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)

Hyperuricemia (HU) is present in 5-30% of the general population, although the prevalence is higher among some ethnic groups and seems to be increasing worldwide. Classically, chronic HU has been considered a risk factor for gout or lithiasis and is associated with alcoholism, obesity, hypertension, dyslipidemia, hyperglycemia/diabetes mellitus, renal failure and intake of certain drugs. HU is also associated with cardiovascular diseases such as hypertension, vascular disease, pre-eclampsia, pulmonary arterial hypertension, stroke, heart failure, ischemic heart disease and also metabolic syndrome, renal disease and increased mortality. It is uncertain if these associations are dependent or not, especially cardiovascular and renal diseases. Patients with chronic HU and also those with gout require both medical investigation for associated diseases or drugs as well as nutritional counseling and life-style changes. HU should alert physicians to possible complications.
Best Pract Res Clin Rheumatol 2004 Apr
PMID:Primary prevention in rheumatology: the importance of hyperuricemia. 1512 Oct 34

The abundance of published data on the neonatal effects of maternal Graves' disease (GD) contrasts with the paucity of information on fetal effects. In our yet unpublished study, we prospectively studied 72 pregnant women with a history of Graves' disease. Fetal ultrasonography was done at 22 and 32 weeks of gestational age. Fetal goiter was found at 32 weeks in 11 of the fetuses of the 41 mothers with positive TSH-receptor antibodies and/or antithyroid treatment and in none of the fetuses of the 31 other mothers. In the 11 fetuses with goiter, ultrasound findings (thyroid Doppler and bone maturation), fetal heart rate, and maternal antibody and antithyroid drug status effectively discriminated between hypothyroidism (n=7) and hyperthyroidism (n=4). One fetus with hyperthyroidism died in utero at 35 weeks from heart failure. Treatment was successful in the ten other fetuses. One fetus without goiter had moderate hypothyroidism at birth. This study showed that it is of the utmost importance to have the fetal thyroid scrutinized by an expert ultrasonographist and to have team work with obstetricians and paediatric endocrinologists in pregnant mothers with GD. This allowed us to accurately determine fetal thyroid status and to adapt the treatment in mothers successfully. Fetal hyperthyroidism does exist and needs an appropriate aggressive treatment.
Best Pract Res Clin Endocrinol Metab 2004 Jun
PMID:Fetal and neonatal thyroid function in relation to maternal Graves' disease. 1515 41

Severe mid-trimester twin-twin transfusion syndrome (TTS) complicates about 15% of monochorionic twin pregnancies. If left untreated, the mortality is 80-100%. The pathophysiological prerequisite for the onset of TTS is unequal blood flow via arteriovenous placental anastomoses from the so-called donor to the recipient twin. This can result in hypovolemia, hypotension and oligo- or anuria in the donor, and hypervolemia, hypertension, polyuria and finally heart failure in the recipient. Leading sonographic signs of TTS include severe oligo- or anhydramnios and a small or absent bladder filling in the donor in contrast to polyhydramnios with increased bladder filling in the recipient. Patients might present with clinical symptoms due to massive polyhydramnios. In severe mid-trimester TTS, fetoscopic laser occlusion of the anastomosing vessels on the placental surface under local anaesthesia plus subsequent amniodrainage is the most promising therapeutic option at present. In acute TTS after 26 weeks of gestation, amniodrainage is the therapy of choice. All patients suspected of this high-risk condition should be referred to a specialized fetal medicine centre.
Best Pract Res Clin Obstet Gynaecol 2004 Aug
PMID:How can we diagnose and manage twin-twin transfusion syndrome? 1527 16

Using the European Group for Blood and Marrow Transplantation (EBMT) registry, we retrospectively studied 19 patients with AL (amyloid light-chain) amyloidosis who underwent allogeneic (allo; n = 15) or syngeneic (syn; n = 4) hematopoietic stem cell transplantation (SCT) between 1991 and 2003. For allo-SCT, full-intensity conditioning was used in 7 patients and reduced-intensity conditioning (RIC) in 8 patients. Engraftment was durable in 12 of those 15 patients. The median follow-up time is 19 months. Kaplan-Meier probabilities of overall and progression-free survival were 60% and 53% at 1 year, respectively. Overall, 40% of patients died of transplant-related mortality (TRM). Best hematologic response after SCT was complete remission (CR) and partial remission (PR) in 8 and 2 patients, respectively, leading to an organ response in 8 of these patients. Seven of the 10 patients in remission are long-term survivors. In 5 of 7 evaluable patients in CR, chronic graft-versus-host disease (GvHD) was observed, indicating the contribution of immune effects to disease control. The main clinical problem was cardiac failure in patients with poor performance status due to amyloidosis or in combination with severe infections. These data suggest that allo-SCT might be a promising and potentially curative treatment modality for selected patients with AL amyloidosis.
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PMID:Allogeneic and syngeneic hematopoietic cell transplantation in patients with amyloid light-chain amyloidosis: a report from the European Group for Blood and Marrow Transplantation. 1629 11

