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Query: UMLS:C0028961 (oliguria)
 1,847 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The diagnostic value of renal concentrating capacity expressed as free water clearance (CH2O), in comparison with other routine criteria for the early identification of acute renal failure (ARF), was evaluated in 1,203 adult patients undergoing cardiac surgical procedures. On the basis of the appearance of pathologic CH2O values in the range of -20 to 0 ml/hour or more positive, reversible or irreversible ARF was observed in 90 (= 7.5%) of our patients. Mortality in the presence of ARF was 47%; total ARF mortality was 3.5%. CH2O was pathologic for the first time on an average of 1.6 days after operation. In contrast, routine ARF criteria reported in the literature, such as serum urea and creatinine at varying substrate levels or oliguria, allowed diagnosis 1 to 5.5 days later. Moreover, these parameters only partially and less frequently met the criteria for ARF at the different levels. Likewise, the incidence of ARF decreased to a minimum of 1.7% and the total ARF mortality to 1.3%, depending on the severity of the criteria used. Altogether, the occurrence of pathologic CH2O values proved to be the earliest, most frequent and most reliable criterion for the recognition of ARF following cardiac surgery with cardiac-pulmonary bypass.
Thorac Cardiovasc Surg 1979 Aug
PMID:The diagnosis of acute renal failure (ARF) following cardiac surgery with cardio-pulmonary bypass. 49 20

A patient developed oliguria, peripheral edema, and dyspnea 5 days after mitral valve replacement. Chest roentgenogram and echocardiogram suggested pericardial effusion. Although pulsus paradoxus was absent, cardiac tamponade was suspected and subsequently confirmed during pericardiocentesis. Before pericardiocentesis right and left ventricular diastolic pressures were equal, as well as intrapericardial and right atrial pressures. The left ventricular cavity was reduced in size on the echocardiogram. Interventricular septal motion was normal. Pericardiocentesis normalized the hemodynamics and allowed the left ventricle to reexpand. Certain atypical features are tentatively explained as the combined effect of constrictive and effusive components caused by intrapericardial hemorrhage.
Cathet Cardiovasc Diagn 1977
PMID:Atypical late cardiac tamponade after mitral valve replacement: case presentation with hemodynamic and echocardiographic observations. 91 39

Acute renal insufficiency after cardiopulmonary bypass can lead to a significant morbidity from fluid overload and electrolyte disturbance, impede pulmonary gas exchange, and postpone weaning from mechanical ventilation. The limitations placed on free water intake result in severe restriction of nutrition while diuretic therapy causes electrolyte imbalance. Artificial renal support either in the form of peritoneal dialysis or hemodialysis may be complicated by sepsis and hemodynamic instability. We reviewed our experience with the use of continuous arteriovenous hemofiltration, an extracorporeal technique for removal of solutes, toxins, and water in critically ill patients with cardiac failure complicated by acute renal insufficiency and hemodynamic instability after cardiopulmonary bypass. Ten infants and children with renal insufficiency caused by low cardiac output had continuous arteriovenous hemofiltration instituted for indications including sepsis, volume overload, oliguria for more than 24 hours nonresponsive to diuretic therapy, and the need for hyperalimentation. All were supported by mechanical ventilation and receiving high-dose inotropic support. Arterial and venous vascular access was successfully obtained by cannulation of the femoral artery and vein in nine patients. Anticoagulation of the circuit was achieved with heparin infusion (6 to 20 micrograms/kg/hr) and monitored by measurement of activated clotting time. The continuous arteriovenous hemofiltration circuit was replaced if there was clot formation, or at 3 days after placement. Dialysis solution (Dianeal) 1.5% or 0.5% was infused as prefilter dilution. With the use of continuous arteriovenous hemofiltration, 20 to 100 m/hr of ultrafiltrate was removed, which allowed correction of hypervolemia, and caloric intake increased from 13.5 kcal/kg/day to 79.5 kcal/kg/day. Continuous arteriovenous hemofiltration was maintained between 5 hours and 8 days and was well tolerated in all patients. Serum urea and creatinine levels declined during continuous arteriovenous hemofiltration. We conclude that continuous arteriovenous hemofiltration is a safe and effective method for fluid and electrolyte homeostasis and that it thus allows hyperalimentation in infants and children after cardiac operations.
J Thorac Cardiovasc Surg 1992 Nov
PMID:Continuous arteriovenous hemofiltration after cardiac operations in infants and children. 143 99

