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

Fibrinolysis treatment with urokinase was successfully undertaken in two patients, aged 71 and 76 years, with phlegmasia coerulea dolens. In the first case, with necrosis in the fore-foot, there was significant regression of the necrotic area, but a later limited amputation was still necessary. In the second, with severe heart failure, recurrent pulmonary emboli and hyperosmolar uncontrolled diabetes mellitus, complete healing was achieved. Venous thrombectomy was not possible in these two patients because of the duration of the thrombosis in the veins of the pelvic region, necrosis had already occurred, and the patients' general condition was so serious. The advanced age and arteriosclerotic changes argued against streptokinase treatment. Mean urokinase maintenance dosage of 1000-1500 IU/kg X h, with simultaneous administration of heparin at about 20 U/kg X h, produced no significant side-effects. Minor gastro-intestinal bleeding did not require stoppage of urokinase administration.
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PMID:[Urokinase treatment of phlegmasia coerulea dolens (author's transl)]. 31 5

Between 1958--1976 204 patients with abdominal aortic aneurysms were admitted to the surgical ward for evaluation. One hundred and thirty-eight patients were operated on, 7 died prior to operation and 59 patients were not recommended operation for different reasons. Elective surgery was performed in 60 patients and 78 underwent acute surgery. The aneurysm had ruptured in 40 of the acutely operated patients. The operative mortality was 33% for the whole series, 65% among the ruptured aneurysms and 10% for the planned operations. The early mortality diminished successively and was during the last 5-year period 4% for planned and 40% for emergency operations. The main causes of the early mortality was renal or cardiac insufficiency and abdominal or gastrointestinal haemorrhage. Intestinal infarction was the cause of death in two patients. Twenty-nine re-operations were made in 24 patients. Abdominal haemorrhage, gastro-intestinal bleeding or arterial embolus in the leg were the most common reasons for the re-operations. An analysis of the factors that may influence the operative mortality revealed that age, sex, pre-operative shock, re-operations and number of blood transfusions may be of importance for prediction of the survival. Previously known hypertension, infarction, myocardial ischaemia or the operation time did not seem to have any predictive value. The most common reasons for not recommending surgery were small aneurysms, technical inoperability, advanced age or severely complicating disease.
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PMID:Abdominal aortic aneurysms. 1. Selection of patients and operative results. 53 37

We have studied 97 patients with dementia who have been discharged from our hospital and 106 inpatients with dementia who have been admitted during last two years in our hospital. The diagnosis of dementia was done according to the criteria of DSM-III. Based on their clinical course, neurological signs, Hachinski's ischemic score and neuroradiological findings, we divided patients into 4 groups, [senile dementia of the Alzheimer type (SDAT), vascular dementia (VD), unclassified dementia and other dementias which includes dementia with Parkinson's disease or motor neuron disease, etc.]. Concerning 70 demented patients who died during hospitalization, the average age of onset and the duration of illness of SDAT were 80.5 years old and 4.6 years respectively and those of VD were 77.6 years old and 2.7 years respectively. The common causes of death were pneumonia (50%) and cardiac failure (24%). Recurrence of cerebral vascular accident (CVA) was also another frequent cause of death in VD. The most common behavioral problems causing admission in patients of SDAT were aimless wandering, nocturnal delirium, illusion and hallucination. In VD, nocturnal delirium, aimless wandering, violence and abnormal monologue were most common causes of admission. The important causes degrading ADL of inpatients were fracture, especially fracture of the hip joint, pneumonia, intestinal bleeding and CVA. Concerning the increase of the population of over 75 years old, it will be suggested that the care and treatment of demented patients in this age group will become a major social problem.
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PMID:[Clinical and epidemiological studies on inpatients with dementia]. 238 92

