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Sample records for venous hypertension related

  1. Pulmonary venous remodeling in COPD-pulmonary hypertension and idiopathic pulmonary arterial hypertension

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    Andersen, Kasper Hasseriis; Andersen, Claus Bøgelund; Gustafsson, Finn

    2017-01-01

    Pulmonary vascular arterial remodeling is an integral and well-understood component of pulmonary hypertension (PH). In contrast, morphological alterations of pulmonary veins in PH are scarcely described. Explanted lungs (n = 101) from transplant recipients with advanced chronic obstructive...... pulmonary disease (COPD) and idiopathic pulmonary arterial hypertension (IPAH) were analyzed for venous vascular involvement according to a pre-specified, semi-quantitative grading scheme, which categorizes the intensity of venous remodeling in three groups of incremental severity: venous hypertensive (VH......) grade 0 = characterized by an absence of venous vascular remodeling; VH grade 1 = defined by a dominance of either arterialization or intimal fibrosis; and VH grade 2 = a substantial composite of arterialization and intimal fibrosis. Patients were grouped according to clinical and hemodynamic...

  2. Venous hypertensive encephalopathy secondary to venous sinus thrombosis and dural arteriovenous fistula.

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    Anand, Pria; Orru, Emanuele; Izbudak, Izlem; Zhang, Jiaying; Kheradmand, Amir

    2017-08-01

    A 52-year-old man with a history of factor V Leiden thrombophilia, persistent headaches and papilloedema presented with worsening vision and confusion. MRI and MR angiography of the brain at the time of this presentation showed findings concerning for transverse sinus thrombosis and an associated dural arteriovenous fistula. Dural venous sinus thrombosis can lead to the formation of a dural arteriovenous fistula, which must be considered in the differential diagnosis for intracranial hypertension in patients with thrombophilia. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. Maternal venous Doppler characteristics are abnormal in pre-eclampsia but not in gestational hypertension.

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    Gyselaers, W; Staelens, A; Mesens, T; Tomsin, K; Oben, J; Vonck, S; Verresen, L; Molenberghs, G

    2015-04-01

    To compare functional characteristics of maternal thoraco-abdominal arteries and veins in proteinuric and non-proteinuric hypertension in pregnancy. This retrospective study included women with singleton pregnancies during the third trimester, which were either uncomplicated or complicated with different clinical types of hypertension: non-proteinuric gestational hypertension (GH), early-onset pre-eclampsia (PE) diagnosed 150 pregnancies were evaluated: 22 with uncomplicated pregnancy, 41 GH, 31 early PE and 56 late PE. Aortic VI and ACI were lower in GH, early PE and late PE than in uncomplicated pregnancy. Both early PE and late PE differed from GH by having shorter APTT in the uterine arcuate arteries and higher RIVI. Hemodynamic abnormalities were most pronounced in early PE, during which uterine arcuate artery RI was higher and VPTT in kidneys was shorter than in late PE. There was a significant correlation between degree of proteinuria and RIVI for the left (r = 0.381) and right (r = 0.347) kidney in late PE, but this was not true for early PE. There is a gradient of worsening arterial and venous hemodynamic abnormalities from GH to late PE and then to early PE. Venous hemodynamic abnormalities are present only in PE, with a linear correlation between proteinuria and RIVI in late PE. The role of the maternal venous compartment in the pathophysiology and etiology of PE-related symptoms may be much more important than considered at present. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

  4. Cerebral perfusion change of venous hypertension on near-infrared spectroscopy signals after operation for dural arteriovenous fistula.

