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

Pulmonary artery hypertension with chronic pulmonary embolism is an uncommon entity that is potentially treatable with pulmonary embolectomy. Although the classic radiographic features have been described, several recent investigators report a significant percentage of these patients with normal chest radiographs. In a series of 22 patients, no normal radiographs were seen. Findings included cardiomegaly (86.4%) with right-sided enlargement (68.4%), right descending pulmonary artery enlargement (54.5%), azygos vein enlargement (27.3%), mosaic oligemia (68.2%), chronic volume loss (27.3%), atelectasis and/or effusion (22.7%), and pleural thickening (13.6%). Good correlation with specific areas of diminished vascularity was seen on chest radiographs compared with pulmonary angiograms.
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PMID:Radiographic findings in pulmonary hypertension from unresolved embolism. 387 21

Recurrent laryngeal nerve palsy and vocal cord paralysis due to mitral stenosis was first described in 1897 (Ortner 1897). Since then other cardiovascular causes, including hypertension, coronary heart disease, aortic aneurysm and congenital heart disease have been described. There are two recorded cases of left recurrent laryngeal nerve palsy due to pulmonary embolism (Albertini 1972; Wilmhurst et al. 1983). We describe what we believe to be the third case.
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PMID:Vocal cord paralysis in association with pulmonary emboli. 394 26

This discussion identifies the risks and benefits of each of the hormonal methods of contraception -- combined estrogen-progesterone oral contraceptive (OCs), progestogen-only pills, and depot progestogen injections. It also explains the use of a profile of risk factors in considering the appropriate prescription for each individual in relation to her contraceptive needs. Information regarding medical risks has come from the consideration of mortality rates in large cohort studies. Looking at categories of the causes of 249 deaths in ever-users of the pill and controls, Layde and colleagues were able to show that there was an excess mortality in the pill group of 40% and that the extra risk was concentrated in cardiovascular causes: myocardial infarctions, cerebral thrombosis, and cerebral hemorrhage constituted the largest proportions. A small proportion of combined OC users may develop clinical hypertension but more suffer a reduction in the high-density lipoprotein (HDL) cholesterol fraction of the blood lipids. Both of these effects tend to increase the risk of cardiovascular complications and both are positively related to the dose of the progestogen components. In prescribing combined OCs, attention needs to be paid to further moves away from the norm towards the extremes: the presence of cardiovascular risk factors and the use of certain longterm medications or the presumptive designation as a "rapid metabolizer." An analysis of progestogen only pill (POP) users in the Oxford-Family Planning Association study confirmed the reasonably low rates of accidental pregnancy in POP users. There is a marked reduction with increasing age, and it is significant that many prescribers are now giving POP to older women for whom combined OCs are contraindicated because of cardiovascular risks. It also seems reasonable to use them in women with some medical disorders, for example, recurrent pulmonary embolism, hypertension, and diabetes. Initially, depot injections of progesterone were developed to provide a long-acting or sustained-release type of drug administration to assist users of the progestogen-only method which, unlike combined OCs, does not make use of regular drug-free intervals. In practice it has been found that the effectiveness against pregnancy is enhanced and the side-effects are increased in giving progestogen by depot injection. The 2 preparations currently licensed in Britain are Depo-Provera (medroxyprogesterone acetate) and Noristerat (norethisterone enanthate). In some cases proper and clear information may not have been given to the patient and proper consent not obtained before giving the drug. This problem is magnified because of the occurrence in some women of disturbed bleeding patterns, especially if given immediately after childbirth or an abortion. Also, in a small proportion of users anovulatory amenorrhea may supervene for some months or even as long as 2 years following depot injection.
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PMID:Hormonal contraceptive methods. 401 68

