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)

Capillary permeability to albumin (CPA) was studied by performing an isotopic noninvasive test with venous compression on 87 nonselected diabetics with no edema, no cardiac failure, and no peripheral vascular disease. Excessive albumin retention (AR greater than or equal to 8%) ten minutes after removal of the compression was found in 27 patients (31%). The radioactivity disappearance curve was then analyzed using the Fast Fourier Transform (FFT). An abnormal isotopic CPA test was thus found in at least 45 out of the 87 patients. The prevalence of an abnormal test was not different in type 1 and type 2 diabetics. We studied the independent effects of hypertension, presence of specific clinical signs of microangiopathy (retinopathy and/or significant proteinuria), and duration of diabetes. Among diabetics free of specific clinical signs of microangiopathy, the prevalence of an AR greater than or equal to 8% was significantly higher in those with hypertension (11/19) than in those with normal blood pressure (2/28) and in nondiabetic hypertensive patients (0/16). Among normotensive diabetics, the prevalence of an abnormal test was higher, but not significantly, in patients with specific clinical signs of microangiopathy (8/11) than in those free of them (7/18). Seven normotensive diabetics without specific clinical signs of microangiopathy had an abnormal test; five of them had had diabetes for more than five years. The prevalence of diabetes of more than five years duration was significantly higher in patients with an abnormal test (35/45) than in normotensive diabetics free of specific clinical signs of microangiopathy with a normal test (4/11).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Isotopic test of capillary permeability to albumin in diabetic patients: effects of hypertension, microangiopathy, and duration of diabetes. 362 65

The results of renal transplantation for end-stage diabetic nephropathy in 17 patients--11 receiving cadaver (CD) grafts and 6 related living donor (RLD) grafts--are reported. The transplants were rejected in 5 cases, in 4 acutely, and these patients were returned to haemodialysis; 3 of them subsequently died. One patient died of heart failure, but the graft was still functioning. The remaining 11 patients enjoy good renal function. The outcome was superior to results on dialysis, particularly for RLD grafts, and was comparable to results of transplantation for non-diabetic renal failure. Visual acuity tended to stabilize or improve after transplantation, but peripheral vascular disease progressed. Blood glucose control was suboptimal and requires more attention. Lipoproteins did not differ from those in non-diabetic patients. Renal transplantation is feasible and probably the preferred method of treatment for end-stage diabetic nephropathy.
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PMID:Transplantation for diabetic nephropathy. 389 12

Blood flow to working skeletal muscle is frequently reduced in patients with heart failure or peripheral vascular disease. To determine if phosphorus nuclear magnetic resonance (NMR) can noninvasively detect such muscle underperfusion, gated phosphorus-31 NMR spectroscopy was used to compare muscle inorganic phosphate, phosphocreatine and pH during mild wrist flexion exercise at 0.2, 0.4 and 0.6 W in eight normal men, before and after reduction of forearm blood flow. Forearm flow was reduced by cuff inflation to a pressure determined by Doppler ultrasound to bring flow to 40 to 60% of control. Attention was focused on the inorganic phosphate to phosphocreatine (Pi/PCr) ratio and pH, two variables potentially sensitive to muscle oxygen delivery. At rest with normal flow, Pi/PCr averaged 0.12 +/- 0.03 and pH averaged 7.02 +/- 0.04. Exercise produced a progressive increase in Pi/PCr (0.2 W = 0.43 +/- 0.12; 0.4 W = 0.75 +/- 0.31; 0.6 W = 1.04 +/- 0.47) and a modest decrease in pH (0.2 W = 6.94 +/- 0.04; 0.4 W = 6.86 +/- 0.18; 0.6 W = 6.85 +/- 0.06). Flow reduction had no effect on Pi/PCr or pH at rest. In contrast, flow reduction during exercise was associated with higher Pi/PCr at all three work loads (0.2 W = 0.60 +/- 0.27; 0.4 W = 0.99 +/- 0.50; 0.6 W = 2.00 +/- 1.26 [all p less than 0.05 versus normal flow]) and lower pH (0.2 W = 6.78 +/- 0.12; 0.4 W = 6.69 +/- 0.23; 0.6 W = 6.65 +/- 0.30 [p less than 0.01 versus normal flow at 0.2 and 0.4 W; p = 0.05 at 0.6 W]).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Detection of skeletal muscle hypoperfusion during exercise using phosphorus-31 nuclear magnetic resonance spectroscopy. 395 35

