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

Central venous catheter (CVC)-related thrombus formation has been increasingly recognized as a complication in adults and somewhat less frequently in children and neonates. However, the association of CVC thrombus and pulmonary embolism (PE) has rarely been reported in infants or children, and the few existing reports primarily involve chronic, indwelling CVCs such as Broviac or Hickman catheters. During an 18-month-period of autopsy review, we found that 5 of our pediatric intensive care unit patients had autopsy-proven CVC thrombus and pulmonary embolism. All of them had prolonged mechanical ventilation for respiratory failure and required insertion of one or more short-term, temporary CVCs during the course of routine critical care management. In retrospect, signs related to CVC thrombus were present in 4 patients (3 had positive blood cultures and 1 had persistent hypertension). PE was not diagnosed until autopsy in every case. The diagnosis may have been missed because the symptoms of PE are the same as those of severe lung disease. We, therefore, advocate a heightened suspicion of CVC thrombus formation and PE in critically ill children with respiratory failure and temporary CVCs and recommend early diagnostic ultrasound to confirm the diagnosis. Once a CVC thrombus is found, subsequent pulmonary deterioration may necessitate evaluation for acute PE.
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PMID:Venous catheter thrombus formation and pulmonary embolism in children. 864 12

Sixteen patients (6 women, 10 men; mean age: 52.5 years) suffering from spontaneous subarachnoid haemorrhage (SAH) of unknown origin underwent a protocol of initial and then weekly computed tomography (CT), initial four-vessel digital subtraction angiography (DSA) and at least one control pancerebral DSA. Fourteen patients had magnetic resonance imaging before undergoing first control DSA. All patients had calcium-antagonists (Nimodipine) via a central venous catheter, were kept on the neurosurgical intensive care unit and followed daily with transcranial Doppler ultrasonography (TCD). One patient (6.3%) developed moderate and 5 (31.1%) developed severe cerebral vasospasm as documented with TCD and exhibited deterioration of their level of consciousness. These 6 patients were treated with induced hypertension, hypervolaemia and haemodilution. Their blood flow velocities were elevated for a mean of 8 (5-17) days with a peak after 12.5 (9-17) days following SAH. No complications due to treatment were noted. One patient of the non-vasospastic group died of pulmonary embolism, another patient had an ischaemic incident during angiography, which has led to permanent disability. On follow-up 2-24 months after SAH 14 patients had returned to their premorbid state. It is concluded that patients suffering from SAH of unknown origin should undergo repeated angiographic investigation and subsequent daily monitoring of their neurologic status including daily TCD recordings so that haemodynamic treatment can be established in the event of cerebral vasospasm, which may occur in up to one third of these patients.
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PMID:Cerebral vasospasm after subarachnoid haemorrhage of unknown aetiology: a clinical and transcranial Doppler study. 880 Mar 32

Several rat models of pulmonary hypertension have been developed. However, up until now it has been difficult to monitor pulmonary arterial pressure for long periods of time. The goal of the present study was to develop a telemetry system allowing chronic monitoring of pulmonary arterial pressure in freely moving rats. For this purpose, while animals were under anesthesia, a sensing catheter was implanted into the pulmonary arterial trunk through the right ventricle. This catheter was connected to an emitter implanted in the abdomen. Validation of the system was performed in three steps. First, acutely, we controlled that the pressure signal transmitted by the telemetry system was accurate and corresponded to a signal obtained with a high-fidelity Millar catheter. Second, we evaluated the chronic consequences of implantation of the system. Third, we used the system to monitor pulmonary arterial pressure in a model of monocrotaline-induced hypertension in which the effects of bosentan, an endothelin-receptor antagonist, were evaluated. The telemetry system was reliable and did not lead to damage of the right ventricle and/or to chronic pulmonary embolism. After a recovery period of 8-10 days, mean pulmonary arterial pressure was stable. With the use of this telemetry system, it was possible to follow the increase of pulmonary arterial pressure induced by monocrotaline. In this model, bosentan decreased mean pulmonary arterial pressure by 13% (P = 0.07), suggesting a role of endothelin in this model of pulmonary hypertension. We conclude that it is possible to use this telemetry system to monitor pulmonary arterial pressure in freely moving conscious rats.
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PMID:Telemetry monitoring of pulmonary arterial pressure in freely moving rats. 887 76

