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Cardiac Insufficiency (cardiac + insufficiency)
Selected AbstractsAdenosine A1 Antagonism Attenuates Atropine-resistant Hypoxic Bradycardia in RatsACADEMIC EMERGENCY MEDICINE, Issue 9 2003Justin L. Kaplan MD Abstract Objectives: To test the following hypotheses: Hypoxia induces bradycardia and hemodynamic compromise that are resistant to atropine but responsive to selective antagonism of the adenosine A1 receptor (A1AdoR). The mechanism for such attenuation is independent of the vagus nerve. Methods: Ten minutes after sham or actual bilateral cervical vagotomy, paralyzed ventilated rats were made hypoxic (5% fractional inspired oxygen, continued until death). Five minutes after beginning hypoxia, intravenous treatment with BG-9719, a selective A1AdoR antagonist (0.1 mg/kg); atropine (0.1 mg/kg); BG-9719 vehicle; or saline was initiated. These drug doses were based on pilot studies. Of the eight treatment groups (eight possible combinations of vagotomy status and drug/vehicle treatment), n= 8 in all except nonvagotomized, vehicle-treated rats (where n= 7). Results: Heart rate and left ventricular contractility decreased rapidly with hypoxia. Atropine had minimal effects in prolonging survival (from mean ± SEM of 15.5 ± 2.1 minutes to 20.2 ± 2.5 minutes, p = 0.94) and attenuating posthypoxic decreases in heart rate (p = 0.89) and contractility (p = 0.83) compared with saline. BG-9719 prolonged survival, however, from 14.4 ± 1.9 minutes (with vehicle treatment) to 37.2 ± 6.8 minutes (p < 0.001). Survival, heart rate, and contractility were preserved with BG-9719 compared with atropine and vehicle (p < 0.05, all comparisons). Vagotomy prevented the effects of BG-9719 on survival prolongation (p = 0.003), heart rate (p = 0.01), and contractility (p < 0.001) but did not affect those outcomes in saline-treated rats. Conclusions: Survival, heart rate, and contractility were better preserved with BG-9719 than atropine. A1AdoR selective antagonism, possibly because of its multiple mechanisms for attenuating hypoxic cardiac insufficiency, resulted in better hemodynamic and clinical outcomes. That attenuation seems to have a component of vagal mediation. [source] Weight restoration in a patient with anorexia nervosa on dialysisINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 4 2005D. Blake Woodside MD Abstract Objective We report a case of weight restoration in a patient with anorexia nervosa, end-stage renal disease (ESRD) requiring dialysis, and cardiac insufficiency. Method The technical challenges and ethical issues involved in her clinical management are reviewed. Renal insufficiency is a common complication of more severe anorexia nervosa. Results Progression to renal failure, when it occurs, is most typically a terminal event. There are currently no published guidelines for monitoring the weight gain of patients undergoing dialysis. Conclusion We present a case of a patient who progressed from renal insufficiency to renal failure while in treatment for anorexia nervosa, and who was ultimately successfully weight restored while on renal dialysis. © 2005 by Wiley Periodicals, Inc. [source] The successful use of peripheral nerve blocks for femoral amputationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2009B. BECH We present a case report of four patients with severe cardiac insufficiency where peripheral nerve blocks guided by either nerve stimulation or ultrasonography were the sole anaesthetic for above-knee amputation. The patients were breathing spontaneously and remained haemodynamically stable during surgery. Thus, use of peripheral nerve blocks for femoral amputation in high-risk patients seems to be the technique of choice that can lower perioperative risk. [source] Aldosterone receptor antagonists , how cardiovascular actions may explain their beneficial effects in heart failureJOURNAL OF VETERINARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2010P. OVAERT Ovaert, P., Elliott, J., Bernay, F., Guillot, E., Bardon, T. Aldosterone receptor antagonists , how cardiovascular actions may explain their beneficial effects in heart failure. J. vet. Pharmacol. Therap.33, 109,117. Historically, aldosterone receptor antagonists (ARA) have been classified as ,potassium sparing diuretics'. However, the positive effect of spironolactone, the most extensively studied ARA, on morbidity and mortality observed in humans suffering cardiac insufficiency could not be explained by the renal effect of the drug alone, and a pivotal clinical