Fever of Unclear Origin and Cytopenia Because of Acute Splenic Sequestration in a Young Immunocompetent Carrier of Beta-Globin Mutation for Hb Valletta

Fever of unclear origin is a clinical challenge in medical practice. Infectious diseases, neoplasms, and collagen vascular illnesses are its main causes in adults and children. Acute splenic sequestration crises, a known potentially fatal complication of sickle cell disease and sickle beta-thalassemia, are uncommon in beta-heterozygosis. We describe a case of prolonged recurrent episodes of fever with spontaneous resolution, commencing at age 10 in a 15-year-old boy with a history of hypochromic microcytic anemia attributed to a thalassemic trait. He was admitted twice to our university hospital for continuous-remittent fever with a pruritic, macular evanescent Still's skin rash, severe spl…

Bioelectrical impedance parameters versus BNP testing to differentiate decompensated heart failure from chronic obstructive pulmonary disease.

Long-term effects on immune-inflammatory and neuro-endocrine pathways of a new therapeutic strategy for advanced heart failure

The safety of diltiazem versus digoxin short-term administration in heart failure rate control of patients with atrial fibrillation and congestive heart failure.

One-year renal and cardiac effects of bisoprolol versus losartan in recently diagnosed hypertensive patients: a randomized, double-blind study.

BACKGROUND AND OBJECTIVES: Hypertension is a significant cause of chronic renal injury and its effective treatment is capable of reducing the rate of renal failure. beta-Adrenoceptor antagonists (beta-blockers) have been reported to induce a deterioration in renal function, while several data have indicated a renoprotective effect of treatment with the angiotensin II type 1 receptor antagonist losartan. Previous studies of the interaction between the selective beta(1)-blocker bisoprolol and kidney function were performed only for short- and medium-term periods. The aim of this study was to compare the antihypertensive efficacy and renal and cardiac haemodynamic effects of bisoprolol with th…

Relationship between non-invasive measurement of endothelial function and familial hystory of cardiovascular event in hypertensives subjects of recent onset.

Is there any novelty on the horizon of heart failure management in internal medicine? The evaluation of body fluid accumulation

Is there a link between liver steatosis, carotid atherosclerosis and C-reactive protein in metabolic and non-metabolic patients?

evaluation of BNP plasma levels and bioelectrical impedance analysis (BIA) in decompensated heart failure. A double blind study

Echocardiographic PCWP evaluation in decompensated heart failure: relationship with B-type natriuretic peptide and bioelectrical impedance anaysis.

Troponin I release after intravenous treatment with high furosemide doses plus hypertonic saline solution in decompensated heart failure trial (Tra-HSS-Fur)

Background High values of cardiac troponin in acute decompensated congestive heart failure (ADHF) identify patients at higher risk and worsened prognosis. A cardiac troponin increase during therapy indicates the need for more appropriate intervention, aimed at compensating cardiac disease and effectively minimizing myocardial wall stress and subsequent cytolysis. This study evaluated the effects of an intravenous high dose of furosemide with (group A) or without small volume hypertonic saline solution (HSS) (group B) on myocardial cytolysis in patients with ADHF. Methods A total of 248 consecutive patients with ADHF (148 men, mean age 74.9 ± 10.9 years) were randomly assigned to group A or …

The dry weight maintainance, estimated with bioelectrical impedance analysis, predicts freedom from congestion and post-discharge clinical outcome in ambulatory heart failure despite previous class III-IV symptoms

Salvage treatment with ganciclovir in a splenectomized, polytransfused patient affected by systemic inflammatory response syndrome

A 23-year-old man was admitted to hospital with a 12-day history of daily fever. A clinical history revealed that 10 months previously, the patient had been splenectomized and polytransfused for a severe blunt trauma. On admission, laboratory data revealed significant leukocytosis (33,230/ul). The patient's general clinical conditions rapidly worsened into a severe systemic inflammatory response syndrome in four days. After 10 days of broad-spectrum antibiotic treatment, the temperature curve was unmodified and severe leukocytosis persisted (44,300 ul) with absolute lymphocytosis. Laboratory tests ruled out hematological diseases, pneumonia, abscesses and endocarditis. In the light of IgM …

