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

A 30-year-old female presented with uncontrolled hypertension due to arteriovenous malformation in the upper third of the right kidney, which worsened during pregnancy. The arteriovenous malformation was detected by color-coded Doppler sonography, confirmed by angiography, and the fistula was sealed by superselective arterial embolization with metallic coils. Superselective embolization is the most effective and safe treatment for this rare and complex pathology.
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PMID:Worsening of hypertension in a pregnant woman with renal arteriovenous malformation: a successful superselective embolization after delivery. 1452 86

Increased interest in aneurysms involving the renal artery and its branches has occurred during the past 3 decades. The prevalence of renal artery aneurysms is approximately 0.01%-1% in the general population as well as 2.5% in hypertensive patients undergoing angiography. Intraparenchymal renal artery aneurysms (IPRAAs) are rare since being detected in less than 10% of patients with renal artery aneurysms. The Authors report an unusual case of multiple small intrarenal artery aneurysms associated with a large IPRAA located in the mid portion of the right kidney. Usually, IPRAAs are secondary to diseases or injuries of the kidney vascular network. They are classified as true, false, saccular, fusiform, dissecting, and microaneurysms. Potential complications of IPRAAs include peripheral dissection, thrombosis, hypertension, renal infarction and rupture. IRAAs may be detected incidentally as well as present with urologic symptoms and signs related to complications. Actually, IRAAs are investigated by non invasive modalities including duplex ultrasound, magnetic resonance angiography, spiral three-dimensional computed tomography angiography, and three-dimensional reconstructed rotational digital substraction angiography of the segmental and distant branches of the renal artery. Angiography with intrarterial injection of contrast material is the gold standard in diagnosing IPRAAs. Treatment options for IPRAAs include observation, aneurysmectomy with surgical repair, endovascular procedures, nephrectomy or partial nephrectomy. Observation is indicated for asymptomatic intraparenchymal renal artery aneurysms measuring less than 2 cm in diameter. Surgical repair of IPRAAs includes aneurysmectomy and reconstruction of the renal artery by in vivo or ex vivo technique. The procedure is indicated for IPRAAs causing renovascular hypertension, dissection, urologic symptoms, embolization, local expansion and women of childbearing age with a potential for pregnancy. In recent years, transcatheter arterial embolization has emerged as a simple, useful and effective technique in managing IRAAs. The procedure is performed by transfemoral catheterization as well as by superselective catheterization and embolization of interlobar arteries with 3F microcatheters. Endovascular occlusion is obtained by using gelatin sponge, steel coils, detachable baloons, and conventional non-detachable microcoils delivered through a microcatheter. Nephrectomy or partial nephrectomy are reserved for conditions precluding renal revascularization which include overt RAA rupture, covert RAA rupture, artery-to-vein fistula, renal cell carcinoma, end stage nephropaty, renal infarction, severe ischemic renal atrophy or complex intrarenal aneurysms. Recently, partial nephrectomy by the laparoscopic approach has been proposed for managing IPRAAs and the procedure is considered feasible and safe.
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PMID:Intraparenchymal renal artery aneurysms. Case report with review and update of the literature. 1578 17

A 70-year-old man had been obese since youth. He had been treated for hypertension and diabetes mellitus. An abdominal ultrasound showed a mass in the liver. He was admitted to St Marianna University School of Medicine Hospital for further evaluation. There was no history of alcohol use, and hepatitis viral markers and autoantibodies were all negative. Several imaging studies showed overt hepatocellular carcinoma (HCC). Transcatheter arterial embolization was performed, followed by surgical resection. Histopathological examination revealed moderately differentiated HCC. The non-tumor areas had pseudolobules in a diffuse pattern similar to alcoholic cirrhosis. The histological findings in the ectopic liver tissue attached to the gallbladder, which was also resected during surgery, were that there was no cirrhosis, but fine fibrosis with inflammatory cell infiltration of sinusoids. These findings were consistent with non-alcoholic steatohepatitis (NASH). There was probably a progression of similar findings that had developed into cirrhosis. These findings confirmed a diagnosis of HCC, cirrhosis, and underlying NASH in this patient. The present case is important for investigation of the development into cirrhosis and carcinogenesis of NASH. The present case demonstrates the importance of evaluating obese patients with fatty liver for underlying NASH and ongoing follow up for development of cirrhosis and HCC.
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PMID:Hepatocellular carcinoma with silent and cirrhotic non-alcoholic steatohepatitis, accompanying ectopic liver tissue attached to gallbladder. 1639 79

