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Refractory hypertension

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https://www.readbyqxmd.com/read/28923638/treatment-of-refractory-gastrointestinal-bleeding-in-patients-with-portal-hypertension-a-case-series-and-treatment-algorithm
#1
J Balogh, S Gordon-Burroughs, P Schwarz, J Galati, R A McFadden, M Cusick, M J Snyder, H R Bailey, M Weiner, A Wong, R A Ochoa, A Saharia, A O Gaber, R M Ghobrial
In patients with portal hypertension, ectopic varices can develop at any site along the gastrointestinal tract outside the classically described gastroesophageal location. Like esophageal variceal hemorrhage, bleeding from ectopic varices can be life-threatening. Diagnosis and treatment of ectopic varices can be challenging; to date, no effective treatment algorithm has been described. A systematic teamwork approach to diagnosing and treatment of ectopic varices is required to successfully manage hemorrhage from ectopic varices...
October 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28919427/age-dependent-atrial-arrhythmic-phenotype-secondary-to-mitochondrial-dysfunction-in-pgc-1%C3%AE-deficient-murine-hearts
#2
Haseeb Valli, Shiraz Ahmad, Karan Chadda, Ali Al-Hadithi, Andrew A Grace, Kamalan Jeevaratnam, Christopher L-H Huang
INTRODUCTION: Ageing and several age-related chronic conditions including obesity, insulin resistance and hypertension are associated with mitochondrial dysfunction and represent independent risk factors for atrial fibrillation (AF). MATERIALS AND METHODS: Atrial arrhythmogenesis was investigated in Langendorff-perfused young (3-4 month) and aged (>12 month), wild type (WT) and peroxisome proliferator activated receptor-γ coactivator-1β deficient (Pgc-1β(-/-)) murine hearts modeling age-dependent chronic mitochondrial dysfunction during regular pacing and programmed electrical stimulation (PES)...
September 14, 2017: Mechanisms of Ageing and Development
https://www.readbyqxmd.com/read/28894410/life-threatening-dyskalaemia-after-barbiturate-coma-therapy-the-strategy-of-management
#3
Yeap Boon Tat, Wan Mohd Nazaruddin Wan Hassan, Ting Yung Chuen, Abdul Rahman Izaini Ghani
Barbiturate coma therapy (BCT) is a treatment option that is used for refractory intracranial hypertension after all other options have been exhausted. Although BCT is a brain protection treatment, it also has several side effects such as hypotension, hepatic dysfunction, renal dysfunction, respiratory complications and electrolyte imbalances. One less concerning but potentially life-threatening complication of BCT is dyskalaemia. This complication could present as severe refractory hypokalaemia during the therapy with subsequent rebound hyperkalaemia after cessation of the therapy...
March 2017: Malaysian Journal of Medical Sciences: MJMS
https://www.readbyqxmd.com/read/28890798/american-football-and-other-sports-injuries-may-cause-migraine-persistent-pain-decades-later-and-can-be-treated-successfully-with-electrical-twitch-obtaining-intramuscular-stimulation-etoims
#4
J Chu, S McNally, F Bruyninckx, D Neuhauser
INTRODUCTION: Autonomous twitch elicitation at myofascial trigger points from spondylotic radiculopathies-induced denervation supersensitivity can provide favourable pain relief using electrical twitch-obtaining intramuscular stimulation (ETOIMS). AIM: To provide objective evidence that ETOIMS is safe and efficacious in migraine and persistent pain management due to decades-old injuries to head and spine from paediatric American football. METHODS AND MATERIALS: An 83-year-old mildly hypertensive patient with 25-year history of refractory migraine and persistent pain self-selected to regularly receive fee-for-service ETOIMS 2/week over 20 months...
April 2017: BMJ Innovations
https://www.readbyqxmd.com/read/28878203/biventricular-cardiac-hypertrophy-in-a-patient-with-primary-aldosteronism-and-atrial-septal-defect
#5
Tjokorda Gde Dalem Pemayun, Ridho M Naibaho, Muhammad Achmad Sungkar
BACKGROUND Primary aldosteronism can be caused by adrenocortical adenoma and is usually associated with left ventricular hypertrophy. Biventricular cardiac hypertrophy and heart failure in the presence of a pre-existing atrial septal defect (ASD) are a rare association of primary aldosteronism. CASE REPORT A 33-year-old woman with resistant hypertension and refractory hypokalemia presented with signs and symptoms of heart failure. She had previously been diagnosed having a right adrenal tumor and ostium secundum type ASD...