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

The presence of lupus anticoagulant (LA) and anticardiolipin antibodies (ACA) are associated with recurring pregnancy loss. Of 387 consecutive patients investigated at a Recurring Miscarriage Clinic over a three year period, 63 (16%) were positive for LA and ACA or both. Fifty-nine patients by definition were classified as having antiphospholipid syndrome and four also had systemic lupus erythematosus (SLE). Fifty-three subsequent pregnancies occurred in 63 patients and of these 37 ended in a live birth giving an overall livebirth rate of 70%. Treatment included low dose aspirin alone in 37 pregnancies and low dose aspirin and low molecular weight heparin (LMWH) in 16 pregnancies. The decision for treatment was made empirically on past obstetric history and level of LA and ACA, and past history of venous thromboembolic disease. Obstetric outcome was worst in the group who were positive for both LA and ACA, with a success rate of 53%, compared to 72 or 81% in the single parameter groups. Complications in the 37 successful pregnancies included eight Caesarean sections, four cases of intra-uterine growth restriction, one case of pregnancy induced proteinuric hypertension, one deep vein thrombosis and one pulmonary embolism. Patients with antiphospholipid syndrome are at high risk of pregnancy loss as well as maternal morbidity, especially thrombo-embolic disease. A randomised prospective controlled trial is necessary to determine the optimum therapy for pregnancy conservation and thrombprophylaxis.
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PMID:Obstetric outcome in antiphospholipid syndrome. 925 8

In the period 1982-1996, 7,476 aortocoronary bypass surgeries were performed at the University Clinic for Cardiovascular Surgery in Novi Sad with perioperative mortality of 2.85%. In 242 patients (3.24%) an additional thrombendarterectomy procedure of carotid arteries was performed with indications such as: positive neurologic symptoms; critical morphology of carotid lesions according to Wesley-Moore symptomatology and critical stenosis. The cardiac status of patients was as follows: poor left ventricular function (EF--ejection fraction--30%) in 42 patients (19.2%), left main coronary artery stenosis in 31 patients (12.8%), endarterectomy of coronary arteries due to diffuse and distal coronary occlusive disease in 93 patients (38.5%) and isolated aortocoronary bypass in 149 patients (61.8%). The status of carotid arteries was as follows: unilateral stenosis in 156 patients and bilateral stenosis in 63. Depending on the carotid or cardiac finding, our surgical strategies differed: 65 patients (26.8%) underwent simultaneous operation, 141 patients (58.2%) underwent two-stage operation and in 36 patients (14.9%) three-stage operation was performed. Postoperative complications included: neurological deficit in 4 patients (1.7%); Transient ischemic attacks in 5 patients (2.1%); myocardial infarction in 6 patients (2.7%); hemorrhage in 2 patients (0.9%); gastrointestinal hemorrhage in 3 patients (1.4%); pulmonary complications in 2 patients (0.9%); serious rhythmic disorders in 1 patient (0.5%) and therapeutically resistant hypertension in 1 patient (0.5%). Ten patients (4.1%) died. Causes of death: cardiac in 3 patients (1.4%), neurological in 3 patients (1.4%), pulmonary embolism in 1 patient (0.5%) and other causes in 3 patients (1.4%). The operative risk in this group of polyvascular patients is higher than in the "group with isolated aortocoronary disease". Appropriate indications for surgery in one, two or three stages significantly decrease mortality in these patients. Simultaneous operation is reserved for patients with severe neurological symptoms and unstable angina.
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PMID:[Coronary and carotid occlusive disease--surgical techniques and results]. 947 32

To assess the influence of oral contraceptives (OC) on the risk for venous thromboembolism (VTE) in young women, a 5-year case-control study including all women 15-44 years old suffering a first deep venous thrombosis or a first pulmonary embolism from all Danish hospitals, along with 1200 control subjects during the period 1994-1995, was conducted. Of 586 patient and 1200 control subject questionnaires sent out, 523 patient (89.2%) and 1074 control (89.5%) questionnaires were returned with an agreement to participate. After exclusion of women with nonvalid diagnoses, women who were pregnant, and women with previous VTE or acute myocardial infarction (AMI), 375 patients and 1041 control subjects were available for analysis. Potential tested confounders included: body mass index, length of OC use, family history of VTE, AMI, or stroke, smoking habits, coagulopathies, diabetes, years of schooling, certainty of diagnosis, previous births, and treated hypertension during any pregnancy. A multivariate analysis was performed. Estrogen dose had no influence on the risk for VTE. The risk for VTE among current users of OC was primarily influenced by duration of use, with significantly decreasing odds ratios (OR) over time: < 1 year; 5.1 (3.1-8.5); 1-5 years; 2.5 (1.6-4.1); and > 5 years; 2.1 (1.5-3.1), all compared with those for nonusers of OC. This trend was still significant after adjustment for progestin types. Without adjustment for duration of use, current users of OC with second generation (levonorgestrel or norgestimate) and third generation (desogestrel or gestodene) progestins had OR of 1.8 (1.1-2.9) and 3.2 (2.3-4.4), respectively. After correction for duration of use, however, no significant differences were found between users of OC with different types of progestins. In conclusion, OC increase the risk for VTE significantly. The risk among current users of OC is primarily influenced by duration of use. No difference in risk was found according to estrogen dose, and the difference in risk between different types of progestins was not statistically significant after adjustment for duration of use.
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PMID:Oral contraceptives and venous thromboembolism. A case-control study. 967 36

Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease resulting from the thromboembolic obstruction of the segmental and/or large size pulmonary arteries, subsequently leading to pulmonary arterial hypertension. Incomplete resolution of acute pulmonary emboli and thrombus organization are believed to be important for the development of the disease. Primary pulmonary hypertension (PPH) is a further disease that at present is poorly understood but shows a clinical picture similar to CTEPH. Since lipoprotein(a) [Lp(a)]. a genetically determined risk factor for atherosclerosis and thrombosis, has been found increased in plasma of patients with deep vein thrombosis and pulmonary embolism, we measured plasma Lp(a) levels in 40 patients with CTEPH and 50 patients with PPH and compared them to 50 matched controls. The median for Lp(a) plasma levels was significantly higher in CTEPH patients (26.6 mg/dl) than in PPH patients (9.6 mg/dl) and controls (7.2 mg/dl). Increased plasma Lp(a) could, therefore. play a significant role in the mechanisms of ongoing thrombosis and thrombus organization in CTEPH, while its possible role in PPH can be limited to a small number of patients.
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PMID:Plasma Lp(a) levels are increased in patients with chronic thromboembolic pulmonary hypertension. 971 43

The case of a 14-year-old girl with Behcet syndrome is described. Besides painful and recurrent oral ulcerations, the patient had a cough and intermittent hemoptysis. The initial chest roentgenogram revealed bilateral parahilar opacities. CT and MRI scans of the thorax showed bilateral thrombosing aneurysms of the pulmonary arteries. Pulmonary blood flow imaging was performed after technegas ventilation lung scanning and Tc-99m MAA injection using a first-pass radionuclide angiography procedure. Altered blood flow in the left pulmonary artery was shown. Bilateral and well-defined ventilation/perfusion mismatched areas suggested a high probability of pulmonary embolism. Little additional information was obtained on subsequent contrast pulmonary angiography. The high incidence of pulmonary artery hypertension and associated vascular injury risk makes pulmonary angiography an unsafe procedure in patients with pulmonary Behcet syndrome. The need for pulmonary angiography could be obviated in such cases with the use of high-precision MRI and ventilation/perfusion lung scanning, including radionuclide pulmonary angiography.
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PMID:Bilateral pulmonary artery aneurysms in a patient with Behcet syndrome: evaluation with radionuclide angiography and V/Q lung scanning. 981 58

Tricuspid regurgitation is relatively common. Due to the progress made in echocardiography, its diagnosis is in general made readily and in reliable fashion. Basically one has to distinguish between functional tricuspid valve regurgitation due to volume and/or pressure overload of the right ventricle with intact valve structures versus tricuspid valve regurgitation due to pathologic valve structures. The clear identification of the regurgitation mechanism is of prime importance for the treatment. Functional tricuspid valve regurgitation can often be improved by medical treatment of heart failure, and eventually a tricuspid valve plasty can solve the problem. However, the presence of pathologic tricuspid valve structures makes in general more specific plastic surgical procedures and even prosthetic valve replacements necessary. A typical example for a structural tricuspid valve regurgitation is the case of a traumatic papillary muscle rupture. Due to the sudden onset, this pathology is not well tolerated and requires in general surgical reinsertion of the papillary muscle. In contrast, tricuspid valve regurgitation resulting from chronic pulmonary embolism with pulmonary artery hypertension, can be improved by pulmonary artery thrombendarteriectomy and even completely cured with an additional tricuspid annuloplasty. However, tricuspid regurgitations due to terminal heart failure are not be addressed with surgery directed to tricuspid valve repair or replacement. Heart transplantation, dynamic cardiomyoplasty or mechanical circulatory support should be evaluated instead.
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PMID:[Tricuspid valve insufficiency: what should be done?]. 1002 91


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