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    Shidoh, Satoka; Akiyama, Takenori; Ohira, Takayuki; Yoshida, Kazunari

    2014-01-01

    A dural arteriovenous fistula (AVF) is an arteriovenous shunt in the dura and is associated with a risk of intracranial hemorrhage and neurologic deficit. The morbidity of this disease depends on venous hypertension, and the classification of this disease is based on the pattern of venous drainage. The pattern of venous drainage relates to the clinical features of the disease, especially to the probability of intracranial hemorrhage. We report 1 case of dural AVF with retrograde leptomeningeal venous drainage. Cerebral hemodynamics were monitored using near-infrared spectroscopy imaging before, during, and after the 2-stage operative treatment. Preoperative functional near-infrared spectroscopy (fNIRS) showed an increase in deoxyhemoglobin (HbR) during a motor task. After partial coil embolization of the shunt points (stage 1), HbR increased during the first half of the task and decreased later, whereas oxyhemoglobin (HbO2) decreased in the first half of the task and increased later. After complete embolization (stage 2), fNIRS showed a pattern similar to that of a normal adult. The patient's symptoms improved gradually, and angiography showed a reduction of the retrograde venous drainage and venous congestion after this 2-stage operation. The reduction in venous hypertension may be the underlying mechanism behind the changes observed with fNIRS. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  5. Central Venous Catheter-Related Hydrothorax

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    Se Hun Kim

    2015-11-01

    Full Text Available This report describes a case of 88-year-old women who developed central venous catheter-related bilateral hydrothorax, in which left pleural effusion, while right pleural effusion was being drained. The drainage prevented accumulation of fluid in the right pleural space, indicating that there was neither extravasation of infusion fluid nor connection between the two pleural cavities. The only explanation for bilateral hydrothorax in this case is lymphatic connections. Although vascular injuries by central venous catheter can cause catheter-related hydrothorax, it is most likely that the positioning of the tip of central venous catheter within the lymphatic duct opening in the right sub-clavian-jugular confluence or superior vena cava causes the catheter-related hydrothorax. Pericardial effusion can also result from retrograde lymphatic flow through the pulmonary lymphatic chains.

  6. Obesity-Related Hypertension

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    Re, Richard N.

    2009-01-01

    Obesity-associated arterial hypertension is characterized by activation of the sympathetic nervous system, activation of the renin-angiotensin system, and sodium retention, among other abnormalities. In this review, the following 3 facets of the obesity/hypertension nexus will be discussed: the potential mechanisms by which obesity can lead to elevated arterial pressure, the interaction of obesity with the sequelae of hypertension, and the therapies that are believed to optimally treat obesit...

  7. Management of venous hypertension following arteriovenous fistula creation for hemodialysis access

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    Varun Mittal

    2016-01-01

    Full Text Available Introduction: Venous hypertension (VH is a distressing complication following the creation of arteriovenous fistula (AVF. The aim of management is to relieve edema with preservation of AVF. Extensive edema increases surgical morbidity with the loss of hemodialysis access. We present our experience in management of VH. Methods: A retrospective study was conducted on 37 patients with VH managed between July 2005 to May 2014. Patient demographics, evaluation, and procedures performed were noted. A successful outcome of management with surgical ligation (SL, angioembolization (AE, balloon dilatation (BD or endovascular stent (EVS was defined by immediate disappearance of thrill and murmur with resolution of edema in the next 48-72 h, no demonstrable flow during check angiogram and resolution of edema with preservation of AVF respectively. Results: All 8 distal AVF had peripheral venous stenosis and were managed with SL in 7 and BD in one patient. In 29 proximal AVF, central and peripheral venous stenosis was present in 16 and 13 patients respectively. SL, AE, BD, and BD with EVS were done in 18, 5, 4, and 3 patients, respectively. All patients had a successful outcome. SL was associated with wound related complications in 11 (29.73 % patients. A total of 7 AVF were salvaged. One had restenosis after BD and was managed with AE. BD, EVS, and AE had no associated morbidity. Conclusions: Management of central and peripheral venous stenosis with VH should be individualized and in selected cases it seems preferable to secure a new access in another limb and close the native AVF in edematous limb for better overall outcome.