Blood urea nitrogen to creatinine ratio is associated with congestion and mortality in heart failure patients with renal dysfunction

Renal dysfunction (RD) and venous congestion are related and common in heart failure (HF). Studies suggest that venous congestion may be the primary driver of RD in HF. In this study, we sought to investigate retrospectively the relationship between common measures of renal function with caval congestion and mortality among outpatients with HF and RD. We reviewed data from 103 HF outpatients (45 males, mean age 74 years, ejection fraction 41.8 ± 11.6 %) with estimated glomerular filtration rate (eGFR) of 25.5 (adjusted OR 2.98, p 0.015) and eGFR ≤45.8 (adjusted OR 5.38, p 0.002) identify patients at risk for caval congestion; a BUN/Cr >23.7 was the best predictor of impaired collapsibility …

Non alcoholic liver steatosis asymptomatic carotid atherosclerosis and C-reactive protein in diabetic and non-diabetic patients.

Comparison of Ivabradine Versus Metoprolol in Early Phases of Reperfused Anterior Myocardial Infarction With Impaired Left Ventricular Function: Preliminary Findings

BACKGROUND: beta-blockers in ST-segment elevation myocardial infarction (STEMI) are indicated for patients without a contraindication, particularly in patients with high heart rates (HR) or blood pressures. Epidemiological studies have shown that elevated HR represents a risk factor for cardiovascular morbidity. The study investigates the feasibility, tolerability, and the effects after 30 days of follow-up of ivabradine (IVA) versus metoprolol (METO) in early phases of anterior STEMI reperfused by percutaneous coronary intervention (PCI). METHODS AND RESULTS: Patients with a first anterior STEMI, Killip class I-II, an acceptable echocardiographic window, and admitted within 4hours of the o…

Increased expression of markers of early atherosclerosis in patients with inflammatory bowel disease.

Recent studies documented an increased cardiovascular risk in patients with inflammatory bowel disease (IBD). Our study aimed at investigating the prevalence of intima-media thickness (IMT) of the carotid arteries and the arterial stiffness indices as markers of early atherosclerosis in young IBD patients.We recruited 68 consecutive IBD patients, and 38 matched healthy controls less than 45years old (median age 31.6±8.1years). Clinical and demographic features, cardiovascular risk factors, history of cardiovascular events, concomitant therapies were registered on a dedicate database. Carotid IMT was evaluated by using high resolution B-mode ultrasonography. Arterial stiffness was assessed b…

DIAGNOSTIC VALUE OF SEGMENTAL AND WHOLE BODY IMPEDANCE ANALYSIS IN PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT WITH ACUTE DYSPNEA

BIOELECTRICAL IMPEDANCE ANALYSIS FOR PREDICTION OF HOSPITAL ADMISSION DUE TO CARDIAC DECOMPENSATION IN AMBULATORY HEART FAILURE: A FOLLOW-UP STUDY

Short-term walking physical training and changes in body hydration status, B-type natriuretic peptide and C-reactive protein levels in compensated congestive heart failure.

BACKGROUND: Congestive heart failure (CHF) is associated with decreased exercise tolerance, alterations in body fluid balance and activation of neurohumoral and inflammatory pathways. Physical training, despite the contraindications of the past, is recommended for its beneficial effects on exercise capacity and quality of life. We investigate the effects of a short-term (ten weeks) walking physical training program (PT) on body hydration state (HS), B-type natriuretic peptide (BNP) and C-reactive protein (CRP) levels. METHODS AND RESULTS: 22 patients with CHF (mean age 62.7+/-4.8 years, 15 men, mean ejection fraction 38.9+/-3.6%, NYHA class II-III), were enrolled. Eleven patients were rando…

Obesity and iron deficiency anemia as risk factors for asymptomatic bacteriuria.

