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

Marked deterioration of neurologic function accompanies organ dysfunction in systemic sepsis. Although previous hypotheses have suggested that cerebral hypoperfusion, anoxia or progressive edema of the brain may be causative, the pathogenesis remains unknown. Patients with sepsis with stable or supported hemodynamics and adequate oxygenation may manifest confusion, stupor or coma. Recent evidence has demonstrated that the brain is the source of many classical mediators of inflammation after various forms of injury. These mediators, including the leukotrienes, have pronounced effect on cerebrovascular function. Endotoxin is known to stimulate the release of arachidonate from cell membranes, the rate limiting step in leukotriene synthesis. The current studies were performed to test the hypothesis that neurologic dysfunction associated with endotoxemia is characterized by alterations in cerebrovascular permeability or vasomotor function manifested by intracranial hypertension, or both. We studied the response of miniature swine to experimental endotoxemic shock and compared this response with hemorrhagic hypotension. We observed a dramatic elevation of intracranial pressure in swine subjected to endotoxemic shock, despite arterial hypotension. Moreover, estimation of cerebral blood volume (CBV) by reflectance infrared photoplethysmography demonstrated a dramatic increase in CBV, which corresponded to this elevation in intracranial pressure. However, cerebral cortical oxygen saturation was significantly reduced despite this net increase in CBV, indicative of an increase in the venous volume of the brain, while arterial volume remained the same or decreased from baseline levels. Oxygen extraction across the brain decreased during this same period compared with baseline and control values. These results demonstrate that endotoxemia is associated with the development of intracranial hypertension and an increase in CBV secondary to elevation of cerebrovascular venous volume coupled with reduced oxygen extraction across the brain. This evidence of cerebrovascular dysfunction probably represents blood flow maldistribution, similar to that seen in other organs with sepsis, suggesting a cause for altered neurologic function in systemic sepsis.
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PMID:Alterations in intracranial pressure and cerebral blood volume in endotoxemia. 842 4

Olfactory dysfunction has been reported in individuals with diabetes mellitus, but the etiology is unknown. Diabetes is often complicated by serious medical conditions which could be related to the development of decreased olfactory ability. Overall, our 111 subjects with diabetes showed deficiencies in their ability to identify odorants measured with the Odorant Confusion Matrix (mean = 67.8% correct). The presence of macrovascular disease was found to be associated with olfactory dysfunction. Glycemic control as well as the type and duration of diabetes were not related to olfactory ability. Also, there was no distinct association with the presence of neuropathy, retinopathy, nephropathy, hypertension, or impotence. Consistent with previous studies utilizing measures of odorant identification, performance decreased with increased age, females were somewhat superior to males, and smoking had a deleterious effect. Other nondiabetes-related medical conditions and medications had no apparent effect on the olfactory ability of our subjects. These results suggest that the sequelae associated with macrovascular disease, such as perhaps, ischemia, to the olfactory area, impact negatively on olfactory ability.
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PMID:Olfactory dysfunction in diabetes mellitus. 843 58

The predominant cause of death among diabetic patients in populations with high cholesterol levels is coronary heart disease. This effect is related to diet and both insulin dependent and non-dependent diabetes are characterized by an increase in circulating very low density lipoprotein (VLDL). Insulin deficiency or resistance accelerates the release of VLDL from the liver. However, the susceptibility to vascular disease seen among diabetics may be a particular function of their raised levels of intermediate density lipoproteins (IDL) produced when VLDL is metabolised to low density lipoprotein. The concept of hyperinsulinaemia is not helpful in explaining the diabetic patient's disturbed metabolism and is a source of confusion. The major therapeutic task in non-insulin-dependent diabetes is often to reduce the patient's weight and thus to reduce insulin resistance. In patients with coronary heart disease, this should be fully investigated at least as promptly as in non-diabetic people. Lipid lowering drugs, and particularly the fibrates, are suitable for treating diabetic patients since they lower both cholesterol and triglycerides and raise HDL. There is much more controversy about the ideal choice of antihypertensive agents, particularly for patients with only moderate increases in blood pressure. Both thiazides and beta-blockers disturb the lipid profile most markedly in many patients with diabetes or primary hyperlipidaemia. Current evidence suggests that many patients with hypertension, but no other cardiovascular risk factors, derive no benefit from receiving antihypertensive therapy. As in the management of hypercholesterolaemia, the decision to introduce drug therapy should not be determined by the blood pressure reading alone, but should take account of the whole patient risk. The combination of even "mild" hypertension with diabetes or hyperlipidaemia demands greater therapeutic activity and then there is a case for the use of antihypertensive agents which do not adversely influence the lipid profile.
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PMID:Diabetes, hypertension and hyperlipidaemia. 849 53

