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)

Eight patients with benign prostatic hypertrophy (BPH), considered as a high risk for an operation because of severe accompanying disease, were treated with a self-retaining intraurethral catheter set. Two patients were judged unfit for operation (one because of severe cardiac failure, the other because of severe respiratory failure) and 1 patient rejected an operation. The BPH surgery was postponed in the others because of recent operations for such diseases as gastric cancer or because of severe gastric ulcer. All patients voided freely after stent placement and were continent. The device was left in place for 1 to 16 weeks. The chief complaint was frequency of voiding, with intervals of 1 to 2 hours. Some micturition discomforts such as urgency were recognized in 2 patients, but disappeared within 1 to 2 days. Pyuria observed before treatment disappeared in all but 1 patient. Average residual urine volume calculated on ultrasonograms was 54 ml. Stone formation was demonstrated in 1 patient 9 weeks after placement. We concluded that the intraurethral stent is an effective device for high-risk patients with BPH. However, a longer follow-up study will be needed to exclude late side effects.
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PMID:Experience with a new intraurethral stent for high-risk patients with benign prostatic hypertrophy. 750 40

Over the past five years, the use of extracorporeal life support in the adult population has gained acceptance. Indications have ranged from respiratory failure secondary to trauma, and adult respiratory distress syndrome, to cardiac failure secondary to a number of causes. The results of extracorporeal life support, when applied to postcardiotomy patients, have been variable. In this article, we present the successful utilization of extracorporeal life support for 28 hours in a patient with postcardiotomy cardiogenic shock following mitral valve replacement.
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PMID:Successful case of extracorporeal life support in a patient with postcardiotomy cardiogenic shock. 761 Jun 44

Patients with mitochondrial disease may present to the Intensive Care Unit (ICU) with a variety of neurological and general medical disorders. Eleven patients were admitted to a neurological ICU between 1970 and 1992 because of respiratory insufficiency, status epilepticus and/or metabolic encephalopathy associated with mitochondrial disease. Respiratory impairment occurred in eight patients and was associated with nocturnal hypoventilation due to respiratory muscle weakness, aspiration due to bulbar weakness and abnormalities of central control leading to a reduced CO2 drive, irregular respiratory patterns and sleep apnoea. Seven patients received continuous respiratory support during the acute illness; three were subsequently weaned to domiciliary ventilation, and four died. Five patients had stroke-like episodes, which in two were recurrent. Four patients developed tonic-clonic grand mal epilepsy associated with myoclonic fits (2 patients), absences (2), focal fits (1) and status epilepticus (2). Encephalopathy was associated with recurrent lactic acidosis (2 patients), cardiac failure (2), hyponatraemia (2), renal abnormalities (3) and complete heart block (1). Although rare, mitochondrial disease should be considered in any patient with unexplained respiratory failure, intractable epilepsy, lactic acidosis or recurrent stroke.
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PMID:Management of mitochondrial disease on an intensive care unit. 776 70

Fatal cytomegalovirus (CMV) myocarditis occurred in a 2 year old boy with acute lymphoblastic leukemia (ALL) in remission. The patient showed mild hepatic dysfunction and a rapid progress of pancytopenia after complete remission had been achieved. At the fifth week of complete remission, he presented signs of heart failure such as tachycardia, S4 gallop on auscultation and decreased ejection fraction on echocardiography. However, no significant electrocardiographic changes were recognized. In addition to the cardiac dysfunction, the patient presented a marked tachypnea and dyspnea associated with hypoxemia. These were dramatically improved by methylprednisolone pulse therapy (30 mg/kg per day, for 3 days) and CMV high titer immunoglobulin (400 mg/kg per day, for 3 days). On the sixth day after signs of respiratory failure were improved, the patient suddenly presented a paroxysmal atrial tachycardia followed by a fatal ventricular fibrillation. Although we could detect neither a specific IgM antibody, a significant increase of IgG antibody, nor CMV genome by DNA hybridization techniques during the course of the illness, microscopic examination of necropsy specimens of the heart showed a marked disruption and disintegration of muscle bands associated with cytomegalic inclusion bodies. Polymerase chain reaction (PCR) yielded a 305 bp amplification product in the heart and lung tissues, supporting the view that myocarditis was caused by CMV.
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PMID:Fatal cytomegalovirus myocarditis in a seronegative ALL patient. 779 59