Background: Few studies examined the risk factors of asymptomatic bacteriuria, showing contradictory results. Our study aimed to examine the association between different clinical and laboratory parameters and asymptomatic bacteriuria in internal medicine patients. Materials and methods: 330 consecutive hospitalized subjects, asymptomatic for urinary tract infections (UTIs), underwent to microscopic examination of urine specimens. 100 subjects were positive for microscopic bacteriuria and were recruited into the study. At the quantitative urine culture 31 subjects of study population were positive while 69 subjects were negative for bacteriuria. Results: The analysis of clinical characteris…

Severe Brochostenosis by Oral Propafenone Immediately After Commencing Treatment

Propafenone is a membrane-stabilizing agent belonging to a subgroup of the Vaughan Williams class I antidysrhythmic agents, structurally resembling propranolol and characterized by weaker beta-blocking activity. Despite respiratory complications having been reported as examples of side effects, very few reports have been published in the literature.We describe the case of an elderly woman with a history of hypertension and allergy to Parietaria, grass, olive, mites, and with periodic asthmatic manifestations, for whom the administration of oral propafenone for recurrent supraventricular dysrhythmia was associated with the sudden onset of severe bronchostenosis.A 78-year-old woman was freque…

Steatosi epatica non-alcolica e aterosclerosi carotidea asintomatica in soggetti con e senza sindrome metabolica: uno studio caso-controllo

P522 Expression of markers of early atherosclerosis in inflammatory bowel disease: a prospective cohort of a single referral centre

P1013 : Chronic intermittent hypoxia is associated with liver damage and atherosclerosis in patients with non-alcoholic fatty liver disease

all the steatosis grades, except S2 vs S3. The diagnostic performances of CAP in quantifying each steatosis grade was: for S ≥1 AUC=0.813 (cutoff 260dB/m, Se = 64.84%, Sp =87.27%, PPV=80.8%, NPV=75%, +LR =5.09, −LR =0.40, DA=76.11%); for S ≥2 AUC=0.822 (cutoff 285dB/m, Se = 69.70%, Sp =85.12%, PPV=47.9%, NPV=93.5%, +LR =4.68, −LR =0.36, DA=82.08%); for S ≥3 AUC=0.838 (cutoff 294dB/m, Se =83.33%, Sp =82.54%, PPV=23.3%, NPV=98.7%, +LR =4.77, −LR =0.20, DA=81.59%). AUCs calculated between two steatosis grades only were: 0.772 (for S0 vs S1), 0.874 (S0 vs S2), 0.904 (S0 vs S3), 0.659 (S1 vs S2), 0.777 (S1 vs S3), and 0.665 (S2 vs S3) respectively. Conclusions: Maximal diagnostic accuracy could …

acute coronary syndrome following large-volume paracentesis. Case report and pathophysiology

Early ultrasonographic markers of atherosclerosis in adul white recent onset of primary hypertension and familial history of cardiovascular event

Beyond left ventricular ejection fraction there is a right heart that pumps.

Role of segmental and whole body bioelecttrical impedance analisys (BIA) in acute heart failure diagnosis

PNPLA3 GG genotype and carotid atherosclerosis in patients with non-alcoholic fatty liver disease.

Background and Aim To evaluate if the presence of carotid atherosclerosis in patients with NAFLD, could be related to gene variants influencing hepatic fat accumulation and the severity of liver damage. Methods We recorded anthropometric, metabolic and histological data(Kleiner score) of 162 consecutive, biopsy-proven Sicilian NAFLD patients. Intima-media thickness(IMT), IMT thickening(IMT≥1 mm) and carotid plaques(focal thickening of >1.3 mm at the level of common carotid artery) were evaluated using ultrasonography. IL28B rs12979860 C>T, PNPLA3 rs738409 C>G, GCKR rs780094 C>T, LYPLAL1 rs12137855 C>T, and NCAN rs2228603 C>T single nucleotide polymorphisms were also assessed. The results we…

Medium term effects of different dosage of diuretic, sodium, and fluid administration on neurohormonal and clinical outcome in patients with recently compensated heart failure.

