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

Authors report on the case of one patient exhibiting, since three months, a spontaneous thinorrhea and directed to them with the diagnosis of pituitary tumor. The neuro-roentgenologic inquiry discovers a ventricular dilatation and an evagination of the III rd. ventricle into the pituitary fossa ; it also puts in evidence a tumor of the posterior cerebral fossa. We are dealing here with a meningioma of the posterior aspect of temporal pyramid (petrosal bone). If tumoral hydrocephalus is common, its complication with a spontaneous rhinorrhea is, on the contrary, exceptional. We are therefore obliged to consider the pre-existing in this female patient of a deficiency of the pituitary diaphragm that has favoured the intra-sellar diverticle of the III rd ventricle, in the same manner as it makes possible, in other circumstances the arachnoidocele in the syndrome of empty pituitary fossa. Exeresis of the tumor, by suppressing the intracranial hypertension, stopped the rhinorrhea and has considerably improved the visual signs.
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PMID:[Spontaneous rhinorrhea of unusual etiology]. 81 54

Twelve cases of the primary empty sella syndrome were analyzed in regard to clinical findings, roentgenographic features, pituitary function and cerebrospinal fluid adenohypophysial hormone concentration. The findings were compared with those in 247 cases of the primary empty sella syndrome reviewed from the literature in order to determine the major characteristics of this disorder. The majority of patients are obese, multiparous women with normal pituitary reserve, normal visual fields and undetectable adenohypophysiol hormone concentrations in cerebrospinal fluid. In addition occasional patients witll have hypertension, pseudotumor cerebri and cerebrospinal fluid rhinorrhea. Patients who present with the typical features of the primary empty sella syndrome should be evaluated periodically with pituitary function testing, visual field examinations and cerebrospinal fluid adenohypophysial hormone determinations. If these parameters remain normal during careful follow-up studies, the patient is likely to have an empty sella, and pneumoencephalographic and angiographic studies can be avoided.
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PMID:The primary empty sella syndrome: analysis of the clinical characteristics, radiographic features, pituitary function and cerebrospinal fluid adenohypophysial hormone concentrations. 85 Nov 32

The empty sella turcica is defined as a sella which, regardless of its size, is completely or partly filled with cerebrospinal fluid. An empty sella of normal size is a frequent and probably normal finding in unselected autopsy series. In clinical series an empty sella usually appears enlarged and is often associated with a variety of clinical disorders, constituting the so-called empty sella syndrome. Several causes of an enlarged empty sella have been suggested: a congenitally missing (deficient) sellar diaphragm with or without altered cerebrospinal fluid dynamics, previous pituitary gland hypertrophy or the outcome of a pituitary tumor necrosis. Increased intracranial pressure will induce a sellar enlargement in some patients and, consequently, also the emptiness. This pathogenesis is, however, applicable only in a minority of patients with an empty enlarged sella. Data from the literature and from own studies suggest that the enlarged empty sellae and the associated findings in the majority of cases are caused by spontaneous necrosis of a previous pituitary adenoma. This theory explains the frequent presence of pituitary insufficiency, pituitary hypersecretion, and visual field defects in patients with an empty sella. Furthermore, it offers an explanation of the finding of an empty enlarged sella in some patients with non-traumatic cerebrospinal fluid rhinorrhea and probably also benign intracranial hypertension. Thus, an empty enlarged sella is a stage in the spontaneous course of some pituitary adenomas and the associated findings constituting the empty sella syndrome are an occasional part of the clinical presentation of pituitary adenomas.
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PMID:The empty sella. A reappraisal of etiology and pathogenesis. 179 61

An unusual case of CSF fistula and tension pneumatocele developing in a patient 22 years after a severe craniocerebral injury is reported. The patient had been asymptomatic during this long interval, but immediately after a minor head trauma massive rhinorrhea and diffuse pneumocephalus occurred. This was followed by the development of bifrontal tension pneumatocele with intracranial hypertension and neurological deterioration. The patient recovered after closure of the CSF fistula. The pathophysiological mechanism of this rare condition and the pertinent treatment are discussed.
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PMID:CSF fistula and tension pneumatocele 22 years after head injury. 323 95

Fifteen patients with recalcitrant cerebrospinal fluid (CSF) fistula underwent the insertion of a lumboperitoneal shunt. The shunt consists of a two-piece Silastic tube and has been used in a population of 150 patients with communicating hydrocephalus, persistent postoperative meningocele, and benign intracranial hypertension. The spinal catheter is introduced subcutaneously and no flushing device is used. We studied three groups: 9 patients had a history of head trauma, and 7 of these had undergone one or several ineffective direct approaches to the dural leak. Four patients presented with a presumably congenital fistula. Two patients had persistent rhinorrhea due to previous intracranial procedures. Indium-111 cisternography was performed in 10 patients before lumboperitonel (LP) shunting and failed in 2 of those to document the site of leakage. Twelve patients showed cessation of rhinorrhea after LP shunting. In 4 of these, shunt-related complications responded to shunt removal with no further recurrence of rhinorrhea. Two patients underwent revision of the shunt. In 3 patients, the LP shunt failed to control the CSF leak and further intracranial procedures were indicated. The LP shunt provides an attractive and technically simple solution when direct methods of treatment have failed. Additionally, LP shunting should be considered as a primary mode of treatment in elderly patients or when impairment of CSF dynamics is documented by radionuclide cisternography and computed tomographic scanning. When an LP shunt is ineffective, shunt function should be checked by isotopic studies before additional surgery is performed.
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PMID:Treatment of cerebrospinal fluid rhinorrhea by percutaneous lumboperitoneal shunting: review of 15 cases. 397 11