September 7, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28866662/serum-ca19-9-response-is-an-early-predictive-marker-of-efficacy-of-regorafenib-in-refractory-metastatic-colorectal-cancer
#6
Azusa Komori, Hiroya Taniguchi, Satoshi Hamauchi, Toshiki Masuishi, Yosuke Kito, Yukiya Narita, Takahiro Tsushima, Makoto Ishihara, Akiko Todaka, Tsutomu Tanaka, Tomoya Yokota, Shigenori Kadowaki, Nozomu Machida, Takashi Ura, Akira Fukutomi, Masashi Ando, Yusuke Onozawa, Masahiro Tajika, Hirofumi Yasui, Kei Muro, Keita Mori, Kentaro Yamazaki
PURPOSE: Regorafenib improves survival in chemorefractory metastatic colorectal cancer (mCRC) patients. However, regorafenib induces various adverse events (AEs) that often impair patients' quality of life. Identification of early predictive markers of the efficacy is warranted. METHODS: We retrospectively examined 146 consecutive mCRC patients who received regorafenib. Clinical parameters, including patient background, AEs, and changes in biochemical parameters until day 28, were evaluated to identify efficacy predictors...
September 2, 2017: Oncology
https://www.readbyqxmd.com/read/28859030/treatment-of-refractory-infantile-hemangiomas-and-pulmonary-hypertension-with-sirolimus-in-a-pediatric-patient
#7
Kelley K Hutchins, Robert D Ross, Daisuke Kobayashi, Alissa Martin, Madhvi Rajpurkar
Infantile hemangioma is a benign vascular neoplasm that spontaneously involutes over time. Management, when needed, consists of medications, laser treatment and surgical excision. We describe a 3-year-old girl who presented shortly after birth with diffuse cutaneous hemangiomas, hepatosplenomegaly with liver lesions, anemia, and acute heart failure. She was diagnosed with hepatic and cutaneous infantile hemangioma based on skin biopsy. She developed progressive pulmonary hypertension with numerous pulmonary nodules suspicious for pulmonary arteriovenous malformations...
August 30, 2017: Journal of Pediatric Hematology/oncology
https://www.readbyqxmd.com/read/28843768/carfilzomib-or-bortezomib-in-relapsed-or-refractory-multiple-myeloma-endeavor-an-interim-overall-survival-analysis-of-an-open-label-randomised-phase-3-trial
#8
Meletios A Dimopoulos, Hartmut Goldschmidt, Ruben Niesvizky, Douglas Joshua, Wee-Joo Chng, Albert Oriol, Robert Z Orlowski, Heinz Ludwig, Thierry Facon, Roman Hajek, Katja Weisel, Vania Hungria, Leonard Minuk, Shibao Feng, Anita Zahlten-Kumeli, Amy S Kimball, Philippe Moreau
BACKGROUND: The phase 3 ENDEAVOR trial was a head-to-head comparison of two proteasome inhibitors in patients with relapsed or refractory multiple myeloma. Progression-free survival was previously reported to be significantly longer with carfilzomib administered in combination with dexamethasone than with bortezomib and dexamethasone in an interim analysis. The aim of this second interim analysis was to compare overall survival between the two treatment groups. METHODS: ENDEAVOR was a phase 3, open-label, randomised controlled trial in patients with relapsed or refractory multiple myeloma...
August 23, 2017: Lancet Oncology
https://www.readbyqxmd.com/read/28843329/safety-and-feasibility-of-the-transcatheter-approach-to-create-a-reverse-potts-shunt-in-children-with-idiopathic-pulmonary-arterial-hypertension
#9
Younes Boudjemline, Aleksander Sizarov, Sophie Malekzadeh-Milani, Cristian Mirabile, Marien Lenoir, Diala Khraiche, Marilyne Lévy, Damien Bonnet
BACKGROUND: The reversed Potts shunt improves right ventricular (RV) function in patients with suprasystemic pulmonary arterial hypertension (PAH). The proximity of the left pulmonary artery (LPA) to the descending aorta (DAo) permits the creation of a transcatheter connection. We sought to assess the safety, feasibility, and hemodynamic efficacy of the transcatheter Potts shunt (TPS) in children. METHODS: The TPS procedure was performed using radiofrequency energy for vessel perforation and deployment of a covered stent to connect the DAo and LPA...
