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

Five patients with double outlet right ventricle, ventricular septal defect, pulmonary arterial hypertension and pulmonary vascular obstructive disease and three patients with complete d-transposition of the great arteries, ventricular septal defect, pulonary arterial hypertension and pulmonary vascular obstructive disease underwent an elective Mustard baffle operation. The ventricular septal defect was not closed. A large patent ductus arteriosus was divided in three patients. Seven of the eight patients are alive five to 32 months after surgery; one patient died 11 months after surgery. Cyanosis, dyspnea on exertion, and exercise limitation improved initially in all and has persisted in the survivors. In pre and postoperative hemodynamic studies in four patients, systemic arterial oxygen saturation and effective pulmonary blood flow increased from mean values of 70% to 90% and 1.7/min/m2 to 3.3 L/mon/m2, respectively. Absolute systemic and pulmonary flows, and pressures and resistances, were not significantly altered. Criteria for selection of patients with transposition of the great arteries of double outlet right ventricle who would benefit from a palliative Mustard procedure (Mustard atrial baffle without closure of the ventricular spetal defect) are: 1) severe symptoms; 2) pulmonary arteiral hypertension (75% systemic) with pulmonary vascular obstructive disease; and 3) pulmonary artieral oxygen saturation greater than systemic (ascending aorta) arterial oxygen saturation by approximately 10%.
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PMID:The palliative Mustard operation for double outlet right ventricle or transposition of the great arteries associated with ventricular septal defect, pulmonary arterial hypertension, and pulmonary vascular obstructive disease. A report of eight patients. 6 24

21 patients with essential sustained mild or moderate hypertension were treated with timolol for an average of 6 months at a mean dosage of 3,14 tablets per day. The mean decreases of supine systolic and diastolic blood pressures were respectively of 17,8 and 7,3 mm Hg. The efficacy of timolol was considered excellent or good in 11 cases (52,4 p. cent) and its tolerance perfect in 15 cases (71,4 p. cent). The study was extended in 15 cases with one dose of timolol per day. Effectiveness remained excellent in 12 cases. There was neither orthostatic hypotension nor brady-cardia of less than 55 beats per minute nor water retention. Side effects appeared in 6 cases requiring discontinance of therapy in only one case (exertional dyspnea).
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PMID:[A treatment of mild and moderate hypertension with timolol (author's transl)]. 21 1

A 29 year old man experienced exertional dyspnea and coughing 3 1/2 years after insertion of a Brauwald-Cutter aortic valve prosthesis. Clinical examination suggested pulmonary arterial hypertension, and cardiac catheterization revealed a saccular lesion apparently arising from the left ventricular outflow tract and producing compression of the right pulmonary artery. Origin from the left ventricular outflow tract just under the aortic ring was confirmed at operation. The lesion apparently arose from an anular excavation related to previous endocarditis with abscess formation. Reported cases of similar aneurysmal lesions are briefly reviewed, and other known causes of the pulmonary arterial compression syndrome are discussed.
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PMID:Pulmonary arterial compression syndrome caused by false aneurysm of left ventricular outflow tract. 99 31

Takayasu's arteritis is a rare inflammatory disease of the aorta and its major branches which occurs predominantly in young women. The clinical course has been described as two stages: 1) initial phase, with inflammatory process and systemic manifestations; and later 2) pulseless phase, with multiple arterial occlusions. A 20-year-old female came to visit this hospital for the first time at 10 years of age with occlusion of the left subclavian artery and of the thoracoabdominal aorta. Aortoaortic bypass surgery was performed using a 14 mm woven graft from the ascending aorta to the descending aorta on the infrarenal portion. The postoperative course was uneventful. Exertional dyspnea and hypertension progressively developed. However, in the past year, angiograms have shown a marked stenosis on the proximal portion of the left renal artery. Autotransplantation for the left-sided kidney was performed. The patient did well, and remained free of symptoms until this time of writing, 12 months after the operation.
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PMID:Takayasu's arteritis with aortoaortic bypass graft and renal autotransplantation: report of one case. 136 2

Congestive heart failure (CHF) is a major cause of mortality and morbidity, and has a prognosis similar to that of several malignancies. There are increasing trends in both prevalence and incidence rates of CHF which points towards CHF becoming a major community health problem. Early detection of CHF is dependent upon criteria to define the initial stages of a condition which progresses slowly over many years. In western countries the dominant causes of CHF are hypertension and coronary heart disease, which account for more than 75% of the cases. Other precursors are diabetes and rheumatic heart disease. Independent risk factors for CHF are hypertension, smoking, obesity, and psychological stress. Early detection of CHF through identification of early symptoms such as dyspnea on exertion, treatment of known heart diseases, and treatment of risk factors may prevent its progress. Epidemiological data indicate that primary preventive efforts should be directed against hypertension, smoking and obesity. A multiple risk factor interventional approach seems to yield the best result since these risk factors act synergistically.
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PMID:Epidemiology and prognosis of heart failure. 179 25

A 26-year-old Ethiopian woman with past history of stroke, presented with complaints of weakness, dyspnea on exertion, headache, and orthopnea. She had severe hypertension, asynchronous pulses, radial-femoral lag, cardiomegaly, and left ventricular hypertrophy. Blood studies were normal. Arteriogram in America showed aortic and mitral incompetence, bilateral subclavian occlusion distal to the origin of the vertebral arteries, with occluded hepatic and superior mesenteric arteries. The infrarenal abdominal aorta and common and external iliac arteries were occluded bilaterally. Renal arteries were normal. Takayasu's arteritis, inactive, was diagnosed. She underwent bilateral carotid-subclavian bypass, thromboendarterectomy of the abdominal aorta, and aorto-iliac bypass grafts. 3 years later she is greatly improved. This is the first report of Takayasu's arteritis from Ethiopia. International studies on the disease are summarized.
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PMID:Takayasu's disease in an Ethiopian. 198 1

