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

A very rare case of a myxosarcoma with metastases to the brain is reported. A 33-year-old female was admitted to our hospital because of lassitude, fever, slight left hemiparesis, headache and other signs of intracranial hypertension and cardiac symptoms such as dyspnea and palpitation. She had the cardiac symptoms once 14 years before, which reappeared and rapidly aggravated two months before the admission. Cerebral angiography revealed a mass in the right temporal lobe and physical and laboratory examinations revealed mitral value failure and hyperthyroidism. On the next day, March 19, 1976, a grossly cystic 60 gm tumor was totally removed which was largely imbedded in the subcortex of the right temporal lobe. The symptoms except for the cardiac symptoms and disseminated intravascular coagulopathy rapidly improved, but headache and left hemiparesis returned 13 days postoperatively. She died suddenly 18 days after the operation due to acute cardiac failure. Autopsy revealed two separate hard and solid tumors both attached to the mitral valve and occupied the whole left atrium and another metastasis to the frontal lobe which had not been diagnosed before the death. Microscopic examinations including electronmicroscopic study established the diagnosis of myxosarcoma in all the four tumors.
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PMID:[Brain metastases from primary cardiac myxosarcoma--report of a case (author's transl)]. 71 43

The authors study a new case of arterio-venous fistula of the left renal pedicle after nephrectomy for trauma. The interest of this case resides in the existence of a right para-umbilical pulsating mass which corresponds to systolic expansion of the inferior vena cava. This sign, which disappeared after corrective operation has the advantage of orienting towards an abdominal vascular condition. In fact, the diagnosis of iatrogenic arterio-venous fistula was made very early : 6 weeks after nephrectomy. The lesion was treated by the purely abdominal route, in the absence of marked peri-aneurysmal fibrosis. Complete removal of the fistula and of the afferent and efferent vessels corrects recent hypertension and prevents later heart failure.
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PMID:[Arterio-venous fistula of the left renal pedicle after nephrectomy. Possibilities and interest of early diagnosis (author's transl)]. 73 47

A case of a 29-year-old man who developed a renal arteriovenous fistula after a gunshot injury is reported. The patient presented with renovascular hypertension associated with high putput cardiac failure, both of which were reversed by surgery.
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PMID:Traumatic renal arteriovenous fistula. 73 46

The syndrome of peri-partum cardiac failure (PPCF) has been studied in 224 women seen in three years in Zaria, in northern Nigeria. A very high proportion were rural Hausa patients. There was a seasonal peak in July, and the incidence was about one per cent of deliveries. The risk increased with both age and parity. Symptoms began most commonly in the second week after delivery, and admission was commonest in the fourth. Typical signs of cardiac failure were found, and pulsus alternans, atrio-ventricular valvular incompetence, transient systemic hypertension and splenomegaly were common. The chest radiograph showed marked cardiomegaly, and extrasystoles and inverted T waves were often present in the electrocardiogram (ECG). Hypoalbuminaemia was common. Digoxin and diuretics were rapidly effective, causing a mean weight loss of 29 per cent in 15 days, resolution of hypertension, and a fall in the cardio-thoracic ratio (CTR) from 61 to 53 per cent. During the first year after diagnosis, the CTR became normal in 82 per cent of patients, and the ECG in 60 per cent. PPCF recurred, again with the same seasonal variation, after 19 per cent of subsequent pregnancies. During follow up for two to five years, 22 per cent of the women became hypertensive, and 11 per cent died. The prognosis was worst in those with an arrhythmia, hypertension, sustained cardiomegaly or aged 30 or more. Asymtomatic post-partum hypertension (PPHT) was found in 61 per cent of normal Hausa women, with a seasonal peak in May, especially in those with hypertension during pregnancy or labour, and twin pregnancies. Peri-partum cardiac failure may be due to the combined pressure load of PPHT, the volume load from eating the customary sodium-rich kanwa, and the cardiovascular demands of heat, both climatic and traditionally self-imposed.
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PMID:Peri-partum cardiac failure. 75 Oct 87

During a six year period twelve patients with insulin dependent diabetes and end-stage renal failure received cadaveric kidney grafts. Eleven of the patients have previous to this been hemodialysed, one patient was transplanted before hemodialysis was necessary. The cumulative two year survival was thirty-seven per cent for the patients, and twenty-nine per cent for the kidney grafts. The average time of observation was eleven months, the motality was fifty per cent. The causes of death were acute myocardial infarction in two cases, sepsis in two cases, severe hypoglycemia in one case and unexpected sudden death in one case. The most prominent problems in the treatment of the diabetic patients after the renal transplantation were difficulties in the regulation of the diabetes, rejections, infections, cardiac failure and aggravation in pre-existing hypertension.
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PMID:Renal transplantation in patients with insulin requiring diabetes and renal failure. 78 7

Investigation in a patient aged 46 years with decompensated heart failure and severe renal insufficiency demonstrated a small, poorly functioning right kidney and severe stenosis of the left renal artery. Cardiac decompensation was corrected and the left kidney revascularised by autotransplantation. Renal function recovered considerably (FG 75/min) and the severe hypertension was reduced. In hypertension patients by main renal artery stenosis, renal autotransplantation is recommended, since it is a safe method without technical difficulty and has given good results. The mutual dependence of hypertension and renal insufficiency is reviewed. When renal function is poor, revascularisation of the stenosed kidney will lead to recovery. The hypertension will usually improve but will always become more responsive to drug therapy.
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PMID:Severe renal insufficiency and renovascular hypertension. 78 49

