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

The authors report a case of toxic hepatitis in a woman of 22 years of age in the third trimester of her first pregnancy treated by methyldopa for hypertension of pregnancy which was diagnosed at 33 weeks of amenorrhoea. The prodromal symptoms were mild and consisted of nausea, vomiting and rise in temperature and this phase was associated with febrile jaundice without pruritus and it was only associated with coagulation disorders in the third stage of labour. This was a case of mixed cytolytic hepatitis (ASAT x 3N) and cholestasis (x 1.5N). The outcome was fatal. The patient died three days after delivery following haematemesis and renal failure as well as hepatic encephalopathy. The main diagnostic feature was acute hepatic stasis in spite of the absence of pruritus and the presence of a raised temperature after hematolytic, viral and obstructive causes had been eliminated. Histology confirmed that there was toxic hepatitis. This aetiology was suggested by the timing of the symptoms after MD (methyldopa) had been taken. Elkington described methyldopa hepato-toxicity in 1969. Fatal cases in the literature were in patients who were over 40 years of age. Methyldopa is used in pregnant women because of its safety as far as the fetus is concerned. Mechanism by which it causes toxic hepatitis is a combination of abnormal metabolism (the cytochrome P450 chain produces an antigen) and an immune reaction in response to this antigen and these explain why such severe and potentially fatal forms of the condition exist.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Fatal toxic hepatitis in pregnancy. A discussion of the role of methyldopa]. 232 42

Pregnancy outcome was followed in 123 women showing maternal serum alpha-fetoprotein, less than or equal to 0.50 MOM. In 28 cases AFP was secondarily considered as normal either after ultrasonography and correction of gestation age or after a second sample normal result. In 95 cases AFP level was confirmed lowered; perinatal outcome was normal in 70 cases and abnormal in 25. Among these 25 cases, 3 autosomal trisomies occurred, 2 trisomies 18 and 1 trisomy 21; in the 22 other cases, we observed antepartum risk factors (10 cases with impending premature labor or premature labor, 9 cases with chronic hypertension, 2 cases with Ag HBs hepatitis and 1 case with diabetes).
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PMID:[Results of pregnancies characterized by a decrease in the level of alpha-fetoprotein in the maternal blood]. 246 77

Recent improvements in the results of orthotopic liver transplantation (OLT) have made this a well-accepted treatment for patients with severe hepatic failure. Current problems encountered following OLT are discussed. Immediate complications comprise surgical bleeding, primary graft non-function, and graft failure due to hepatic artery occlusion. Secondary complications are frequent. Surgical ones include biliary and vascular (hepatic artery thrombosis most often) problems, as well as intra-abdominal abscesses associated with gastrointestinal perforation, biliary leak, graft ischaemia or an infected haematoma. 40% of patients having undergone OLT will be reoperated on, 2/3 of them within 3 months. Non-surgical complications are mostly pulmonary. The risk of pneumonitis is increased by prolonged mechanical ventilation; it is always potentially disastrous in the immunosuppressed, transplanted patient. Hypertension is also often seen in the early postoperative period; it requires prompt treatment. Early renal impairment after OLT is common, and of better prognosis than late onset renal failure, which is generally associated with shock, graft failure, sepsis or use of nephrotoxic agents. Seizures, usually only one, occur in about 10% of patients; recovery is complete. Encephalopathy with intracranial oedema related to fulminant hepatitis has a worse prognosis, but survival figures are quite encouraging. Three type of rejection are described after OLT: 1) severe accelerated rejection (very rare), 2) acute rejection encountered in about 70% of patients over the first 3 months, and 3) late rejection, which can lead to the vanishing bile duct syndrome (VBDS). Diagnosis of rejection is made by liver biopsy. Prophylactic immunosuppression includes cyclosporin, methylprednisolone and azathioprine. Cyclosporin toxicity and drug interactions are reviewed. Treatment of acute rejection episodes comprises an initial bolus of high doses of corticoid drugs; if there is no response, antilymphocyte globulin or monoclonal antibodies may have to be used. Infection is the main cause of death following OLT. Early infections, mostly intra-abdominal and pulmonary, are bacterial or fungal. Vital (especially CMV) and other opportunistic infections occur generally after the second week. Retransplantation, carried out in 10 to 25% of patients, may be urgent in case of primary graft failure, or hepatic artery thrombosis associated with graft failure, or hepatic artery thrombosis associated with graft failure. Other indications are early graft rejection with severe hepatic dysfunction, chronic rejection with severe VBDS, and recurrence of the initial disease.
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PMID:[Liver transplantation in adults: postoperative management and development during the first months]. 262 46

