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

From June 1974 to December 2001 we performed operative treatment on 33 patients with descending thoracic or thoracoabdominal aortic aneurysm in association with Takayasu disease. There were 25 men and 8 women with a mean age of 40.2A years (range 16-64A years). Nineteen patients came from North Africa, 6 were from France, and 8 were from various locations in the world. The revealing symptom was hypertension in 12 cases, thoracic or abdominal pain in 7, isolated inflammatory syndrome in 5, neurologic or ocular manifestations in 3, rupture in 3, and embolization to the lower extremity in 1. In the remaining two cases discovery was coincidental. The aneurysm was confined to the thoracic aorta in 10 cases and involved both the thoracic and abdominal aorta in 23 cases. There were 8 type I, 6 type II, 4 type III, and 5 type IV aneurysms according to Crawford's classification. Two patients had undergone previous repair of the thoracoabdominal aorta. Four patients required first-stage treatment of a renal artery lesion to control hypertension. Six patients had associated aneurysms of the proximal aorta, including five treated via the distal elephant trunk technique in first-stage procedures. Aneurysm repair consisted of prosthetic replacement of the thoracoabdominal aorta in 31 cases, exclusion bypass in 1 case, and stent graft placement in 1 case. The procedure was performed with cross-clamping alone in 13 cases, distal perfusion in 17 cases, and deep hypothermic circulatory arrest in 3 cases. Twenty patients (61%) had associated renal and/or intestinal artery lesions that were treated during the same procedure as that for the thoracoabdominal aorta in 19 patients (58%). A total of 24 procedures were performed on renal arteries (17 revascularizations, 7 nephrectomies). Associated supraaortic trunks lesions were present in 15 patients (45%) and were treated in 12 patients, including 8 in first-stage procedures prior to thoracoabdominal aortic aneurysm repair. Three patients died of multiple organ failure, after reoperation in two cases and infection in one case involving prior long-term corticosteroid therapy. Three patients developed paraplegia, including one who had undergone emergency treatment following rupture. Two patients required reoperation, for hematoma in one case and bowel necrosis in one. Four patients developed respiratory complications requiring artificial ventilation for more than 48 hr. During follow-up, two patients died from complications after repair of the proximal aorta and one patient required nephrectomy. Despite the extent of aneurysmal lesions and high frequency of association with visceral and supraaortic vessel lesions, the outcome of surgery in patients presenting with descending thoracic or thoracoabdominal aortic aneurysm in association with Takayasu disease was satisfactory.
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PMID:Descending thoracic and thoracoabdominal aortic aneurysm in patients with Takayasu's disease. 1553 28

A 56-year-old Japanese man with hypertension presented with a 10 days history of high fever, right and left upper quadrant tenderness. An abdominal ultrasonography and computerized tomographic scan revealed a large collection in the right lobe of the liver that was consistent with an abscess. A drainage catheter was placed and purulent fluid was drained. Cultures of the fluid and blood were positive for a strain of ampicillin-resistant Klebsiella pneumoniae. Six days after admission, paraplegia and urinary retention were found. On the neurological examination, deep tendon reflexes of the lower extremities were absent bilaterally. Magnetic resonance imaging scan detected thoracic spinal epidural abscess and paraspinal abscess. He received the emergent decompressive laminectomy. Culture of surgical specimen grew ampicillin-resistant K. pneumoniae. The patient was treated with biapenem intravenously. Thereafter, clinical symptoms improved gradually and he was removed to the professional hospital to continue rehabilitation for gait disturbance on hospital day 147.
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PMID:Klebsiella pneumoniae liver abscess associated with septic spinal epidural abscess. 1565 71

The hypertension is an uncommon cause in acute spinal epidural haematomas. The severe motor disability and need to emergency treatment to avoid the permanent neurological impairments underline its importance. Seventy-five year old male, admitted with acute paraplegia, numbness in the lower extremities and urinary incontinence for 4 hours. The neurological examination showed complete paraplegia, numbness from the below of thoracal 9 dermatomes, and loss of all sensory motor reflexes including anal reflexes. The blood pressure was 210/120 mm Hg on his admission. Thoracolomber magnetic resonance examinations detected an acute epidural haematoma, which was compressing to the cord. The patient underwent emergent laminectomy involving T 9 to L 2 and clots were removed with microsurgical technique. The patient was mobilized on the 3. and discharged from the hospital on the 7. postoperative day without neurological impairment. Although majority of the spontaneous spinal epidural haematomas is a recognized idiopathic condition, hypertension is much more commonly seen etiological factor than estimated. Early diagnosis, surgical decompression of the spinal cord and high dose corticosteroids might result in complete recovery.
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PMID:[Acute paraplegia caused by hypertensive spinal epidural haematoma]. 1568 73

