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

During the last 4 years, fifty-seven patients of acute severe asthma (ASA) were admitted to intensive care unit (ICU). Twenty-three patients required mechanical ventilation (MV) on 25 occasions. Indications to intubate were persistent hypoxia (PaO2 < or = 55 mm Hg) or hypercapnia with respiratory acidosis (64%), abnormal mentation (24%) and respiratory arrest (12%). All the patients were monitored for clinical features, arterial blood gases (ABG) and peak airway pressure (PAP). During MV, there was one case of pneumothorax (4%), seven (28%) cases of transient hypertension and one (4%) patient died. Mean duration of MV was 3 days and the outcome was favourable. Therefore, resorting to aggressive treatment early in the course of disease proves life saving in acute severe asthma.
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PMID:Role of mechanical ventilation in acute severe asthma. 803 18

After it was reported in 1981 that phenobarbital reduced the incidence of intraventricular hemorrhage from 46.7% in control infants to 13.3% in treated premature infants, routine phenobarbital prophylaxis (loading dose, 20 mg/kg; maintenance, 5 mg/kg per day for 5 days) was introduced at the hospital of the original trial for all premature infants with birth weights of < or = 1800 gm. To assess continued efficacy, we reviewed all records of these infants from 1985 through 1989. The overall incidence of intraventricular hemorrhage was 27.5% (168/612); the proportion of severe intraventricular hemorrhage (grade 3 and 4) was 41.1% (69/168). The incidence of intraventricular hemorrhage was lower when loading occurred at < 4 hours: 25.9% (124/478) versus 32.8% (44/134). Outborn infants had a higher incidence of intraventricular hemorrhage than inborn infants (45.3% vs 23.0%). In addition to already known risk factors (gestational age, vaginal delivery, outborn status, pneumothorax, birth asphyxia, patent ductus arteriosus), intraventricular hemorrhage occurred more often in infants with hyperoxia (PO2 > 180 mmHg), hypocarbia (PcO2 > 28 mmHg), hypercarbia (PcO2 > 55 mmHg), and hypotension and hypertension (blood pressure > norm +/- 15 mmHg). These results support the hypothesis that phenobarbital has a role in the prophylaxis against intraventricular hemorrhage. Differences in the efficacy of phenobarbital prophylaxis between various studies may be caused by variations of age at loading and differences in the proportion of very low birth weight infants.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Routine administration of phenobarbital for the prevention of intraventricular hemorrhage in premature infants: five years' experience. 816 72

The neonatal outcome of 78 consecutive singleton pregnancies complicated by intrauterine growth retardation (IUGR) and gestational hypertension were compared with the outcome of 78 adequately matched pregnancies complicated by idiopathic IUGR. The rate of low (< 5) 1-minute Apgar scores was higher in infants born to hypertensive mothers (12.8% vs 2.6% p = .035). No differences in the prevalence of other perinatal factors such as acidosis, respiratory distress syndrome, hypoglycemia, pneumothorax, bronchopulmonary dysplasia, intracranial hemorrhage, requirement for assisted ventilation or survival were found between cases and controls. After two years' follow-up, the rate of major neurological neonatal handicaps, was 2.8% in the cases and 1.4% in the controls (p = 0.56). Mild neurodevelopmental abnormalities were more frequent in infants born to hypertensive mothers (14.3% vs 2.9% p = .025). After adjustment by multiple logistic regression, to eliminate the effect of confounding factors, the probability of normal neurodevelopmental outcome was reduced by 82% in infants born to hypertensive mothers as compared to controls (Odds Ratio = 0.18; 95% confidence interval 0.05 to 0.82 p = .028). These findings suggest that pregnancies complicated by IUGR and gestational hypertension are associated with a high prevalence of subsequent neurodevelopmental problems among infants.
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PMID:Infant neurodevelopmental outcome in pregnancies complicated by gestational hypertension and intra-uterine growth retardation. 822 10