A 22-year-old man was admitted to hospital with severe, accidental intoxication with 4-aminopyridine, a medicine which increases the acetylcholine concentration in the synapses and has a limited application in the treatment of some neurological diseases. The patient acted on the assumption of body-building capacities of this 'amino'. Apart from the previously documented symptoms of intoxication such as an epileptic attack and confusion, he showed cardiac arrhythmias, conduction disorders and severe hypertension. The serum concentration of 4-aminopyridine was 335 mg/l, while the therapeutic level is 25-75 mg/l.
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PMID:[Severe poisoning by 4-aminopyridine in a body builder]. 872 Aug 23

A retrospective study of 100 consecutive elderly Chinese patients (29 males, 71 females) aged 65 years and above admitted to a general hospital psychiatric unit, showed a predominance of depressive disorders (n = 36) and dementia (n = 26). Depressed patients (mean age = 72.0; SD = 5.8) were significantly younger than demented patients (mean age = 75.6; SD = 6.7) (p < 0.03). Patients with depressive disorders presented with low mood, sleep disturbance, attempted suicide as well as vague somatic symptoms in the absence of organic causes. Those suffering from dementia presented with cognitive dysfunctions (especially memory impairment), confusional state, deteriorated self care and sleep disturbance. More than three quarters of the depressed patients were prescribed antidepressants, and five had required electroconvulsive therapy. Almost nine out of every ten patients had co-existing physical disorders, with one in two being afflicted by two or more physical disorders; the average number of physical disorders was 1.55 per patient. The commonest were cardiovascular disorders such as hypertension (37%) and ischaemic heart diseases (12%). Endocrine disorders like diabetes mellitus, constituted 21%. The mean duration of admission of all patients was 16.3 days (SD = 12.6 days.)
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PMID:Chinese psychogeriatric patients in a general hospital. 878 40

1. Confusion between the criteria for defining and diagnosing hypertension may have misled the search for the causes of hypertension. 2. The systematic approach of molecular genetics appears to offer the best chance of explaining hypertension, but the attractions are partly offset by the large numbers required, and unproven record of the genetic techniques in finding functional mutations in complex human disorders. 3. Part of the evidence for the polygenic nature of essential hypertension derives from the variable response to a large number of different anti-hypertensive agents. Systematic investigation of this variability may provide a basis for dividing patients into genetically more homogeneous sub-groups, within which smaller numbers will be required to detect the genes responsible for the susceptibility to hypertension. 4. The proportion of hypertensive patients with affected siblings has been studied in 6000 patients from Addenbrookes Hospital and local general practices. A recurrence risk for hypertension of approximately 3.5 was found. 5. Approximately two-thirds of patients have no known affected siblings. The next largest group, about one third, is patients whose siblings are all hypertensive. In a small group, < 10% of all patients, half the siblings are hypertensive. 6. We conclude from these surprising findings that hypertension is not a continuous, multifactorial part of the normal blood pressure distribution. They suggest that several more single-gene disorders causing hypertension will be found. The sibships where all members are hypertensive are inconsistent with the segregation of Mendelian genetics and suggest the selection of some genes linked to hypertension at the time of gamete maturation.
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PMID:The causes of essential hypertension. 880 40

Unlike hypertension, heart failure is not readily identified, defined and evaluated. Research and clinical management of heart failure has been handicapped by the absence of a clear definition. In other branches of medicine, e.g. renal or pulmonary failure can be clearly defined with the help of direct measures of organ function. Unfortunately such a parameter does not exist in cardiology to help us with defining cardiac function or failure. Representative definitions of heart failure hitherto proposed are reviewed. A common error in these 'definitions' is the confusion between formulating a definition and giving instructions on how to identify or diagnose heart failure. Other short-comings are also recognised. From these it is possible to compile criteria which a definition of heart failure should possess. When formulating any definition, in order to avoid unnecessary detail, the importance of including only the essence and not the contingents is recognised. To find a new definition which complies best with these criteria is an important challenge facing cardiologists.
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PMID:Heart failure: can it be defined? 883 27

