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)

To determine whether mitral valve or anular sclerosis or calcification (MC) is associated with reduced survival in patients with end-stage renal disease on continuous ambulatory peritoneal dialysis (CAPD), 53 CAPD patients were followed with echocardiography and Doppler echocardiography over 35 months. Both nonsurvivors and survivors with MC had higher systolic blood pressure before CAPD and calcium-phosphorus products during CAPD treatment than patients without MC (p < 0.05). Serum calcium and phosphorus concentrations, alkaline phosphatase and parathyroid hormone activities were higher in nonsurvivors and survivors with than without MC (p > 0.05). Left ventricular end-diastolic and end-systolic volumes were greater (p < 0.01), ejection fractions were smaller (p < 0.05) in nonsurvivors with than without MC, but not in survivors with versus without MC. Severe MC and grade III mitral valve regurgitation were more frequent in nonsurvivors than in survivors (p < 0.03). No valvular stenoses were found. It is concluded that the development of MC is favored by long-standing predialysis arterial hypertension and by high calcium-phosphorus products during CAPD. Nonsurvivors with MC are characterized by reduced systolic left ventricular function or severe valvular lesions. A close cardionephrologic cooperation is necessary to improve the survival of CAPD patients with these risk factors.
 ...
PMID:Predictive value of mitral and aortic valve sclerosis for survival in end-stage renal disease on continuous ambulatory peritoneal dialysis. 850 38

This type of disease has benefited considerably, over recent decades, from progress in ultrasound technique and new methods of medical and surgical treatment. The aetiologies of mitral incompetence can be classified into 4 categories according to their mechanism: 1. Mutilating valve lesions, usually secondary to bacterial endocarditis, but sometimes secondary to trauma (percutaneous valvuloplasty). 2. Rupture of chordae tendineae, either spontaneous or bacterial, in a context of pre-existing valvular heart disease, usually degenerative. 3. Papillary muscle lesions, usually corresponding to rupture of a papillary muscle or the head of a papillary muscle, associated with myocardial infarction. 4. Biological or mechanical valve prosthesis dysfunction. The consequences of acute mitral incompetence depend on its aetiology and the presence or absence of previous mitral valve disease. Three factors determine the clinical presentation and prognosis: the volume of regurgitation, left ventricular function and left atrial compliance. In pure forms, such as those occurring after rupture of chordae tendineae, the haemodynamic profile consists of a marked elevation of left ventricular filling pressures, left atrial mean and systolic pressures (large V wave), and a reduction of the cardiac output. The left ventricular end-diastolic volume is moderately increased, while the end-systolic volume is normal or decreased and the ejection fraction is increased. The clinical picture is that of acute left ventricular failure with a systolic murmur of mitral regurgitation and a pulmonary hypertension syndrome. The absence of left ventricular hypertrophy on the electrocardiogram and the absence of left-sided dilatation on radiological examination indicate the recent nature of the haemodynamic disturbances. The diagnosis of acute IM is confirmed by Doppler ultrasound, which defines the mechanism and sometimes eliminates the need for an invasive investigation. The clinical course depends on the aetiology, the volume of regurgitation, left ventricular function and the treatment implemented. First-line treatment must include vasodilators. Sodium nitroprussate infusion decreases the left ventricular end-diastolic volume and the volume of regurgitation and increases the cardiac output. It allows a rapid reduction of pulmonary artery and capillary hypertension. When this treatment is not sufficient, intra-aortic counterpulsation may be useful. Emergency surgery is sometimes necessary, but usually after improvement of the haemodynamic state by vasodilators. Depending on the aetiology, surgery may consist of valve replacement or surgical repair, which can give excellent results even in the presence of active bacterial endocarditis. In other cases, following control of the acute phase by medical treatment, mitral incompetence will become chronic.
 ...
PMID:[Acute mitral valve insufficiency]. 878 32

