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hypertensive crisis in adults review

Mili V Mehta, Daniel K Manson, Evelyn M Horn, Jennifer Haythe
Pulmonary arterial hypertension (PAH) is a known complication of rheumatologic diseases, but it is only rarely associated with adult-onset Still's disease (AOSD). We describe the case of a 30-year-old woman who presented in a pulmonary hypertension crisis and was found to have underlying AOSD with PAH and nonspecific interstitial pneumonia (NSIP) with a course complicated by macrophage activation syndrome (MAS). She dramatically improved with steroids, cyclosporine A, and anakinra, with total resolution of the MAS and significant improvement of her pulmonary arterial pressures...
March 2016: Pulmonary Circulation
Wen-Chieh Yang, Mao-Jen Lin, Chun-Yu Chen, Han-Ping Wu
Hypertensive emergencies and hypertensive urgencies in children are uncommonly encountered in the pediatric emergency department and intensive care units, but the diseases are potentially a life-threatening medical emergency. In comparison with adults, hypertension in children is mostly asymptomatic and most have no history of hypertension. Additionally, measuring accurate blood pressure values in younger children is not easy. This article reviews current concepts in pediatric patients with severe hypertension...
June 16, 2015: World Journal of Clinical Cases
Barbara P Yawn, George R Buchanan, Araba N Afenyi-Annan, Samir K Ballas, Kathryn L Hassell, Andra H James, Lanetta Jordan, Sophie M Lanzkron, Richard Lottenberg, William J Savage, Paula J Tanabe, Russell E Ware, M Hassan Murad, Jonathan C Goldsmith, Eduardo Ortiz, Robinson Fulwood, Ann Horton, Joylene John-Sowah
IMPORTANCE: Sickle cell disease (SCD) is a life-threatening genetic disorder affecting nearly 100,000 individuals in the United States and is associated with many acute and chronic complications requiring immediate medical attention. Two disease-modifying therapies, hydroxyurea and long-term blood transfusions, are available but underused. OBJECTIVE: To support and expand the number of health professionals able and willing to provide care for persons with SCD. EVIDENCE REVIEW: Databases of MEDLINE (including in-process and other nonindexed citations), EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, TOXLINE, and Scopus were searched using prespecified search terms and keywords to identify randomized clinical trials, nonrandomized intervention studies, and observational studies...
September 10, 2014: JAMA: the Journal of the American Medical Association
Jill M Mhyre, Robyn DʼOria, Afshan B Hameed, Justin R Lappen, Sharon L Holley, Stephen K Hunter, Robin L Jones, Jeffrey C King, Mary E DʼAlton
Case reviews of maternal death have revealed a concerning pattern of delay in recognition of hemorrhage, hypertensive crisis, sepsis, venous thromboembolism, and heart failure. Early-warning systems have been proposed to facilitate timely recognition, diagnosis, and treatment for women developing critical illness. A multidisciplinary working group convened by the National Partnership for Maternal Safety used a consensus-based approach to define The Maternal Early Warning Criteria, a list of abnormal parameters that indicate the need for urgent bedside evaluation by a clinician with the capacity to escalate care as necessary in order to pursue diagnostic and therapeutic interventions...
October 2014: Obstetrics and Gynecology
Mukul Vij, Vinita Agrawal, Manoj Jain
Mixed connective tissue disease (MCTD) is an overlap syndrome first defined in 1972 by Sharp et al. In this original study, the portrait emerged of a connective tissue disorder sharing features of systemic lupus erythematosus, systemic sclerosis (scleroderma) and polymyositis. Scleroderma renal crisis (SRC) is an extremely infrequent but serious complication that can occur in MCTD. The histologic picture of SRC is that of a thrombotic micro-angiopathic process. Renal biopsy plays an important role in confirming the clinical diagnosis, excluding overlapping/superimposed diseases that might lead to acute renal failure in MCTD patients, helping to predict the clinical outcome and optimizing patient management...
July 2014: Saudi Journal of Kidney Diseases and Transplantation
P P Bassareo, V Bassareo, N Iacovidou, G Mercuro
Similarly to a series of chronic diseases, essential arterial hypertension (HTN) may be manifested during childhood as a blood pressure (BP) reading which repeatedly rises above the 95(th) percentile of population-specific standards. Since BP tends to track along the same percentiles throughout life, children with higher BPs are more likely to become hypertensive adults. When healthy measures aimed at reducing BP (i.e. body weight reduction, aerobic physical exercise, low sodium intake) have failed, pharmacological treatment is usually required...
