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)

A 15-year experience with 27 patients, 20 to 75 years of age, with refractory venous stasis ulcers is presented. All patients had been managed with support hose, elevation, elastic wraps, Unna's paste boots, and graduated compression stockings. Because of multiple recurrences of their ulcers, the patients were offered surgical treatment to reduce the venous hypertension in the areas of ulceration. The 27 patients had 32 modified Linton procedures. Five had bilateral procedures. At the time of operation, 18 limbs had medial malleolar ulcers, five had bimalleolar ulcers, four had lateral ulcers, three had posterior ulcers, and two patients were free of ulcer. Medial incisions were used in 20 limbs, lateral incisions in six, medial and lateral incisions in three, and midposterior incisions in three. Split-thickness skin grafts were placed on six limbs the day of surgery and on 22 limbs 4 to 7 days later. Postoperative complications included deep venous thrombosis in two, partial flap necrosis in three, and cellulitis of the lower leg in three patients. Follow-up has ranged from 6 months to 10 years. During the most recent clinic visits, 21 limbs were completely healed, whereas six limbs had a recurrence of the ulcer. Five patients have been lost to follow-up. The good long-term results in 78% of the cases indicate that patients with recurrent venous stasis ulcers may receive lasting benefit from modified Linton procedures.
 ...
PMID:Surgical management of refractory venous stasis ulceration. 334 63

One of the most common and effective treatments for venous stasis ulcers (VSUs) is the Unna boot dressing (UBD), first described by Unna in the 1890s. No one technique for UBD application has been documented by research to be the most effective for ulcer healing. This article discusses the open-heeled UBD application technique. Twelve patients with 17 VSUs that have been treated with the open-heeled UBD application technique are reviewed. The patients were primarily treated by the first author. Detailed patient education instructions are given. The open-heeled UBD is easier to apply patients are more comfortable and can fit into their normal shoewear condition of the heel can be monitored while the UBD is in place, and specially trained practitioners can apply UBDs with minimal to no compression on patients with concomitant venous arterial insufficiency. Ambulatory patients can also maintain greater ankle mobility during treatment. This may have important implications for activating the muscle pump under compression, which can facilitate blood return and reduce venous hypertension while the patient with venous stasis ulcer is ambulatory. The open-heel method may also allow greater mobility of the ankle that can help prevent "frozen" ankles associated with VSUs.
 ...
PMID:Experience with open-heeled Unna boot application technique. 923 44

Venous stasis ulcers of the lower extremity are a common problem usually treated successfully with conservative measures or skin grafting. However, for a minority of wounds that are refractory to standard therapy, microsurgical flap reconstruction has been used to introduce new tissue with its own healthy microvenous system. This retrospective study analyzes the long-term outcome of venous ulcers treated with free tissue transfer. Between 1983 and 1993, 14 free flap reconstructions of chronic leg wounds were performed (mean follow-up, 5.4 years). A complication rate of 43% occurred in the postoperative period, with two complete flap failures. Development of new ulcers was noted in all patients by an average of 17.2 months. In all patients the ulcers developed in previously intact skin, usually at the margin of the flap, but in some instances they developed distant to the original area of involvement. It is inferred that the ongoing effects of venous hypertension in the leg lead to ulcer recurrence, and therefore the widest possible resection of all chronically inflamed tissue around the ulcer is recommended. This report suggests that microsurgical flap reconstruction is a palliative measure for venous stasis ulcers, rather than a permanent solution. However, even with recurrent ulceration, many of the patients appeared to have had some symptomatic improvement from the use of free flaps.
 ...
PMID:Long-term results following free tissue transfer for venous stasis ulcers. 971 45

