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

Small, deep lesions of the internal capsule are an uncommon cause of infantile hemiplegia. We report the clinical and radiographic findings of three children with hemiplegia with capsular lesions. Although the etiology of capsular stroke in these children remains uncertain, neither hypertension, coagulopathy, nor vascular malformation was an important factor.
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PMID:Capsular stroke as a cause of hemiplegia in infancy. 668 99

Approximately 6 per cent of placentae of babies admitted to a special care paediatric unit show evidence of peripheral villous stem branch oedema. In more than half of these cases there is evidence of fibrinous vasculosis (FV) in truncal veins. The affected placentae are generally thick and of small diameter, often of extrachorialis type, very congested and often cyanosed. The aetiology of the lesions is discussed with reference to abnormal fetal vascular patterns, poor perfusion, anoxia, oedema and spasm and the effect such factors may have on vessels with an irregularly distributed muscle coat and tendency to a spiral course. A small heterogeneous group with FV lesions unassociated with stem branch oedema was also identified. Chorionic vessels were more commonly involved in this group, and it would seem that, in addition to the other factors mentioned above, pressure variations may have some aetiological significance. Lesions of FV occurred mainly in mature placentae. The mothers showed a high incidence of pregnancy-induced hypertension and other complications. Fetal distress and asphyxia at birth were common. Where chorionic vessels were involved there was a high risk of intrauterine death (40 per cent) and coagulopathy among survivors (46.7 per cent). FV lesions affecting truncal vessels carried no greater risk than truncal arterial thrombotic lesions, which have been assessed in the past. In both these groups the hypoxia and intrauterine growth retardation which the babies showed are probably the most important factors, though one could postulate that their clotting mechanism was already triggered.
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PMID:Fibrinous vasculosis in the human placenta. 685 90

Among 140 cases of chronic extracerebral fluid collections treated surgically, 7 cases (5%) of intracerebral hematoma occurring immediately after drainage were encountered. In none of the patients was a preoperative intracerebral clot or contusion identified by either computed tomographic scan or angiography. One patient had pre-existing systemic hypertension. Five of the patients had chronic subdural hematomas, 1 had a subdural hygroma and had been previously radiated for medulloblastoma, and 1 patient had a middle fossa arachnoid cyst. Four of the group had had craniotomies and three had undergone trephination for the primary lesion. The postoperative intracerebral hematomas were manifest by rapid deterioration of consciousness and focal neurological findings occurring usually immediately (but, in 2 cases, a few days after) the original procedure. Five patients underwent secondary craniotomy and 2 had external drainage. Despite rapid treatment, 2 of the patients died, 4 were left with severe disability, and only 1 survived intact. None of the patients had identifiable coagulopathy, and only 1 patient was hypertensive in the immediate postoperative period. The factors that all of the patients had in common were preoperative increased intracranial pressure and shift of the midline structures, as well as rapid surgical decompression of the initial lesion. Possible pathogenic mechanisms include hemorrhage into previously undetected areas of contusion, a sudden increase in cerebral blood flow combined with faulty autoregulation, and damage to parenchymal vessels secondary to rapid intra- or postoperative shift of the intracranial contents. Perhaps this devastating complication can be avoided if closed system drainage is used for the treatment of chronic surface collections.
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PMID:Intracerebral hematoma after evacuation of chronic extracerebral fluid collections. 711 May 41

In 58 patients with progressive neurological deterioration from angiographically confirmed cerebral vasospasm after spontaneous subarachnoid hemorrhage, arterial hypertension was induced in an attempt to improve their deficits. The most effective regimen consisted of intravascular volume expansion, blockade of the vagal depressor response, and the administration of antidiuretics and vasopressor agents. With this protocol, arterial blood pressure could be sustained at high levels for prolonged periods. Neurological deterioration was reversed in 47 patients, transiently in 4; permanent improvement occurred in 43. Complications experienced during therapy included pulmonary edema, dilutional hyponatremia, aneurysmal rebleeding, coagulopathy, hemothorax, and myocardial infarction. Elevating systemic arterial pressure in states of cerebrovascular insufficiency resulting from vasospasm is safe if meticulous attention is paid to physiological, biochemical, and hematological parameters, with the exception that it may be hazardous in the presence of an untreated ruptured or intact aneurysm. Intravascular volume expansion and induced hypertension are effective in reversing ischemic deficits from vasospasm provided that treatment commences before cerebral infarction and that adequate pressures are maintained for a sufficient period. The production of a hypervolemic state by the use of colloid and crystalloid infusion accompanied by atropine blockade of the vagal depressor response and blunting of the diuresis with vasopressin enables arterial pressure to be elevated for longer than 1 week.
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PMID:Treatment of ischemic deficits from vasospasm with intravascular volume expansion and induced arterial hypertension. 713 49

One hundred and one patients below 45 years and showing objective signs of cerebral ischemia were studied retrospectively for pathogenic factors. Twelve were below 15 years; the male to female ratio was 1:1. Factors known as predisposing (heart disease, hypertension, hyperlipemia, diabetes mellitus or infectious diseases) and other possible factors (e.g. trauma, abuse) were found in 41 patients. Among women using contraceptive pills there might be an increased risk of development of cerebral thrombosis, but the material was not large enough to warrant statistical analysis. In 64 patients one or more abnormal coagulation values were found, the most frequent being a deficient vessel wall fibrinolysis, which was noted in 38%. We therefore consider it worthwhile to investigate the fibrinolytic defence mechanism of the vessel wall in patients with cerebral thrombosis, since it is possible to treat this condition with specific fibrinolytic stimulating agents.
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PMID:Coagulation studies in children and young adults with cerebral ischemic episodes. 732 67

