, chest X-ray studies, CT scan, lung perfusion scan, lung function testing, and blood gas analysis. Selection criteria are severe emphysema (FEV1 20-35% pred., TLC > 120% pred., RV > 250% pred.), dyspnea despite optimized medical therapy, abstinence from smoking, acceptable nutritional status and rehabilitation potential. Patients with a uniform pattern of lung destruction benefit far less than those with a more localised pattern (> 30% on chest X-ray or CT scan) with the remaining lung being quite normal and a reduced perfusion of only the damaged areas. Prior to the final decision for LVR, all patients are enrolled in a supervised rehabilitation programme of 4 weeks duration. Some patients benefit so much that LVR can be postponed. The surgical approach of choice is a median sternotomy for bilateral LVR when the upper lobes are the target areas and a bilateral thoracotomy if the lower lobes are mainly affected. When a bilateral procedure is contraindicated, a unilateral approach may be an option. It is not yet clear whether an approach by thoracoscopy allows adequate surgical removal of all affected areas and whether the morbidity is lower. Laser ablation is a further therapeutic option but is much less effective than the surgical resection. Reinforcement of sutures using bovine pericardium strips reduces the chance of a prolonged air leak but is expensive. The results from our institution in 57 patients 1 month after LVR surgery showed the following improvement in dyspnea was a consistent finding in 88% of patients, the 6-min walking distance increased on average by 150 m, the FEV1 by 0.3 1 for unilateral LVR and 0.5 1 for bilateral LVR. The mean PaO2 in ambient air increased 6 mmHg after unilateral and 8 mmHg after bilateral LVR. There was also a significant improvement in respiratory muscle function and a reduction in respiratory drive. A significant improvement in quality of life was documented in 83% of the patients. Major hospital complications are prolonged air leak, pneumonia, and myocardial failure. Three cases of a delayed pneumothorax were observed. Early hospital mortality (< 30 days) was 1.7% and 90 days mortality 3.4%. Few follow-up data are available beyond 1 year, and the long-term benefit of LVR surgery therefore remains to be defined.
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PMID:[Principles of lung volume reduction]. 908 81

Recently, spinal cord stimulation (SCS) has been used for the treatment of patients in prolonged coma. However, the results of SCS in unresponsive patients with hypoxic encephalopathy at the chronic stage have not been satisfactory. Considering these circumstances, we began SCS from one month after the onset of hypoxic encephalopathy and evaluated its effect. Twelve patients (5 males and 7 females) with hypoxic encephalopathy, ranging in age from 7 to 72 years, were treated with SCS. The causes of hypoxia were acute cardiac failure in 4, automobile exhaust gas poisoning in 2, and asthma, pneumothorax, anaphylaxis, asphyxia, drowning and hypotension during aortic surgery in one patient each. One month after the onset, an electrode for electrical stimulation was implanted in the epidural space at the C2-C4 level under general anesthesia. The spinal cord was stimulated for 8 hours each day, starting on the day after implantation, and was continued for 3 months. Magnetic resonance imaging (MRI), cerebral blood flow (CBF) measurement using xenon-computed tomography (Xe-CT), and measurement of auditory evoked potential (AEP) and somatosensory evoked potential (SEP) were carried out 3 weeks after the onset for presurgical evaluation. Among the 12 patients, 7 (58%) showed clinical improvement, beginning within two weeks after starting stimulation. They were able to communicate with others and to express their emotion. However, disturbance of writing, picture drawing and calculation were not improved by stimulation. From presurgical evaluation, cases in which SCS therapy was effective had the following features: 1) No hemorrhagic infarction in the basal ganglia was demonstrable by MRI. 2) Mean hemispheric CBF measured by the Xe-CT method exceeded 25 ml/100 g per min. 3) The mean increase in hemispheric CBF 20 min after acetazolamide administration exceeded 5 ml/100 g per min. 4) An N20 peak was evident on the median nerve SEP, SCS appears to be an effective supplementary for unresponsive patients with hypoxic encephalopathy at the subacute stage, in addition to rehabilitation and drug therapy.
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PMID:[Spinal cord stimulation therapy at an early stage for unresponsive patients with hypoxic encephalopathy]. 959 12

Pleural involvement is frequently seen among patients hospitalized in Intensive Care Units (ICU). In most cases, patients are hospitalized with or will develop scarce transsudative effusion secondary to cardiac failure or atelectasis. Other pleural issues in ICU concern pneumothorax in ventilated patients (barotrauma), empyema following nosocomial pneumonia or investigation procedures. More rarely hemo(pneumo)thorax or chylothorax will be diagnosed. As a rule, acute pleural pathologies rarely justify hospitalization in the ICU, depending on the etiologic mechanism or concomittant clinical signs of intolerance (respiratory insufficiency, collapsus, coma...). After tube thoracostomy, most patients will be managed in the respiratory ward to monitor the drainage, to begin etiologic diagnosis and to discuss a possible surgical intervention, usually a few weeks or months after the ICU.
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PMID:[Management of acute pleural diseases in intensive care units]. 1061 48


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