The traditional options available for the correction of hemodialysis-related anemia are blood transfusions and androgen therapy to stimulate erythropoiesis. A new therapeutic option, recombinant human erythropoietin (r-HuEPO; EPOGEN, AMGEN Inc, Thousand Oaks, CA), is currently undergoing clinical trials. Each treatment alternative has certain attendant adverse effects. The adverse effects of transfusion include transmission of infections such as hepatitis or acquired immunodeficiency syndrome, iron overload, and sensitization to histocompatibility antigens. Androgen therapy can cause masculinization of women and children and, in some forms, is associated with a high incidence of abnormal liver function. Treatment with r-HuEPO has some potential adverse effects, including hypertension, thrombosis of arteriovenous fistulae, prolonged duration of dialysis, hyperkalemia, and iron deficiency. Gradual and careful introduction of r-HuEPO should prevent hypertension from becoming problematic.
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PMID:Adverse effects of therapy for the correction of anemia in hemodialysis patients. 264 19

Atenolol, a beta 1-selective beta-adrenergic receptor-blocking agent, is frequently used for the treatment of hypertension and angina pectoris. We report our experience with a patient who developed cholestatic hepatitis related to the initiation of therapy with atenolol with prompt resolution of symptoms and biochemical abnormalities upon discontinuation of this medication. A review of the literature failed to demonstrate any prior report of atenolol-associated hepatic injury. Although rare, because of the common use of atenolol, clinicians should be aware of this potential adverse effect.
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PMID:Atenolol-associated cholestasis. 277 3

The clinical characteristics was studied on 431 women with uterine bleedings during the premenopaussal phase of the climacterium. The author established that menarche, duration of menstrual interval and the menstruation itself before the bleeding did not differ from those of female population in the country. The same was referred to the reproductive characteristics. Premenopausal bleeding reached its peak between 46 and 48 years of age as its duration was relatively great. It was connected with frequent neuro-endocrine and metabolic pathology. The most frequent manifestations were obesity and hypertension. The number of the former hepatitis patients was comparatively large. Diseases of the uterine body were frequent in the structure of genital pathology. The frequency of benign, precancerous and malignant neoplastic processes (without myoma) was high-12.7%.
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PMID:[The clinical characteristics of women with uterine hemorrhages in premenopause]. 280

The authors studied clinical and biological data occurring in 165 patients observed during 23 years and afflicted with polyarteritis nodosa. Hypertension was present in 52 patients (31.5%) and seven of them suffered from malignant hypertension (4%). Mean age of patients (6 male, 1 female), with malignant hypertension was 38 +/- years old. Mean follow up was 49 +/- 28 months including 26 +/- 21 months after discontinuation of treatment of polyarteritis nodosa. Malignant hypertension occurred during the first year of evolution of polyarteritis nodosa. Renal insufficiency was present in 5 of 7 patients. Proteinuria was greater than 1 gr/d in 4 cases. Renal arteriography was performed in 6 patients and showed in every case renal ischemia and microaneurysms in five. In 4 patients measurements of plasma renin activity and of aldosterone were obtained. A stimulation of those hormones was demonstrated. Some symptoms of polyarteritis nodosa were present with a high incidence in case of malignant hypertension: digestive signs (6/7), orchitis (3/6). HBs antigen was present in 6 cases and hepatitis in 5. Captopril was effective in every case, alone or associated with other treatments. Follow up of hypertension went from 8 months to 4 years. At present time 6 patients are alive and one is lost of follow up. A treatment is necessary in 6 of 7 patients. Creatininemia is greater than 300 micromol/l in 4 patients. A successful kidney transplantation was performed in one case. Our study shows a close relation between malignant hypertension observed in polyarteritis nodosa, vascular nephropathy, digestive and urologic signs. Hepatitis B virus could be responsible of those manifestations.
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PMID:[Malignant arterial hypertension in periarteritis nodosa. Incidence, clinicobiologic parameters and prognosis based on a series of 165 cases]. 287 20

