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

Fibromuscular dysplasia of the arteries (FMD) is a segmental angiopathy which may produce obstruction of the carotid, cerebral, renal, mesenteric, coronary or iliac arteries. Except for lesions related to arterial hypertension, retinal manifestations have not yet been reported. This paper describes the case of a 10-year-old boy with progressive deafness, a history of an unexplained stroke and progressive occlusions of the retinal arterioles in the fundus periphery. This resulted in retinal neovascularization and recurrent retinal and vitreous hemorrhages. Despite repeated photo- and cryocoagulation the eyes progressed to a tractional retinal detachment which was successfully treated by vitrectomy and scleral buckling. The diagnosis of FMD was made on the basis of a histopathological examination of a temporal artery biopsy. The child also presented an asymptomatic but severe aneurysmal dilatation of the aorta and CT scan and MRI showed dilated cerebral arteries. The father of our patient had died at the age of 27 years either from myocardial infarction or rupture of a dissecting aortic aneurysm. He was highly myopic and had lost one eye from retinal detachment. The younger brother of our patient also presents aneurysmal dilatation of the aorta and tortuous cerebral vessels. Ocular examination is still normal. The findings in this family are compatible with an autosomal dominant inheritance with variable expression.
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PMID:Retinal manifestations in fibromuscular dysplasia. 182 Dec 2

Five of 182 recipients of allogeneic bone marrow transplants performed between 2/84 and 6/90 developed seizures while receiving cyclosporine and methylprednisolone to prevent acute graft-versus-host disease. All received a radiation-free regimen of busulfan and cyclophosphamide as preparative therapy. Two patients received HLA-mismatched allografts; and three patients received marrow from HLA-identical sibling donors. Two patients had received extensive intrathecal therapy prior to transplantation. All patients were receiving standard prophylactic doses of CsA and MP at the time of onset (median 31 days posttransplantation) of seizures. Three patients had mild-to-moderate hypertension and varying degrees of morphologic evidence of microangiopathic hemolytic anemia. None had unusually low magnesium levels. Cyclosporine levels were not in the toxic range. Cranial magnetic resonance imaging and computed tomography (CT) showed bilateral abnormalities primarily in the posterior temporal, occipital, and parietal lobes. These abnormalities were shown to be transient on sequential MRI exams in two patients. Seizures as well as radiologic abnormalities resolved on stopping CsA and did not recur in 2 patients who subsequently received CsA in lower doses. These findings confirm and expand previous observations of CsA-associated seizures and demonstrate that they occur in allogeneic bone marrow transplant recipients following a radiation-free preparative regimen of busulfan and cyclophosphamide.
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PMID:Cyclosporine-associated seizures in bone marrow transplant recipients given busulfan and cyclophosphamide preparative therapy. 187 5

A case of persistent primitive proatlantal intersegmental artery (PPPIA) is reported. A 65-year-old male with treated hypertension was admitted to our clinic complaining of dysarthria and hemiparesis of sudden onset two days after the ictus. CT revealed spotty low-density lesions in the left corona radiata and bilateral thalami with bilateral watershed infarction. MRI findings were also compatible with cerebral infarction. Left common carotid angiography demonstrated a large anastomosis between the external carotid artery and the vertebral artery at the proatlantal region. Neither of the vertebral arteries were visualized on digital subtraction aortography. All the blood circulation of the vertebro-basilar system was through this anastomotic artery (PPPIA). A flow study revealed hypoperfusion in the territory of the left middle cerebral artery on 133Xe SPECT. Bone window CT of cervical vertebrae revealed hypoplasia of the left transverse foramen in C2, C3, C4, C5, C6 vertebrae. This case is very suggestive of an anaplasia or hypoplasia of the vertebral arteries. The etiology of his left frontal infarction seemed to be a blood-stealing phenomenon of long standing, from the anterior to the posterior circulation through the PPPIA.
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PMID:[Persistent primitive proatlantal intersegmental artery (PPPIA) presenting with cerebral infarction]. 188 24