A 63-year-old male patient was admitted for the treatment of malignant pheochromocytoma with multiple liver metastases. Plasma and urinary levels of catecholamines were elevated. Transcatheter arterial embolization (TAE) with concomitant administration of mitomycin C and gelatin sponge was performed for the treatment of liver metastases. Dose of alpha-1 blocker before TAE was increased to prevent hypertensive crisis during and after TAE. The hepatic metastatic lesion of CT findings was decreased after TAE. Although blood pressure showed a transient hypertension (180/100 mmHg) after every TAE, it returned rapidly to normal. The patient experienced transient abdominal pain, nausea, and loss of appetite after every TAE; however, those symptoms were readily controlled by conventional medications. Slight elevation of liver transaminases was recognized but returned to normal range within 3 weeks. No other major side effects were seen with TAE. While plasma and urinary level of catecholamines were unchanged, plasma chromogranin A (CgA) level was significantly decreased. These results suggest that TAE is a useful treatment for hepatic metastases. Plasma CgA level is a useful marker in the treatment of malignant pheochromocytoma.
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PMID:Transcatheter arterial embolization for the treatment of liver metastases in a patient with malignant pheochromocytoma. 1654 73

A 71-year-old man was referred to our hospital because of hematuria. A computed tomography scan showed a huge aneurysm (43 x 32 x 30 mm) in the right kidney. The patient was treated successfully with transcatheter arterial embolization (TAE) using detachable steel coils. At present, 1 year after TAE, the patient has no hematuria and hypertension. To our knowledge, this case is the second largest aneurysm treated successfully by TAE.
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PMID:Large renal aneurysm successfully treated by percutaneous embolization using detachable steel coils. 1688 70

A 60-year-old male patient with hypertension was referred to our hospital because of insufficient blood pressure control (190/98 mmHg) and to rule out secondary hypertension. A computed tomography scan revealed no adrenal tumor but a large liver mass (5 x 5 cm), and magnetic resonance imaging showed a high signal intensity lesion on the T2-weighted image. Twenty-four hour urinary excretion of catecholamine metabolites was markedly increased, although a 123I-metaiodobenzyl guanidine (MIBG) scintigram failed to show accumulation in the hepatic mass, and no difference was noted between the catecholamine concentration in the tumor-drainage vein and that obtained from the vein draining from the non-tumor area. Liver biopsy did show features compatible with pheochromocytoma (i.e., chromogranin A-positive cells). Transcatheter arterial embolization of the liver tumor was conducted and resulted in a marked (50%) decrease in the 24-h urine normetanephrine excretion. Several metastatic foci were noted in the spinal bone and transcatheter arterial embolization (TAE) was also conducted with successful results. Thus, we experienced a case of primary malignant hepatic pheochromocytoma with negative 123I-MIBG scanning.
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PMID:Primary malignant hepatic pheochromocytoma with negative adrenal scintigraphy. 1704 68

Nine patients with hepatocellular carcinoma (HCC) in nonalcoholic steatohepatitis (NASH) (six men and three women, median age 71.5 years) and one patient with intrahepatic cholangiocarcinoma (ICC), a 50-year-old man, in NASH are described. Most patients were associated with obesity, diabetes, hypertension, hypercholesterolemia, or hypertriglyceridemia. Seven patients showed insulin resistance and hyperinsulinemia. All patients except one met the criteria for metabolic syndrome. An HCC or ICC diagnosis was confirmed by tumor biopsy, surgery or autopsy except in two patients, who were diagnosed by computed tomography or hepatic angiography. The underlying liver disease was liver cirrhosis in six patients and chronic liver disease including mild hepatic fibrosis in four patients. The treatment of liver cancers consisted of surgery, radio-frequency ablation (RFA), transcatheter arterial embolization and transcatheter arterial infusion. Although the follow-up period was relatively short (median 27.5 months, average 32.1 months), all postoperative and post-RFA patients have not had a recurrence of HCC to date, except for one patient who had a palliative operation with intra-arterial infusion of anticancer drugs through an implanted reservoir port. Older age and liver cirrhosis are considered risk factors for HCC in NASH, and regular screening of these patients is necessary. Diabetes may contribute to the development of ICC in NASH. Curative therapy (surgery or RFA) and weight loss by the active therapeutic intervention (nutritional care and exercise therapy) after curative therapy may help us improve the prognosis of HCC in NASH.
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PMID:Primary liver cancers with nonalcoholic steatohepatitis. 1787 5