ETIOLOGY AND ANATOMY: Up to the Middle Ages, nosebleeds were considered a natural means of purification in internal diseases. In addition injuries, extreme physical exertion, and influences from the sexual sphere were recognized causes. In the 19th century, low atmospheric pressure on mountains and in balloons was also assumed to be an etiological factor. It was only at the end of the 19th century that the importance of high blood pressure and defective coagulation were diagnosed in context with nosebleeds. In ancient times, it was known that compressing the nasal alae can often stop the bleeding, but that blood may as well run down the throat and mimick a hemorrhage coming from the trachea. Between 1874 and 1884, several authors, among them J. L. Little in USA and W. Kiesselbach in Germany, recognized the anterior part of the nasal septum as a frequent location of bleeding. GENERAL THERAPY AND ANTERIOR NASAL PLUGGING: General measures of hemostasis recommended already in ancient times were the application of cold and diverting the blood to other regions of the body by applying tourniquets to legs and arms, or by cupping. Anterior nasal plugging was already known to the ancient Assyrians and Hippocrates. Scribonus Largus (1st century) was the first to describe a nasal plugging around a tube, thus preserving a patient respiratory passage. During the Middle Ages local application of assumedly hemostatic substances of the apothecary of that time played an important part, among them "cranial moss", the lichen that grew on the skulls of hanged corpses exposed to the weather for a long time, and "mumia", a black unctuous substance made of Egyptian mummies. Plugging the nares with an inflated balloon, fabricated from animal intestines, was described first by J. P. Frank in 1807. During the second half of the 19th century, numerous varieties of rubber balloons, rubber caps, and condoms came in use for this technique. The first nasal balloon combined with a respiratory tube was presented by Dionisio in 1890. POSTERIOR NASAL PLUGGING: Plugging of the posterior nares was anticipated by Hippocrates technique of removing a pendulous polyp by pulling a sponge tied to four strings backwards through the nasal cavity. Le Dran, surgeon in Paris in 1731, was the first to adopt this technique for stopping a nasal hemorrhage. The instrument named after Belloc (or Belloq) for placing a posterior nasal plug consists of a metal tube in which a curved spring can be pushed forwards and backwards. The first description of this instrument remains a mystery. There were at least two French surgeons named Belloc and Belloq, and this has been the source of some confusion. A paper of a certain Belloq of 1757, which is generally regarded as the source, deals with means of stopping certain hemorrhages. It exists in two different printed versions with identical wording and describes the application of candle wax for stopping severe hemorrhages after tooth extraction and abdominal puncture; however, it makes no mention of nosebleeds. Bellocq's tube was made known by Deschamps' book on diseases of the nose in 1804. For about 150 years, it was one of the instruments most frequently illustrated in textbooks and most rarely used in practice because surgeons generally preferred a simple catheter for placing a posterior nasal plug. The article concludes with a short survey of the history of chemical and thermal cauterisation and ligation of blood vessels for stopping nosebleeds.
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PMID:[Nosebleed in the history of rhinology. Images of the history of otorhinolaryngology presented by instruments from the collection of the Ingolstadt Medical History Museum]. 886 51

On June 29, 1995, a 49-year-old man was admitted with acute onset of fever, petechiae on his legs, and mental confusion He had suffered hypertension since 6 months previously and was on nicardipine (60 mg/day), ifenprodil (60 mg/day) and ticlopidine (300 mg/day). He had been on ticlopidine for 4 weeks and on the other drugs for 6 months. Soon after admission he had frequent grand mal seizures and needed mechanical ventilation. A diagnosis of TTP was made. He was treated with plasmapheresis (50 ml/kg per day), aspirin 81 mg/day and dipyridamole 300 mg/day. On the sixth day his mental status returned to normal. He recovered gradually from microangiopathic hemolytic anemia, thrombocytopenia and elevated serum creatinine. We reviewed the literature and discussed the possible mechanism of TTP related to the use of ticlopidine.
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PMID:[Thrombotic thrombocytopenic purpura after administration of ticlopidine]. 896 Jun 74

Two hundred and eighty-two consecutive surgical operations were performed over a period of 11 months, February-September, 1991, December 1991-February 1992 at two private medical centres. Anaesthesia was conducted by the surgeon assisted by the theatre nurses. Intravenous ketamine was given in 72% of operations, xylocaine infiltration in 12.8%, spinal anaesthesia in 11.3% and intravenous thiopentone anaesthesia in 4% of the patients. Major and minor surgical operations were performed on 180 (63.9%) and 102 (36.2%) patients, respectively. With ketamine anaesthesia side effects included transient intra-operative hypertension in 76.8%, delirium/confusion in 56.7% and dreams in 5.4% of the patients. Hypotension at induction and postoperative headache/neck stiffness were the principal side effects in spinal anaesthesia occurring in 59.2% and 12.8%, respectively. Reversible apnoea occurred in three patients and cardiac arrest in one patient of those who had intravenous thiopentone. It appeared, therefore, that where there is no anaesthetist as is often the case in under-doctored areas, after careful patient selection, intravenous ketamine, spinal and local infiltration anaesthetic techniques are safe and useful for many surgical procedures. There is the need to avoid intravenous thiopentone by untrained personnel and in settings poorly equipped for cardiopulmonary resuscitations.
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PMID:Where there is no anaesthetist: a study of 282 consecutive patients using intravenous, spinal and local infiltration anaesthetic techniques. 1041 88


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