Clinical picture of Moya Moya Disease was analyzed in 18 cases. In 16 cases whose CT scan were available at the time of the first bleeding, hematoma at the basal ganglia was noted in 43.8%, primary ventricular hemorrhage in 37.5%, thalamic hemorrhage with ventricular rupture in 12.5% and subcortical hemorrhage in 6.3%. The frequencies shown above were well correlated to previous reports. In MRI performed 1 year or more after primary ventricular hemorrhage, the primary bleeding site was demonstrated at the lateral wall of the lateral ventricle, in proton weighted and T2 weighted images. MRI can detect the site of old bleeding points and its chronological change if the study is repeated. In a follow-up period of 5.4 years, 27.8% of the cases had rebleeding one or more times. As a result, good outcome was noted in 72.2% after the 1st bleeding, and in 55.6% after re-bleedings. Death occurred in 5.6% of patients after the 1st bleeding and in 22.2% after further rebleeding. Rebleeding worsened the outcome. Therefore, prevention of rebleeding is important. From a therapeutic viewpoint, although a direct relation between rebleeding and untreated hypertension could not be established, blood pressure control is critical at both the acute and the chronic stages. Reconstructive vascular surgery is a recommendable method for properly selected patients.
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PMID:[Hemorrhagic type of moyamoya disease]. 189 15

Postural stimulation tests (PST) from 146 patients with primary aldosteronism were reviewed: 83 had an aldosterone-producing adenoma (APA), 48 idiopathic hyperaldosteronism (IHA), nine primary adrenal hyperplasia (PAH), and six aldosterone-producing renin-responsive adenoma (AP-RA). Plasma aldosterone and cortisol levels were measured after overnight recumbency and in response to upright posture for 2 to 4 h. The test was considered invalid in 32% of the patients because cortisol levels increased during the maneuver. As both cortisol and aldosterone are responsive to ACTH in subjects with primary aldosteronism, as well as in normal subjects, we examined their percent variation instead of the absolute values. In order to validate those tests in which cortisol increased, we subtracted the percent cortisol change from the percent aldosterone response. An aldosterone increase of less than 30% (considered a positive response for the presence of an adenoma) identified 76 of the 89 patients with an adenoma (APA and AP-RA) (sensitivity of 85%). Among the 13 false-negative tests, six were proven cases of AP-RA. In each and every case an adenoma was detected by CT/MRI scanning (or bilateral adrenal vein catheterization). Hypertension was ameliorated or cured by surgery. A postural response of less than 30% was also present in 11 of the 57 patients who did not have a discrete adenoma confirmed by imaging techniques (specificity of 81%). Among these false-positive results there were the nine cases of PAH where the hypertension could be ameliorated or cured by partial removal of hyperplastic adrenal tissue.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Reassessment of the predictive value of the postural stimulation test in primary aldosteronism. 193 Aug 62

In 3 hypertensive patients, aged 57 to 66, profound behavioral and personality changes occurred rather abruptly, characterized by total loss of spontaneous activity and initiative, apathetic behavior, passivity, lack of drive and motivation, loss of interest for any of previous occupations and hobbies, and total flatness of affect. Neurological examination was normal or only showed mild extra-pyramidal signs. Neuropsychological evaluation was only remarkable for mild intellectual impairment suggestive of frontal lobe dysfunction. None of the 3 patients fulfilled criteria for dementia or severe depression. This neurobehavioral syndrome has been coined "athymhormic syndrome" (Habib & Poncet, 1988), a term emphasizing the specific defect in drive ("horme") and affect ("thumos"). Electrical and clinical heart examination was unremarkable. Blood pressure was always found within normal limits during hospitalization, including 24-hour monitoring in one case. However, all patients were known as hypertensive in the past, with repeated bouts of high blood pressure (up to 270 mmHg systolic in one case). X-ray CT-scan was usually normal or showed non-specific white matter changes (so-called "leukoaraiosis"). In all 3 cases, a brain MRI scan showed multiple small infarcts mainly involving deep subcortical structures (caudate nuclei and/or adjacent periventricular white matter) of both hemispheres, consistent with the definition of lacunes.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Changes in personality and hypertension. The "athymhormic" syndrome]. 195 72