The purpose of this study was to analyze outcome following malabsorptive distal gastric bypass (D-GBP) in superobese patients who were reoperated for recurrent obesity comorbidity after a failed standard gastric bypass (S-GBP). Twenty-seven formerly superobese patients with a failed S-GBP converted to a D-GBP were studied. The small bowel was anastomosed 250 cm from the ileocecal valve to the disconnected Roux limb; the bypassed small intestine was connected to the ileum 50 cm from the ileocecal valve in five patients between 1985 and 1986 and 150 cm from the ileocecal valve in 22 patients thereafter. Comorbidity was reassessed yearly following conversion to D-GBP. Malnutrition occurred in all five patients with a 50 cm "common tract"; all required further revision and two died of hepatic failure. Three of 22 patients with a 150 cm common tract were reoperated with bowel lengthening because of malnutrition. Initial body mass index was 57+/-2 kg/m2 and fell from 46+/-2 kg/m2 before revision to 37+/-2 kg/m2 at 1 year and 32+/-2 kg/m2 at 5 years after revision; the percentage of excess weight lost went from 30+/-4% to 61+/-4% at 1 year and 69+/-5% at 5 years after revision. Preoperative comorbidity in patients undergoing revision included 14 with insulin-dependent type II diabetes mellitus, 11 with sleep apnea, 14 with hypoventilation, 13 with hypertension, and two with venous stasis ulcers. Obesity comorbidity was corrected within 1 year in all but two patients with hypertension and remained stable in all patients followed for 5 years. Revision of a failed S-GBP to a 150 cm common tract D-GBP corrects failed weight loss and severe obesity comorbidity but requires nutritional support to prevent protein-calorie malnutrition, iron and fat-soluble vitamin deficiencies, and further revision in some patients to correct malnutrition. A 50 cm common tract has an unacceptable morbidity and mortality.
 ...
PMID:Conversion of proximal to distal gastric bypass for failed gastric bypass for superobesity. 983 87

This article gives an overview, citing animal and clinical studies, of the effects of increased intra-abdominal pressure (IAP) in severe obesity. Animal studies demonstrate that increased IAP increases pleural pressure, cardiac filling pressures, femoral venous pressure, renal venous pressure, systemic blood pressure, and vascular resistance, renin and aldosterone levels, and intracranial pressure. Thus, the comorbidities presumed secondary to increased IAP in obese patients include congestive heart failure, hypoventilation, venous stasis ulcers, gastroesophageal reflux, urinary stress incontinence, incisional hernia, pseudotumor cerebri, proteinuria, and systemic hypertension.
 ...
PMID:Effects of increased intra-abdominal pressure in severe obesity. 1158 45

CGRP is a potent vasodilator that has been shown to have a physiological and/or pathological role in neurogenic inflammation, headaches including migraine, thermal injury, circulatory shock, pregnancy and menopause, hypertension and heart failure and is known to be cardioprotective. CGRP is also a positive inotrope and increases heart rate. Clinical trials have shown beneficial effects of the vasodilatory action of CGRP in hypertension, angina, heart failure, Raynaud's disease and venous stasis ulcers. However, the clinical potential of CGRP is limited as it has to be given by infusion and is quickly broken down. Oral long acting CGRP-mimetics may have potential in disorders in which CGRP has been shown to be beneficial. CGRP-mimetics include capsaicin/vanilloid receptor agonists and gene transfer of an adenoviral vector that encodes prepro-CGRP. CGRP inhibitors have therapeutic potential in conditions in which excessive CGRP-mediated vasodilatation is present; neurogenic inflammation, migraine and other headaches, thermal injury, circulatory shock and flushing in menopause. CGRP inhibitors include capsaicin, antagonists at capsaicin/vanilloid receptors, civamide, CGRP receptor antagonists and 5-HT1D-receptor agonists. Drugs that are 5-HT1D-receptor agonists, the 'triptans' are already commonly used in migraine and the first small molecule CGRP antagonist, BIBN4096BS, is under clinical investigation for the treatment of migraine.
 ...
PMID:Migraine and beyond: cardiovascular therapeutic potential for CGRP modulators. 1177 40

