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

Contrary to the conclusion reached by A. Mitchell in an article recently publshed in the British Medical Journal, the present author contends that administering subcutaneous heparin before and after major surgery prevents the subsequent development of pulmonary embolus. The current author recommended the use of subcutaneous heparin for surgical patients with a history of untreated hypertension or coronary artery disease. During the last 7 years the author observed no infractions during the perioperative period among 50 patients who were treated with subcutaneous heparin. In addition, among another 34 patients, who received the treatment and who were followed-up after surgery, only 1 patient developed chest pains. Mitchell did not give sufficient weight in his conclusions to the results of a multivate trial of subcutaneous heparin treatment in which only 2 deaths occurred among the experimental patients and 18 deaths occurred among the control patients.
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PMID:Preventing postoperative thromboembolism. 46

Erythromelalgia is an unusual condition characterized by attacks of burning pain in the hands and feet with local congestion and increased skin temperature. We report a case of erythromelalgia, with transient hypertension and elevated urinary catecholamines successfully treated by hypnotherapy. Such an association has not to our knowledge been previously reported in English language publications.
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PMID:Erythromelalgia--the role of hypnotherapy. 156 Nov 90

Polycythemia vera (PV) is one of the myeloproliferative diseases, and, as such, is an example of clonal hematopoiesis. The progeny of a single, abnormal, hematopoietic stem cell gain a growth advantage over their normal counterparts resulting in overproduction of red cells generally accompanied by overproduction of granulocytes and platelets as well. There are a variety of nonspecific symptoms at onset related to the increased red cell mass and hematocrit accompanied by the more specific manifestations of pruritus, erythromelalgia, and hepatic, portal, and mesenteric vein thrombosis. Splenomegaly and hypertension are common. The laboratory hallmark is an increased red cell mass. There is also often an increase in white cell count, platelet count, and leukocyte alkaline phosphatase along with other findings reflecting the increased rate of turnover of hematopoietic cells. The bone marrow biopsy generally displays hypercellularity involving all three cell lines and absent iron stores. The diagnosis of PV depends on excluding spurious polycythemia in which there is a high hematocrit but a normal red cell mass and secondary polycythemia in which there is an increased red cell mass in response to tissue hypoxia or the inappropriate production of erythropoietin, generally by a tumor. In addition, one should try to establish the diagnosis in a positive fashion by a combination of studies of the blood and bone marrow. Phlebotomy and occasionally plateletpheresis should be used as acute therapy. Chronic therapy is guided by the knowledge that patients treated with phlebotomy alone have an increased rate of thrombotic complications particularly in older patients and those with previous thrombotic disease. Myelosuppressive therapy can reduce the incidence of these complications, but is commonly associated with an increased incidence of second malignancies, particularly acute leukemia. At present, hydroxyurea is the myelosuppressive agent of choice. Antiplatelet agents have a limited role except in the palliation of the syndrome of erythromelalgia. Median survival is approximately 10 years. As implied above, the causes of morbidity and mortality vary with the mode of chronic therapy which has been employed, leukemia being more common after myelosuppressive therapy and thrombotic complications being more common after therapy with phlebotomy alone. Ten percent to 50% of patients move into a spent phase followed by postpolycythemic myeloid metaplasia, irrespective of previous therapy employed. Eventually, the major problems may be cytopenias and massive splenomegaly.
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PMID:Polycythemia vera. 158 7

A case of erythermalgia with arterial hypertension that appeared in a 13 year-old boy is described. This condition led to a loss of weight of 10 kg within one month. None of the diseases known as a cause of this rare condition was found. Clinical manifestations were only improved when extremities were placed in cold water: treatment with pizotifene was also effective suggesting the role of serotonine in the mechanism of the crises.
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PMID:[Erythermalgia: a rare vascular acrosyndrome]. 176 95

Mitchell has proposed a series of factors that may aid in the identification of individual patients with intracranial hypertension at risk for decreased intracranial adaptive capacity. The etiology of decreased intracranial adaptive capacity is failure of normal intracranial compensatory mechanisms. The defining characteristic of this nursing diagnosis is repeated disproportionate increase in intracranial pressure (ICP) that can occur in response to a variety of noxious and nonnoxious stimuli. The purpose of this study was to determine predictive validity of two risk factors (wide amplitude of ICP tracing and increased level of ICP at rest) for the phenomenon of decreased intracranial adaptive capacity. Data were derived from secondary analysis of 30 recordings from a sample of eight children who had ICP monitoring as part of their medical treatment. Results indicated that wide amplitude of ICP tracing or wide amplitude plus increased level of ICP at rest (specificity and positive predictive value were each 100%) with suctioning and turning was more likely to be associated with a disproportionate increase in ICP than when an increased level of ICP at rest alone was the only risk factor (specificity = 25% and positive predictive value = 67% with suctioning and specificity and positive predictive value each = 40% with turning). It was also concluded that, despite high positive predictive values, the combination of risk factors was sufficient but not solely necessary for a disproportionate increase in ICP (false negative predictive value for wide amplitude was 65% with suctioning and false negative predictive value for increased level of ICP was 83% with suctioning and 43% with turning).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Validation of risk factors for the nursing diagnosis decreased intracranial adaptive capacity. 214 91

