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Query: UMLS:C0235108 (tense)
 2,176 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The present article examines the relations among self-reported and physician-estimated chest pain variables to angiographically determined coronary stenosis (CAD) and neuroticism scores. Six of the 48 chest pain variables were significantly related to coronary stenosis, but only one variable, chest pain elicited by walking, was positively related to stenosis. Chest pain during sleep, sighing and dizziness accompanying chest pain, right lower chest pain radiation, and infrequent rest to cope with the chest pain were significantly negatively related to stenosis. Neuroticism scores (N) were not significantly related to CAD but were significantly correlated with 13 of the 48 chest pain variables. In addition to correlating positively with the chest pain variables that were negatively correlated with CAD, N scores were significantly related to higher pain severity ratings, being angry, annoyed, tense, afraid, worried, and upset before the chest pain, breathlessness during the pain episode, and pain sensations described as stabbing. The six chest pain variables significantly correlated with CAD yielded a multiple correlation of 0.58, accounting for 34% of the variance, whereas N scores accounted for only 5% of the variance; however, N contributed less than 1% unique variation to stenosis in combination with the six chest-pain variables. That N influences chest pain reports more than actual stenosis is further confirmed by the results of physicians' ratings of their patients' typical chest pain episodes. Recognition of patients' characteristic levels of distress or neuroticism may aid physicians in evaluating symptoms more accurately and in treating their chest pains more appropriately.
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PMID:The relation of chest pain symptoms to angiographic findings of coronary artery stenosis and neuroticism. 400 Dec 86

A 36-year-old man presented with chest pain, an anterior mediastinal mass and a loud pulmonary systolic murmur. At operation a large, tense, well encapsulated, cystic thymoma was found to be compressing the right ventricular outflow tract and the main pulmonary trunk, producing a systolic thrill over the artery. After excision of the cyst, the thrill and the murmur disappeared and there was complete symptomatic relief. Classification, pathology, clinical presentation, diagnosis and treatment of cysts of the thymus are discussed. The syndrome of pulmonary artery compression characterized by a triad of chest pain, dyspnoea and a loud pulmonary systolic murmur, which decreases in intensity during inspiration, is described. Pertinent literature on cysts of the thymus, and acquired pulmonary stenosis due to extrinsic compression is reviewed.
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PMID:Cystic thymoma simulating pulmonary stenosis. 742 59

Tense, nonchylous ascites following a Whipple procedure has not been reported to date. We describe the course of such a patient successfully treated by a peritoneovenous shunt. A 49-year-old male developed tense ascites following pancreaticoduodenectomy. Despite conservative measures, abdominal distension developed to the point of dyspnea and orthopnea for over a six-month period. Because the physicochemical characteristic of the ascitic fluid was consistent with that of hepatic lymph, ascites was considered due to injury to the lymphatics around the porta hepatis. A peritoneovenous shunt was established for the treatment of ascites and was removed when the ascites had resolved at nine months after shunting. Our experience suggests that, in case conservative measures fail in the control of ascites, either direct repair of the lymphatic leak by laparotomy or the temporary use of peritoneovenous shunting may be considered.
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PMID:Temporary use of peritoneovenous shunting for treatment of tense ascites following a Whipple procedure. 755 48

Cor triatriatum (CT) is a rare malformation consisting of a fibromuscolar membrane that subdivides the left atrium in a postero-superior (or accessory) chamber and an antero-inferior chamber (true left atrium, containing the left atrial appendage). In its classic form, the accessory chamber receives the pulmonary veins and communication with the left atrium is accomplished by way of one or more fenestrations in the membrane. The malformation is usually isolated, but in about one in four patients is associated with other congenital defects of a complex nature. We describe a case of CT associated with atrial septal defect, in which transthoracic echocardiography failed to document the existence of CT membrane, while this abnormality was clearly seen and defined by use of transesophageal echocardiography. The patient was a 26 year-old girl, presented at our outpatient clinic after an episode of palpitations and dyspnea, which lasted for two hours. She suffered of mild dyspnea on exertion during the last three months. Physical examination revealed the typical findings of an atrial septal defect (ASD), and the electrocardiogram revealed right bundle branch block. The two-dimensional echocardiography disclosed an ostium secundum ASD with left to right shunt; dilatation of the right cavities; paradoxical movement of the interventricular septum. A small linear echo originating from the lateral wall of the left atrium, with no evidence of turbulent flow on pulsed wave Doppler and color flow examination, was interpreted as an artifact. Transesophageal echocardiography clearly visualized a tense, bulging membrane separating left atrium into two chambers.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Cor triatriatum associated with inter-atrial defect: diagnosis by transesophageal echocardiography]. 836 12

