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

The rate of radiation-induced side-effects is dependent from exogenous technical and endogenous factors. Widespread endogenous factors are arterial hypertension and other cardiovascular diseases. 130 breast cancer patients were retrospectively evaluated for side-effects to estimate the influence of arterial hypertension. All were treated with mastectomy and irradiation (telecobalt) and consecutively followed. 79 patients had normal blood pressure, 51 showed arterial hypertension. Hypertension proved to be the strongest endogenous factor for the development of side-effects. In contrast to the patients with normal blood pressure those with hypertension showed significant more arm lymphedema (p less than 0.005) and telangiectasia (p less than 0.0001). Other endogenous factors, like cardiovascular diseases or obesity, taken together led only to a higher rate of subcutaneous fibrosis (p less than 0.002). Patients with arterial hypertension should receive axillary radiation only for strict indications and perhaps with a reduced dosage.
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PMID:[Hypertension as risk factor for increased rate of side effects in the framework of breast carcinoma irradiation]. 162 Dec 13

After presenting an overview on classification and history of arteriosclerosis theories, the physiological factors involved in the transmural permeability of the arteries are discussed in detail. The development and characteristic features of the altered transmural permeability were studied in various experimental models such as in rat's hypercholesterolemia, local aortic hypoxia, lymphedema of the vascular wall and in hypertension. Results appear to show that alterations in permeability invariably developed in all of the pathological conditions examined, they were transient in nature and preceded the onset of intimal proliferation(s). The disturbance of transmural permeability might be the common pathologic clue which initiates uniform vascular responses to injuries produced by a variety of noxious stimuli. The possible role of the altered transmural permeability in the induction of smooth muscle cell proliferation is also discussed and evidence is provided that after withdrawal of stimulus for vascular injury intimal proliferation will not develop despite the manifest disorders in permeability.
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PMID:Role of the altered transmural permeability in the pathomechanism of arteriosclerosis. History of arteriosclerosis theories. Role of the altered permeability in experimental arteriosclerosis models. 355 Jul 47

A total of 510 cases of primary and secondary lymphoedema in upper and lower extremities have been examined with two thirds of primary lymphoedema cases among them. Radical mastectomy combined with irradiation has led to the development of obstructive lymphoedema of upper limbs in most patients. 230 patients with primary and secondary lymphoedema have been subjected to microlymphatic surgery and lymphaticovenous anastomoses have been carried out with microsurgical techniques. Limb volume measurement, the results of direct lymphangiography and intralymphatic pressure reading were taken into account to select patients suitable for microlymphatic surgery. Most favourable results have been obtained in secondary obstructive lymphoedema cases (total 81.2%) due to well-marked hypertension in lymphatic vessels that contributes to better functioning of the lymphaticovenous anastomoses made in a patient.
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PMID:Reconstructive microsurgery in treatment of lymphoedema in extremities. 383 Nov 35

Over the past 10 years we have treated 36 patients affected by upper limb lymphedema, associated with mastectomy and axillary dissection, by either macrosurgical exeresis or microsurgical techniques. All cases had been unresponsive to prior drug or physical therapy (pressure and thermal therapy). Preoperative upper limb status was thoroughly examined by evaluating volume measurements, dynamic lymphoscintigraphy, venous Doppler fluximetry, ultrasonography, and nuclear magnetic resonance. Selected tests were repeated during follow-up to obtain more statistically significant results. Twenty-five of the 36 patients in our series presented a grade II lymphedema and underwent Degni-Cordeiro's microsurgical indirect lymphatico-venous shunt (L.V.S.) surgery. Fifteen of the 25 also received fasciotomies performed along the posterior aspect of the forearm. Three of the 36 patients presented grade II lymphedema and upper limb venous hypertension. These were treated with multiple fasciotomies alone. The remaining eight patients presented grade III lymphedemas. Seven underwent Kondoleon's partial superficial lymphangectomy, and one was treated with Servelle's total superficial lymphangectomy. Of the 36 patients who underwent surgery, only 27 were checked at 6 months; 22 were seen at 18 months. The remaining patients were followed up for too short of a period of time to be considered. Results were arranged into three groups. Classification criteria were: reduction of upper limb dimensions and the presence of the pre-existing symptoms (episodes of lymphangitis, pain, functional deficits. Results were considered good (class 3), fair (class 2), or poor (class 1). A positive clinical picture (class 2-3) was seen in 74% (20/27) at 6 months and in 59% (13/22) at 18 months.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Modern therapeutic approaches to postmastectomy brachial lymphedema. 783 May 45