Morbid obesity is a serious disease that is responsible for several co-morbid conditions. Increased risks of hypertension, adult onset diabetes mellitus, dyslipidemia, pulmonary disease (Pickwickian syn- drome), musculo-skeletal disorders, gallbladder disease, deep vein thrombosis, venous stasis ulcers, and increased prevalence of certain types of cancers (uterine, breast, colon carcinoma) have been reported, ( together with severe psychological and social disability.' Nonsurgical treatment options including various combinations oflow-calorie or very-low-calorie diets, behavior modification, exercise, and drug therapy may achieve acceptable transient weight reduction but fail to maintain reduced body weight in most patients.'
 ...
PMID:Laparoscopic adjustable silicone gastric banding (LASGB) for the treatment of morbid obesitiy. 1585 31

Obesity both in adults and children has emerged as a worldwide epidemic. Obesity is associated with an increased risk of a number of comorbidities including type 2 diabetes mellitus, hypertension, dyslipidemia, obstructive sleep apnea, certain types of cancer, degenerative joint disease, non-alcoholic fatty liver disease, reflux esophagitis, stroke, coronary heart disease, venous stasis ulcers, cholelithiasis, erectile dysfunction and polycystic ovary syndrome. It is now generally accepted that bariatric surgery procedures induce long-term weight loss and offer resolution or dramatic improvement in numerous comorbidities of obesity, including type 2 diabetes mellitus, hypertension and dyslipidemia. These effects mainly arise from endocrine changes resulting from the gastrointestinal surgical procedures. The aim of this short review was to evaluate the pros and cons of bariatric surgery for morbid obesity seen from the perspective of a practicing endocrinologist.
 ...
PMID:The pluses and minuses of bariatric surgery for morbid obesity: An endocrinological perspective. 2290 56

Acute deep vein thrombosis (DVT) is associated with significant morbidity in the form of acute limb-threatening compromise from phlegmasia cerulea dolens, development of the postthrombotic syndrome (PTS), and even death secondary to pulmonary embolism. Initial therapy for DVT is anticoagulation, which inhibits thrombus propagation but lacks the thrombolytic properties to facilitate active thrombus removal. The existing thrombus burden can cause increased venous hypertension from occlusion as well as damage to venous valves by initiating an inflammatory response, which can ultimately result in PTS in up to half of patients on anticoagulation. The manifestations of PTS include leg pain, swelling, lifestyle-limiting venous claudication, skin hyperpigmentation, venous varicosities, and, in rare cases, venous stasis ulcers. Furthermore, patients with iliocaval DVT and large, free-floating thrombus are at an increased risk for pulmonary embolism despite adequate anticoagulation. Early attempts at thrombus removal with surgical thrombectomy or systemic thrombolysis or both demonstrated reductions in the incidence of PTS but were of limited utility owing to their invasiveness and increased risk of bleeding complications. New minimally invasive endovascular therapies, such as pharmacomechanical catheter-directed thrombolysis, have been proposed, which focus on rapid thrombus removal while decreasing the rate of bleeding complications associated with systemic therapy. This article provides an overview of the current pharmacomechanical catheter-directed thrombolysis protocol utilized at the Mount Sinai Hospital for acute iliocaval DVT.
...
PMID:Catheter-directed interventions for acute iliocaval deep vein thrombosis. 2484 Sep 64

Pseudohyperaldosteronism, or Liddle syndrome, is a rare, autosomal dominant condition characterized by early-onset hypertension, often associated with hypokalemia and metabolic alkalosis. Martorell hypertensive ischemic leg ulcer is a rare, underdiagnosed ulcer characterized by subcutaneous arteriolosclerosis, classically appearing over the dorsolateral lower extremity or Achilles tendon in patients with hypertension and diabetes. It presents an important diagnostic challenge because it can appear grossly similar to other entities such as pyoderma gangrenosum or venous stasis ulcers, but requires surgical intervention. This article presents a case study of surgical management of a Martorell ulcer in a 69-year-old woman with Liddle syndrome. To the authors' knowledge, this is the first case reported in the literature of this rare ulcer occurring secondary to this rare cause of hypertension.
 ...
PMID:A Novel Association of Martorell Ulcer With Liddle Syndrome. 3162 69


1