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

Radiation exacerbates the development of atherosclerosis in the large arteries of animals and is postulated to do likewise in human beings. To study this relationship, we used high-resolution B-mode ultrasonography to measure carotid artery wall thickness in 29 previously irradiated head and neck cancer patients and compared the results with those of nine epidemiologically similar but nonirradiated head and neck cancer patients. Maximal intima-media thickness was greater in the study group (mean, 1.28 +/- SE 0.06 mm) than in the control group (mean, 0.90 +/- SE 0.05 mm). Even after the effects of age, hypertension, and tobacco consumption were controlled, these differences remained statistically significant. This study suggests that irradiation may contribute to the development of more severe and extensive carotid atherosclerosis in head and neck cancer patients who receive radiation therapy.
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PMID:Irradiation. A significant risk factor for carotid atherosclerosis. 191 Jun 99

A retrospective analysis of 19 patients aged 70 years or more with head and neck cancer, admitted between January 1982 and March 1983, was performed. Of these patients, radical surgical excision was performed on seven. At present recurrence has been observed in only one. Associated illness was found in 11 patients, hypertension and cardiac disease, in four cases each, being most frequent. Surgical operation should be performed even on elderly patients if the operation is indicated. However, careful and delicate management before, during and after the operation is essential.
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PMID:Surgery in elderly patients with head and neck cancer. 374 Dec 71

The management of the contralateral neck in patients with head and neck cancer who have undergone a radical neck dissection (RND) is controversial. A number of these patients will require a second RND. Sacrifice of both internal jugular veins (IJV) has been felt to lead to increased intracranial pressure (ICP) with subsequent neurologic sequelae. From 1987 to 1991 four patients had staged bilateral RNDs at the West Virginia University. In these patients a subarachnoid bolt was placed to directly monitor ICP. Jugular bulb, mean arterial, pulmonary artery, and central venous pressures were monitored. Electroencephalographic (EEG) monitoring was also performed. All patients demonstrated elevations in ICP immediately on head rotation. Further marked elevations were noted immediately after IJV ligation with a maximum peak at 30 minutes. Pressure levels of greater than 40 mm Hg were observed in three of four patients. Systemic hypertension was observed in response to elevated ICP (Cushing's reflex). All patients studied recovered from surgery without significant sequelae. Within 24 hours the ICP had returned to normal in all patients. Three patients required intraoperative intervention to lower their ICP. We demonstrate that even in a staged second RND there are significant rises in ICP. These are to a level that suggests emergency medical intervention is required. We feel that when the second IJV is sacrificed an increase in ICP should be anticipated, monitored, and treated accordingly.
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PMID:Intracranial pressure changes during bilateral radical neck dissections. 825 63

As the average life span has increased, the number of elderly patients with cancer has increased. One of the greatest dilemmas in the management of cancer in the elderly is the fact that often regular curative treatment cannot be executed. From this viewpoint, 679 patients with head and neck cancer treated during a recent 5-year period were reviewed. They were classified into two age groups: those younger than 75 years (n = 560) and those 75 years and older (n = 119). The frequency with which curative treatment could not be executed was 8.8% in the younger group and 26.1% in the older group. The major reasons were concomitant health problems and failure to obtain the patient's consent, and these problems were significantly more common in the older group. The incidence of asthma, pulmonary emphysema, cardiac failure, hypertension, arrhythmia, cerebrovascular disease, and kidney failure was greater in the older group. The overall 3-year survival rate was 18% in the cases with no curative treatment and 77% in those curatively treated.
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PMID:Management of cancer in the elderly: therapeutic dilemmas. 945 Aug 40

METHODS: We investigated the possibility of carotid baroreflex dysfunction as the cause of cerebral insufficiency in head and neck cancer patients treated with neck radiotherapy. Three patients cured with radiation therapy were evaluated for light-headedness and syncope. Orthostatic blood pressure, heart rate responses to esmolol and atropine, and baroreceptor sensitivity to amyl nitrite and phenylephrine were measured. The results were compared with measurements in six normal control subjects. RESULTS: All three patients had intact sympathetic and parasympathetic cardiac innervation. Nevertheless, their heart rate responses to amyl-nitrite-induced hypotension and phenylephrine hypertension were only one-third normal (P = 0.013), indicating poor baroreceptor function. Upon standing, diastolic pressure of control participants increased but that of the three patients decreased by 3 mmHg. After inhalation of amyl nitrite their systolic and diastolic blood pressures decreased by 70+/-9 and 28+/-2 mmHg, much more than the control participants' decrease of 33+/-5 and 17+/-3 mmHg (P = 0.006, P = 0.02). CONCLUSION: The baroreflex is the most important mechanism for short-term blood pressure homeostasis. Patients with transient light-headedness or syncope after radiotherapy to the neck may have baroreceptor damage. This defect is unlikely to be apparent on routine cardiovascular testing. However, testing with a rapidly acting hypotensive stimulus can reveal gross deficits in the regulation of heart rate and blood pressure.
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PMID:Light-headedness and defective cardiovascular reflexes after neck radiotherapy. 1022 7

A histological study of both recipient and flap vessels was performed in 30 patients with head and neck cancer, and relevant preoperative risk factors were assessed. A total of 35 free flaps were transferred in 30 patients; 16 patients had preoperative radiotherapy, 13 were smokers, eight had hypertension and six had peripheral vascular disease. No significant venous pathology was found in either the flap or the neck veins. However, over two-thirds of the neck arteries and one-half of the flap arteries were found to have microscopic arterial pathology. The only pre-existing factor significantly influencing vessel pathology was hypertension (P=0.007). All flaps survived, although in two there was some loss of the skin paddle. This study reveals that the majority of patients undergoing microsurgery in the head and neck region have pre-existing arterial damage in both the flap and the recipient arteries, but this does not have a significant effect on the overall patency of the microvascular anastomoses.
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PMID:Microvascular histopathology in head and neck oncology. 1279 58