We reported a case of ruptured aneurysm of the anterior communicating artery with marked dilatation of bilateral cervical carotid arteries. A 38 year old female suffered a subarachnoid hemorrhage. Angiography on admission revealed markedly dilated cervical carotid arteries with smooth lumen and a few segmental areas with mild constrictions in their entire course up to the carotid canals (their maximal sagittal diameters exceeded those of a cervical vertebral body). A saccular aneurysm was also seen at the junction of right A1, A2, and Acom. External carotid arteries were normal in size. Vertebral arteries were not examined because of failures of selective cannulation. The patient was operated upon and trapping of Acom was performed. During the operation, no definite arteriosclerotic changes were identified in the intracranial arteries. Histopathological examination of the surgical specimens revealed marked hyperplasia of the smooth muscle of the tunica media with intact internal elastic lamina both in a superficial temporal artery and a middle meningeal artery. During the operation, pneumothorax developed due to the rupture of bullae in the right lung. Past history of this patient disclosed hypertension noted a few years previously, and frequent severe bruises following minor trauma. Repeated angiography performed three months after the operation disclosed unchanged dilatation of the cervical carotid arteries as well as mild intraluminal irregularities in the proximal one third of the left renal artery. This patient died of pneumonia one year after the operation, but autopsy was not permitted. Possible diagnosis of this patient was discussed, with particular emphasis on fibromuscular dysplasia and Ehlers-Danlos type IV (arterial, ecchymotic, or Sack-Barabas type).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Markedly dilated cervical carotid arteries in a patient with a ruptured aneurysm of the anterior communicating artery: a case report]. 847 88

A 65-year-old male was admitted to our hospital because of bilateral giant bullae and right side pneumothorax. He had had a myocardial infarction and had been receiving medications. Considering his age, ischemic heart disease and hypertension, we excised the bullae in two operations. The first operation was open chest bullectomy of a giant bulla and small bulla on the right side. After this procedure, his clinical course was uneventful. In the second operation, thoracoscopic excision of the left side giant bulla was performed using only one endoscopic stapler by rotating each side of the bulla and making a clear excision line between the bulla and normal lung. His post operative course was excellent and he was discharged from our hospital on the 15th day after the second operation.
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PMID:[Successful second stage operations for bilateral giant bullae with cardiovascular disease by thoracotomy and thoracoscopic surgery: a case report]. 891 73

A review summarizing recent findings on the causes of the development, pathogenesis, diagnosis and treatment of acute cardiac failure. It is a condition when the heart is unable to pump blood in amounts needed for the metabolic activity of tissues. It may be the first manifestation of disease or acute deterioration of chronic heart failure. The most frequent causes of acute left-sided failure include acute myocardial infarction, arterial hypertension, valvular defects, myocarditis, toxic damage or metabolic myocardial disorders. In right-sided failure pulmonary embolism, extensive affections of the lungs and pleura, right ventricular infarction and affection of the pericardium predominate. The clinical picture of cardiac failure is due to a combination fo the basic disease, evoking causes, signs of an inadequate minute volume, transudation of fluids into the interstitium and the presence of compensating mechanisms. The diagnosis of cardiac failure is based on an analysis of subjective and objective clinical symptoms and other auxiliary examinations such as X-ray examination of the chest, electrocardiogram, echocardiography, examination of blood gases and other laboratory examinations. In right-sided insufficiency the examination is supplemented by pulmonary scintigraphy, possibly by catheterization of the right heart and pulmonary angiography. As to the differential diagnosis, we must differentiate from acute cardiac failure, asthma bronchiale, spontaneous pneumothorax, dyspnoea in neuroasthenic patients, non-cardiac pulmonary oedema. Treatment of cardiac failure involves lifestyle and dietary provisions, medicamentous treatment which has undergone great changes in recent years. Cardiac failure is controlled by reduction of the cardiac filling pressure and support of the efficiency of the cardiac pump (Inotropy) and control of excessive fluid and salt retention. Decisive for the subsequent development of the disease is diagnosis of the basic cardiac or non-cardiac disease and its aimed treatment. In uncontrolled cardiac failure mechanical support of cardiac activity and transplantation of the heart are options.
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PMID:[Clinical aspects of acute heart failure]. 892 24