CSF fistulas are a major complication of head injury but also occur spontaneously or symptomatically in connection with tumours of the skull base, empty sella syndrome, ethmoidal encephalomyelocele, intracranial hypertension or postoperatively in connection with operations on skull base tumours or ENT operations. Their main risk is the possibility of meningitis. The main clinical symptom is CSF leakage from the nose, but meningitis may be the first manifestation. Isotope cisternography and metrizamide CT cisternography are the most important methods for precise localization, sometimes also for verification of a suspected fistula. Most traumatic CSF fistulas of the frontal and ethmoidal region have to be treated operatively. The method of choice is the transfrontal approach and the closure of the fistula opening using a pedicled pericranial flap or fascia lata graft. Most sphenoidal fistulas have to be treated by packing the sphenoidal sinus with muscle. The treatment methods of the rare spontaneous and symptomatic CSF fistulas are also described. The results of operative treatment are satisfactory. About 6% recurrences, which as a rule can be cured by reoperation, and a mortality rate of about 1-3% seem to be an acceptable price for prevention of an otherwise unavoidable and oftenly deadly meningitis. Future efforts are necessary to improve the operative technique in order to reduce the incidence of anosmia. Our descriptions and advice are based not only on literature reports but also on our own experiences with a combined material of 237 cases operated on for rhinorrhea.
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PMID:Traumatic, spontaneous and postoperative CSF rhinorrhea. 653 67

Labetalol, an antihypertensive agent that blocks both beta- and alpha-adrenergic receptors, was administered intravenously to 19 patients with accelerated hypertension who required rapid lowering of blood pressure. Systolic blood pressure was lowered from 209 +/- 4 to 143 +/- 2 mm Hg; diastolic blood pressure was reduced from 140 +/- 2 to 93 +/- 2 mm Hg. Side-effects were minimal and included nausea, epigastric burning, rhinorrhea, and premature ventricular contractions. One patient became hypotensive and required treatment. Overall, the study demonstrates labetalol to be a safe and effective agent for the emergency lowering of blood pressure, with demonstrated results comparable to other parenteral agents.
Hypertension
PMID:Antihypertensive effectiveness of intravenous labetalol in accelerated hypertension. 686 81

The authors present 2 cases of tumours of third ventricle with intracranial hypertension and cerebrospinal fluid rhinorrhea. The cause of the CSF rhinorrhea most often was thinning of lamina ethmoidalis and dura mater and rarely intussusception of arachnoidea into the intrasellar space in patients with oval orifice for the stalk of pituitary body due to prolonged intracranial hypertension. Efficacious treatment of CSF rhinorrhea comprises not only removing of the tumor but also introducing the valve and in some cases tightening of the base of the anterior and middle fossa.
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PMID:[Two cases of colloid cysts of the third ventricle with nasal rhinorrhea]. 850 51

Patient and physician perspectives on the impact and management of perennial (PAR) and seasonal allergic rhinitis (SAR) were studied. In all, 2139 subjects were questioned about their medical conditions, severity and frequency of symptoms and satisfaction with treatment. A group of general practitioners (GPs) were also invited to discuss their experiences in the management of rhinitis. In this UK survey, allergic rhinitis was more common than asthma, hypertension, skin rashes, eczema and diabetes. The prevalence of SAR and PAR was 15% and 2%, respectively. Sneezing and runny nose were the most common symptoms and GPs were the main contact for advice and treatment (54% of patients). Symptoms were well-controlled in 32% of patients. Allergic rhinitis affected work, home and social life in 29%, 34% and 30% of patients, respectively. The GPs considered PAR to be more difficult to treat than SAR, and GP and patient level of satisfaction in the treatment of PAR was low. This suggests that education of patients and physicians on the benefits of allergen avoidance, and the selective use of the highly effective therapies available on prescription could improve the level of satisfaction with therapy. Adherence to current guidelines on the management of rhinitis could lead to an effective, structured treatment plan for patients.
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PMID:Patient and physician perspectives on the impact and management of perennial and seasonal allergic rhinitis. 1112 98

Consequences of obstructive sleep apnea syndrome in children include reduced performance during day, behaviour problems, diurmal hypersomnia, psychomotor development delay, severe forms of cor pulmonale, systemic hypertension, growing delay and death. This paper describes the clinical case of a 3-year-old girl with perennial symptoms of nasal obstruction characterized by nocturnal snoring, oral breathing, nasal voice, sleep apnea, nasal pruritus and rhinorrhea. Her treatment is also described.
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PMID:[Non-surgical treatment in case of obstructive sleep apnea syndrome in children. Report of a case]. 1496 87


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