Case histories of 62 elderly amputees with peripheral vascular disease are reviewed. Almost one half had previous infarction, heart failure or digoxin therapy. An arm ergometer test revealed myocardial ischemia in two thirds of the group. The theoretical maximum oxygen intake is low, but many patients were unable to reach the theoretical figure because of myocardial ischemia. Application of these findings to an exercise prescription for amputees is discussed, and it is questioned how many elderly amputees have the potential for useful ambulation.
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PMID:The application of exercise testing to the elderly amputee. 469 Oct 93

Timolol, a nonselective beta-adrenoreceptor blocking agent without intrinsic sympathomimetic or membrane stabilizing activity, has been shown effective in the treatment of angina and hypertension. It is particularly useful in patients with stable angina pectoris and patients with mild to moderate hypertension. In both of these conditions, timolol appears to be comparable to propranolol. A recent study has suggested that timolol reduces mortality and reinfarction rate in patients who have recently had a myocardial infarction. When given topically timolol reduces intraocular pressure in patients with open-angle glaucoma; the drug may be used as the primary agent or as an adjunct to standard therapy. Careful selection of patients will reduce the frequency of adverse effects due to beta-receptor inhibition. Thus, timolol should not be used in patients who are predisposed to asthmatic bronchitis or cardiac failure, and it should be used with caution in patients with peripheral vascular disease or diabetes mellitus.
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PMID:Pharmacokinetics, mechanisms of action, indications, and adverse effects of timolol maleate, a nonselective beta-adrenoreceptor blocking agent. 676 88

End-stage renal disease (ESRD) patients have a high cardiovascular mortality rate. Precise estimates of the prevalence, risk factors and prognosis of different manifestations of cardiac disease are unavailable. In this study a prospective cohort of 433 ESRD patients was followed from the start of ESRD therapy for a mean of 41 months. Baseline clinical assessment and echocardiography were performed on all patients. The major outcome measure was death while on dialysis therapy. Clinical manifestations of cardiovascular disease were highly prevalent at the start of ESRD therapy: 14% had coronary artery disease, 19% angina pectoris, 31% cardiac failure, 7% dysrhythmia and 8% peripheral vascular disease. On echocardiography 15% had systolic dysfunction, 32% left ventricular dilatation and 74% left ventricular hypertrophy. The overall median survival time was 50 months. Age, diabetes mellitus, cardiac failure, peripheral vascular disease and systolic dysfunction independently predicted death in all time frames. Coronary artery disease was associated with a worse prognosis in patients with cardiac failure at baseline. High left ventricular cavity volume and mass index were independently associated with death after two years. The independent associations of the different echocardiographic abnormalities were: systolic dysfunction-older age and coronary artery disease; left ventricular dilatation-male gender, anemia, hypocalcemia and hyperphosphatemia; left ventricular hypertrophy-older age, female gender, wide arterial pulse pressure, low blood urea and hypoalbuminemia. We conclude that clinical and echocardiographic cardiovascular disease are already present in a very high proportion of patients starting ESRD therapy and are independent mortality factors.
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PMID:Clinical and echocardiographic disease in patients starting end-stage renal disease therapy. 773 Nov 45

