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)

Systemic lupus erythematosus (SLE) patients, especially those with antiphospholipid antibodies, have a high incidence of arterial and venous thrombotic manifestations. However, renovascular hypertension (RVH) has been rarely reported in these patients. We describe here a 49-year-old female with antiphospholipid antibodies, complicated with RVH and presenting with sudden onset of severe hypertension, headache and nausea. She had experienced phlebitis and arterial thrombosis of the right leg. At the age of 38 years, she was diagnosed as SLE and steroid therapy was started, but she had poor drug compliance and irregularly visited our clinic. On admission, hypertension was recognized and abdominal bruit was audible on physical examination. Serological findings were compatible with SLE. She was also found to have IgG anti-cardiolipin antibody and lupus anticoagulant. Peripheral plasma renin activity (PRA) was elevated, and captopril test showed hyper-response of PRA with lowering of blood pressure. Renal echography and scintigram showed a small and poorly perfused right kidney. Selective angiography demonstrated a severe stenosis of the right renal artery at origin. A stenosis at the origin of both the superior mesenteric artery (SMA) and celiac trunk was also detected. Percutaneous transluminal angioplasty was performed, achieving successful dilatation of the right renal artery and SMA, whereas the attempt to insert the catheter into the celiac trunk was unsuccessful. After this procedure, abdominal bruit has not been audible. Following the initiation of steroid pulse therapy combined with heparin and dipyridamole, her blood pressure was gradually depressed and the test for lupus anticoagulant became negative. Therefore, RVH of this patient is thought to be associated with antiphospholipid antibodies.
 ...
PMID:[Renovascular hypertension associated with antiphospholipid antibodies in a woman with systemic lupus erythematosus]. 891 95

We investigated the effect of locally altered blood pressure on the remodeling processes of the cells and extracellular matrices of the splenic and ileal arteries and used an indicial function approach to quantitatively analyze the relationship between the altered blood pressure and the remodeling processes. Blood pressure in these arteries was locally modulated by constricting the aorta at a location between the celiac and mesenteric bifurcations, resulting in a higher blood pressure at the splenic arteries then at the ileal arteries, After the pressure changes, the cross-sectional areas and the fractions of the cells and extracellular matrices of the splenic and ileal arteries were examined by electron microscopy at 2, 6, 10, 20, and 30 days. We found that both arteries remodeled, but the splenic arteries (higher blood pressure) remodeled more rapidly and to a larger degree than the ileal arteries (lower pressure compared with the splenic arteries) of the same animal. To verify whether an identical change in the blood pressure at the splenic and ileal arteries leads to the same remodeling process in these arteries, we created another model by constricting the aorta at a location between the mesenteric and renal bifurcations, resulting in hypertension of the same level at both splenic and ileal arteries. We found that the remodeling processes of the cells and matrices were almost identical in the arteries with similar changes in blood pressure. Thus we conclude that the remodeling processes of cells and matrices of the splenic and ileal arteries are dependent on the local blood pressure in aorta constriction-induced hypertension, and the indicial analysis is a useful approach in the description of the relationship between the blood pressure and the arterial remodeling processes.
 ...
PMID:Indicial functions of arterial remodeling in response to locally altered blood pressure. 896 72

Midaortic syndrome (MAS) is a well-recognized but rare cause of renovascular hypertension (RVH). Several techniques have been described to treat RVH caused by MAS. The authors recently treated two children with MAS and RVH. In both patients the right kidney had two renal arteries. A 13-year-old boy presented with severe headaches, pain in his lower extremities with exertion, and marked hypertension (blood pressure, 170/110). An aortogram demonstrated 70% narrowing of his abdominal aorta from the suprarenal region to 5 cm above the iliac bifurcation. There was significant stenosis of the celiac axis, superior mesenteric artery, and left renal artery. The right kidney had two renal arteries, and the upper pole artery was stenotic at its origin. A 10-year-old girl, known to have hypertension for several years had an aortogram that demonstrated 70% narrowing of the abdominal aorta from the suprarenal region to 3 cm above the iliac bifurcation. There was involvement of the left renal artery at its orifice. She also had two renal arteries to the right kidney with the right upper pole artery being stenotic at its origin and in the mid-portion of the vessel. Aortic reconstruction was accomplished with a polytetrafluoroehtylene (PTFE) bypass graft in each case. The first case also involved patch angioplasty of the celiac axis. In both cases, the right kidney was autotransplanted. It was removed intraoperatively, cold perfused, and the two renal arteries reconstructed followed by transplantation to the right iliac vessels. In both cases the left renal artery was reimplanted into the PTFE graft. Both patients had uncomplicated postoperative courses. The 13-year-old boy had evidence of renal ischemia in a portion of the lower pole of the autotransplanted kidney by DTPA scan. He has mild hypertension controlled with antihypertensive medication. The 10-year-old girl has a normal DTPA scan and is normotensive. MAS is a rare and challenging congenital vascular anomaly that causes RVH. In the presence of double renal arteries the technique of autotransplantation with cold perfusion and "bench" vascular reconstruction reduces the warm ischemia time and should produce satisfactory results.
 ...
PMID:Renal autotransplantation for renovascular hypertension caused by midaortic syndrome. 904 31

