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

Laser-Doppler flowmetry has been used to study the skin microcirculation in 20 normal limbs and 80 limbs of patients with venous hypertension and leg ulceration due to deep venous reflux. It was found that limbs with venous hypertension had a high skin resting blood flow (BRF) and an impaired veno-arteriolar reflex (VR). There was a marked improvement in both BRF and VR after elastic compression for three weeks and an association between this improvement and the rate of healing of the leg ulcers. The results indicate that elastic compression may affect the microcirculation even though it does not alter the venous pressure measurements when the elastic stockings are removed.
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PMID:Evaluation of the effects of elastic compression in patients with postphlebitic limbs by laser-Doppler flowmetry. 307 99

In 1945 Martorell described ischemic leg ulcers in patients with hypertension and suggested that the ischemic necrosis was secondary to hypertensive arteriolar disease. The aim of the study was to examine the minimum vascular resistance in the skin of patients with these ulcers. Twelve control subjects (median age 52 years), eight patients with peripheral vascular disease (PVD) (median age 73 years), and six patients with hypertensive ulcers (median age 74 years) were studied. The minimum vascular resistance (MVR) and skin perfusion pressure (SPP) were determined by an isotope clearance method. Presence and severity of PVD were assessed by ankle/arm pressure ratios. The ulcer patients had a higher ankle/arm pressure ratio than the PVD group (p = 0.026) but had similar SPP (p = 0.47). When compared with the control group they had a similar pressure ratio (p = 0.09) but lower SPP (p = 0.001). The MVR was higher in the ulcer patients than the control subjects (p = 0.005) and the PVD group (p = 0.01). The study shows that patients with hypertensive ulcers have a high vascular resistance. This increase in resistance may interfere with the compensatory relaxation that normally occurs distal to an arterial narrowing, resulting in poor tissue perfusion and subsequent ulcer development.
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PMID:Martorell's hypertensive ischemic leg ulcers are secondary to an increase in the local vascular resistance. 400 40

Although several attempts have been made in the developed countries to study the effect of various environmental factors on morbidity, it is disappointing that in developing countries where very poor conditions exist, very little information is available on the subject. This study was therefore designed to examine the influence of the living and working environment on the state of health of two groups of Nigerian workers namely farmers and industrial workers. The study was carried out in two villages Badeku and Ewekoro. 200 farmers from Badeku and 150 industrial workers from Ewekoro were selected by appropriate sampling methods. Most of the data were obtained by means of a questionnaire administered by the authors. In addition to a detailed clinical examination of each subject, blood stool and urine specimens were obtained for laboratory investigations. A high incidence of hookworm and ascaris infection, anaemia, leg ulcer, malaria parasitaemia and onchodermatitis was found among the farmers. The industrial workers on the other hand had a higher incidence of chronic bronchitis and hypertension. Some of these findings have been attributed to poor environmental hygiene of the homes and work places, atmospheric pollution and other health hazards associated with living and working in the rural areas.
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PMID:Health and the environment-a comparative study of agricultural and industrial workers in Nigeria. 628 44

A case report of hypertensive leg ulcer and its management is described. The diagnosis of hypertensive leg ulcer is primarily based upon clinical findings after other etiologies have been excluded. Microscopic arteriolar changes associated with hypertensive disease do not necessarily preclude the development of hypertensive ulcers. Therapy of these ulcers is based upon a sound understanding of their pathophysiology--control of systemic hypertension, possible enhancement of local tissue perfusion, atraumatic debridement, and skin graft closure.
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PMID:Hypertensive leg ulcers. 686 35

Since the incidence of inflammatory arterial disease has been higher in Japan, its surgical treatment has been one of the main themes of vascular surgery from its beginning in this country. Buerger disease has been the main cause of chronic occlusive arterial disease before the middle of 1970s. and many patients suffered from intractable ischemic leg ulcer with severe pain. Reconstructive surgery, however, has been so much limited that number of the candidates for bypass surgery were around 10% of the patients, because of distal nature of the disease. We have developed a new technique in distal bypass surgery named as Esmarch's rubber bandage method, which was intended to minimize surgical injury to the host artery, and the results of its application to Buerger disease is very encouraging, and we have confirmed that this technique enables a bypass to the collateral arteries and muscular branches in place of the diseased tibio-peroneal artery. We expect this technique will clear a new avenue to surgical treatment of Buerger disease with limb threatening ischemia. In Takayasu's arteritis, the carotid reconstruction was popular between the late 1950s and 1960s and, at the same time atypical coarctation, renovascular hypertension, and aneurysm, along with their combined lesion became the objects of vascular surgery. This expansion of surgical indication contributed to the improvement of the prognosis and rehabilitation of the patients. Long term function of the reconstruction has been also confirmed. On the other hand, several problems emerged with the widespread application of vascular reconstruction which were peculiar to the disease state. Among them, the most important problems were neurological complications due to sudden increase in the intracranial blood pressure after carotid reconstruction, and anastomotic aneurysm as the delayed complication affecting eventual outcome which are inherent to the inflammation and extensive destruction of the medial component in this disease. A new method to prevent the postoperative neurological complications is discussed in this report. To improve the long term survival, meticulous observation of postoperative course is essential in Takayasu's arteritis. Recently, abdominal aortic aneurysms showing the peculiar gross appearance and clinical presentation have become the subject of discussion as inflammatory abdominal aortic aneurysm because of remarkable thickening of the aneurysmal wall and a severe inflammatory change, and some difficulties of its surgical treatment have been stressed in the most of the reports. The recent researches offered the conclusion that etiology of the aneurysm is not inflammation, but inflammatory reaction during formation of atherosclerotic aneurysm.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Surgical treatment of intractable vasculitis syndromes--with special reference to Buerger disease, Takayasu arteritis, and so-called inflammatory abdominal aortic aneurysm]. 793 11