study has led to extensive research. Many experimental studies have demonstrated that ARA have previously unexpected beneficial effects on the cardiovascular system including reduction in remodelling of the vascular smooth muscle cells and myocytes and improvement of endothelial cell dysfunction in heart failure. These effects improve vascular compliance and slow down the progression of left ventricular dysfunction and end-organ damage. Furthermore, aldosterone receptor blockade also restores the baroreceptor reflex, improving heart rate variability in heart failure in humans. Some of these effects have been demonstrated in dog models of cardiac disease and so justified further investigation of the potential benefit of ARA in dogs with congestive heart failure (CHF). Positive effects of spironolactone on morbidity and mortality appear to have been seen in studies conducted in dogs suffering from naturally occurring CHF. In addition, eplerenone has been shown to have benefits in canine models of heart failure. The precise mechanisms by which ARA produce these beneficial effects in dogs remain to be determined but this group of drugs clearly provide therapeutic actions out-with their diuretic effects. [source] Laser Polishing in Medical EngineeringLASER TECHNIK JOURNAL, Issue 2 2010Laser Polishing of Components for Left Ventricular Assist Devices Cardiac surgery has made significant progress during the last 50 years. nowadays, almost every congenital or contracted dysfunction of the heart can be treated clinically or at least the etiopathology can be alleviated. During these years, implantable Left Ventricular Assist Devices (LVADs) have proven to be an effective and reliable medical product. In particular, the survival rate of patients with cardiac insufficiency has risen due to these devices. This type of heart-assist device is implanted either to bridge the time until cardiac transplantation or recovery has occurred, or for permanent implantation in the patient's body. Berlin Heart GmbH produces the clinically tested axial pump system INCOR® (Figure 1, above). The INCOR heart-as-sisting pump is a powerful implantable LVAD which has been used in more than 500 clinical applications. The main function of the axial pump is to unload the patient's heart by transporting blood from the left ventricle to the aorta. In order to assure high reliability of the pump's operation, the components used for blood transport have to be highly bio- and hemocompatible. [source] Death after re-exposure to propofol in a 3-year-old child: a case reportPEDIATRIC ANESTHESIA, Issue 3 2004Josef Holzki MD Summary This case report discusses the cause of death in a 3-year-old child who survived a high dose (20 mg·kg,1·h,1) of propofol, infused over a period of 15 h, following which the patient developed a combined respiratory and metabolic acidosis, the oxygenation remaining normal. Bronchospasm was assumed to be the cause of hypercapnia. At this time the doctors in charge did not think of a possible side-effect of propofol. The administration of propofol was interrupted, the patient recovered within 13 h from the acidosis, woke up and required further sedation. A supposedly entirely safe infusion of 4 mg·kg,1·h,1 propofol, as recommended in the literature for up to 48 h, was administered. After only 8 h intractable bradycardic dysrhythmias occurred. Although pharmacokinetic studies have pointed to a possible accumulation of propofol during continuous infusions, an interruption of an infusion for several hours has been considered sufficient for practically total clearance of the drug from the body. In this case re-exposure with a recommended dose of propofol was accompanied by bradycardia and dysrythmias that proved to be resistant to therapy and led to fatal cardiac insufficiency with a functioning artificial pacemaker in place. This case raises concerns about the safety of long-term infusions of propofol for sedation in children and possibly also in adults. [source] Pathway analysis of dilated cardiomyopathy using global proteomic profiling and enrichment mapsPROTEINS: STRUCTURE, FUNCTION AND BIOINFORMATICS, Issue 6 2010Ruth Isserlin Abstract Global protein expression profiling can potentially uncover perturbations associated with common forms of heart disease. We have used shotgun MS/MS to monitor the state of biological systems in cardiac tissue correlating with disease onset, cardiac insufficiency and progression to heart failure in a time-course mouse model of dilated cardiomyopathy. However, interpreting the