Studies have shown that patients with compensated heart failure (HF) receiving high diuretic doses associated with normal sodium diet and fluid intake restrictions demonstrated significant reductions in readmissions and mortality compared with those who received low-sodium diets, and over a 6-month observation period, a reduction in neurohormonal activation was also observed. The aim of this study was to evaluate the effects of different sodium diets associated with different diuretic doses and different levels of fluid intake on hospital readmissions and neurohormonal changes after 6-month follow-up in patients with compensated HF. Four hundred ten consecutive patients with compensated HF …

Obstructive Sleep Apnea Is Associated with Liver Damage and Atherosclerosis in Patients with Non-Alcoholic Fatty Liver Disease

Background/Aims We assessed whether obstructive sleep apnea (OSA) and nocturnal hypoxemia are associated with severity of liver fibrosis and carotid atherosclerosis in patients with biopsy-proven NAFLD and low prevalence of morbid obesity. Secondary aim was to explore the association of OSA and hypoxemia with NASH and severity of liver pathological changes. Methods Consecutive patients (n = 126) with chronically elevated ALT and NAFLD underwent STOP-BANG questionnaire to estimate OSA risk and ultrasonographic carotid assessment. In patients accepting to perform cardiorespiratory polygraphy (PG, n = 50), OSA was defined as an apnea/hypopnea index ≥5. A carotid atherosclerotic plaque was defi…

A case of febrile illness and multiple pulmonary embolism in a young woman acting hormonal contrapceptives.

OC.03.2 THE PRESENCE OF WHITE MATTER LESIONS IS ASSOCIATED WITH THE HISTOLOGICAL SEVERITY OF NON-ALCOHOLIC FATTY LIVER DISEASE

The Usefulness of Bioelectrical Impedance Analysis in Differentiating Dyspnea Due to Decompensated Heart Failure

Acute dyspnea poses a diagnostic challenge for physicians, and the current methods in differentiating cardiac from non-cardiac causes have been limited to date. Recently, the brain natriuretic peptide (BNP) rapid test has been validated in the emergency room. Nevertheless, the early accumulation of fluid in the interstitial space in the body and in the lungs, which characterizes patients with ADHF, is well estimated by BIA. We investigate whether bioelectrical impedance analysis (BIA) can serve as a noninvasive diagnostic tool in the differential diagnosis of acute decompensated heart failure (ADHF) in the emergency department (ED).A total of 292 patients presenting with acute dyspnea to th…

Medium term effects of different dosage of diuretic, sodium, and fluid administration on neurohormonal and clinical outcome in patients with recently compensated heart failure.

Early and personalized ambulatory follow-up to tailor furosemide and fluid intake according to congestion in post-discharge heart failure

Congestive heart failure (CHF) worsening is a worldwide cause of rehospitalization and mortality, specially during the early period after hospitalization. Fluid accumulation plays a key role in the pathophysiology of both acute heart decompensation and disease progression. The effective use of drugs to maintain restored clinical stabilization in recently discharged patients is a difficult task, and it relies on matching the most appropriately tailored therapy to specific clinical profiles. However, no successful treatment has been shown to reduce post-discharge readmission. We evaluated in a case-control study the effectiveness of an early and personalized congestion-guided ambulatory progr…

Medium-term effects of bisoprolol administration on renal hemodynamics and function in mild to moderate essential hypertension

Arterial hypertension is a significant cause of end-stage renal failure; effective treatment of hypertensive patients reduces the rate of progression of this disorder. ss-Blockers, particularly nonselective agents, are associated with deterioration of renal function in patients with chronic renal failure. Previous studies on the interaction of the beta1-selective adrenergic antagonist bisoprolol with kidney function have been performed only acutely and over the short term. This study was designed to evaluate the antihypertensive efficacy and effects on renal hemodynamics and function of bisoprolol during medium-term (6 mo) treatment of patients with mild to moderate essential hypertension. …