The authors sent questionnaires to the members of the French speaking Gynecology and Obstetrics societies and received 216 replies, of which 129 covering 86,700 patients are summarized here. There were 53 cases of phlebitis, 4 of pulmonary embolism, 2 of acute hypertension, 1 of hypotension, 1 of cerebral thrombosis, 1 of retinal hemorrhage, 1 of facial paralysis and 1 of acute pancreatitis and mesenteric infarction. If the 57 cases of phlebitis and pulmonary embolism are grouped, the frequency is 6.5 per 1000, which is not sufficiently greater than 2 per 1000 found by Drill in nonpregnant women, to incrimin ate the pill. The frequency of morbidity from phlebitis and thromboembo lism in this survey may be artificially low because most respondents wer e gynecologists; some women with these disorders may have consulted other physicians.
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PMID:[Survey of vascular accidents caused by oral contraceptives]. 540 35

During a 28-year period the incidence of thrombosis and pulmonary embolism (TE) in pregnancy remained practically equal (0.7%), the incidence of puerperal TE was higher (2.3%) but decreased during the last 7 years. Puerperal TE was influenced by age, mode of delivery, hypertension and prophylactic anticoagulant therapy. TE during pregnancy was not noticeably correlated with age and hypertension. TE during pregnancy and in the puerperium are closely related diseases, but their epidemiological characteristics are apparently distinct. Both are associated with a high rate of preterm deliveries and a high perinatal mortality rate.
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PMID:Epidemiological observations of thrombo-embolic disease during pregnancy and in the puerperium, in 56,022 women. 614 Oct 88

History and clinical course were studied in 299 patients with acute myocardial infarction. 133 patients aged 70 and older (group 2) were compared to 166 patients under 70 (group 1). Hospital mortality of the total group was 23%. The mortality rate among the older patients (31%) was significantly higher than among the younger patients (17%) (p less than 0.01). The major cause of death in both groups was cardiogenic shock. It is noteworthy that in eight cases from group 2 pulmonary embolism was diagnosed at autopsy in spite of the fact that the patients were receiving prophylactic antithrombotic therapy. Analyzing the histories, it was noticed that group 2 had a significantly higher percentage of hypertension and left heart failure, whereas in group 1 significantly more smokers and hyperlipidemics were found. During hospitalization left ventricular enlargement and insufficiency were diagnosed more often in the elderly. It may be assumed that this fact is one of the reasons for the increased mortality of group 2.
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PMID:[Acute myocardial infarction in patients over 70]. 622 56

From 1965 to 1981, 27 patients over 35 years of age were operated for isthmic coarctation of the aorta. Surgery consisted of resection and direct suture in 16 cases, implantation of a Dacron prosthesis in 7 cases, isthmoplasty in 1 case, aortotomy-graft in 1 case, insertion of a Dacron tube between the left subclavian artery and the descending thoracic aorta in 1 case; finally, one patient presented with a rare form of coarctation in a double aortic arch and was treated by a bypass from the brachiocephalic trunk to the descending thoracic aorta. Ten patients had associated pathology. This was treated at the same time in 4 cases: closed heart mitral commissurotomy, cardiac plexectomy, section-suture of patent ductus arteriosus, and a resection of aneurysms of four intercostal arteries. A Bjork aortic valve prosthesis had been inserted nine months previously in a women with calcific aortic stenosis. There were 2 deaths (7,4%) in the immediate postoperative woman with calcific aortic stenosis. There were 2 deaths (7,4%) in the immediate postoperative period (one acute pulmonary oedema, one pulmonary embolism). There has been no operative mortality in the last 10 years. Twenty-three of the 25 survivors have been followed-up for an average period of 91,5 months (range 1 to 18 years). Two patients died of cardiovascular causes. Analysis of these results show: that the mortality rate is not prohibitive compared to that of the natural history of the condition (the average survival rate of unoperated patients is 35 years), good secondary results despite frequent technical difficulties, the possibility of residual hypertension (especially in older patients) which responds well to drug therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Isthmic coarctation of the aorta: characteristics and results of surgical treatment in subjects surgically-treated after 35 years of age]. 623 25

