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

In regard to the diagnostic and therapeutic dilemma concerning rare neoplasms in childhood, the presented paper includes the comprehensive description of a malignant pheochromocytoma in a 14-year-old girl on the one hand and the detailed analysis of a collected series of 21 equal cases in pediatric literature on the other hand. In our patient there was in particular a lack of hypertension in spite of proven hypercatecholaminemia, an initially good effect of the post-operative aggressive chemotherapy according to the neuroblastoma study NBL 79 (4b) resulting in a transient reduction of the pulmonary metastases, furthermore a diminuation of the total tumour mass induced by the last applied treatment with the radiopharmaceutical 131I-metaidiobenzylguanidine. The analysis of 21 case reports revealed a peak between 10 and 15 years of age, a striking prevalence of the female sex in all age groups, and a high frequency of metastases (75%) at the time of diagnosis. Two thirds of the primary tumours arose in extra-adrenal sites, about one third occurred in the adrenal gland. The regional lymph nodes, the bone system and the lungs were the main locations of metastatic lesions. The association with a group of other conditions, particularly hypoxemic congenital heart malformations has proved to be a remarkable feature, but not only in the malignant forms.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Malignant pheochromocytoma in childhood and adolescence--clinical case and review of the literature]. 647 75

A 17-month-old girl had a neuroblastoma with high preoperative urinary excretion of norepinephrine and a manifest hypertension. She developed during and after surgery circulatory complications similar to those seen when a pheochromocytoma is removed without prior sympathetic blockade. This complication in connection with a neuroblastoma has not been described previously. This case points to the necessity of careful preoperative evaluation of the circulatory function in cases of neuroblastomas in children. The paediatric surgeon and the anaesthetist should take a preoperative sympathetic blockade into consideration.
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PMID:An unusual complication following the removal of a neuroblastoma. 652 95

Endocrine and neurological diseases are rare causes of arterial hypertension in childhood. They represent less than 5% of all cases of secondary hypertension. Inflammatory, traumatic, and tumorous disorders of the central nervous system rarely result in chronic hypertension but may frequently be associated with acute hypertensive crisis. The most important hypertensinogenic endocrine diseases are the catecholamine producing tumors pheochromocytoma and neuroblastoma and disorders of the adrenal cortex such as Cushing's syndrome, hyperaldosteronism, 11-hydroxylase deficiency and other mineralocorticoid excess syndromes. Renin producing tumors, hyperthyroidism and hyperparathyroidism are rare causes of hypertension in children. Neurogenic and endocrine forms of hypertension have contributed considerably to a better understanding of the pathophysiology of blood pressure regulation. They are of particular interest to the pediatrician since specific therapy may be available.
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PMID:[Endocrine and neurogenic hypertension in childhood]. 666 53

Treatment of severe arterial hypertension associated with neuroblastoma is not well discussed in the literature. A six-month-old boy was referred for evaluation of an abdominal mass which proved to be neuroblastoma stage IV. Arterial hypertension of 26/16 kPa (190/110 mmHg) was also found. Because of the degree of malignancy and the risk of intra-tumoral haemorrhage, urgent management of the hypertension was required before proceeding to surgery. Phentolamine, a short-acting alpha-blocking agent, was administered as a continuous infusion of a 0.01 per cent solution, at a rate of 1 to 4 microgram X kg-1 X min-1 titrated according to the arterial blood pressure (BP), central venous pressure and urinary output. BP was rapidly controlled and the child went to surgery within 48 hours. The operation was uneventful but only 80 per cent of the tumour could be resected. Phentolamine was discontinued intraoperatively but was reinstituted postoperatively when hypertension recurred. With the return of normal intestinal function five days after surgery, phenoxybenzamine was begun p.o. and phentolamine was tapered over 24 hours and discontinued. A continuous infusion of phentolamine provided satisfactory control pre- and post-operatively with no significant hypotension. We consider this technique to be potentially very useful in the management of severe arterial hypertension associated with neuroblastoma, as it permits early surgical intervention under optimal conditions.
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PMID:[Continuous phentolamine perfusion in the treatment of severe arterial hypertension associated with neuroblastoma]. 670 85

Results of hypertension screening using the Doppler technique in a group of premature infants following discharge from an intensive care nursery are reported. Systolic blood pressure (BP) was measured at follow-up in 79/99 premature infants who were cared for in the special care nursery over a 9-month period. The mean BP was 99.3 +/- 2.0 (SEM) mm Hg at a mean age of 14.7 +/- 1.3 weeks; mean age corrected for 40 weeks of gestation was 7.4 +/- 1.3 weeks. Seven infants (8.9%) with BP greater than 113 on three separate occasions were identified as hypertensive. Three of these hypertensive infants were found to have a specific etiology requiring treatment: neuroblastoma, coarctation of the aorta, and unilateral ureteropelvic junction obstruction. No difference was found between the hypertensive and normotensive infants for a variety of perinatal and neonatal factors, including the presence or duration of an umbilical arterial catheter. These data suggest that the premature infant may be at risk for the development of hypertension. In the future, neonatal follow-up programs may find hypertension screening a useful part of their evaluation.
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PMID:Hypertension screening in the follow-up of premature infants. 683 59

