Changes in red blood cell volume during transition of heart failure status: a reflection of cellular hydration status?

This study examined how changes in heart failure (HF) status induce changes in the index of erythrocyte hydration based on mean red blood cell volume (MCV). Data from 47 HF patients (32% men; 78.2 ± 9.

Proposal for heart failure progression based on the 'chloride theory': worsening heart failure with increased vs. non-increased serum chloride concentration.

Aims: Chloride (Cl) is an established key electrolyte for the activation of the renin-angiotensin-aldosterone system. Recent studies have shown the serum Cl as a key electrolyte for the regulation of body fluid distribution in heart failure (HF) patients. The clinical differences of worsening HF status according to the changes in serum Cl concentration are unclear.

The "chloride theory", a unifying hypothesis for renal handling and body fluid distribution in heart failure pathophysiology.

Body fluid volume regulation is a complex process involving the interaction of various afferent (sensory) and neurohumoral efferent (effector) mechanisms. Historically, most studies focused on the body fluid dynamics in heart failure (HF) status through control of the balance of sodium, potassium, and water in the body, and maintaining arterial circulatory integrity is central to a unifying hypothesis of body fluid regulation in HF pathophysiology. The pathophysiologic background of the biochemical determinants of vascular volume in HF status, however, has not been known.

Vascular expansion during worsening of heart failure: Effects on clinical features and its determinants.

Background: This study investigated the relation of the changes in serum solutes/albumin to the level of vascular expansion and clinical features during worsening HF.

Methods: Data from 47 patients with acute on chronic HF worsening were analyzed. Blood tests included hemoglobin, hematocrit, albumin, solutes (Na/K/Cl/BUN/Cr), and b-type natriuretic peptide (BNP).

Strategy for monitoring decompensated heart failure treated by an oral vasopressin antagonist with special reference to the role of serum chloride: A case report.

Compared with conventional diuretic therapy, monitoring decompensated heart failure (HF) under treatment with a vasopressin antagonist is problematic because (1) use of this medication usually allows the patient free water intake to prevent drug-induced hypernatremia and (2) this medication often induces only minimal changes in the hemodynamics and blood concentration. In a 68-year-old female HF patient, use of tolvaptan did not induce much change in the urine output, presumably because of the low water intake due to a lack of thirst, but she did achieve a profound weight loss. Both the changes in chloride and sodium were negatively correlated with changes in the hemoglobin and serum creatinine, and positively correlated with changes in the mean red blood cell volume, but changes in the serum chloride were better correlated with each variable than were changes in the serum sodium.

Reversible cerebral vasoconstriction syndrome manifesting as focal seizures without a thunderclap headache: A pediatric case report.

We report a pediatric case of reversible cerebral vasoconstriction syndrome with focal seizures without a thunderclap headache. A 7-year-old girl had a mild acute headache with nausea after swimming. She subsequently developed hemi-convulsions followed by right hemiplegia.

Clinical significance of bilateral leg edema and added value of monitoring weight gain during follow-up of patients with established heart failure.

Purpose: This study evaluated the clinical characteristics of bilateral leg edema during follow-up of heart failure (HF) patients and determined the added value of monitoring fluid weight gain for deciding whether this non-specific sign is a more clinically relevant sign.

Methods: Retrospective analysis was performed on 1826 visits from 83 ambulatory patients with established mild-to-moderate HF. Evaluated HF-related signs included leg edema, pulmonary crackles, S3, weight gain, and ultrasound pleural effusion.

How Do Hospital Palliative Care Teams Use the WHO Guidelines to Manage Unrelieved Cancer Pain? A 1-Year, Multicenter Audit in Japan.

It has been reported that pain relief for patients with cancer is suboptimal in Japan. This has been mainly attributed to inadequate dissemination of the World Health Organization (WHO) guidelines for cancer pain management. To better understand this problem, we reviewed how 6 hospital palliative care teams (HPCTs) used the WHO guidelines for unrelieved pain in a 1-year audit that included 534 patients.

Long-term survival after resection of brain metastases from esophagogastric junction adenocarcinoma: report of two cases and review of the literature.

