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

In contrast to type A aortic dissection, the indication for acute surgical repair as treatment of choice in type B aortic dissection is not the actual dissection, but the complications resulting from the dissection (rupture, potential rupture and ischemic syndromes of the aortic branches). Between 1978 and 1994, 92 patients underwent surgical repair of type B aortic dissection at our institution. Following diagnostic confirmation by echocardiography and/or CT scan, all patients received conservative antihypertensive therapy. 52% of the patients underwent emergency surgical repair. Symptoms prompting surgical repair were: visceral ischemia (23%), pleural effusion (19%), paraparesis (17%), refractory hypertension (12%), further aortic enlargement (12%), and rupture (10%). In chronic type B aortic dissection, the main symptom in 84% of the cases was further enlargement of the aorta. The early mortality decreased in the course of initial treatment from 33% to 16%, and to 8% after exclusion of patients operated on for ruptured aorta. Improved early mortality has led to an increase in acute surgical repair. In cases of chronic dissection, strict antihypertensive therapy is indicated and regular checks on the width of the aorta, as well expeditious diagnostic confirmation of its enlargement, are important.
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PMID:[Early results in the surgical treatment of type B aortic dissection]. 915 26

Twelve heart transplant recipients were admitted to the rehabilitation unit (RU) of a tertiary general hospital during a five-year period. Demographic, medical, and functional data were collected on these patients in a prospective and retrospective chart review. Functional status of each patient was assessed at both admission and discharge by means of the Modified Barthel Index (MBI). All transplant patients admitted to the RU were male, with an average age of 58 (range, 48-64) years. The mean MBI at admission was 57 (range, 31-75), and mean MBI at discharge was 86.5 (range, 55-100). The difference between the mean MBI admission score and that at discharge was demonstrated to be statistically significant (P < 0.001) using the paired t test. The average length of stay on the RU for the 12 patient cohort was 26 (range, 10-63) days. Ten of the 12 patients (83%) were discharged from the RU to the community. Two patients had to be transferred back to the acute care units after developing significant medical problems. Of the patients who returned to the community, the average number of medications at discharge was nine (range, 7-13), with all patients taking prednisone and cyclosporine. At the time of admission, all patients presented with numerous secondary medical problems. Six patients (50%) had hypertension, which required a medical regimen for control. Five patients had either inadequate oral intake or swallowing problems, thus requiring a feeding tube. In four of the five patients, the feeding tube was able to be removed during the RU course. Seven patients had associated neuromuscular deficits, which included hemiparesis (2 patients), paraparesis (1 patient), and myopathy (1 patient). Four patients were found to have pressure sores on admission to the RU, three of whom were completely healed by the time of discharge. Two of the patients had affective disorders that required follow-up by the psychiatry service during their stay on the RU. One patient was found to have radiographic evidence of a vertebral compression fracture but no other recipients had known fractures, osteoporosis, or osteopenia. As well as discussing the above data, the authors will also review basic exercise guidelines for cardiac transplantation patients.
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PMID:Rehabilitation after cardiac transplantation. Case series and literature review. 920 13

