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

The incidence of mycotic infection of C.N.S. seems to have increased in the last few years and the diagnosis is being made more and more frequently. The authors are reporting a case of a 27 year old man, admitted with severe intracranial hypertension, very poor visual acuity and right motor weakness. The C.T. Scan showed a massive space occupying lesion in the left hemisphere. Only the biopsy, then the surgical removal of the lesion revealed the true histological nature. It turned out to be aspergilloma. The patient expired 13 hours later. Up to date, 25 cases of Aspergillus granulomas have been reported. This disease is included in the entity of neuromycosis. Its specificity compared to the other types of cerebral mycotic localization as for example abscess, meningitis, mycotic aneurysm, lies in the fact that it presents as granulomatous mass in the hemisphere, mimicking a brain tumor without any specific neuroradiological findings. In the light of so far published literature, the authors draw the attention to the fact of the difficulty of diagnosis of this dreadful benign disease due to the lack of specific clinical and radiological findings. They are stressing the necessity of early and vigorous diagnosis mainly in patients with a risk factor to try to reduce the high mortality that has been universally reported in almost all cases.
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PMID:[Cerebral aspergilloma. Review of the literature apropos of a case]. 219 Dec 35

To evaluate the prevalence of lacunar syndromes due to non ischaemic causes 97 consecutive patients with recent (less than 72 hours) onset of a recognised lacunar syndrome were studied. Investigations showed that nine cases were due to non ischaemic pathologies (four primary intracerebral haemorrhages, one rupture of a mycotic aneurysm, one cerebral abscess, one subdural haematoma, one glioblastoma, one multiple sclerosis). Clinical features did not allow a separation of non ischaemic from ischaemic patients; however, hypertension was significantly more frequent in the latter group, and its positive predictive value in identifying ischaemic patients was 96.6%. Lacunar syndromes due to non ischaemic causes are not rare; since CT scan allowed appropriate treatment in two patients and demonstrated contraindications to antithrombotic therapy in five others, its early use appears warranted in patients with acute lacunar syndromes, particularly if normotensive.
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PMID:Non ischaemic causes of lacunar syndromes: prevalence and clinical findings. 224 71

From August 1986 to October 1987, there were 5 cases of primary mycotic aneurysm of the lower abdominal aorta in Chang Gung Memorial Hospital at Kaoshiung. All patients were proved to have Salmonella cholerasuis (Sal. chol.) septicemia by blood culture. The ages ranged from 60 to 80 years old, the mean age was 71.6 years old. The male to female ratio was 4 to 1, 3 patients had diabetes mellitus (DM) and 3 had hypertension. The duration of symptoms lasted from 1 week to 2 months before diagnosis. Clinically, all patients had sepsis with fever, chills, leucocytosis, and complained of pain in the lower abdomen (80%), at flank (20%) or low back (20%). Abdominal tenderness was present in 3 (60%). Two patients underwent surgery, 1 expired during the operation, the other expired 1 month after operation because of retroperitoneal abscess and sepsis. Three were discharged in septic shock and expired within 1 day. The mortality rate was 100%. The diagnosis of complicated aneurysm of the lower abdominal aorta was established in all by computed tomography (CT). In conclusion, when there are clinical manifestations of sepsis, positive blood culture for Sal. chol., and pain or tenderness in the lower abdomen, flank area or back, one should consider the possibility of mycotic aneurysm of the lower abdominal aorta. Although the prognosis is poor, early surgical intervention may improve the outcome. And the diagnosis is best established by CT.
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PMID:Salmonella cholerasuis bacteremia and mycotic aneurysm of abdominal aorta--report of five cases. 280 69

The finding of an abdominal mass in an 18-month old infant ultimately led to the diagnosis of mycotic aneurysm of a common iliac artery. The lesion was resected and the vessel was ligated. The short and long-term outcome was favourable. The child had been operated upon for cervical teratoma and had undergone catheterization of the umbilical artery complicated with Staphylococcus aureus infection. The presence of a mycotic aneurysm must be suspected in infants with a history of umbilical artery catheterization or neonatal staphylococcal infection, or presenting with a posterior mediastinal or abdominal mass, or arterial hypertension. The vessel most commonly involved is the aorta. Surgical resection, when performed, results in cure. The present case is remarkable on three points: the lesion involved an iliac artery, the diagnosis was delayed and calcifications were present around the aneurysm.
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PMID:[Mycotic aneurysm after catheterization of the umbilical artery]. 294 May 58

During a 16-year period at the Massachusetts General Hospital 77 patients underwent 79 procedures (29 hepatorenal bypasses, 50 splenorenal arterial anastomoses) for treatment of renovascular hypertension, renal preservation, or both. The procedure was chosen primarily to avoid a diseased or scarred aorta in 41, to allow a staged approach to bilateral renal artery stenoses or multiple vascular lesions in 17, as a "lesser operation" for five poor-risk patients, for complex problems including trauma, mycotic aneurysm, aortic dissection, thoracoabdominal aneurysm, and renal artery aneurysm in five, and as the procedure of choice in 11 patients. The perioperative mortality rate was 6% for the 77 patients studied. No hepatic dysfunction was seen. Deterioration of renal function occurred on three occasions but only in patients with bilateral simultaneous repair. Cure or improvement of hypertension was achieved in 52 of 63 patients and renal function preserved or improved in 67 of 77 patients. Long-term functional results remain good during follow-up periods up to 14 years. Our experience indicates that use of the hepatic or splenic artery may provide a safe and largely successful alternative for renal revascularization in selected circumstances.
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PMID:Use of the splenic and hepatic arteries for renal revascularization. 394 26