Laparoscopic cholecystectomy is the standard method for surgical treatment of non-malignant gall bladder disease. Well tolerated in otherwise healthy patients, it remains however, questionable whether the laparoscopic procedure in patients with severe pre-existing morbidity is associated with a higher incidence of negative intraoperative events than open cholecystectomy. Therefore, the incidence of negative intraoperative events was prospectively investigated in a series of 1,367 patients (319 with open cholecystectomy and 1,048 with laparoscopic cholecystectomy) who were analysed for occurrence of events such as hypertension, hypotension, arrhythmia, unusual bleeding and transfusion requirement, regurgitation or aspiration of gastric content and respiratory disorders. For further analysis the patients undergoing each operative procedure were divided into two subgroups with either preoperative ASA physical status I and II or III and IV. The study groups were comparable in sex and age. There were no intraoperative deaths. The frequency of hypertension, hypotension or arrhythmia alone and in combination was similar in both groups. The need for intervention was significantly more frequent in ASA class I/II patients with laparoscopic cholecystectomy. Respiratory disorders were rare. There was a significantly higher incidence of postoperative ventilatory support in patients with conventional cholecystectomy. Transfusion was required significantly less often in patients with laparoscopic cholecystectomy (0.19% versus 15.36%). CO2-pneumoperitoneum led to severe circulatory alterations in 7 healthy patients. The most severe negative event was a cardiac arrest in 1 female patient who was successfully resuscitated without any sequelae. In ASA-class III and IV patients intraoperative negative events were equally frequent and independent of the procedure. Severe preoperative morbidity per se seems to be no contraindication for laparoscopic cholecystectomy.
 ...
PMID:Preoperative morbidity and anaesthesia-related negative events in patients undergoing conventional or laparoscopic cholecystectomy. 884 27

Primary vesicoureteric reflux (VUR) is one of the more common genetic disorders. Little is yet known about the genetics of this potentially manageable childhood condition, which is characterised by regurgitation of urine from the bladder to the kidney. The VUR phenotype is associated with shortness of the submucosal segment of the ureter due to congenital lateral ectopia of the ureteric orifice. VUR is found in 30-50% of infants and young children with a urinary tract infection. A serious concern in families with an affected patient is that approximately one half of siblings or offspring will be affected, but up to a half of these affected siblings and offspring may be asymptomatic in childhood. If left untreated, these patients may present later in life with proteinuria, hypertension or renal failure. VUR is the commonest cause of end-stage renal failure in children, and an important cause in adults. As the kidney damage resulting from severe VUR is preventable, early detection is desirable. The techniques for clinical diagnosis are invasive and costly, reinforcing the importance of identification of a gene for VUR to facilitate genetic screening. Although family studies suggest a major dominant gene, the inheritance pattern is still a matter of debate. In rare instances, VUR occurs in association with other diseases, such as the coloboma-ureteric-renal syndrome, which is caused by a PAX2 gene mutation. In this review, we present evidence that this common disorder may be caused by mutations in the developmental pathway of which the PAX2 gene forms a part.
 ...
PMID:Unravelling the genetics of vesicoureteric reflux: a common familial disorder. 887 47

In the decade beginning 1 January 1985, 916 individuals (including five females) were medically examined with a view to joining the full-time service of Strathclyde Fire Brigade (SFB). One hundred and nine (11.9%), including two females, were rejected. The five main causes of failure were: ocular (n = 46, 42.2%); lack of stamina (n = 21, 19.2%); 'others' (n = 12, 11.0%); cardiovascular (n = 9, 8.3%) and orthopaedic (n = 6, 5.5%). Thirty-two had chest X-rays. One abnormality was found -an azygous lobe-but it played no part in the decision to decline the applicant. There was little life- or health-threatening pathology found. The most serious cases were murmurs consistent with mitral stenosis and regurgitation (one each), one case of ocular melanoma, four cases of hypertension and two cases of haematuria/ proteinuria (++). This study shows that potentially serious findings can occasionally be detected in a population of 18-30 year olds who might be expected to be of better than average fitness, and that routine chest X-rays are not helpful in the selection process.
 ...
PMID:Reasons for rejection: why people fail to qualify as firefighters. 898 75