So far propofol has only been used in clinical settings for sedation and induction of anaesthesia. This study describes several indications in preclinical and emergency events. All users were anaesthetists, so that experience of administration and dosage was extremely helpful. Since the drug met the expected criteria it is now regularly used for the sedation of ventilated patients during transport. The most important indications for preclinical induction of anesthesia with propofol are patients with isolated head injury and patients with respiratory insufficiency due to status asthmaticus resistant to therapy. After repeated unsuccessful attempts at therapeutic intervention with benzodiazepines and other antiepileptics we were able to interrupt status epilepticus in 11 patients by means of propofol, thereby preventing the patient from being intubated as a consequence of iatrogenic respiratory failure. However, emergency doctors must always be aware of the severe cardiocirculatory side effects of the drug, and must, hence, ensure that hypovolaemia or cardiac failure is excluded or corrected prior to propofol administration.
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PMID:[Propofol in emergency care--areas of application and initial experiences]. 781 Jan 46

A 66-year-old man was admitted for mitral valve replacement required by a mitral regurgitation resulting in a severe heart failure. He also suffered from chronic respiratory failure, related to a left concavity cyphoscoliosis. Postoperatively, hypoxemia occurred. His chest X-ray showed a left pleural effusion indicating a percutaneous pleural drainage. A local anaesthesia with a 21 G needle was performed prior to drain insertion, which was easily introduced into the pleural cavity. A few minutes later, the patient experienced an acute haemorrhagic shock. He was immediately transferred into the operating room, where the cardiac surgeon discovered and treated a coronary artery effraction. The vascular lesion was attributed to the needle used for local anaesthesia. The patient was discharged twelve days later without sequelae. Two factors were responsible for this accident: the patient's cyphoscoliosis and his left ventricle enlargement. This complication is uncommon. However, in case of a particular patient's anatomy, it is suggested to use a score devised to anticipate the risk of a difficult pleural drainage. This score should include general, thoracic, spinal, cardiac, hepatic and splenic morphology.
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PMID:[An unusual cause of pericardial effusion during pleural drainage]. 799 52

Long-term survival at our institution for postcardiotomy cardiogenic shock patients supported with the BioPump is 36% (29/80 patients). A heparin-coated extracorporeal membrane oxygenator (ECMO), first introduced in 1991, may reduce organ injury associated with cardiopulmonary bypass. The device can be employed rapidly because it connects directly to the cardiopulmonary bypass cannula. In an effort to improve our results in the treatment of postcardiotomy cardiogenic shock, we used ECMO in 21 patients with this syndrome and accompanying complications. The patients were divided into three groups: group 1, ECMO after coronary artery bypass grafting; group 2, ECMO after mitral valve operation; and group 3, ECMO after open heart operation with prolonged cardiac arrest. Survival in group 1 was 80% with 12 of 14 patients discharged to home. All three deaths were caused by cardiac failure. Bleeding complications in this group were moderate. There was no evidence of disseminated intravascular coagulation, and levels of fibrin split products remained within the normal range. Postoperative complications included stroke (2), renal failure (1), mediastinitis (1), and prolonged respiratory failure (6). Mortality in group 2 was 100%. The major problem limiting recovery was left ventricular distention secondary to inadequate left ventricular decompression. Mortality in group 3 was 100%; all 4 died of brain death. Extracorporeal membrane oxygenation without left ventricular drainage clearly is not effective in patients undergoing mitral valve operations as it does not effectively decompress the left ventricle, but it was highly effective in treating postcardiotomy cardiogenic shock in our coronary artery bypass grafting patients. Extracorporeal membrane oxygenation also proved to be safe as the patient-related complications of stroke, renal failure, and mediastinitis were low. Our preliminary success with heparin-coated ECMO now needs to be confirmed by studies from other centers with larger groups of patients.
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PMID:Extracorporeal membrane oxygenation: preliminary results in patients with postcardiotomy cardiogenic shock. 801 Jul 88