This is a case of acute spontaneous thoracic epidural hematoma in a laboring patient at term who presented with severe preeclampsia and acute spinal cord compression, paraplegia, and sensory loss below T8. In early labor, at home, the patient experienced sudden lumbar back pain that progressed to mid-scapular pain leading to paraplegia and T8 sensory loss within one hour of onset of pain. Her symptoms were caused by a spontaneous thoracic epidural hematoma. Upon arrival at the first hospital, the correct presumptive diagnosis was made in the emergency room, magnesium sulfate was administered, and the patient was transferred to our medical center. Her hypertension was not treated despite severe preeclampsia in order to maintain spinal cord perfusion pressure. Following cesarean section under general anesthesia, thoracic laminectomy was performed and an epidural hematoma compressing the spinal cord to 2-3 mm was evacuated 13 h after the onset of symptoms. After approximately three months of paraplegia, five months with quad-walker and cane use, the patient can now walk with a cane or other minimal support but has remaining bowel and bladder problems. The conflicting anesthetic management objectives of severe preeclampsia and acute paraplegia secondary to spinal epidural hematoma required compromise in the management of her preeclampsia in order to preserve spinal cord perfusion.
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PMID:Spontaneous acute thoracic epidural hematoma causing paraplegia in a patient with severe preeclampsia in early labor. 1593 38

Endovascular stent grafting (EVSG) is a minimally invasive alternative to open repair of thoracic aortic aneurysms. It is useful in the treatment of thoracic aneurysms, dissections, and ruptures. Currently, the incidence of thoracic aortic aneurysms is 6:100,000 people. Comorbidities often include hypertension, coronary artery disease, chronic obstructive pulmonary disease, peripheral vascular disease, and cerebrovascular disease, and there often is a history of smoking. Without surgical intervention, a high risk of mortality exists, primarily due to aneurysm rupture. Due to the complexity of performing open surgical repair of the thoracic aorta and its associated morbidities such as paraplegia, renal failure, stroke, and prolonged ventilator support, new approaches to thoracic aneurysm repair are being investigated. When compared with open repair, stent grafting is a palliative rather than a curative treatment, and the risk of aneurysmal rupture still exists. This article describes a patient who underwent EVSG who had a history of abdominal aortic aneurysm repair and a known bovine arch.
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PMID:Thoracic endovascular stent graft placement: a case report. 1661 18

The study was a cross sectional study conducted among 48 stroke patients in Medicine & Neuromedicine department of Mymensingh Medical College & Hospital. The objective of the study was to reveal the risk factors and other relevant information & immediate outcome of stroke patients. The sample size was 48 who were selected purposively and study area was selected for easy access. Study period was from 15th May 2007 to 15th July 2007. Forty eight (48) respondents and their reliable attendants were interviewed by pre tested structured questionnaire. Among 48 stroke patients 60% were male& 40% were female. Occupations of the patients were 21% desk job, 15% laborious work, 37% housewife, 6% businessman &21% in other profession. Age group of respondents were 13% below 45 years of age, 25% were 45-55 years of age, 29% were 55-65 years of age & 33% were over 65 years of age. Among 48 stroke patients 62.5% had 1st attack & others had multiple attacks. Among all the stroke patients 37.5% performed physical exercise. Forty six percent (46%) patients have family history of Hypertension. 27% have no family history of Hypertension & 27% have no idea. Sixty six percent (66%) patients have suffering from Hypertension, 23% have no history of Hypertension & 10% have no idea. Sixty percent (60%) patients had habit of Smoking, 40% had no habit of Smoking. 21% patients have family history of Diabetes, 48% have no family history of Diabetes & 31% have no idea about family history of Diabetes. Complications among stroke patients are 51% have Hemiplegia, 10% have Paraplegia, 23% have Paresis, 10% have Aphasia & 6% have others complications.
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PMID:Epidemiological study of risk factors of stroke and its immediate consequence. 1862 44

