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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 17 year experience (1958-1975 with anastomotic aneurysms of the femoral anastomosis after aortic bifurcation graft is presented. An anastomotic aneurysm is a progressive dilatation of an anastomosis between an artery and a prosthesis, caused either by a defective suture line or by a wall dilatation. One thousand one hundred and eighty-four femoral anastomoses with a decent follow-up were reviewed and 89 aneurysms were encountered, a per site incidence of 7.5%. Aetiological agents were arterial hypertension, non-infective bad wound healing, type of suture material, defect of the graft and trauma. The therapeutical approach with only 12% recurrences is a segmental interposition. The rate of satisfactory results was 78%. By reducing our bad wound healing from 15 to 10% of the anastomoses over the last five years, we reduced considerably our percentage of anastomotic aneurysms. The use of ultraleight weight prostheses seems to have also reduced the incidence and, in our study that we closed in December 1975, we encountered no aneurysm on Cooley or Milliknit, even with a follow-up of four years. Since the end of the study, however, we encountered one case of bilateral anastomotic aneurysm with Milliknit, one year after the primary operation but with a definite trauma in the anamnesis.
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PMID:Anastomotic aneurysms of the femoral anastomosis after aortic bifurcation graft. 14 80

Reports of aneurysmal dilatation involving Dacron aortic prostheses have raised questions concerning the incidence, degree and significance of postoperative alterations in graft size. Consequently, a study was undertaken to evaluate Dacron graft size by ultrasooud in 95 asymptomatic patients selected at random after aortic surgery. A Vidison Real Time ultrasound unit was used to determine the internal diameter of the aortic portion of the various grafts utilized: 41 Cooley knitted, 25 Vasculour-D; 13 U.S.C.I. ultralightweight; nine Wesolowski Weavenit; and seven DeBakey standard weight knitted. Patients were studied at from two weeks to 138 months postoperatively (average of 33 months). Hypertension was present in 64% of patients. In the total series, the degree of mean dilatation was 17.6%. Average dilatation in patients with normotension was 15% compared to 21% in hypertensive patients. Graphic analysis of the data collected indicated that dilatation of a significant degree occurs in the immediate postoperative period and slowly increases with time; the time regression period and slowly increases with time; the time regression lines for normotensive and hypertensive patients were almost parallel. Results of this clinical study appear to corroborate the results of in vitro quality control tests performed by two graft manufacturers (Meadox and U.S.C.I.).
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PMID:Postoperative alterations in size of Dacron aortic grafts: an ultrasonic evaluation. 15 23

We present a surgical case of 61-year-old man with distal aortic arch aneurysm. Under selective cerebral perfusion in deep hypothermia, we approached to the aneurysm through median sternotomy. Dilated distal aortic arch and proximal descending aorta with mural thrombus in the aneurysmal lumen were found. The aortic occlusion balloon catheter was inserted into the descending aorta. A Cooley woven Dacron graft (26 mm in diameter) was anastomosed at 5 cm above its distal end loosely to the descending aorta with five interrupted mattress sutures, and the distal portion of the graft was pushed down into the distal aorta ("elephant trunk" technique). Postoperative course was uneventful and the dead space around the graft in aneurysm was filled with thrombus. Six months later, however, emergent operation was performed because of compression of the bronchus and the esophagus by enlargement of the aneurysm due to leakage. The second operation was approached through 5th left intercostal thoracotomy and median sternotomy. The aneurysm was opened, and the thrombus was amounted to 500 g. The distal end of the graft was anastomosed end-to-end to the mid-portion of the descending thoracic aorta. Postoperative course was uneventful and the patient was discharged. It is concluded that Elephant trunk technique is effective and the postoperative control of hypertension is very important.
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PMID:[Surgical repair of distal aortic arch aneurysm using "elephant trunk" technique]. 156 45

A 43-year-old lady was hospitalized due to easy fatiguability in the legs during exercise, and for evaluation of an abnormal shadow in the chest X-ray, and hypertension. Her blood pressure was 200/80 mmHg in the right arm, 140/70 mmHg in the left, and 110/70 mmHg in both lower extremities. Systolic vascular bruit radiating to her neck and back was audible in the Erb's area. DSA and aortogram disclosed extremely dilated vessels around the origin of the left common carotid artery. The left subclavian artery was opacified retrogradely as a subclavian blood steal via the left vertebral artery, and mild stenosis was seen at its origin. There was no evidence of associated congenital anomaly such as VSD, PDA, or ASD. The final diagnosis, solitary interruption of the aortic arch (S-IAA, type B), was made by MRI. The patient had an extra-anatomical bypass operation by using Cooley woven dacron graft from the ascending to the abdominal aorta. The result was good. S-IAA is a very rare congenital anomaly. As far as we know, only 21 patients with S-IAA including this case have been reported. A physician should be aware that a patient with S-IAA tends to have a difference of blood pressure not only between the upper and lower extremities but also between both arms, and pressure in the right arm is usually higher than that in the left. These are good signs to suspect S-IAA. And they also can be helpful to differentiate S-IAA from coarctation of the aorta.
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PMID:[An operative case of solitary interruption of the aortic arch in adult]. 206 91