2014: Current Medicinal Chemistry
Tennille N Webb, Ibrahim F Shatat, Yosuke Miyashita
Acute hypertension (HTN) in hospitalized children and adolescents occurs relatively frequently, and in some cases, if not recognized and treated promptly, it can lead to hypertensive crisis with potentially significant morbidity and mortality. In contrast to adults, where acute HTN is most likely due to uncontrolled primary HTN, children and adolescents with acute HTN are more likely to have secondary HTN. This review will briefly cover evaluation of acute HTN and various age-specific etiologies of secondary HTN and provide more in-depth discussion on treatment targets, potential risks of acute HTN therapy, and available pediatric data on intravenous and oral antihypertensive agents, and it proposes treatment schema including unique therapy of specific secondary HTN scenarios...
April 2014: Current Hypertension Reports
Deborah E Meyers, Haseeb Ilias Basha, Mary Kay Koenig
Mitochondrial disease is a heterogeneous group of multisystemic diseases that develop consequent to mutations in nuclear or mitochondrial DNA. The prevalence of inherited mitochondrial disease has been estimated to be greater than 1 in 5,000 births; however, the diagnosis and treatment of this disease are not taught in most adult-cardiology curricula. Because mitochondrial diseases often occur as a syndrome with resultant multiorgan dysfunction, they might not immediately appear to be specific to the cardiovascular system...
2013: Texas Heart Institute Journal
Carrie E McCurdy, Dwight J Klemm
In the United States, obesity is a burgeoning health crisis, with over 30% of adults and nearly 20% of children classified as obese. Insulin resistance, a common metabolic complication associated with obesity, significantly increases the risk of developing metabolic diseases such as hypertension, coronary heart disease, stroke, type 2 diabetes, and certain cancers. With the seminal finding that obese adipose tissue harbors cytokine secreting immune cells, obesity-related research over the past decade has focused on understanding adipocyte-macrophage crosstalk and its impact on systemic insulin sensitivity...
July 1, 2013: Adipocyte
Jay Idrees, Amr Arafat, Lars G Svensson, Daniel Clair, Eric E Roselli
OBJECTIVES: Hybrid operations combining open and endovascular techniques have evolved for patients with complex aortic and coexisting cardiovascular disease. Our objectives were to describe the repair techniques and assess the outcomes in patients undergoing hybrid repair for aneurysm associated with previous aortic coarctation. METHODS: From 2004 to 2012, 14 patients underwent hybrid repair by elephant trunk with endovascular completion (n = 5), frozen elephant trunk (n = 8), or antegrade stent grafting (n = 1)...
July 2014: Journal of Thoracic and Cardiovascular Surgery
Philippe Vignon
PURPOSE OF REVIEW: Left-ventricular diastolic dysfunction is associated with various conditions frequently encountered in ICU patients. Due to prolonged relaxation and increased left-ventricular stiffness, patients with diastolic dysfunction are at high risk of developing abrupt pulmonary venous congestion. The present review describes the clinical spectrum of left-ventricular diastolic abnormalities in ICU patients. RECENT FINDINGS: Left-ventricular diastolic dysfunction is associated with a preserved ejection fraction in half of the patients presenting with acute pulmonary edema...
June 2013: Current Opinion in Critical Care
Rosa Marcela Castellón Pasos, José Antonio Hernández Pacheco, Ariel Estrada Altamirano, Rogerio Armando Chacón Solís, Mauricio Ríos Barba
BACKGROUND: Preeclampsia complicates pregnancy in 3% to 8%, in Mexico it occurs in 5% to 10% of all pregnancies. The world incidence of the severe form all is unknown; however, in United States an incidence of 1% has been reported. Among the causes precipitating birth induction are intrauterine growth restriction, fetal distress and placenta abruption. OBJECTIVES: To determine maternal and fetal complications in women with severe preeclampsia who were admitted to the National Institute of Perinatology, and to establish the indications for birth induction in these women undergoing expectant management between 25 to 32 weeks of gestation...
February 2013: Ginecología y Obstetricia de México
Neil E Anderson, Kong Chung, Ernie Willoughby, Michael S Croxson
OBJECTIVE: To determine the frequency and range of neurological manifestations of phaeochromocytomas and secretory paragangliomas. METHODS: A retrospective review of case notes of patients admitted to Auckland Hospital from 1985 to 2011 with a discharge diagnosis of phaeochromocytoma or secretory paraganglioma. RESULTS: Ninety-three patients were admitted with a phaeochromocytoma or secretory paraganglioma. Sixty-eight patients (73%) had neurological symptoms, but only 15 patients (16%) received a neurological consultation...
April 2013: Journal of Neurology, Neurosurgery, and Psychiatry
Chih-Chin Kao, Vin-Cent Wu, Chin-Chi Kuo, Yen-Hung Lin, Ya-Hui Hu, Yao-Chou Tsai, Che-Hsiung Wu, Kwan-Dun Wu
Hypertension is a frequent early manifestation of autosomal dominant polycystic kidney disease (ADPKD). Several mechanisms can cause hypertension in ADPKD patients, although, primary aldosteronism (PA) as a possible manifestation of hypertension in ADPKD is extremely rare. We retrospectively reviewed the Taiwan Primary Aldosteronism Investigation (TAIPAI) database, which listed a total of 346 patients diagnosed with PA. Of these 346 patients, only three cases of concurrent PA and ADPKD were identified. These patients presented with hypertensive crisis and hypokalemia, and subsequent testing revealed aldosterone-producing adenomas (APAs) that were removed by laparoscopic adrenalectomy...