The microlymphatic pressure was monitored by using the servo-nulling technique at the forefoot skin in 24 healthy volunteers (number of capillaries studied: 97) and in 27 patients with primary lymphedema (capillary number: 67). The lymphatic capillaries were stained by fluorescence microlymphography with fluorescein isothiocyanate-dextran 150 and cannulated using glass needles with a diameter between 7 and 9 microns. The lymphatic capillary hypertension described recently in primary lymphedema was confirmed in this series (mean pressure of controls 6.7 +/- 3.8 and, of patients 12.8 +/- 5.9 mm Hg; p < 0.001). Two patterns of pressure fluctuation were observed: rhythmic low-amplitude (mean value 3.7 mm Hg) waves with a frequency identical to respiration (respiratory movements of the thorax recorded simultaneously by a photo cell) and spontaneous nonrhythmic, low-frequency waves with a higher amplitude (mean value 5.5 mm Hg). The prevalence of waves synchronous with respiration was identical in patients and controls, whereas the low-frequency waves exhibited a significantly (p < 0.05) higher prevalence in the patients (41.7%) than in the controls (70.4%). The hypothesis is advanced that in primary lymphedema a considerable amount of lymphatic fluid is removed by lymphatic pathways with small calibre and high resistance, resulting in microvascular hypertension, and that contractions of the few preserved large proximal lymphatic collectors are enhanced. The latter mechanism could explain the increased prevalence of spontaneous microlymphatic pressure fluctuations with high amplitude and low frequency.
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PMID:Fluctuation of skin lymphatic capillary pressure in controls and in patients with primary lymphedema. 808 92

Flow and pressure dynamics in minute human lymphatics are unexplored. Lymphatic capillary pressure was measured by the servo-nulling technique at the foot dorsum of 14 patients with primary lymphedema and 15 healthy controls. Glass micropipettes (7-9 microns) were inserted under microscopic control into lymphatic microvessels previously stained by fluorescence microlymphography (FITC-Dextran 150,000). Mean lymphatic capillary pressure was 7.9 +/- 3.4 mm Hg in the controls and 15.0 +/- 5.1 mm Hg in the patients. The difference was significant at the P < 0.001 level. In about half of the patients and control subjects studied pressure fluctuated by more than 3 mm Hg. The mean intralymphatic pressure of lymphedema patients was slightly below mean interstitial pressure measured by J. T. Christensen, N. J. Shaw, M. M. Hamas and H. K. Al Hassan (1985, Microcirc., Endothelium, Lymphatics 2, 267-384) (17.9 mm Hg) in lower leg lymphedema. Microlymphatic hypertension present in patients with primary lymphedema is probably an important factor for edema formation.
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PMID:Lymphatic capillary pressure in patients with primary lymphedema. 824 14

Microlymphatics of human skin form two superposed networks. The superficial one located at the level of dermal papillae may be visualized by fluorescence microlymphography. Microlymphatics fill from a subepidermal depot of minute amounts of FITC-dextran 150,000. In primary lymphedema with late onset the depicted network with vessels of normal size is significantly larger than in healthy controls, whereas in congenital lymphedema (Milroy's disease) microlymphatics are aplastic or ectatic (diameter > 90 microns). Lymphatic microangiopathy with obliterations of microvessels develops in chronic venous insufficiency, in lipedema (preliminary results) and after recurrent erysipelata. In healthy controls microlymphatics are permeable to FITC-dextran 40,000 and impermeable to the larger molecule 150,000. Preserved fragments of the network in chronic venous insufficiency exhibit increased permeability to FITC-dextran 150,000. After visualization of the vessels by the fluorescent dye microlymphatic pressure may be measured by the servo-nulling technique. First results indicate that microlymphatic hypertension contributes to edema formation in patients with primary lymphedema.
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PMID:Microlymphatics of human skin. 847 66

