Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The incidence of essential hypertension has been retrospectively studied in a group of sixty-four fatal cases of ruptured berry aneurysm, and compared with a non-fatal group. Hypertension is more frequent in the fatal group, and is associated with a higher incidence of multiple aneurysms, a smaller size of aneurysm at rupture and a poorer survival after two haemorrhages when comparison is made with normotensive patients. The possible role of hypertension in the development and rupture of aneurysms is discussed, and it is concluded that it may contribute to both. Following rupture it carries a poor prognosis with a resulting over emphasis of its significance in autopsy series. Possible mechanisms for this effect include diffuse vascular disease, and an increased liability to oedema or spasm following rupture of an aneurysm.
 ...
PMID:Prognostic factors in ruptured aneurysms of the circle of Willis: the significance of systemic hypertension. 68 59

Although families with several members suffering a cerebral haemorrhage have been reported previously, a family history of this stroke sub-type has not yet been firmly established as a risk factor for the disease. A family in whom cerebral haemorrhage has been clearly documented in five members, spanning three generations, is reported. In three a berry aneurysm was detected. There was no evidence of hypertension among any of the five cases. A sixth member of the family probably died of a cerebral haemorrhage but no necropsy was performed. By using established incidence rates for cerebral haemorrhage in the population, the probability of five such unrelated events arising in any family of similar size and longevity was calculated to be 4.9 x 10(-10). This family strengthens the case that an underlying genetic susceptibility does exist for a proportion of patients who have a cerebral haemorrhage. This susceptibility appears to be consequent upon berry aneurysm formation. The distribution of cases within this family is consistent with an autosomal dominant pattern of inheritance.
 ...
PMID:Cerebral haemorrhage and berry aneurysm: evidence from a family for a pattern of autosomal dominant inheritance. 195 6

From November 24, 1964 through July 3, 1979, 81 patients underwent coarctation repair with resection and end-to-end anastomosis. Mean age at operation was 13.4 years, with a range of 4 months to 55 years. Thirty-two patients (39%) had associated cardiac defects. There were no hospital deaths. Eighty of the 81 hospital survivors were followed (99%) for a total of 10,780 months postoperatively, at a mean of 134.6 (+/- 7.1) months. There was one late death (1.3%) of a ruptured berry aneurysm at 120 months after repair. Actuarial survival was 100% at 10 years and 92.9 +/- 7% at 20 years. Five patients (6.3%) required late re-repair at a mean of 142.8 months postoperatively, range 85 months to 195 months. Actuarial freedom from reoperation was 97 +/- 2.0% at 5 years and 91.7 +/- 3.6% at 20 years. Earlier age at initial repair (P = 0.002), higher mean transrepair gradient (P = 0.005), and late hypertension (P = 0.08) were associated with re-coarctation. The hazard function for reoperation according to age at initial repair revealed a single early risk phase with a plateau starting at 7 years of age and zero hazard after 10 years of age. We conclude that correction of coarctation of the aorta using resection and end-to-end anastomosis permits a long history of event-free survival and continues to be an excellent method of repair.
 ...
PMID:Late events following repair of aortic coarctation with resection and end-to-end anastomosis: a twenty-five-year experience. 235 93

