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

Transient erythrocytosis during the neonatal period may result in serious complications. Among the well recognized problems are respiratory distress, acute heart failure, and death. Little attention has been ascribed to the neurologic complications of a high hematocrit level in the neonatal period. This report describes four pediatric patients with neurologic deficits presumably due to transiently high hematocrit levels during the neonatal period. The neurologic findings in these patients were consistent with the general diagnosis of cerebral palsy. We hypothesize that they may be representative of a group of patients with seizures, structural central nervous system defects, and/or mental retardation secondary to transient erythrocytosis. Moreover, prompt recognition and treatment of this hematologic finding may prevent the immediate or late appearance of such neurologic findings.
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PMID:Transient erythrocytosis during the neonatal period: possible neurologic compications. 45 51

Patients with chronic obstructive lung disease often present with a combination of respiratory and circulatory insufficiency. In secondary erythrocytosis (polycythemia) blood viscosity rises and further impairs peripheral oxygenation. Against this background, a patient with acute exacerbation of a chronic respiratory disease with secondary erythrocytosis was treated with isovolemic hemodilution during two periods of hospitalization. During each of these two periods, hemodilution was achieved by removing 1 700 and 1750 ml blood, respectively, and replacing this simultaneously by infusing equal volumes of dextran 70 (Maacrodex). The patient's general condition improved, her dependence on supplementary oxygen drastically decreased and the blood gas values improved after hemodilution. The progress of the disease in this case suggests that the raised hematocrit rather than hypervolemia contributed to the patient's poor condition. It also illustrates that too intensive diuretic therapy in cardiac insufficiency with concomitant erythrocytosis can lead to hemoconcentration and thereby add to the strain on an already overloaded circulation.
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PMID:Isovolemic hemodilution in erythrocytosis secondary to chronic obstructive lung disease. 50 7

Chronic hypoxaemia < or = 55 mmHg, induces various clinical and physiological consequences in patients with stable COPD: dyspnoea, decrease in exercise performances, erythrocytosis impairment of neuropsychological functions, pulmonary hypertension, right ventricular heart failure, all of these troubles impairing quality of life and vital prognosis. To restore a PaO2 > 60 mmHg (or SaO2 > 90%), long term oxygen therapy (LTOT) is the best method in the management of COPD with severe chronic respiratory failure. For patients with PaO2 55-70 mmHg. Almitrine bismesylate a piperazine derivative improving the ventilation/perfusion matching, used in low dosage and in sequential administration, is a useful drug to increase the PaO2 and so, to delay but not to avoid LTOT in responder patients when PaO2 remains < or = 55 mmHg.
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PMID:The hypoxaemia in chronic obstructive pulmonary disease (COPD) and its management. 960 25

During the past three decades, interventional cardiology and cardiac surgery have found solutions even for the most complex congenital heart malformations with an overall low operative mortality. A careful clinical and instrumental follow-up of postoperative congenital heart disease patients is fundamental not only to prevent complications and/or to treat eventual residua and sequelae, but also to modify future surgical strategies on the basis of long-term results. To be able to give a correct prognostic meaning to the data collected during the follow-up, the cardiologist should have an excellent knowledge of the native defect, the surgical technique and the post-surgical anatomy and physiology. Major cardiological concerns during a follow-up after corrective surgery are: arrhythmias; heart failure; cyanosis and erythrocytosis; and infective endocarditis. Psychosocial needs, such as employment, contraception, pregnancy and physical exercise, are very important to enable a 'normal' life, complying with the postoperative hemodynamic situation of the patients.
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PMID:Follow-up and physical activity in postoperative congenital heart disease. 1725 23

