Acute heart failure and acute renal failure in Kawasaki disease

Acute renal failure and acute heart failure are rare in Kawasaki disease. We experienced two patients with Kawasaki disease who presented acute renal failure and acute heart failure. These two patients gave us an important insight into the understanding of water balance and fluid therapy in Kawasaki disease. One patient showed acute prerenal failure due to fluid exudation from the intravascular to the extravascular space, and subsequent acute heart failure. The other patient showed acute heart failure caused by fluid infusion for the treatment of dehydration. It is suggested that acute renal failure could be caused by a fluid shift from the intravascular to the extravascular space in Kawasaki disease. It is also demonstrated that the reserve of cardiac function could be decreased in patients with Kawasaki disease due to myocarditis even with normal echocardiography and chest X-rays.     

A Ro/SS-A auto-antibody positive mother's infant revealed congenital complete atrioventricular block,followed by insulin dependent diabetes mellitus and multiple organ failure

We experienced a congenital complete atrioventricular block infant who was born from a Ro/SS-A antibody positive mother. Ro/SS-A antibody was also found in this baby which was presumed to be mediated by the maternal placenta. Temporary cardiac pacing was required at birth and pacemaker implantation was performed at 9 months. At 11 months of age, the baby fell into shock and experienced multiple organ failure because of diabetes mellitus-induced coma. The association between congenital complete heart block and the Ro/SS-A antibody is well known. However, the accompaniment of insulin-dependent diabetes mellitus has not been reported previously. As the Ro/SS-A antigen appears in the cytoplasm of many tissues, the possibility of an association between Ro/SS-A antibody and diabetes mellitus is difficult to deny. We report this rare case to draw attention to the possibility that babies who are born from an Ro/SS-A antibody positive mother may develop diabetes mellitus as well as congenital complete heart block.     

川芎嗪和维拉帕米对缺血性急性肾衰初期保护效应的实验研究

１８只犬切除右肾，钳夹左肾动脉６０分的肾缺血模型，再灌注５小时。将动物随机分成对照组、川芎嗪组及维拉帕米组。观察尿量、菊糖清除率、利钠指数、平均动脉压及心率；再灌注５小时取肾组织作形态学检查。结果显示川芎嗪对肾功能及形态有保护作用，维拉帕米则无此作用，提示在手术中有肾缺血时以川芎嗪作为肾保护药物优于维拉帕米。     

A 3-month double-blind cross-over study of the effect of benazepril and hydrochlorothiazide on functional class in symptomatic mild heart failure.

The non-sulfhydryl selective angiotensin-converting enzyme inhibitor benazepril (20 mg daily) was compared with hydrochlorothiazide (50 mg daily) in post-infarction (6-24 months) patients with symptomatic (NYHA functional class 2) mild heart failure. No concomitant drug therapy was given. The study had a double-blind cross-over design with 3-month treatment periods. Both drugs were well tolerated, and both caused a similar reduction in systolic blood pressure. Heart rate was higher with the diuretic. Benazepril improved the NYHA functional class in 17 out of 29 (59%) patients, whereas one patient improved with hydrochlorothiazide (P = 0.0004). With regard to global efficacy score, benazepril was also superior. Thus, angiotensin-converting enzyme inhibitors may be superior to diuretics as first-choice therapy in symptomatic mild heart failure.     

烧伤创面切削痂植皮对纠正烧伤后肾脏损害的价值

目的　探讨烧伤合并肾脏损害的治疗方法。方法　对 47例烧伤合并肾损害进行烧伤创面切削痂植皮 ,以减少烧伤毒素、促进创面修复、促进肾脏功能恢复。结果　术后 1周观察 ,3 6例肾损害治愈、9例好转、2例无效 ;完成手术后 ,最快 3d肾损害即可控制。本组最后治愈41例、死亡 6例。结论　对于烧伤合并肾损害 ,及时采用手术治疗 ,不仅利于肾功能的恢复 ,也是保证患者最终康复的重要手段。一旦烧伤病人出现肾功能损害 ,应尽早进行烧伤创面切削痂植皮术修复深度创面。     

Vanishing pleural fluid collections in cardiac failure simulating lung tumours

Vanishing fluid collections in interlobar fissures, associated with congestive cardiac failure, are uncommon but well-recognized. Previous studies have highlighted the occurrence of solitary vanishing ‘tumours’, but in the study reported here 7 out of 12 consecutive patients presented with more than one interlobar fluid collection simulating pulmonary tumours. In most cases a lateral radiograph confirmed the correct diagnosis and in all cases follow-up radiographs demonstrated resolution of all pleural fluid collections. In one case ultrasound was helpful. Making the correct diagnosis is very important inorder to prevent inappropriate investigations and treatment such as biopsy or surgery. It is suggested that unusual pleural fluid collections may be more common in communities where pleural disease following stab wounds or tuberculosis are more prevalent.     

Physiological consequences of a high work of breathing during heavy exercise in humans

The healthy respiratory system has a remarkable capacity for meeting the metabolic demands placed upon it during strenuous exercise. For example, in order to regulate alveolar partial pressure of oxygen and carbon dioxide during heavy workloads, a 20-fold increase in alveolar ventilation can occur. The high metabolic costs and subsequent increased work of breathing associated with this ventilatory increase can result in a number of limitations to the healthy respiratory system. Two examples of respiratory system limitations that are associated with a high work of breathing are expiratory flow limitation and exercise-induced diaphragmatic fatigue. Expiratory flow limitation can lead to an inability to increase alveolar ventilation () in the face of increasing metabolic demands, resulting in gas exchange impairment and diminished endurance exercise performance. Furthermore, the high ventilatory requirements of endurance athletes and the inherent anatomical differences in females could make these groups more susceptible to expiratory flow limitation. Fatigue of the diaphragm has also been documented after strenuous exercise and may be related to a mechanism which increases sympathetic vasoconstrictor outflow and reduces limb blood flow during prolonged exercise. This competition between the muscles of respiration and locomotion for a limited cardiac output may have dramatic consequences for exercise performance. This brief review summarizes the literature as it pertains to the work of breathing, expiratory flow limitation, and exercise-induced diaphragmatic fatigue in healthy humans.     

Undersensing of VF in a Patient With Optimal R Wave Sensing During Sinus Rhythm

We describe a case of potentially fatal undersensing of VF by a third generation ICD with predetermined automatic gain control. In this patient, ventricular sensing was optimal, as R wave amplitudes during sinus rhythm were at least 16 mV. Cyclical, high amplitude signals during VF elevated the sensing floor to such an extent that complete undersensing of subsequent lower amplitude local electrograms occurred. This led to bradypacing and complete ICD therapy failure. Therefore, high R wave amplitudes during sinus rhythm do not warrant flawless sensing during VF. (PACE 2004; 27[Pt. I] 833–834)