Four of 44 patients who had undergone the Fontan operation had persistent low cardiac output necessitating takedown of the shunt 6 to 65 hours (average 23 hours) postoperatively. All four were in a group of 22 patients with complex lesions other than tricuspid atresia with ventriculoarterial concordance. The development of postoperative right atrial hypertension (average 24 torr), hepatomegaly, marked ascites, and decreasing lung compliance led to severe systemic hypotension with systolic arterial pressure ranging from 55 to 82 torr (average 68 torr), persistent metabolic acidosis, and oliguria despite massive colloid and crystalloid infusions (11,000 ml/m2/24 hr) and inotropic support. At reoperation the atriopulmonary anastomosis, which was found to be wide open, was taken down and an atrial septal defect was created in all patients. Three patients were left with a Glenn shunt and an aortopulmonary shunt to the left lung. One patient had bilateral aortopulmonary shunts. Two patients who survived reoperation had immediate postoperative improvement in systolic arterial and mean right atrial pressure (average 100 torr and 11.5 torr, respectively). Both are well 5 months and 4 years later. Repeat Fontan operation remains a possibility with acceptable risks because of the presence of the Glenn shunt in both patients. We believe that takedown should be considered in patients with persistent low cardiac output after the Fontan operation.
J Thorac Cardiovasc Surg 1986 Sep
PMID:Persistent low cardiac output after the Fontan operation. Should takedown be considered? 374 71

Female Sprague-Dawley rats were sham operated, adrenal-enucleated, or mononephrectomized. Half of each group received 30 mg/kg of nitrendipine; the remainder were given equal volumes of vehicle, and all rats were then injected i.p. with 40 ml/kg of 0.9% NaCl solution. Urine was collected over a 6-h period. Nitrendipine-treated intact rats excreted slightly more water and Na+ and less K+ than controls, but none of the differences were significant statistically. Adrenal-enucleate controls displayed oliguria and Na+ retention, but normal K+ excretion and reduced Na+/K+. Nitrendipine did not modify oliguria or antinatriuresis or affect Na+/K+. Mononephrectomized rats behave similarly, but in these nitrendipine abolished oliguria and improved Na+ excretion. The most characteristic nitrendipine effect in all three cases was a reduction in urine osmolality. This was particularly evident in adrenal-enucleated and mononephrectomized rats, in which control urine displayed a relative hyperosmolarity as compared with normal control values.
J Cardiovasc Pharmacol 1984
PMID:Effect of nitrendipine on urine volume, osmolality, and electrolyte excretion in normal, adrenal-enucleate, and mononephrectomized rats. 608 61

This study presents an analysis of the influence of the site of rupture of abdominal aortic aneurysms on the postoperative survival rate. A series of 226 patients, who underwent emergency operations for ruptured aneurysms, is examined. The three most important methods of rupture are: (1) Retroperitoneal rupture: this type is associated with a very high mortality (52.8% in our experience), which reaches almost 75% when the posterior parietal peritoneum tears and massive intraperitoneal bleeding occurs. This mortality is related to the amount of blood loss, hypovolemic shock, the number of transfused blood units and, especially, to increasing renal insufficiency. (2) Rupture into the inferior vena cava: in this event the mortality rate it less severe (38.4% in our experience) and it is mostly related to the occurrence of an high output cardiac failure, as well as to oliguria or anuria following renal venous hypertension. (3) Enteric rupture: this is, in our experience, the most uncommon event. It carries a high mortality rate (50%). The copious bleeding, which is unrestricted in hollow organs, explains the dangerous hypovolemic shock, while massive blood reabsorption from the enteric tract leads to a renal insufficiency.
J Cardiovasc Surg (Torino)
PMID:Influence of the rupture site of abdominal aortic aneurysms with regard to postoperative survival rate. 650 97

