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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Analysis of the clinical and autopsy reports of 200 deaths following surgery for colorectal cancer from 1956 to 1974, at the Dept. of Surgery, University of Heidelberg, revealed that pneumonia (24.5%) was the most common cause of death followed by peritonitis (22%), pulmonary embolism (15.5%), advanced tumor disease (14%), cardiac failure (9.5%), ileus (5.5%), and others (9%). The explanation for the postoperative mortality rate of 12% (cancer of colon) and 13.2% (cancer of rectum) lies in the fact that 82.5% of those who died postoperatively were beyond the age of 60, and 40.5% beyond 70 years at the time of surgery. Moreover, in 50.5% advanced tumors with regional and/or distant metastases were found. In 55.5% severe preoperative complications (ileus: 38%, peritonitis: 11%, abscess formation or hemorrhage: 6.5%) required an emergency operation. Only 38.5% of the procedures were considered for cure. Besides the need for early recognition of the cancer, intensification of pre- and postoper treatment appears to be the predominant task in the effort to decrease postoperative mortality.
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PMID:[Analysis of postoperative deaths in colon and rectal cancer (author's transl)]. 84 78

During a period of 13 years 11 patients were operated on because of a spontaneous aortocaval fistula caused by a ruptured abdominal aortic aneurysm. The classic diagnostic signs of an aortocaval fistula (pulsatile abdominal mass with bruit and high output heart failure) were present in approximately half of the patients, whereas hematuria was a constant finding in all patients. Six patients had macrohematuria, and five had microhematuria. Seven patients (64% survived, and four had postoperative complications: 1 ileus, 2 postoperative pneumonias, 2 deep venous thrombosis, 1 postoperative hemorrhage. The mean operative blood loss was 7 L. After operation the average follow-up time was 4 years. In four patients who died the perioperative (within 30 days) causes of death were renal failure, a bleeding duodenal carcinoma, myocardial infarction, and operative bleeding. It is concluded that hematuria is a more frequent finding than earlier assumed among patients whose abdominal aortic aneurysm has ruptured into the vena cava. The presence of hematuria in a patient suffering from an abdominal aortic aneurysm is an indication for aortography to rule out an aortocaval fistula.
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PMID:Hematuria is an indication of rupture of an abdominal aortic aneurysm into the vena cava. 203 12

In a prospective study of 103 patients with carcinoid tumors consecutively referred for medical treatment, the most common sites of the primary tumors were the ileum (73%), bronchi (7%), and jejunum (4%). All patients had local metastases, and 96 (93%) also had liver metastases. The most common initial symptoms were diarrhea (32%), ileus (25%), and flush (23%). The overall frequency of diarrhea was 84% and of flush was 75%. Heart insufficiency caused by cardiac valve disease was seen in 33% of the patients. The carcinoid syndrome, including flush, diarrhea, and elevated urinary 5-hydroxyindole acetic acid (5-HIAA) concentrations, was manifested by 69 patients (67%), 64 of whom (93%) had carcinoid tumors of mid-gut origin. Elevated urinary 5-HIAA was found in 91 patients (88%), of which 89 displayed liver metastases. The plasma concentration of the tachykinin neuropeptide K (NPK) was elevated in 67 patients (66%), 63 of whom had tumors of the mid-gut region. Serum pancreatic polypeptide (PP) and human chorionic gonadotrophin alpha levels were elevated in 43% and 28% of the patients, respectively, and the highest levels were found in patients with metastatic bronchial carcinoid tumors. Thirty-nine of the 103 patients are now dead; 18 died of tumor progression, whereas 14 patients died of heart failure secondary to a carcinoid tricuspidal valve insufficiency. The estimated median survival from the time of histologic diagnosis was 14 years, and from the time of carcinoid syndrome was 8 years.
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PMID:Malignant carcinoid tumors. An analysis of 103 patients with regard to tumor localization, hormone production, and survival. 244 Mar 90

