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

A 7-yr-old boy undergoing treatment for respiratory failure after near-drowning developed a pneumomediastinum. Intracranial hypertension refractory to previously successful therapy led to placement of a mediastinal tube, after which intracranial pressure decreased and was easier to control. A pneumomediastinum may cause intracranial hypertension by interfering with venous drainage from the cranium.
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PMID:Increased intracranial pressure: an indication to decompress a tension pneumomediastinum. 671 17

Latrodectus mactans has now invaded towns and cities. The spider's venom is a neurotoxin that causes little local reaction but produces pain and spasm in large skeletal muscle groups within 30 minutes to three hours after the bite. Severe envenomation may result in respiratory failure and coma. First aid is of no value. Muscle relaxants are useful in treatment, as is calcium gluconate. Antivenin is indicated for high-risk victims, such as those with hypertension and persons younger than 16 or older than 60 years of age.
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PMID:Black widow spider bite. 673 Dec 42

Noninvasive radiographic techniques have provided a means of studying the natural history and pathogenesis of cardiovascular performance in acute and chronic respiratory failure. Chest radiography, radionuclide angiocardiography and thallium-201 imaging, and M mode and cross-sectional echocardiography have been employed. Each of these techniques has specific uses, attributes and limitations. For example, measurement of descending pulmonary arterial diameters on the plain chest radiograph allows determination of the presence or absence of pulmonary arterial hypertension. Right and left ventricular performance can be evaluated at rest and during exercise using radionuclide angiocardiography. The biventricular response to exercise and to therapeutic interventions also can be assessed with this approach. Evaluation of the pulmonary valve echogram and echocardiographic right ventricular dimensions have been shown to reflect right ventricular hemodynamics and size. Each of these noninvasive techniques has been applied to the study of patients with respiratory failure and has provided important physiologic data.
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PMID:Noninvasive radiographic assessment of cardiovascular function in acute and chronic respiratory failure. 701 Sep 79

We studied 10 obese volunteers, mean age 36.5 +/- 10.3 years, who weighed 123.56 +/- 28.7 g and were 69.96 +/- 22.5 kg overweight. The subjects did not have diabetes, arterial hypertension or signs of cardiac and respiratory failure or disease and all underwent right- and left-heart catheterization. cardiac output and stroke volume were high, according to increased oxygen consumption and to the degree of obesity. Ventricular end-diastolic and atrial pressures ranged from normal to high and correlated with body weight, signs of volume overloading and reduced left ventricular (LV) compliance. The mean pulmonary artery pressure was elevated and correlated well with weight, pulmonary resistance being normal; mean aortic pressure did not correlate with weight, and systemic arterial resistance tended to have a negative correlation. The LV function curve showed impaired ventricular function, particularly for the heaviest subjects, in whom Vmax and the ratio of the stroke work index to LV end-diastolic pressure were reduced. These indexes correlated well with each other and both correlated negatively with the degree of obesity. In contrast, maximal dP/dt was normal and did not correlate with excess weight. These observations show that depressed LV function is already present in relatively young obese people, even if they are free from signs of cardiopathy and other associate diseases. The degree of impairment of heart function seems to parallel the degree of obesity.
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PMID:Obesity and cardiac function. 726 Dec 80

We report of five patients, suffering from central sleep-apnea. All patients had a global respiratory failure during day-time and developed severe pulmonary artery hypertension during sleep. Therapy with n-BiPAP leeds to an improvement of blood gases and a decrease of pulmonary artery hypertension during sleep.
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PMID:[Effect of n-BiPAP therapy on the hemodynamics in patients with central sleep apnea]. 761 5

A case of non-immunitary hydrops fetalis, following supraventricular tachycardia, in a fetus of 29 weeks of a 28-year-old woman at the first pregnancy, who evolved with systemic hypertension and amniorrhexis, being submitted to cesarean deliver. The child needed bilateral thoracic drainage and oro-tracheal intubation for treatment of respiratory failure. Treated with digoxin and diuretic, the newborn went home at the 56th day of life. The authors emphasize the importance of the intrauterine diagnosis of the arrhythmia for the success of the treatment.
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PMID:[Fetal supraventricular tachycardia and nonimmune fetal hydrops]. 766 9

The recognition that inhaled nitric oxide (NO.) selectively vasodilates the pulmonary vasculature and the fact that pulmonary artery hypertension appears to play a pivotal and central role in the clinical manifestations of adult respiratory distress syndrome have led to an explosion of interest in this treatment modality. Improved pulmonary function and reduced ventilatory support have been noted in some patients with acute lung disease treated with inhaled NO.. The efficacy of inhaled NO. in various animal models has been inconsistent. Although it appears likely that inhaled NO. will be a useful adjunct in the treatment of patients with acute lung disease, the appropriate role of inhaled NO. in the treatment of ARDS remains uncertain. In order for inhaled NO. to be clinically useful in patients, this modality will have to be combined with other treatments that alter the florid inflammatory response. One should anticipate the most benefit in patients in whom respiratory failure is secondary to pressure-driven pulmonary edema and true intrapulmonary shunt.
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PMID:Inhaled nitric oxide in acute lung disease. 770 94

