Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

HELLP syndrome continues to be a clinical entity of difficult diagnosis. Weinstein first defined it in 1982 giving the practicing obstetrician a sequence of useful initials (H = hemolysis; EL = elevated liver enzymes; LP = low platelets). Since then a lot has been written and it has become clear that the syndrome is a form of severe preeclampsia. The American College of Obstetrics and Gynecology does not include HELLP in the description of severe pre-eclampsia as such but does accept each of its components as being part of severe pre-eclampsia. The case presented deals with a 33 year old white female, admitted at 27 weeks gestation with nausea, epigastric pain resembling acute abdomen, nose bleeding and mild hypertension. The analysis revealed an abnormal liver profile with elevated GOT, GPT and LDH, heavy proteinuria (14.4 g/day), decreased platelet count (92000/mm3) and elevated total bilirubin. Pregnancy was terminated by cesarean section 24 hours after admission because the patient's condition was deteriorating. Obviously in pre-eclampsia/eclampsia there is a systematic injury to all tissues. Proof of this is the hypertension as a consequence of vascular spasm and proteinuria due to glomerular injury. In HELLP the sequence of events is probably altered; hepatic injury precedes vascular and renal injury of conventional preeclampsia. The syndrome results from many clinical and pathological symptoms derived from endothelial microvascular injury which determine a rapid platelet activation causing vascular spasm, platelet aggregation and further endothelial injury through a feedback mechanism.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[Massive proteinuria and HELLP syndrome]. 130 8

The HELLP-syndrome is a severe complication in late pregnancy. The etiology is still largely unknown. It is defined as a separate disease but also as a severe course of EHP-gestosis. It is mainly characterised by increased liver enzymes, a low platelet count, increased haemolysis and hypertension. According to primary organ affection, neurological symptoms and acute respiratory distress syndrome, acute renal insufficiency and/or upper abdominal complaints may occur. The only causal therapy is immediate caesarean section. Postoperative intensive care must be guaranteed. As a gentle anaesthetic method neuroleptanalgesia is recommended. Based on 7 of our own case reports, pathophysiology and therapy are discussed.
 ...
PMID:[The HELLP syndrome--a challenge to the obstetrician and the intensive care therapist]. 141 82

A serious complication to pregnancy-induced hypertension and preeclampsia is the HELLP syndrome (H - haemolysis, EL - elevated liver enzymes, LP - low platelet count). Perinatal and maternal mortality are reported to be high, 7-60% and 2-24%, respectively. A non-obstetric diagnosis is often made, such as gastrointestinal or haematologic disease. Typical symptoms are epigastric and right upper-quadrant pain and tenderness, nausea and vomiting. Recognition of the clinical and laboratory findings is important, so that early, aggressive therapy can be initiated in order to prevent maternal and perinatal death. We present data from 14 patients with the HELLP syndrome treated in our hospital. There was one intrauterine death. The other infants were discharged in good condition. Two of the patients had eclampsia.
 ...
PMID:[HELLP syndrome--a life-threatening pregnancy complication]. 849 85

Pregnancies complicated by hypertension require a well-formulated management plan. Women with chronic hypertension should be evaluated prior to pregnancy. At onset of pregnancy, they should be classified into low-risk and high-risk groups. The majority of pregnant women identified as low-risk hypertensives will have good perinatal outcome without the use of antihypertensive drugs. In general, antihypertensive medications should be reserved for those considered as having high-risk hypertension. In either case, all these women should have close follow-up of maternal and fetal conditions throughout pregnancy. All women with diagnosed preeclampsia should be hospitalized at the time of diagnosis for evaluation of maternal and fetal well-being. Subsequent management will then depend on gestational age and the severity of the disease process. An individualized management plan and a referral to a tertiary care center will improve maternal and perinatal outcome in those women who are remote from term and in those with the HELLP syndrome.
 ...
PMID:Hypertension in pregnancy. 148 51

The HELLP syndrome (haemolysis, elevated liver enzymes, low platelet count) was first referred to by Weinstein in 1982 as an extremely progressive form of gestosis. In addition to the more common gestotic symptoms, such as oedema, proteinuria and hypertension, the clinical picture is characterized by microangiopathic haemolysis, thrombocytopenia and, especially, impaired hepatic function. Within this clinical picture severe complications can occur, such as eclamptic attacks, renal dysfunction, intracranial haemorrhage, intrahepatic haemorrhage and coagulopathy. An imbalance in prostanoid metabolism has been implicated in the pathogenesis. A decrease in synthesis of the vasodilator and thrombocyte aggregation inhibitor prostacyclin leads to a preponderance of the vasoconstrictor thromboxane A2, which promotes thrombocyte aggregation. This results in local vascular spasms and endothelial lesions, which in the case of hypercoagulopathy are accompanied by the formation of fibrin deposits with resultant vascular constriction. Intravascular fibrin deposits indicate that the coagulation system has been compromised and can lead to consumption coagulopathy in approximately 10% of cases. In the majority of cases, however, one finds low-grade disseminated intravascular coagulation (DIC), i.e. mild hypercoagulopathy with thrombocytopenia, a tendency to thrombocyte aggregation and fibrinogen deficiency in the presence of usually normal plasmatic coagulation. These vascular changes occur particularly in organs that have high blood flow, such as liver, kidneys and placenta. In the liver, sinusoidal obstruction causes vascular congestion, leading to an increase in intrahepatic pressure, dilatation of Glisson's capsule, development of subcapsular hepatic haematomas and hepatic rupture. Hepatic haematoma virtually always requires surgical treatment, and otherwise the patient has hardly any chance of survival. Nevertheless, mortality is around 35%.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[Spontaneous liver rupture as a rare complication of the HELLP syndrome]. 149 26