  8. Venous or arterial endothelium evaluation for early cardiovascular dysfunction in hypertensive patients?

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    Rubira, Marcelo Custódio; Consolim-Colombo, Fernanda Marciano; Rabelo, Eneida Rejane; Yugar-Toledo, Juan Carlos; Casarini, Dulce; Coimbra, Silmara Regina; Martins, Luis Cláudio; Moreno, Heitor; Krieger, Eduardo Moacir; Irigoyen, Maria Claúdia

    2007-11-01

    Veins and arteries have active endothelium, producing vasoactive substances like nitric oxide. The aim of this study was to evaluate whether hypertensive patients exhibit venous endothelial dysfunction and to determine the relationship between endothelial-dependent and endothelial-independent vasodilation responses in venous and arterial systems. Sixteen unmedicated patients with stage I and II hypertension and without other risk factors and 15 matched normotensive volunteers had venous and arterial endothelial function evaluated with the dorsal hand vein technique and brachial artery ultrasonography. Hypertensive patients had a marked reduction of maximum dilation to acetylcholine (54.9% +/- 21.6%) compared with normotensive controls (85.2% +/- 27.0%). The flow-mediated dilation responses were reduced in hypertensive patients compared with controls (6.6% +/- 3.3%vs 12.4% +/- 2.6%, respectively). The responses to nitric oxide were similar in both groups, and the responses with the dorsal hand vein technique and flow-mediated dilation agreed in both groups. Hypertensive patients had an attenuated endothelial dependent response, indicating that endothelial dysfunction is also present in the venous system.

  9. Mesenteric lymphatic vessels adapt to mesenteric venous hypertension by becoming weaker pumps.

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    Dongaonkar, R M; Nguyen, T L; Quick, C M; Heaps, C L; Hardy, J; Laine, G A; Wilson, E; Stewart, R H

    2015-03-01

    Lymphangions, the segments of lymphatic vessels between two adjacent lymphatic valves, actively pump lymph. Acute changes in transmural pressure and lymph flow have profound effects on lymphatic pump function in vitro. Chronic changes in pressure and flow in vivo have also been reported to lead to significant changes in lymphangion function. Because changes in pressure and flow are both cause and effect of adaptive processes, characterizing adaptation requires a more fundamental analysis of lymphatic muscle properties. Therefore, the purpose of the present work was to use an intact lymphangion isovolumetric preparation to evaluate changes in mesenteric lymphatic muscle mechanical properties and the intracellular Ca(2+) in response to sustained mesenteric venous hypertension. Bovine mesenteric veins were surgically occluded to create mesenteric venous hypertension. Postnodal mesenteric lymphatic vessels from mesenteric venous hypertension (MVH; n = 6) and sham surgery (Sham; n = 6) animals were isolated and evaluated 3 days after the surgery. Spontaneously contracting MVH vessels generated end-systolic active tension and end-diastolic active tension lower than the Sham vessels. Furthermore, steady-state active tension and intracellular Ca(2+) concentration levels in response to KCl stimulation were also significantly lower in MVH vessels compared with those of the Sham vessels. There was no significant difference in passive tension in lymphatic vessels from the two groups. Taken together, these results suggest that following 3 days of mesenteric venous hypertension, postnodal mesenteric lymphatic vessels adapt to become weaker pumps with decreased cytosolic Ca(2+) concentration. Copyright © 2015 the American Physiological Society.

  10. Extracellular matrix remodelling in response to venous hypertension: proteomics of human varicose veins.

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    Barallobre-Barreiro, Javier; Oklu, Rahmi; Lynch, Marc; Fava, Marika; Baig, Ferheen; Yin, Xiaoke; Barwari, Temo; Potier, David N; Albadawi, Hassan; Jahangiri, Marjan; Porter, Karen E; Watkins, Michael T; Misra, Sanjay; Stoughton, Julianne; Mayr, Manuel