The treatment of patients with lymphedema is still controversial. Combined physical therapy with manual lymph drainage and compression therapy is most frequently used to reduce lymphatic leg swelling. However, objective evidence is rare that this empirical form of treatment has a scientific basis. In a prospective study fluorescence microlymphography and pressure measurements in cutaneous lymph capillaries were used to assess objectively the effect of combined decongestive physical therapy on abnormal microlymphatic dynamics in lymphedema. 12 patients with primary and secondary lymphedema were studied before treatment, after 2 weeks of intensive physical therapy and 3 months of continuing compression and ergotherapy. After 2 weeks of intensive manual lymph drainage and compression bandaging (phase 1) microlymphatic hypertension (12.8 +/- 5.7 mm Hg) was significantly (p = 0.01) reduced to a mean lymph capillary pressure of 5.9 +/- 4.5 mm Hg. More than 3 months later after continuing compression lymph capillary pressure (3.2 +/- 5.2 mm Hg) was still significantly (p = 0.03) reduced. Simultaneously the maximum spread of the fluorescent contrast medium in the superficial lymph capillary network decreased significantly (p = 0.01) from 21.3 +/- 14.3 to 11.3 +/- 4.8 mm. Accordingly the clinical condition improved, and the mean circumferences of the forefoot and ankle were significantly (p < 0.05) reduced. Combined decongestive physical therapy is an effective treatment for lymphedema which results in a normalization of microlymphatic hypertension and an improvement of the clinical appearance.
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PMID:Combined physical therapy for lymphedema evaluated by fluorescence microlymphography and lymph capillary pressure measurements. 925 91

The authors review the current understanding of lymphatic anatomy and physiology, and the pathophysiology of lymphedema. The skin lymphatic system consists of the initial lymphatics, which converge into lymphatic precollectors, collectors and lymphatic ducts; these in turn convey the lymph to the regional lymph nodes. Interstitial fluid and particles enter the initial lymphatics through interendothelial openings and by vesicular transport. Lymphatic uptake is enhanced by external compression. Lymphatic transport depends greatly on contraction of lymphangions, which generate the suction force that promotes absorption of interstitial fluid and expels lymph to collecting ducts. In lymphedema, various types of congenital and acquired abnormalities of lymphatic vessels and lymph nodes have been observed. These often lead to lymphatic hypertension, valvular insufficiency and lymphostasis. Accumulation of interstitial and lymphatic fluid within the skin and subcutaneous tissue stimulates fibroblasts, keratinocytes and adipocytes eventuating in the deposition of collagen and glycosaminoglycans within the skin and subcutaneous tissue together with skin hypertrophy and destruction of elastic fibers.
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PMID:Lymphedema: anatomy, physiology and pathogenesis. 957 6

Turner syndrome is the complex human phenotype associated with complete or partial monosomy X. Principle features of Turner syndrome include short stature, ovarian failure, and a variety of other anatomic and physiological abnormalities, such as webbed neck, lymphedema, cardiovascular and renal anomalies, hypertension, and autoimmune thyroid disease. We studied 28 apparently nonmosaic subjects with partial deletions of Xp, in order to map loci responsible for various components of the Turner syndrome phenotype. Subjects were carefully evaluated for the presence or absence of Turner syndrome features, and their deletions were mapped by FISH with a panel of Xp markers. Using a statistical method to examine genotype/phenotype correlations, we mapped one or more Turner syndrome traits to a critical region in Xp11.2-p22.1. These traits included short stature, ovarian failure, high-arched palate, and autoimmune thyroid disease. The results are useful for genetic counseling of individuals with partial monosomy X. Study of additional subjects should refine the localization of Turner syndrome loci and provide a rational basis for exploration of candidate genes.
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PMID:Evidence for a Turner syndrome locus or loci at Xp11.2-p22.1. 983 29


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