Severe pregnancy induced hypertension (PIH, pre eclampsia) is a disease which is now treated in the intensive care unit rather than with sedation in a dark room. The pathophysiology is now well understood and allows for better and more effective management. This paper looks at the strict haemodynamic monitoring and management required to prevent complications such as eclampsia, DIC, HELLP syndrome, maternal and foetal death. The nurse's role in the management of severe PIH is discussed.
 ...
PMID:The intensive care management of severe pregnancy induced hypertension. 159 5

The serum level of interleukin-2 receptor (sIl-2R) and CD-8 antigen were determined as basic parameter in terms of the stimulation of the t-cell mediated immune reaction in patients suffering from pre-eclampsia (n = 21), HELLP syndrome (n = 12) and pre-existing hypertension (n = 10). The data were compared with those of healthy nonpregnant female volunteers (n = 10) and normotensive pregnant women in the course of pregnancy. Hypertension in pregnancy was associated with an increase of sIl-2R and sCD-8 levels depending on the severity of the hypertensive disorder. In the group of patients with severe pre-eclampsia the median of sIl-2R serum level increased from 370 U/ml (normotensive patients) to 730 U/ml and that of sCD-8 from 640 U/ml to 1100 U/ml. In patients with pre-existing hypertension there was a smaller increase of sIl-2R (median 520 U/ml) and decrease of sCD-8 (median 520 U/ml). 6 to 8 weeks after delivery in the group of hypertensive patients the sIl-2R levels were normalized and the levels of sCD-8 were elevated (median 1030 U/ml). The results support the hypothesis of T-cell mediated immunological reactions as pathogenetic factors of the genesis of the hypertensive disorders in pregnancy.
 ...
PMID:[Changes in the basic immunologic parameters interleukin-2 receptor and CD8-antigen in pre-eclampsia]. 160 31

The course of preeclamptic/eclamptic patients may be complicated by HELLP syndrome, a syndrome of intravascular hemolysis (H), elevated liver enzymes (EL) and low platelet count (LP). These patients typically present at early third trimester with epigastric or right upper quadrant pain, nausea and vomiting. They may present without the clinical signs of preeclampsia (hypertension and proteinuria or edema), thus an initial wrong nonobstetric diagnosis is not uncommon. The most frequent maternal complication is intravascular coagulopathy (30%). Placental abruption and acute renal failure are also common. Ten cases of maternal deaths were reported among 295 cases reviewed in the English language literature, while the perinatal mortality rate was 226/1000. The grave prognosis for mother and fetus warrants physician awareness in order to accomplish early diagnosis and proper management. This paper is a review of the literature in English.
 ...
PMID:HELLP syndrome--a syndrome of hemolysis, elevated liver enzymes and low platelet count--complicating preeclampsia-eclampsia. 168 23

This report is on a 35-year-old II-para (status post-Caesarean Section due to breech presentation, at that time normal pregnancy) progress, who was hospitalized with hypertension and proteinuria during the 40th week of pregnancy. Both symptoms occurred initially three days before hospitalization. Blood pressure was within the high normal range (140/90 mmHg) as a result of medication with Dihydralazine (50 mg/die). After induction of labour with prostaglandin (PGE2), the patient delivered normally, and the highest blood pressure measured was 140/90 mmHg, following a subsequent curettage under general anaesthesia, which had to be performed due to incomplete deliver of the placenta. Two hours post delivery, sudden epigastric pain occurred, followed by nausea and vomiting. Blood chemistry showed the development of a severe post-partal HELLP-Syndrome with acute renal failure. The case demonstrates, that the life threatening picture of the HELLP-Syndrome may develop without preexistent severe hypertension or proteinuria. For this reason a post-delivery screening of blood chemistry should be mandatory in cases of severe epigastric or right-upper-quadrant pain.
 ...
PMID:[HELLP syndrome--postpartum]. 174 78

Pregnancy-induced hypertension is a disorder of unknown etiology unique to pregnant women. Classic clinical manifestations include hypertension, proteinuria, and edema. Early recognition and proper management of this disease may serve to avoid serious maternal complications. Ultimate maternal treatment depends on delivery of the fetus and placenta. Advanced stages of this disease result in multi-organ system dysfunction that may be life-threatening to the mother and her fetus. Such maternal complications of PIH include severe hypertension, oliguria or anuria, HELLP syndrome, eclamptic seizures, liver rupture, pulmonary edema, cerebral edema, and abruptio placentae. A multidisciplinary approach of the critical care team often will effect a reduction in maternal morbidity and mortality.
 ...
PMID:Management of severe preeclampsia and eclampsia. 174 3


1 2 3 4 5 6 7 8 9 10 Next >>