This retrospective study from two hospitals is about a hundred patients who have been operated upon a spontaneous cerebral hematoma. By a spontaneous cerebral hematoma we mean a hematoma without a proven tumor, without aneurysm, without arteriovenous malformation, without preceding trauma, without aortical phlebitis and without pathology of the vessel-wall. In this study patients with coagulopathy, arterial hypertension and artherosclerosis are included. In order to comply with these conditions an angiography will have to take place pre-operatively as well as postoperatively. Moreover histological examination of the wall of the hematoma will have to be done. The etiology of the spontaneous cerebral hematoma is not clear in most cases. The indication to operate, the way of operating and the moment in which the operation takes place, vary strongly in medical literature. We operate when there is an aggravation of the clinical picture, persisting severe headache and neurological paresis which does not improve. As a rule we abide for one week before operating, if the clinical picture allows this. After the operation unconscious patients may recover and a hemiparesis may improve. The best way of diagnosing a cerebral hematoma is computerised tomography.
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PMID:[The spontaneous cerebral hematoma (author's transl)]. 744 12

Reported in this paper is a case of severe superimposed toxaemia of pregnancy with concomitant coagulopathy. Heparin, fresh blood, PPSB, and cryoprecipitates were used for the treatment of the coagulopathy. Hypertension was brought under control, but the general condition of the patient deteriorated for uncontrollability of the coagulopathy. Therefore, caesarean section was applied in the 31st week of pregnancy, before coagulation normalised and the patient's general condition improved.
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PMID:[A case of severe superimposed toxaemia of pregnancy accompanied by coagulopathy (author's transl)]. 746 54

Hypertension-induced hepatic disease is a common cause of abdominal pain and liver function test abnormalities in the pregnant patient. Liver hemorrhage and rupture, in turn, are the most unusual and serious complications of preeclamptic/eclamptic or HELLP (Hemolysis Elevated Liver enzymes and Low Platelet count) associated disease. Should a liver hematoma be documented, management must be aggressive, with treatment of hypertension, correction of any coagulopathy, and prompt delivery of the child. Rupture remains a surgical emergency with control of bleeding based on trauma principles. Postoperative care is difficult, with a propensity toward multiple system organ failure. With an aggressive multidisciplinary approach to the management of these patients, mortality rates have been decreased by fifty per cent. Subsequent pregnancies appear to carry no increased risk of liver rupture over the general population but should be followed carefully by a high-risk obstetrician.
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PMID:Hepatic hemorrhage and the HELLP syndrome: a surgeon's perspective. 766 69

Endoscopic resection of the prostate is a well defined surgical procedure. Nevertheless, certain coagulation disorders (hypercoagulability with risk of deep vein thrombosis, haemorrhage) can raise special problems. In patients not given heparin prophylaxis, the incidence of deep vein thrombosis is 10% in transurethral resections of the prostate (TURP). The risk is higher for cancer. Among the diagnostic tools (D-dimer assay, continuous Doppler, pulsed echo-Doppler, thermography, plethysmography, ...) ascending phlebography or pulmonary angiography in case of suspected pulmonary emboli remains the gold standard. Haemorrhage is rarely related to defribination but frequently to dilution coagulopathy favoured by high blood pressure, resorption of irrigation fluid, deficient haemostasis with loss of coagulation factors or massive transfusions. Only clinically patent coagulation disorders leading to haemorrhage should be treated. For dilution coagulopathies and diffuse intravascular coagulation, treatment is based on viro-inactive fresh plasma infusion. Aprotinine is the first choice in case of fibrinolysis.
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PMID:[Coagulation disorders after endoscopic resection of the prostate]. 774 59

Twenty-five patients who underwent resection of a thoraco-abdominal aneurysm between 1985-1993 were reviewed to study determinants of survival in patients undergoing the procedure in a community hospital. Twelve procedures were performed electively, six urgently and seven emergently. Type I aneurysm was present in one patient (n = 1), Type II n = 7; Type III n = 5 and Type IV = 12. Hypertension (n = 17), cardiac disease (n = 10) and renal insufficiency (n = 4) were most common risk factors. Aneurysms were repaired using inclusion method without special techniques for renal or spinal cord preservation. Eighteen patients survived and were discharged; four patients died 30 days and three patients died 30 days. Causes of death were multisystem failure (n = 3), acute myocardial infarction (n = 2) coagulopathy (n = 1) and bowel infarction (n = 1). Major complications included renal failure (n = 2) myocardial infarction (n = 3), bleeding (n = 3), paraplegia (n = 1). Statistical significance was determined using Fisher's exact test-2 tail. Risk factors for death and complication included emergency or urgent surgery (4 deaths-emergent, 2 deaths-urgent) and preoperative renal insufficiency (2 deaths; 1 dialysis) 52% of patients in a community hospital setting underwent emergent or urgent operation and this accounted for 87% of deaths and most morbidity. Mortality in elective procedures was 8%. Based on this data, we believe that thoracoabdominal aneurysm resection can be reasonably undertaken in a community-type hospital.
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PMID:Thoraco-abdominal aneurysm resection. Determinants of survival in a community hospital. 777 50


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