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

A 70-year old man is described who had specialized columnar epithelium in the esophagus up to the upper esophageal sphincter, 19 cm from the incisor teeth. The patient had a small sliding hiatus hernia but the lower esophageal sphincter was located at 39-41 cm. Above the sphincter the patient had large peptic ulcers which failed to heal after 1 year of a conventional antireflex regimen. Carbenoxalone sodium administration led to healing in 3 months. However, the ulcers recurred after discontinuation of the drug. On a second attempt carbenoxalone effected modest healing but was stopped because of hypertension and hypokalemia. Cimetidine therapy led to complete healing of the the ulcer within a month. The authors concluded that both carbenoxalone and cimetidine are useful in the treatment of an ulcer in Barrett's esophagus. However, cimetidine may be more rapidly effective and does not produce dangerous side effects.
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PMID:Pharmacotherapy of an ulcer in Barrett's esophagus: carbenoxalone and cimetidine. 89 84

Because of the multiplicity of disease conditions and diminished tolerance for drugs in the aged, it is necessary to know concomitant pathologic conditions to determine which antihypertensive drug to use. In the Philadelphia Geriatric Center, there are about 1,000 residents, between 70 and 100 years of age. About 40% have hypertension; almost 50% have or once had depression; there are many cases of hiatal hernia and/or peptic ulcer; in one subdivision of residents, almost 40% have renal disease with BUN above 30 mg/100 ml. In antihypertensive treatment, some individuals respond fairly well to reassurance and weight reduction, when obese, even without drugs. All are given a low-salt diet. A diuretic is first used--thiazide in cases of good renal function, furosemide with impaired renal function. Liquid potassium supplements are given. If there is but little reduction in blood pressure in several weeks, methyldopa is added in ascending doses, in cases with or without renal impairment. In hypertension with impaired renal function, furosemide and/or methyldopa were especially valuable. Furosemide as an antihypertensive drug was also noted to delay the onset of congestive heart failure. Since reserpine can aggravate peptic ulcer and can precipitate or aggravate depression, it should seldom be used to treat hypertension in the aged. Guanethidine is rarely used, since it can cause cerebrovascular insufficiency and marked weakness. High blood pressure should be reduced slowly in the aged, to avoid untoward effects.
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PMID:An approach to the treatment of hypertension in the aged. 105 27

A silicone collar containing circumferential tape was tied around the cardio-esophageal junction in eight patients with symptomatic, refractory reflux, who were not good candidates for a standard antireflux procedure. A fine polypropylene tie or clip secured the knot. In two patients with large hiatal defects, the crura were approximated loosely. Mean operating time, including one cholecystectomy and one ventral hernia repair, was 51 minutes. Patients who underwent this simple operation had a combination of hypertension, heart disease, obesity and old age, and two had undergone horizontal gastroplasty previously for morbid obesity. The reflux was associated with hiatal hernia in seven of the eight patients. Preoperative studies included barium swallow roentgenography in all eight patients, and endoscopy, manometry and Bernstein test in six. All the studies were repeated postoperatively. Follow-up ranged from 17 to 48 months (mean 37.8 +/- 10.6 months). Postoperatively, there was a significant (p less than 0.01) improvement in symptoms, endoscopic findings and lower esophageal sphincter pressures. No prosthesis has migrated yet.
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PMID:The Angelchik antireflux prosthesis. 397 Dec 43

This study was intended to specify the most appropriate procedure of myotomy and fundoplication in the modified Belsey Mark IV operation toward the esophageal achalasia to prevent post-operative refluxes. Adult mongrel dogs were prepared under surgical operation of, short myotomy, short fundoplication, long myotomy, long fundoplication, long myotomy, long fundoplication of artificial hiatus hernia type control. After the well recovery, they were examined on their simultaneous evaluation of pH and inner pressure at three points, i.e. the esophagus, the high pressure zone (HPZ), and the stomach. At the same time, withdrawal pH curves, etc. were also determined. The discussion resulted that the group of short myotomy, short fundoplication and the group of artificial hiatus hernia type long myotomy, long fundoplication were significantly superior to the group of long myotomy, long fundoplication. As the consequence of the experiment, firstly, the possibility that the surgical operation of long myotomy, long fundoplication causes hypertension of the intrathoracic esophagus, which resulted in the dysfunction of the anti-reflux mechanism of the valves was suggested. Secondly, it has been revealed that this dysfunction did not occur in the surgical operations on the length of HPZ. And thirdly, when the conventional Mark IV operation, which buries all the portions of the fundoplication under the diaphragm, causes hypertension to the intrathoracic esophagus, the surgical operation of artificial hiatus hernia type shall be applied to herniate the upper portion of the fundoplication to the thoracic cavity.
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PMID:[An experimental study on post-operative anti-reflux effect by modified Mark IV operation to esophageal achalasia]. 667 63

A patient had syncope induced by swallowing. Electrocardiographic monitoring during eating and esophageal balloon inflation demonstrated a second-degree atrioventricular block (Mobitz type II) with dizziness. Radiologic and manometric examinations of the esophagus showed diffuse esophageal spasm associated with hypertension of the upper esophageal sphincter (UES), gastroesophageal reflux, and a sliding hiatal hernia. Cineradiographic observations were made during ingestion of a meal mixed with barium; at the time of cardiac dysrhythmia, the proximal part of the esophagus containing the bolus assumed a balloonlike shape, while the distal part and the UES contracted. On the basis of these observations and review of all published cases, we propose the pathways of this esophagocardiac reflex and discuss up-to-date treatment.
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PMID:Atrioventricular block induced by swallowing in a patient with diffuse esophageal spasm. 713 82