Reported are the concentrations of beta-endorphin, beta-lipotropin, and adrenocorticotropic hormone (ACTH) in the amniotic fluid and plasma of 40 healthy pregnant women at different stages of gestation. Moreover, the amniotic fluid levels of the three peptides were evaluated in 20 other pregnant women affected by different pathologic conditions (Cooley's disease, gestosis, diabetes, placental insufficiency, etc.). A silicic acid extraction procedure was performed on the samples. Each extract was subjected to Sephadex G-75 column chromatography, and the two fractions corresponding to beta-lipotropin and beta-endorphin were collected, freeze-dried, and assayed by two specific radioimmunoassays. Levels of ACTH were measured by radioimmunoassay directly on the extracts. Levels of beta-endorphin in amniotic fluid showed the highest values in the first trimester (173 +/- 30 fmol/ml, mean +/- SEM) but were significantly decreased in the second (75.2 +/- 14) and third trimesters (14.3 +/- 1.8). An inverse trend characterized plasma levels of beta-endorphin, which showed a progressive increase from the first trimester to term (10.4 +/- 11.1). Amniotic fluid levels of beta-lipotropin remained stable during the first (48.6 +/- 6.3) and second (54.6 +/- 11.1) trimesters, but decreased significantly in the third trimester (17.9 +/- 2.3). The plasma concentrations of beta-lipotropin showed the highest levels in the first trimester (10.9 +/- 0.9), and decreased significantly at term (8.9 +/- 1.3). Last, amniotic fluid levels of ACTH decreased from 55.3 +/- 4.75 fmol/ml in the first trimester to 12.5 +/- 1.16 in the second trimester, and rose again in the third trimester to 34.4 +/- 6.6 fmol/ml. Plasma levels of ACTH were characterized in the first two trimesters by values twice those recorded for nonpregnant women, and decreased at term to 8.9 +/- 1.4 fmol/ml. In the pregnant patients with fetuses affected by Cooley's disease (second trimester) and in those with edema-proteinuria-hypertension (EPH) gestosis (third trimester), amniotic fluid levels of beta-endorphin, beta-lipotropin, and ACTH were in the same range as those in healthy pregnant women.
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PMID:Lack of correlation between amniotic fluid and maternal plasma contents of beta-endorphin, beta-lipotropin, and adrenocorticotropic hormone in normal and pathologic pregnancies. 631 61

Thalassaemia major determines an impaired effort tolerance because of a condition of severe anaemia, progressive left ventricular dysfunction, pulmonary circulation compromise. The aim of our study is to evaluate haemodynamic response to exercise in thalassaemic patients without clinical features of heart failure. We have selected 13 patients affected by thalassaemia major (Thal+; 10-18 years). Each patient was transfused when haemoglobin values were < 9-9.5 g/dl and was treated with desferrioxamine (40 mg/kg sc) when serum ferritin values were > 2,000 ng/ml. Thal+ patients were compared with normal subjects (Thal- 10-16 years). No patient assumed hypotensive therapy, no had familiar history of hypertension. Both groups have undergone an ergometric stress test at the cycloergometer, with increase of 25 W every 2 min, up to the reaching of the maximum age-related heart rate, or up to muscle exhaustion or unbearable dyspnea, followed by a 10 min recovery phase. The following parameters were taken in consideration: systolic (SBP) and diastolic (DBP) blood pressure, heart rate (HR), the product of the heart rate by the systolic blood pressure (DP), at rest, at the maximum common work (MCW), at maximum stress and in the recovery phases. At rest, only DP showed significant differences between the two groups: in Thal+ patients higher than in Thal- (p = 0.045). At the MCW, Thal+ patients had SBP (p = 0.019), DBP (p = 0.01), HR (p = 0.035) and DP (p = 0.003) higher than Thal- patients. At maximum stress only DBP showed significant differences in Thal+ patients (p = 0.019), although Thal+ patients achieved lower levels of workload (p = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Cardiovascular adaptation to the stress test in subjects with Cooley's disease]. 780 70

Neurological complications may occur in BMT recipients (11-59%), frequently contributing to morbidity or mortality. They are the main causes of death in 10-15%. Life-threatening neurological complications were seen in 11 out of 113 (9.7%) children who underwent BMT from HLA-matched family (n=7) or mismatched donors (n=4) at our institution. Diagnoses of patients with neurological complications were acute myeloblastic leukemia (AML) (five), thalassemia major (two), Fanconi anemia (two), Omenn syndrome (one) and leukodystrophy (one), and the neurological events were seen between days +13 and +85 after transplantation. Minor symptoms including reversible, nonrepetitive seizures were excluded. Cyclosporine A toxicity was diagnosed in six children. The rest of the complications were brain abscess/meningoencephalitis (two), severe hypomagnesemia (one), busulfan toxicity (one), sustained hypertension (three), and intracranial hemorrhage (three). Six patients with neurological complications suffered from >grade II graft-versus-host disease (GvHD), and all were high risk for transplant-related complications. In this study, risk status of the underlying disease, mismatched transplantation, a diagnosis of AML (advanced stage), older age and >grade II GvHD were important adverse factors for the development of severe life-threatening neurological complications.
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PMID:Life-threatening neurological complications after bone marrow transplantation in children. 1553 98