Data were analyzed from 581 consecutive cases of thoracoabdominal aortic aneurysm (TAAA) repairs. Preoperatively, 32 patients (6%) had only one functioning kidney (single-kidney group), and 549 patients (94%) had tow functioning kidneys (reference group). The patients' mean age was higher in the reference group (64.9 years, range: 21-85) than in the single-kidney group (63.2 years, range: 38-79); p < 0.05. However, there was a significantly higher incidence of hypertension (97% versus 78%), coronary artery disease (50% versus 34%), and renal artery stenosis ipsilateral to functioning kidneys (88% versus 26%) in the single-kidney group than in the reference group; p < 0.05. Preoperatively, renal insufficiency (serum creatinine > or = 2.5 mg/dl or patients on dialysis) was present in four patients (13%) in the single-kidney group and in 21 patients (4%) in the reference group; p < 0.05. In the former group, the unilateral loss of kidney function was secondary to atrophy in 30 patients (94%) and agenesis in two patients (6%). The simple clamp-open distal anastomosis technique was employed in the majority of the cases in the single-kidney group (91%) and in the reference group (83%); p > 0.05. Renal artery endarterectomy or bypass ipsilateral to functioning kidneys was performed on 18 patients (56%) in the single-kidney group and 68 patients (12%) in the reference group; p < 0.05. Renal perfusion with cold Ringer's lactate solution was done in 18 cases (56%) in the single-kidney group and 228 cases (42%) in the reference group; p > 0.05. There was no difference in the operative mortality (9% versus 7%) and the incidence of paraplegia/paraparesis (6% versus 5%) between the single-kidney group and the reference group; p > 0.05. Postoperatively, new onset renal insufficiency developed in 10 patients (31%) in the single-kidney group, and 58 patients (11%) in the reference group; p < 0.05. In the single-kidney group, four patients (13%) had mild renal dysfunction (serum creatinine > or = 2.5 mg/dl), and two patients (6%) were on dialysis on discharge. Notably, there was no significant difference in the incidence of renal insufficiency on admission compared to the incidence of renal insufficiency on discharge in the single-kidney group (13% versus 19%; p > 0.05). TAAA repair in patients with one functioning kidney can be performed safely. Postoperative renal insufficiency can be managed successfully in the majority of patients.
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PMID:Thoracoabdominal aortic aneurysm repair in patients with single kidney. 951 27

As any other organ, the spinal cord also suffers in chronic congestion. Since the epidural venous system drains into the vena cava system and participates in collateral circulation, there is increased inflow with impaired blood flow along its large tributaries in the vertebral canal along with poor outflow, resulting in intracanal hypertension and chronic congestion. Venous hemodynamic disorders are found beyond the vertebral canal and detected by selective phlebography of the large tributaries of the vena cava system. The technique was used to examine 46 patients with spastic paraparesis or tetraparesis of unclear etiology, which provides evidence for the fact that vena cava stenoses, compressions, atresia, and thromboses can be responsible for impaired venous hemodynamics in the vertebral apparatus and its surgical correction is possible.
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PMID:[The selective phlebography of the large tributaries of the vena cava system in the diagnosis of venous circulatory disorders in the spinal complex]. 1042 May 38

Chronic subdural haematomas are mainly related to slight or moderate head trauma with consecutive lesion of bridge or cortical veins and bleeding in the subdural space. Further predisposing factors are known impairment of coagulation (coagulopathies, treatment with anticoagulants, alcohol abuse), risk factors for degenerative disease of the arteries (diabetes mellitus, arterial hypertension), and development of pressure gradients (hydrocephalus, epileptic seizures, lumbar puncture, CSF drainage and cerebral atrophy). Chronic subdural haematomas appear bilaterally in 20 to 25% of cases. We report on a 69-year-old male with a 4-day history of intermittent, proximal, painless paraparesis (BMA grade M2-5) without a trigger event. Sensibility was normal in all qualities and vigilance was not disturbed. Computed tomography of the neurocranium revealed a bitemporally located chronic subdural haematoma with extension to parietal on both sides. Trepanation was performed over the tuber parietale and temporoparietally on both sides, with release of 150 ml fluid. The neurologic deficits regressed totally within 12 hours postoperatively. To the best of our knowledge, we are the first to describe the clinical paradox of intermittent, painless paraparesis with preserved sensibility and without disturbances of vigilance, as manifestation of a chronic subdural haematoma possibly leading to impairment of cerebral blood flow in the area of the middle cerebral artery. Small changes in systemic blood pressure lead to changes in cerebral perfusion pressure due to vessel compression by the haematoma, thus explaining the intermittent character of the clinical presentation.
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PMID:[Intermittent paraparesis as manifestation of a bilateral chronic subdural hematoma]. 1046 9

Primary leptomeningeal lymphoma (PLML) is a rare disease. The most common presentation is symptoms of increased intracranial pressure. Confusion, dysarthria, hearing loss, paraparesis and lumbosacral spinal root symptoms have also been reported. Chemotherapy and radiotherapy have been tried, but its prognosis is usually poor. We experienced a case of PLML with a relatively benign course in an 18-year-old girl. Initial diagnosis was made as idiopathic intracranial hypertension. Lumbosacral shunt was done with good response for 3 years. When headache recurred, she was reevaluated and was correctly diagnosed as PLML.
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PMID:Primary leptomeningeal lymphoma with long-term survival: a case report. 1102 96