    2016-06-01

    Extracellular matrix remodelling has been implicated in a number of vascular conditions, including venous hypertension and varicose veins. However, to date, no systematic analysis of matrix remodelling in human veins has been performed. To understand the consequences of venous hypertension, normal and varicose veins were evaluated using proteomics approaches targeting the extracellular matrix. Varicose saphenous veins removed during phlebectomy and normal saphenous veins obtained during coronary artery bypass surgery were collected for proteomics analysis. Extracellular matrix proteins were enriched from venous tissues. The proteomics analysis revealed the presence of >150 extracellular matrix proteins, of which 48 had not been previously detected in venous tissue. Extracellular matrix remodelling in varicose veins was characterized by a loss of aggrecan and several small leucine-rich proteoglycans and a compensatory increase in collagen I and laminins. Gene expression analysis of the same tissues suggested that the remodelling process associated with venous hypertension predominantly occurs at the protein rather than the transcript level. The loss of aggrecan in varicose veins was paralleled by a reduced expression of aggrecanases. Chymase and tryptase β1 were among the up-regulated proteases. The effect of these serine proteases on the venous extracellular matrix was further explored by incubating normal saphenous veins with recombinant enzymes. Proteomics analysis revealed extensive extracellular matrix degradation after digestion with tryptase β1. In comparison, chymase was less potent and degraded predominantly basement membrane-associated proteins. The present proteomics study provides unprecedented insights into the expression and degradation of structural and regulatory components of the vascular extracellular matrix in varicosis. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Cardiology.

  11. Restenosis of the sigmoid sinus after stenting for treatment of intracranial venous hypertension: case report

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    Tsumoto, T.; Miyamoto, T.; Shimizu, M.; Inui, Y.; Nakakita, K.; Hayashi, S. [Department of Neurosurgery, Minami Wakayama National Hospital, Wakayama (Japan); Terada, T. [Department of Neurological Surgery, Wakayama Medical University, Wakayama (Japan)

    2003-12-01

    We report what we believe to be the first case of restenosis of the sigmoid sinus after stenting, in a 42-year-old man with an arteriovenous malformation with progressive right hemiparesis secondary to venous hypertension. Angiography revealed severe stenosis of the left sigmoid sinus, which was dilated with a self-expandable stent. Six months after the procedure, however, the sinus was again severely stenosed. Intravascular sonography revealed intimal proliferation in the stented sinus. It was dilated percutaneously, and the venous pressure decreased from 51 to 33 mmHg. On sonography, the intimal tissue decreased in thickness and the diameter of the stent enlarged a little. (orig.)

  12. Pregnancy-related venous thromboembolism and risk of occult cancer

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    Veres, Katalin; Horváth-Puhó, Erzsébet; Ehrenstein, Vera

    2017-01-01

    The cancer risk during the first year after a pregnancy-related venous thromboembolism episode is higher than expected.An aggressive search for cancer in women with pregnancy-related venous thromboembolism is probably not warranted, due to low absolute risk.......The cancer risk during the first year after a pregnancy-related venous thromboembolism episode is higher than expected.An aggressive search for cancer in women with pregnancy-related venous thromboembolism is probably not warranted, due to low absolute risk....

  13. Dynamic CT and MRA findings of a case of portopulmonary venous anastomosis (PPVA) in a patient with portal hypertension: a case report and review of the literature

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    Ko, Jeong Min; Ahn, Myeong Im; Han, Dae Hee; Jung, Jung Im; Park, Seog Hee (Dept. of Radiology, Seoul St Mary' s Hospital, College of Medicine, The Catholic Univ. of Korea, Seoul (Korea, Republic of)), email: ami@catholic.ac.kr

    2011-06-15

    Portopulmonary venous anastomosis (PPVA), which has been rarely reported in conventional CT and MR studies, is an unusual collateral pathway in patients with portal hypertension. It has clinical implications related to right-to-left shunt that are different from the clinical implications related to other more usual portosystemic shunts in portal hypertensive patients. Here, we report the dynamic CT and MRA findings of a case of PPVA in a patient with portal hypertension, directly demonstrating the shunt flow from the paraesophageal varix to the left atrium via the right inferior pulmonary vein