The prognosis for brain metastasis from primary esophageal or gastric cancer is often poor because of late detection and a lack of effective treatments. We encountered two cases of long-term survival after resection of brain metastasis that was detected >1 year after primary esophagogastric junction adenocarcinoma resection. Both patients underwent total gastrectomy, middle to lower esophagectomy, and Roux-en-Y reconstruction using the jejunum, and intrathoracic anastomosis was performed via right thoracotomy and laparotomy for primary tumor resection as well as brain metastasis resection followed by CyberKnife irradiation.

Psychotropic drug-associated electrocardiographic presentation of diffuse J-waves in hypothermia: case report and literature review.

The use of psychotropic drugs is often associated with electrocardiographic (ECG) QT-interval prolongation, but there are few reports of J-waves. This report describes the case of a schizophrenic patient under treatment with several psychotropic drugs (olanzapine, valproate, and flunitrazepam), in whom ECG J-waves diffusely appeared during a hypothermic episode. We further performed a literature review of psychotropic drug-related J-waves in hypothermia.

Clinical characteristics of lower-extremity edema in stage A cardiovascular disease status defined by the ACC/AHA 2001 Chronic Heart Failure Guidelines.

Background: Checking for lower-extremity edema is important for diagnosing, monitoring, and managing heart failure (HF). However, the characteristics of this sign in the early stages of cardiovascular disease (stage A, as defined by the American College of Cardiology/American Heart Association 2001 chronic HF guidelines) have not been adequately explored.

Hypothesis: We hypothesized that stage A HF patients (at risk for HF) are free from leg edema.

Ultrasound pleural effusion sign as a useful marker for identifying heart failure worsening in established heart failure patients during follow-up.

Clinical significance of UltraSound Pleural Effusion (US-PLE) and test characteristics of this sign for identifying worsening heart failure (HF) during follow-up of HF patients are unclear. Clinical records of 83 established HF patients were examined. The diagnosis of worsening HF was classified as "highly certain,""probable,""uncertain," or "no" based on the combination of the changes in symptoms/signs and B-type natriuretic peptide (BNP).

Detection of preclinical body fluid retention in established heart failure patients during follow-up by a digital weight scale incorporating a bioelectrical impedance analyzer.

This study examined the characteristics of asymptomatic worsening heart failure (HF) events and validated the role of a novel HF monitoring method (measuring body weight [BW] and percent body fat [BF%]) to identify such worsening HF events. A clinician determined worsening HF status by evaluating symptoms, physical signs, and pleural effusion on ultrasonography. A criterion of significant fluid weight gain was defined as BW gain ≥1.

A case of orthostatic tachycardia syndrome presenting with panic attack during tilt table testing.

A 26-year-old woman experienced syncope on standing 2-3 times a year for more than 15 years. The attack was typically associated with palpitations and frequently accompanied by a feeling of intense fear. The patient underwent head-up tilt table testing at 70° for 40 min to determine the cause of the syncope.

Changes in the amplitude of electrocardiogram QRS complexes during follow-up of heart failure patients.

Introduction: Changes in the electrocardiogram QRS amplitudes (ECGΔ) during follow-up of heart failure (HF) patients have not been clinically exploited heretofore.

Methods: We examined ECGΔ during follow-up of HF patients by employing 42 triplets of ECGs, other laboratory and HF-related clinical data corresponding to clinical stability, worsening, and recovery from 37 HF patients.

Results: The % changes (Δ%) in the summed QRS amplitude of all 12 leads (ΣQRS(12L)), 6 precordial leads (ΣQRS(V1-V6)), 6 limb leads (ΣQRS(6L)), leads I+II (ΣQRS(I + II)), and lead aVR were evaluated.

Novel monitoring method for the management of heart failure: combined measurement of body weight and bioimpedance index of body fat percentage.

Although body weight scales are most commonly used to evaluate body fluid status during follow-up of definite heart failure (HF) patients, bioimpedance measurement methods have become increasingly available in the clinical setting. These monitoring methods, however, are typically used separately to evaluate body fluid status in HF patients. Kataoka developed a novel method for monitoring HF patients using a digital weight scale that incorporated a bioelectrical impedance analyzer.

A new monitoring method for the estimation of body fluid status by digital weight scale incorporating bioelectrical impedance analyzer in definite heart failure patients.

