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

Inferior mesenteric arterial blood flow was measured with an electromagnetic blood flowmeter in five anesthetized rhesus monkeys. The effects of vasopressin on this vasculature were determined to evaluate the optimal, safe concentration of this agent during its clinical application in the management of hemorrhagic lesions of the colon. Control flow was 29 +/- 3 (SE) ml min-1; aortic pressure was 124 +/- 4 mm Hg. Intraarterial injections of vasopressin, in doses ranging logarithmically from 5 X 10(-5) to 5 X 10(-2) U kg-1, caused dose-dependent decreases in flow. At the highest dose, vasopressin reduced flow by 50% and increased arterial pressure by 9 mm Hg. When infused, at a rate of 5 X 10(-3) U kg-1 min-1, vasopressin produced a significant and sustained reduction in inferior mesenteric arterial blood flow. Autoregulatory escape was not observed. At this rate, vasopressin increased arterial pressure 10 mm Hg, by the 6th minute of infusion. This hypertension was unaccompanied by significant bradycardia. After cessation of the infusion, flow gradually returned to control values over a period of minutes. These observations indicate that vasopressin is a potent constrictor in the inferior mesenteric arterial circulation of the monkey, and support the use of this agent to control lower intestinal bleeding in man. At a dose of 5 X 10(-3) U kg-1 min-1, vasopressin causes a significant reduction in flow without adverse systemic side effects.
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PMID:Influence of vasopressin on colon blood flow in monkeys. 40 50

A case of mesenteric arteritis complicating the post-operative coarctectomy in a 5 day old infant is described. This case was of interest due to diagnostic difficulties and the fatal outcome. In order to avoid the disastrous consequences of this syndrome, the following symptoms including fever, intestinal bleeding, ileus, nausea, vomiting, leucocytosis, hypertension or abdominal pain should alert the physicians and treatment should start without delay.
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PMID:Postcoarctectomy mesenteric arteritis presenting as neonatal appendicitis. 51 13

Between 1958--1976 204 patients with abdominal aortic aneurysms were admitted to the surgical ward for evaluation. One hundred and thirty-eight patients were operated on, 7 died prior to operation and 59 patients were not recommended operation for different reasons. Elective surgery was performed in 60 patients and 78 underwent acute surgery. The aneurysm had ruptured in 40 of the acutely operated patients. The operative mortality was 33% for the whole series, 65% among the ruptured aneurysms and 10% for the planned operations. The early mortality diminished successively and was during the last 5-year period 4% for planned and 40% for emergency operations. The main causes of the early mortality was renal or cardiac insufficiency and abdominal or gastrointestinal haemorrhage. Intestinal infarction was the cause of death in two patients. Twenty-nine re-operations were made in 24 patients. Abdominal haemorrhage, gastro-intestinal bleeding or arterial embolus in the leg were the most common reasons for the re-operations. An analysis of the factors that may influence the operative mortality revealed that age, sex, pre-operative shock, re-operations and number of blood transfusions may be of importance for prediction of the survival. Previously known hypertension, infarction, myocardial ischaemia or the operation time did not seem to have any predictive value. The most common reasons for not recommending surgery were small aneurysms, technical inoperability, advanced age or severely complicating disease.
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PMID:Abdominal aortic aneurysms. 1. Selection of patients and operative results. 53 37

A 19 year experience (1958-1977) with aortoenteric fistulas is presented. An aorto-enteric fistula is a direct communication between the aortic lumen and the gastro-intestinal tract producing a gastro-intestinal bleeding. The commonest cause of a primary or spontaneous aorto-enteric fistula is aneurysm formation. If there has been an operation on the aorta then the aorto-enteric fistula is called secondary. No primary aorto-enteric fistulas were encountered but thirteen secondary aorto-enteric fistulas are reported on a total of 841 aorto-femoral by-pass operations reviewed. Six hundred and sixty-one of these had an acceptable follow-up: this gives a 2% incidence. Our survival rate is 40%. Four different possible mechanisms are proposed for the formation of the secondary aorto-enteric fistula: anastomotic aneurysm formation, fibrous reaction, intra- or postoperative contamination or a combination of these possibilities. Some etiological factors as type of anastomosis, suture material, prosthesis material, hypertension, end-arterectomy and preoperative aneurysmatic tendency are analysed. A study is made of the different available diagnostic tools and the different possible therapies are discussed.
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PMID:Aorto-enteric fistula as clinical entity. 67 39

A 42 year woman presented with malignant hypertension, anuria and hemolytic anemia with schistocytosis. The diagnosis of thrombotic microangiopathy was confirmed by early renal biopsy. Purely symptomatic treatment (peritoneal dialysis and hypotensive drugs) was supplemented by administration of heparin and Dipyridamole. Gastro-intestinal bleeding prevented early thrombolytic therapy. Microangiopathic anemia rapidly disappeared but anuria persisted. Three months later a second renal biopsy showed persistence of active lesions and absence of irreversible parenchymal damage. Streptokinase treatment was then instituted and followed by a rapid return of urinary output. Hemodialysis was stopped and renal function continued to improve over the following months. Two years later the patient remains well despite persistence of hypertension difficult to control. Creatinine clearance is stable at 20 ml/min. This observation suggests that late thrombolytic therapy may be effective in patients with thrombotic microangiopathy when histological findings do not indicate extensive irreversible lesions.
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PMID:Late streptokinase therapy in thrombotic microangiopathy: a case study. 123 14

