The Halting Shadow

Author(s):  
Deirdre David

The last years of Pamela’s life were marked by further illness but also by a remarkable dedication to work. She was hospitalized several times for respiratory illnesses, but in 1974 she published a book of autobiographical essays, Important to Me, which covered such topics as memories of her father, her relationship with Dylan Thomas, her visits to the USSR, and her friendship with other writers such as Edith Sitwell. After months of undiagnosed pain, Snow died in 1980 of a perforated ulcer and Pamela died almost one year later of congestive heart failure and respiratory illness exacerbated by having smoked since the age of fourteen. Yet characteristically she worked courageously until the very end on a novel published posthumously: A Bonfire, which similarly to her first novel deals explicitly with sexual desire. Her ashes were scattered at Stratford-upon-Avon, a place she visited every year on Shakespeare’s birthday.

2020 ◽  
Vol 9 (8) ◽  
pp. 931-938 ◽  
Author(s):  
Mattias Skielta ◽  
Lars Söderström ◽  
Solbritt Rantapää-Dahlqvist ◽  
Solveig W Jonsson ◽  
Thomas Mooe

Aims: Rheumatoid arthritis may influence the outcome after an acute myocardial infarction. We aimed to compare trends in one-year mortality, co-morbidities and treatments after a first acute myocardial infarction in patients with rheumatoid arthritis versus non-rheumatoid arthritis patients during 1998–2013. Furthermore, we wanted to identify characteristics associated with mortality. Methods and results: Data for 245,377 patients with a first acute myocardial infarction were drawn from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions for 1998–2013. In total, 4268 patients were diagnosed with rheumatoid arthritis. Kaplan-Meier analysis was used to study mortality trends over time and multivariable Cox regression analysis was used to identify variables associated with mortality. The one-year mortality in rheumatoid arthritis patients was initially lower compared to non-rheumatoid arthritis patients (14.7% versus 19.7%) but thereafter increased above that in non-rheumatoid arthritis patients (17.1% versus 13.5%). In rheumatoid arthritis patients the mean age at admission and the prevalence of atrial fibrillation increased over time. Congestive heart failure decreased more in non-rheumatoid arthritis than in rheumatoid arthritis patients. Congestive heart failure, atrial fibrillation, kidney failure, rheumatoid arthritis, prior diabetes mellitus and hypertension were associated with significantly higher one-year mortality during the study period 1998–2013. Conclusions: The decrease in one-year mortality after acute myocardial infarction in non-rheumatoid arthritis patients was not applicable to rheumatoid arthritis patients. This could partly be explained by an increased age at acute myocardial infarction onset and unfavourable trends with increased atrial fibrillation and congestive heart failure in rheumatoid arthritis. Rheumatoid arthritis per se was associated with a significantly worse prognosis.


Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 216
Author(s):  
Maja Stojanovic ◽  
Sanvila Raskovic ◽  
Marija Boricic-Kostic ◽  
Vesna Bozic ◽  
Maja Vuckovic ◽  
...  

Takayasu arteritis (TA) is a rare, large vessel vasculitis that affects aorta, its major branches, and occasionally pulmonary arteries. Patients with TA can present with constitutional features and/or various symptoms and signs caused by morphological changes in the blood vessels affected by the inflammatory process. Corticosteroids (CS) and immunosuppressives (IS) are the first line treatment for active TA. Open surgery remains a treatment of choice for TA patients with moderate-to-severe aortic regurgitation (AR) and ascending aortic aneurysm (AAA). We present a 26-year-old female diagnosed with an advanced stage of TA, initially presented as congestive heart failure. Due to a progressive course of the disease (AR 3+, AAA 5.5 cm), surgery of the Aortic valve and root (Bentall procedure), with total arch reconstruction and replacement of supra-aortic branches was performed. The patient has had an uneventful recovery during the postoperative course with no complications at one year follow-up. Normal left ventricle (LV) diameter, LV ejection fraction 67%, and a trace of AR were seen on the last echocardiography.


Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Simon Hoenig ◽  
Robert Hofmann ◽  
Clemens Steinwender ◽  
Alexander Kypta ◽  
Franz Leisch

It has been reported previously that elevated N-terminal pro-brain natriuretic peptide levels (BNP) decrease in patients with atrial fibrillation (AF) within one month of pulmonary vein isolation (PVI). The purpose of the study was to examine the development of BNP levels after successful PVI. In 71 patients (mean age of 62 ± 8 years) undergoing successful PVI for drug-resistant highly symptomatic paroxysmal or shortly persistent AF, BNP levels were analysed the day before, 30 days after, three months after and one year after the procedure, respectively. Based on a personal log of duration and frequency of symptoms and repetitive 24h-ECG recordings, patients were divided into two groups: 36 patients had clinical success, and 16 patients had clinical failure. Clinical demographic and procedural data were similar in both groups. Of note, all patients had lone AF without any clinical signs of congestive heart failure. Baseline BNP levels were similar in both groups (387± 550 pg/ml vs. 492 ± 513 pg/ml, p=0.6). After 30 days, patients who had a clinical successful procedure showed a significant decrease of BNP levels compared to those patients with clinical failure (315 ± 430 pg/ml vs. 754 ± 888 pg/ml, p=0.02). After three months, a further reduction of BNP levels could be observed in clinical successful treated patients compared to patients with clinical failure, in whom no significant change compared to baseline could be detected (214 ± 213 pg/ml vs. 673 ± 907 pg/ml, p=0.01). After one year of successful PVI a repeated reduction of BNP in patients with clinical success could be observed (173 ± 198 pg/ml vs. 448 ± 628 pg/ml, p=ns.), but due to the small sample size the difference did not reach statistic significance. Similar to previous observations, BNP levels after successful PVI decreased only in patients with clinical success during follow-up. However, our study revealed a long-term effect showing a further decrease after one year whereas BNP levels showed even a further increase during the first three months in patients without clinical success. This observation points to an underestimated impact of AF concerning congestive heart failure even in patients without regarding symptoms.


2000 ◽  
Vol 86 (3) ◽  
pp. 353-357 ◽  
Author(s):  
Cristina Opasich ◽  
Luigi Tavazzi ◽  
Donata Lucci ◽  
Marco Gorini ◽  
Maria Cecilia Albanese ◽  
...  

CHEST Journal ◽  
2010 ◽  
Vol 138 (4) ◽  
pp. 181A
Author(s):  
Hitoshi Koito ◽  
Tomoko Takahashi ◽  
Kumiko Nishimura ◽  
Miwako Satoh

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ho-Jun Choi ◽  
Han-Kook Yoon ◽  
Hyun-Cheol Oh ◽  
Ju-Hyung Yoo ◽  
Chong-Hyuk Choi ◽  
...  

AbstractThis study aimed to analyze the rates and risk factors of postoperative mortality among 560,954 patients who underwent total knee arthroplasty (TKA) in Korea. The National Health Insurance Service-Health Screening database was used to analyze 560,954 patients who underwent TKA between 2005 and 2018. In-hospital, ninety-day, and one-year postoperative mortality, and their association with patient’s demographic factors and various comorbidities (ie., cerebrovascular disease, congestive heart failure, and myocardial infarction) were assessed. In-hospital, ninety-day and one-year mortality rates after TKA were similar from 2005 to 2018. The risk of in-hospital mortality increased with comorbidities like cerebrovascular disease (hazard ratio [HR] = 1.401; 95% confidence interval [CI] = 1.064–1.844), congestive heart failure (HR = 2.004; 95% CI = 1.394 to 2.881), myocardial infarction (HR = 2.111; 95% CI = 1.115 to 3.998), and renal disease (HR = 2.641; 95% CI = 1.348–5.173). These co-morbidities were also independent predictors of ninety-day and one-year mortality. Male sex and old age were independent predictors for ninety-day and one-year mortality. And malignancy was risk factor for one-year mortality. The common preoperative risk factors for mortality in all periods were male sex, old age, cerebrovascular disease, congestive heart failure, myocardial infarction, and renal disease. Malignancy was identified as risk factor for one-year mortality. Patients with these comorbidities should be provided better perioperative care.


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