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)

Forty patients were operated on in the early phase of active endocarditis between 1980 and 1988. Indications for operation were heart failure (30 patients), severe valvular regurgitation (4), uncontrolled sepsis (2), septic emboli (3), and other (1 patient). Time between onset of endocarditis symptoms and operation ranged from 12 to 45 days (mean, 30 days). The aortic valve was involved in 3 patients; the mitral valve, in 28; both valves, in 7; and the tricuspid valve, in 2. There was no previous underlying valve pathology in 40%. Lesions found were cusp perforation (17 patients), annular abscess (4), vegetation (13), and chordal rupture (22). Positive blood cultures were found in 30 patients (75%). Bacterial findings were Streptococcus in 12 patients (30%), Staphylococcus in 15 (37.5%), gram-negative in 3 (7.5%), and unknown in 10 (25%). Criteria to perform valve repair were adequate antibiotic therapy for at least 1 week and large excision of all macroscopically involved tissues. In all cases, Carpentier's reconstructive techniques were used. Perioperative mortality was 2.5% (1 patient). Reoperation was necessary in 1 patient. Late mortality was 2.5% (1 patient). Repair was assessed either by angiography or by Doppler echocardiography before hospital discharge: 32 patients showed no regurgitation, whereas 7 had mild regurgitation (3 aortic, 4 mitral). Mean follow-up of 30 months was achieved in all survivors. There was no recurrence of endocarditis and no reoperation for valvular insufficiency. We conclude that valve repair in acute endocarditis is possible and effective in most instances.
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PMID:Valve repair in acute endocarditis. 233 26

Left ventriculography (LVG) was performed to assess severity of mitral regurgitation (MR) on a scale of 0-4+ in 157 patients before and immediately after percutaneous mitral balloon valvotomy (PMV). There were 129 women and 28 men aged 51 +/- 1 (range 13-87) yr. With PMV, mitral valve area increased from 0.9 +/- 0.1 cm2 to 2.0 +/- 0.1 cm2 (P less than .0001). Increase in mitral regurgitation (MR) occurred in 69 patients (44%). Patients were divided into two groups based on increase in MR after PMV. Group A (n = 136) had 0-1+ increase in MR. Group B (n = 20) had greater than or equal to 2+ increase in MR after PMV. The only predictor of increase in MR greater than or equal to 2+ was the ratio of effective balloon dilating area to body surface area (EBDA/BSA). EBDA/BSA was 4.0 +/- 0.1 cm2/m2 in Group A vs. 4.37 +/- 0.2 cm2/m2 in Group B (P = .02). Follow-up of patients in Group B showed: Four patients remained NYHA Class III and required mitral valve replacement 4.3 +/- 1.1 (range 5-21) mo after PMV. One patient who had undergone combined aortic and mitral valvotomy died in the hospital of worsening heart failure. One patient died 1 mo later of sepsis related to a dental abscess. Follow-up of the remaining 14 patients at 9.5 +/- 1.1 (range 2-7) mo showed 10 in NYHA Class I and four in NYHA Class II. Eight of 15 patients (53%) who had repeat left ventriculogram at 9.0 +/- 0.8 mo after PMV had a decrease in MR of one grade when compared to LVG immediately after PMV.
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PMID:Predictors of increased mitral regurgitation after percutaneous mitral balloon valvotomy. 234 3

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

The present study explored the possibility of using a short-term dobutamine infusion to disclose oxygen uptake/supply dependency. The effects of a standard dose of 5 micrograms/kg/min of dobutamine on oxygen-derived variables were studied in 73 acutely ill patients with heart failure (n = 24) or sepsis (n = 49). In each group, patients were separated according to their blood lactate concentrations (either above or below 2 mEq/L). In all patient groups, dobutamine resulted in significant increases in cardiac output and oxygen transport. However, oxygen consumption increased significantly only in patients with elevated blood lactate levels (cardiac failure: from 108 +/- 26 to 131 +/- 25 ml/min/M2, n = 8, p less than 0.01; sepsis: from 139 +/- 44 to 167 +/- 68 ml/min/M2, n = 16, p less than 0.01) and not in the other patients (heart failure: from 121 +/- 29 to 115 +/- 31 ml/min/M2, n = 28, NS; sepsis: from 158 +/- 39 to 166 +/- 45 ml/min/M2, n = 21, NS). These data, therefore, indicate that dobutamine at the dose used does not increase oxygen consumption in critically ill patients unless there is coexistent tissue hypoxia reflected by increased blood lactate levels. A short-term dobutamine infusion can be used to disclose an oxygen uptake/supply dependency phenomenon.
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PMID:Oxygen uptake/supply dependency. Effects of short-term dobutamine infusion. 236 71