Congestive heart failure is a widely prevalent sequel to myocardial infarction and other chronic conditions (including ischaemia without infarction, hypertension, various infections, toxic metabolic and endocrine disorders). Exercise tolerance is severely limited; the cardiac ejection fraction is often less than 20% and the peak oxygen intake may be less than 10 ml/kg x min, with a resulting deterioration in the quality of life. Possible factors contributing to the poor tolerance of exercise include: (i) disturbances of myocardial function (damage to the ventricular wall; decreased inotropic response, mitral valve regurgitation and increased diastolic pressures); (ii) peripheral vascular factors (decreased metaboreceptor discharge, reduced vasodilator response, increased activity of sympathetic afferents and less efficient distribution of cardiac output); (iii) hormonal disturbances (increases of catecholamines, renin/angiotensin/aldosterone, antidiuretic and natriuretic factors, endothelin and decreased endothelium-relaxing factor); (iv) impaired muscle function (loss of lean tissue, increase of type II fibres, increased impedance to perfusion, enzyme changes); (v) ventilatory disturbances (increased oxygen cost of activity, pulmonary congestion, increased ventilatory drive, mismatching of ventilation and perfusion, increased anaerobic effort); and (vi) psychological factors (anxiety, depression and iatrogenic limitation of effort). The prognosis with conventional treatment is poor, but patients with stable congestive heart failure respond favourably to a progressive exercise programme. Reported gains depend on the cause of congestive failure, initial status, study duration and compliance, and the type of training programme. Most studies to date have been short term (4 to 16 weeks), and relatively few have adopted a randomised controlled design. Suggested bases for the enhancement of aerobic performance of up to 20% include an increased intensity of peak effort, an enhanced matching of ventilation to perfusion, improved cardiac function, a strengthening of skeletal muscle and an increase of aerobic enzyme activity in the muscles. A few studies have continued for a year or longer and it appears that the gains realised over the first 16 weeks of training can be sustained for this period; the quality of life is enhanced, but data are as yet insufficient to judge effects upon mortality rates. Useful clinical information can be obtained from a 6-minute walk, but the choice for more precise evaluation lies between a measurement of ventilatory threshold or peak oxygen intake. Given initial muscle wasting, prescribed exercise should include both aerobic activity and resisted muscle exercises.
 ...
PMID:Exercise for patients with congestive heart failure. 906 93

Changes in valvular function and blood pressure level during long-term pharmacological anti-hypertensive therapy were investigated in patients with mild to moderate essential hypertension. Sixty-seven patients with hypertension (mean [+/-SD] 60 +/- 10 years) were followed up for 5.4 +/- 1.6 years with antihypertensive medication. During the follow-up period, valvular dysfunction was assessed by color Doppler echocardiography. Increased mitral valve regurgitation > or = grade II and/or aortic valve regurgitation > or = grade II were aggravated in 17 patients, whereas the other 50 patients did not reveal any significant changes in valvular functions. Systolic blood pressure and end-systolic wall stress at the end of the follow-up period were higher in the aggravated group (156 +/- 30 mmHg and 79 +/- 23 dyne/cm2) than in the unchanged group (143 +/- 17 mmHg and 63 +/- 18 dyne/cm2). Dimensions of the left atrium and left ventricle at both systole and diastole were enlarged in the aggravated group (37 +/- 4 to 40 +/- 4, 31 +/- 4 to 33 +/- 4 and 48 +/- 3 to 51 +/- 3 mm, respectively), but not in the unchanged group. Nine patients in the aggravated group received additional treatment with imidapril hydrochloride over 6 months in an attempt to further reduce blood pressure levels, resulting in significant improvements in systolic blood pressure (151 +/- 12 to 129 +/- 7 mmHg), diastolic blood pressure (91 +/- 4 to 79 +/- 8 mmHg), left atrial dimension (41 +/- 3 to 39 +/- 3 mm) and left ventricular end-diastolic dimension (49 +/- 4 to 48 +/- 3 mm). Adequate pharmacological intervention can ameliorate valvular dysfunction, left ventricular enlargement and increased ventricular wall stress.
 ...
PMID:[Clinical significance of valvular regurgitation during long-term antihypertensive therapy in patients with mild to moderate essential hypertension]. 912 37