The study investigated the Taiwanese elderly in two different ethnic groups (Paiwan and Min-Nan) regarding their multifunctional status. The purpose was to make known and compare the subjective and objective health status of these two groups. The results for the objective measurements indicated that an elderly Paiwanese had 2.74 kinds of diseases on average. The most prevalent diseases among the Paiwan elderly were arthritis (rheumatism), circulation troubles in arms or legs, high blood pressure, stomach or intestinal disorders or gall bladder problems, cataract, heart trouble, emphysema (chronic bronchitis), skin disorder (leg ulcers or severe burns), asthma, and digestive system ulcers. Of all disease, five (arthritis, circulation trouble, emphysema, skin disorder, and tuberculosis) were statistically more prevalent among the Paiwan elderly than among the Min-Nan elderly. In terms of health scoring, the two groups were comparable except in the following two aspects: (1) more Paiwan elderly were unable to take medicine by themselves, and (2) the Paiwan elderly had lower cognitive ability ratings. In the subjective arena, the Paiwan elderly had a lower score in self-rating health status. Condensed, the health status of the Paiwan was worse than that of the Min-Nan elderly both in objective and subjective measurements.
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PMID:[A comparison on health status between Paiwan and Min-Nan elderly]. 808 76

We report clinical and histological features of 16 consecutive patients with hypertensive leg ulcers. The lumen/wall ratio in arterioles at the edges of these hypertensive leg ulcers was compared with that in other types of chronic leg ulcers and was found to be significantly reduced (P < 0.001). Additional conditions such as venous hypertension or main vessel arterial disease contributed. Nineteen of 22 ulcers were completely healed after a mean of 4.9 months. Recognition of this condition enables correct treatment choice, which usually involves excision and grafting, and early healing.
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PMID:Arterial hypertension causing leg ulcers. 856 43

In terms of prevalence, total cost and morbidity, venous leg ulcers are probably by far the most important type of ulcerations in the leg. The macrocirculatory defect leading to a raised ambulatory venous pressure is now accepted as a common initial pathologic pathway. Most current treatment modalities, such as surgery or external compression, are designed to control the macrovascular defect. However, it is the microcirculatory consequences of the venous hypertension that give rise to the trophic skin changes and ultimately to ulceration. At this microcirculatory level, pharmacotherapy may be a useful adjunct in the treatment of venous leg ulcers. The microcirculatory pathophysiologic changes include decreased fibrinolytic activity, elevated plasma fibrinogen, microcirculatory thrombi, and inappropriate activation of the white blood cells. The oxidative burst from the activated white cells probably plays a key role by releasing locally leukocyte-derived free radicals, proteolytic enzymes, cytokines, platelet-activating factor, and a number of other noxious mediators. An important additional component in recalcitrant venous ulcers is co-existing arterial disease, which is probably present in 15-20% of cases. Decreased arterial perfusion pressure will further aggravate the ischemic changes caused by the venous hypertension. Pentoxifylline downregulates leukocyte activation, reduces leukocyte adhesion, and also has fibrinolytic effects. A number of clinical studies have therefore been carried out to examine the clinical efficacy of pentoxifylline in treatment of venous leg ulcers. Probably the largest published placebo-controlled, double-blind randomized study was reported in 1990. In this study, 80 patients received either pentoxifylline 400 mg three times a day orally or matching placebo for 6 months or until their reference ulcer healed if this occurred sooner. Complete healing of the reference ulcer occurred in 23 of the 38 patients treated with pentoxifylline compared to 12 of the 42 patients treated with placebo. The odds ratio in favor of pentoxifylline was 1.81 (95 confidence intervals 1.20-2.71).
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PMID:Pharmacologic treatment of venous leg ulcers. 869 64

The effect of nifedipine in the treatment of hypertensive venous leg ulcers was studied on 30 outpatients in a double-blind placebo-controlled trail over a period of 2 months. The dose of nifedipine or the matching placebo was 10 mg 3 times daily. Most of the subjective symptoms such as pain, paraesthesia and cramps at night considerably improved during the treatment with nifedipine and were slightly affected in the placebo group. The ulcer surface area decreased after 2 months treatment with nifedipine by 26.9% (p < 0.05), and after treatment with placebo by 8.6% (p > 0.05). An improvement of the photopletysmographic record of the lower legs in the nifedipine group was observed, demonstrated by an increase of the index recovery time (by 36.1%, p < 0.05), while there were no significant changes in the placebo group. The results show favorable effect of nifedipine in the treatment of hypertensive venous leg ulcers which might be due to a great extent to improvement of the subcutaneous circulation of the lower legs. Nifedipine may be an important adjunct to the conservative management of the complications caused by chronic venous insufficiency and hypertension.
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PMID:Treatment of hypertensive venous leg ulcers with nifedipine. 874 28

Graduated compression hosiery has an important role in the management of venous leg ulcers by counteracting chronic venous hypertension. The historically high rates of venous ulcer recurrence can be significantly reduced by optimizing compliance with the wearing of support hosiery. This is facilitated by providing information, practical support and opportunities for regular professional monitoring. Compliance is also aided by ensuring that the garment fits correctly and is comfortable and by offering the client a choice of products from those available.
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PMID:Scholl compression hosiery in the management of venous disorders. 915 88


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