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

A controlled randomized study of endoscopic evacuation versus medical treatment was performed in 100 patients with spontaneous supratentorial intracerebral (subcortical, putaminal, and thalamic) hematomas. Patients with aneurysms, arteriovenous malformations, brain tumors, or head injuries were excluded. Criteria for inclusion were as follows: patients' age between 30 and 80 years; a hematoma volume of more than 10 cu cm; the presence of neurological or consciousness impairment; the appropriateness of surgery from a medical and anesthesiological point of view; and the initiation of treatment within 48 hours after hemorrhage. The criteria of randomization were the location, size, and side of the hematoma as well as the patient's age, state of consciousness, and history of hypertension. Evaluation of outcome was performed 6 months after hemorrhage. Surgical patients with subcortical hematomas showed a significantly lower mortality rate (30%) than their medically treated counterparts (70%, p less than 0.05). Moreover, 40% of these patients had a good outcome with no or only a minimal deficit versus 25% in the medically treated group; the difference was statistically significant for operated patients with no postoperative deficit (p less than 0.01). Surgical patients with hematomas smaller than 50 cu cm made a significantly better functional recovery than did patients of the medically treated group, but had a comparable mortality rate. By contrast, patients with larger hematomas showed significantly lower mortality rates after operation but had no better functional recovery than the medically treated group. This effect from surgery was limited to patients in a preoperatively alert or somnolent state; stuporous or comatose patients had no better outcome after surgery. The outcome of surgical patients with putaminal or thalamic hemorrhage was no better than for those with medical treatment; however, there was a trend toward better quality of survival and chance of survival in the operated group.
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PMID:Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study. 292 92

In summary, a natriuresis and diuresis following the relief of BUO is common. This is frequently associated with the reversal of hypertension and other signs of salt and water retention. The need for replacement therapy is best determined from clinical assessment of salt and water status. Only rarely will a prolonged salt-losing state ensue, but the physician must be aware of this possibility, since long-term replacement of water and electrolytes may be required. Recovery of function occurs in two phases, an early tubular phase and a later glomerular phase. The tubular phase appears to be quantitatively more important. There is some disparity between the improvement in creatinine clearance and that in 99mTc DTPA and iohexol clearance, and we would postulate that the initial improvement in creatinine clearance is due to secretion of creatinine during the predominantly tubular phase of recovery. It follows that when assessing renal functional recovery after insertion of a nephrostomy tube or other form of decompression of an obstructed upper urinary tract, these different phases must be borne in mind. Following the relief of UUO, changes in water and electrolyte excretion do occur, but they are rarely of clinical significance.
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PMID:Postobstructive renal function. 331 Jan 74

Mortality due to epidural hematoma is virtually restricted to patients who undergo surgery for that condition while in coma. The authors have analyzed the factors influencing the outcome of 64 patients who underwent epidural hematoma evacuation while in coma. These patients represented 41% of the 156 patients operated on for epidural hematoma at their centers after the introduction of computerized tomography (CT). Eighteen patients (28.1%) died, two (3.1%) became severely disabled, and 44 (68.8%) made a functional recovery. The mortality rate for the entire series was 12%, significantly lower than the 30% rate observed when only angiographic studies were available. A significant correlation was found between the final result and the mechanism of injury, the interval between trauma and surgery, the motor score at operation, the hematoma CT density (homogeneous vs. heterogeneous), and the hematoma volume. The patient's age, the course of consciousness before operation (whether there was a lucid interval), and the clot location did not correlate with the final outcome. The mortality rate was significantly higher in patients operated on within 6 hours or between 6 and 12 hours after injury than in those undergoing surgery 12 to 48 hours after injury. Compared with the patients operated on later, the patients undergoing surgery in the early period were, on the average, older and had more rapidly developing symptoms, more pupillary changes, lower motor scores at surgery, larger hematomas, a higher incidence of mixed CT density clots, more severe associated intracranial lesions, and higher postoperative intracranial pressure (ICP). The mechanism of trauma seems to influence the course of consciousness before and after surgery. Passengers injured in traffic accidents had a lower incidence of a lucid interval and longer postoperative coma than patients with low-speed trauma, suggesting more frequent association of diffuse white matter-shearing injury. The duration of postoperative coma correlated with the morbidity rate in survivors. Forty-eight patients (75%) had one or more associated intracranial lesions, and 70% of these required treatment for elevation of ICP after hematoma evacuation. An ICP of over 35 mm Hg strongly correlated with poor outcome; administration of high-dose barbiturates was the only effective means for lowering ICP in nine of 15 patients who developed severe intracranial hypertension after surgery. This study attempts to identify patients at greater risk for presenting postoperative complications and to define a strategy for control CT scanning and ICP monitoring.
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PMID:Acute epidural hematoma: an analysis of factors influencing the outcome of patients undergoing surgery in coma. 333 12