An extremely rare case of cerebral phaeohyphomycosis caused by Exophiala dermatitidis is reported. We described an otherwise healthy young child whose presentation was a progressive intracranial hypertension and paraplegia, accompanied by urine retention and constipation. His blood test showed eosinophilia with the proportion of eosinophilic cell up to 28%. A computed tomography and magnetic resonance imaging of the brain and the spinal cord revealed multiple lesions. A cerebral biopsy was performed and the pathological report was cerebral phaeohyphomycosis. Cultures of the tissue and cerebrospinal fluid grew the same fungus. Extraction of genomic DNA from cultures was performed, and the DNA sequence displayed 99% sequence homologies with E dermatitidis. The patient's response to therapy was poor, and the boy died 2 months later. Our experience suggests that phaeohyphomycosis should be included in the differential diagnosis in children with multiple intracranial lesions of unknown origin and eosinophilia.
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PMID:Phaeohyphomycosis of the central nervous system caused by Exophiala dermatitidis in a 3-year-old immunocompetent host. 1925 94

Acute aortic dissection and a ruptured aortic aneurysm are both catastrophic events that usually present suddenly. Although these conditions are relatively uncommon compared to other diseases treated by the orthopedists as a primary practitioner, they are of primary importance. The purpose of this study was to investigate the key points that differentiate these conditions from spinal disease. A review of 50 patients with aortic dissection (n=40) or a ruptured aortic aneurysm (n=10) was performed to determine the manifestations (eg, back pain and paraplegia). We also evaluated the predisposing factor and blood pressure on admission and reviewed clinical imaging (radiographs, computed tomography [CT]) retrospectively. Sudden severe isolated back pain was observed in 18 (45.0%) of 40 patients, and 31 (77.5%) of 40 patients had at least some back pain in aortic dissection, while 1 patient had sudden paraplegia with a ruptured aortic aneurysm. Hypertension was the most predisposing factor and was present in 29 (58.0%) of 50 patients. On admission, hypertension was present in 26 (56.5%) of 46 patients, and hypotension was present in 14 (30.4%) of 46 patients. In all cases, the correct diagnosis was made based on CT. For a patient with an abrupt onset of severe back pain, acute aortic dissection and a ruptured aortic aneurysm should be considered in the differential diagnosis from spinal disease. The most reliable tool for imaging diagnosis was CT.
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PMID:Acute aortic dissection or ruptured aortic aneurysm associated with back pain and paraplegia. 1929 87

The treatment of aortic dissections type B Stanford using endovascular stents represents one of the newest advances in the treatment of this diseases, less invasive alternative to classic surgical repair. Aortic stent-grafts initially were used in treatment of abdominal aortic aneurysms, and then to treat aneurysms, dissections and traumatic ruptures of the descending aorta, with good early and mid-term outcomes. Thoracic aortic aneurysms are frequently diagnosed in mid-age or elderly patients who have arterial hypertension, coronary artery disease, chronic obstructive pulmonary disease. Scientific data reveal a two-year mortality rate of > 70% in untreated patients, most deaths occurring due severe haemorrhages secondary aneurysm rupture. Development of endovascular techniques is naturally, due to the inherent complications of surgery in the distal thoracic aorta (paraplegia, renal failure, stroke). Endovascular deployment of stent-grafts in the treatment of Stanford B aortic dissections represents a possible and quite safe procedure. There is a continuous debate in medical literature about the best therapeutic decision in the treatment of extensive aortic dissections. We present a case of an extensive dissection of thoraco-abdominal aorta in a 55 years old hypertensive patient treated with an aortic stent-graft. Angiograms performed at the end of the procedure revealed complete occlusion of thoracic dissection, abdominal dissection remains untouched. One and three months post procedural evaluation showed a good follow up, with partial thrombosis of abdominal dissection without renal failure or ischaemic events.
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PMID:[Type B aortic dissection--endovascular stent-graft repair. Case report]. 2050 94

Anatomic repair of complex aortic coarctation is associated with significant mortality and morbidity, including paraplegia. Extra-anatomic bypass strategies have been developed to reduce these complications and allow the correction of any concomitant conditions during the same operation. We present the case of a woman with uncontrolled hypertension and preductal coarctation of the aorta diagnosed at age 22 who underwent an unsuccessful attempt at primary repair, followed by extra-anatomic bypass from the ascending-to-infrarenal aorta. The patient has remained normotensive, with no additional complications related to the disease or the procedure, during a follow-up of 17 years.
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PMID:Seventeen-year follow-up after ascending-to-infrarenal aorta bypass for recurrent coarctation in an adult. 2067 49


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