Background: This pilot study examined the feasibility of monitoring changes in body weight and body-fat percentage (BF%) using commercially available digital weight scale incorporating bioelectrical impedance analyzer (HBF-352-W, Omron Healthcare Co, Kyoto, Japan) to estimate changes in body fluid status in definite heart failure (HF) patients during follow-up.

Methods And Results: A total of 64 patients completed a prospective study (June 2003-December 2006). During the study period, 38 patients developed worsening HF over a mean duration of 34 +/- 3 days from the most recent visit with clinical stability to the time of worsening HF status.

Influence of age on symptoms and laboratory findings at presentation in patients with influenza-associated pneumonia.

Influenza virus infection is a major respiratory infectious disease that generally induces pneumonia. The clinical manifestations of influenza virus infection and community-acquired pneumonia (CAP) differ between elderly persons and younger adults. To determine the clinical features of influenza-associated pneumonia, we studied 21 adult patients with influenza-associated pneumonia, as indicated by positive test results for influenza virus antigen.

Age-related pulmonary crackles (rales) in asymptomatic cardiovascular patients.

Purpose: The presence of age-related pulmonary crackles (rales) might interfere with a physician's clinical management of patients with suspected heart failure. We examined the characteristics of pulmonary crackles among patients with stage A cardiovascular disease (American College of Cardiology/American Heart Association heart failure staging criteria), stratiffed by decade, because little is known about these issues in such patients at high risk for congestive heart failure who have no structural heart disease or acute heart failure symptoms.

Methods: After exclusion of comorbid pulmonary and other critical diseases, 274 participants, in whom the heart was structurally (based on Doppler echocardiography) and functionally (B-type natriuretic peptide <80 pg/mL) normal and the lung (X-ray evaluation) was normal, were eligible for the analysis.

Utility of thoracic sonography for follow-up examination of chronic heart failure patients with previous decompensation.

Background: Thoracic sonography searching for pleural effusion is helpful in diagnosing heart failure (HF) in emergency situations, but utility of this test for follow-up examination of chronic HF patient is unknown.

Hypothesis: Thoracic sonography searching for pleural effusion may be suitable for monitoring deterioration in chronic HF outpatients during long-term follow-up.

Methods: Patients with stable HF at the time of study entry, but with previous deterioration (n = 46) were recruited and followed between June 2003 and September 2005.

Relation of body fluid status to B-type natriuretic peptide levels in patients with chronic heart failure during long-term follow-up.

Background: Little is known about the relationship of body fluid status with the levels and fluctuations of B-type natriuretic peptide (BNP) over the long-term.

Hypothesis: If BNP is to become useful for monitoring of patients with chronic heart failure (HF), the levels should reliably reflect both decompensation and improvement in the patient's condition.

Methods: Forty-six patients with chronic HF who were stable at study entry but had previous decompensation were recruited and followed up between June 2003 and September 2005.

Pacemaker-induced mitral regurgitation as a cause of refractory congestive heart failure during pacing therapy in a patient with hypertrophic obstructive cardiomyopathy.

This report describes a woman with hypertrophic obstructive cardiomyopathy in whom initial hemodynamic improvement by dual chamber (DDD) pacing with short atrioventricular delay was excellent, but severe mitral regurgitation developed during the subsequent follow-up period, resulting in refractory congestive heart failure. There were two possible explanations for the origin of the complicating mitral regurgitation in this patient: pacing-induced semiclosure of the mitral valve, or left ventricular asynchrony caused by right ventricular pacing. Heart failure in patients with hypertrophic obstructive cardiomyopathy who undergo placement of a DDD pacemaker to improve not only mitral regurgitation but also heart failure symptoms can be associated with systolic mitral regurgitation as the cause of failure in DDD pacing therapy.

A case of diffuse panbronchiolitis (DPB) in a patient positive for HTLV-1.

Diffuse panbronchiolitis (DPB), an important cause of progressive obstructive lung disease in the Far East, represents a distinctive sinobronchial syndrome with typical radiologic and histologic features. Human T-cell lymphotrophic virus (HTLV-1) is a retrovirus that clinically and experimentally suppresses T-cell function and immune responses. The clinical and immunologic features of DPB in HTLV-1 carriers are unclear, because DPB and HTLV-1 endemic areas around the world are mostly non-overlapping.