From 1979 to 1990, 56 children ranging between 4 days and 16 years of age (mean 73 +/- 51 months) underwent Goretex patch aortoplasty for coarctation of the aorta. The mean weight at operation was 20.2 +/- 3.5 kg (range 3.3-42 kg). Forty-two patients had primary repair, and the remaining 14 had reoperation for recoarctation. The aorta was opened through a standard left thoracotomy, the posterior fibrous ridge was partially excised when it was prominent, and a large patch from a Goretex tube was sutured into place. The postoperative complications were as follows: paradoxical hypertension in 14 cases, massive haemorrhage due to aortic wall rupture in a diabetic child, and intestinal bleeding in 1 case. There were no early deaths and only 1 case of late death, which was not related to coarctation repair (mortality rate 1.8%). The average follow-up was 48 +/- 26 months. Continuous wave-Doppler examination at rest showed no arm-leg systolic gradient in 52 cases and a gradient of about 15 mmHg in 4 cases. Graded exercise testing showed only 1 case with an arm-leg gradient higher than 35 mmHg. Nuclear magnetic resonance (NMR) imaging, performed on 26 patients at a mean of 7 years from operation, showed excellent morphology and size of the aortoplasty. No cases of recoarctation or late aneurysm formation were found. We conclude that Goretex patch aortoplasty can be performed effectively and safely in children. Nuclear magnetic resonance provides high resolution imaging of the coarctation repair site.
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PMID:Goretex patch aortoplasty for coarctation in children: nuclear magnetic resonance assessment at 7 years. 157 82

Mesenteric varices can appear as massive, acute lower gastrointestinal bleeding. The small bowel or colon may be involved, varices usually developing at sites of previous surgery or inflammation in patients with portal hypertension. Two patients with alcoholic cirrhosis and protal hypertension presented with rectal bleeding. Tc-99m RBC studies demonstrated varices and extravasation into the adjacent bowel. The varices were documented by mesenteric angiography. Characteristic features of Tc-99m labeled RBC studies can identify mesenteric varices as the cause of intestinal bleeding and localize the abnormal vessels.
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PMID:Scintigraphic demonstration of gastrointestinal bleeding due to mesenteric varices. 238 39

Among 9343 colonoscopic examinations (1975-1983) colonic angiodysplasias (AD) were diagnosed in 78 patients (0.8%). The mean age of patients with AD was 68 (17-86) years which was significantly higher than that of patients without AD (p less than 0.0001). 76% of the AD were localized in cecum or colon ascendens, 13% in colon transversum, 4% in colon descendens and 6% in sigmoid colon. 69 patients (88.5%) had 1-4 AD; 4 (5.1%) 5-10 AD and 5 (6%) more than 10 AD. A high incidence of associated diseases leading to vascular complications (i.e. hypertension, diabetes mellitus) was noted. 14 of the 78 patients had anticoagulation or bleeding disorders, possibly precipitating intestinal bleeding. The 21 patients (26.9%) with symptomatic AD had either lower intestinal bleeding (n = 8) or severe anemia (n = 13). In 57 patients (73.1%) the AD were asymptomatic during a mean follow-up of 48 (1-108) months. Whereas age and sex distribution were not significantly different between symptomatic and asymptomatic patients, the number and size of AD were significantly increased in symptomatic patients (p less than 0.005).
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PMID:[Clinical significance of colonic angiodysplasias]. 633 23

Three children with pronounced livedo reticularis present since birth (cutis marmorata-telangiectasia congenita) have been followed to the ages of eight, 17 and 21 years. During childhood they developed frequent recurrent transient stroke-like hemipareses, affecting either side of the body, associated with ipsilateral pain, headache, visual symptoms, dysphasia, fits and confusion. Intellectual failure and, in one, progressive spasticity have followed. Attacks were more frequent in winter. Other problems have included abnormal peripheral vascular responses to temperature change, gastro-intestinal bleeding, glaucoma, local tissue hypertrophy and, in the two older patients, renal involvement with hypertension. Their condition represents a form of congenital vasculopathy. Anticonvulsants, anti-migraine agents, anti-platelet drugs and flunarizine have been ineffective. Nifedipine prevented further attacks in one patient and reduced attacks in another, but has not helped the third child. Adequate clothing and warmth may also be important.
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PMID:Congenital livedo reticularis and recurrent stroke-like episodes. 840 21

With the introduction of VBscript & Active-X it is now possible to construct interactive websites with ease. This paper discusses the author's experience in setting up TWO different 'VIRTUAL PATIENT' websites. One such site, named VIRTUAL PATIENT 97, is based upon a goal based scenario, in this case the clinical management of common clinical problems like upper gastro-intestinal bleeding in a surgical ward. The second website, CLICK 'n' LEARN, is essentially a health education website providing material on common chronic illnesses like diabetes, hypertension and asthma. The first module deals with aspects of self care in diabetes. Included are textual as well as video clips which show various elements of diabetes self care: like the administration of insulin or the usage of a glucometer. An added twist is a target oriented interface borrowed from the TAMAGOTCHI. If the user dutifully looks after his virtual diabetic, it will thrive & the disease will be well controlled, else the virtual patient deteriorates in accelerated time. This allows for safe experimentation & promotes awareness of the importance of self care in the total management of chronic illnesses.
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PMID:Virtual patients for a virtual hospital. 1038 65


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