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

A review of the literature on Spontaneous Dissecting Aneurysms (DA's) of cerebral arteries is presented with 3 personal cases of DA's of the Internal Carotid Artery (ICA). Patients with spontaneous DA's of the extracranial ICA are of middle age (30 to 60 year old) and present with an ipsilateral pain in the neck or face and/or with TIAs (45 p. 100 and 50 p. 100 of the cases respectively). Claude Bernard-Horner's sign is frequent. The clinical, radiological and pathological data suggest that in most cases, if not all, neurological deficits are due to embolism and/or anterograde thrombus. This has led to recommend anticoagulant therapy. Nevertheless, surgery may be indicated is some situations such as in DA's on kinking arteries. The treatment of spontaneous DA's of extracranial vertebral arteries is still a detectable matter, though they have common features with DA's of the extracranial ICA. The DA's of the basilar and intracranial vertebral arteries are often associated with a subarachnoid haemorrhage and most of them have a severe outcome. Lesions of the arterial wall such as cystic medial necrosis and fibromuscular dysplasia play a role in the extent, and presumably in the initiation, of the so-called spontaneous DA's at least in some cases. Minor trauma, high blood pressure (20 p. 100 of the cases), oral contraceptives and coughing have been as well suspected.
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PMID:[Spontaneous dissecting aneurysms of the cerebral arteries]. 636 8

The purpose of this study was to investigate the nature of the serotonin-induced coronary chemoreflex in the conscious monkey. Ten chronically prepared and four acute monkeys were used in this study. Five chronically prepared animals had catheters in the left atrium, ascending aorta, descending aorta, and, bilaterally, in the common carotid arteries. In addition, Silastic catheters were placed next to both vagi to permit vagal block with 2% lidocaine. Serotonin was injected (12-200 micrograms/kg) into the left atrium, ascending aorta, descending aorta, or, bilaterally, into the carotid arteries while blood pressure, heart rate, and respiratory movements were recorded. Injections of serotonin were associated with hypertension and bradycardia followed by tachycardia, all of which were preceded by a cough response. Atropine blocked the bradycardia, whereas atropine and phentolamine eliminated the cardiovascular components of the reflex. Vagal blockade eliminated the bradycardia but otherwise did not alter the response to left atrial serotonin. Three monkeys were prepared with aortic and left atrial catheters. Subsequently, they were subjected to sinoaortic deafferentation. Serotonin injected into these animals did not alter blood pressure or respiration. The results of this study show that serotonin injected into the left atrium of the conscious monkey produces respiratory and cardiovascular alterations by its effect on aortic and carotid chemoreceptors, and that there is no coronary chemoreflex in the conscious monkey.
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PMID:Is there a serotonin-induced hypertensive coronary chemoreflex in the nonhuman primate? 640 20

Following its approval for use in man, an unblinded, unrandomized epidemiological study of isoflurane anaesthesia was undertaken in the United States and Canada. The haemodynamic and reflex behaviour of 6798 patients were compared with their demographic characteristics and the anaesthetic drugs used. The decrease in arterial pressure and the increase in heart rate during isoflurane anaesthesia were confirmed. Intraoperative arrhythmias were most often associated with a history of similar arrhythmia before operation, as well as the occurrence of intraoperative hypertension. Airway reflexes were the predominant form of reflex activity identified, with coughing being the most frequently observed reflex. Serious complications were infrequent, and were unrelated to the use of isoflurane as the anaesthetic agent. The safety and efficacy of isoflurane anaesthesia in man was confirmed.
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PMID:Clinical anaesthesia with isoflurane. A review of the multicentre study. 650 72

Using two infusion anaesthesiamethods for laryngomicroscopy in 187 non-selected patients we studied the recovery phase with the aid of a special questionnaire filled in by the recovery room nurse. Premedication was with Thalamonal and atropine. Muscle relaxation was achieved by a succinylcholine drip. Induction doses: fentanyl 0.05-0.1 mg and thiopental 3-5 mg/kg bodyweight (Th-group) or diazepam 10-20 mg and ketamine 1 mg/kg bodyweight (K-group). Infusion doses: Thiopental 11.7 mg/min. (Th-group) or diazepam 0.2 mg/min. and ketamine 2 mg/min (K-group). Anaesthesia lasted for 20-30 min. We observed and noted during recovery: Breathing, cough-frequency and -quality, alertness, reaction to speech and stimulation, orientation, motor behaviour and well-being. Anaesthesia was sufficient in both groups. The patients of the K-group woke up earlier and their laryngeal reflexes seemed to stabilize quicker than in the Th-group. Because of the elevation of blood pressure caused by the stimulation of the laryngoscopy both methods are not recommended for patients at risk from high blood pressure.
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PMID:[Recovery after ketamine-diazepam and thiopental-fentanyl-infusion anesthesia with jet-ventilation for laryngomicroscopy]. 685 95

A child, who had undergone ventriculoperitoneal shunting, presented with repeated episodes of pneumonia and expectoration of CSF. Chest x-ray demonstrated the presence of the shunt catheter in the base of the left lung. In the present case the distal end of the catheter perforated the diaphragm, entering the thoracic cavity through the pleura and penetrating the pulmonary parenchyma. CSF then flowed freely into the alveoli and bronchi and became expectorated during repeated bouts of coughing associated with pneumonia. This respiratory complication disappeared after the removal of the catheter. We theorize that the penetration of the catheter into the thoracic cavity was secondary to its displacement from the iliac fossa to the left infradiaphragmatic space between the spleen and the diaphragm where the intra-abdominal pressure is lowest. The respiratory movements and the hypertension inside the abdomen created a constant friction of the catheter against the diaphragm which was finally perforated, permitting the passage of the peritoneal end of the shunting device into the thoracic cavity and secondary penetration of the lung.
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PMID:[Expectoration of cerebrospinal fluid: an unusual complication of ventriculoperitoneal shunt]. 700 50