Five patients requiring dialysis for acute pulmonary edema and uremia from severe renal artery occlusive disease underwent surgical revascularization. Three patients with oliguria had excellent outcomes and remain dialysis-independent as long as twenty-four months following operation (mean serum creatinine 2.0 mg/dl). The two patients who were anuric both had technically successful operations but remained dialysis-dependent. Diagnostic evaluation of the azotemic patient suspected to have renal arterial occlusive disease should include a history and physical examination, urinalysis, renal ultrasound, and duplex scan of the renal arteries. In appropriate patients, arteriography should then be considered if other diagnoses appear unlikely. This algorithm may help identify those patients who might benefit from renal revascularization. It appears that oliguria rather than anuria and the angiographic demonstration of a patent distal vessel and nephrogram suggest a better functional outcome after revascularization. Unfortunately, the response to surgery cannot be reliably predicted and patient selection remains a challenge, but retrieval of renal function can be achieved in some cases even if patients are already being hemodialyzed.
J Cardiovasc Surg (Torino) 1995 Jun
PMID:Renal revascularization in patients on dialysis. 762 7

A case of acute lower-body ischemia 2 days following intraaortic balloon pump insertion is reported. Fluoroscopy revealed persistent balloon inflation throughout the cardiac cycle with distal aortic occlusion. Attempts to manually deflate the balloon were unsuccessful until a guidewire was advanced through the gas-exchange lumen into the body of the balloon. The balloon catheter was removed without clinical sequelae other than transient oliguria and an asymptomatic increase in creatinine phosphokinase (CPK). This is a previously unreported complication of intraaortic balloon counterpulsation.
Cathet Cardiovasc Diagn 1993 Nov
PMID:Total aortic occlusion caused by sustained balloon inflation: a previously unreported complication of intraaortic balloon counterpulsation. 826 91

We tested the hypothesis that enhanced intravascular coagulation in pregnancy could produce clinical symptoms similar to those of preeclampsia, such as hypertension, proteinuria, and edema. Having confirmed this, we then examined whether the pathological changes caused by intravascular coagulation could be suppressed by administration of antithrombin III (AT III), an endogenous inhibitor active to thrombin and factor X a. Intravascular coagulation was induced in Wistar rats on day 16-20 of pregnancy by 1-h arterial infusion of tissue thromboplastin (TP) through the left ventricle of the heart. One hour after the end of the infusion period, organ blood flows were measured by the radioactive ((57)Co-labeled) microsphere method, and fibrin deposition in organs was measured by radiolabeling with [(125)I] fibrinogen injected before TP infusion. Infusion of TP produced fibrin deposition in the kidney, lung, and liver, but not in the myometrium and placenta, as well as an 80% decrease in renal blood flow (RBF), with oliguria and proteinuria. TP also caused an increase in blood pressure (BP) accompanied by an increase in plasma renin activity (PRA), both of which were suppressed by bilateral nephrectomy before TP infusion. The prophylactic administration of AT III concentrates (60 or 300 U/kg intravenously (i.v.), followed by infusion of 30 or 150 U/kg/2 h, respectively) prevented all pathological changes in a dose-dependent manner. AT III increased placental blood flow regardless of the state of coagulation. These findings suggest that intravascular coagulation plays a significant part in the pathophysiology of preeclampsia and that AT III concentrates may have therapeutic potential in the treatment of this condition.
J Cardiovasc Pharmacol 1996 May
PMID:Antithrombin III prevents renal dysfunction and hypertension induced by enhanced intravascular coagulation in pregnant rats: pharmacological confirmation of the benefits of treatment with antithrombin III in preeclampsia. 885 41