By activating plasminogen into plasmin, which in turn dissolves fibrin, fibrinolytic agents can dissolve pathologic thrombi. Streptokinase, a fibrinolytic agent derived from group C beta-hemolytic streptococci, is antigenic and can elicit allergic reactions. Urikinase, a fibrinolytic agent obtained by purification from human urine or from human fetal kidney cell culture, is not antigenic, and for this reason can be used repeatedly, if needed, whereas streptokinase cannot be used for retreatment within six months of a course of therapy. Either agent can be introduced into the circulation systemically (intravenously) or locally (via catheter). The indications for systemic therapy include deep-vein thrombosis, pulmonary embolism, and arterial thrombosis and embolism. The indications for local therapy include acute myocardial infarction, arterial thrombosis and embolism, and the clearing of occluded arteriovenous cannulae and access shunts. Contraindications include an actively bleeding lesion, a vascular intracranial disorder, or uncontrolled hypertension; relative contraindications include pregnancy; a recent wound, fracture, surgery, or deep closed biopsy; or a general contraindication to anticoagulation, such as coagulopathy, uremia, or severe liver disease. During thrombolytic therapy, invasive procedures, intramuscular injections, and the use of other anticoagulant or antiplatelet agents should be avoided. Measurement of fibrinogen levels, the titer of fibrin/fibrinogen degradation product, or thrombin time can be used to monitor therapy.
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PMID:Fibrinolysis and its current usage. 634 82

A patient with a circulating lupus anticoagulant in the absence of systemic lupus erythematosus developed recurrent deep venous thromboses and pulmonary emboli. Pulmonary emboli recurred despite prolonged oral anticoagulant therapy and resulted in fatal pulmonary arterial hypertension. Extended anticoagulant therapy alone may not prevent recurrent thromboembolism in patients with a lupus anticoagulant. Pulmonary thromboembolism may be an important factor in the pathogenesis of pulmonary hypertension in patients with a lupus anticoagulant.
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PMID:The lupus anticoagulant, pulmonary thromboembolism, and fatal pulmonary hypertension. 643 49

4 kinds of progestin only oral contraceptives (OCs) and numerous combined OCs containing ethinyl estradiol (EE) or occasionally mestranol and either norgestrel or norethindrone are currently available in Australia. All progestins except norgestrel are effective in vivo after metabolism to norethindrone. Mestranol is effective in the human after demethylation to EE. The main side effects of OCs, including menstrual disturbances and changes in weight and mood, are primarily of nuisance value. Menstrual blood loss with OCs is almost invariably less than during spontaneous menses, but breakthrough bleeding and midcycle spotting may cause concern in patients. Amenorrhea and weight gain are rare with low dose pills. Approximately 6 in 1000 women remain anovulatory for 12 months or more after discontinuing OCs, but it is not yet know whether the amenorrhea is related to pill use and it is usually corrected by induction of ovulation. Cardiovascular side effects including venous thrombosis and pulmonary embolism are seen less frequently with new lower dose pills. The effects of OCs on the cardiovascular system are complex and depend on the interaction of estrogen and progestin. Amounts of estrogen and progestin should be the lowest possible to prevent ovulation, and routine monitoring should be provided for all women using pills. Older high dose formulations altered lipid metabolism in the direction of greater risk of coronary heart disease. Although research suggests the lowest dose triphasic pills have no significant effect, not enough large studies have been done with matched controls. Any effects on carbohydrate metabolism of the low dose pills are apparently minor and of little clinical significance. Insulin dependent diabetics with adequate supervision may safely use low dose pills. Combined OCs reduce the incidence of endometrial and ovarian malignancy. No relationship between OCs and the risk of breast cancer has been demonstrated except possibly in women under 35 when the cancer developed. The risk of intraepithelial neoplasia may be increased in women taking OCs for more than 8 years. Data on drug interactions are inconclusive, but women on rifampicin should use some other method. Absolute contraindications to OCs include breast cancer, history of deep venous thrombosis or pulmonary embolism, active liver disease, use of rifampicin, familial hyperlipidemia, previous arterial thrombosis, and pregnancy, while relative contraindications include smoking, age over 35, hypertension, breastfeeding, and irregular spontaneous menstruation. Progestin only OCs have a higher rate of failure and irregular bleeding than combined pills and their main use is for breastfeeding women and those with contraindications to estrogen. The pill of 1st choice should be a triphasic low-dose formulation.
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PMID:Oral contraceptives. 650 52


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