We prospectively studied 34 patients with clinical and radiologic evidence of rostral basilar artery syndrome, a vaso-occlusive disorder, who had uniformly excellent short-term functional recovery, in marked contrast to the classic syndrome. All patients displayed important neurobehavioral disturbances, including an acute confusional state, necessitating medical consultation. The composite group had minimal hypertension, significant arrhythmias in the young, and no history of vertebrobasilar insufficiency. Unsuspected cases of idiopathic orthostatic hypotension, as well as cardiac arrhythmias in the elderly, were discovered. A vascular cause was not considered in 79% of those presenting for emergency evaluation and prevented proper acute diagnostic evaluation in 88%. Recognition of this potentially reversible cerebrovascular syndrome may prevent hazardous diagnostic and therapeutic interventions.
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PMID:Reversible rostral basilar artery syndrome. 333 91

Although there has been concern that a variety of nursing care procedures may serve as potent adaptive demands in patients with intracranial hypertension, research shows that activities such as bathing, oral hygiene, touching, and suctioning produce relatively small increases in ICP and are accompanied by adequate CPP. Head rotation and flexion are potent stimuli to increased ICP, although CPP has remained adequate in the small number of people in whom it has been measured. While considerable descriptive work has been done with respect to a variety of nursing care activities, much remains to be done. Little is known about the mechanisms by which activities (turning and suctioning) effect demands upon the craniospinal system, nor what the best predictors are of individuals who will respond adversely to such demands. The potential of affective touch and environmental sensory stimulation to reduce ICP and reduce the need for potent pharmacologic agents is intriguing but has not been adequately explored. Further investigators need to attend to reporting individual as well as group patterns to guide clinical application and describe predictors of individual response. In addition, the oscillatory nature of ICP and cardiovascular variables needs to be taken into account in interpreting whether or not "real" change has occurred in response to given activities. The full range of cerebrovascular variables needs to be measured to determine if changes in ICP pose a threat to cerebral perfusion. Finally, we need to examine nursing therapeutics with respect to ultimate outcomes (functional recovery) as well as to individual care activities.
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PMID:Intracranial hypertension: influence of nursing care activities. 353 70

To elucidate the incidence of severe disability due to cerebral stroke and its related factors, prospective data of 1,621 Hisayama residents aged 40 and over were examined. Severe disability resulting from stroke was defined as patients who were unable to dress, take care of their toilet needs, and feed themselves without assistance, or who required a wheel chair for ambulation three months after the most recent episode. During 20 years of follow-up 255 stroke patients were observed among the sample population. The annual incidence of stroke per thousand was 9.8, and rate of severe disability was 2.8 for men and 6.4 and 2.0 for women, respectively. Of the 74 cases with severe disability, approximately 92% were attributed to cerebral infarction. Related factors to severe disability due to cerebral infarction were recurrent attacks, hypertension, changes in ocular fundi and diabetes mellitus among predispositions and quadriplegia or muscular contraction, and intelligent or mental disorders among inhibiting factors for functional recovery. Furthermore, in 59 autopsy cases with multiple cerebral infarctions, the frequency of disability increased as the number of infarcts increased. Hypertension and diabetes mellitus, as risk factors for cerebral infarction and factors inhibiting post-ictal functional recovery were discussed.
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PMID:Severe disability related to cerebral stroke: incidence and risk factors observed in a Japanese community, Hisayama. 358 64

