RESUMO
BACKGROUND: The management of children with congenital heart disease (CHD) has improved over recent decades and several patients surviving with CHD into adulthood are increasing. In developed countries, there are now as many adults as there are children living with CHD. Pulmonary arterial hypertension (PAH) occurs in â¼ 5% of patients with CHD. AIM: We aimed to understand the characteristics and outcomes of this emerging population. METHODS: We collected data retrospectively and prospectively from 12 contributing centres across Australia and New Zealand (2010-2013). Patients were included if they had been diagnosed with PAH and CHD and had been seen once in an adult centre after 1 January 2000. RESULTS: Of 360 patients with CHD-PAH, 60% were female and 90% were New York Heart Association functional class II or III at the time of adult diagnosis of PAH. Mean age at diagnosis of PAH in adulthood was 31.2 ± 14 years, and on average, patients were diagnosed with PAH 6 years after symptom onset. All-cause mortality was 12% at 5 years, 21% at 10 years and 31% at 15 years. One hundred and six patients (30%) experienced 247 hospitalisations during 2936 patient years of follow up. Eighty-nine per cent of patients were prescribed PAH specific therapy (mean exposure of 4.0 years). CONCLUSIONS: Adults with PAH and CHD often have this diagnosis made after significant delay, and have substantial medium-term morbidity and mortality. This suggests a need for children transitioning to adult care with CHD to be closely monitored for this complication.
Assuntos
Anti-Hipertensivos/administração & dosagem , Antagonistas dos Receptores de Endotelina/administração & dosagem , Cardiopatias Congênitas/epidemiologia , Hipertensão Pulmonar/epidemiologia , Sistema de Registros , Adulto , Austrália/epidemiologia , Terapia Combinada , Diuréticos , Feminino , Seguimentos , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/fisiopatologia , Humanos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Masculino , Nova Zelândia/epidemiologia , Qualidade de Vida , Estudos Retrospectivos , Fatores de RiscoRESUMO
â¢A young woman diagnosed with early-stage cervical cancer whilst pregnant is a clinical dilemma.â¢The maternal risks need to be balanced against the risks to the foetus.â¢Radical vaginal trachelectomy has a potential role as treatment with a favourable outcome for mother and baby.
Assuntos
Cardiomiopatia Dilatada/diagnóstico , Cardiomiopatia Dilatada/cirurgia , Técnica de Fontan , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/cirurgia , Insuficiência Cardíaca/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Adulto , Técnicas de Imagem Cardíaca , Pré-Escolar , Humanos , Imageamento por Ressonância Magnética , MasculinoAssuntos
Abscesso Encefálico/etiologia , Veia Cava Superior/anormalidades , Adulto , Evolução Fatal , Feminino , Átrios do Coração/anormalidades , Átrios do Coração/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Humanos , Radiografia , Ultrassonografia , Veia Cava Superior/diagnóstico por imagemRESUMO
Evidence is presented that the hypoglycemic action of the human growth hormone fragment, Ile-Pro-Leu-Ser-Arg-Leu-Phe-Asp-Asn-Ala (hGH 4-15) is due to the interaction of hGH 4-15 with plasma membrane resulting in a time- and temperature-dependent release of a cellular mediator which acts to increase insulin binding and hexose transport with consequent potentiation of insulin action. The findings suggest that the hGH 4-15 mediator is a low molecular weight (500-2000 daltons) peptide or has a small peptide moiety in its structure containing an aromatic residue but no arginine or lysine.