A 7-year-old boy with bacterial endocarditis developed renal artery mycotic aneurysm and diffuse distal occlusions of the renal branches. Blood pressure in the patient returned to normal after obliteration of flow to the left kidney with Gelfoam, Ivalon, and a Gianturco coil. An end loop of the coil used for embolization remained in the lumen of the aorta against its lateral side. Improper coil placement did not result in complications; the boy later died due to neurologic and pulmonary complications. We discuss the therapeutic potential of renal embolization, as well as the risks of particulate and ethanol embolization, in the treatment of renal vascular hypertension from mycotic aneurysms.
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PMID:Total therapeutic embolization of the kidney for hypertension in a child with a mycotic aneurysm. 668 57

Presently we favor heparinless femorofemoral venoarterial bypass for all descending thoracic aneurysm resections. The advantages are minimal blood loss due to the absence of heparin, ease of insertion, especially in large aneurysms where it would be difficult to insert a temporary shunt, distal aortic perfusion, possibly a safety factor in preventing spinal cord and visceral ischemia, and prevention of left heart overload and myocardial failure. In acute traumatic ruptures, simple aortic cross clamping is a suitable alternative. It is safe and can be carried out expeditiously in any community hospital where bypass facilities may not be available. Proximal hypertension can be controlled pharmacologically. We have also used this successfully in ruptured atherosclerotic aneurysms. We have no experience with temporary tridodecylmethylamonium (TDMAC) shunts; several groups have used them successfully. We believe they may be difficult to insert in the proximal aorta with a large mediastinal hematoma or extensive aneurysm. Cannulation of the left ventricular apex necessitates cardiac manipulation and may produce effective aortic valve insufficiency. In patients with aortoesophageal and bronchoesophageal fistula, permanent extrathoracic bypass is preferable to a prosthetic graft in a contaminated field. We propose using a permanent bypass with a no. 10 or 12 right axillofemoral bypass. Our experience is limited to only two patients. This is also a method of treating a mycotic aneurysm or infected thoracic aortic graft.
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PMID:Descending thoracic aortic aneurysm: a 10 year surgical experience. 697 87

A 6-year-old boy with a congenital bicuspid aortic valve presented with finger clubbing and hypertrophic osteoarthopathy, and subsequently he developed severe hypertension. The hypertension was successfully treated by nephrectomy, at which a thrombosed mycotic aneurysm of the renal artey was found. Echocardiography showed the presence of aortic valve vegetations. Blood cultures were sterile, but high antibody titres to the phase 1 and 2 antigens of Coxiella burneti strongly suggested Q fever infection. We believe this is the first reported case of Q fever endocarditis in early childhood.
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PMID:Q fever endocarditis in a 6-year-old child. 741 83

Fifty-seven young stroke patients (aged 45 years and below) admitted to a rehabilitation centre were assessed for underlying risk factor/aetiology and functional outcome after rehabilitation. The mean age was 37.2 +/- 6.3 years and the mean length of stay in the rehabilitation ward 38.3 +/- 19.9 days. There were 37 (64.9%) haemorrhagic and 20 (35.1%) ischaemic strokes. Hypertension was the single most important risk factor accounting for 49.1% of all strokes. Vascular abnormalities (arteriovenous malformation, mycotic aneurysm, vasculitis and Moya-moya disease) and cardiogenic embolism secondary to rheumatic valvular heart disease were also significant causes. There was significant improvement in functional status--activities of daily living (ADL) and mobility--after rehabilitation, the mean Functional Status score improving from 9.76 +/- 2.2 on admission to 5.07 +/- 1.95 on discharge (P < 0.01). Higher ADL and mobility function and upper and lower limb motor power of grade 3 and above on admission, absence of dysphasia, left hemiplegia, age less than 40 years and rehabilitation stay of less than 28 days were associated with better functional outcome whilst sex, nature and site of stroke, and length of stay in the acute ward had no significant bearing.
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PMID:Functional outcome in young strokes. 760 88

Mycotic aneurysm secondary to tuberculous infection of the aorta is a rare entity with less than 50 cases having been described in the literature. Clinical presentation is usually a consequence of the aneurysm, including pain, palpable mass, or hypovolemia secondary to leak. Definitive treatment is surgical, with nearly 30 documented successful cases. The authors present a case of tuberculous aortitis with mycotic aneurysms that presented with uncontrolled hypertension and occlusion of the right renal artery that underwent successful surgical repair.
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PMID:Tuberculous aneurysm of the aorta presenting with uncontrolled hypertension. 1128 42


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