We have described a spectrum of pancreatic surgery after cardiopulmonary bypass. At one end is a subclinical lesion which was manifested only by elevations in serum isoamylase levels (27 percent of patients) and increased ribonuclease levels (13 percent of patients) in asymptomatic patients followed after cardiac surgery. At the other end is a severe and often lethal necrotizing pancreatitis. Acute necrotizing pancreatitis was found at autopsy in 25 percent of 138 patients who died after cardiac surgery, and it correlated strongly with low output, acute tubular necrosis, and infarction of the liver, spleen, or bowel. It was the principal cause of death in 4 percent of these patients. In addition, 24 percent of 38 nonsurgical patients who died from cardiac failure and hypoperfusion had acute pancreatitis at autopsy, whereas acute pancreatitis was not observed in 55 nonsurgical patients who died without a significant period of low output. Acute pancreatitis was recognized postoperatively in 12 patients (0.2 percent). Three had mild pancreatitis, and all responded well to conservative therapy. In nine patients, fulminant necrotizing pancreatitis developed. Their courses were characterized by significant early postoperative hemodynamic compromise, abdominal distention, ileus, fever, and episodes of late vascular instability associated with hypocalcemia. The diagnosis of pancreatitis was usually missed because of the absence of pain, tenderness and hyperamylasemia. The diagnosis was confirmed at laparotomy in eight patients and at autopsy in one. The only two survivors among the nine with severe cases had aggressive mobilization, debridement, and wide drainage of the necrotic pancreas. We suggest that a mild subclinical injury to the pancreas may occur as a consequence of cardiopulmonary bypass and may progress to severe ischemic necrosis if hypoperfusion follows in the postoperative period, the presentation of necrotizing pancreatitis may be atypical in the cardiac surgical patient and should be considered if nonspecific abdominal symptoms are present, and aggressive debridement and drainage may be the optimal treatment for aggressive forms of this disease.
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PMID:Acute pancreatitis after cardiopulmonary bypass. 258 Apr 53

A spontaneous and asymptomatic pneumoperitoneum was observed in two women presenting with pseudoileus resulting from severe gastrointestinal involvement in progressive systemic sclerosis. In the first case, pneumoperitoneum was associated with pneumatosis cystoides intestinalis and remained unchanged during 3 years. As obstruction resisted to medical management, surgery was performed; however at laparotomy neither perforation nor obstruction of the bowel could be found; the patient died during the postoperative course. In the second case, pneumoperitoneum disappeared after medical management of low-grade intestinal ileus but the patient died 6 months later because of cardiac failure. Autopsy revealed major distention of the bowel but failed to show any signs of perforation. These findings show that, in progressive systemic sclerosis, pneumoperitoneum can occur in the absence of digestive perforation and that surgery is not required. However this complication seems to carry a very poor prognosis.
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PMID:[Spontaneous pneumoperitoneum in scleroderma]. 674 77

The surgical technique recommended for vaginal extirpation of the uterus from patients with corpus carcinoma differs from methods suggested for any other indications, including inadequately controllable metrorrhagia, uterus myomatosus, in situ carcinoma, Stage Ia carcinoma of the cervix, and positional abnormality. Reported are 1,052 cases of hysterectomy for which these indications had been valid. More than 25 per cent of the patients concerned had been above 60 years of age. There had been complications of two types, intra-operative and postoperative. Infections of the urinary tract ranked on top of the list and accounted for 5.6 per cent of all complications. They were followed by intra-operative bleeding in 2.6 per cent of the cases and postoperative bleeding in 1.6 per cent. There were also two cases of ileus, one of them fatal. Another death occurred due to cardiac insufficiency.
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PMID:[Indications for vaginal hysterectomy]. 713 61

The results have been reviewed of 41 patients with end stage polycystic kidney disease on maintenance hemodialysis. The patients ranged in age from 34 to 83 years with an average age of 55 years and 25 patients were male, 16 were female. The duration of maintenance hemodialysis in the patients was from 1 to 200 months with an average time of 69 months. Infection of the cysts and pyelonephitis occurred 22 times in 13 patients (32%) and hemorrhage into the cysts occurred 15 times in 13 patients (32%). To control the infection, bilateral nephrectomy was required in 10 patients and 1 patient was undergone unilateral nephrectomy. Of 13 patients with the hemorrhagic cysts, 5 were undergone bilateral nephrectomy and 2 were undergone unilateral nephrectomy. Six patients died during follow up and the cause of death were 1) cardiac failure, 2) cerebral hemorrhage, 3) cardiac infarction, 4) pneumonia after nephrectomy, 5) massive bleeding after second operation for adhesive ileus due to first nephrectomy, 6) unknown. Fourteen patients but one undergone bilateral nephrectomy were followed for an average time of 70 months after nephrectomy. Such as complication due to bilateral nephrectomy, anemia occurred in 13 patients (93%) and hypotension occurred in 5 patients (33%). Bilateral nephrectomy was effective procedure in safety for end stage polycystic kidney patients with the infection and the hemorrhagic cysts because anemia and hypotension which occurred usually after bilateral nephrectomy now can be controlled goodly.
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PMID:[End stage polycystic kidney disease: the study for upper urinary tract infection & hemorrhage into the cysts]. 780 76