This paper reviews the evidence of hypertensive target organ damage (HTOD) in Africa, and the difficulties of its assessment, with a focus on implications for further research and prevention. Specific examples of HTOD reviewed include left ventricular hypertrophy, heart failure, ischaemic heart disease, arrhythmias and sudden death, kidney failure, cerebrovascular accidents, retinopathy and central as well as peripheral vascular disease. There is evidence that the prevalence of hypertension is increasing in some parts of Africa, thus increasing the number of people who suffer from fatal and nonfatal complications. Analysis of the type, frequency and distribution of HTOD is critical to the design of interventions to prevent and manage hypertension, and in the design of future clinical research. As would be expected, the frequency of atherosclerotic complications, particularly involving the heart, is lower in Africa than in developed countries. Stroke, renal failure and heart failure appear to be the principal adverse outcomes and are likely to be associated with a high case fatality rate. Community-based data on these issues are limited, however, and hospital series cannot estimate the population burden and may be unreliable in describing the case mix. Improved data on HTOD will more accurately reflect the health impact of hypertension, provide the basis for aggressive efforts at prevention, detection and control of high BP and establish their relevance in the overall scheme of resource allocation during fiscal austerity and limited healthcare spending. Additionally, knowledge of the prevalence and relative frequencies of HTOD has direct and important implications for clinical outcomes research in hypertension.
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PMID:Spectrum of hypertensive target organ damage in Africa: a review of published studies. 785 22

Revascularization after prolonged complete limb ischemia may result in severe damage to skeletal muscle and systemic alterations (postischemic syndrome). Our previous experimental studies have shown that this injury can be reduced substantially by treating the jeopardized extremity by controlling the conditions of reperfusion and composition of the initial reperfusate. In the present study this concept of controlled limb reperfusion was applied in patients with prolonged severe limb ischemia. Controlled limb reperfusion was used in 14 patients after prolonged complete uni- or bilateral ischemia. The ischemic interval ranged from 5 to 21 h. Two patients were in cardiogenic shock, 11 had associated cardiac disease, and seven coexistent peripheral vascular disease. After systemic heparinization, standard thromboembolectomy was done using a Fogarty catheter. Cannulas were placed into the iliac, profunda, and superficial femoral arteries and were connected to a reperfusion set. Oxygenated blood was drawn from the iliac artery and mixed with an asanguineous solution (ratio 6:1). This controlled reperfusate was delivered into the profunda and superficial femoral arteries using a single rollerpump. The system allows control of the composition of the reperfusate (calcium, pH, osmolarity, glucose, substrate, pO2, free radical scavengers) and the conditions of reperfusion (pressure, flow, temperature). After 30 min of controlled limb reperfusion, the cannulas were removed and normal blood reperfusion started. All 12 patients who were stable hemodynamically before the operation survived the revascularization. Eleven patients, including one with acute aortic occlusion for several hours, were discharged with functional recovery of their extremities. Despite the severe ischemic insult, controlled limb reperfusion avoided amputation and profound systemic complications. Two patients who were in cardiogenic shock preoperatively died from progressive cardiac failure. We conclude that controlled arterioarterial limb reperfusion may reduce the local manifestations of the postischemic syndrome after prolonged periods of ischemia, may salvage limbs thought previously to be damaged irreversibly by prolonged ischemia, and can be done easily in the operating room.
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PMID:New surgical treatment for severe limb ischemia. 800 66

