A high cardiac output state has been an infrequent but previously reversible cause of heart failure in patients with hemodialysis fistulas. A patient with two proximal upper extremity fistulas was found to have progressive depression in his left ventricular function and a high output state. His symptoms did not respond to the removal of the most prominent fistula, suggesting that chronic volume...

AIMS Hypertrophic cardiomyopathy (HCM) is an important cause of heart failure-related disability over a wide range of ages. Profiles of severe progressive heart failure symptoms and death, or heart transplantation deserve more complete definition within large patient cohorts. METHODS AND RESULTS Clinical and morphological features of heart failure were assessed in 293 consecutive HCM patients...

BACKGROUND Karyomegalic nephropathy, first identified in 1974, represents an increasingly recognized, but perhaps underdiagnosed condition associated with interstitial nephritis. It undoubtedly leads to end-stage renal disease requiring renal support. METHODS AND RESULTS We present a series of six cases of karyomegalic nephropathy. The age at diagnosis was 9-51 years, median 33 years. Impaire...

A 55-year-old woman presented with recurrent episodes of hypoglycaemia over 4 weeks. She had had type 1 diabetes mellitus (DM) for 35 years, managed by an insulin basal bolus regime. Her comorbidities included retinopathy, chronic renal failure, (presumed to be on the basis of diabetic nephropathy), hypertension, obesity, gout and an ischaemic stroke 15 years earlier. Over 5 years of follow-up,...

A 73-year-old woman presented with an eight-month history of swelling of the right leg. The calf and ankle were found normal, but there was non-pitting swelling of the thigh of "woody" consistency. Both flanks were firm with cutaneous thickening. There were no other abnormal physical findings. A cutaneous biopsy confirmed the diagnosis of scleroderma. The chest radiograph was normal and initial...

Heart failure is associated with autonomic imbalance, and this can be evaluated by a spectral analysis of heart rate variability. However, the time course of low-frequency (LF) and high-frequency (HF) heart rate variability changes, and their functional correlates during progression of the disease are not exactly known. Progressive heart failure was induced in 16 beagle dogs over a 7-wk period ...

To investigate the role of the autonomic nervous system (ANS) in the generation of the circadian blood pressure (BP) variation, the degree of impairment of the ANS was related to the results of ambulatory BP recordings in 212 patients with progressive autonomic failure due to familial amyloid polyneuropathy. On the basis of BP and/or heart rate (HR) responses to the Valsalva maneuver, 60 degree...

The purpose of this study was to discover how functional nephrons produce the plasminogen activator as renal function progresses to renal failure. Urine Plasminogen activator (U-PA) activity was measured by the fibrin plate method in 73 patients with various degrees of renal function deterioration from various underlying diseases and in one healthy individual in order to evaluate the plasminoge...