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

Physiologic changes in metabolism may make thyroid diseases difficult to diagnose during pregnancy. Such diagnoses depend principally on clinical acumen and an understanding of the alterations of laboratory values, particularly thyroid-stimulating hormone (TSH), induced by pregnancy. Untreated thyrotoxicosis may lead to abortion, stillbirth, neonatal death and low birth weight. The principal cause of thyrotoxicosis in pregnancy is Graves' disease, which may be treated with antithyroid drugs or surgery. The use of radioactive iodine is absolutely contraindicated during pregnancy. Hypothyroidism during pregnancy is associated with hypertension and premature labor. The goal of thyroxine replacement therapy is to maintain serum TSH levels in the normal range. Many thyroid conditions and treatments directly affect the fetus and the principal antithyroid drugs are secreted in breast milk. Both the mother and neonate require monitoring. In addition, autoimmune postpartum thyroiditis may recur following each pregnancy in susceptible patients.
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PMID:Thyroid disease during pregnancy. 854 48

Presentation of 6 cases of pheochromocytoma, diagnosed and treated in our Unit over the last 5 years. Five were adrenal pheochromocytomas and 1 an abdominal paraganglioma in a 42 year-old woman. Distribution by gender was 4 male and 2 female, and mean age at presentation was 45.2 years ranging from 35 to 55 years. Clinically, all patients were hypertensive. Two of the 5 cases with adrenal location presented with catecholaminic crisis with BP > 240/140 mmHg. The paraganglioma was diagnosed while studying a case of sustained HBP in a 42 year-old female referred from another unit. With regard to diagnosis, the sensitivity of urinary tests was 100%, and gammagraphy with meta-iodine-benzyl-guanidine (MIBG) was particularly useful in the extra-adrenal location case. In all our patients, computerized tomography (CT) was the choice procedure to locate the tumour. Treatment was surgical in all cases, access being transperitoneal in 3 cases, thoracoabdominal in 2 and classic lumbotomy in 1. All our patients received prior treatment with alpha-blocking agents, and intraoperative complications were 1 arrythmic crisis, 1 hypotensive picture and 1 hypertensive crisis, all of which resolved successfully. Currently, 5 patients remain disease free. Mild HBP controlled with low dose captopril still persists in one patient.
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PMID:[Pheochromocytoma: a review of our own cases]. 872 Sep 98

Nests of cells within the central nervous system, namely the circumventricular organs (CVOs) which include the subfornical organ (SFO), organum vasculosum lamina terminalis (OVLT), area postrema (AP) and the median eminence (ME) are known to contain not only receptors for angiotensin II (ANG II) but also ANG II itself. Though the significance of this central ANG II network in the pathophysiology of certain conditions like hypertension is well established, there appears to be a lack of knowledge as to how this system might be involved after subarachnoid haemorrhage (SAH). In this study, we have investigated ANG II receptor content change at various circumventricular organs after experimental subarachnoid haemorrhage in rats using a transcervical transclival model. ANG II receptor content was detected by in vivo autoradiography using intracisternal ANG II Sar 1, Ile 8 labelled with iodine (I) 125 both at 30 minutes and 48 hours after the SAH. Serum angiotensin converting enzyme activity was also detected during the time course reflecting the involvement of the peripheral angiotensin system and showed an early rise and a fall after two days. Immunohistochemistry was utilized to show the ANG II-containing cells within the circumventricular organs. SFO and OVLT were found to have a statistically significant increase in ANG II receptor content persisting over two days after the SAH. These alterations in the receptor content of CVOs may indicate their possible role in delayed ischaemic deficits seen after SAH.
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PMID:Angiotensin II receptor content within the subfornical organ and organum vasculosum lamina terminalis increases after experimental subarachnoid haemorrhage in rats. 873 97

