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

The authors present a case of acute intermittent porphyria (AIP) in an almost fatal relapse with quadriplegia, bulbar paralysis and coma. Intravenous hematin produced an immediate arousal from coma and allowed a gradual resumption of bulbar and autonomic functions. Persistent tachycardia and hypertension necessitated huge doses of intravenous propranolol. Both hematin and propranolol administrations were followed by a remarkable decrease in urinary amino-levulinic acid and porphobilinogen excretion. Nevertheless, after the acute stage, the patient was left with a severe generalized muscle wasting. After 7 months of intensive physical therapy, complete recovery of all neuromuscular functions was achieved. The modern aspects of the management of AIP are presented; the efficacy and the limits of hematin and propranolol therapy are discussed.
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PMID:Hematin and propranolol in acute intermittent porphyria. Full recovery from quadriplegic coma and respiratory failure. 52 4

Impact between the brain and the cristae of the base normally results as a consequence of inertia when an obstacle is hit, followed by contusion, or intra-, sub- or extradural haematoma. The skull itself may be briken (usually at the interpilasters or the weak points of the pilasters) or dented. Denting resulted in the depression of a circular fragments or fragments, with compression of the dura mater or brain; this, in turn, may be contused, lacerated or even crushed. Spinal crash fractures usually involve the lumbar region. Neck fractures are rare. The picture may be one of clinical silence (local pain) or marked neurological involvement. Damage to the cord is expressed in the form of shock, complete flaccid para- or tetraplegia, complete loss of sensation below the lesion, loss of deep and superficial reflexes, urinary retention and rectal incontinence. Treatment is rendered complicated by profuse scalp haemorrhages, respiratory insufficiency requiring orotracheal intubation and assisted respiration, convulsions, which should be handled with care, since ordinary anti-epilepsy products may mask the onset of hypertension and haematoma. Swelling should be reduced with cortisones. Diuretics may be too brusque and lead to intracerebral haematoma. In the case of spinal injuries, particular care should be excercised in shifting the patient and conveying him to hospital. Where high neck lesions are suspected, the possibility of damage to the originating segments of the phrenic nerve must be borne in mind.
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PMID:[Aeromedical problems in cranio-vertebral injuries]. 112 65

The daily variation in blood pressure (circadian blood pressure rhythm) is characterized by a nocturnal fall and a diurnal rise. The circadian blood pressure rhythm seems to be mediated mainly by the circadian rhythm of sympathetic tone, linked to changes in physical and mental activities, e.g. the waking-sleeping cycle. Statistically significant circadian blood pressure rhythms have been confirmed in approximately 80% of mild to moderate essential hypertensive patients as well as in normal subjects. However, the normal pattern of circadian blood pressure rhythm is reversed in elderly people and in those with Cushing's syndrome, those undergoing glucocorticoid treatment, and those with hyperthyroidism, central and/or peripheral autonomic dysfunction (Shy-Drager syndrome, tetraplegia, diabetic or uremic neuropathy, etc), chronic renal failure, renal or cardiac transplantation, congestive heart failure, eclampsia, sleep apnea syndrome, malignant hypertension, systemic atherosclerosis and accelerated hypertensive organ damage. However, in those with primary aldosteronism, renovascular hypertension, pheochromocytoma without paroxysmal hypertension, or those with cardiac pacing, a nocturnal blood pressure fall is ordinarily observed. It may be that a fall in cardiac output rather than in peripheral resistance may be mainly responsible for the nocturnal fall in blood pressure. It also seems that a nocturnal heart rate fall is not responsible for it, since the nocturnal blood pressure fall remained unchanged in patients undergoing cardiac pacing and was disturbed in patients with Cushing's syndrome or hyperthyroidism in whom the circadian heart rate rhythm remained unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Circadian blood pressure variations under different pathophysiological conditions. 209 80

A report is given of pregnancy in a tetraplegic patient. The main complications that patients who are suffering from tetraplegia have in pregnancy are urinary tract infection, anaemia, and complications of bed rest, as well as premature delivery and autonomic hyperreflexia. Autonomic hyperreflexia is provoked by stimuli such as distension of the bladder or of the rectum or stimulation of the cervix. In this syndrome bradycardia, arterial hypertension and headaches are associated. The major risk is of intra-ventricular haemorrhage in labour. The care of the pregnant tetraplegic patient requires the cooperation of the obstetrician, the anaesthetist and the nursing staff, as well as of the patient.
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PMID:[Tetraplegia and pregnancy]. 266 45

We report a case of spinal artery aneurysm, secondary to the coarctation of aorta, who presented with initial signs of transverse myelopathy. A 45-year-old woman was admitted to the hospital because of quadriplegia. She had a history of subarachnoid hemorrhage traced to unknown origin. Physical examination revealed hypertension of upper limbs, but any artery of the lower limbs was not palpable. On neurological examination, she was alert, quadriplegic, and anesthetic below C4 level. Neck was stiff and meningeal signs were presented. The liquor was bloody. Myelography demonstrated complete block at C5-6. The right retrograde brachial angiography showed an aneurysm of cervical spinal artery. Digital subtraction angiography demonstrated a coarctation of the aorta. Coarctation of the aorta was considered to have caused spinal artery aneurysm, and is the first reported case in Japan.
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PMID:[A case of spinal artery aneurysm presenting transverse myelopathy associated with coarctation of the aorta]. 268 31