To determine the clinical, laboratory and hemodynamic profile in patients with primary pulmonary hypertension and associated portal hypertension, 7 new cases and 71 previously reported cases were analyzed. There was no gender predilection and the average age at diagnosis was 41 years. Liver cirrhosis was the most frequent cause of hypertension (82%) and a surgical portosystemic shunt was present in 29%. Almost invariably, portal hypertension either preceded or was diagnosed concurrently with pulmonary hypertension, favoring the hypothesis that in portal hypertension, the pulmonary vasculature may be exposed to vasoactive substances normally metabolized or produced by the diseased liver, possibly inducing vasoconstriction or direct toxic damage to the pulmonary arteries. Clinically, exertional dyspnea was the most frequent presenting symptom (81%); other symptoms, such as syncope, chest pain and fatigue, were present in less than 33%. An accentuated pulmonary component of the second heart sound (82%) and a systolic murmur (69%) were the most common physical findings. At least 75% of these patients had evidence of pulmonary hypertension on electrocardiography (right ventricular hypertrophy) or roentgenography (cardiomegaly or dilated main pulmonary arteries, or both). Hemodynamic findings included severe pulmonary hypertension (mean pulmonary artery pressure 59 +/- 19 mm Hg) with normal pulmonary capillary wedge pressure and cardiac output. Treatment was basically palliative and the mean and median survival times were 15 and 6 months, respectively. In brief, on the basis of clinical presentation and laboratory features, patients with combined primary pulmonary hypertension and portal hypertension seldom represent a diagnostic challenge. Further research is needed on treatment, which remains palliative. The survival rate is poor and worse than that seen in isolated primary pulmonary hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Association between primary pulmonary hypertension and portal hypertension: analysis of its pathophysiology and clinical, laboratory and hemodynamic manifestations. 199 8

Functional impairment and local pathological changes of the aorta especially at the site of correction are well known complications after surgery for coarctation of the aorta. To evaluate the longterm results after this operation, 23 patients were assessed by physical examination, EKG, ergometry, spirometry, and magnetic resonance imaging. The postsurgical interval ranged from 1 to 28 years. The most frequent postoperative symptoms were vertigo, headache, dyspnea on exertion, cardiac arrhythmia, and left thoracic pain. Elevation of the left shoulder was found in 19 patients to be due to left lateral thoracotomy; 14 patients suffered from arterial hypertension; five additional patients showed hypertension on exertion. Magnetic resonance imaging showed pathological changes of the aorta and aortic branches in all patients. The origin of the left subclavian artery was displaced distally in eight patients. The proximal part of the left subclavian artery was dilated in 11 patients. Fourteen patients had a hypoplastic aortic arch. An aneurysm of the ascending aorta was found in five patients. Aneurysmal dilatation of the descending aorta in the region of the anastomosis was present in three patients. Restenosis of the descending aorta occurred in two patients. In conclusion, after surgery of coarctation many patients continued to have symptoms which require regular follow-up. Magnetic resonance imaging provides a complete and noninvasive examination of the heart and the great vessels and is therefore ideally suited for this purpose.
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PMID:[Clinical and magnetic resonance tomography follow-up of surgically treated aortic isthmus stenoses in adults]. 262 20

We studied a patient with a very small somatostatinoma that arose from the prominence of the orifice of the duct of Santorini. The patient presented clinically with epigastric discomfort, marked loss of weight, diarrhea, exertional dyspnea, and chest pain. He flushed intermittently and had occasional tachycardia and hypertension. Levels of serum serotonin and urinary 5-hydroxyindoleacetic acid were normal. A small ampullary tumor was resected and identified by immunohistochemical staining to be a somatostatinoma. The patient had gained 6.75 kg and was essentially free of symptoms 16 months after surgery.
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PMID:Early somatostatinoma of the papilla of the duct of Santorini. 286 41

The benefit of any medical intervention, particularly drug therapy, must be weighed against its cost. These costs are not only dollar expenditures but effects on lifestyle and overall health. Diuretic therapy for hypertension has been in use long enough to allow long-term clinical evaluation. It is clear from the numerous prospective drug intervention trials involving hypertensive patients that diuretic therapy is not free of "costs." Aside from the fact that 15 to 20% of diuretic-treated patients reportedly drop out of trials because of side effects, including exertional dyspnea, fatigability, lethargy and impotence, numerous metabolic derangements have been reported with these drugs, i.e., potassium, uric acid, lipid, sodium, glucose and magnesium alterations. Perhaps most important are the changes in lipid fractions, which may be responsible for the failure of antihypertensive therapy to decrease the risk of coronary heart disease. Thus, although diuretics are somewhat less expensive than other antihypertensive drugs in terms of dollars, their overall costs are high. The major alternatives, such as the alpha-blocker prazosin or the central nervous system agent clonidine, are preferable, do not impair a patient's lifestyle and are recommended to be used along with changes in diet and an exercise program for control of mild to moderate hypertension.
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PMID:Diuretic therapy for mild hypertension: the "real" cost of treatment. 642 Nov 37


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