functional significance of the hundreds of differentially expressed proteins has been challenging. Here, we utilize improved enrichment statistical methods and an extensive collection of functionally related gene sets, gaining a more comprehensive understanding of the progressive alterations associated with functional decline in dilated cardiomyopathy. We visualize the enrichment results as an Enrichment Map, where significant gene sets are grouped based on annotation similarity. This approach vastly simplifies the interpretation of the large number of enriched gene sets found. For pathways of specific interest, such as Apoptosis and the MAPK (mitogen-activated protein kinase) cascade, we performed a more detailed analysis of the underlying signaling network, including experimental validation of expression patterns. [source] Fukutin gene mutations cause dilated cardiomyopathy with minimal muscle weaknessANNALS OF NEUROLOGY, Issue 5 2006Terumi Murakami MD Objective The fukutin gene (FKTN) is the causative gene for Fukuyama-type congenital muscular dystrophy, characterized by rather homogeneous clinical features of severe muscle wasting and hypotonia from early infancy with mental retardation. In contrast with the severe dystrophic involvement of skeletal muscle, cardiac insufficiency is quite rare. Fukuyama-type congenital muscular dystrophy is one of the disorders associated with glycosylation defects of ,-dystroglycan, an indispensable molecule for intra-extra cell membrane linkage. Methods Protein and functional analyses of ,-dystroglycan and mutation screening of FKTN and other associated genes were performed. Results Surprisingly, we identified six patients in four families showing dilated cardiomyopathy with no or minimal limb girdle muscle involvement and normal intelligence, associated with a compound heterozygous FKTN mutation. One patient died by rapid progressive dilated cardiomyopathy at 12 years old, and the other patient received cardiac implantation at 18 years old. Skeletal muscles from the patients showed minimal dystrophic features but have altered glycosylation of ,-dystroglycan and reduced laminin binding ability. One cardiac muscle that underwent biopsy showed altered glycosylation of ,-dystroglycan similar to that observed in a Fukuyama-type congenital muscular dystrophy patient. Interpretation FKTN mutations could cause much wider spectrum of clinical features than previously perceived, including familial dilated cardiomyopathy and mildest limb girdle muscular dystrophy. Ann Neurol 2006 [source] Risk factors for severe infections in patients with rheumatoid arthritis treated with rituximab in the autoimmunity and rituximab registryARTHRITIS & RHEUMATISM, Issue 9 2010J.-E. Gottenberg Objective The risk of severe infection is a crucial factor in the assessment of the short-term risk:benefit ratio of biologic drugs in rheumatoid arthritis (RA). There is no increase in severe infections in RA patients treated with rituximab (RTX) in controlled trials, but this has not yet been assessed in daily practice. We undertook this study to investigate the occurrence of and risk factors for severe infections in off-trial patients using data from the AutoImmunity and Rituximab (AIR) registry. Methods The AIR registry was set up by the French Society of Rheumatology. The charts of patients with severe infections were reviewed. Results Of the enrolled patients, 1,303 had at least 1 followup visit at 3 months or later, with a mean ± SD followup period of 1.2 ± 0.8 years (1,629 patient-years). Eighty-two severe infections occurred in 78 patients (5.0 severe infections per 100 patient-years), half of them in the 3 months following the last RTX infusion. Multivariate analysis showed that chronic lung disease and/or cardiac insufficiency (odds ratio 3.0 [95% confidence interval 1.3,7.3], P = 0.01), extraarticular involvement (odds ratio 2.9 [95% confidence interval 1.3,6.7], P = 0.009), and low IgG level (<6 gm/liter) before initiation of RTX treatment (odds ratio 4.9 [95% confidence interval 1.6,15.2], P = 0.005) were significantly associated with increased risk of a severe infection. Conclusion The rate of severe infections in current practice is similar to that reported in clinical trials. The risk factors for severe infections include chronic lung and/or cardiac disease, extraarticular involvement, and low IgG before RTX treatment. This suggests that serum IgG should be checked and the risk:benefit ratio of RTX discussed for patients found to have low levels of IgG. [source] | ||||||||||