June 2013: Journal of the Renin-angiotensin-aldosterone System: JRAAS
Shintaro Mandai, Yohei Arai, Suguru Hirasawa, Toshiyuki Hirai, Shota Aki, Naoto Inaba, Makoto Aoyagi, Hiroyuki Tanaka, Teiichi Tamura, Sei Sasaki
Two patients with anti-centromere antibody (ACA), hypertensive emergency, and acute renal failure, mimicking scleroderma renal crisis, without Raynaud's phenomenon and typical skin manifestations of systemic sclerosis (SSc), are reported. A review of 26 ACA-positive patients between March 2003 and March 2011 in Yokosuka Kyosai Hospital identified four additional patients with similar manifestations. All patients were Japanese women between 41 and 84 years of age at presentation. Human leukocyte antigen (HLA) genotyping tests revealed the absence of the HLA-DQB1*0501 and DRB1*0101 alleles, which are associated with disease susceptibility to ACA-positive SSc among Japanese...
2012: Internal Medicine
Umer Darr, Tabish Jabeen, Shakaib Chughtai
OBJECTIVES: To evaluate the safety of valve replacement surgery in rheumatic heart disease patients with severe pulmonary hypertension (SPH); defined as pulmonary artery systolic pressure (PASP > or = 60 mmHg) on patients operated for valve replacement at Tabba Heart Institute, Karachi. METHOD: From July 2005 to September 2007, total of 112 patients underwent valve replacement (AVR, MVR, AVR+MVR) at our institution. We retrospectively examined the patients with SPH...
September 2011: JPMA. the Journal of the Pakistan Medical Association
Parul Sinha, Suresh C Sharma, Shipra Agarwal, Siddhartha Datta Gupta
OBJECTIVES: Ganglioneuroma is a rare benign tumor of the sympathetic nervous system that is seldom localized to the head and neck. Rarer still are cases of functional ganglioneuroma with catecholamine production. We report an unusual case of a large parapharyngeal space ganglioneuroma in a patient with neurofibromatosis that caused an intraoperative hypertensive crisis in the absence of a neuroblastomatous component - hitherto an undocumented complication. METHODS: We present a case of functional parapharyngeal ganglioneuroma and review the clinicopathologic and biochemical features of these rare tumors...
December 2011: Annals of Otology, Rhinology, and Laryngology
Fei Xue, Indiana Strombom, Bruce Turnbull, Shao Zhu, John Seeger
BACKGROUND: Cardiovascular events are inconclusively associated with duloxetine use in clinical trials and spontaneous reports. This analysis of cardiovascular events in relation to duloxetine use within a large health insurance database provides further data on the association. METHODS: This cohort study was conducted within a population with commercial health insurance. Adults with depression who initiated duloxetine were matched to separate cohorts of initiators of venlafaxine, selective serotonin reuptake inhibitors (SSRIs), and tricyclic antidepressants (TCAs), along with untreated patients with depression, and enrollees without depression...
February 2012: Journal of Clinical Psychopharmacology
Gaurav Agarwal, Dhalapathy Sadacharan, Vivek Aggarwal, Gyan Chand, Anjali Mishra, Amit Agarwal, Ashok K Verma, Saroj K Mishra
PURPOSE: Laparoscopic excision is preferred for small non-invasive pheochromocytoma over open approach. Applicability of laparoscopic procedures for large organ-contained pheochromocytoma is unclear. A database of 137 pheochromocytoma patients managed during 1990-2010 was reviewed to compare outcomes of open and laparoscopic procedures for 101 unilateral organ-contained pheochromocytoma patients in this retrospective non-randomized study. PATIENTS AND METHODS: Forty-nine patients underwent open procedures, and 52 underwent laparoscopic procedures...
October 2012: Langenbeck's Archives of Surgery
Amparo Roda-Safont, Carmen Pilar Simeón-Aznar, Vicent Fonollosa-Plà, Alfons Segarra-Medrano, Miquel Vilardell-Tarrés
BACKGROUND AND OBJECTIVE: Scleroderma renal crisis is a severe complication of systemic sclerosis, which causes arterial hypertension and acute renal failure. Early treatment of these patients with ACE inhibitors may improve prognosis. We aimed to analyze the frequency, clinical and epidemiological characteristics, morbidity and mortality and prognosis of scleroderma renal crisis. PATIENTS AND METHODS: Retrospective study of a cohort of 328 patients with SSc, of whom 194 had the limited form, 64 the diffuse form, 49 the sine scleroderma and 21 preescleroderma...
October 15, 2011: Medicina Clínica
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