September 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28842917/impact-of-race-and-gender-on-clinical-outcomes-of-catheter-ablation-in-patients-with-atrial-fibrillation
#10
Abdallah Bukari, Hemal Nayak, Zaid Aziz, Amrish Deshmukh, Roderick Tung, Cevher Ozcan
BACKGROUND: Radiofrequency catheter ablation (CA) is an effective treatment of drug-refractory atrial fibrillation (AF). However, the efficacy of CA by race and gender has not been well characterized. We sought to determine the impact of ethnicity and gender on clinical outcome following CA in patients with AF. METHODS: Patients who underwent CA for AF from September 2013 to April 2016 were included in this study. Patients were identified retrospectively and followed prospectively...
August 26, 2017: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/28838434/management-of-portal-hypertension-after-liver-transplantation
#11
D Korda, P Á Deák, G Kiss, Z Gerlei, L Kóbori, D Görög, I Fehérvári, L Piros, Z Máthé, A Doros
INTRODUCTION: Post-transplantation portal hypertension has severe complications, such as esophageal varix bleeding, therapy refractory ascites, extreme splenomegaly, and graft dysfunction. The aim of our study was to analyze the effectiveness of the therapeutic strategies and how to visualize the procedure. METHODS: A retrospective study involving liver transplantation patients from the Semmelweis University Department of Transplantation and Surgery was performed between 2005 and 2015...
September 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28836115/management-of-ascites-and-hepatorenal-syndrome
#12
REVIEW
Salvatore Piano, Marta Tonon, Paolo Angeli
Ascites represents the most common decompensating event in patients with liver cirrhosis. The appearance of ascites is strongly related to portal hypertension, which leads to splanchnic arterial vasodilation, reduction of the effective circulating volume, activation of endogenous vasoconstrictor systems, and avid sodium and water retention in the kidneys. Bacterial translocation further worsens hemodynamic alterations of patients with cirrhosis and ascites. The first-line treatment of uncomplicated ascites is a moderate sodium-restricted diet combined with diuretic treatment...
August 23, 2017: Hepatology International
https://www.readbyqxmd.com/read/28835975/-baroreceptor-activation-therapy-for-therapy-resistant-hypertension-indications-and-patient-selection-recommendations-of-the-bat-consensus-group-2017
#13
REVIEW
M Koziolek, J Beige, M Wallbach, D Zenker, G Henning, M Halbach, N Mader, F Mahfoud, G Schlieper, V Schwenger, M Hausberg, J Börgel, M Lodde, M van der Giet, J Müller-Ehmsen, J Passauer, S Parmentier, S Lüders, B K Krämer, S Büttner, F Limbourg, J Jordan, O Vonend, H-G Predel, H Reuter
Baroreceptor activation therapy (BAT) has been available for several years for treatment of therapy-refractory hypertension (trHTN). This procedure is currently being carried out in a limited number of centers in Germany, also with the aim of offering a high level of expertise through sufficient experience; however, a growing number of patients who are treated with BAT experience problems that treating physicians are confronted with in routine medical practice. In order to address these problems, a consensus conference was held with experts in the field of trHTN in November 2016, which summarizes the current evidence and experience as well as the problem areas in handling BAT patients...
August 23, 2017: Der Internist
https://www.readbyqxmd.com/read/28828324/simultaneous-genotyping-of-the-rs4762-and-rs699-polymorphisms-in-angiotensinogen-gene-and-correlation-with-iranian-cad-patients-with-novel-hexa-primer-arms-pcr
#14
Mehri Khatami, Mohammad Mehdi Heidari, Mehdi Hadadzadeh, Barbara Scheiber-Mojdehkar, Morteza Bitaraf Sani, Massoud Houshmand
BACKGROUND: A significant role of Renin-angiotensin system (RAS) genetic variants in the pathogenesis of essential hypertension and cardiovascular diseases has been proved. This study aimed to develop a new, fast and cheap method for the simultaneous detection of two missense single nucleotide polymorphisms (T207M or rs4762 and M268T orrs699) of angiotensinogen (AGT) in single-step Multiplex Hexa-Primer Amplification Refractory Mutation System - polymerase chain reaction (H-ARMS-PCR)...
June 2017: Iranian Journal of Public Health
https://www.readbyqxmd.com/read/28818233/transcatheter-embolization-of-persistent-embryonic-veins-in%C3%A2-venous-malformation-syndromes
#15
Naiem Nassiri, Dustin Crystal, Lauren A Huntress, Susan Murphy
Persistent embryonic veins represent a major source of venous hypertension and morbidity in venous malformation syndromes, such as Klippel-Trénaunay syndrome and congenital lipomatous overgrowth, vascular malformations, epidermal nevus, and skeletal deformities syndrome. Surgical stripping and phlebectomy are the most commonly reported alternatives to compression therapy for refractory cases. These techniques, although effective in those patients who meet the necessary anatomic criteria, can be associated with bleeding, wound-related complications, and recurrence...
