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

The case of a 21-year-old female patient with neck pain and brain stem symptomatology after appendectomy is reported. Duplex sonographic findings were compatible with right vertebral artery dissection and occlusion of the vessel. Angiography confirmed the diagnosis. The patient recovered within weeks and was free of symptoms 6 months after the acute episode. Dissection of the vertebral artery can occur with or without minor trauma. Associations with fibromuscular dysplasia, arterial hypertension and the use of oral contraceptives have been reported. As in our own patient, dissection can appear without any vessel pathology or risk situation. The most dangerous complication of the disease is rupture of the adventitia with subarachnoid hemorrhage. Without this complication, prognosis of vertebral artery dissection is favourable with complete recovery within weeks. Clinical findings, diagnostic procedure and therapy are discussed.
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PMID:[Spontaneous dissection and stenosis of the vertebral artery]. 192 54

Between September 1955 and January 1990, 94 pediatric patients were managed for renovascular hypertension caused by renal artery occlusive disease. Patients (50 boys and 44 girls) were aged 4 days to 17 years (median age: 7 years). At initial evaluation, 34 patients had symptoms of hypertensive encephalopathy or acute heart failure, 36 had moderate symptoms, and 24 were symptom-free. Sixty-five cases were classified on the basis of clinical, radiological, and histological features, as follows: neurofibromatosis (17), fibromuscular dysplasia (11), diffuse arterial calcified elastopathy (11), renal artery thrombosis (10), Williams syndrome (4), Takayashu disease (3), and miscellaneous diseases (9). In the 29 remaining patients, classification was based only on radiological features: causes included unilateral renal artery stenosis (15), bilateral renal artery stenosis with or without aortic stenosis (11), and miscellaneous disorders (3). Surgical treatment consisted in 47 renal revascularization, procedures (14 aortorenal bypasses, 8 aortorenal reimplantations, 9 anastomoses in the upper mesenteric arterial system, 7 autotransplantations, 4 resection-reanastomosis procedures, and 5 miscellaneous procedures). Renal revascularization failed in 15 cases (32%) (because of thrombosis in 14 cases and dehiscence in one). Residual or recurrent stenosis was seen in 7 arteries, whereas the anatomic result was satisfactory in 25 arteries (53%). Blood pressures returned to normal in 16 of 40 (40%) patients successfully treated by revascularization. An additional 25 patients recovered normal blood pressure values after primary nephrectomy (21), partial nephrectomy (4) or nephrectomy after failed renal revascularization.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Renal artery pathology and its therapeutic indications in the child]. 192 4

Renovascular hypertension is caused by two distinct conditions with different causes, fibromuscular dysplasia and atheroma. Diagnosis of the former is both simpler and more rewarding, whereas atheromatous lesions of the renal artery may be secondary to essential hypertension. It is therefore important to establish existence of functional renal ischemia as well as an anatomical lesion. Universal screening of all hypertensive patients is not recommended because of the relatively low prevalence of the disease and insufficient accuracy of available screening tests. When renovascular hypertension is clinically suspected, an oral captopril test is the most reliable office screening test. After this, digital subtraction angiography with renal vein renins or captopril renography are appropriate steps. However, the latter procedure, while promising, requires further evaluation. Duplex scanning of the renal arteries also comes into this category. Arteriography is done last, so that if renal ischemia is indicated, angioplasty can be attempted at the same time as arteriography.
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PMID:Diagnosis and evaluation of renovascular hypertension. Indications for therapy. 199 96

Renovascular hypertension is not easily identified clinically, and most tests are not totally reliable in detecting its presence. The condition may be due to fibromuscular dysplasia or congenital anomalies in patients younger than age 30 or to atherosclerosis in patients older than 50. The goal of treatment is to lower blood pressure and improve or maintain renal function. Cure or improvement of hypertension is more likely in patients with fibromuscular dysplasia than in those with atherosclerosis. Interventional procedures include percutaneous transluminal angioplasty, surgical revascularization, and nephrectomy.
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PMID:Renovascular hypertension. Difficulties in diagnosis and treatment. 200 6

A 19-year-old female patient with renovascular hypertension accompanied by focal segmental glomerulosclerosis like lesion in the contralateral kidney is described. She was admitted to our hospital for uncontrollable hypertension which was first pointed out at check-up when she was 18 years old. On admission physical examination revealed remarkable hypertension and a bruit around the umbilical region. Laboratory findings disclosed renal dysfunction and slight proteinuria (0.8-1.1 g/day). Arteriography revealed severe narrowing of the right renal artery suggesting fibromuscular dysplasia. Taken together, renovascular hypertension was diagnosed. She underwent an operation to reconstruct the artery with autotransplantation of the ipsilateral kidney in the pelvic cavity, and sections were taken from both kidney for histological evaluation during the procedure. After the operation her blood pressure normalized and proteinuria decreased. And interestingly, the kidney specimens revealed that the left side consisted of focal segmental glomerulosclerosis like lesion whereas the right was only of ischemic change. Hyperfiltration theory has recently been highlighted experimentally. And the etiology of the renal findings in this case may be based on such hemodynamic alteration as has been described in animal models. We present the case so that it may be of some help to understand how focal segmental glomerulosclerosis is brought about in humans.
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PMID:[A case of renovascular hypertension accompanied by focal segmental glomerulosclerosis like lesion in the contralateral kidney]. 205 44