Initial and follow-up investigations were done systematically in 15 cases of internal carotid artery (ICA) dissections by means of angiography, computerized tomography, Magnetic Resonance Imaging, extracranial and transcranial Doppler sonography, as well as B-mode imaging. Cerebral hemodynamic reserve was evaluated by means of both SPECT and CO2-dependent vasomotor reactivity. The findings are focussed on two major issues: Do modern diagnostic tools permit to make the diagnosis of ICA dissection without angiographical proof? What is the pathogenesis of brain infarctions due to ICA dissections? Our findings demonstrate that the diagnosis of carotid artery dissection can reliably be done noninvasively by means of ultrasound techniques and MRI. These methods also allow for frequent follow-up investigations without any inconvenience for the patient. Embolic brain infarctions caused by carotid artery dissections are equally frequent as low flow induced lesions. Acute and follow-up findings suggest that surgical intervention is contraindicated in the acute phase, but may be considered for chronic pseudoaneurysms. Initial anticoagulation with high dose heparin is safe and seems to be efficacious. In certain cases, subsequent cumarine therapy may be indicated for a maximum of six months. Measures improving hemodynamics, e. g. induced hypertension, are reasonable, as long as the vasomotor reserve is exhausted.
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PMID:[Dissections of the internal carotid artery--new diagnostic and pathogenetic aspects]. 200 7

A case of local recurrence of rectal cancer was successfully treated by UFT combined with two-route CDDP chemotherapy under the AT-II induced hypertension. UFT (600 mg/day) was orally administered every day. CDDP (75 mg/m2) was infused into the right internal iliac artery via subcutaneously grafted Infuse-a-port under hypertensive state induced by the AT-II (3 micrograms/min). Sodium thiosulfate was intravenously given to protect the CDDP induced nephrotoxicity. The recurrence tumor palpated by digital examination and revealed by MRI disappeared after the fourth two-route CDDP chemotherapy. The serum CEA level elevated before the treatment also normalized. This combined chemotherapy was considered to be an effective measure to cure the local recurrence of rectal cancer.
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PMID:[A case of local recurrence of rectal cancer successfully treated by UFT combined with two-route CDDP chemotherapy under the AT-II induced hypertension]. 201 3

A 32-year-old primigravida showed signs of pre-eclampsia before delivery of a healthy boy at term. The CSF-space was accidentally punctured during epidural anaesthesia in labour. One day later hypertension was noted and the patient had a single generalized fit. For the next three weeks she had postural headaches, fluctuating hypertension, intermittent hearing loss and double-vision. On the 22nd day of postpartum, the patient had the first of a series of partial and later generalized seizures, followed by hemiparesis, alteration of consciousness, and finally slow recovery with corticosteroid therapy. Bilateral subdural effusions and generalized meningeal thickening were found on MR scans. Repeated MRI excluded sinus thrombosis and documented the response to treatment.
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PMID:Neurological cause of late postpartum seizures. 201 11

A 43-year-old lady was hospitalized due to easy fatiguability in the legs during exercise, and for evaluation of an abnormal shadow in the chest X-ray, and hypertension. Her blood pressure was 200/80 mmHg in the right arm, 140/70 mmHg in the left, and 110/70 mmHg in both lower extremities. Systolic vascular bruit radiating to her neck and back was audible in the Erb's area. DSA and aortogram disclosed extremely dilated vessels around the origin of the left common carotid artery. The left subclavian artery was opacified retrogradely as a subclavian blood steal via the left vertebral artery, and mild stenosis was seen at its origin. There was no evidence of associated congenital anomaly such as VSD, PDA, or ASD. The final diagnosis, solitary interruption of the aortic arch (S-IAA, type B), was made by MRI. The patient had an extra-anatomical bypass operation by using Cooley woven dacron graft from the ascending to the abdominal aorta. The result was good. S-IAA is a very rare congenital anomaly. As far as we know, only 21 patients with S-IAA including this case have been reported. A physician should be aware that a patient with S-IAA tends to have a difference of blood pressure not only between the upper and lower extremities but also between both arms, and pressure in the right arm is usually higher than that in the left. These are good signs to suspect S-IAA. And they also can be helpful to differentiate S-IAA from coarctation of the aorta.
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PMID:[An operative case of solitary interruption of the aortic arch in adult]. 206 91


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