Alagille syndrome (AS) is characterized by the association of at least three of the following five abnormalities: chronic cholestasis, peripheral pulmonary artery stenosis, vertebral arch defects, embryotoxon, and typical facies. In addition to urological abnormalities, tubulointerstitial nephritis, renal tubular acidosis, and mesangiolipidosis have been noted in AS. The usual manifestations of such renal pathologies rarely include hypertension. We report five patients with at least four of the five major features of AS who developed secondary hypertension of renovascular origin 3.5-28 years after the initial diagnosis of AS. Angiography demonstrated uni- or bilateral renal artery stenosis and various other abnormalities of the main arteries in all five patients: aorta (3 cases), celiac artery (4 cases), superior mesenteric artery (1 case), subclavian artery (1 case). Our findings underscore the value of arterial blood pressure monitoring in patients with AS. If hypertension occurs, a renovascular origin should be sought. The diffuse vascular abnormalities which appeared to be a feature of AS in these patients should prompt larger studies of vascular abnormalities in AS.
 ...
PMID:Renovascular hypertension and vascular anomalies in Alagille syndrome. 954 69

Abdominal pain, excruciating and recurrent, is the dominant feature of chronic pancreatitis that initially brings most of the patients to the physician's attention. The pathogenesis of pancreatic pain is often multifactorial and explains why not all patients respond to the same mode of therapy. Increased intraductal pressure as a result of ductal stricture and/or calculi is the most frequent cause for pain in the large majority of patients with large duct disease. Interstitial hypertension, ongoing pancreatic ischemia, neuronal inflammation, and extra pancreatic complications may be the sole or additional factors in the pathogenesis of pain. The management of pain is difficult and requires a team approach. Internist, gastroenterologist, radiologist, surgeon, and a psychiatrist may have to work together to achieve maximum success. Drug and alcohol dependency needs vigorous management by a psychiatrist. Supportive therapy with a low-fat diet and antioxidant supplementation are helpful. When analgesic therapy fails, surgery may have to be considered much before a narcotic dependency develops. If at all of use, oral pancreatic enzyme therapy is suitable only in a selected group of patients--women with idiopathic pancreatitis. Endoscopic papillotomy, stent placement, and stone removal, although becoming popular, are under trial only and appear to be suitable in those with obstructive disease mostly localized to the head of the pancreas without much proximal disease. A patient with a dilated duct system is a good candidate for Puestow's pancreatico-jejunal anastamosis, which appears to be the best surgical procedure. Those with small duct diseases are difficult to be managed. Resective procedures and celiac ganglion blocking are suggested but not of much help.
 ...
PMID:Chronic pancreatitis: pathogenesis and management of pain. 975 70

A woman with ophthalmic migraine was found to have bilateral cerebellar and cerebral calcifications. She progressively developed severe intracranial hypertension, with swelling of the brain and downward transtentorial and tonsillar herniation. Because steroid treatment was ineffective, the right occipital pole was resected. Histological study demonstrated meningo-cortical calcifying angiomatosis. Within 2 months, brain swelling and papilledema disappeared. Subtle signs of malabsorption led to the hypothesis of celiac disease, confirmed by jejunal biopsy. Similar cerebral histological findings have been reported in the brain of two young patients affected by epilepsy and celiac disease. The association between cerebral calcifications and celiac disease is peculiar; the pathogenetic relationship is unknown.
 ...
PMID:Meningo-cortical calcifying angiomatosis and celiac disease. 982 44

Reports of Ask-Upmark kidney, initially described as a congenital defect in renal development, are uncommon. We report a case with the features of bilateral asymmetrical segmental atrophy in a patient with childhood-onset hypertension. As an adult, she developed cerebral, celiac, and renal artery aneurysms. She underwent successful clipping of the cerebral aneurysm and renal artery repair with preservation of renal function. Novel radiologic techniques make possible the noninvasive diagnosis of segmental atrophy and its complications.
 ...
PMID:Ask-Upmark kidney associated with renal and extrarenal arterial aneurysms. 1019 35