With westernization of diet and lifestyle among South African Blacks, particularly urban dwellers, hitherto unknown gastro-intestinal diseases are becoming evident. Previously unreported is hiatus hernia, now a definite disease entity, although still very uncommon. At Baragwanath Hospital, Johannesburg, over 17 months in 1977-1978, 46 patients with hiatus hernia were detected from barium meal examinations on 1392 persons, i.e. 3,3%, or 0,07% of total hospital admissions of adults. The disease affected mainly middle-aged and elderly women. Prevalences of obesity, comparative physical inactivity and hypertension appeared commoner than in the general urban adult population. Just as appendicitis is a marker of westernization in young urban Blacks, hiatus hernia may be regarded as a marker in the middle-aged and elderly.
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PMID:Hiatus hernia in Johannesburg blacks. 740 65

We report the case of a 69-year-old woman with a history of hypertension and transient ischemic attack who was admitted because of a diagnosis of left atrial mass on transthoracic echocardiography. Monoplane transesophageal echocardiography showed an extracardiac mass compressing the left atrium posteriorly and an apparent intraatrial mass. As the procedure did not clarify the nature of the masses, a thoracic magnetic resonance imaging was performed. This technique revealed a large hiatal hernia impinging on the left atrium without evidence of an upper gastrointestinal tract. Our experience confirm that hiatal hernia may mimic an echocardiographic left atrial mass and should be considered in the differential diagnosis of this finding.
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PMID:[The false image of a left atrial mass due to a hiatal hernia: a case report]. 807 31

An understanding of changes in pulmonology disease patterns observed at a general hospital before and after implantation of a population-based model of health care not only provides useful insight into the diseases treated but also aids adjustment of health care service organization. The aim of this study was to compare data collected after 1992 (when the new system was established) with records kept by the same pulmonology group in earlier years (1974-1986). Data after 1992 described patients attended in Health District 11 by the newly organized pneumologists. For the two periods the most common pneumological diagnoses were chronic air flow obstruction and chronic hypersecretory bronchitis. The most common non pneumological diagnoses were systemic arterial hypertension, obesity, diabetes, liver disease and hiatus hernia/gastroesophageal reflux. The prospective study covered a larger population and was closer to primary care, including as it did patients at clinics unattached to hospitals. In the earlier hospital-based experience the most common diagnoses were acute respiratory infection, chronic air flow obstruction and asthma, apart from those patients referred in whom no respiratory disease was found. With the organizational integration of hospital and health district pulmonology service, contact between patients and specialists has increased. Record systems have been established for a well-defined population to permit better forecasting at less cost and facilitate contact with primary care givers and epidemiological studies.
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PMID:[Diseases diagnosed at a pneumology unit integrated with its health area. Comparison with historical controls]. 894 84

Gastroesophageal reflux disease (GERD) is a frequent illness, sometimes causing disabling symptoms and/or permanent oesophageal lesions. Etiology is multifactorial and not completely defined. Therapy is medical at first step, surgical indication is reserved to those patients with less compliance for medical therapy, unsuccessful medical therapy or reflux related complications. Different surgical techniques have been suggested for treatment of GERD, like Nissen, Rossetti or Toupet fundoplication. During the last decade laparoscopy has been proposed as a less invasive approach when surgery is indicated. From 1995 to the first months of 1999, 42 pts (28 females, 14 males, mean age 53.7 years), were operated on. Diagnosis and surgical indication were confirmed preoperatively by barium X-rays, endoscopy and 24 hrs-Ph-manometry. Hiatal hernia was demonstrated in 37 cases (88%), I or II grade esophagitis in 16 and III grade in 2; 1 patient had Barrett oesophagus. 37 pts were operated on by laparoscopic Nissen fundoplication, 5 patients had a Toupet operation. Mortality and conversion rate were 0. Complications occurred in 3 patients: 1 intraoperative pneumothorax, 1 acute cardiac ischemia in a patient with known hypertension, 1 permanent dysphagia successfully treated by endoscopic dilatation. Mean postoperative hospital stay was 6.1 days. Mean follow up was 9 months (3-48) in 100% of cases. Despite the fact that few patients were operated on by using this new less invasive approach, results are encouraging with no mortality, less morbidity and great advantages for patients.
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PMID:[Laparoscopic treatment of gastroesophageal reflux]. 1051 27

A 40-year-old woman with type 2 diabetes mellitus, hypertension, central obesity (body mass index: 40 kg/m2) and mixed hyperlipidaemia was treated with oral hypoglycaemic, antihypertensive and hypolipidaemic drugs as well as with intramuscular insulin. She kept gaining weight and developed hiatus hernia with regurgitation. Treatment was changed to a very low caloric diet during 9 months. She lost 18 kg of body weight and all drugs could be discontinued, as she became normoglycaemic, normotensive and normolipidaemic. Obesity is a risk factor for insulin resistance and type 2 diabetes mellitus. To reach euglycaemia in overweight type 2 diabetics is a difficult task. Oral hypoglycaemic agents and insulin are often used in combination with dietary intervention without adequate results. Losing body weight should be first-line treatment. However, compliance with weight-reducing methods is often low. The pathophysiologic importance of significant weight loss in the treatment of (morbid) obesity in type 2 diabetic patients is great.
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PMID:[Very-low-calorie diet in treatment of morbidly obese patient with diabetes mellitus type 2]. 1087 1


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