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

Systemic childhood polyarteritis nodosa (C-PAN) is a rare primary vasculitis involving medium or small sized arteries. Abdominal angina is an important and serious complication of PAN, occurring usually 15 to 30 min after food intake, and particularly in adult patients. However, to our knowledge, this involvement as the first manifestation of C-PAN was not described. Therefore, we reported herein two C-PAN cases that fulfilled the new criteria for this vasculitis. These patients were young boys that had malignant arterial hypertension and recurrent post-prandial cramping with acute abdomen. Both of them were submitted to laparotomy that revealed multiple and diffuse intestinal necrosis. One of our cases had a severe post-prandial cramping, even after drinking water, and the laparotomy evidenced multiple intestinal perforations. In spite of use of antihypertensive therapies, immunosuppressive agents (corticosteroids, cyclophosphamide and/or methotrexate) and intravenous immunoglobulin, they died possibly due to severe and disseminated activity disease. In conclusion, we described herein the first two fatal cases of C-PAN that presented severe abdominal pain as initial manifestation. We suggest that the diagnosis of PAN should be considered in patients under acute abdominal angina with no apparent etiology.
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PMID:Severe intestinal involvement as initial manifestation of systemic childhood polyarteritis nodosa: report of two cases. 2341 78

We report 2 cases of megacolon associated with cerebrovascular accident and neuropsychiatric drug consumption. Case report 1: a 75-year-old woman with diabetes mellitus, hypertension, tachycardia with atrial fibrillation, bilateral pleural effusions and previous cerebral hemorrhage was admitted in our hospital. She presented clouded sensorium and abdominal distension, with closed alvus. The CT scan showed a distension of the colon, with severe fecal impaction. A volvulus of the sigma was found at surgical intervention.Case report 2: a 59-year-old man with a medical history of oligophrenia was admitted to our hospital for acute abdomen.He presented stupor and closed alvus with abdominal distension. The abdominal CT scan showed a dolichosigma, with fecal impaction. The patient was submitted to a laparotomy and a two millimetres perforation of the sigma was found.The sigma had a diameter of 28 cm and a length of 75 cm.Even if a clear correlation has not been found yet, anomalies of the regulation of the gastro-intestinal motility can occur at different levels in patients with psychiatric or cerebrovascular diseases and drug consumption with anticholinergic properties,and they should be carefully monitored. The purpose is an early diagnosis of colon function anomalies in order to avoid potentially fatal complications.
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PMID:Could the complications of megacolon be avoided by monitoring the risk patients? cases report. 2514 23

Abdominal problems, both as a primary reason for admission or developing as a part of multiple organ dysfunction syndrome during an ICU stay, are common in critically ill patients. The definitions, assessment, incidence and outcome of different abdominal signs, symptoms and syndromes are assessed in the current review. General abdominal signs and symptoms include abdominal pain and distension, as well as other signs assessed during the physical examination (e.g. palpation, percussion). Gastrointestinal (GI) symptoms include vomiting, high gastric residual volumes, diarrhoea, GI bleeding, paralysis of the lower GI tract, bowel dilatation and absent bowel sounds. Although around half of patients suffer from these symptoms, the reported incidences of single symptoms vary within a large range due to variable definitions and case-mix. In a few studies, the total number of coincident GI symptoms was associated with increased mortality. Although acute abdomen is a well-recognized severe syndrome in emergency medicine, its incidence in ICUs is not known. Next to subjective clinical evaluation, intra-abdominal pressure, as a reproducible numerical variable, provides useful assistance in the assessment of the abdominal compartment, whereas intra-abdominal hypertension has been shown to impair the outcome of the critically ill. In conclusion, abdominal symptoms occur in half of patients in ICUs. Clinical evaluation, albeit largely subjective, remains the main bedside tool to detect abdominal problems and to assess GI function in the critically ill. IAP is a useful additional tool in the assessment of abdominal complications in ICUs.
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PMID:Abdominal signs and symptoms in intensive care patients. 2597 64

Thoracic aortic disease is an important contributor to arterial disease and therefore, mortality in the UK. It has close associations with hypertension, atherosclerosis and genetic conditions such as Marfan syndrome. The cardiovascular consequences of acute aortic dissection or the rupture of a thoracic aneurysm are life threatening with a 1% increase in mortality per hour with a type A aortic dissection and a high 30-day mortality rate. The clinical diagnosis can be difficult for the general physician as the symptoms can mimic more common conditions such as acute coronary syndrome, pulmonary embolism or acute abdomen. The investigations that carry the highest sensitivity and specificity, CT, transoesophageal echocardiography and MRI are not usually first-line investigations in most patients so a high index of clinical suspicion is key. The management of acute aortic syndromes involves good initial resuscitation and early discussion with the cardiothoracic surgeons. Given the serious consequences of acute aortic syndromes, it is important for all military doctors to be aware of these presentations and to appreciate the difficulties that can be encountered when trying to accurately diagnose them. Routine medicals, particularly entrance medicals, present a unique clinical opportunity to recognise the clinical features that would warrant further investigation and specialist advice.
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PMID:Thoracic aortopathies in the military patient. 2624 6

Latrodectism following Black Widow envenomation is rare in Canada. We present the case of a previously healthy 50 year old male who presented with an acute abdomen, hypertension, and urinary retention. After a thorough work up it was determined to be as a result of a Black Widow spider bite. Due to climate change we may see more cases of Latrodectism in the future and it should be considered as a differential diagnosis in anyone presenting with an acute abdomen after an insect bite.
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PMID:Acute urinary retention after Black Widow envenomation: a case report. 2903 77


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