Drug therapy of asthma in the elderly with sympathomimetics, theophylline, steroids, and mucokinetic agents is described, with discussion of dosage evaluation, toxicity, possible drug interactions, and suggested management of common problems. The aspirin hypersensitivity syndrome is reviewed, with an admonition to avoid this drug in asthmatic patients who have nasal polyps, nasal obstruction, or sinusitis, especially patients over the age of 30. The treatments of coughs and colds, and common respiratory infections such as tuberculosis and bronchitis, in the elderly are also outlined. Antihistamines are not advised for elderly patients who have viral or bacterial infections of the nose or throat, and oral preparations containing nasal mucosal vasoconstrictors should also be avoided in managing the elderly patient who has hypertension, vascular disease, or prostatism. Cough suppressants must be used with care, especially if cough is associated with chronic obstructive pulmonary disease. Special attention is given to the role of oxygen therapy for chronic obstructive pulmonary disease.
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PMID:Management of respiratory problems in the aged. 713 May 88

In a group of 132 patients with transient ischemic attacks ((TIAs) 7 patients (4 men, 3 women, ages 64 to 81) had TIAs preceded by hypotension. The average fall of mean blood pressure during an attack was 26.4 +/- 5.5 mm Hg (SD). Only one of these patients had a TIA which was not preceded by hypotension. This episode occurred during a paroxysm of coughing. All 7 of these patients had hypertension, and cerebral arteriography performed in 4 of the 7 revealed hemodynamically significant carotid artery stenosis. Each of the 4 patients developed hypotension and a TIA after the procedure. Twenty of the other patients had hypotensive episodes but did not develop focal neurological deficits. None of these patients had carotid artery stenosis. This study suggests that hypertensive patients with carotid artery stenosis may be at risk to develop focal cerebral ischemia during acute hypotensive episodes.
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PMID:Transient ischemic attacks associated with hypotension in hypertensive patients with carotid artery stenosis. 724 1

Despite intensive hydatid control measures in New Zealand, hepatopulmonary fistula resulting from infection by the echinococcus granulosus still occurs. Although the patients may quickly become debilitated from coughing bile and pus and associated septic complications, appropriate surgical therapy is usually effective. The exact diagnosis may be obscure, but it is helped by a high index of suspicion. A retrospective study of eight patients seen over a 27-year period is presented, and principles of management are outlined. Where biliary hypertension is not present adequate evacuation of the intrahepatic cysts, obliteration of the cyst space, freeing of the adherent lung, and closure of the pulmonary fistula(e) usually give satisfactory long-term results. Pulmonary lobectomy or segmental resection is seldom required.
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PMID:Hepatobronchial fistula caused by hydatid disease. The Dunedin experience 1952-79. 729 77

Angiotensin-converting enzyme (ACE) inhibitors are one of the first drugs of choice for the treatment of hypertension. However, there have been many reports of persistent chronic dry cough and inflammatory skin reactions (rash and/or angioedema, etc.) induced by ACE inhibitors. In this study, in order to evaluate the cough and inflammatory reaction, we measured the number of citric acid-induced coughs and the intradermal inflammation with ovalbumin in guinea pigs consecutively treated with ACE inhibitors (lisinopril, enalaprilat and imidapril) for 3 days. The number of citric acid-induced coughs and the inflammatory responses were significantly enhanced by treatment with lisinopril and enalaprilat, whereas imidapril produced no change in either response. These results correspond to the frequency of adverse effects in clinical practice, which suggests that imidapril has the least ability to induce the inflammatory skin response and cough. Furthermore, the enhancement produced by the ACE inhibitors in the number of coughs and the inflammatory responses were significantly reduced by pretreatment with indomethacin (prostaglandin synthesis inhibitor). This finding suggests that PGs at least participate in the mechanism for ACE inhibitor-induced cough and inflammatory skin response.
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PMID:Toxicodynamic analysis of cough and inflammatory reactions by angiotensin-converting enzyme inhibitors in guinea pig. 747 83

Anesthetic care for patients with traumatic brain injury involves an integration of cerebral resuscitation, resuscitation of other vital organs, the provision of "anesthesia," and the prevention of harmful physiologic responses to surgery. Adverse responses to surgery such as hypertension, tachycardia, coughing, and straining can increase intracranial pressure (ICP). Airway manipulations can aggravate spinal cord injury as well as increase ICP. Anesthetic agents can exacerbate hemodynamic instability, increase cerebral blood volume and ICP, and produce respiratory depression. Cerebral resuscitation during surgery resembles that in the preoperative and postoperative periods. ICP measurement and jugular venous saturation monitoring may help define end-points for cerebral resuscitation. Various anesthetic techniques and agents have distinct advantages and disadvantages. The choice of agents and techniques is determined by the nature and severity of the patient's injuries and by pre-existing medical problems. The investigation of drugs that might protect against cerebral ischemia has included anesthetic agents but none appear to be uniformly effective. Intraoperative hypothermia is also being investigated as a cerebral protectant.
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PMID:Anesthesia and head trauma. 749 63


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