Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Ciclosporin is a cyclic undecapeptide discovered in the 1970s to possess a potent inhibitory action on T lymphocytes. The subsequent discovery, in 1979, that it was remarkably effective in treatment of psoriasis transformed thinking about the nature of the disease, which subsequently became generally recognized as autoimmune in nature. Ciclosporin remains one of the most effective and rapidly acting treatments currently available for psoriasis. Virtually all the diverse manifestations of this disease can respond. The main side effects are nephrotoxicity and hypertension. There is considerable variation between individuals in susceptibility to these so careful monitoring is required. Ciclosporin should be used in single or intermittent short courses for all except the most severe cases as this is safer than continuous treatment. The rate of improvement depends very much on the dose, which ranges from 2 to 5.0 mg/kg/day. Ciclosporin can be combined with any topical treatment and a useful dose-sparing effect can be achieved in this way if patients are compliant. In severe cases ciclosporin is often used in combination with other systemic antipsoriatic drugs in order to spare the dose of each agent and reduce toxicity. Concurrent or intercurrent use of ultraviolet therapy is discouraged due to the increased risk of non-melanoma skin cancer. This article reviews the mode of action, pharmacokinetics, indications, contraindications, side effects, dosage regimens, pretreatment screening and monitoring, drug interactions, and use of treatment combinations with ciclosporin in the management of psoriasis.
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PMID:The use of ciclosporin in psoriasis. 1642 45

There is no doubt that solar ultraviolet (UV) exposure is the most important environmental risk factor for the development of non-melanoma skin cancer. Therefore, sun protection is of particular importance to prevent these malignancies, especially in risk groups. However, 90% of all requisite vitamin D has to be formed in the skin through the action of the sun-a serious problem, for a connection between vitamin D deficiency and a broad variety of independent diseases including various types of cancer, bone diseases, autoimmune diseases, hypertension and cardiovascular disease has now been clearly indicated in a large number of epidemiologic and laboratory studies. An important link that improved our understanding of these new findings was the discovery that the biologically active vitamin D metabolite 1,25(OH)(2)D is not exclusively produced in the kidney, but in many other tissues such as prostate, colon, skin and osteoblasts. Extra-renally produced 1,25(OH)(2)D is now considered to be an autocrine or paracrine hormone, regulating various cellular functions including cell growth. We and others have shown that strict sun protection causes vitamin D deficiency in risk groups. In the light of new scientific findings that convincingly demonstrate an association of vitamin D deficiency with a variety of severe diseases including various cancers, the detection and treatment of vitamin D deficiency in sun-deprived risk groups is of high importance. It has to be emphasized that in groups that are at high risk of developing vitamin D deficiency (e.g., nursing home residents or patients under immunosuppressive therapy), vitamin D status has to be monitored. Vitamin D deficiency should be treated, e.g., by giving vitamin D orally. Dermatologists and other clinicians have to recognize that there is convincing evidence that the protective effect of less intense solar UV radiation outweighs its mutagenic effects. Although further work is necessary to define an adequate vitamin D status and adequate guidelines for solar UV exposure, it is at present mandatory that public health campaigns and recommendations of dermatologists on sun protection consider these facts. Well-balanced recommendations on sun protection have to ensure an adequate vitamin D status, thereby protecting people against adverse effects of strict sun protection without significantly increasing the risk of developing UV-induced skin cancer.
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PMID:The challenge resulting from positive and negative effects of sunlight: how much solar UV exposure is appropriate to balance between risks of vitamin D deficiency and skin cancer? 1660 32