Wet BNP, fluid and hemodynamic status at discharge in Acute Heart Failure

We comment the noteworthy results of Pimenta et al. concerning the significance of discharge BNP levels in acute HF patients. The innovation of Pimento's study is the systematic research of the potential relationship between BNP and clinical and hemodynamic parameters. We focused the attention on the importance of wet "BNP" in managing HF and its ability to reflect congestion and multiple underlying patho-physiological disturbances. The first observation, regarding the statistical order, underlines the importance of renal insufficiency at discharge in genesis of higher BNP levels. Secondly, we note that the relationship between natriuretic peptides and the non-invasive measurement of the fl…

Inflammation and Aortic Pulse Wave Velocity: A Multicenter Longitudinal Study in Patients With Inflammatory Bowel Disease

Background Inflammatory bowel disease ( IBD ) is characterized by a low prevalence of traditional risk factors, an increased aortic pulse‐wave velocity ( aPWV ), and an excess of cardiovascular events. We have previously hypothesized that the cardiovascular risk excess reported in these patients could be explained by chronic inflammation. Here, we tested the hypothesis that chronic inflammation is responsible for the increased aPWV previously reported in IBD patients and that anti‐TNFa (anti‐tumor necrosis factor‐alpha) therapy reduce aPWV in these patients. Methods and Results This was a multicenter longitudinal study. We enrolled 334 patients: 82 patients with ulcerative colitis, 85 pati…

Intravenous high dose furosemide plus small volume of hypertonic saline solution (HSS) versus seriated paracentesis in treatment of refractory ascites: a pilot study

Long-Term Effects of Dietary Sodium Intake on Cytokines and Neurohormonal Activation in Patients With Recently Compensated Congestive Heart Failure

Abstract Background A growing body of evidence suggests that the fluid accumulation plays a key role in the pathophysiology of heart failure (HF) and that the inflammatory and neurohormonal activation contribute strongly to the progression of this disorder. Methods and Results The study evaluated the long-term effects of 2 different sodium diets on cytokines neurohormones, body hydration and clinical outcome in compensated HF outpatients (New York Heart Association Class II). A total of 173 patients (105 males, mean age 72.5±7) recently hospitalized for worsening advanced HF and discharged in normal hydration and in clinical compensation were randomized in 2 groups (double blind). In Group …

Chronic Intermittent Hypoxia is associated with Liver Damage and Atherosclerosis in Patients with Non-alcoholic Fatty Liver Disease

Bioelectrical Impedance Analysis For Prediction Of Hospital Admission Due To Cardiac Decompensation In Ambulatory Heart Failure: A Follow-Up Study

Biolectrical impedance analysis as a new diagnostic tool for heart failure diagnosis in parimary care: preliminary data

Carotid atherosclerosis and chronic hepatitis C: A prospective study of risk associations

BACKGROUND AND AIMS: There are contrasting results in studies of cardiovascular risk in patients with genotype 1 chronic hepatitis C (G1 CHC). We evaluated the prevalence of carotid atherosclerosis compared with a control population in order to assess the potential association between atherosclerosis, host and viral factors, and liver histological features. MATERIALS AND METHODS: One hundred seventy-four consecutive biopsy-proven G1 CHC patients were evaluated by anthropometric and metabolic measurements. One hundred seventy-four patients attending an outpatient cardiology unit were used as controls. Intima-media thickness (IMT) and carotid plaques, defined as focal thickening of > 1.3 mm a…

The glucocorticoid in acute decompensated heart failure: Dr Jekyll or Mr Hyde?