We report a rare case of idiopathic myelofibrosis transformed to acute myelomonocytic leukemia associated with non-Hodgkin's lymphoma. A 64-year-old woman was admitted to our department because of anemia and leukocytosis. On admission, anemia and hepatosplenomegaly were noted. The hemoglobin content was 6.8 g/dl, and WBC count was 26,200/microliters with an increased number of immature neutrophils. Bone marrow biopsy revealed an increased amount of reticulin fiber. Because she had no disease which causes secondary myelofibrosis, idiopathic myelofibrosis was diagnosed, and she was treated with prednisolone, anabolic steroid and blood transfusion. Fifteen months after the diagnosis of myelofibrosis, blast increased in her peripheral blood and her spleen and liver enlarged remarkably. A tumor of right parotid region was recognized at the same time. The pathological diagnosis of biopsied tumor was non-Hodgkin's lymphoma. The cytochemical study of blasts in her peripheral blood showed that she had acute myelomonocytic leukemia. In spite of intensive chemotherapy, she died from heart failure, respiratory failure and renal insufficiency.
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PMID:[Idiopathic myelofibrosis transformed to acute myelomonocytic leukemia associated with non-Hodgkin's lymphoma]. 807 93

To investigate the role of neutrophil activation in the pathophysiology and sequelae of disseminated intravascular coagulation (DIC), we measured plasma levels of granulocyte elastase-alpha 1-proteinase inhibitor complex (GEPIC) in 41 patients with DIC and 27 patients with similar underlying conditions but without DIC. Mean GEPIC levels were significantly higher in patients with DIC (421.0 +/- 45.6 ng/ml) than in patients without DIC (246.1 +/- 41.9 ng/ml, P < 0.01). Significant differences were also noted in DIC patients with or without infection (474.7 +/- 61.2 ng/ml vs. 302.4 +/- 48.9 ng/ml, P < 0.04), with or without organ dysfunction (546.6 +/- 72.7 ng/ml vs. 305.6 +/- 42 ng/ml, P < 0.01), and with or without respiratory failure (640.0 +/- 91.2 ng/ml vs. 328.1 +/- 55.1 ng/ml, P < 0.01). No significant difference was found in mean GEPIC levels in DIC patients with or without renal failure, heart failure, hepatic failure, or gastrointestinal bleeding. The frequency of respiratory failure correlated with rising plasma levels of GEPIC. Mortality was higher in patients with GEPIC levels > 500 ng/ml (53.8%) than in patients with GEPIC levels < 500 ng/ml (28.6%). This correlation was particularly strong in patients with DIC, infection, and respiratory failure. Based on these data, we suggest that neutrophil activation, triggered by the coagulation cascade and perhaps augmented by endotoxin or cytokine release with infection, significantly contributes to respiratory failure and mortality in patients with DIC.
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PMID:Plasma levels of granulocyte elastase-alpha 1-proteinase inhibitor complex in patients with disseminated intravascular coagulation: pathophysiologic implications. 809 45

Patients with Becker muscular dystrophy (BMD) have milder muscular impairment and better prognosis than patients with Duchenne muscular dystrophy (DMD). Another difference is that while cardiac failure due to myocardial involvement is a frequent cause of death in BMD, respiratory failure is the most common cause of death in DMD. We examined cardiac function and the mechanism of cardiac failure in 21 BMD patients aged 3 to 63 years (mean, 40.4) by electrocardiography, mechanocardiography, echocardiography, and post-mortem examination. Diagnosis of BMD was made by characteristic symptoms, dystrophic change in muscle histology, and the followings: 1) a deletion in the dystrophin gene, 2) "patchy" staining of dystrophin on immunocytochemical analysis, 3) abnormal dystrophin size on Western blotting, and 4) presence of a definite carrier in the family. To be diagnosed as BMD, patients exhibited one or more of 1)-3). Patients who were diagnosed only by 4) had a relative who had been diagnosed as BMD by one of 1)-3). The control group included 43 DMD patients (age 4-26 years, mean 16.2) and 20 healthy males (age 15-60 years, mean 33.3). Electrocardiogram showed prominent Q waves in leads II, III, aVF and V6, and tall R in V1, suggesting myocardial injury in the posteroinferior and lateral walls. The ratio of ejection time to pre-ejection period (ET/PEP) decreased to 2.0-3.3 in BMD, and was significantly lower than that in DMD patients with comparable muscle weakness. Left ventricular dilatation became more prominent with age, and end-diastolic left ventricular dimension (EDLVD) averaged 52.3 mm.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical feature and mechanism of cardiac failure in patients with Becker muscular dystrophy]. 819 65


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