Fifty-eight outpatients with panic disorder (PD) were examined to determine their clinical features in comparison with a cohort of 52 patients with generalised anxiety disorder (GAD). Both groups were of comparable age, sex, educational level, marital status and ethnicity. PD patients were more likely to complain of palpitations, breathlessness, chest pain, numbness, choking sensations and especially fear of dying. GAD patients tended to complain of feeling tense, insomnia, headaches, weakness, restlessness and muscle aches. PD patients had greater comorbidity especially with agoraphobia and depression. Contrary to other reports, there were more males than females in both groups but alcohol dependence and suicide attempts were relatively rare. PD symptoms seemed more distressing, caused more social and occupational disruption, led to more requests for medical investigations and earlier psychiatric consultations. These factors seemed to suggest that panic disorder is a more severe illness than generalised anxiety disorder.
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PMID:Panic disorder in Singapore: clinical features and comparisons with generalised anxiety disorder. 920 72

A 68-year-old man was admitted to our hospital presenting cutaneous pruritic lesions consisting of tense blisters with serous content on his arms and legs. Histological findings of skin biopsy confirmed a diagnosis of bullous pemphigoid in March 2005. After 10 weeks of prednisone therapy for bullous pemphigoid, he presented with increasing breathlessness and high fever. He was admitted to our hospital because of severe hypoxemia on May 29, 2005, and mechanical ventilation was started from the first hospital day. Chest computed tomography showed marked ground-glass opacities in both lungs. The levels of beta-D glucan and KL-6 in his sera were elevated. We suspected Pneumocystis pneumonia and Cytomegalovirus pneumonia. Under mechanical ventilation, he received steroid pulse therapy, and sulfamethoxazole-trimethoprim and ganciclovir. A polymerase chain reaction assay of bronchoalveolar lavage fluid showed Pneumocysitis DNA and Cytomegalovirus DNA. On the 12th hospital day, he was weaned from mechanical ventilation. Follow-up chest computed tomography showed marked resolution of diffuse ground-glass opacity in both lungs. We need to consider the development of Pneumocystis pneumonia and Cytomegalovirus pneumonia during steroid therapy for bullous pemphigoid.
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PMID:[A case of bullous pemphigoid associated with Pneumocystis pneumonia and Cytomegalovirus pneumonia]. 1723 4

Desmoplastic small round-cell tumor is an uncommon, highly aggressive tumor with a predilection for pediatric age groups and young adults. It is very unusual in the elderly population. Although Agent Orange has been associated with soft-tissue sarcoma, an association with desmoplastic small round-cell tumor has not been reported. A 52-year-old male presented with abdominal distention, dyspnea, and a 9 kg weight loss. Prior history was significant for hepatitis C and diabetes. He was a Vietnam veteran and he admitted being exposed to Agent Orange. On physical examination, the abdomen was distended and tense. Computed tomography scan of the chest, abdomen and pelvis demonstrated extensive mediastinal and retroperitoneal adenopathy, diffuse omental masses and extensive pleural, intra-abdominal and pelvic ascites. Omental core needle biopsy was consistent with desmoplastic small round-cell tumor based on morphology and immunohistochemistry. He responded poorly to chemotherapy with high-dose cyclophosphamide, doxorubicin and vincristine and died 5 months after presentation secondary to neutropenic sepsis despite G-CSF support and antibiotics.
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PMID:Desmoplastic small round-cell tumor: an adult with previous exposure to agent orange. 2038 35