Video-assisted thoracoscopic surgery (VATS) was recently described as an approach to clip the patent ductus arteriosus (PDA). Between May 1994 and May 1996, we performed this procedure on 34 children below 12 years of age (mean 7 years). Thirty-two had an isolated PDA and two had associated small perimembranous ventricular septal defect (VSD), diagnosed on echocardiography and colour flow mapping. None had pulmonary arterial hypertension. The procedure was successful in 33 (97%) children confirmed by absence of residual shunt on serial echocardiography. Complications in the form of pneumothorax (1) and vocal card paralysis (2) were encountered in three children. The overall hospital stay was reduced to five days. In conclusion, the technique of PDA clipping using VATS is easy to learn and highly successful with acceptable risk of complications.
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PMID:Video-assisted thoracoscopic surgery for closure of patent ductus arteriosus in children. 929 55

Infection following median sternotomy is a devastating and potentially life-threatening complication. The use of muscle flaps has become widely accepted as a mainstay in the treatment of these problems. We have previously described our successful use of a bipedicle muscle flap for reconstruction of sternal defects in 16 patients. In this paper, we describe follow-up in those patients as well as an evaluation of this procedure in an additional 26 patients. All records of those patients who had sternal reconstruction using the bipedicle pectoralis major-rectus abdominis flap were reviewed. Factors analyzed included the type of cardiac surgery, associated conditions, complications of surgery, and outcome. There were 42 patients in this group from 1989 to 1996. There were a variety of cardiac procedures represented. Associated conditions included diabetes, chronic hypertension, prolonged postcardiotomy hypotension, prior radiation therapy, pulmonary failure, and steroid use. There were no deaths in this series. There was one flap failure, one persistent infection, one pneumothorax, and one hernia in this series. Three patients developed hematomas after surgery. The most common complication was a skin slough, which occurred in nine patients. This technique provides a large flap that can fill the entire mediastinum. The dissection is rapid, and the complication rate compares favorably to that of other methods.
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PMID:Bipedicle muscle flaps in sternal wound repair. 946 66

A 32-year-old patient experienced a postoperative acute myopericarditis following laparoscopic surgery for gastro-oesophageal reflux (Toupet's fundoplication). His medical history was unremarkable, apart from controlled arterial hypertension. Peroperative circulation was stable, except a short hypertensive episode at CO2 insufflation, controlled with nicardipine. A myopericarditis occurred at the fourth postoperative hour, with apical and inferior hypokinesia at ventriculography, ST-segment elevation with unremarkable coronary arteriography. The patient was discharged at day seven, with a NSAIDs treatment. Echocardiography three and nine months later postoperatively, showed an apical akinesia and persistence of the ST-segment modification, without clinical symptoms. Complications of laparoscopic fundoplication is either specific to surgery (gastro-oesophageal injury, diaphragmatic injury, mediastinitis, stenosis) or secondary to pneumoperitoneum (pneumothorax, carbon dioxide embolism). In this case, following an apparently uncomplicated laparoscopy and, except a direct cardiac trauma from a laparoscopic instrument, either coronary artery spasm, or pneumopericardium with CO2, or delayed gas embolism, or preoperative "silent" myopericarditis could be the potential cause of this cardiac complication.
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PMID:[Acute myopericarditis following laparoscopic treatment of gastroesophageal reflux]. 983 86

We report a case of tuberous sclerosis associated with bilateral renal angiomyolipomas (AMLs), pulmonary lymphangioleiomyomatosis (LAM) and subungual fibroma of hands and feet. A 42-year-old woman who was diagnosed as tuberous sclerosis at the age of 18 complained of left flank pain and abdominal fullness. Bilateral renal AMLs were pointed out when complete examinations were performed for hypertension at the age of 32. She suffered from severe left flank pain and abdominal distension due to the left renal tumor. Left nephrectomy and excision of the renal hilar tumor were performed. The left renal tumor weighed 1120 g, the perirenal space was filled with the tumor. histopathological diagnosis of the left renal tumor and renal hilar tumor was AML. In our case, bilateral pneumothorax appeared, and chest CT scan revealed bilateral multiple pulmonary cysts. Histopathological diagnosis of pulmonary cysts was LAM. Other complications of our case are intracranial calcification and adenoma sebaceum.
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PMID:[Tuberous sclerosis associated with renal angiomyolipoma, pulmonary lymphangioleiomyomatosis and subungual fibroma: report of a case]. 984 2


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