This review describes current management of acute hypertension in the University of Cincinnati Hospitals and emphasizes prevention of recurrent vascular incidents. Careful management of hypertension involves: 1) accurate measurement of recumbent and standing blood pressure to document definite abnormality, severity of disease, and need for antihypertensive medication; 2) concise history and physical examination to identify the possible role of medication in blood pressure elevation; 3) compilation of a laboratory database for evaluating target organ function; and 4) discussion with the patient concerning the physician's findings, treatment plan, and risks of untreated hypertension. In the patient with antecedent hypertension cerebral crisis usually results from ruptured berry aneurysm, massive intracerebral hemorrhage, lacunar hemorrhage in critical areas, large artery occlusion, or hypertensive encephalopathy. Principal elements in managing accelerated or malignant hypertension include a careful history to determine duration of disease, symptoms, and current drug therapy. Oral contraceptives (OCs) and other drugs may sharply escalate otherwise stable hypertension. Cerebral hemorrhage dissecting and ruptured or aortic aneurysms account for the majority of sudden hypertension-related deaths, and hypertension is the leading cause of left ventricular failure causing pulmonary edema. Hypertension complicates pregnancy in several settings including the primigravida without antecedent hypertension. It can also be a complicating factor in the primigravida with known antecedent hypertension. Initial management of most hypertensive pregnancies requires observation, usually in a hospital. Most patients exhibit a fall in blood pressure during the 1st 2 trimesters, but antihypertensive medication (diuretics, reserpine, hydralazine, and methyldopa) have been administered without complications. OC medication is the most prevalent cause of hypertension in young women. Revision of estrogen-gestagen dosage formulas, shortened periods of administration, and periodic blood pressure measurement have diminished the incidence of OC associated hypertension. Emergency surgery situations, renal transplantation, diabetic nephropathy, and coronary disease are also discussed.
 ...
PMID:Systemic hypertension: prevention and treatment of target organ catastrophe. 634 Sep 42

A unique case is described of subarachnoid hemorrhage from a ruptured berry aneurysm of the right anterior ethmoidal artery, and its pathogenesis is discussed. The literature suggests an increased incidence of posterior circulation aneurysms in moyamoya disease, of contralateral anterior circulation aneurysms in agenesis of the carotid artery, and of aneurysms at various sites in spontaneous and iatrogenically acquired obstructions of the internal carotid artery. In addition to congenital anomalies of the vessel wall and systemic hypertension, increased regional blood flow should be regarded as an important factor in the generation of berry aneurysms.
 ...
PMID:Ruptured berry aneurysm of the anterior ethmoidal artery associated with bilateral spontaneous internal carotid artery occlusion in the neck. Case report. 688 91

Ex vivo artery reconstruction with autotransplantation was performed on 34 occasions in 33 patients over the past 10 years. The cause of the renal artery disease was fibromuscular disease in 26 patients, arteriosclerosis or reoperation in 5 patients, acute dissection of the thoracic and abdominal aorta in 1 patient, and renal artery aneurysm in a single kidney in 1 patient. All patients were thought to be inoperable by in situ reconstruction. Many patients were treated with a combination of methods including bilateral ex vivo reconstruction, unilateral in situ and contralateral ex vivo reconstruction, and unilateral ex vivo reconstruction with contralateral nephrectomy. Arterial autografts were used in all but one patient to replace the diseased segment of renal artery. Follow-up was from 6 months to 10 years. The following results were obtained. One patient died 7 days after surgery from a ruptured berry aneurysm, and one patient required nephrectomy 6 months after reconstruction because of restenosis. There was no morbidity in the remaining patients. Results in the remaining patients were as follows. Twenty patients were classified as having excellent results, seven patients good results, 2 patients fair results, and two patients poor results. Combining the excellent and good groups showed an 86% cure or considerable improvement rate. These results suggest that ex vivo renal artery reconstruction is an effective and safe method of treating renal vascular hypertension when indicated.
 ...
PMID:Ex vivo renal artery reconstruction with autotransplantation. 712 84

An 11-year-old girl with renal artery fibromuscular hyperplasia and a berry aneurysm of the anterior communicating artery with subarachnoid haemorrhage is reported. She presented with subarachnoid hemorrhage and was shown to have hypertension attributable to unilateral renal artery fibromuscular hyperplasia. Cerebral angiography showed an aneurysm of the anterior communicating artery. The aneurysm was not treated surgically, but control of the hypertension was obtained by renal revascularisation with an aortorenal graft of saphenous vein. The patient remained well subsequently, and follow-up angiography demonstrated virtual disappearance of the aneurysm and also a functioning aortorenal graft.
 ...
PMID:Renal fibromuscular hyperplasia associated with subarachnoid hemorrhage from a berry aneurysm: a case report. 743 15

