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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The mechanism of hypertension induced by recombinant human erythropoietin (rHuEPO) is unclear but may include an increase in peripheral vascular resistance. We studied changes of arterial pressure and plasma endothelin in nine consecutive hemodialysis patients before, and 6 and 12 weeks after, starting rHuEPO. In six patients, changes in cardiac index (CI), stroke index (SI) and total peripheral resistance index (TPRI) were measured by bioimpedance, and forearm vascular responsiveness to intra-arterial norepinephrine (30 to 240 pmol/min) and endothelin-1 (5 pmol/min) were assessed. Six healthy age and sex matched subjects also underwent assessment of forearm vascular responsiveness to norepinephrine and endothelin-1. Treatment with rHuEPO significantly increased hemoglobin and mean arterial pressure (MAP). TPRI also increased by 35 +/- 11%. Plasma endothelin, although elevated basally, remained unchanged. Intra-arterial infusion of norepinephrine caused a maximal increase in forearm vascular resistance (FVR) of 17 +/- 9% before rHuEPO, significantly less than the 32 +/- 5% increase in healthy control subjects (P = 0.04). The response increased to 65 +/- 15% (P = 0.03) after 12 weeks rHuEPO treatment (P = 0.51 vs. controls). Endothelin-1 caused a maximal increase of FVR at 60 minutes of 45 +/- 24% before rHuEPO, which was not significantly different from controls, and tended to decrease with rHuEPO therapy. The response to endothelin-1, but not norepinephrine, correlated inversely with MAP (r = -0.52; P = 0.03) and TPRI (r = -0.51; P = 0.04). In conclusion, these studies show that anemia in chronic renal failure is associated with depressed vascular responsiveness to norepinephrine which is restored by rHuEPO therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Erythropoietin enhances vascular responsiveness to norepinephrine in renal failure. 747 68

This report reviews the literature on the impact of exposure to trichloroethylene (TCE) on human health. Special emphasis is given to the health effects reported in excess of national norms by participants in the TCE Subregistry of the Volatile Organic Compounds Registry of the National Exposure Registries--persons with documented exposure to TCE through drinking and use of contaminated water. The health effects reported in excess by some or all of the sex and age groups studied were speech and hearing impairments, effects of stroke, liver problems, anemia and other blood disorders, diabetes, kidney disease, urinary tract disorders, and skin rashes.
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PMID:Trichloroethylene--a review of the literature from a health effects perspective. 748 70

Two men aged 33 and 31 years suffered a fatal heat stroke on a warm summer day. One of them used pimozide and clomipramine, the other zuclopenthixol, dexetimide, droperidol, promethazine and propranolol as psychiatric medication. Both of them had a body temperature > 42.3 degrees C, without perspiring. At first only a comatose situation with practically normal laboratory values existed; this was rapidly followed by massive liver damage, disseminated intravascular coagulation, anaemia, thrombopenia and acute renal failure. In spite of adequate and rapid treatment these complications were fatal. Both patients used medication with an antidopaminergic and anticholinergic (side) effect. The set point of the temperature regulation centre can be elevated by the antidopaminergic activity of antipsychotics. Use of anticholinergic medication can disturb the thermoregulation via inhibition of the parasympathicomimetically mediated sweat secretion. It is recommended to point out the danger of unusually high outdoor temperatures to patients using this medication.
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PMID:[Psychiatric drugs as risk factor in fatal heat stroke]. 862 30

For daily clinical practice an isovolemic hemodilution down to an arterial O2 content of 10 ml/dl, corresponding to a hemoglobin content of 7.5 g/dl or a hematocrit value of 22.5%, is described as a tolerable value, as long as normovolemia and normoxia (no disturbances of lung function) are guaranteed and local restrictions in perfusion (coronary or cerebral sclerosis) are excluded. This value is not derived from the mixed venous O2 status but from the situation of the myocardium as the main limiting organ for anemic hypoxemia. Compensation of anemia is regulated hemodynamically: First, by an increase in stroke volume; secondary, by an increase in heart frequency and, tertiary, by an increase in venous utilization. The last may reach 100% without any restrictions from the so-called critical mixed venous pO2 as a possible limiting factor for hemodilution.
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PMID:[Critical limits of hemodilution: theoretical principles]. 769 Jun 62