The aim of the present study was to evaluate the use of the noradrenaline analogue iodine-123 metaiodobenzylguanidine ([123I]MIBG) for the assessment of cardiac sympathetic activity in the presence of diabetes mellitus and/or hypertension in animal models. One model used Wistar-Kyoto rats (WKY) and spontaneously hypertensive rats (SHR) rendered diabetic at 12 weeks of age by an intravenous injection of streptozotocin (STZ). The other model used lean and obese Zucker rats. In all groups basic haemodynamic values were established and animals received an intravenous injection of 50 microCi [123I]MIBG. Initial myocardial uptake and wash-out rates of [123I]MIBG were measured scintigraphically during 4 h. After sacrifice, plasma noradrenaline and left cardiac ventricular beta-adrenoceptor density was determined. The diabetic state, both in STZ-treated rats (direct induction) and in obese Zucker rats (genetic induction), appeared to induce a lower cardiac density of beta-adrenoceptors, indicative of increased sympathetic activity. Cardiac [123I]MIBG then showed increased wash-outs, thereby confirming enhanced noradrenergic activity. This parallism of results led to the conclusion that [123I]MIBG wash-out measurements could provide an excellent tool to assess cardiac sympathetic activity non-invasively. However, in hypertension (WKY vs SHR), both parameters failed to show parallelism: no changes in beta-adrenoceptor density were found, whereas [123I]MIBG wash-out rate was increased. Thus, either [123I]MIBG washout or beta-adrenoceptor density may not be a reliable parameter under all circumstances to detect changes in the release of noradrenaline. Changes in the initial uptake of [123I]MIBG were observed as well. This may be a good marker for the disappearance of cardiac innervation, but it seems not to be a good parameter for distinguishing between loss of sympathetic innervation and enhanced uptake of noradrenaline in pathological conditions.
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PMID:Cardiac iodine-123 metaiodobenzylguanidine uptake in animals with diabetes mellitus and/or hypertension. 875 78

Renovascular hypertension represents 1 to 2% of all causes of hypertension. It is important to make the diagnosis as radical treatment may be proposed. Digitised arteriography is the reference diagnostic method. Spiral angiotomography is a new diagnostic technique for the investigation of the aorta and its branches. The examination was performed with a Siemens Somatom Plus S spiral scanner. The images were acquired after intravenous injection of 140 ml of iodine contrast medium in the forearm. Three dimensional reconstruction of the renal arteries may be performed secondarily. The results of 16 examinations were compared with those of arteriography. Nine stenoses were suspected after spiral angiotomography and confirmed in 7 cases by arteriography (sensitivity 100%; specificity 77%); two adrenal abnormalities were also detected by spiral tomography. In this series, spiral angiotomography detected all cases of renal artery stenosis with good specificity. Moreover, this investigation also allowed evaluation of the adrenal glands. The simple, non-invasive and polyvalent nature of this method should, if the results are confirmed in a large series, lead to its use as the investigation of first intention for suspected secondary causes of hypertension.
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PMID:[Value of spiral computed tomography with three-dimensional reconstruction in the investigation of renal arteries. An initial clinical experience apropos of 16 cases]. 876 Jun 57

Pheochromocytomas are uncommon tumors that represent a potentially curable cause of hypertension. They are usually located in the adrenal glands, but 10% arise from extra-adrenal sites, located along the paravertebral sympathetic chains. We report a case of primary hepatic pheochromocytoma responsible for a severe hypertension in a 24-year-old man. Echotomography showed a lightly heterogeneous mass located in the segment 8 of the liver. Iodine 131-metaiodobenzylguanidine scintigraphy showed a large hepatic concentration of the tracer and no other localization. This tumor appeared highly vascularized on enhanced CT scan and on aortic angiography. Magnetic resonance imaging revealed a hepatic tumor with a high signal intensity on T2-weighted images and with a signal isointense to the liver on T1-weighted images. The hepatic venous sampling contained the highest catecholamine level, whereas the adrenal venous sampling was normal. After surgical resection of the hepatic tumor, the tension level and catecholamines plasmatic level normalized. No recurrent symptoms appeared during a 3-year follow-up.
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PMID:Primary hepatic pheochromocytoma. 879 58