In 1983, 28 Rohsai Hospitals in Japan cooperated to study 926 spinal cord injury (SCI) patients to reveal the problems of their rehabilitation. Fifty per cent complained of poor physical condition and were anxious about their health. In addition to complications rising from the SCI, the morbidities of heart disease, diabetes mellitus, liver disease, hypertension and CVA were higher than the Japanese average. It was noted that 1) 44% of tetraplegic patients were confined to living in their home. 2) Ageing exerted a serious influence upon daily life. 3) Crutch gait for patients with paraplegia was not practical. It was also shown that utilisation of automobiles played an important role in extending social activities. For SCI patients, especially those with tetraplegia, it was very difficult to find employment. The rate of employment was only 30% in all and 46% of these were self-employed.
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PMID:Physical and social condition of rehabilitated spinal cord injury patients in Japan: a long-term review. 304 34

Forty-three cases of primary pontine hemorrhage were seen in our hospital from 1979 to 1986. We studied the correlations between clinical signs, CT, ABR findings and their outcomes, and then reported surgical results. The case consisted of 30 males and 13 females between 32 to 73 years with an average age of 54.5. Thirty cases were confirmed to have had hypertension prior to the hemorrhage. In ten other cases hypertension was suspected, although their past histories were not obtained. In the remaining three cases, no hypertension was detected. On admission, comatose state, ocular fixation, absence of light reaction, tetraplegia, decerebrate posture, respiratory disturbance, tachycardia and hyperthermia were the signs of unlikely recovery. On the CT, the hematomas of the group of likely recovery patients were less than 25% of the cross section of the pons and lower midbrain in vertical. Greater size of hematomas were seen exclusively among the groups of death and severe disability cases. Acute stage ABR and CT findings showed discrepancy. We suggest, if ABR, CT findings and clinical symptoms were studied more in depth, it is possible to determine a patient's prognosis more precisely. Three cases were treated by Stereotactic Aspiration, three cases by ventricular drainage and the remaining thirty-seven cases conservatively. There was, however, no significant difference in recovery between surgically treated cases and conservatively treated one. We think that surgical indication is doubtful except for limited cases.
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PMID:[Clinical study of primary pontine hemorrhage]. 336 97

To elucidate the incidence of severe disability due to cerebral stroke and its related factors, prospective data of 1,621 Hisayama residents aged 40 and over were examined. Severe disability resulting from stroke was defined as patients who were unable to dress, take care of their toilet needs, and feed themselves without assistance, or who required a wheel chair for ambulation three months after the most recent episode. During 20 years of follow-up 255 stroke patients were observed among the sample population. The annual incidence of stroke per thousand was 9.8, and rate of severe disability was 2.8 for men and 6.4 and 2.0 for women, respectively. Of the 74 cases with severe disability, approximately 92% were attributed to cerebral infarction. Related factors to severe disability due to cerebral infarction were recurrent attacks, hypertension, changes in ocular fundi and diabetes mellitus among predispositions and quadriplegia or muscular contraction, and intelligent or mental disorders among inhibiting factors for functional recovery. Furthermore, in 59 autopsy cases with multiple cerebral infarctions, the frequency of disability increased as the number of infarcts increased. Hypertension and diabetes mellitus, as risk factors for cerebral infarction and factors inhibiting post-ictal functional recovery were discussed.
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PMID:Severe disability related to cerebral stroke: incidence and risk factors observed in a Japanese community, Hisayama. 358 64

A 24-year-old woman with a two-year history of hypertension was hospitalized for coma and quadriplegia secondary to pontine hemorrhage. A seven-year history of intermittent severe headaches, diaphoresis, and anxiety together with persistent severe hypertension led to the diagnosis of pheochromocytoma. This unusual but devastating manifestation of pheochromocytoma illustrates the importance of excluding remedial forms of hypertension in young patients before initiating antihypertensive therapy.
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PMID:Pontine hemorrhage in a patient with pheochromocytoma. 397 97

Because controversy exists regarding continued use of the seated position for neurosurgical procedures, this prospective (1981-1983) and retrospective (1972-1981) analysis of 554 seated patients was done to establish the incidence and severity of venous air embolism (VAE) related to type of surgical procedure and anesthetic technique; to examine the impact of specific monitoring practices on detection, morbidity, and mortality; and to establish the incidence of other complications related to the seated position (hypotension, quadriplegia, and arterial air embolism (AAE)). The overall morbidity and mortality related to the seated position was 1% (2 VAE, 1 AAE, 2 hypotension, 1 myocardial infarction) and 0.9% (1 VAE, 1 AAE, 2 hypotension, 1 quadriplegia), respectively. There has been no mortality since 1975. N2O did not seem to increase the incidence or severity of VAE. The seated position is safe in experienced hands if appropriate surgical and anesthetic skills are exercised in patient selection and management. Caution is advised in patients with atherosclerotic cardiovascular disease, severe hypertension, cervical stenosis, and right to left intracardiac shunts.
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PMID:Anesthesia and surgery in the seated position: analysis of 554 cases. 406 24


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