Serum concentration, urinary excretion and clinical application of aztreonam (AZT) were studied as follows: 1. Serum concentrations of AZT 1 hour after intravenous injection were 21.0 micrograms/ml in 1 case administered with approximately 10 mg/kg drug and 44.2 micrograms/ml on the average for 7 cases given approximately 20 mg/kg, indicating that serum concentrations are dose-dependent. Average serum half-life in 3 mature babies was 4.75 hours and that in 4 premature babies was 6.59 hours thus T 1/2 was longer in the latter. T 1/2 of 64 days of age newborn was 3.80 hours. Urinary recovery rates in 2 cases examined were 52.1 and 51.9%. 2. Daily dosages of AZT 39.9-63.3 mg/kg were intravenously administered to 10 newborns and prematures b.i.d. or t.i.d., 5 cases of which received AZT alone and the other 5 received AZT in combination with ampicillin (ABPC). Of the above 10 cases, AZT was given to 8 cases for treatment and to the other 2 cases for prophylaxis. Excluding 2 unascertainable cases, AZT showed good or better effectiveness in all the 6 cases in the treatment group, i.e., sepsis 1, suspected sepsis 1 and urinary tract infection 4 cases. All the identified pathogens (Escherichia coli 2 strains, Klebsiella pneumoniae 1 strain and Enterobacter 2 strains) were eliminated by the treatment. No onset of infection was observed in either of the 2 cases with prophylaxis. One of them was administered with AZT for 52 days consecutively but neither side effect nor abnormal laboratory test value was observed. 3. Side effect was not observed at all. One case each of minor degree of platelet increase and GOT elevation was recorded as an abnormal test value. The elevated GOT value continued to be high even after the completion of the administration and it was presumed to be due to the primary disease, heart failure. 4. As results of the above studies, AZT was considered to be effective and safe for neonatal infections caused by Gram-negative bacteria. It may be safer to initiate the treatment with AZT and ABPC in combination than with AZT alone before the identification of pathogen and to change the therapy to single administration of either AZT or ABPC when the pathogens are identified. With respect to method of administration, AZT 20 mg/kg 2 or 3 times a day appeared to show expected efficacy for the newborns with in 7 days after birth.
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PMID:[Clinical evaluation of aztreonam in neonatal infections]. 237 99

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

From 1974 to 1984, 46 patients underwent emergency surgery for acute native valve endocarditis. Urgent valve replacement was necessary because of rapid hemodynamic deterioration in 34 (73%), uncontrolled sepsis plus heart failure in 9 (19%), and life-threatening emboli in 3 (7%) patients. At the time of surgery 23 patients (50%) were in NYHA functional class IV, 20 in Class III, and 3 in class II. Streptococcus was the most common organism encountered, followed by staphylococcus. Thirty-four cases presented severe aortic regurgitation, 3 mitral incompetence, 8 mitral plus aortic insufficiency, and one aortic plus tricuspid insufficiency. Operative mortality rate was 17% (8/46). Most deaths were due to preoperative multiple system deterioration, especially in cases with lesions of both the aortic and mitral valves, and were unrelated to the duration of preoperative antibiotic therapy. The postoperative observation period of long-term survival is from 6 to 102 months (= 44 months). There were 7 late deaths. The actuarial survival, including operative mortality, is 67%. Twenty-two patients are now in NYHA class II, 6 in class III. The duration of postoperative antibiotic treatment (6 weeks in our series) seems to be important for the prevention of reinfection, early surgery is of great benefit; our 31 survivors showed an excellent clinical improvement.
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PMID:Valve replacement in acute native valve endocarditis. 242 26

The results of combined medical and surgical management of 66 patients with active prosthetic valve endocarditis (APVE) are analyzed. Between 1970 and 1985, 3510 patients were operative survivors of mitral, aortic or double mitral-aortic valve replacement. Cumulative follow-up was 15,640 patient-years (mean 4.4 years). The overall annual incidence of reoperation for APVE was 0.42 +/- 0.05% (0.34 +/- 0.08% for biological and 0.46 +/- 0.06% for mechanical prostheses, p = n.s.). Early APVE occurred in 21 patients and 45 patients had late APVE. Indications for surgery were heart failure in 92%, systemic emboli in 5% and persistent sepsis in 3% of patients. Overall operative mortality (less than 30 days) was 38% (25/66). (Early APVE 52% and late APVE 31%). Anatomical location, valve design and number of prostheses implanted did not correlate with a higher operative risk. Overall endocarditis-related mortality was 56% (37/66). Uni and multivariate stepwise logistic regression analysis identified: 1) date of surgery (p = 0.01), 2) renal failure (p = 0.03) and 3) early APVE (p = 0.03) as predictors of endocarditis-related death. Actuarial survival at 1, 5 and 10 postoperative years was 41 +/- 6%, 30 +/- 6% and 24 +/- 7% respectively. This study confirms the high lethality of APVE. However, with adequate and aggressive combined medical and surgical management, some patients can be saved.
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PMID:Surgical treatment of active prosthetic valve endocarditis. Results in 66 patients. 244 2

The efficacy, morbidity, and 1-year follow-up of balloon aortic valvuloplasty in patients with low ejection fraction (less than 40%) were studied on a consecutive series of 55 patients (mean age, 77 years) treated from September 1985 to February 1987. Because of their age (20 patients greater than 80 years old), poor left ventricular function, and associated diseases, 45 patients were definitely not surgical candidates. Balloon dilatation with 15-23-mm diameter balloon catheters decreased the transvalvular gradient from 66 +/- 24 to 28 +/- 14 mm Hg (p less than 0.001) and increased the valve area from 0.47 +/- 0.15 to 0.83 +/- 0.27 cm2 (p less than 0.001). Immediately after dilatation, ejection fraction mildly increased from 29 +/- 7% to 34 +/- 9% (p less than 0.001) in 38 patients who had undergone a second left ventricular angiogram after dilatation. No significant change in the degree of aortic regurgitation was found after the procedure. Three patients died in hospital (femoral arterial complications in two, septicemia in one). Immediate clinical improvement was noted in 80% of the patients. During the follow-up (mean, 11 months), 22 patients died (heart failure in 15 patients, sudden death in five patients, myocardial infarction in one patient, cancer in one patient). Thirty patients survived, 21 with persistent clinical improvement. Repeat cardiac catheterization was performed at 6 months in 20 patients, of whom eight had recurrence of symptoms. Nine patients had restenosis: their hemodynamic indexes had returned to prevalvuloplasty values.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Percutaneous balloon valvuloplasty in patients with severe aortic stenosis and low ejection fraction. Immediate results and 1-year follow-up. 247 May 29

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


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