Arterial hypertension develops in up to 80% of renal transplant recipients. Uncontrolled hypertension induces left ventricular hypertrophy, heart failure and death, but also promotes deterioration of allograft function. Cadaveric transplantation, delayed graft function, renal artery stenosis, presence of native kidneys, increased body weight and therapy with calcineurin inhibitors and steroids have been associated with an increased incidence of hypertension after kidney transplantation. Cyclosporine increases both systemic and renal vascular resistance, enhances sympathetic activation, endothelin production and, possibly, decreases vascular relaxation by decreasing the generation of nitric oxide. Tacrolimus has less pronounced prohypertensive role after renal transplantation. Corticosteroids contribute to the development of hypertension, since their withdrawal results in a significant decrease of blood pressure in the majority of patients. Renal artery stenosis occurs in almost 12% of hypertensive renal transplant recipients. It is a correctable cause of hypertension, and for this reason should be investigated in all suspected patients. Doppler ultrasonography is used as the screening method that is highly sensitive and specific in the hands of a well-experienced investigator. However, dependence of the method on the experience of the investigator is its major drawback. Magnetic resonance angiography and spinal computed tomography angiography are useful noninvasive methods, but arteriography remains a method for establishing the definitive diagnosis. Percutaneous balloon angioplasty, with or without placement of the stent, is successful in the majority of patients, but with a high incidence of restenoses (20%). Surgery is indicated for stenoses that cannot be treated with angioplasty or that recur. Auto-transplantation of the kidney with complex stenoses of graft arteries is useful in selected cases. Posttransplant hypertension should be aggressively treated to prevent the development of end-organ damage. Every effort should be invested in reducing immunosuppression when appropriate, together with salt restriction and weight reduction. Calcium channel blockers have good antihypertensive properties accompanied with minimization of cyclosporine-induced renal vasoconstriction. Angiotensin-converting enzyme inhibitors (ACEi) should be used in patients with proteinuria. Renal function should be carefully monitored after their introduction since they may cause transitory deterioration of glomerular filtration and/or hyperkaliemia. ACEi can induce anemia in renal transplant recipients, side effect that is often used in the treatment of posttransplant erythrocytosis. All other antihypertensive drugs could be used, with minoxidil being the most potent one. Patients with resistant hypertension should be investigated for the presence of renal artery stenosis. After exclusion of rejection, renal artery stenosis and recurrent disease, in cases of severe hypertension, native kidneys laparoscopic nephrectomy should be considered.
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PMID:[Arterial hypertension in renal transplant recipients]. 1836 9

Increased longevity and population aging will increase the number of men with relative testosterone deficiency, as systemic levels of testosterone decrease by about 1% each year. Androgen deficiency should only be diagnosed in men with definite signs and symptoms, accompanied by low total testosterone levels measured in the morning by a reliable assay. Although clinical trials data are limited, current practice guidelines recommend testosterone replacement therapy for symptomatic men with low testosterone levels to improve bone mineral density, muscle mass and strength, sexual function, and quality of life. Testosterone replacement is not recommended for all older men with low testosterone levels, and should be avoided in patients with prostate or breast cancer, hyperviscosity, erythrocytosis, untreated obstructive sleep apnea, or severe heart failure. The goal of all available testosterone treatment modalities (intramuscular injections, nongenital patch or gel, bioadhesive buccal and oral testosterone, and pellets) is to achieve serum testosterone levels in the mid-normal range during treatment. Cost varies widely among these preparations and may limit their use. Patients receiving testosterone replacement therapy should be re-evaluated 3 months after testosterone initiation and at least annually thereafter.
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PMID:Considerations for the diagnosis and treatment of testosterone deficiency in elderly men. 1790 50

Increased longevity and population aging will increase the number of men with late onset hypogonadism. It is a common condition, but often underdiagnosed and undertreated. The indication of testosterone-replacement therapy (TRT) treatment requires the presence of low testosterone level, and symptoms and signs of hypogonadism. Although controversy remains regarding indications for testosterone supplementation in aging men due to lack of large-scale, long-term studies assessing the benefits and risks of testosterone-replacement therapy in men, reports indicate that TRT may produce a wide range of benefits for men with hypogonadism that include improvement in libido and sexual function, bone density, muscle mass, body composition, mood, erythropoiesis, cognition, quality of life and cardiovascular disease. Perhaps the most controversial area is the issue of risk, especially possible stimulation of prostate cancer by testosterone, even though no evidence to support this risk exists. Other possible risks include worsening symptoms of benign prostatic hypertrophy, liver toxicity, hyperviscosity, erythrocytosis, worsening untreated sleep apnea or severe heart failure. Despite this controversy, testosterone supplementation in the United States has increased substantially over the past several years. The physician should discuss with the patient the potential benefits and risks of TRT. The purpose of this review is to discuss what is known and not known regarding the benefits and risks of TRT.
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PMID:The benefits and risks of testosterone replacement therapy: a review. 1970 53