September 2017: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/28817373/cabozantinib-as-salvage-therapy-for-patients-with-tyrosine-kinase-inhibitor-refractory-differentiated-thyroid-cancer-results-of-a-multicenter-phase-ii-international-thyroid-oncology-group-trial
#16
Maria E Cabanillas, Jonas A de Souza, Susan Geyer, Lori J Wirth, Michael E Menefee, Stephen V Liu, Komal Shah, John Wright, Manisha H Shah
Purpose Sorafenib and lenvatinib are oral multikinase inhibitors targeting vascular endothelial growth factor receptor (VEGFR) and approved for radioiodine (RAI)-refractory differentiated thyroid cancer (DTC). However, there are no approved second- or third-line therapies. MET is implicated in resistance to VEGFR inhibitors. Cabozantinib is an oral multikinase inhibitor targeting MET in addition to VEGFR and is approved for medullary thyroid cancer. In a phase I study of cabozantinib, five of eight patients with DTC previously treated with a VEGFR-targeted therapy had an objective response to cabozantinib...
August 17, 2017: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28816096/management-of-severe-pulmonary-hemorrhage-in-a-neonate-on-veno-arterial-ecmo-by-the-temporary-clamping-of-the-endotracheal-tube-a-case-report
#17
Vaclav Vobruba, Tomas Grus, Frantisek Mlejnsky, Jan Belohlavek, Jan Hridel, Lukas Lambert
Severe pulmonary hemorrhage in the newborn is an infrequent, but life-threatening, event. A newborn with persistent pulmonary hypertension and a large persistent ductus arteriosus and open foramen ovale presented with hypoxemia and progressive right heart failure shortly after birth, requiring veno-arterial extracorporeal membrane oxygenation (ECMO) support. Twenty minutes after the initiation of ECMO, the patient developed severe pulmonary hemorrhage refractory to conventional treatment. As a last resort, the endotracheal tube was clamped...
August 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28814329/severe-persistent-pulmonary-hypertension-of-the-newborn-and-dysmorphic-features-in-neonate-with-a-deletion-involving-twist1-and-phf14-a-case-report
#18
Carina Schinagl, Guro Reinholt Melum, Olaug Kristin Rødningen, Kathrine Bjørgo, Jannicke Hanne Andresen
BACKGROUND: Persistent pulmonary hypertension is a well-known disease of the newborn that in most cases responds well to treatment with nitric oxide and treatment of any underlying causes. Genetic causes of persistent pulmonary hypertension of the newborn are rare. The TWIST1 gene is involved in morphogenetics, and deletions are known to cause Saethre-Chotzen syndrome. Deletions of PHF14 have never been reported in neonates, but animal studies have shown a link between severe defects in lung development and deletions of this gene...
August 17, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28810583/kidney-dysfunction-following-adrenalectomy-in-autosomal-dominant-polycystic-kidney-disease-complicated-with-primary-aldosteronism-a-case-report
#19
Hiroyuki Hirai, Makoto Kanno, Tsuyoshi Watanabe, Hiroaki Satoh
The present study reported a case of autosomal dominant polycystic kidney disease complicated with primary aldosteronism in a 49-year-old woman. The patient was referred for refractory hypertension. Laboratory examinations revealed low potassium and renin levels. Computed tomography indicated a right adrenal tumor and multiple renal cysts. Adrenal vein sampling revealed a high aldosterone level on the side of the tumor. The patient was diagnosed with autosomal dominant polycystic kidney disease complicated by primary aldosteronism and adrenalectomy was performed...
August 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28806209/refractory-intracranial-hypertension-the-role-of-decompressive-craniectomy
#20
Martin Smith
Raised intracranial pressure (ICP) is associated with worse outcomes after acute brain injury, and clinical guidelines advocate early treatment of intracranial hypertension. ICP-lowering therapies are usually administered in a stepwise manner, starting with safer first-line interventions, while reserving higher-risk options for patients with intractable intracranial hypertension. Decompressive craniectomy is a surgical procedure in which part of the skull is removed and the underlying dura opened to reduce brain swelling-related raised ICP; it can be performed as a primary or secondary procedure...
August 10, 2017: Anesthesia and Analgesia
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