A 60-year-old man under digitalis treatment for hypertensive heart tried to commit suicide by absorbing a 15 mg dose of digitoxin. Severe intestinal bleeding occurred 12 hours later, followed by pseudo-occlusive syndrome and ischaemia of the distal lower limbs. On abdominal incision the whole gut was found to be invaded by haemorrhagic necrosis and perforated on three points. The patients subsequently died of peritonitis. The responsibility of digitoxin in these events was demonstrated by the absence of any other cause of ischaemia, such as heart failure, shock, arrhythmia, consumption coagulopathy or use of sympathomimetic drugs. This case shows that the vasoconstrictor effect of digitalis, experimentally demonstrated but clinically controversial, is a reality, and that digitalis compounds are contra-indicated in patients with haemorrhagic necrosis of the digestive tract.
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PMID:[Haemorrhagic necrosis of the digestive tract consecutive to massive digitalis intoxication (author's transl)]. 697 39

During 1996, 585 patients, aged 55 to 96, were admitted into hospital at the Geriatric Department of Ospedale Maggiore (Turin). Acute confusion was seen in 22.2% of these patients who tended to have more serious clinical condition, were more likely to have chronic cognitive impairment, were treated with a greater number of drugs and suffered more from immobility with pressure ulcer. The confusional state, manifested at admission to Geriatric department, was mostly related with the patient's clinical severity, while the one which developed during hospital stay was linked to situations of physical frailty, as pressure ulcer and low albumin values. The most frequent causes of acute confusional state were acute infectious diseases, heart failure, gastro-intestinal bleeding with secondary anaemia, stroke and dehydration. In many cases the very cause of the acute confusional state could not be identified. Falls, more than 31 days length of stay in hospital and death were more frequent in patients suffering from confusional state. Chronic cognitive impairment, functional dependence, clinical severity and treatment involving a great number of drugs, are the main contributing factors in this syndrome. Thus, a multi-dimensional evaluation which takes into account both clinical-functional and socio-economical aspects, is useful for a correct preventive and diagnostic approach of acute confusional state.
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PMID:[Acute confusion in the geriatric patient]. 967 28

The high incidence of cancer after renal transplantation is now a critical concern since the graft survival rate has been improved extensively. We experienced 9 malignancies in 8 patients out of 168 recipients up to December 31, 1999 in our hospital, consisting of a case of gastric plasmacytoma and cases of cancer in the liver (2), thyroid (2), prostate (1), breast (1), sigmoid colon (1) and gall-bladder (1). Two patients were diagnosed as having tumors within 3 months after transplantation, suggesting post-transplant acceleration of growth of the latent tumors. The other patients were diagnosed at an average of 128 months, ranging from 84 to 263 months after transplant. Two patients died of gastro-intestinal bleeding and acute heart failure. Four patients died directly of progressive neoplasm within 3 months after diagnosis. These results suggest that the course of malignancies developing in post-transplant recipients is more aggressive than that expected in non-transplant patients, and it is very important to intensively follow long-term surviving cases to detect the malignant tumors as early as possible.
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PMID:Study on eight patients with malignant tumors after renal transplantation. 1092 May 78

Acute liver failure is a rare but potentially fatal disease. Adult definition of fulminant hepatic failure, which includes the development of hepatic necrosis and encephalopathy within 8 weeks of onset of liver disease does not apply to acute liver failure in children particularly if secondary to autoimmune or metabolic liver disease. The etiology of acute liver failure varies with the age of the child. In neonates, infection or an inborn error of metabolism are common, while viral hepatitis and drug induced liver failure are more likely in older children. The clinical presentation of acute liver failure includes jaundice, coagulopathy and encephalopathy. In neonates, encephalopathy may be subclinical. The management of acute liver failure includes assessment of prognosis for liver transplantation; prevention and treatment of complications while awaiting hepatic regeneration or a donor liver and hepatic support. The major complications of acute liver failure are sepsis, gastro-intestinal bleeding, cerebral edema, renal and cardiac failure. Selection for liver transplantation depends on the etiology of the disease, prognostic factors, the presence or absence of multisystem disease and/or reversible brain damage. Prognostic factors for survival are less well established in children than in adults but children with metabolic liver disease, prothrombin time > 50 seconds, rising bilirubin and falling transaminase, grade II or higher grade of hepatic coma indicate poor prognosis. Most children receive a reduced or split liver graft. Living related donations for acute liver failure are also carried out by some centres. Survival post liver transplantation for acute liver failure has improved and most recipients can expect a 70% five year survival.
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PMID:Acute liver failure. 1113 56