A prospective study of patients with acute aortic occlusion (AAO) admitted to the Vascular Unit, Hospital Kuala Lumpur was carried out over a 12 month period. There were a total of 11 patients admitted with a clinical diagnosis of AAO. There was a male preponderance with 10 patients. The median age was 58 years (40-70 years). Hypertension was the commonest underlying medical illness (n = 7). All patients had painful lower limb paraparesis or paraplegia with bilateral absent limb pulses from the groin downwards on admission to the vascular unit. The majority of patients (10 patients) were referred from other hospitals, of which 6 patients came from outside the Klang Valley. Only eight (8) patients underwent an operative procedure with seven (7) having an initial bilateral balloon catheter thromboembolectomy. There was one (1) aorta-bifemoral bypass after failed embolectomy. An aneurysectomy with inlay-graft was done as the initial procedure in one (1) patient. Mortality was 82% (9/11). The two survivors were in the group that had vascular reconstructive surgery. Acute aortic occlusion is an uncommon but catastrophic event with a high mortality. Clinicians must have a high index of suspicion in patients who present with painful paresis or paraplegia. Clinical examination of peripheral pulses in these patients is mandatory. Early diagnosis and treatment is important to improve the outcome of this disease.
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PMID:Acute aortic occlusion: the need to be aware. 1107 87

Intrathecal administration of baclofen has proved to be an effective treatment of spasticity related to CNS damage. Especially patients with spinal spasticity due to traumatic spinal cord injury or transverse myelitis showed a dramatic reduction of spasticity and improvement of their Ashworth scores. The results are, however, often disappointing in patients with muscular hypertension of the extensor muscles, which is frequently found in patients with multiple sclerosis or cerebral hypoxia. In the latter, using intrathecal baclofen may be restricted by serious side effects. Botulinumtoxin A is widely used in patients with various forms of dystonia. It has also been studied in spastic disorders, where local injections were valuable in relieving focal spasticity in hemiparetic patients and in infantile cerebral palsy. It is used only cautiously in severe paraspasticity. The case reports of 4 patients with incomplete and complete paraparesis due to spinal cord injury, neurodegenerative pyramidal disorder, and cerebral hypoxia demonstrate that a combination of intrathecal baclofen and botulinumtoxin A can improve clinical benefits and reduce side effects.
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PMID:[Optimized therapy of spastic syndrome by combination intrathecal baclofen with botulinum toxin]. 1113 87

An elderly lady developed an epidural hematoma following combined spinal-epidural anesthesia with a local anesthetic-opioid mixture for a vaginal hysterectomy. This occurred in association with the use of prophylactic subcutaneously administered unfractionated heparin. She had diabetes, hypertension and had previously undergone coronary artery bypass surgery and right carotid endarterectomy. Warfarin and aspirin were discontinued 2 weeks before the surgery. Postoperatively, an atypical presentation of backache, bilateral sensory loss and left lower limb monoplegia ensued. The initial clinical impression was of a cerebrovascular accident. Magnetic resonance imaging, however, revealed an extensive epidural hematoma that necessitated decompression laminectomy. Progression to paraparesis occurred but the patient gradually regained much of her functionality over the next 2 years.
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PMID:Postoperative epidural hematoma or cerebrovascular accident? A dilemma in differential diagnosis. 1194 75

A painful worsening of known difficulties in walking led us to investigate a man who presented a spastic paraparesis. Radiological investigations had to be repeated three times before making a diagnosis of a right C6 spinal dural arteriovenous fistula after a 22-month follow-up. Knowing the mechanisms leading to spinal venous hypertension may explain the low yield of the early radiological investigations that should be repeated. The efficiency of the treatment depends on the severity of the presurgical neurologic manifestations.
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PMID:[Chronic progressive myeloradiculopathy in a 61-year-old man]. 1245 45


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