Pulmonary sequestration (PS) is a rare congenital malformation of the lower respiratory tract. The exact natural course of PS is not well understood and there are no well-established treatment guidelines for antenatally diagnosed PS. The aim of this study was to describe clinical outcomes in neonates with PS and to evaluate the efficacy of transumbilical arterial embolization (TUE). From 1998 to 2006, total 30 neonatal cases were included. Serial antenatal ultrasound in 26 cases found 6 (23%) regressed lesions, all of which were demonstrated on postnatal chest CT. Six (20%) cases were classified as mixed-type (combined cystic) lesions. Surgery was performed early (during initial hospitalization) in two cases and lately (after the neonatal period) in four cases. TUE was performed for 17 (57%) cases of intrapulmonary PS. Follow-up images obtained a median of 19 months (range, 4-51) after TUE demonstrated complete (9, 53%), partial (5, 29%), and no (3, 18%) regression. The regression rate was significantly higher in solid-type lesions (13/13, 100%) than in mixed-type (1/4, 25%) (P = 0.006). Complications included transient hypertension (two cases, 12%), post-embolization fever (two cases, 12%) and migration of a microcoil (one case, 6%), without long-term morbidities. Natural courses could be observed in 10 cases of extralobar PS and regression was observed in 2 cases (20%) during a median follow-up of 12 months (range, 6-45). A well-designed comparative study is warranted to evaluate the long-term efficacy and safety of TUE.
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PMID:Neonatal pulmonary sequestration: clinical experience with transumbilical arterial embolization. 1830 35

Intraparenchymal renal artery aneurysms in the renal artery are rare in the general population. Prevalence range from 0.01 to 1.0%, women are more often affected and the predominant location is the right kidney. Several complication have been described, hypertension, dissection, thrombosis, renal infarction and spontaneous rupture. Here, we report a case of an aneurysm of a branch of the left renal artery diagnosed after gross haematuria. Selective intra-arterial embolization leads to the thrombosis of the aneurysm and the disappearance of haematuria.
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PMID:[Macroscopic hematuria and artery aneurysm]. 1983 18

A complex dural arteriovenous fistula (dAVF) may require complex treatment strategies to achieve successful obliteration. We describe a combined open surgical and endovascular approach to a dAVF involving the superior sagittal sinus (SS) and torcula. A 68-year-old male with Factor V Leiden mutation presented with altered mental status from venous hypertension secondary to a complex, high-flow Borden III dAVF with internal carotid and bilateral external carotid artery feeders draining into the SS and torcula. Because the venous channel to the recipient SS at the point of convergence of the AV shunting was not accessible transfemorally due to venous stenosis, a surgical strategy using a midline burrhole for direct catheterization of the SS was devised. A balloon was inflated in the sinus during arterial embolization. This technique was effective in achieving embolization of multiple arterial feeders via a single vessel injection. Covered Atrium iCasts were introduced in a telescoping fashion after angioplasty of the posterior SS-torcular junction in an attempt to functionally occlude further AV shunting. Postembolization angiography revealed greatly diminished AV shunting with improved intracranial transit time and retrograde cortical venous drainage. The patient was maintained on anticoagulation and made a complete recovery following the intervention; however, he subsequently deteriorated acutely, and died on postprocedure day 4. This case illustrates the difficulties associated with treating a complex AVF, describes a temporizing solution, and reports a potential complication from placing a covered stent in the SS.
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PMID:Combined surgical and endovascular approach to a complex dural arteriovenous fistula involving the superior sagittal sinus and torcula. 2088 86


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