Neuropathies after coronary artery bypass (CABG) and cardiac surgery are usually transient and have been described fairly frequently. Our patient presented with an acute onset of a surprisingly symmetrical bilateral axillary and suprascapular neuropathy during the immediate CABG period (which to our knowledge has not been reported on before). The patient, aged 64 years, suffered from diabetes mellitus type 2 and hypertension, and underwent a triple CABG. Electroneuronographic and electromyographic examination confirmed the presence of the bilateral axillary and suprascapular neuropathy, which showed only minimal improvement 15 months later. The surmise is that the neuropathy developed as a result of compression or overstretching of the involved nerves during the surgical procedure, associated with suboptimal positioning of the arms. The 'hands-up position', with careful sternal retraction (Cooley retractor), may appear to prevent the posterior displacement of the shoulders and plexus injuries. The diabetes mellitus may have acted as an aggravating factor.
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PMID:Bilateral axillary and suprascapular neuropathy after coronary artery bypass surgery. 1711 33

Increased tolerance to cerebral ischemia produced by general anesthesia during temporary carotid occlusion. By B. A. Wells, A. S. Keats, and D. A. Cooley. Surgery 1963; 54:216-23. Local anesthesia with little or no preoperative sedation is currently recommended as the anesthetic of choice for temporary carotid occlusion during carotid endarterectomy. Purported advantages include minimal circulatory and respiratory changes from the local anesthetic, and constant verbal contact can be maintained with the patient so that neurologic changes are promptly recognized. However, local anesthesia may not be satisfactory in uncooperative or semiconscious patients. We therefore undertook a trial of general anesthesia in 56 consecutive patients undergoing carotid endarterectomy. Patients were induced in standardized fashion using intravenous thiopental (100-400 mg), atropine (0.2 mg), and succinylcholine (40-80 mg). Cyclopropane, along with deliberate hypercapnia and hypertension, was used for anesthesia maintenance. All patients tolerated carotid occlusion for periods of up to 30 min during general anesthesia without shunt, bypass, or hypothermia. Except for one patient, electroencephalogram evidence of cerebral ischemia was not apparent during occlusion, and no patient suffered postoperative neurologic sequela. Twenty percent of patients who had their carotid arteries occluded preoperatively for 30-60 s without general anesthesia suffered convulsions. These data suggest that general anesthesia increased the tolerance to cerebral ischemia. Potential mechanisms involved might include: 1) decreased cerebral metabolic rate for oxygen; 2) increased cerebral blood flow from hypercapnia; 3) increased arterial oxygen tension; and 4) recruitment of new routes of collateral circulation.
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PMID:Contributions of anesthesiology to the surgical treatment of cerebrovascular disease: the role of Arthur S. Keats, M.D. 1836 8

Advances in hematopoietic stem cell transplantation (HSCT) for beta-thalassemia major make the long-term outcome of these patients very important. Few data on long-term renal function of thalassemia patients are available. We evaluated the renal function in children after successful allogeneic HSCT for beta-thalassemia. Twenty-nine patients were included; the mean age at HSCT was 4.9 years. Mean follow-up time was 7.6 years. After HSCT, two patients developed acute renal failure and two had graft versus host disease. At last follow up, height standard deviation score (SDS) remained the same, but weight SDS had improved. Mean hemoglobin was 12.5 g/dl, and serum ferritin level was 545 ng/ml. All children had normal estimated glomerular filtration rate (GFR). One patient had hypertension and proteinuria, 10 years after HSCT. When comparing 39 children of the same age with beta-thalassemia of similar disease severity but who had not experienced HSCT, we found that the parameters of renal tubule function were better in patients that had undergone HSCT, as demonstrated by urine protein level (0.36 mg/mg creatinine vs 3.03 mg/mg creatinine, P < 0.001), osmolality (712 mosmol/kg vs 573 mosmol/kg, P = 0.006), N-acetyl-beta-D: -glucosaminidase (17.7 U/g creatinine vs 42.9 U/g creatinine, P = 0.045), and beta 2 microglobulin (0.09 microg/mg creatinine vs 0.13 microg/mg creatinine, P = 0.029). This study showed a low incidence of long-term renal impairment after HSCT and indicated that renal tubule function may be better in beta-thalassemia patients after HSCT.
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PMID:Renal tubule function in beta-thalassemia after hematopoietic stem cell transplantation. 1868 53


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