  14. The dark side of the kidney in cardio-renal syndrome: renal venous hypertension and congestive kidney failure.

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    Di Nicolò, Pierpaolo

    2018-01-31

    Renal involvement in some forms of acute or chronic diseases, such as heart failure or sepsis, presents with a complex pathophysiological basis that is not always clearly distinguishable. In these clinical settings, kidney failure is traditionally and almost exclusively attributed to renal hypoperfusion and it is commonly accepted that causal elements are pre-renal, such as a reduction in the ejection fraction or absolute or relative hypovolemia acting directly on oxygen transport mechanisms and renal autoregulation systems, causing a reduction of glomerular filtration rate. Nevertheless, the concept emerging from accumulating clinical and experimental evidence is that in complex clinical pictures, kidney failure is strongly linked to the hemodynamic alterations occurring in the renal venous micro and macrocirculation. Accordingly, the transmission of the increased venous pressure to the renal venous compartment and the consequent increasing renal afterload has a pivotal role in determining and sustaining the kidney damage. The aim of this review was to clarify the physiopathological aspects of the link between worsening renal function and renal venous hypertension, analyzing the prognostic and therapeutic implications of the so-called congestive kidney failure in cardio-renal syndrome and in other clinical contexts of its possible onset.

  15. Increased pulsatile intracranial pressure in patients with symptomatic pineal cysts and magnetic resonance imaging biomarkers indicative of central venous hypertension.

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    Eide, Per Kristian; Ringstad, Geir

    2016-08-15

    In symptomatic individuals with non-hydrocephalic pineal cysts (PCs), it remains controversial what causes the symptoms. Based on magnetic resonance imaging (MRI) biomarkers, we proposed that PC-associated crowding of the pineal recess may cause central venous hypertension. The aim of this study was to compare pulsatile and static ICP in patients with PCs and chronic daily headache (CDH), and compare ICP data in PC patients with the previously identified MRI biomarkers. All patients assessed with over-night ICP monitoring for PCs or CDH who had been ruled out for idiopathic intracranial hypertension without papilledema (IIHWOP) were retrieved from the database. The symptoms as well as the pulsatile and static ICP scores were compared between the PC and CDH patients, and ICP scores were compared with the MRI biomarkers indicative of central venous hypertension. The pulsatile ICP was significantly increased in the symptomatic patients with non-hydrocephalic PCs as compared to the CDH patients. Pulsatile ICP was significantly increased in the individuals with PC-grades 3-4, who had MRI biomarkers indicative of central venous hypertension. The tectum-splenium-cyst ratio correlated positively with pulsatile ICP and an index of thalamic edema. Pulsatile ICP is increased in symptomatic patients with PCs and imaging evidence of central venous hypertension, supporting the hypothesis that PC-induced crowding of the pineal recess and venous obstruction may cause a central venous hypertension syndrome. Copyright © 2016 Elsevier B.V. All rights reserved.

  16. Medullary Venous Hypertension Secondary to a Petrous Apex Dural Arteriovenous Fistula: A Case Report

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    Meghan Murphy

    2012-11-01

    Full Text Available Background: Dural arteriovenous fistulae (dAVF are common intracranial vascular lesions typically becoming symptomatic with cortical venous hypertension and possible hemorrhage. Here, we present a case illustration of a petrous apex dAVF with marked medullary venous hypertension and a unique clinical presentation. Methods: Case report. Results: A 72-year-old female, whose clinical progression was significant for altered mental status and progressive weakness, presented with diplopia, right leg paresis, and ataxia. Magnetic resonance imaging revealed edema involving the medulla. On digital subtraction cerebral angiogram, the patient was found to have a petrous apex dAVF, Cognard type IV. Following treatment with Onyx embolization, her symptoms rapidly improved, with complete resolution of diplopia and drastic improvement of her ataxia. Conclusion: The importance of this case is in the presentation and deterioration of the clinical exam, resembling an acute ischemic event. Further, this case illustrates that dAVF may cause venous hypertension with rapid onset of focal neurologic symptoms not exclusive to cortical locations.