Hyperplasia of myocytes in cardiac adaptation is a rare event in the mammalian cardiac muscle. Recent findings support the concept that proliferation of myocytes in the adult mammalian heart may be induced after a prolonged increase in pressure load on the myocardium. To determine whether short-term hypertension leads to hyperplasia of myocyte nuclei in the rat heart renal hypertension was produced in 12 Wistar rats. As soon as hypertension occurred, bromodeoxyuridine (BrdU) (50 mg/kg/day) was injected intraperitoneally on three subsequent days. Twelve sham-operated rats served as controls. After 3 days, the left cardiac ventricle was excised and double-staining with anti-BrdU antibody and propidium iodide was performed to determine the phase of cell-cycle of the BrdU-positive cells by flow-cytometry. Immunohistochemical double-staining with desmin, smooth muscle actin, vimentin, and BrdU was done to classify the BrdU-positive cells. Most of the BrdU-positive cells were in the G0/G1-phase of the cell-cycle, suggesting cell proliferation or DNA-repair have taken place; polyploidy was not observed. In the hypertensive group (4.62% +/- 2.36) significantly more cells incorporated BrdU than in the control group (1.46% +/- 0.96). Immunohistochemically, the majority of the BrdU-positive cells consisted of fibrocytes, smooth muscle cells, and endothelial cells. Only 0.35% +/- 0.26 of cardiac myocytes in the normotensive group showed positive BrdU-staining compared to 0.48% +/- 0.32 in the hypertensive group. This difference was statistically not significant. This study showed that early after onset of hypertension proliferation of non-myocytes, but not of myocytes occurred. DNA synthesis is limited almost completely to the interstitial cells and does not occur in any significant extent in cardiac myocytes. In conclusion, hyperplasia of cardiac myocytes is not observed at early stages of hypertension, but it may develop at a late stage of cardiac adaptation.
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PMID:Early proliferative changes in hearts of hypertensive Goldblatt rats: an immunohistochemical and flow-cytometrical study. 887 76

We tested several peptides related to des-Arg9-bradykinin as stimulants or inhibitors of B1 (rabbit aorta, human umbilical vein) and B2 (rabbit jugular vein, guinea pig ileum, human umbilical vein) receptors. We also incubated the compounds with purified angiotensin-converting enzyme from rabbit lung to test their resistance to degradation. We evaluated apparent affinities (in terms of the affinity constant pA2) of compounds and their potential residual agonistic activities (alpha E). Bradykinin and des-Arg9-bradykinin were used as agonists for the B2 and B1 receptors, respectively. Degradation of peptides by the angiotensin-converting enzyme was prevented in the presence of a D-residue in position 7 of des-Arg9-bradykinin. Replacement of Pro7 with D-Tic combined with Leu, Ile, Ala, or D-Tic in position 8 led to weak B1 receptor antagonists, some of which had strong residual agonistic activities on the B2 receptor preparations. The use of D-beta Nal in position 7, combined with Ile in position 8 and AcLys at the N-terminal (eg, AcLys[D-beta Nal7, Ile8]des-Arg9-bradykinin) gave the most active B1 receptor antagonist (pA2 of 8.5 on rabbit aorta and human umbilical vein), which is also partially resistant to enzymatic degradation. Extension of the N-terminal end by Sar-Tyr-epsilon Ahx (used for labeling purposes) and even cold-labeling of Tyr with iodine were compatible with high, selective, and specific antagonism of the B1 receptors. We compared some compounds with some already known B1 receptor antagonists to underline the novelty of new peptidic compounds.
Hypertension 1996 Nov
PMID:Structure-activity studies of B1 receptor-related peptides. Antagonists. 890 31

