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

When performed by a team who are experienced in the use of embolization of the external carotid region, this procedure is nowadays a safe and extremely effective method for treating severe, massive, uncontrolled, recurrent epistaxis. Arteriography shows the site of bleeding, the nature of the lesion, and the arteries affected. When carried out by the femoral or common carotid route, this method was effective in 52 cases of severe epistaxis of various origins: essential epistaxis, or from hypertension, trauma, Rendu Osler's disease, vascular malformations, carotidocavernous fistulae, benign or malignant tumors, hematological affections, or hemostatic disorders. To avoid risk it is essential that a perfect technique be used and a certain number of principles respected. The method is effective in cases were surgical hemostasis is insufficient, and its rapidity of action allows removal of packs immediately after embolization. This clearly underlines the value of constantly available vascular radiology units for treatment in this region as well as in other parts of the body.
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PMID:[The value of embolization in severe epistaxis. Indications and methods (author's transl)]. 49 Apr 77

The data of 140 patients with polycythemia vera during the period 1955--1975 were analyzed with regard to clinical signs and prognosis. The average age was 53,4 years. The sex ratio was 1.9:1 in favor of men. The most frequent symptoms were headache and vertigo. In more than half of the cases hepatosplenomegaly and hypertension were found. Besides typical changes in the blood count with elevated erythrocytes, hemoglobin, hematocrit, leukocytes and thrombocytes, increased levels of alkaline leukocyte phosphatase and uric acid were found. As to therapy, after 32P-medication the survival was two years longer than after phlebotomy. In 9 patients osteomyelofibrosis developed, and in 7 cases chronic myeloic leukemia. The mean age of death was 61 years.
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PMID:[Polycythemia vera, clinical aspects and disease course]. 64 97

The peak systolic pressure ratio PRV/PLV of the right and left ventricle after correction of the outflow tract (OFT) in Tetralogy of Fallot (TF) yields reliable dates about the efficiency of the outflowtract correction and the probability of survival. In 110 patients (2 to 57 years) the ratio after correction PRV/PLV was measured and compared with different methods of reconstruction of the OFT. Infundibulectomy (54) pericard-patch insertion across the pulmonary valve ring (43) and a valve bearing Hancock-Conduit (13) were used. To calculate the statistical differences the U-test according to Wilcoxon, Whitney, Mann was applied on the 95% level. Moreover the pulmonary insufficiency (PI) was evaluated in 60 patients within 15 to 60 days, after correction with a videodensitometric method. There is no PI after use of a valve bearing Hancock-Conduit. In severe TF a valve bearing Hancock-Conduit is hemodynamically superior to a pericard-patchreconstruction of OFT to relief right ventricular hypertension, particularly if hypoplasia of pulmonary vessels and pulmonary vascular disease after shunt-operation is present.
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PMID:[Hemodynamics after reconstruction of the outflow tract in tetralogy of Fallot. Infundibulectomy, patchreconstruction or valve rearing conduit (author's transl)]. 92 67

Studies of the pulmonary circulation in normal man, performed with external radiation detectors, have shown that pulmonary blood volume is about 10% of total blood volume. Pulmonary blood volume was unchanged in patients with acute or chronic left atrial hypertension and in normal persons during expansion of total blood volume in spite of marked increases in pulmonary vascular pressures. However, pulmonary blood volume was greatly increased in patients with polycythemia rubra vera and a large total blood volume and in patients with a left to right shunt but normal pulmonary intravascular pressure. Studies of regional myocardial perfusion with injection of xenon-133 solution into the left coronary artery revealed localized areas of ischemia distal to stenotic lesions even when the patient was at rest. During angina produced by pacing, more severe ischemia occurred, thus suggesting that functional factors reduce local perfusion below resting levels. In patients with "variant" angina, intravenous injection of thallium-201 chloride during spontaneous attacks has revealed large cold areas in myocardial scintigrams not present under control conditions, thus suggesting severe transmural reduction of perfusion in heart muscle corresponding to S-T segment elevation in the electrocardiogram.
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PMID:Pathophysiologic studies of the pulmonary and coronary circulations in man. 99 14

Polycythemia vera (PV) is one of the myeloproliferative diseases, and, as such, is an example of clonal hematopoiesis. The progeny of a single, abnormal, hematopoietic stem cell gain a growth advantage over their normal counterparts resulting in overproduction of red cells generally accompanied by overproduction of granulocytes and platelets as well. There are a variety of nonspecific symptoms at onset related to the increased red cell mass and hematocrit accompanied by the more specific manifestations of pruritus, erythromelalgia, and hepatic, portal, and mesenteric vein thrombosis. Splenomegaly and hypertension are common. The laboratory hallmark is an increased red cell mass. There is also often an increase in white cell count, platelet count, and leukocyte alkaline phosphatase along with other findings reflecting the increased rate of turnover of hematopoietic cells. The bone marrow biopsy generally displays hypercellularity involving all three cell lines and absent iron stores. The diagnosis of PV depends on excluding spurious polycythemia in which there is a high hematocrit but a normal red cell mass and secondary polycythemia in which there is an increased red cell mass in response to tissue hypoxia or the inappropriate production of erythropoietin, generally by a tumor. In addition, one should try to establish the diagnosis in a positive fashion by a combination of studies of the blood and bone marrow. Phlebotomy and occasionally plateletpheresis should be used as acute therapy. Chronic therapy is guided by the knowledge that patients treated with phlebotomy alone have an increased rate of thrombotic complications particularly in older patients and those with previous thrombotic disease. Myelosuppressive therapy can reduce the incidence of these complications, but is commonly associated with an increased incidence of second malignancies, particularly acute leukemia. At present, hydroxyurea is the myelosuppressive agent of choice. Antiplatelet agents have a limited role except in the palliation of the syndrome of erythromelalgia. Median survival is approximately 10 years. As implied above, the causes of morbidity and mortality vary with the mode of chronic therapy which has been employed, leukemia being more common after myelosuppressive therapy and thrombotic complications being more common after therapy with phlebotomy alone. Ten percent to 50% of patients move into a spent phase followed by postpolycythemic myeloid metaplasia, irrespective of previous therapy employed. Eventually, the major problems may be cytopenias and massive splenomegaly.
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PMID:Polycythemia vera. 158 7

