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

The medical records and autopsy data of patients over the age of 70 years at death with a diagnosis of intracerebral hemorrhage (ICH) in the Yokufukai Geriatric Hospital were reviewed. All cases with ICH caused by head injury, rupture aneurysms or arteriovenous malformations were excluded from this study. There were 73 autopsied cases with spontaneous ICH from January 1978 to September 1988. There were 33 men and 40 women. Fourteen percent of the patients had a stroke while hospitalized for another disorder. Their ages at death ranged from 70 to 99 years with a mean of 81.8 years. Of these, 48 cases (66%) were 70 years or older at the time of ICH. In the senile ICH (over 70 years), the following characteristics were observed; (1) the most common location was the thalamus, which accounted for 33.3% of the hemorrhage. (2) subcortical and cerebellar hemorrhage accounted for 16.6% and 14.6% of the total, respectively. (3) there was no pontine hemorrhage. Fifty-seven percent had anamnestic hypertension before the stroke. The ages at which they became bedridden state ranged from 62 to 92 years with a mean of 79.5 years. This study revealed that the non-organic factors such as insidious generalized muscular weakness or decreased spontaneity were important as causes of the deterioration of ADL in the chronic stage of the senile ICH. Within one year after becoming bedridden state, 76.1% of all patients died. The bedridden state in the elderly with the residuals of ICH indicated a poor prognosis. As causes of death, pneumonia occurred in 28.8% of all patients, brain death in 19.2%, and sudden death in 12.3%.
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PMID:[Cerebrovascular disease in the elderly--a clinicopathological study of 73 autopsied cases with intracerebral hemorrhage]. 236 29

In experimental informational neurosis, accompanied by the development of stable arterial hypertension, tachycardia and dystrophic alterations in myocardium, the contractile protein ability to generate force and produce work as well as the power of the contractile process are significantly decreased and so is the intensity of Ca2+ transport through membranes of sarcoplasmic reticulum and mitochondria. Ca2+ content in these structures and energetic supply to the cardiac muscle do not change as compared with the control. Noradrenaline content in myocardium increases 5-fold compared with the control and 2.5-fold compared with the norm, while blood content falls to zero (sympathetic neuro-muscular contact is 'locked up' for noradrenaline outflow into the blood); dopamine content increases. Adenylate cyclase sensitivity to the stimulating effect of noradrenaline and NaF diminishes. Basal activity of phosphodiesterase increases, and its sensitivity to the inhibitory action of high calcium concentrations decreases. The disturbance in these systems may, on the one hand, be due to neural effects, and pressure overload of the heart, on the other hand, to the sharp rise in noradrenaline content in the myocardium and the change in the activity of cyclic adenosine monophosphate enzymes. It is suggested that similar changes may take place in the human myocardium and may underlie the cardiac weakness.
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PMID:Subcellular bases of cardiac disturbance in experimental informational neurosis. 243 90

Thirty-five patients with trigeminal neuralgia (TN) bilaterally underwent posterior fossa microvascular decompression (MVD) between 1971 and 1984. They comprised 5.0% of a larger series of 699 patients with TN who underwent MVD during that interval. Compared to the subgroup of 664 patients with only unilateral symptoms, the population with bilateral TN included a greater percentage of females (74% vs. 58%, p less than 0.1), a higher rate of "familial" TN (17% vs. 4.1%, p less than 0.001), and an increased incidence of additional cranial nerve dysfunction (17% vs. 6.6%, p less than 0.05) and hypertension (34% vs. 19%, p less than 0.05). Of the 35 patients with bilateral TN, 10 underwent bilateral MVD (22 procedures) and 25 underwent unilateral MVD (30 procedures). In the latter patients, pain on the nonoperative side was well controlled with medication alone or had previously been treated by ablative procedures. Good or excellent pain control was achieved after one MVD was performed in 40 of the 45 sides treated (89%), and was maintained 1, 5, and 10 years after surgery in 82%, 66%, and 60%, respectively, based on life-table analysis. Six of 10 patients with recurrent symptoms underwent repeat unilateral MVD. Good or excellent long-term pain control was maintained in all six. With these repeat procedures included, symptom control at 1, 5, and 10 years after initial surgery was maintained in 87%, 78%, and 78% of the treated sides, respectively. Overall, 26 of 35 patients (74%) maintained good or excellent pain relief throughout the duration of the study (mean follow-up period 75 months) without resumption of regular medication usage. Although preoperative neurological deficits resulting from previous ablative procedures were seen in the majority of patients before MVD, no patient developed new major trigeminal sensory loss or masseter weakness after MVD. Operative mortality was zero. The results indicate that posterior fossa MVD is an effective and relatively safe treatment for the majority of patients with bilateral "idiopathic" TN, avoiding the risks of bilateral trigeminal nerve injury seen with other approaches.
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PMID:Bilateral trigeminal neuralgia: a 14-year experience with microvascular decompression. 245 Sep 74