Glucocorticoid administration is not recommended in patients with heart failure because of its related sodium and fluid retention. However, previous experimental and clinical studies have demonstrated that glucocorticoids can also induce a diuretic effect and improve renal function in patients with acute decompensated heart failure (ADHF) with refractory diuretic resistance. We report the case of a 65-year-old man with a known diagnosis of aortic stenosis, systolic ventricular dysfunction, and chronic obstructive pulmonary disease who was admitted for ADHF. After 3 days, during which resistance to conventional therapy was observed, intravenous methylprednisolone (60 mg/d) was added to ongoi…

The pathophysiology of acute heart failure: the key role of fluid accumulation

Naïve hepatitis B e antigen-negative chronic hepatitis B patients are at risk of carotid atherosclerosis: A prospective study

BACKGROUND There is an increased risk of atherosclerosis in patients with chronic hepatitis C or human immunodeficiency virus, but there is scarce data on hepatitis B virus infection. The hypothesis of this study is that hepatitis B virus infection increases the risk of carotid plaques and subclinical atherosclerosis in naïve hepatitis B e antigen (HBeAg) negative subjects. AIM To assess the rate of carotid plaques and subclinical atherosclerosis in naïve HBeAg negative subjects in comparison with a cohort of healthy controls. METHODS Prospective case-control collaborative study conducted in two tertiary hospitals. Four hundred and two subjects prospectively recruited at the outpatient clin…

Time to ferry heart failure onto new shores: The need to effectively customize long-term therapy

158: Is Bioelectrical Impedance Analysis Helpful for Heart Failure Management in the Emergency Department?

Right ventricular diameter predicts all-cause mortality in heart failure with preserved ejection fraction.

Left ventricular ejection fraction (EF) is helpful to differentiate heart failure (HF) phenotype in clinical practice. The aim of the study was to identify simple echocardiographic predictors of post-discharge all-cause mortality in hospitalized HF patients. Patients with acute HF (75 ± 9.8 years), classified in preserved (≥ 50%) and reduced (< 50%) EF (HFpEF and HFrEF, respectively), were enrolled. The mean follow-up period was of 25.4 months. Patients definitively analyzed were 135. At multivariate Cox model, right ventricular diameter (RVd), inferior vena cava diameter (IVCd) and blood urea nitrogen (BUN) resulted to be significantly associated with all-cause mortality in HFpEF (HR 2.…

Whole-body and segmental bioelectrical impedance analyisis to predict rehospitalization due to worsening of congestive heart failure in anbulatory patients

Insufficienza renale inapparente nei soggetti anziani: correlazioni con l'impiego dei farmaci

Bed-side inferior vena cava diameter and mean arterial pressure predict long-term mortality in hospitalized patients with heart failure: 36 months of follow-up.

In discharged patients with heart failure (HF), diverse conditions can intervene to worsen outcome. We would investigate whether such factors present on hospital admission can affect long-term mortality in subjects hospitalized for acute HF.One hundred twenty-three consecutive patients hospitalized for acute HF (mean age 74.8 years; 57% female) were recruited and followed for 36 months after hospitalization.At multivariate Cox model, only inferior vena cava (IVC) diameter and mean arterial pressure (MAP) registered bed-side on admission, resulted, after correction for all confounders factors, the sole factors significantly associated with a higher risk of all-cause mortality in long-term (H…

The Presence of White Matter Lesions Is Associated With the Fibrosis Severity of Nonalcoholic Fatty Liver Disease

Abstract We tested whether nonalcoholic fatty liver disease (NAFLD) and/or its histological severity are associated with vascular white matter lesions (WML) in patients with biopsy-proven NAFLD and in non-NAFLD controls. Data were recorded in 79 consecutive biopsy-proven NAFLD, and in 82 controls with normal ALT and no history of chronic liver diseases, without ultrasonographic evidence of steatosis and liver stiffness value  45 years (OR 3.09, 95% CI: 1.06–9.06, P = 0.03; and OR 11.1, 95% CI: 1.14–108.7, P = 0.03), and F2–F4 fibrosis (OR 3.36, 95% CI: 1.29–8.73, P = 0.01; and OR 5.34, 95% CI: 1.40–20.3, P = 0.01) were independently associated with WML (mostly of mild grade) by multivariate…

Is Bioelectrical Impedance Analysis Helpful for Heart Failure Management in the Emergency Department?