Cardiac rehabilitation is an integral component of secondary prevention, and is indicated for patients with a wide variety of cardiac conditions, ranging from coronary artery disease to chronic heart failure. Best results are obtained with integrated, multicomponent cardiac rehabilitation programs, which include exercise training together with counseling and psychosocial measures that may help patients maintain sustained changes toward a more healthy lifestyle. Evidence from randomized controlled trials and meta-analyses supports the efficacy of cardiac rehabilitation on clinically relevant outcomes such as reduced long-term morbidity and mortality, enhanced functional profile and improved control of cardiovascular risk factors. However, the vast majority of this evidence derives from trials with only small numbers of patients > 70 years of age. In elderly patients the goal of cardiac rehabilitation may differ from those of younger patients, and include the preservation of mobility, self-sufficiency and mental function. Cardiac rehabilitation my represent an opportunity to provide effective health care and achieve a high quality of life for older patients. Future research programs should therefore be aimed at specifically investigating the efficacy and effectiveness of cardiac rehabilitation in older, frail cardiac patients.
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PMID:[Cardiac rehabilitation in the elderly]. 1644 29

Bevacizumab is a humanized monoclonal antibody directed against vascular endothelial growth factor (VEGF-A). Non-Hodgkin's lymphoma patients with high serum VEGF levels have an inferior survival compared to patients with low VEGF levels. Bevacizumab was administered through a central line at 15 mg kg(-1) IV on day 1 followed by rituximab (R) and CHOP on day 2 for cycle 1 and day 1 for cycles 2 - 8. Serum levels of bevacizumab and R were measured at specified time points to assess pharmacokinetics (PK). Plasma and urine samples were also analysed for VEGF. Tumor samples were stained for VEGF, CD31 and factor VIII by immunohistochemistry. Thirteen patients with newly-diagnosed DLBCL received a total of 88 cycles (range 2 - 8, median 7). Best response included five CR, six PR, one SD and one PD with an overall response rate of 85% and complete response rate of 38%. The 12-month PFS is 77% and a median follow-up of 16.9 months for the surviving patients. All tumor samples stained strongly positive for VEGF and there was a marginal association between baseline plasma VEGF and response (p = 0.04). Patients with higher plasma VEGF levels were generally younger and had bulky disease. Micro-vessel density did not correlate with presenting disease characteristics, VEGF expression or response. The PK of bevacizumab and rituximab were not influenced by combined treatment. In this patient population, treatment with RA-CHOP did not result in any episodes of grade 3 or 4 proteinuria, heart failure or hemorrhage. The RA-CHOP combination was generally well tolerated and safe.
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PMID:Rituximab, bevacizumab and CHOP (RA-CHOP) in untreated diffuse large B-cell lymphoma: safety, biomarker and pharmacokinetic analysis. 1684 Jan 82

Worldwide, over 400,000 patients have been treated with tumour necrosis factor (TNF)-alpha antagonists for indications that include rheumatoid arthritis, juvenile rheumatoid arthritis, inflammatory bowel disease, psoriatic arthritis and ankylosing spondylitis. Since their approval, concerns regarding safety have been raised. There is a risk of re-activation of granulomatous diseases, especially tuberculosis, and measures should be taken for detection and treatment of latent tuberculosis infections. Preliminary data suggest that anti-TNF therapy may be safe in chronic hepatitis C. However, TNF-alpha antagonists have resulted in re-activation of chronic hepatitis B if not given concurrently with antiviral therapy. Solid tumours do not appear to be increased with anti-TNF therapy. Variable rates of increased lymphoma risk have been described with anti-TNF therapy compared with the general population, although no increased risk was found compared with a rheumatoid arthritis population. Large phase II and III trials with TNF-alpha antagonists in advanced heart failure have shown trends towards a worse prognosis, and should therefore be avoided in this population. Both etanercept and infliximab are associated with the formation of autoantibodies, and these autoantibodies are rarely associated with any specific clinical syndrome. Rare cases of aplastic anaemia, pancytopenia, vasculitis and demyelination have been described with anti-TNF therapy. This chapter will discuss the safety profile and adverse events of the three commercially available TNF-alpha antagonists: etanercept, infliximab and adalimumab. The data presented in this review have been collected from published data, individual case reports or series, package inserts, the Food and Drug Administration postmarketing adverse events surveillance system, and abstracts from the American College of Rheumatology and European Congress of Rheumatology meetings for 2005.
Best Pract Res Clin Rheumatol 2006 Aug
PMID:Problems encountered during anti-tumour necrosis factor therapy. 1697 37