The clinically acceptable limit of acute normovolemic, normothermic hemodilution, a standard procedure in scoliosis surgery, is not yet well defined. Eight ASA class I patients undergoing idiopathic scoliosis correction were administered a standard anesthetic with 100% oxygen and controlled ventilation. Hemodilution was accomplished by exchanging whole blood for 5% albumin in 0.9% saline. Blood gases, acid-base status, and circulatory variables were recorded prior to and after hemodilution, and every 30 min throughout surgery. The impact of hemodilution was judged by mixed venous oxygen saturation which was maintained at > or = 60%, while intravascular volume was maintained with the 5% albumin solution. Reinfusion of the autologous blood was completed by the end of surgery. In the eight controlled cases in which normovolemic hemodilution was studied, hemoglobin levels decreased from 10.0 +/- 1.6 g/dL to 3.0 +/- 0.8 g/dL. Mixed venous oxygen saturation decreased from 90.8% +/- 5.4% to 72.3% +/- 7.8%. Oxygen extraction ratio increased from 17.3% +/- 6.2% to 44.4% +/- 5.9%. Oxygen delivery decreased from 532.1 +/- 138.1 mL.min-1.m-2 to 260.2 +/- 57.1 mL.min-1.m-2, while global oxygen consumption did not decrease and plasma lactate did not appreciably increase. Central venous pressure increased and peripheral resistance decreased during hemodilution. Cardiac index increased, heart rate remained essentially constant, and left ventricular stroke work index did not decrease significantly. No patients suffered clinically adverse outcomes. Global oxygen transport and myocardial work can be maintained at extreme normovolemic anemia. Our evidence suggests that stages of normovolemic hemodilution more severe than previously reported may be clinically acceptable for young, healthy patients during normocarbic anesthesia.
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PMID:Oxygen consumption and cardiovascular function in children during profound intraoperative normovolemic hemodilution. 781 2

In a 69-year-old female patient a moderately pleomorphic spindle-cell thyroid tumour measuring 5 cm in diameter was initially misinterpreted as primary anaplastic thyroid carcinoma. During clinical investigations to elucidate the cause of severe anaemia, 17 months later an ulcerated duodenal leiomyosarcoma was detected and removed by duodenopancreatectomy. Reevaluation of the thyroid nodule led to revision of the initial diagnosis to metastatic leiomyosarcoma. Six months later the patient died from cerebral stroke. Autopsy findings confirmed the diagnosis of primary leiomyosarcoma of the duodenum with initial manifestation as thyroid metastasis.
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PMID:[Leiomyosarcoma in the thyroid gland--primary tumor or metastasis?]. 782 41

The purpose of this study was to examine the effect of recombinant human erythropoietin (r-HuEPO) on left ventricular mass. Twenty-seven hemodialysis patients (13 men and 14 women) were given r-HuEPO for renal anemia. Blood pressure and heart rate were measured before and after the 16-week course of r-HuEPO, and at the same time echocardiography was performed to measure left ventricular dimensions and wall thickness. These measurements were used to calculate left ventricular volume, cardiac output (CO), and left ventricular mass (LVmass). Diastolic blood pressure (DBP) increased after administration of r-HuEPO (from 75.8 +/- 10.8 mmHg to 85.6 +/- 12.7 mmHg), but there was no change in systolic blood pressure (SBP) or heart rate. LVmass increased significantly in seven cases (from 194.7 +/- 40.0 g to 240.3 +/- 47.3 g). These cases, Group I, showed no decline in stroke volume (SV) or CO, and showed significant increases in SBP. In the remaining 20 cases, Group II, LVmass decreased or was unchanged. In this group SV and CO decreased, but there was no increase in SBP. We conclude that increases in LVmass may be associated with elevated systolic blood pressure and hypertrophy of the left ventricular wall, when hemodialysis patients with severe renal anemia are given r-HuEPO.
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PMID:The effect of recombinant human erythropoietin (r-HuEPO) on left ventricular mass and left ventricular hemodynamics in hemodialysis patients. 793 70