Atrial septal aneurysm is a localized "saccular" deformity, generally at the level of the fossa ovalis, which protrudes to the right or the left atrium or both. For 39 months we prospectively analyzed 205 consecutive patients in whom atrial septal aneurysm was diagnosed echocardiographically. The direction and movement of atrial septal aneurysms were carefully studied in multiple views, and, according to our findings, we now propose a new classification: type 1R if the bulging is in the right atrium only, type 2L if the bulging is in the left atrium only, type 3RL if the major excursion bulges to the right atrium and the lesser excursion bulges toward the left, type 4LR if the maximal excursion of the atrial septal aneurysm is toward the left atrium with a lesser excursion toward the right atrium, type 5 if the atrial septal aneurysm movement is bidirectional and equidistant to both atria during the cardiorespiratory cycle. We found an incidence of 1.9%, a mean age of 63 years (25 to 97 years), a female/male ratio of 2:1, valvular regurgitation 74%, hypertension 64%, left ventricular hypertrophy 38%, coronary heart disease 32%, patent foramen ovale 32%, pulmonary hypertension 31%, stroke 20%, dysrhythmias 16%, valvular prolapse 15%, and atrial septal defect 3%. No differences were found between mobile and motionless types of atrial septal aneurysm. However, differences were found between predominantly left bulging or right bulging atrial septal aneurysm (134 versus 57 patients), as well as other variables. All types of atrial septal aneurysm have particular clinical or echocardiographic characteristics. The new classification is a complete, simple, and practical form. Atrial septal aneurysm is associated with congenital and acquired heart diseases but also can present as an isolated abnormality.
 ...
PMID:Atrial septal aneurysm: a new classification in two hundred five adults. 928 54

We present the case of a 39-year-old woman with aortic regurgitation that may have been induced by primary antiphospholipid syndrome. The patient had suffered recurrent miscarriages, thrombocytopenia, and deep-vein thrombosis for the previous 16 years, and had been diagnosed as having primary antiphospholipid syndrome 9 years previously because of a high titer of anticardiolipin antibody. She had been receiving medication for moderate hypertension for 7 years. The patient was admitted to Tenri Hospital because of heart failure, which was thought to be caused by moderate aortic regurgitation, moderate hypertension, and mild chronic renal failure. Echocardiography revealed thickened aortic and mitral valves. Primary antiphospholipid syndrome might have induced valve regurgitation as a result of valvular thickening.
 ...
PMID:Aortic regurgitation in a patient with primary antiphospholipid syndrome--a case report. 958 54

We studied the efficacy of the cuffed oropharyngeal airway in 100 patients. Insertion of the airway after induction of anaesthesia with propofol was easy in 95 of 100 patients, moderately difficult in four patients and failed in one patient. Complications, such as coughing, gagging or body movement, occurred during induction and insertion in 15 patients. Insertion of the airway was not associated with tachycardia or hypertension. Manual ventilation through the airway was easy in less than 30% of patients immediately after insertion. Manual ventilation became easier after adjusting the position of the patient's head, neck or jaw. During spontaneous breathing, adjustment of the head, neck or jaw was required in 30% of patients. Complete airway obstruction occurred in one patient after insertion of the device and in two patients during maintenance of anaesthesia. The airway was left in place during emergence from anaesthesia in the remaining 97 patients. No complications occurred in 91 patients and coughing occurred in the remaining six patients before or during removal of the airway. No regurgitation, vomiting or laryngospasm occurred in any patient at any time. Therefore, the cuffed oropharyngeal airway has a potential use in anaesthetised patients who are breathing spontaneously.
 ...
PMID:The cuffed oropharyngeal airway. Its clinical use in 100 patients. 1045 57


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>