Recombinant human TNF (rhTNF) has a selective effect on endothelial cells in tumour angiogenic vessels. Its clinical use has been limited because of its property to induce vascular collapsus. TNF administration through isolated limb perfusion (ILP) for regionally advanced melanomas and soft tissue sarcomas of the limbs was shown to be safe and efficient. When combined to the alkylating agent melphalan, a single ILP produces a very high objective response rate. ILP with TNF and melphalan provided the proof of concept that a vasculotoxic strategy combined to chemotherapy may produce a strong anti-tumour effect. The registered indication of TNF-based ILP is a regional therapy for regionally spread tumours. In soft tissue sarcomas, it is a limb sparing neoadjuvant treatment and, in melanoma in-transit metastases, a curative treatment. Despite its demonstrated regional efficiency TNF-based ILP is unlikely to have any impact on survival. High TNF dosages induce endothelial cells apoptosis, leading to vascular destruction. However, lower TNF dosage produces a very strong effect that is to increase the drug penetration into the tumour, presumably by decreasing the intratumoural hypertension resulting in better tumour uptake. TNF-ILP allowed the identification of the role of alphaVbeta3 integrin deactivation as an important mechanism of antiangiogenesis. Several recent studies have shown that TNF targeting is possible, paving the way to a new opportunity to administer TNF systemically for improving cancer drug penetration. TNF was the first agent registered for the treatment of cancer that improves drug penetration in tumours and selectively destroys angiogenic vessels.
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PMID:Recombinant human tumor necrosis factor: an efficient agent for cancer treatment. 1693 77

Patients with melanoma may experience a variety of different vision symptoms, in part associated with melanoma-associated retinopathy. For several melanoma patients with or without melanoma-associated retinopathy, colour vision deficiencies, especially involving the tritan system, have been reported. The frequency of colour vision deficiencies in a larger cohort of melanoma patients has not yet been investigated. The aim of this study was to investigate the frequency of colour vision deficiencies in melanoma patients subject to stage of disease, prognostic factors such as tumour thickness or Clark level, S100-beta and predisposing diseases that may have an impact on colour vision (hypertension, diabetes mellitus, glaucoma or cataract). Three hundred melanoma patients in different tumour stages and 100 healthy age-matched and sex-matched controls were examined with the saturated Farnsworth panel D 15 test. Seventy out of 300 (23.3%) melanoma patients and 12/100 (12%) controls showed pathologic results in colour testing. This discrepancy was significant (P < 0.016; odds ratio = 2.23, 95% confidence interval 1.15-4.32). Increasing age was identified as a highly significant (P = 0.0005) risk factor for blue vision deficiency. Adjusting for the age and predisposing diseases, we could show that melanoma was associated with the risk of blue vision deficiency. The frequency of blue vision deficiency in 52/260 melanoma patients without predisposing diseases (20%) compared with 4/78 controls without predisposing diseases (5.1%) differed significantly (odds ratio 4.441; confidence interval 1.54-12.62; P < 0.004). In 260 melanoma patients without predisposing diseases, blue vision deficiency, as graded on a 6-point scale, showed a weak positive correlation (Spearman) with tumour stage (r = 0.147; P < 0.01), tumour thickness (r = 0.10; P = 0.0035), Clark level (r = 0.12; P = 0.04) and a weak negative correlation with time since initial diagnosis (r = -0.11; P = 0.0455). Blue vision deficiency is associated with melanoma, but is only weakly related to stage of disease. Although we saw a positive correlation with well-known prognostic markers, such as tumour thickness and Clark level, blue vision deficiency as assessed by the Farnsworth panel D 15 test in general is inappropriate as a marker of tumour progression. For the use of blue vision deficiency in melanoma patients without predisposing diseases, a diligent test performance and interpretation is very important.
Melanoma Res 2006 Oct
PMID:Frequency of colour vision deficiencies in melanoma patients: results of a prospective comparative screening study with the Farnsworth panel D 15 test including 300 melanoma patients and 100 healthy controls. 1701 90

Choroidal melanoma is the most common primary intraocular cancer in adults. A sixty-nine years old, hypertensive male with a choroidal melanoma underwent enucleation. After extubation he woke up confused and unconscious. An emergent computed tomographic (CT) scan demonstrated intracerebral hematoma. The underwent repeat surgery in the postoperative first hour, because of left parietotemporal intracerebral hematoma. His neurological state became worse and he died in the eighth postoperative day. Sympathetic stimulation due to extubation, causing increase in the intracranial pressure or uncontrolled hypertension, may be reasons precipitating intracranial hemorrhage. In patients, who undergo intracranial or intraorbital surgery, had risk factors of intracranial hemorrhage or showed labile blood pressure perioperatively and were confused or unconscious in the postoperatively or had delayed emergence, intracranial hematoma must be suspected.
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PMID:Intracerebral hemorrhage following enucleation: a result of surgery or anesthesia?--A case report. 1709 36