while the cardiocirculatory response to dynamic exercises (e.g. running, cycling, swimming) is the object of the physician's full attention, the cardiovascular repercussions of static exercises, such as weight-lifting, sustained postures in gymnastics or immobilization in judo, are often ignored. Yet any sustained isometric contraction is associated from the art with an increase in blood pressure which may be major and involves about equally the systolic and diastolic pressures. As soon as the strength developed by the muscle exceeds 20 p. 100 of its maximum voluntary strength (MVS) the increase of blood pressure continues until the contraction comes to an end. Whatever the muscle used, the intensity of a cardiovascular response is independent of the muscular mass in action, but it mostly depends on the MVS percentage This rise in blood pressure is mainly due to an increase in heart and cardiac output. The reactions are such that relatively moderate and localized static effort may result in a rapid and important increase in myocardial work, and this may cause serious accidents in subject with a cardiovascular weakness, either isolated or associated with such risk factors as age or arterial hypertension. In consequence, adults who are insufficiently trained and present with one or several risk factors should avoid sports which required frequent respiratory arrests and/or sustained postures. If such sports are nevertheless chosen, it would seem that practising also a dynamic sport relying on aerobic metabolism might lin , at least in part, the effects of increased blood pressure due to static activities.
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PMID:[Changes in blood pressure during static work. Practical implication]. 251 Jun 88

Based on a retrospective evaluation of 107 patients with congenital venous angiodysplasia of the Type Klippel-Trenaunay (n = 76) and Type Servelle-Martorell (n = 31) the frequency and pathogenesis of aneurysm formation in the venous system has been analysed. The vascular patterns include both cylindric ectasias and fusiform aneurysms with an incidence of approximately 40%. Preferred locations are subcutaneous drainage veins, the popliteal, external iliac vein and atypic communicating veins between the superficial and the deep venous system. Complications of the aneurysm such as local thrombosis, recurrent pulmonary embolism or bleeding from rupture were not observed. From a pathogenetic point of view the aneurysm formation in venous angiodysplasias results probably from two causative factors, i.e., a congenital weakness of the venous wall (inborn error?) and an abnormal hemodynamical stress situation. The latter is caused by concomitant malformations of the deep venous system (avalvulia, hypo- and/or aplasia). The persistent intermittent venous hypertension associated with a more or less pronounced increase of the venous volume in the affected venous system of the limb results in a deep venous insufficiency respectively venous reflux disease. Surgery is indicated under two conditions: a) in the presence of aneurysm complications or b) for the elimination of a pathological short circuit flow in some drainage veins. Antireflux surgery, e.g., venous valve transfer form the brachial vein, is up to recently still in a stage of experimental-clinical investigation. The therapy of choice is predominantly conservative, i.e., external compression bandages or stockings to reduce the deleterious effects of a chronic deep venous insufficiency respectively venous reflux disease.
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PMID:[Aneurysmic transformation of the venous system in venous angiodysplasias of the limbs]. 254 55

The specific competitive alpha 1-postsynaptic blocking action and haemodynamic effects of prazosin (Minipress) have been summarized. Prazosin causes dilatation of arterioles and veins, reduces total peripheral resistance as well as preload and afterload. Cardiac output does not change at rest, stroke volume and subsequent cardiac output increase during exercise. The changes in heart rate have non-significant. It does not cause sympathetic counter-regulation, plasma renin activity does not increase, aldosterone level decreases, salt- and fluid retention may rarely be observed. It does not provoke angina. The authors report on the results of their examinations with the first dose of prazosin in 61 patients (in 33 cases by the double-blind cross-over method by placebo control), and summarize the observations made with the drug in long-term treatment in Hungary. The authors and other teams used prazosin as a long-term treatment (of approximately 3 months) in combination with other drugs in a total of 344 patients, and as monotherapy in 159 patients. In the course of combination treatment side-effects were observed in 15% of the patients (dizziness, headache, weakness, occasionally palpitation). During monotherapy, side-effects occurred in 12% of the patients (tachycardia, headache, weakness, dizziness). Hungarian results confirm the usefulness of prazosin in all stages of hypertension. It is effective in 30-35% of the cases as a monotherapy (this rate is congruent with the efficacy of beta-blockers, calcium antagonists and antihypertensive drugs of central action). Earlier prazosin had been used as a third agent in combination treatment of hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The mechanism of the action of Minipress. Examinations in hypertension. 257 64