The government of Senegal, in March of 1986, requested assistance from the UN Development Program (UNDP) to formulate and execute a program for safe motherhood. Senegal, with an estimated maternal mortality rate of 580-760/100,000, was the 1st country to initiate a concrete national program to address the problem of maternal mortality. Despite the existence of a well-developed health infrastructure, data showed that the majority of Senegalese women deliver at home and that only 20% of maternal mortality is reported. Causes of mortality include endemic diseases (malaria and hepatitis), and abrupted placenta as a complication of hypertension. To identify the target areas of intervention, a "Mission of Identification" was organized by the UNDP in collaboration with the government of Senegal. 4 levels of the health infrastructure--village or rural maternity, the health post, the health center, and regional and national hospitals--were assessed as to existing and potential capacity to prevent maternal deaths. Epidemiology, social barriers to care, service delivery problems, and management issues were addressed. Results revealed a minimal knowledge of family planning, an expressed desire to solve the problems, and the strong influence of traditional beliefs in health care intervention, all of which contribute to maternal mortality. Interventions to reduce mortality were outlined based on identified causes of death and capabilities to address a specific problem. Over 50% of maternal deaths could be prevented by improved access and optimization of health care delivery and timely medical/surgical intervention. Adequate prenatal coverage and reducing pregnancy rates at the extremes of maternal age and parity were also cited as methods to reduce mortality. Estimates of the efficacy of these interventions were based on universal access, which does not now exist. A significant investment must be made to assure such access and to emphasize the priority given to maternal/child health by the government of Senegal.
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PMID:Preliminary report of an identification mission for safe motherhood, Senegal: putting the M back in M.C.H. 289 92

Technetium-99m galactosyl-neoglycoalbumin ( [Tc]NGA) is a radiolabeled ligand to hepatic binding protein, a receptor which resides at the plasma membrane of hepatocytes. This receptor-binding radiopharmaceutical and its kinetic model provide a noninvasive method for the assessment of liver function. Eighteen patients were studied: seven with hepatoma, eight with liver metastases, four with cirrhosis (two had concurrent hepatoma and one chronic active hepatitis), and one patient with acute fulminant non-A, non-B hepatitis. Technetium-99m NGA liver imaging provided anatomic information of diagnostic quality comparable to that obtained with other routine imaging modalities, including computed tomography, angiography, ultrasound, and [Tc]sulfur colloid scintigraphy. Kinetic modeling of dynamic [Tc]NGA data produced estimates of standardized hepatic blood flow, Q (hepatic blood flow divided by total blood volume), and hepatic binding protein concentration, [HBP]. Clinical correlation was by classical Child-Turcotte criteria (CTC). Significant rank correlation was obtained between [HBP] estimates and CTC scores (rs = -0.72, p = 0.001). This correlation supports the hypothesis that [HBP] is a measure of functional hepatocyte mass. The combination of decreased Q and markedly reduced [HBP] may have prognostic significance; all three patients with this combination died of hepatic failure within 6 wk of imaging.
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PMID:Technetium-99m NGA functional hepatic imaging: preliminary clinical experience. 299 17

The majority of epidemiological studies on the benefits and risks of oral contraceptive (OC) use have been conducted during the late 1960s and early 1970s when OCs had 50 mcg of estrogen. Based on these studies, the risk of death due to OC use for nonsmokers 35-39 years old was lower than using no contraceptive at all (14.1 deaths/100,000 women/year vs. 25.7 deaths/100,000 women/year). In addition to smoking, other contraindications include women with a history of angina, myocardial infarction, blood clots or stroke, estrogen dependent cancer, hypertension, a known lipid disorder, and women with hepatitis or cirrhosis of the liver. Suitable 35 year old candidates for OC use would be nonsmokers with blood group O, at low risk for cardiovascular disease, and who might receive additional benefits, including those with severe dysmenorrhea or hypermenorrhea and possibly those who have a strong family history of osteoporosis, early menopause, or ovarian cancer. Practitioners should take a thorough history of these women and give a physical examination with a blood pressure check. They should also administer screening tests, such as a PAP test, mammograms, a lipoprotein profile, and a glucose test. After the practitioners have deemed these women to be healthy based on the examination and the results of the screening test, they then should prescribe only a low dose OC containing 50 mcg of estrogen. Today most estrogen based OCs contain 35 mcg and research on their effects have not yet begun. Scientists expect to find that the dose response effects for risks for thromboembolism, myocardial infarction, stroke, and gallbladder disease to be lower in users of the low dose preparations.
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PMID:Risks and benefits of oral contraceptive use in women over 35. 323 16


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