Eighty-two consecutive patients with interrupted aortic arch were referred to our institution between 1985 and 1995. Three died before any attempt at operation and 79 underwent surgical repair. Median age at operation was 9 days (range 1 day to 6 years) and median weight was 3.0 kg (range 1.8 to 20 kg). All but one were in severe congestive heart failure and 31.5% had oliguria or anuria. Preoperative pH varied between 6.8 and 7.4 (median 7.3). Sixty-nine received prostaglandin E1 infusion and 54 received mechanical ventilation. Aggressive preoperative ressucitation was necessary in 43 cases. Preoperative transfontanellar echography (performed routinely) since 1987 revealed intracerebral bleeding in six patients. Type A interrupted aortic arch was present in 37 cases, 41 patients had type B, and one had type C. Interrupted aortic arch was associated with single ventricular septal defect in 35 cases, 24 patients had associated complex heart defects, and 30 had significant subaortic stenosis (six had both subaortic stenosis and complex association). Aortopulmonary window was found in four patients, truncus arteriosus was found in eight, and transposition of the great arteries was found in five, double-outlet right ventricle was found in one, single ventricle was found in three, multiple ventricular septal defects were found in two and superior-inferior ventricles were found in one. Sixty-four patients underwent single-stage repair and 15 underwent multistage repair. Aortic arch repair consisted of direct anastomosis in 59 cases, patch augmentation in eight, and conduit interposition in 12. Ten patients underwent associated pulmonary artery banding and 19 underwent concomitant repair of complex associated lesions. The subaortic stenosis was addressed by four surgical techniques: myotomy or myectomy in five patients; creation of a double-outlet left ventricle, aortopulmonary anastomosis, and conduit insertion between the right ventricle and pulmonary artery bifurcation in four; no direct attempt to relieve the subaortic stenosis in six; and left-sided ventricular septal defect patch in 15. Mean duration of deep hypothermic circulatory arrest, crossclamp time, and cardiopulmonary bypass time were 38.8 +/- 15.6 min, 60.5 +/- 24.7 min, and 143 +/- 40.1 min, respectively. Postoperative mortality rate was 18.9% (70% confidence limits 14% to 24.6%), and overall mortality rate was 31% (70% confidence limits 20.9% to 42.2%). The results have improved with time, with an overall operative mortality rate of 12% since 1990. Univariate statistical analysis revealed that early survival was influenced by preoperative renal function, detection of cerebral bleeding by transfontanellar echography, the number of cardioplegic injections, and the date of operation. Multivariate analysis revealed that preoperative renal function and the number of cardioplegic injections were independent risk factors for early mortality. Echocardiographic measurements of the left heart-aorta complex with preoperative Z values as low as-4 demonstrated rapid growth after repair. In the presence of subaortic stenosis, better survival was obtained with a left-sided patch for ventricular septal defect closure (p < 0.05). Twenty-three patients underwent 26 reoperations for recoarctations (seven), left bronchial compression (two), second-stage repair (eight), right ventricle-pulmonary artery conduit replacement (three), and miscellaneous (four). One of the survivors was reoperated on for subaortic membrane. Survival at 5 years for the entire series was 70%. For isolated forms, it was 73.5% (90% for 1990 to 1995), for complex forms it was 70%, and in the presence of subaortic stenosis it was 60%. In conclusion, interrupted aortic arch remains a surgical challenge with continually improving results. Early diagnosis with preoperative resuscitation and adequate myocardial protection seem extremely important for further improvements. Associated subaortic stenosis or complex lesions
J Thorac Cardiovasc Surg 1996 Nov
PMID:Repair of interrupted aortic arch: a ten-year experience. 945 Oct 87


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