This study analyzes 234 patients who recovered from an initial ischemic episode. The object was to see if the duration of the first episode influenced the chance of finding a treatable lesion or the chance of a further episode. The initial episodes varied from less than 5 minutes to longer than 3 weeks. There seemed to be no fundamental difference between transient ischemic attacks (TIAs) (less than 24 hours) and strokes which recover. However, 51% of those whose initial episode lasted less than 5 minutes had a subsequent stroke compared to 28% of those with an initial episode of more than 24 hours duration. Thirty percent of the former group who had angiograms had an operable lesion against 10% in the latter group. It seems that angiography has sufficiently high yield to be warranted in all patients where the initial attack lasted less than 30 minutes. In those with longer attacks the yield from angiography was much lower and noninvasive techniques should be considered in these patients, where available, prior to consideration for angiography. Investigation should be based on the degree of functional recovery and not on the arbitrary time division which normally divides TIAs and strokes. Bruits were the most reliable clinical indicators of stenosis. However the presence of intermittent claudication, hypertension and age over 50 were all more common in those with carotid stenosis.
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PMID:Transient ischemic attacks and strokes with recovery prognosis and investigation. 730 66

A 61 year old man experienced oliguric acute renal failure during therapy with indomethacin. Proteinuria (5.1 g/24 hours) and hypertension, which accompanied renal insufficiency, cleared with recovery of function. These features may suggest drug-associated acute kidney failure.
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PMID:Indomethacin-associated acute renal failure. 738 99

The stress-induced changes in peripheral benzodiazepine receptors (PBR) can be observed in a number of different tissues, depending upon the nature and chronicity of the aversive experience. In addition, virtually all stress procedures that cause rapid changes in PBR simultaneously increase the physical activity or metabolic rate of the subjects. The present study analyzed the contributions of rapid alterations in activity or metabolic rate with and without aversive stimulation and their subsequent impact on PBR. Mechanically induced increases in activity by forced running stress results in a significant reduction in [3H]Ro 5-4864 binding to PBR in olfactory bulb, opposite to the PBR changes in this tissue following forced cold-water swim stress. Pharmacological induction of increased locomotor activity as well as metabolic rate by d-amphetamine causes a significant increase in cardiac PBR binding, again, opposite to the response typically observed following inescapable shock stress. Finally, administration of the anxiogenic beta-carboline, FG-7142, causes increases in both hippocampus and adrenal gland PBR binding reminiscent of acute noise stress exposure. These experiments demonstrate that increased locomotor activity or metabolic rate alone is not a necessary and sufficient condition for previous stress-induced changes in PBR. Conversely, increased metabolic rate coupled with an aversive stimulus appears to be an important factor for inducing stress-like changes in PBR. This data, coupled with previous reports, suggests that rapid alterations in these sites are stressor and tissue dependent. Finally, we propose that the PBR may be involved in many aspects of the stress response including: a) a blowarning system in adrenal gland, b) participation in stress-induced hypertension via renal PBR, and c) a modulator of stress-induced immunosuppression and subsequent recovery of function or recuperation by actions on immune cells.
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PMID:Environmentally induced changes in peripheral benzodiazepine receptors are stressor and tissue specific. 761 1

Heart rate, an important risk factor of coronary mortality, is highly correlated with numerous anthropometric and biochemical variables: height, body weight and hyperlipidemia; it varies, furthermore, with smoking and age and can be modified during pharmacotherapy for hypertension. From meta-analyses on different cardiovascular treatments, given after coronary events, only the efficacy of drugs significantly reducing heart rate is borne out (beta-blockers with sympathomimetic activity, or calcium-antagonists with a prevalent vasodilatory action do not provide a protective effect). Among calcium-antagonists, while the mechanism of action is similar at the cell level (delay of opening of voltage-operated slow channels), the distribution of activity within the vascular system varies markedly. Dihydropyridines (e.g., nifedipine) exert a dominant peripheral effect, with consequent vasodilation, whereas phenylalkylamines (verapamil) have both peripheral vasorelaxant and cardiac negative chronotropic activity, because of a reduced sinus node action potential. A relative tachycardia may occur with dihydropyridines, secondary to the activation of baroreceptors; the compensatory heart mechanism operated by verapamil antagonizes this reflex tachycardia. The activity of verapamil on the atrioventricular conduction allows both a slowing of functional recovery of the channel in hyperexcitable conditions (supraventricular tachycardia), and, moreover, increased diastolic intervals, with consequent improvement of coronary flow. New molecules can selectively reduce the sinus node activity without exerting other effects (hypotensive, anti-arrhythmic). From a comparative evaluation of these molecules with verapamil, it clearly emerges how this latter can provide a more acceptable pharmacodynamic profile, both for the hypotensive activity, and also for the control of reflex tachycardia, with a consequently improvement of coronary flow.
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PMID:[Pharmacological control of heart rate]. 785 54


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