The role of alpha 1- and alpha 2-adrenoceptors in the vascular effects of catecholamines, either released locally from sympathetic nerve endings (e.g., in vascular smooth muscle) or derived from the adrenal medulla or administered intravenously, was studied using selective antagonists of these adrenoceptors. The ganglionic stimulant dimethylphenyl-piperazinium-iodide (DMPP) exerted dual actions on blood pressure: a rapid and short-term pressor reaction (phase I) resulting from catecholamine release elicited by ganglion stimulation, followed by a more sustained blood pressure elevation (phase II) resulting from the circulating catecholamines released from the adrenal medulla. The selective alpha 2-adrenoceptor, but a not subtype selective, antagonist 7,8-(methylenedioxi)-14-alpha-alloberbane HCl (CH-38083) (50-100 micrograms/kg, IV) significantly (p < 0.05) inhibited the pressor effects of epinephrine and norepinephrine given intravenously and phase II of the DMPP-induced pressor reaction. Idazoxan exerted similar effects, but at higher doses (400-600 micrograms/kg, IV). WB-4101 (50-100 micrograms/kg, IV) and BRL-44408 (2-3 mg/kg, IV), two selective alpha 2A-adrenoceptor antagonists, had the same activity as CH-38083, except did not inhibit the pressor effect of intravenously administered norepinephrine. The alpha 2B-adrenoceptor selective antagonist, ARC-239 (150 micrograms/kg, IV) did not influence phase II of DMPP-induced pressor reaction. Prazosin (200 micrograms/kg, IV), an antagonist of alpha 1 and alpha 2B-adrenoceptors, reduced blood pressure, the pressor response to intravenously administered epinephrine, and phase I of the DMPP-induced pressor effect. In addition, it completely inhibited the pressor responses to DMPP remaining after administration of CH-38083. These results suggest that the postsynaptically located alpha 1- and alpha 2(A and B)-adrenoceptors are involved in pressor response to norepinephrine and epinephrine, and are sensitive and accessible to catecholamines released locally from the axon terminals, and from the circulation to a different extent. These results may have great therapeutical importance in hypertension, for which the involvement of both a high level of circulating and locally released catecholamines may be indicative of the usefullness of a combination (alpha 1- and alpha 2-adrenoceptors- and Ca-channel-blocking agents) therapy.
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PMID:Role of different subtypes of adrenoceptors in pressor responses to catecholamines released from sympathetic nerve endings. 897 34

In China, health care delivery follows a three-tiered structure set up in the 1950s for rural and urban areas. In 1990, China set baseline criteria for primary health care in rural areas which is largely funded by a reestablished rural cooperative medical care financing system. Financing reform efforts in urban areas are using a model through which contributions are collected from salaries and from local governments and other public organizations. The overall incidence of infectious diseases is more than 500/100,000 people, but associated mortality has declined. Diseases covered by the Expanded Programme of Immunology have been controlled, but China is at high risk for viral hepatitis (epidemics of hepatitis A infections occurred in 1988), and incidence of tuberculosis has increased. In addition, the HIV/AIDS epidemic is spreading rapidly with an estimated 50,000-100,000 infected. Parasitic diseases are also widespread, and causes of death seen in developed countries (hypertension, stroke, coronary health disease, cancer, and diabetes) are increasing. With 510 million people living in iodine-deficient areas, iodine deficiency diseases have disabled an estimated 8 million people. China has promised to eradicate iodine-deficiency by the year 2000. The disabling Kaschin-Beck disease is also endemic in China. Occupational diseases threaten nearly 20 million Chinese people, and the prevalence of smoking and alcohol abuse is increasing, especially among young people. By the year 2000, 10% of the population will be older than 60, and 30% of this group will have health problems requiring care. The health care system is, thus, undergoing rapid change to meet its new challenges.
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PMID:Health care delivery system and major health issues in China. 898 46


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