In this study we report our experience in 74 patients with hypertension and renal artery stenosis (42 with atherosclerotic stenosis, 32 with fibromuscular dysplasia) who were followed-up for a mean observation period of 21.7 months after percutaneous transluminal angioplasty (PTA). Stenosis was unilateral in 45 cases, bilateral in 16 and located in the renal artery of a solitary functioning kidney in 13 cases. Ostial involvement was observed in 26 cases. A total of 24 patients showed impaired renal function before PTA. Overall results for BP control were 8 cures (13%), 29 improvements (48%) and 24 (39%) who remained unchanged. Five of the 24 patients (21%) with impaired renal function showed improvement with a decrease in serum creatinine levels of more than 30%. Complications of PTA were rare, being limited to two haematomas at the puncture site which resolved spontaneously. These results emphasize that PTA, an easily repeatable procedure of relatively low risk, short hospital stay and low cost, is a first choice technique in the management of renovascular hypertension.
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PMID:Percutaneous transluminal angioplasty in the treatment of renovascular hypertension. 207 73

To examine the efficacy and usefulness of captopril-enhanced renal vein renin (RVR) measurements in detecting the functional significance of renal artery stenosis found in hypertensives, we compared these values in 22 patients with arteriographically documented renovascular hypertension due to unilateral (URVH: 14 patients) or bilateral renal artery stenosis (BRVH: 8 patients) and 12 patients with high renin essential hypertension (EHT). Before captopril administration, RVR ratio was less than 1.5 in 8 patients (36.4%) with renovascular hypertension and all patients (100%) with EHT. Captopril enhanced the lateralization of renal vein renin in renovascular hypertension; the postcaptopril RVR ratio was greater than 2.0 in 18 patients (81.8%) and greater than 1.5 in all the patients (100%). On the other hand, RVR ratio remained unchanged in most patients with EHT. There was no significant difference in the postcaptopril RVR ratios between URVH and BRVH. However, the postcaptopril RVR ratio was higher in atherosclerosis (10 patients) than in fibromuscular dysplasia (11 patients) (P less than .05). Captopril also elucidated contralateral renin suppression as expressed by a contralateral/peripheral renin ratio of less than 1.0, which was associated with a favorable outcome of unilateral surgical intervention. Captopril-stimulated RVR indices were valuable in detecting the functionally significant renal artery stenosis and predicting surgical curability in renovascular hypertension.
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PMID:Captopril-stimulated renal vein renin in hypertensive patients with or without renal artery stenosis. 208 Oct 13

We present a post-mortem examination of two hearts in which we found organized mural thrombi attached to the right atrial endocardium in the recess called antrum atrii dextri. This region is a place where the sinus node is situated very close to the endocardium of right atrium. Any pathological process involving the node (inflammation, degeneration) may reach this part of endocardium by continuity, this in turn creates convenient conditions for mural thrombi formation. The first case--a 52-year old man who died of severe congestive heart failure caused by rheumatic disease with mitral and aortic stenosis. Atrial fibrillation had developed several years before his death. Apart from typical changes of mitral and aortic valves a post-mortem examination revealed an organized, globular thrombus in antrum atrii dextri. In the microscopical findings of the sino-atrial region the fatty degeneration of the sinus node with multiple mononuclear cell infiltration was the most striking feature. The sinus node artery was narrowed due to fibro-muscular dysplasia of its wall. The second case--a 74-years old man who suffered from arterial hypertension and chronic pyelonephritis with a history of heart infarct in the past. The ECG recording showed multifocal atrial rythm with variable P wave morphology and P-Q distance. At necropsy the whole heart was significantly enlarged with no scars or any other signs of healed infarct. The microscopical findings revealed the heart muscle to be infiltrated by amyloid deposits particularly apparent in the sinus node. Similar thrombus of 1.5 cm in diameter was found in antrum of the right atrium.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Unusual location of mural thrombi in the right atrium caused by pathological changes in the sinoatrial node]. 209 51

The results of PTRA in treatment of renovascular hypertension in four children aged 5, 7, 13 and 15 are presented. All patients suffered from severe hypertension. Tests showed all of them to have fibromuscular dysplasia stenosis of the main renal artery and significant lateralization of renin levels. One suffered from associated polycystosis of kidneys and in another the renal artery stenosis was bilateral. In all patients successful patency was achieved. In one patient, the arterial pressure after PTRA was normalized, while in the others it was considerably improved. Two patients, tested 8 and 12 months after PTRA, were lost to further follow-up. In one of the remaining two, stenosis and hypertension reappeared 5 years after PTRA. After autotransplantation the patient was normotensive. In the other, also 5 years later, recurrent hypertension appeared related to the associated polycystosis.
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PMID:Percutaneous transluminal renal angioplasty (PTRA) as a method of therapy for renovascular hypertension in children. 214 97

The authors, following recent observation of two cases of renovascular hypertension, one related to single right renal artery stenosis and the other to fibromuscular dysplasia of the left renal artery, examine the value of the Captopril-Test and treatment with Percutaneous Transluminal Angioplasty (PTA), in the diagnosis and therapy of this form of hypertension. According to the latest experience, reported in the literature, the Captopril-Test yields valid information as regards the dependence of hypertension on the renin-angiotensin system, while PTA represents the primary procedure in the treatment of renovascular hypertension when some conditions are satisfied as in our cases.
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PMID:[Transluminal percutaneous angioplasty in renovascular hypertension caused by monolateral fibromuscular dysplasia]. 214 Mar 13


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