Chronic inflammation is a common feature of end-stage renal disease (ESRD) that is gaining increasing attention as a major cause of morbidity and mortality. It is well established that ESRD per se carries a heightened risk of inflammatory disorders and other co-morbid conditions, but it should also be pointed out that dialysis treatment per se can bring additional risk factors for inflammation, such as impure dialysate or bio-incompatible membranes. Inflammation has recently been associated with atherosclerosis and malnutrition in ESRD, and this link has led to the development of the malnutrition, inflammation, atherosclerosis (MIA) hypothesis. This describes a syndrome whereby raised levels of pro-inflammatory cytokines (such as IL-1, IL-6 and TNF-alpha) are a common link between malnutrition, inflammation and atherosclerosis. Also, anaemia appears to be an important element linking elevated cytokine levels with poor patient outcomes. Several mechanisms for cytokine-induced anaemia have been proposed, including intestinal bleeding, impaired iron metabolism and suppression of bone marrow erythropoiesis and erythropoietin production. These effects suggest that pro-inflammatory cytokines may also be an important cause of lack of response to recombinant human erythropoietin (rh-Epo) therapy. In the light of this putative role of pro-inflammatory cytokines, anti-cytokine agents may prove useful to optimize efficacy of rh-Epo in anaemic chronic renal failure patients. Other potential therapeutic strategies include minimizing exposure to causes of inflammation from various co-morbid conditions, such as persistent infections and chronic heart failure.
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PMID:The role of inflammation in the anaemia of end-stage renal disease. 1159 Feb 55

From January 2004, R/R MM cases referred to the Institution received LD-VTD regimen. Patients, irrespective of age, PS and life expectancy, were enrolled in the study once they had a measurable disease. Planned therapy: Velcade 1.0 mg m(-2) i.v. twice weekly for 2 weeks of a 28-day cycle for up to 6 cycles, oral Dexamethasone 24 mg on the day of and the day following each Velcade dose and Thalidomide 100 mg each evening. DVT prophylaxis with warfarin to maintain international normalized ratio between 2.0-3.0 was planned in all patients. As of 1 June 2005, 18 were the treated patients: median age 63 years, median time from diagnosis 5.8 years, a median of 4 previous therapy lines. Seventeen were the valuable patients and 9 (53%) were the responders: 2 CR, 6 PR, 1 MR. Six were the stable disease and 2 the progressive ones. Median time to best response was 2 months. Toxicity was negligible. No case of DVT was recorded. Except for the first cycle, subsequent cycles were delivered on an outpatient basis. After a median follow-up of 11 months, 12 patients were alive and 5 died (3 disease progression, 1 heart failure, 1 intestinal bleeding). Thus, the LD-VTD regimen applied appears feasible and effective in elderly and heavily pre-treated R/R myeloma patients.
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PMID:Low dose Velcade, thalidomide and dexamethasone (LD-VTD): an effective regimen for relapsed and refractory multiple myeloma patients. 1632 46

Gastritis cystica polyposa (GCP) is a rare inflammatory disease of the gastric remnant that usually develops after partial gastrectomy. It is defined by the presence of polyps on anastomotic gastric mucosa and at histopathological examination, by the presence of mucosal and submucosal cysts with foveolar hyperplasia. The disease is characterized by the frequency of gastro-intestinal bleeding and possibility of carcinomatous association. We report seven cases of GCP collected over 5 years (1994-1999). Diagnosis was made 9 to 45 years after partial gastrectomy and Finsterer. The patients were 52 to 72 years old. Revealing symptoms were cardiac failure, cardiac ischemia, melena, severe anemia and epigastric pain. For one patient, GCP was discovered casually. Endoscopic examination showed in all patients; the presence of several polyps sized between 3 to 15 mm on the perianastomotic gastric remnant. Histology examination of the polyps showed microscopic features of GCP in all cases. In one patient, there was a mild glandular atrophy with extensive intestinal metaplasia and mild dysplasia. Helicobacter pylori was present only in this case.
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PMID:[Gastritis cystica polyposa: report of 7 cases and literature review]. 1638 3


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