We investigated the rate of decline in GFR and the changing prevalences of micro- and macrovascular complications in 20 type II diabetic patients [mean age 58 (46-71) years, female:male = 7:13, duration of diabetes 16 (12-30) years] from the stage of macroproteinuria with GFRs which were still normal until the beginning of dialysis or the time of death. Controls of renal function, proteinuria, HbAlc, serum lipids, and blood pressure were performed every 6 months at the beginning of the study and later on at 3-month intervals. Fundoscopy, electrocardiogram at rest and in case of need a symptom-limited treadmill ECG, a Duplex ultrasound examination of the carotid vessels, and a Doppler sonographic examination of the femoral arteries were repeated each year. The creatinine clearance (mean +/- SD) of the patients was 81 +/- 6 mL/min/1.73 m2 at the beginning of the study. The rate of decline in creatinine clearance was 1.01 +/- 0.38 mL/min/month during the whole period of observation. Twelve patients (group A) required dialysis after a mean time of 74 (40-119) months; their creatinine clearance was 7 +/- 2 mL/min/month at the beginning of renal replacement therapy. Eight patients (group B) died a short time before the beginning of dialysis treatment; their creatinine clearance was 13 +/- 5 mL/min/1.73 m2. The causes of death were sudden death (n = 4), cardiac failure (n = 1), and stroke (n = 2); in one case it was unknown. The two patient groups did not differ in respect to the mean age, duration of diabetes, HbAlc values, serum cholesterol levels, and blood pressure. The decline in the creatinine clearance was also similar in both patient groups, with 1.07 +/- 0.35 versus 0.98 +/- 0.41 mL/min/month. Only the mean serum triglyceride concentration was significantly higher in the patients who died before dialysis. At the start of the study, cerebrovascular disturbances (including plaques in the carotid vessels) were found in 30%, cardiovascular disturbances (including pathologic ECG findings) in 45%, a peripheral vascular disease in 15%, and diabetic retinopathy (grade I and II) in 75%. At the beginning of dialysis treatment or the time of death, respectively, the prevalence of cerebrovascular diseases was increased to 70% and the prevalence of cardiovascular diseases to 90%; peripheral vascular disease was present in 50% and diabetic retinopathy in all of the cases. We conclude that type II diabetic patients show high mortality (40%) and poor quality of life, not only when they require dialysis treatment, but also in the predialysis phase.
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PMID:High mortality and poor quality of life during predialysis period in type II diabetic patients with diabetic nephropathy. 804 65

To examine the effects of recombinant human erythropoietin (rHuEPO) on hospital utilization, hospital costs, and Medicare reimbursements for hospital care, a longitudinal, matched cohort study was conducted using Medicare claims data of 23,806 Medicare-eligible, dialysis patients who received rHuEPO, did not have a transplant, and were alive for 18 mo or longer and 22,720 controls matched on age, sex, race, cause of ESRD, and dialysis modality. The relative odds (rHuEPO versus control) of admission for all causes and for specific causes over 9 mo, adjusted for admission in the prior 9 mo and the per patient change in total admissions, inpatient days, hospital costs, and Medicare hospital payments between the prior 9-mo period and the subsequent 9-mo period was examined. The adjusted relative odds (95% confidence interval) of admission (rHuEPO versus control) was: higher and statistically significant for all causes, 1.08 (1.03 to 1.14); seizure, 1.52 (1.28 to 1.75); vascular access revision, 1.11 (1.06 to 1.17), and heart failure, 1.17 (1.09 to 1.26); higher but not statistically significant for angina, 1.09 (0.99 to 1.20) and stroke, 1.08 (0.86 to 1.31); and lower but not statistically significant for myocardial infarction, 0.91 (0.72 to 1.10); peripheral vascular disease, 0.81 (0.60 to 1.02); anemia, 0.86 (0.56 to 1.17); and depression, 0.89 (0.37 to 1.40). The mean change per 1,000 patients in admissions was less by 38 (P = 0.03) because of fewer readmissions, and in days was 1,309 less (P < 0.001), for patients treated with rHuEPO versus controls. The mean change per patient in hospital costs was $371 less and was statistically significant (P = 0.03) and in Medicare hospital payments was $132 less but was not statistically significant (P = 0.43) for patients treated with rHuEPO versus controls. rHuEPO was associated with an increase in the probability of hospital admission (particularly admissions potentially related to adverse effects) but a decrease in readmissions, overall admissions, hospital days, and cost to hospitals in this cohort of patients surviving for 18 mo. Although not realized short term, Medicare savings from potential rHuEPO-related reductions in hospital care may be long term through future adjustments in diagnosis-related group-based hospital payment.
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PMID:Effect of recombinant erythropoietin on hospital admissions, readmissions, length of stay, and costs of dialysis patients. 816 27


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