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

The aim of this study was to investigate the effects of recombinant human erythropoietin (rh-EPO) in patients with cancer-related anaemia. Thirty-six ambulatory patients who had malignant neoplasms and haemoglobin (Hb) values of < 11 g/dl (Pretoria is 1,310 m above sea level) entered the study. Patients with renal insufficiency or anaemia caused by bleeding or haemolysis, and patients with iron deficiency or megaloblastic anaemia, were not entered in the study. 22 IU/kg rh-EPO was given subcutaneously 3 times/week. The dose was escalated if Hb values did not rise after 4 weeks. All 36 patients were evaluable for toxicity. Side effects ascribed to rh-EPO were pain or discomfort at the site of injection (12 patients), heart palpitations (3 patients), skin rash (2 patients) and hypertension, deep vein thrombosis, and myalgia in 1 patient each. Thirty of the 36 patients who entered the study were evaluable for response. There were 16 females and 14 males among the evaluable patients. Median age was 64.5 years. Response, defined as an increase of Hb of at least 2 g/dl or to 12.5 g/dl, for at least 1 month, was documented in 12 patients. This was accompanied by an improvement in performance status and occurred within 1 month in 5 of the 12 patients who responded. rh-EPO has a limited but measurable therapeutic value for patients with cancer-associated anaemia.
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PMID:Recombinant human erythropoietin in the treatment of cancer-related anaemia. 797 Apr 93

Deep venous thrombosis (DVT) of the upper extremity is infrequent, occurring with an incidence estimated at 1-3% of that of DVT of the lower extremity; acute pulmonary embolism following upper extremity DVT is very uncommon; thromboembolic chronic hypertension is quite rare. Therefore a case of chronic thromboembolic pulmonary hypertension due to a non-traumatic ("spontaneous") left axillary vein thrombosis is described: in this case only the double lung transplantation has been shown to be effective in the treatment of advanced cardiopulmonary disorder.
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PMID:[Chronic pulmonary hypertension caused by left axillary vein thrombosis. Report of a clinical case]. 805 86

Chronic venous insufficiency of the lower limbs is a frequent disorder that has costly repercussions for society as a whole. It is important to distinguish between abnormality of venous function and its most frequent causes, which are sequelae of deep venous thrombosis and varices of the lower limbs. Chronic venous insufficiency manifests by functional symptoms, based on the heavy leg syndrome, which is very frequent but not specific, and on objective distal signs that are highly specific. Both prognosis and cost of the disorder are based on such objective signs, cutaneous and subcutaneous complications of stasis and of venous hypertension, ranging from simple ochre dermatitis to recurring ulcers and ankylosis of the ankle. Dermo- and hypodermatitis and ulcers complicate less than 10% of chronic venous insufficiency but are responsible for most of the cost involved, two-thirds of which is linked to invalidity. Clinical grades of chronic venous insufficiency have been established, which should facilitate standardisation and comparison of epidemiological, pathophysiological and therapeutic data. Diagnosis of chronic venous insufficiency is by clinical examination, while etiological investigation should most often be done by technical investigation.
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PMID:[Mechanisms, epidemiology and clinical evaluation of venous insufficiency of the lower limbs]. 805 8

Several aspects comprise the medical treatment of chronic venous insufficiency: adoption of daily routines favouring mechanisms for return of venous blood; wearing of elastic stocking to reduce superficial venous hypertension, the basis of medical treatment; use of venotonic agents as adjuvant therapy; association of crenotherapy; and finally the possibility of sclerotherapy when such treatment can correct the dysfunction of the superficial venous network. Various therapeutic strategies should be considered to manage not only the functional and/or clinical signs of chronic venous insufficiency, but also the complications which may occur (varicose thrombosis and haemorrhage, or deep venous thrombosis). Lastly, prevention is based not only on respect of daily hygienic measures but above all on early treatment that is adapted to any deep venous thrombosis.
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PMID:[Medical treatment of chronic venous insufficiency]. 805 14

Ulceration of the skin is the most severe complication of chronic venous insufficiency of the lower limbs. The ulcer reflects a profound impairment of the venous anatomy and function, often the late sequel to a deep venous thrombosis. The available surgical techniques are rarely apt to repair these lesions completely. Medical treatment is palliative, based upon the strict control of superficial venous hypertension (leg drainage and compression) and the rational use of local therapies (ulcer cleanliness, debridement and dressing). The physician must obtain the co-operation of the patient and the help of a competent nurse. Failures and recurrences are frequent. Rather than to hopeless resignation or even to abandon, such drawbacks should lead to a critical reassessment of each step in the treatment to identify imperfections, and to correct them.
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PMID:[Treatment of skin ulcers of venous origin]. 805 15

The indications for thrombolytic therapy in acute myocardial infarction, pulmonary embolism, deep venous thrombosis and ischemic stroke are reviewed on the basis of a risk-benefit analysis. There is strong evidence that thrombolysis benefits the majority of patients with acute myocardial infarction. Nevertheless, the overall proportion of patients actually receiving this therapy is disappointingly low (10-30%). Efforts are mainly required in minimizing delays in initiating thrombolysis (patient, doctor, in-hospital) and in providing thrombolytic therapy to an extended proportion of qualifying patients. This implies that many traditional but inappropriate exclusion criteria (e.g. age, presentation 6 to 12 hours after onset of symptoms, hypertension, reinfarction, brief cardiopulmonary resuscitation) are unfounded. Depending on duration of symptoms, infarct localization and age, we favor a differentiated thrombolytic regimen with rt-PA or streptokinase. In contrast to acute myocardial infarction, the risk-benefit ratio for the other thrombotic disorders discussed favours thrombolytic therapy only in a minority of carefully selected patients.
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PMID:[Possibilities and limitations of thrombolysis. Benefits and risk in acute myocardial infarct, lung embolism, pelvic and leg vein thrombosis as well as cerebrovascular accidents]. 817 7