Over the last 5 years, 15 patients received ventricular assist devices (VADs) (Group 1) and 5 received percutaneous cardiopulmonary support (CPS) (Group 2) while in postoperative cardiogenic shock. Group 1 consisted of 8 men and 7 women ranging in age from 22 to 73 years (average age, 55 years). Nine of these patients underwent surgery for valve replacement, 5 for coronary artery bypass grafting, and 1 for closure of a ventricular septal rupture. The duration of VAD support ranged from 6 h to 9 days (mean, 3.9 days). Group 2 consisted of 4 men and 1 woman ranging in age from 49 to 68 years (average age, 57 years). One of these patients underwent surgery for valve replacement, 1 for coronary artery bypass grafting, 2 for replacement of a thoracic aneurysm, and 1 for left ventricular aneurysmectomy. The duration of CPS ranged from 4 h to 8 days (mean, 2.8 days). In Group 1, 13 patients were weaned from the VADs and 8 survived. Bleeding occurred in 5 patients, renal failure in 4, infection in 3, cardiac failure in 4, cerebral infarction in 1, perioperative myocardial infarction in 1, arrhythmia in 1, and ileus in 1. In Group 2, 4 patients were weaned from the CPS and 3 survived. Bleeding occurred in 3 patients, renal failure in 2, CNS injury in 2, and cardiopulmonary failure in 1. The 8 survivors in Group 1 have been followed for 2 to 56 months (mean, 28.7 months). Five patients were in NYHA class I, 2 were in class II and 1 was in class III.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Results of circulatory support for postoperative cardiogenic shock. 799 88

Long-term outcome and survival after emergency embolisation of life-threatening bleeding caused by non-malignant small pelvic lesions were analysed and related to the techniques and embolisation materials used. Emergency transcatheter embolisation was performed in 11 patients, heavily bleeding from uterine arteriovenous malformations (4 patients), pelvic fractures (4 patients), Endoxan induced cystitis (1 patient), haemorrhoids (1 patient) and polyposis recti (1 patient) using GAW-coils. Ethibloc and Gelfoam strips as embolisation materials, alone or in combination. Follow-up was obtained up to 7.5 years with analysis of survival. Only in one patient, with terminal hepatic insufficiency and severe disturbance of coagulation, recurrent bleeding occurred 1 month after embolisation. Two other patients died during follow-up for other reasons (cardiac insufficiency at 17 months, ileus at 52 months). Complications in relation to the embolisation therapy did not occur. In conclusion, percutaneous transcatheter embolisation is a safe and effective procedure in severe hemorrhage resulting from non-malignant lesions of the pelvis.
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PMID:Embolisation of bleeding pelvic lesions from benign origin--long-term results. 857 20

Thirty-one patients with biliary enteric fistula who were operated on over a 19-year period (1976-1994) with an incidence of 0.74% in all biliary tract operations were reviewed retrospectively to identify etiologic factors, types of fistulas, signs and symptoms, methods of diagnosis, management and prognosis of the cases. Most common symptoms were abdominal pain, nausea, vomiting and jaundice. Two patients had gallstone ileus. The majority of the patients had severe concomitant medical illnesses. The exact preoperative diagnosis of a biliary enteric fistula was established in only five (16%) patients. In 81% of the cases fistula was secondary to chronic calculous biliary tract disease. Postoperative complications included wound infection in six (19%), biliary fistula in two (6%) and erosive gastritis in one (3%) patient. Two patients died of intra-abdominal sepsis and two of cardiac failure, with an operative mortality of 13%. Early elective cholecystectomy is recommended to avoid complications of chronic calculous cholecystitis such as bilioenteric fistulas and their increased mortality and morbidity.
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PMID:Biliary enteric fistulas. 937 75


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