  17. Pycnogenol® in chronic venous insufficiency and related venous disorders.

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    Gulati, Om P

    2014-03-01

    The present review provides an update of the biological profile of Pycnogenol in the light of its use in the treatment of chronic venous insufficiency (CVI) and related venous disorders such as deep vein thrombosis (DVT), post-thrombotic syndrome, long haul air-travel-related leg oedema, venous ulcers and acute haemorrhoids. Pycnogenol is a French maritime pine bark extract produced from the outer bark of Pinus pinaster Ait. subsp. atlantica. Its strong antioxidant, anti-inflammatory and vasodilator activities, antithrombotic effects and collagen stabilizing properties make it uniquely able to target the multi facet pathophysiology of CVI and related venous disorders. Clinical studies have shown that it can reduce oedema of the legs in CVI, reduce the incidence of deep venous thrombosis during long haul flights and enhance the healing of venous ulcers and haemorrhoidal episodes by topical application and/or oral administration. This review highlights clinical research findings on the safety, compliance and efficacy of Pycnogenol, including its use in combination products. Copyright © 2013 John Wiley & Sons, Ltd.

  18. Pulmonary injury at the anhepatic phase without veno-venous bypass in portal hypertensive rats.

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    Zhao, Xin; Zeng, Qiang; Ren, Guijun; Cao, Jinglin; Dou, Jian; Gao, Qingjun

    In order to understand the characterization and evolution of pulmonary injury, a portal hypertension rat model was used to imitate the anhepatic phase during standard orthotopic liver transplantation without veno-venous bypass. In this study, 135 healthy male Wistar rats were selected; in which 15 rats were assigned in the normal control (NC) group and the remaining 120 rats were used to establish a recoverable prehepatic portal hypertension model, which were further evenly divided into eight groups after ischemia-reperfusion: portal hypertensive control group (PHTC), R0h, R6h, R12h, R24h, R48h, R72h, and R7d groups. Meanwhile, arterial blood pressure, dry-to-wet weight ratios of the lung, alanine aminotransferase (ALT) level in serum, arterial oxygen pressure (PaO 2 ), and myeloperoxidase (MPO) activity in lung tissue were measured. Morphology changes of the lung were observed using an optical microscope and a transmission electron microscope. The portal hypertension rat model was successfully established three weeks after the first operation. These portal hypertensive rats could withstand 1 hour at the anhepatic phase. Pulmonary injury severity increased to the most at 12-24 hours, and decreased to normal at seven days after reperfusion. Ischemia-reperfusion injury is an important mechanism that results in pulmonary injury after liver transplantation. It is safe for portal hypertensive rats to tolerate 1 hour at the anhepatic phase. Pulmonary injury was the most severe within 12-24 hours after ischemia-reperfusion.

  19. [Treatment of idiopathic intracranial hypertension by endovascular improvement of venous drainage of the brain].

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    Aguilar-Pérez, M; Henkes, H

    2015-10-01

    Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, is a syndrome of elevated intracranial pressure (ICP) in the absence of any known causative factor. Most patients with IIH respond to weight reduction, repeated lumbar punctures and carbonic anhydrase inhibitors, such as acetazolamide and topiramate to reduce cerebrospinal fluid (CSF) production. Despite a number of pathogenetic theories, the cause of IIH remains unknown. With the availability of magnetic resonance (MR) venography and cerebral angiography, venous disease is increasingly being discussed as the etiology of IIH, with a high proportion of patients presenting with nonthrombotic unilateral or bilateral dural venous sinus stenoses. Based on this observation, endovascular stenting of stenotic dural sinuses in patients with IIH has gained popularity. Whether dural venous sinus stenoses are the cause or the consequence of increased ICP is still under debate. In patients with failure of conservative treatment or non-compliance, a more aggressive treatment, such as CSF shunting or surgical optic nerve fenestration, should be performed. For approximately 13 years endovascular stenting of the stenotic sinuses has been used and discussed as an alternative and effective treatment of IIH. Since the first report in 2002, individual cases and case series have been published demonstrating that stents immediately lower the venous pressure gradient, which is associated with clinical improvement. This effect occurs within days or weeks and is permanent in many cases.