Stroke represents a major cause of disability among middle-aged and elderly people. Carotid artery stenosis is an important risk factor for stroke and is prevalent in elderly men with hypertension, diabetes mellitus, and those who smoke or have atherosclerotic disease, or both. Patients who undergo neck dissection for head and neck cancer may have some or all of the above characteristics and may experience surgical manipulation of the carotid arteries. This combination of medical and surgical factors may predispose such patients to perioperative stroke. A critical review of the literature was completed to determine the incidence of stroke perioperatively in patients undergoing a neck dissection for head and neck cancer. We found 2 studies that quoted the risk of stroke to be between 3.2% and 4.8%. The implications of these results are significant because they suggest a need for preoperative screening (with Doppler ultrasonography) or intervention (with carotid endarterectomy), or both. However, the quality of these 2 studies is such that future research is first needed to define the rate of stroke in head and neck surgery.
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PMID:Perioperative stroke occurring in patients who undergo neck dissection for head and neck cancer: unanswered questions. 1457 3

Local relapses of head and neck tumors are not often eligible for surgical and/or radiotherapy retreatment, and the efficacy of systemic chemotherapy is poor. A greater accumulation and efficacy of anticancer drugs with lower systemic toxicity is theoretically obtained with intratumoral chemotherapy. In experimental studies, epinephrine has been shown to increase the concentration and antitumor effect of intratumoral cisplatin. Fourteen patients with locally recurrent head and neck tumors (median age, 58.7 years) were included in this phase 2 trial. Recurrent tumors (squamous cell carcinomas) were located on the tongue, oral pharynx, or cervical nodes. Prior therapy was surgery and/or radiotherapy with or without intravenous chemotherapy. Inclusion criteria included an Eastern Cooperative Oncology Group/World Health Organization performance status of 0, 1, or 2, an anticipated survival of >3 months, adequate cardiac, kidney, liver, and bone marrow function, and no coagulopathy or carotid invasion. Fifty intratumoral injections of cisplatin-epinephrine (average, 3.6 injections per patient; range, 1 to 5 injections) were given to the 14 patients from November 1998 to July 2000. Patients were treated with cisplatin (1 mg/mL; maximum dose, 50 mg) at an injection volume corresponding to the tumor volume (1 mL/cm3 of tumor; maximum volume, 50 mL). Epinephrine was added at a concentration of 0.02 mg/mL. Intratumoral injections were repeated every 2 to 3 weeks at different locations in the tumors to obtain a homogeneous distribution. Tumor response was evaluated by clinical examination and computed tomography. Eight objective responses were registered among the 14 patients. Four were complete responses, and 4 were partial responses. The average time to disease progression was 11.5 +/- 8.9 weeks. Local adverse effects were transient pain, swelling, and erythema at the site of the injection. No nephrotoxicity, neurotoxicity, or ototoxicity was observed. Intratumoral injection of cisplatin and epinephrine in an aqueous solution has a definite antitumor activity in recurrent head and neck cancer with acceptable local tolerance and no major systemic toxic effects except for transient tachycardia and high blood pressure at the time of injection.
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PMID:Phase 2 study of intratumoral cisplatin and epinephrine treatment for locally recurrent head and neck tumors. 1505 8

Vascular disease, which can be asymptomatic until arterial stenosis is severe, is common in head and neck cancer patients as the risk factors for both cancer and atherosclerosis are similar. Although studies of common and internal carotid artery stenosis in head and neck patients have been reported, none have specifically assessed the external carotid system, especially in asymptomatic patients undergoing major microvascular free flap reconstructive surgery. A prospective study of 44 patients using pre-operative duplex scanning to assess the common, external and internal carotid arteries bilaterally. Eighteen patients (41%) had no obvious carotid disease in any vessel. Although the remaining 26 patients (59%) had some carotid tree stenosis, only nine patients (20% of study group) had disease affecting the external carotid artery, with significant stenosis (greater than 50%) of this vessel being found in only three patients (7%). A correlation was found between the degree of carotid stenosis and hypertension (P<0.05). No correlation was found between carotid artery stenosis and flap failure (t=5.4; P=1). Significant stenosis of the external carotid artery, even in the presence of atherosclerosis elsewhere in the carotid tree, is uncommon. The screening of the external carotid artery in head and neck patients requiring microvascular reconstruction should be considered when there are significant risk factors for carotid stenosis, including hypertension.
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PMID:External carotid artery stenosis in patients with head and neck squamous cell carcinoma--a prospective study. 1759 98

A case of a patient with bilateral internal, external, posterior external and anterior jugular vein ligations and excisions performed in the neck due to a larynx tumor is presented. Radical neck dissection is a standard otorhinolaryngological procedure in the management of head and neck cancer patients with bilateral lymph node metastasis to the neck. Sacrifice of both internal and external jugular veins bilaterally has been recognized as a dangerous approach leading to intracranial hypertension with subsequent neurological sequela and death. In this report, we aimed to demonstrate how venous outflow from the brain diverts after jugular venous system obliteration. After bilateral jugular vein ligations, digital subtraction angiography (DSA) showed that the venous drainage route of the brain had been diverted from the jugular veins to the vertebral venous plexus.
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PMID:Venous outflow of the brain after bilateral complete jugular ligation. 1838 80


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