Acute intoxication with either cocaine or methamphetamine may contribute to formation and rupture of a berry aneurysm by causing transient hypertension and tachycardia. We report the results of a retrospective study to determine the incidence of acute cocaine or methamphetamine intoxication in deaths due to ruptured berry aneurysm in our jurisdictions. We reviewed all deaths from ruptured cerebral aneurysms that fell within our jurisdictions during the seven years from 1 January 1987 to 31 December 1993 and found 83 cases. The mechanism of death invariably involved subarachnoid hemorrhage, although some cases also had intracerebral hemorrhage. A history of drug abuse was found in 13 cases. Toxicological analysis was performed in 39 cases. Of these methamphetamine was detected in six cases and cocaine in three cases--an incidence of 21%. (In one case both methamphetamine and cocaine were detected). The incidence of acute cocaine intoxication in all autopsies in Jefferson County was 13.6%. The incidence of methamphetamine intoxication in all autopsies in San Diego County was 4.9%. Although the exact mechanism by which berry aneurysms form remains undetermined, research indicates that propagation and rupture of the aneurysm are aggravated by hypertension and tachycardia, both of which are pharmacologic side effects of cocaine and methamphetamine. Based on the preponderance of methamphetamine associated with deaths due to ruptured berry aneurysms it appears that methamphetamine is more toxic than cocaine, perhaps owing to the longer half-life of methamphetamine.
 ...
PMID:The incidence of acute cocaine or methamphetamine intoxication in deaths due to ruptured cerebral (berry) aneurysms. 875 72

Cerebral vasospasm and related ischemic stroke continue to be significant complicating factors in the course of many patients with subarachnoid hemorrhage from berry aneurysm rupture. The risk of this well-recognized but poorly understood complication can be estimated on the basis of patient medical history, neurologic examination, and head CT findings. Every patient with possible risk needs specialized neurologic intensive care unit care after aneurysm obliteration. Surgical and pharmacologic wash-out of subarachnoid blood around the basal arteries, proper management of intracranial pressure and fluid status, hyponatremia, hypomagnesemia, and fever, as well as use of calcium channel blockers, have been considered helpful in patient management prior to and with the symptomatic vasospasm development. Transcranial Doppler (TCD) ultrasound is important in detecting vasospasm before the patient suffers ischemic neurologic deficit or infarct. Elevated TCD velocities often initiate the use of triple-H (HHH: hypertension, hemodilution, and hypervolemia) therapy and subsequently guide it. Up to the end of the first 3 weeks after subarachnoid hemorrhage and aneurysm obliteration, development of any focal neurologic deficit or mental deterioration, unless convincingly proven otherwise, is assumed to be from cerebral vasospasm. When a hemodynamically significant vasospasm in the arterial segments of clinical concern is suggested, emergency cerebral angiography with balloon dilatation angioplasty or intra-arterial infusion of vasodilating agents may be helpful in relieving ischemic symptoms.
 ...
PMID:Cerebral Vasospasm Following Subarachnoid Hemorrhage. 1219 10

Intra-aneurysmal embolization by Guglielmi detachable coil (GDC) is becoming an important method in treatment of intracranial aneurysm. However, intraoperative bleeding remains an essential problem. We reviewed our anesthesia records in patients treated with GDC embolization. Ninety four cases of ruptured cerebral aneurysms were treated with GDC embolization, including 59 females and 35 males. Their ages ranged from 21 to 88, with mean age of 67 years. Preoperative Hunt and Hess grading scales were 1 in 3 cases, 2 in 31, 3 in 40, 4 in 16 and 5 in 4. Intraoperative re-bleeding occurred in 3 cases. These were confirmed by extravasation in angiography or by increased HDA in CT. Each case has berry aneurysm. Acute hypertension at re-bleeding was treated with nicardipine as well as by increasing dose of anesthetic, and hemostasis was obtained by hypotension and reversal of heparin with protamine. After disappearance of extravasation, the procedures were continued. Anesthesia was maintained with fentanyl-propofol in 1 case and sevoflurane in 2 cases. Direct hemostasis is impossible during endovascular surgery and management of systemic circulation by an anesthesiologist is necessary.
 ...
PMID:[Re-bleeding during embolization of ruptured cerebral aneurysms by Guglielmi detachable coil]. 1248 50


1 2 Next >>