There were 101 (4.6%) cases of malignant and accelerated hypertension among 2195 hypertensives patients treated in Department of Hypertension of National Institute of Cardiology between 1981 and 1990. Almost 30% of these patients were diagnosed as having secondary cause of hypertension. Comparison with control group of patients with moderate or mild hypertension revealed that malignant hypertensives had a shorter history of illness, lower level of education, higher evidence of smoking and over-consumption of alcohol. The systolic and diastolic blood pressure values were significantly higher in this group. The patients with malignant hypertension had significantly higher blood concentration of urea, creatinine and uric acid. Mild anemia was also present. Severe cardiovascular complications (myocardial infarction, stroke, encephalopathy, left ventricular failure) were observed in 44% cases of malignant hypertension. Due to efficacious hypotensive treatment blood pressure decreased significantly and biochemical indicators of renal function improved. Withdrawal of characteristic for malignant hypertension changes in fundoscopy was also observed. Results of this study indicate that prompt and aggressive treatment with normalization of blood pressure results in reversal of vascular lesions and permits recovery of cerebral and renal function.
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PMID:[Accelerated and malignant hypertension--clinical observation]. 802 29

A 40-year-old woman presented with profound muscle weakness resulting in failure to wean from a ventilator and persistent lactic acidosis after having recovered from a pneumonia complicated by adult respiratory distress syndrome, myocardial infarction, renal failure and shock. She had a 28 year history of chronic anemia and exercise intolerance. Anemia and thrombocytopenia persisted after admission. Nonobstructive hypertrophic cardiomyopathy was present. A stroke-like episode occurred. A mitochondrial myopathy with deficiencies in complexes IV and II was demonstrated, but no DNA defect has yet been found. This patient represents a distinct clinical presentation of a mitochondrial disorder characterized by late onset mitochondrial myopathy, chronic anemia, cardiomyopathy, and lactic acidosis.
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PMID:Mitochondrial myopathy with anemia, cardiomyopathy, and lactic acidosis: a distinct late onset mitochondrial disorder. 809 86

Anaemia may increase the risk of tissue hypoxia in preterm infants. The effect of transfusion on circulation was studied in 33 preterm infants with a mean (SD) gestational age of 29 (5) weeks (range 26-34), birth weight 1153 (390) g (range 520-1840), and postnatal age of 48 (21) days (range 19-100). Packed cell volume, blood viscosity (capillary viscometer), cardiac output, and cerebral blood flow velocities in the internal carotid artery, anterior cerebral artery, and coeliac trunk (Doppler ultrasound) were determined before and after transfusion of 10 ml/kg of packed red blood cells. Transfusion increased packed cell volume from a mean (SD) 0.27 (0.45) to 0.37 (0.48). Mean arterial blood pressure did not change while heart rate decreased significantly from 161 (14) l/min to 149 (12). Cardiac output decreased from 367 (93) ml/kg/min to 311 (74) due to decrease in stroke volume from 2.28 (0.57) ml/kg to 2.14 (0.46) and in heart rate. There was a significant increase in systemic red cell transport (cardiac output times packed cell volume) by 17%, systemic flow resistance (blood pressure to cardiac output ratio) by 23%, and blood viscosity by 33%. Vascular hindrance (flow resistance to blood viscosity ratio) did not change significantly, thereby suggesting that neither vasoconstriction nor vasodilation occurred with transfusion. After transfusion blood flow velocities decreased significantly in the anterior cerebral artery by 23%, in the internal carotid artery by 8%, and in the coeliac trunk by 12%. Red cell transport estimated as products of blood flow velocities times packed cell volume increased significantly by 25% in the internal carotid artery and by 21% in the coeliac trunk. These results indicate that red cell transfusion improved systemic oxygen transport as well as oxygen transport in the internal carotid artery and coeliac trunk.
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PMID:Effects of red cell transfusion on cardiac output and blood flow velocities in cerebral and gastrointestinal arteries in premature infants. 809 71


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