Prostaglandin concentrations are elevated in intestinal lymph during brief abdominal visceral ischemia, and exogenously applied prostaglandins can directly stimulate or sensitize ischemically sensitive visceral sympathetic nerve fibers. However, it is not known if prostaglandin production during abdominal ischemia is sufficient to contribute to the reflex cardiovascular response (e.g., hypertension). Accordingly, in anesthetized cats, the femoral artery was cannulated for measurement of arterial blood pressure, and the superior mesenteric and celiac arteries were isolated and fitted with snare occluders. After dual occlusion of these arteries (</=20 min), the cyclooxygenase inhibitors indomethacin (10-20 mg/kg iv, n = 5, group 1) or acetylsalicylic acid [50 mg/kg iv (n = 6) and ia (n = 2); group 2] were administered and ischemia was repeated. In group 1, indomethacin lowered the reflex arterial blood pressure increment by 39% from 31 +/- 7 to 19 +/- 5 mmHg (P > 0.05). In group 2, acetylsalicylic acid significantly (P < 0.05) reduced the reflex rise in blood pressure by 46% (28 +/- 3 to 15 +/- 4 mmHg). A second, more invasive preparation (group 3) was utilized to 1) minimize the confounding, transient, nonreflex rise in blood pressure associated with arterial ligation, and 2) further assess the inhibitory effect of indomethacin. In group 3, the ischemia-induced blood pressure rise of 28 +/- 6 mmHg was reduced by 43% to 16 +/- 4 mmHg after indomethacin (n = 4, P < 0.05). Thus blockade of the cyclooxygenase pathway by two structurally dissimilar inhibitors attenuated the visceral-cardiovascular reflex response to brief ischemia, suggesting that prostaglandins released during visceral ischemia contribute significantly to the activation of the reflex cardiovascular response.
 ...
PMID:Reflex cardiovascular response to brief abdominal visceral ischemia is mediated in part by prostaglandins. 1056 32

A 52-year-old male presented with severe hypertension and acute renal failure. Carbon dioxide (CO(2)) angiography identified a saccular thoracic aortic aneurysm, right renal artery stenosis, left renal artery occlusion, an infrarenal aortic aneurysm, celiac artery, and inferior mesenteric artery (IMA) orificial stenoses. Via an anterior retroperitoneal approach, bilateral renal artery thromboendarterectomy, infrarenal aortic aneurysmectomy, and IMA reimplantation were performed. The patient's tortuous iliac arteries were straightened to permit future passage of a thoracic stent graft by mobilizing the aortic bifurcation and anastomosing it to a Dacron graft within 4 cm of the renal vessels. Two weeks later, a stent graft was placed via a femoral incision utilizing CO(2) angiography, successfully excluding the saccular thoracic aneurysm. Recovery from both procedures was quick, with rapid return of renal function, and alleviation of the hypertension. At 8 months follow-up, his renal arteries and aorta are patent.
 ...
PMID:Staged thoracic and abdominal aortic aneurysm repair using stent graft technology and surgery in a patient with acute renal failure. 1074 24

A series of 11,890 patients from the senior investigator's surgical service between 1949 and 1998 is analyzed for the significance of distinct risk factors for recurrence of, and survival from, atherosclerotic occlusive disease. Eight risk factors have been assessed for their importance in 4 defined arterial categories (the coronary arterial bed, the branches of the aorta, the abdominal visceral [celiac, superior mesenteric, and renal] arteries, and the terminal abdominal aorta and its major branches) in determining survival rate of the entire group and their impact on rate of recurrence of atherosclerosis in a subgroup of 5,568 patients who had > or =1 postoperative arteriogram, permitting precise identification of changes in the atherosclerotic process. Patients in these 2 groups were followed for > or =25 years; univariate and multivariate analyses were used. On admission all patients had symptomatic atherosclerotic occlusive disease in a single vascular category. Each patient was treated surgically for alleviation of the disease. Two primary outcomes are included: (1) survival, by atherosclerosis category, in all 11,890 patients; and (2) recurrence, also by category, in the subset of 5,568 patients. Multivariate results for recurrence showed little consistency across categories. Only 1 risk factor, diabetes, appeared in 2 of the 3 categories fully analyzed. Other variables that are significant in only a single category are male sex, cholesterol, hypertension, and smoking. Survival showed much greater consistency, with age, diabetes, and hypertension significant in all 3 categories, male sex and smoking in 2, and cholesterol in only Category I. Univariate results followed much the same trend. For recurrence and survival, the response of the arterial bed to the risk factors in each of the 4 categories is distinctly different, an observation that we have not found to be previously reported.
 ...
PMID:Patterns of atherosclerosis: effect of risk factors on recurrence and survival-analysis of 11,890 cases with more than 25-year follow-up. 1078 66


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>