Heart disease during pregnancy necessitating cardiac surgery is potentially increasing maternal and fetal morbidity and mortality. Most patients know about their heart disease long before conception however the relation between the deteriorating cardiac function and the perinatal complications is not emphasized. Best possible results can be achieved by providing preconception counseling for cardiac patients. Consequently, heart-surgery can be performed before pregnancy thereby the maternal risk is lower and fetal loss or induced abortion can be avoided. The pregnant state is not optimal for cardiac surgery as the principal interest of the mother and the fetus is different. Cardiac surgery should be reserved only for saving the patient's life when medical therapy proves insufficient or when conservative management leads to acute heart failure. The multidisciplinary approach, correct risk assessment, diagnosis, operative indication, timing along with appropriate anaesthesia, extracorporeal circulation and alert monitoring of the uterine activity and fetal heart rate patterns make the intervention technically safe. Fetal monitoring is inevitable for prompt correction of operative conditions in case of impending hypoxemia. The perioperative fetal risk can be reduced by applying normothermia, high mean arterial pressure and cardiac index during the intentionally shortest intervention. Cardiac operation with cardiopulmonary bypass during pregnancy has become a relatively safe procedure for the mother but not for the baby.
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PMID:[Pregnancy and cardiac surgery with cardiopulmonary bypass]. 1850 32

Hazleton General Hospital (HGH) was 1 of 2 rural area community hospitals selected to participate in Accelerating Best Care in Pennsylvania, a demonstration project conducted by Baylor University and Jefferson Medical College. This paper describes how a project team from HGH succeeded in learning and applying a rapid-cycle QI methodology that was developed for a large, academic health care system. The 5 projects undertaken for the demonstration included: heart failure discharge instructions, surgical antibiotic prophylaxis, care of the stroke patient, pneumonia care-administering antibiotic within 4 hours, and pneumococcal vaccine administration. The project teams achieved 100% compliance by the end of the initial measurement period. The program boosted QI at HGH and has been instrumental in the facility's continued performance improvement on CMS core measures.
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PMID:Accelerating Best Care in Pennsylvania: the Hazleton General Hospital experience. 1865 98

VENTRICULAR ARRHYTHMIAS: Different factors--like hypertrophy, fibrosis, ischemia and apoptosis increase the risk of ventricular arrhythmias and sudden arrhythmic death. ACE inhibitors and Angiotensin receptor antagonists offer a curative therapeutic approach. Beta-blocker are strongly recommended. Amiodarone may be used for symptomatic arrhythmia suppression--but with no proven favourable prognostic effect. The use of class-1 antiarrhythmic drugs is obsolete in the presence of left ventricular hypertrophy and heart failure. Implantable cardioverter/defibrillators (ICD) have been proven to have a positive effect on survival in secondary and primary prevention of sudden cardiac death, and so has cardiac synchronization in severe cardiac dysfunction and widened QRS complex. Atrial fibrillation (AF): Arterial hypertension represents the main risk factor for AF. Patients' age, left ventricular hypertrophy, left atrial dilatation and angiotensin-II activation play an important role in the induction and maintenance of AF. Angiotensin-receptor and beta-blockers seem to be efficacious in AF suppression and also on the regression of hypertrophy. The use of antiarrhythmic agents (AA) is limited because of their relatively low long-term efficacy and pro-arrhythmia properties. Best results may be achieved with class 1C AA drugs in patients with no or minimal structural heart disease. In all other cases amiodarone is suitable but is limited by its side effects. In patients with no or only a few symptoms rate control may be sufficient, but if there are symptoms interventional left atrial ablation of pulmonary veins should be attempted as a real curative strategy.
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PMID:[Arterial hypertension and cardiac arrhythmias]. 1908 3


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