Hiatal herniation of the stomach and pancreas in a patient with oxygen desaturations

Hiatal hernia (HH), a neglected cause of cardiorespiratory symptoms, is a frequent entity characterized by the displacement of the gastro- esophageal junction and part of the stomach into the mediastinum. Although often asymptomatic, HH may also exert a wide spectrum of clinical presentations due to cardio-pulmonary compression, including acute cardiovascular events such as arrhythmias, post-prandial syncope, angina-like chest pain, recurrent acute heart failure, hemodynamic collapse, electrocardiographic changes (T-wave inversion, ST elevation) simulating myocardial ischemia or pericarditis, and respiratory manifestations that can range from exercise intolerance and dyspnea on exertion to …

Unusual case of recurrent pyrexia of unknown origin and cytopenia due to acute splenic sequestration crisis in a young patient with splenomegaly and beta-globin mutation for Hb-Valletta

Aterosclerosi carotidea asintomatica e livelli plasmatici di Adiponectina in soggetti con Steatosi Epatica non-alcolica

Changes in estimating echocardiography pulmonary capillary wedge pressure after hypersaline plus furosemide versus furosemide alone in decompensated heart failure.

BACKGROUND: The aim of the study was to verify the effects of hypertonic saline solution (HSS) plus a high furosemide dose and light restriction of sodium intake compared with a high-dose infusion of furosemide alone on pulmonary capillary wedge pressure (PCWP), as determined by Doppler echocardiography and tissue Doppler imaging in patients suffering from decompensated heart failure. METHODS AND RESULTS: Consecutive patients in New York Heart Association functional class IV, unresponsive to oral high doses of furosemide up to 250-500 mg/d and/or combinations of diuretics, with ejection fraction <40%, serum creatinine <2 mg/dL, blood urea nitrogen ≤60 mg/dL, reduced urinary volume (<500 mL/…

Hypertonic Saline in Conjunction with High-Dose Furosemide Improves Dose-Response Curves in Worsening Refractory Congestive Heart Failure.

Introduction Diuretic responsiveness in patients with chronic heart failure (CHF) is better assessed by urine production per unit diuretic dose than by the absolute urine output or diuretic dose. Diuretic resistance arises over time when the plateau rate of sodium and water excretion is reached prior to optimal fluid elimination and may be overcome when hypertonic saline solution (HSS) is added to high doses of furosemide. Methods Forty-two consecutively hospitalized patients with refractory CHF were randomized in a 1:1:1 ratio to furosemide doses (125 mg, 250 mg, 500 mg) so that all patients received intravenous furosemide diluted in 150 ml of normal saline (0.9%) in the first step (0–24 h…

The challenge of the volume status assessment in heart failure.

Non-Invasive Detection Of PCWP In Decompensated Heart Failure Patients Treated With Intravenous High-Dose Furosemide And Small-Volume Hypertonic Saline Solution: Relationship with BNP and Bioimpedance.

Intravenous high dose furosemide plus small volume of hypertonic saline solution (HSS) versus seriated paracentesis in treatment of refractory ascites.

Ultrasonography NAFLD subclinical carotid atherosclerosis and inflammatory markers in patients with and without metabolic syndome.

ASSOCIAZIONE TRA HS-PCR E DIMENSIONI DELL'ATRIO SINISTRO IN IPERTESI MAI TRATTATI IN RITMO SINUSALE

Relationship between ultrasonographic measurements of inferior vena cava and bioelectrical impedance analysis parameters in patients with decompensated congestive heart failure.