The authors report the case of a 10-year-old girl who died after suffering from severe erythromelalgia combined with digestive and general disorders associated with multiple vegetative disturbances (high blood pressure, hypothermia, colic and urinary disorders, raised catecholamine levels) for 2 years. Although the appearance of the tongue was normal and in spite of the absence of genetic criteria the diagnosis of Riley-Day dysautonomia was made and its association with neural crest disorders was indicated.
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PMID:[The acrodynic form of the Riley-Day syndrome]. 279 5

A 7 year-old girl was hospitalized with acute, severe and drug resistant erythromelalgia. During her stay in the hospital, she presented with an epileptic seizure associated with hypertension (220-120 mmHg). Catecholamine urinary excretion was markedly increased. Diagnoses of pheochromocytoma and acrodynia were excluded. Erythromelalgia and hypertension both disappeared in a few days without any relapse after a 2 year-follow-up. Catecholamine urinary excretion returned to normal levels in a few weeks. A skin biopsy which was performed in an affected site, showed a slight and questionable reduction of the density of autonomic adrenergic nerve terminals in the periarterial and glandular plexuses. The relevance of transitory excess catecholamine excretion and its link with erythromelalgia and hypertension are discussed. The hypothesis that the disorder could be explained by an abnormality of distal autonomic axons is likely.
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PMID:[Erythromelalgia, arterial hypertension and increased excretion of urinary catecholamines]. 344 72

The authors report the case of a 60-year-old white man with a previous history of pulmonary tuberculosis, smoking habits, hypertension, intermittent claudication and erythromelalgia, admitted to our ward with an ischemic cerebral event. Initial laboratory evaluation documented thrombocytosis (platelet-950000/mm3) and discrete anemia. Additional studies confirmed the diagnosis of essential thrombocythemia, meeting all the criteria proposed by the Polycythemia Vera Study Group in 1986, after exclusion of the possible causes of reactive thrombocytosis. Therapy was initiated with alpha-2b interferon (3 MU/m2 subcutaneously three times a week) and aspirin. Platelet count control was obtained and the patient remained asymptomatic. Nine months later cutaneous toxicity obliged the discontinuance of alpha-interferon. Due to a continuous increase of platelet count, hydroxyurea was introduced. The patient is asymptomatic, with platelet counts < 500000/mm3, without toxicity manifestations, two years after diagnosis. The contribution of cardiovascular risk factors versus thrombocythemia in the pathogenesis of the ischemic cerebral event and the benefit of platelet count control are discussed.
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PMID:[Essential thrombocythemia. Apropos a case of cerebrovascular stroke]. 828 17

We studied the clinical symptoms in nine children (seven females and two males; mean age 11.6 years) with severe but transient acute secondary erythermalgia. The classical symptoms at presentation were episodic attacks of painful burning hands and feet which felt warm with congested appearance of the feet. Each attack lasted for a mean period of 25 days (range from 6 to 56 days). The blood pressure was elevated in seven patients. Intravenous sodium nitroprusside was effective in ameliorating the symptoms with drop in blood pressure to normal in five patients; pizotifene, labetolol, prostaglandin E1 and hypnotherapy were effective in each of four separate cases. The episodes of acute secondary erythermalgia were transient in all and did not recur after a mean follow up period of 1.6 years. These cases suggest that acute secondary erythermalgia, however transient, is not rare and can be associated with mild to moderate hypertension which may respond to sodium nitroprusside. A greater awareness of this condition is necessary to make an accurate and timely diagnosis and institute appropriate therapy in order to prevent undue complications.
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PMID:Acute secondary erythermalgia and hypertension in children. Erythermalgia Multidisciplinary Study Group. 858 98

The patient described herein had 3 features known to be associated with secondary erythermalgia: 1) onset during pregnancy, 2) hypertension, and 3) verapamil treatment (6). Unusual was the fact that while the patient's condition did not respond to aspirin consistently or completely, the skin biopsy did show arteriolar fibromuscular intimal proliferation, which is usually seen with erythromelalgia. Also unusual was the recurrence of symptoms with a second pregnancy 2 years after the presentation reported herein. The syndrome resolved completely within 1 year of delivery. The platelet count was monitored for 4 year after the initial resolution of symptoms (which included the second pregnancy and its associated recurrence of symptoms) and was never higher than 350 x 10(9)/liter. The literature is confusing in mixing of terminology concerning these 3 clinically similar syndromes. The classifications as outlined herein are the emerging standards. A working knowledge of the definitions of these 3 syndromes is critical for appropriate diagnosis and treatment.
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PMID:Painful, swollen, and erythematous hands and feet. 884 70


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