With the advent of sonography and CT, renal cell carcinoma has increasingly been diagnosed in its early stage, with simple hematuria or no symptoms as the incidence of patients with masses and extrarenal extensions decreased. Correlating the clinical manifestations with stage, hematuria and pain may not imply an advanced lesion (31.4% Stage I). By adequate use of B ultrasonography and/or other instrument, many of renal cell carcinoma could be detected in its asymptomatic stage, a crucial requirement for better therapeutic results. The authors' data showed that fever, elevated ESR, varicocele and general malaise did imply advanced lesions or possible early metastasis after operation. On the other hand, complication with hypertension or erythremia could speak for an early lesion if diagnosis is made in time. Therefore, stratification of the extrarenal manifestations into endocrine and non-endocrine phases may help assess prognosis.
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PMID:[A new concept on clinical manifestations in relation to staging of renal cell carcinoma]. 178 54

Thirty-seven patients affected by polycythaemia rubra vera (PRV) and with at least one additional thrombotic risk factor (overt vascular disease, diabetes mellitus, treated hypertension, smoking habit, plasma hyperviscosity, hyperfibrinogenemia) were enrolled in a double-blind randomized placebo-controlled study, and 18 were given ticlopidine 250 mg, b.i.d., for 60 days. All the patients had previously been submitted to cytoreduction, and PRV was under control in all cases at the start of the study. During the study, the haematological parameters were controlled every 15 days, and venesection was performed if haematocrit was greater than 46%. Whole blood viscosity, at low and high shear rates, plasma viscosity, and fibrinogen were measured on days 0 and 60. In the ticlopidine group, we recorded a significant 13.14% reduction of the mean fibrinogen level after treatment (390 +/- 63 vs. 449 +/- 97 mg/dl, p less than 0.01). All the other haemorheological parameters were not significantly modified by ticlopidine treatment, nor were there significant modifications recorded in the placebo group. Our study shows that ticlopidine may reduce a probable thrombotic risk factor (hyperfibrinogenemia) in PRV patients.
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PMID:Ticlopidine lowers plasma fibrinogen in patients with polycythaemia rubra vera and additional thrombotic risk factors. A double-blind controlled study. 204 43

The haematological, biochemical and clinical features of six patients with polycythaemia after renal transplantation were studied. The patients had an absolute increase in red cell mass, but normal plasma and whole blood volumes. Primary proliferative polycythaemia was excluded. Polycythaemia developed within one year of transplantation and persisted for 3-7 years. Chronic rejection, renal artery stenosis, severe hypertension and corticosteroid therapy were probably not the cause of the polycythaemia. There were no occlusive vascular lesions during the observation period and venesections were generally not required. The polycythaemia is probably the result of the cumulative production of erythropoietin by the donor and recipient kidneys.
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PMID:Polycythaemia after renal transplantation. 331 62

An autosomal erythrocytosis, inherited as a dominant, occurred in seven members of a family. The propositus was first diagnosed as having erythrocytosis at 26 years of age. He had headaches and marked plethora. Polycythaemia vera and secondary erythrocytosis of known cause were excluded. Erythropoietin level was not elevated. Two of his three children were also found to have erythrocytosis. As in this family, the disease is characterized in middle age by hypertension, cardiovascular and thromboembolic phenomena, as well as abnormal bleeding. For over eight years the propositus has been successfully treated with repeated venous blood lettings.
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PMID:[Idiopathic familial erythrocytosis. Report on a family with autosomal dominant inheritance]. 337 Dec 13

In order to make effective use of the statistical theory of design of clinical trials for chronic diseases such as periodontal disease, certain issues must be considered. Any clinical trial requires that the disease definition be well-specified; that patient eligibility be explicit; that the observation times be explicit; that the duration and endpoint of therapy be specified; that the duration of subsequent followup observation be specified; and that the unit of observation (e.g., tooth, set of teeth, patient) be defined. In a chronic disease, the potential biases that can readily be introduced by self-selection of patients who enter the trial and/or who return for subsequent observation become more important, because subjects are required to remain on treatment and/or observation for prolonged periods. Further, the cyclical nature of some chronic diseases may require special attention to baseline definitions of active disease and disease outcome. These issues are illustrated with examples from clinical trials of hypertension, breast cancer screening, and Polycythemia Vera. Implications for periodontal disease are discussed.
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PMID:Design of clinical trials for chronic diseases: implications for periodontal disease. 352 49


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