Patients with Eisenmenger syndrome form a small percentage of congenital heart disease patients. The rarity of this syndrome, combined with its complex pathophysiology, account for the insufficient understanding of the principles underlying its proper treatment. The main clinical symptoms are: cyanosis due to secondary erythrocytosis, resulting in increased blood viscosity, iron deficiency anemia (enhanced by unnecessary phlebotomies), blood clotting disturbances, heart failure and serious supraventricular and ventricular arrhythmias. Recent decades have seen developments in pulmonary hypertension pathophysiology which have led to the introduction of new groups of drugs: prostacycline analogs (Epoprostenol, Treprostinil, Beraprost, Illoprost), phosphodiesterase inhibitors (Sildenafil, Tadalafil), endothelin receptor antagonists (Bosentan, Sitaxantan, Ambrisentan) and nitric oxide. These drugs should be administered to patients in III-IV NYHA class. Despite successful early results, the therapeutic effect on patients with Eisenmenger syndrome has not been conclusively established. Our therapeutic efforts should be directed mainly towards preventing complications. As a rule, we should avoid agents with no established therapeutic efficacy and try to alleviate symptoms without any additional risk, so as not to disrupt the existing clinical balance.
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PMID:Therapeutic methods used in patients with Eisenmenger syndrome. 1995 85

Increased longevity and population aging will increase the number of men with late-onset hypogonadism, a common condition that is often under diagnosed and under treated. The indication of testosterone replacement therapy (TRT) treatment requires the presence of low testosterone level and symptoms and signs of hypogonadism. Although there is a lack of large-scale, long-term studies assessing the benefits and risks of TRT in men with hypogonadism, reports indicate that TRT may produce a wide range of benefits that include improvement in libido and sexual function, bone density, muscle mass, body composition, mood, erythropoiesis, cognition, quality of life, and cardiovascular disease. Perhaps the most controversial area is the issue of risk, especially the possible stimulation of prostate cancer by testosterone, even though there is no evidence to support this risk. Other possible risks include worsening symptoms of benign prostatic hypertrophy, liver toxicity, hyperviscosity, erythrocytosis, worsening untreated sleep apnea, or severe heart failure. Despite this controversy, testosterone supplementation in the United States has increased substantially in the past several years. The physician should discuss with the patient the potential benefits and risks of TRT. This review discusses the benefits and risks of TRT.
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PMID:Late-life onset hypogonadism: a review. 2049 41

Globally, it is estimated that > 140 million people live at a high altitude (HA), defined as > 2,500 m (8,200 ft), and that countless others sojourn to the mountains for work, travel, and sport. The distribution of exposure to HA is worldwide, including 35 million in the Andes and > 80 million in Asia, including China and central Asia. HA stress primarily is due to the hypoxia of low atmospheric pressure, but dry air, intense solar radiation, extreme cold, and exercise contribute to acute and chronic disorders. The acute disorders are acute mountain sickness (also known as soroche), HA cerebral edema, and HA pulmonary edema (HAPE). Of these, HAPE is highly correlated with acute pulmonary hypertension. The first chronic syndrome described in HA dwellers in Peru was chronic mountain sickness (Monge disease), which has a large component of relative hypoventilation and secondary erythrocytosis. The prevalence of chronic mountain sickness in HA dwellers ranges from 1.2% in native Tibetans to 5.6% in Chinese Han; 6% to 8% in male residents of La Paz, Bolivia; and 15.6% in the Andes. Subacute mountain sickness is an exaggerated pulmonary hypertensive response to HA hypoxia occurring over months, most often in infants and very young children. Chronic pulmonary hypertension with heart failure but without hypoventilation is seen in Asia. Not only does HA pulmonary hypertension exact health consequences for the millions affected, but also the mechanisms of disease relate to pulmonary hypertension associated with multiple other disorders. Genetic understanding of these disorders is in its infancy.
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PMID:High-altitude disorders: pulmonary hypertension: pulmonary vascular disease: the global perspective. 2052 76


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