851 Role of segmental and whole body bioelectrical impedance analysis (BIA) in acute heart failure diagnosis

Safwty of bioelectrical impedance analysis inevaluation of patient with liver chirrosis and relation with severity of disease

Bioelectrical Impedance Analysis and prediction of hospitalization for heart failure in ambulatory patients with symptomatic left ventricular dysfunction: preliminary data

impedance analyisis to predict rehospitalization due to worsening of congestive heart failure in anbulatory patients

Ultrasonography of the inferior vena cava and analysis of bioelectrical impedance in the assessment of decompensated heart failure.

A new option in measuring bioimpedance in congestive heart failure

We read with particular attention the interesting article of Tang and Tong1 concerning the measurement of impedance for assessing volume status in heart failure (HF). This technology is useful in detecting subclinical congestion and predicting future HF events.

Sudden severe abdominal pain after a single low dose of paracetamol/codein in a cholecystectomized patient: learning from a case report.

We report the case of an elderly patient with diastolic heart failure and renal insufficiency admitted to hospital as he complained of having a history of hypogastric pain and dysuria without fever due to renal lithiasis and urinary infection. Because the pain was persistence, and considering the presence of renal dysfunction, it was administered a single low dose of paracetamol/codein (500/30 mg). After about 1 hour of the administration, he suddenly complained of the onset of a lancinating epigastric pain radiating to the whole abdomen and retrosternum accompanied by nausea. The electrocardiogram (EKG) was negative for myocardial infarction and computed tomography excluded aortic dissecti…

Role of segmental and whole body bioelectrical impedance analysis in acute heart failure diagnosis.

Giant area of transient hepatic attenuation difference, mimicking incidentaloma at liver ultrasound.

Concurrent with recent advances in diagnostic imaging techniques, the incidental finding of liver tumors, or incidentalomas, is increasing in asymptomatic and healthy individuals [1]. A 56-year-old healthy man underwent an abdomen ultrasound for a clinical check-up. A diffuse bright liver echo-pattern (indicating a low-moderate grade steatosis) and an unusual image (diameter approximately 10 cm) in the VI–VII hepatic segment, characterized by a massive giant hypoechoic lesion with poorly defined margins and a near rounded hyperechoic area (diameter about 4 cm) in the context were found (Fig. 1). The ultrasonographer suspected an angioma as first diagnostic hypothesis; however the large hypo…

Are BNP plasma levels useful in heart failure diagnosis each time? A dyspneic patient with anasarca.

Large hiatal hernia at chest radiography in a woman with cardiorespiratory symptoms

Hiatal hernia (HH) is a frequent entity. Rarely, it may exert a wide spectrum of clinical presentations mimicking acute cardiovascular events such as angina-like chest pain until manifestations of cardiac compression that can include postprandial syncope, exercise intolerance, respiratory function, recurrent acute heart failure, and hemodynamic collapse. A 69-year-old woman presented to the emergency department complaining of fatigue on exertion, cough, and episodes of restrosternal pain with less than 1 hour of duration. Her medical history only included some episodes of bronchitis and no history of hypertension. The 12-lead electrocardiogram demonstrated sinus rhythm with right bundle-bra…

Hepatitis C Virus Eradication by Direct Antiviral Agents Improves Carotid Atherosclerosis in patients with Severe Liver Fibrosis.

Abstract BACKGROUND AND AIM: Recent studies suggest an association between HCV infection and cardiovascular damage, including carotid atherosclerosis, with a possible effect of HCV clearance on cardiovascular outcomes. We aimed to examine whether HCV eradication by direct antiviral agents (DAA) improves carotid atherosclerosis in HCV-infected patients with advanced fibrosis/compensated cirrhosis. MATERIALS AND METHODS: One hundred eighty-two consecutive HCV patients with advanced fibrosis or compensated cirrhosis were evaluated by virological, anthropometric and metabolic measurements. All patients underwent DAA-based antiviral therapy according to AISF/EASL guidelines. Intima-media thickne…