A well established part of therapeutic approaches applying to cases of chronic heart failure (CHF) with extreme fluid retention is represented by intensive intravenous (i.v.) therapy with loop diuretics. This kind of therapy, if appropriately modulated according to the individual clinical picture and biohumoral pattern, is able to decrease the abnormally high ventricular filling pressures, thereby relieving the breathlessness while being able to retrieve a suitable urine output, so as to propitiate regression or disappearance of edema without unfavorable influences on renal clearance of nitrogenous compounds. Nevertheless, the intensive i.v. diuretic therapy should be tailored on the basis of a close assessment of baseline hemodynamic data and hemodynamic response to the medications, in addition to the careful diuretic dose titration and cautious evaluation of risk/benefit ratio. Actually, by using this kind of therapy, there is a risk that a tubular or glomerular injury can be generated and that a frequently preexisting renal dysfunction can be aggravated, especially when excessive doses of loop diuretics are being erroneously administered, so as to cause hypotension, hypoperfusion and/or relative dehydration in patients with decompensated CHF who could have expressly benefitted from intensive unloading therapy. Recently, the genesis of CHF-related progressive renal deterioration has been highlighted by affirming that a major role may be played rather by neurovegetative disorders, that is, by increase in sympathetic tone and abnormalities in kidney's vasomotility than by cardiac inotropism deficiency. The measures, thought to be able to prevent renal arterial constriction and to impede deterioration of glomerular filtration rate (GFR) due to the ischemic-necrotic tubular injury, as occurring in the set of intensive unloading therapy with i.v. furosemide or other loop diuretic, are represented by application of inotropic and renal vasodilator support by dopamine i.v. infusion at low doses or by other inotropic agents provided with recognized renal vasodilator properties and/or by addition to i.v. furosemide of osmotic agents able to expand the hematic volume, so counteracting or minimizing the reflex renal vasoconstriction induced by furosemide-related reduction in intravascular circulating volume: i.v. infusion of small volumes of hypertonic saline solution, as well as administration of albumin, mannitol and/or plasma expanders. Because renal impairment, as developing in the setting of CHF, has proven to represent a very important indicator of adverse outcome, every effort should be addressed to prevent any significant (>25% of basal value) rise in serum creatinine consequent to diuretic unloading therapy or to other procedures (paracentesis of tense ascites, ultrafiltration) aimed at rapid fluid removal in edematous or ascitic CHF or cardiogenetic anasarca. Ultrafiltration, even though a promising technique highly valued for its acknowledged property to obtain a more rapid fluid and weight loss in CHF patients with marked fluid retention, has been demonstrated so far to produce neurohumoral activation, creatinine abnormalities and symptomatic hypotensions similar to those due to i.v. loop diuretics; thus, the hypothesized advantages of this technique remain to be further clarified and confirmed, with regard to its safety profile and cost-effectiveness.
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PMID:Unloading therapy by intravenous diuretic in chronic heart failure: a double-edged weapon? 2126 35

Primary pulmonary hypertension is a well known entity with characteristic features more common in females presenting commonly with dyspnea. However primary pulmonary hypertension presenting as hoarseness of voice is rare occurring most likely due to compression of left recurrent laryngeal nerve between normal aorta and dilated tense pulmonary artery. Here we are presenting a case of 19 year old boy with primary pulmonary hypertension who presented with hoarseness of voice as predominant symptom.
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PMID:Cardiovocal syndrome--a rare presentation of primary pulmonary hypertension. 2497 50

Cardiac tamponade is a common and often life-threatening process, which is typically associated with a pericardial effusion or, in rare cases, with a large pleural effusion. Theoretically, as reported in only a single prior case, it can be caused by extrinsic compression from tense ascites. We present a case in which dynamic inferior wall collapse was secondary to increased abdominal pressure from tense ascites. This phenomenon may be more common than previously diagnosed, especially in patients with liver disease. These patients often develop frequent ascites and present with clinical signs and symptoms similar to cardiac tamponade (tachycardia, hypotension and dyspnea). Presently, no formal practice guidelines exist regarding cardiac imaging for these patients. A high index of suspicion is required for timely diagnosis and management.
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PMID:Cardiac Tamponade Physiology Secondary to Tense Ascites. 2712 Apr 37


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