Over the past 50 years, survival has improved in patients with systemic lupus erythematosus and associated nephritis. Yet, there are few long-term outcome studies in patients with well-defined nephropathy. We examined the outcome of 439 patients with lupus nephritis who were seen at the Mayo Clinic between 1964 and 1986 in whom renal biopsies were assessed using the World Health Organization (WHO) classification. There were 341 women and 98 men (mean +/- s.d., age 33.5 +/- 14 years); 200 (46%) patients were hypertensive and 249 (57%) had impaired renal function at renal biopsy. All WHO morphologic classes were represented and 339 (77%) patients had class III, IV and V (the more severe forms of nephritis). Follow-up averaged 10.2 years per patient. At last contact, 286 (65%) patients were alive and 153 (35%) were dead. Overall patient survival was 80%, 69% and 53% at 5, 10 and 20 years after biopsy that was significantly worse than expected survival (P < 0.001). Ten-year cumulative patient survival improved comparing earlier to more recent time spans: 64% in 231 patients seen during 1964-75; 76% in 2089 patients studied during 1976-86 (P = 0.03). Survival free of renal failure was 83%, 74% and 64% at 5, 10 and 20 years, and survival was unfavorably influenced by progressive WHO class, hypertension, impaired renal function, nephrotic range proteinuria, hypoalbuminemia and anemia. Multivariate analysis found impaired renal function, increased urine protein, anemia and younger age to be independent predictors of renal failure. WHO class was not a significant predictor when adjusted for these four factors. Cardiovascular events accounted for 48% of the known deaths and were equally distributed across all WHO classes, followed by infections, renal failure, malignancy, respiratory failure and gastrointestinal bleeding.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prognostic determinants in lupus nephritis: a long-term clinicopathologic study. 779 13

Development of acute lung injury (ALI) in the critically ill is associated with an array of abnormal interactions between the heart and lungs. Of these abnormalities, increased pulmonary vascular resistance (PVR) is common and seems to indicate a worse prognosis than when PVR is normal. Increased pulmonary artery pressure, which follows ALI in humans, has been attributed to many factors. Early in ALI, pulmonary artery hypertension (PAH) is secondary to an imbalance between the release of vasoactive mediators derived from arachidonic acid, endothelium-derived relaxing factor, and other metabolites. As ALI progresses, the combination of mechanical obstruction and severe regional hypoxic pulmonary artery vasoconstriction probably becomes the main factor responsible for PAH. In addition to these elements, in situ and peripherally derived thromboemboli can be seen in ALI, owing to diverse disturbances in the coagulation and fibrinolytic processes. The result is increased workload of the right ventricle which is caused by increased afterload and may induce hemodynamic disturbances that culminate in overt right ventricular failure. However, epidemiologic studies have demonstrated that death following ALI is more often the result of respiratory failure or sepsis. The absence of effective therapy for PAH in ALI might be explained by the pathophysiological and clinical course of the disease. A reasonable conclusion from the contributing elements cited above is that PAH complicating sepsis and trauma is simply a marker of the gravity of the systemic insult that leads to the development of ALI and probably not a separate process.
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PMID:Cardiopulmonary interactions in acute lung injury: clinical and prognostic importance of pulmonary hypertension. 780 95

Haemorrhagic fever with renal syndrome (HFRS) is an acute disease caused by Hantavirus and clinically characterised by abrupt onset of fever, various haemorrhagic manifestations and transient renal and hepatic dysfunction. We retrospectively reviewed 63 cases of HFRS in children from 13 different hospitals in Korea who presented over a 15-year period. The age of the patients ranged from 7 to 15 years, with a male to female ratio of 8 to 1. Fifty-four (86%) patients were 10 years or older. On admission, 24 (38%) were in the febrile phase and 35 (56%) were in the oliguric phase. Fever (100%) abdominal pain (91%), headache (76%) and vomiting (73%) were the most common symptoms. Backache, subconjunctival haemorrhage and hypertension were also noted in about one-third of patients. Hypotension was documented in only 7 (11%) patients. Leucocytosis (> 10,000/mm3) and thrombocytopenia (< 150,000/mm3) were noted in more than two-thirds of patients. Elevated blood urea nitrogen and serum creatinine was observed in 94% by the 7th (median) day of illness. Elevated aspartate aminotransferase and/or alanine aminotransferase were found in more than two-thirds of patients. Renal biopsy was performed in 12 patients and revealed various stages of acute tubular necrosis with occasional interstitial cell infiltration and oedema. Only 2 showed evidence of interstitial haemorrhage. Eleven patients required 1-3 days of dialysis and the remaining patients required only conservative management. Three (5%) patients died of shock, respiratory failure and pulmonary haemorrhage. All other patients recovered without sequelae. Although childhood cases were much less common than adults, clinical and laboratory findings were in general similar between children and adults.
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PMID:Haemorrhagic fever with renal syndrome in Korean children. Korean Society of Pediatric Nephrology. 781 97


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