In a multicentre, double-blind, between-patient study the hypotensive effect of oxprenolol was investigated in 329 patients with mild to moderate hypertension. A factorial experimental design with three factors was chosen: oxprenolol--none or daily doses of 20, 40, 60 and 80 mg; dihydralazine and hydrochlorothiazide, respectively, none or 30 mg daily. Each treatment was given for 4 weeks after an adequate period of withdrawal from any other possible hypotensive therapy and one week of placebo wash-out. Irresponsive of the association with dihydralazine and/or hydrochlorothiazide, oxprenolol had a hypotensive effect linearly related to dose for standing systolic (P less than 0.05) and diastolic (P less than 0.01) pressure, and for lying diastolic (P less than 0.05) pressure. The additional of dihydralazine enhanced the time-course of the hypotensive effect of oxprenolol, particularly the 80 mg dose level. In general, the combination of oxprenolol with dihydralazine and hydrochlorothiazide caused larger reductions in blood pressure, particularly with oxprenolol 80 mg. In the latter group, the eventual falls in blood pressure were 30.5 and 14.4 mmHg for lying systolic and diastolic, respectively; and 32.1 and 20.0 mmHg for the standing systolic and diastolic pressures. The drug was well tolerated; major side effects (heart failure and bronchospasm) occurred in three patients.
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PMID:Hypotensive effect of oxprenolol in mild to moderate hypertension: a multicentre controlled study. 78 73

Baroreflex sensitivity (BRS) has not been assessed in coarctation, though it is diminished in renal and essential hypertension. Previous experimental studies of coarctation have dealt primarily with renal mechanisms of hypertension, and have relied on constricting the aorta in adult animals. We banded the thoracic aorta in newborn puppies, and performed studies 2 yr later. Blood pressure (BP) elevations, abundant chest wall collaterals, the absence of heart failure, and subsequent necropsy confirmed the full syndrome of natural coarctation in all dogs. Transient BP elevations were induced in conscious, unrestrained dogs with intravenous phenylephrine injections. Reflex bradycardia was quantitated by plotting each pulse interval in microseconds against BP of the preceding beat, and expressing BRS as the linear regression coefficient (slope) in ms/mmHg. Mean BRS in 10 dogs with coarctation did not differ significantly (P greater than 0.1) from 8 normal controls. Carotid sinus diameter (CSD) was also assessed. Carotid arteries were fixed in vivo by prolonged exposure to glutaraldehyde to prevent contraction, then were excised and measured in a calibrated microscope. Mean CSD in 10 dogs with coarctation was significantly greater (P less than 0.01) than in 10 control dogs. The unexpectedly normal BRS in experimental coarctation may be due to changes in CSD induced by hypertension; such changes may only develop in growing animals. Experimental studies of coarctation should use a preparation that mimics the natural lesion.
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PMID:Baroreflex sensitivity and carotid sinus dimensions in dogs with coarctation. 78 71

The use of beta-adrenergic blocking drugs in angina pectoris was one of the original indications for these drugs suggested by Black. An anti-anginal effect was demonstrated with the first beta-adrenergic blocking drug, pronethalol, that was used clinically. This benefit in angina was confirmed in the early trials with propranolol in 1964-65. Although some definite anti-anginal effect can be demonstrated with low fixed dosage, evidence suggested that those trials which used a higher and a variable dose displayed a greater anti-anginal action of the drug. After a two dose trial (Gillam and Prichard, 1966,) demonstrated a dose dependent anti-anginal effect, a log-dose response study demonstrated a progressive reduction in angina attacks as dosage was increased (Prichard and Gillam, 1971). While a highly significant effect was found with an average dose of 52 mg a day a progressive reduction in angina attacks was found with logarithmic increases in dosage up to an average of 417 mg a day. Dosage in this trial was adjusted to produce a supine heart rate of 55-60 beats/minute provided this was not prevented by side effects. As the dosage of 417 mg a day was still on the straight line part of the dose response curve and therefore suboptimal, we not adjust dosage to produce a standing heart rate of 55-60. Fully meaningful comparative trials require that optimum dose of the drugs being compared are used. A variable dose comparative trial comparing propranolol and practolol, showed propranolol was the more effective agent. More recently a variable dose comparative trial of sotalol and propranolol indicated propranolol had greater anti-anginal action although sotalol, unlike practolol, was more effective than low dose propranolol. The use of beta-blocking agents in angina pectoris is relatively safe provided that the contraindications of asthma and cardiac insufficiency are observed and that treatment is commenced at a low dosage. The most dramatic change in the sympathetic environment of the heart takes place when treatment with a beta-blocking drug is commenced. The greatest danger of precipitating heart failure is therefore at the beginning of treatment even with a small starting dose. Once treatment has begun even an increase of 25% per dose represents a small pharmacological increment as there is no great change in the sympathetic drive to the heart. The larger dosage of beta-blocking drugs required for optimum treatment of angina may be gradually approached, but it has been my experience that heart failure is not likely to be precipitated at larger doses, provided they are not used initially. In other than mild angina pectoris the average optimum dosage of propranolol is 500-800 mg a day, similar, or perhaps more than the average dose in hypertension.
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PMID:Propranolol in the treatment of angina: a review. 78 54

The presented analysis deals with the physiopathological mechanisms of the debelopment of postinfarction cardiac insufficiency and the clinical peculiarities of its manifestations. It is emphasized that the leading cause of cardiac insufficiency consists in a reduction of the contractile function of the left ventricular myocardium due to the development of asynergy in the cicatrical zone. The addition of several accompanying factors, such as heart mitralization, tachysystolic form of ventricular fibrillation, repeated infarction with a growing asynergic zone, aggravate the course of cardiac insufficiency providing for the development of hypertension in the general circulation system.
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PMID:[Cardiac insufficiency in ischemic heart disease]. 78 66


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