A patient with a nasal neuroblastoma was found to have hypertension and severe hyponatraemia. Radiotherapy and cytotoxic chemotherapy were ineffective in reducing the size and vascularity of the neoplasm. Assay of tumor tissue post mortem revealed high levels of arginine vasopressin. The possibility of vasopressin formation to be added to the better known potential hormonal secretory activities of neuroblastomas.
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PMID:Nasal neuroblastoma secreting vasopressin. A case report. 726 Aug 47

We describe a child with a localised pelvic neuroblastoma and a hypertensive crisis during the first weeks of life due to elevated systemic norepinephrine of tumoural origin. In spite of treatment with high doses of alpha-blockers, blood pressure did not respond fully and the boy had a very unstable circulation. Surgery was performed at one month of age. Adenosine, a potent short-acting vasodilator, was used for peroperative blood pressure control to protect the patient from an uncontrolled hypertensive crisis. During tumour manipulation the child became hypertensive with systolic pressure exceeding 130 mm Hg and adenosine infusion (100 micrograms.kg-1.min-1) was started with a prompt normalisation of the blood pressure. Adenosine infusion could be discontinued after tumour removal. Norepinephrine, dopamine, homovanillic acid and vanillylmandelic acid in urine were elevated preoperatively and normalised at follow up. Plasma concentrations of norepinephrine and dopamine were elevated preoperatively. Norepinephrine increased during hypertension due to tumour manipulation. Plasma neuropeptide Y increased during tumour manipulation but still within the normal range for infants. It is concluded that adenosine can be used peroperatively in children with severe hypertension and in this case no adverse effects of adenosine were noted. Furthermore, tumour synthesis and systemic release of norepinephrine, but not neuropeptide Y, contributed to hypertension in this child with neuroblastoma.
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PMID:Adenosine for per-operative blood pressure control in an infant with neuroblastoma. 757 24

We have evaluated a new commercially available ELISA kit for determination of plasma chromogranin A with respect to its usefulness in the diagnosis of neuroendocrine tumors, mainly pheochromocytoma. Serum and differently anticoagulated plasmas gave different chromogranin A concentrations. Control values (n = 21) were 18.9 +/- 5.8 units/l. Chromogranin A values > 30.4 units/l (mean + 2 S.D.) were considered elevated. In 22 patients suspected of (but found not to have) pheochromocytoma and in 24 patients with renovascular hypertension, 18% were found to have elevated chromogranin A concentrations. In renovascular hypertension chromogranin A correlated positively with serum creatinine; chromogranin A was strongly elevated especially in chronic renal failure. In 45 patients with pheochromocytoma, 13 (29%) had chromogranin A concentrations within the normal range, as had 3 out of 11 patients with neuroblastoma (27%). In 13 pheochromocytoma patients with elevated chromogranin A, measurements were repeated after surgical removal of the tumor; values then all fell within the normal range. We conclude that measurement of chromogranin A adds little to already existing methods for the diagnosis of pheochromocytoma.
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PMID:Sensitivity and specificity of a new ELISA method for determination of chromogranin A in the diagnosis of pheochromocytoma and neuroblastoma. 758 87

Extensive pharmacological investigations on tetrandrine, one of the traditional medicinal alkaloids, are reviewed. Tetrandrine has been used clinically in China for centuries in the treatment of many diseases. A recent series of studies has revealed major mechanisms underlying its multiple pharmacological and therapeutic actions. One of the most interesting discoveries is that tetrandrine is a new kind blocker of the voltage-activated, L-type Ca2+ channel in a variety of excitable cells, such as cardiac, GH3 anterior pituitary and neuroblastoma cells, as well as in rat neurohypophysial nerve terminals. Although tetrandrine does not belong to any of the three classical Ca2+ channel blocker groups, electrophysiological and radioligand binding studies show that tetrandrine is an L-type Ca2+ channel blocker with its binding site located at the benzothiazepine receptor on the alpha 1-subunit of the channel. In addition, tetrandrine is a blocker of the voltage-dependent T-type Ca2+ channel. It is clear that tetrandrine's actions in the treatment of cardiovascular diseases, including hypertension and supraventricular arrhythmia, are due primarily to its blocking of voltage-activated L-type and T-type Ca2+ channels. Furthermore, this alkaloid is a potent blocker of the Ca(2+)-activated K+ (K(Ca)) channels of neurohypophysial nerve terminals. The blocking kinetics of tetrandrine on the K(Ca) channel is quite different from that of typical K(Ca) channel blockers such as tetraethylammonium and Ba2+. Although the clinical role of tetrandrine as a blocker of the K(Ca) channels is unclear, it is a promising ligand for the study of K(Ca) channel function.
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PMID:Tetrandrine: a new ligand to block voltage-dependent Ca2+ and Ca(+)-activated K+ channels. 783 29

Five cases of central congenital hypoventilation, Ondine's curse, were studied. The diagnostic criteria were: lack of respiratory autonomy during sleep, abnormal CO2 test results and abnormal respiratory monitoring results during sleep. This hypoventilation induced chronic complications, such as a pulmonary arterial hypertension and psychomotor and/or growth retardation. The other conditions frequently associated with Ondine's curse were: brainstem disturbances, Hirschsprung disease and neuroblastoma. Since other brainstem dysfunctions are sometimes associated with hypoventilation and because complications can arise, these children routinely underwent complementary investigations. Treatment was symptomatic. Assisted mechanical ventilation was initiated as soon as possible and carefully monitored. The prognosis for these children has greatly improved and some of them lead a normal life with nightly assisted ventilation at home.
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PMID:Ondine's curse: a discussion of five cases. 813 76


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