The first generation high-dose ( 80 mcg estrogen) oral contraceptives (OCs) were associated with an increased risk of deep venous thrombosis (DVT). So manufacturers removed the high-dose OCs and first replaced them with OCs with 50 mcg estrogen, resulting in a lower incidence of thromboembolic events (40 vs. 20/100,000 users). When they introduced an even lower dose OC (30 mcg estrogen), the incidence fell further (about 8/100,000 users). Yet, women using the lowest-dose OCs still have DVT more often than do control women. Life-style, age, and smoking may be confounding factors, however. It is not clear whether loss of endogenous ovarian steroid production or the effects of the orally administered contraceptive steroids cause significant changes in hemostatic factors (antithrombin III, protein S, protein C, plasminogen, tissue-type plasminogen activator, plasminogen activator inhibitor 1, histidine-rich glycoprotein, and VII, VIII, X, XII coagulation factors) during OC use. These changes tend to be within normal ranges. There is some doubt that these changes have any clinical significance. In nonsmokers, increased activity of anticoagulant factors and fibrinolytic factors counteract the effects on coagulation factors. Progestin-only OCs appear to affect hemostasis but have not increased the risk of thrombosis. There are considerable differences between people in pharmacokinetics and pharmacodynamics of contraceptive steroids. These differences may account for the increased risk of thromboembolic events in some people. Further research should identify methods of individualizing the dose of contraceptive steroids for a single patient. It should also explore the close interrelationship between hemostasis and lipid metabolism, carbohydrate metabolism, and hypertension in the development of cardiovascular disease in OC users. Providers should discourage women with a past history of DVT from using hormonal contraception.
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PMID:Coagulation and anticoagulation effects of contraceptive steroids. 817 1

Severe chronic venous insufficiency (CVI) demonstrates as chronic, hard-to-heal wounds of the lower extremity. The wound is the result of poor skin perfusion due to a complex series of pathologic events, often initiated by a deep vein thrombosis (DVT). As years pass, the DVT causes venous valvular damage and incompetence. The calf muscle pump fails to augment venous return, and venous blood pressure is chronically elevated upon standing. Mechanisms that normally prevent the transmission of venous hypertension back upstream to the dermal microcirculation are lost. Early dermal microvascular responses include increased fluid filtration and edema. An inflammatory response induces white cell activation and adhesion. It is thought that activated white cells are trapped in dermal capillaries and increase microvascular permeability. Plasma proteins leak into the tissue space, increasing the edema. Ischemic damage to the epidermis leads to epithelial cell necrosis and ulceration. The ulcer is often slow to heal, due to inadequate perfusion and delivery of substrates required for proper wound healing. Current treatments aim to improve calf pump function, reduce edema, improve perfusion, and enhance wound healing.
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PMID:The microvascular pathophysiology of chronic venous insufficiency. 825 61

After decades of focus on the effects of cocaine abuse on the central nervous system (CNS), the cardiovascular toxicity of cocaine is just beginning to be appreciated. The most common cardiovascular pathologies associated with cocaine use include: cardiomyopathy, left ventricular dysfunction, myocarditis, arrhythmia, hypertension, myocardial infarction, stroke, arterial thrombosis, deep vein thrombosis, and gastrointestinal, renal, and skeletal muscle ischemia. This article reviews the above pathologies with speculations on the mechanisms by which cocaine produces cardiovascular tissue damage.
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PMID:Cardiovascular and thrombosis pathology associated with cocaine use. 829 12

Twenty-one patients who underwent a four-compartment fasciotomy between January 1, 1986, and December 31, 1987, were revisited with respect to venous calf-pump function 32 to 56 months (mean, 46.2 months) after fasciotomy. Enrollment criteria consisted of an intact motor innervation, palpable pedal pulses, the absence of venous hypertension, and deep venous thrombosis before and during the treatment requiring fasciotomy and unimpaired ankle and knee joint function. None of the patients showed signs of chronic venous hypertension at assessment. Ambulatory strain-gauge plethysmography revealed no significant difference in recovery time and refilling volume values between the two limbs of each patient (p > 0.1) and between limbs in which fasciotomy was performed and those of normal subjects (p > 0.1). Color flow duplex scanning revealed patent popliteal veins with normal respiration-induced phasic flow pattern and absent reflux in all patients. All visible calf veins were patent, compressible, and without morphologic alterations. The fasciotomy wound was closed by delayed skin suture (the fascia remaining divided) in 48% and by skin grafts of the lateral incision in 52% of the patients, without significant difference in recovery time and refilling volume values (p > 0.1) at assessment. Fasciotomy does not lead to venous calf-pump dysfunction, irrespective of whether the wound is closed by delayed suture or skin grafts.
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PMID:Four-compartment fasciotomy and venous calf-pump function: long-term results. 841 89


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