Appropriate diagnostic procedure for spinal epidural hematomas has not been established yet. The authors reported a case of spontaneous epidural hematomas at the thoracic level, in which correct diagnosis was made with MRI and good results were obtained by surgery. A 63-year-old female experienced a severe back pain which appeared suddenly during a walk and was followed by motor weakness in both legs deteriorating quickly to paraplegia. The patient had no history of hypertension, trauma or bleeding tendency. The laboratory data were normal. On admission, neurological examination revealed flaccid paraplegia, total sensory loss below the level of Th 6 and urinary and fecal incontinence. Myelograms showed incomplete block at the Th 6 level and postmyelographic CT scan showed an isodense mass, which was suspected to be an epidural tumor located behind the spinal cord. Emergent MRI confirmed an epidural hematoma as a high intensity area extending from Th 3 through Th 11. Sixty-five hours after onset, laminectomy of Th 4 through Th 11 and the evacuation of epidural hematoma were performed without identification of the origin of the bleeding. Neither vascular malformation nor tumor was recognized during operation. Neither was it noticed on histological examination. The patient made favorable progress after the surgery. During the first two weeks in the postoperative period, she regained muscle strength enough to do standing exercise, and satisfactory improvement was made in sensory function including urination and defecation. We emphasize that MRI is indispensable to make a differential diagnosis of thoracic lesions. In the reported case, a correct diagnosis was made with MRI, and an extremely good result was obtained by an emergency operation.
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PMID:[Spontaneous spinal epidural hematoma diagnosed by MRI: a case report]. 259 57

Type I dissecting aortic aneurysm is not only the most common type of all but an extremely lethal event. It is important to create the experimental model of type I dissection for clarifying behavior of this disease and successful treatment. The purpose of this study is: (1) production of experimental model of type I aortic dissection; (2) examination of progression manner of dissection; (3) and investigation of influence of dissection upon aortic valve and coronary artery. The experimental model of type I aortic dissection was produced in adult mongrel dogs. Bilateral thoracotomy was made and intimal tear was created in the ascending aorta by modified Blanton's procedure. Hypertension and creation of large pocket of the aortic media were necessary to produce type I aortic dissection. Extension of dissection had a tendency toward the inner layer of the aortic wall at distal site. However, at proximal site the dissection progressed in the same layer of the aortic wall. In this series, retrograde extension of dissection remained blind above annulus of aortic valve, and no incidence of aortic regurgitation or coronary ischemia was occurred. But on histologic examination, degeneration of the aortic wall by the dissection was observed. Such weakness of aortic wall showed potentiality to developed into subsequent aortic regurgitation or coronary ischemia.
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PMID:[Experimental study on the dissecting aortic aneurysm]. 260 44

The congenital theory of the etiology of intracranial berry aneurysms has been widely accepted for many years. Review of the supporting evidence indicates that it is not based on sound scientific data but on unscientific and unsubstantiated allegations. There is no evidence of a congenital, developmental, or inherited weakness of the vessel wall. The most plausible explanation is that the aneurysms are acquired degenerative lesions--the effect of hemodynamic stress. The mural atrophy leading to aneurysmal dilatation is an acquired lesion which can be produced experimentally by hemodynamics alone. Hypertension and connective tissue disorders associated with acquired loss of tensile strength of the connective tissues are not essential: they appear to be aggravating rather than causal factors. Occlusion of one or more feeding vessels may enhance the possibility of aneurysm formation at large arterial forks subjected to the augmented hemodynamic stress associated with collateral flow.
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PMID:Etiology of intracranial berry aneurysms. 265 34

While the evidence for a clustering of health habits is not particularly strong, there are both pedagogic and economic arguments in favour of a multifaceted approach to health education. The present review thus examines the impact of regular physical exercise upon other forms of health behaviour, testing the extent to which an activity programme can be a catalyst of improved lifestyle in both primary and secondary preventive therapy. The conceptual framework of health promotion is examined with particular reference to the models of Skinner, Becker, Fishbein, Triandis and Rokeach. Certain differences are noted between the decision to exercise and the marketing decisions for which Fishbein's model was originally designed. Nevertheless, in its later modifications, it provides a basic framework for understanding how human lifestyle is shaped. Theoretical mechanisms are suggested whereby exercise could influence such behaviours as cigarette smoking, alcohol consumption and drug usage, seat-belt usage, hypertension, body mass, lipid profile, promiscuous sexual behaviour, the carrying of lethal weapons, and acceptance of regular preventive medical examinations. The empirical evidence from both cross-sectional and longitudinal experiments shows a relatively weak association between exercise habits and other desirable forms of health behaviour. Moreover, it is arguable that other forms of health intervention such as smoking withdrawal or dieting might be equally effective as a primary change agent, and much of the observed association between exercise and other health habits could be attributable to a common dependence on demographic and socio-economic factors. On the other hand, the apparent weakness of associations may arise in part from difficulties in measuring both habitual physical activity and other forms of health behaviour, with a resultant attenuation of correlations. Possibly, a stronger association between exercise participation and other favourable health habits would be uncovered if attention were focused upon those forms of endurance exercise currently thought to enhance cardiac health. Given that moderate endurance exercise is also positive and pleasant advice, further examination of the potential of multifaceted but exercise-centered health promotion programmes appears warranted.
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PMID:Adolphe Abrahams memorial lecture, 1988. Exercise and lifestyle change. 265 29


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