Vitreous fluorophotometry is an investigation that facilitates the quantitative study of the blood-retinal barrier (thus allowing a better understanding of its physiopathology and opening new therapeutical research fields). It can be performed for the vast majority of the ocular diseases: diabetic retinopathy, arterial hypertension, uveitis, post-cryotherapy/laser photocoagulation, retinal vascular diseases, choroidal melanoma, optic nerve diseases etc.
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PMID:[Vitreal fluorometry]. 1714 12

Axitinib is an oral inhibitor of the VEGF, PDGF and colony stimulating factor-1 receptor tyrosine kinases and is currently in development by Pfizer Inc for the potential treatment of various solid tumors. Phase II trials with this agent alone or in combination with chemotherapeutic drugs were reported in several types of malignancy, with activity observed in thyroid, pancreatic, lung, renal, breast and colorectal cancers, melanoma and other carcinomas. Although frequent side effects have included fatigue, hypertension, diarrhea, hand-foot syndrome and proteinuria, axitinib was well tolerated overall. Larger, randomized phase II/III studies were ongoing at the time of publication.
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PMID:Axitinib, a novel anti-angiogenic drug with promising activity in various solid tumors. 1851 65

Ilioinguinal dissection is associated with a high rate of lymphatic complications. Prolonged lymph flow causes greatest concern and preventive strategies are needed. A retrospective study of 28 consecutive patients undergoing groin dissection for melanoma metastases was performed to evaluate the influence of sartorius muscle transposition on lymph flow. Modification of the surgical technique with transposition of the sartorius muscle was not associated with reduced drainage time (P = 0.66). A 2-staged approach, with initial sentinel lymph node resection and lymph node dissection in a second operation, however, lead to shortened duration of the lymph flow (P = 0.01). Prolonged lymphorrhea was more frequent in older (P = 0.03), obese (P = 0.02) patients affected by diabetes mellitus (P = 0.03) and hypertension (P = 0.04).
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PMID:A study of the effect of sartorius transposition on lymph flow after ilioinguinal node dissection. 1872 34

We present a case report of a 59-year-old man with a history of arterial hypertension and excision of malignant melanoma. He was admitted to the hospital because of two months history of diarrhoea, weight loss and circulatory collapse. In addition, the patient suffered from marked vegetative instability with symptomatic hypotension, polyneuropathy and progression of renal insufficiency, without proteinuria. Complex examination did not reveal neoplasms, endocrine, autoimmune, infectious or neurodegenerative disorders. A serial biopsy of colon failed to provide a clue to the diagnosis. However, AA amyloidosis was found on the kidney biopsy. Neither chronic inflammation nor malignancy was revealed and, hence, no causal treatment could have been established. The patient died from multiple organ failure. The autopsy confirmed systemic AA amyloidosis. The triad consisting ofdiarrhoea, polyneuropathy and hypotension should rise the suspicion on amyloidosis.
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PMID:[Persistent diarrhoea, hypotension, polyneuropathy]. 1906 86

Vitamin D has a positive impact on our overall health. Also there are a few conditions with strong evidence for a protective effect of vitamin D, such as bone diseases, internal cancers, multiple sclerosis, hypertension and DM type 1. Skin is the major source of vitamin D through the action of UVB light on keratinocytes, although the biologically active form of vitamin D is not exclusively produced in the kidney but also in prostate, colon, skin and osteoblast where it acts as an autocrine or paracrine hormone. In the past decade raising incidence of skin cancers, especially melanoma and its connection with sun exposure lead to a sun protection policies and practices as part of the public health campaigns. The question is how much solar UV exposure is adequate to maintain the balance between the risk and the benefit. We as dermatologists have to raise public awareness of the potential health effects from excessive exposure to UV radiation but also we have to be aware that adequate blood level of vitamin D is necessary for optimal health. So future recommendation on sun protection have to balance between the risk and benefits of sun exposure, as well as to promote vitamin D supplementation as a safe alternatives in high risk population.
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PMID:Vitamin D--the true and the false about vitamin D. 1913 20


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