  20. Metabolomics of renal venous plasma from individuals with unilateral renal artery stenosis and essential hypertension.

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    Rhee, Eugene P; Clish, Clary B; Pierce, Kerry A; Saad, Ahmed; Lerman, Lilach O; Textor, Stephen C

    2015-04-01

    To compare the metabolite profiles of venous effluent from both kidneys of individuals with unilateral atherosclerotic renal artery stenosis (ARAS) in order to directly examine how impaired renal blood flow impacts small-molecule handling in humans. We applied liquid chromatography-mass spectrometry based metabolite profiling to venous plasma obtained from the stenotic (STK) and contralateral (CLK) kidneys of ARAS patients (n = 16), and both the kidneys of essential hypertensive controls (n = 11). Study samples were acquired during a 3-day protocol that included iothalamate clearance measurements, radiographic kidney phenotyping (Duplex ultrasound, multidetector computed tomography, and blood-oxygen-level-dependent MRI), and controlled sodium and caloric intake and antihypertensive treatment. Partial least squares-discriminant analysis demonstrated clear separation of essential hypertensive kidney metabolite profiles versus STK and CLK metabolite profiles, but no separation between metabolite profiles of STK and CLK samples. All of the discriminating metabolites were similarly elevated in the STK and CLK samples, likely reflecting the lower glomerular filtration rate in the ARAS versus essential hypertensive individuals (mean 66.1 versus 89.2  ml/min per 1.73 m). In a paired analysis within the ARAS group, no metabolite was significantly altered in STK compared with CLK samples; notably, creatinine was the same in STK and CLK samples (STK/CLK ratio = 1.0, P = 0.9). Results were unchanged in an examination of ARAS patients in the bottom half of renal tissue perfusion or oxygenation. Metabolite profiling does not differentiate venous effluent from STKs or CLKs in individuals with unilateral ARAS, despite the measurable loss of kidney volume and blood flow on the affected side. These findings are consistent with the kidney's ability to adapt to ARAS to maintain a range of metabolic functions.

  1. Focal stenosis of the sigmoid sinus causing intracranial venous hypertension: Case report, endovascular management, and review of the literature.

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    Honarmand, Amir R; Hurley, Michael C; Ansari, Sameer A; Alden, Tord D; Kuhn, Ryan; Shaibani, Ali

    2016-04-01

    Regardless of the underlying pathology, elevated intracranial pressure is the endpoint of any impairment in either cerebrospinal fluid (CSF) absorption (including arachnoid villi) or intracranial venous drainage. In all age groups, the predominant final common pathway for CSF drainage is the dural venous sinus system. Intracranial venous hypertension (ICVH) is an important vascular cause of intracranial hypertension (and its subsequent sequelae), which has often been ignored due to excessive attention to the arterial system and, specifically, arteriovenous shunts. Various anatomical and pathological entities have been described to cause ICVH. For the second time, we present a unique case of severe focal stenosis in the distal sigmoid sinus associated with concurrent hypoplasia of the contralateral transverse sinus causing a significant pressure gradient and intracranial hypertension, which was treated with endovascular stent placement and angioplasty. © The Author(s) 2016.

  2. The effects of posture on abnormalities of forearm venous tone in women with pregnancy-induced hypertension.

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    Stainer, K; Pickles, C; Cowley, A J

    1987-09-01

    1. Forearm venous tone was measured in the left lateral supine position and in response to passive leg elevation in a group of women with pregnancy-induced hypertension and compared with a group of normotensive pregnant women and a group of non-pregnant women. 2. The women with pregnancy-induced hypertension were venoconstricted in the supine position compared with the normal pregnant women (P less than 0.002). There was no difference in forearm venous tone between the women with pregnancy-induced hypertension and the non-pregnant women. 3. In response to passive leg elevation the women with pregnancy-induced hypertension venodilated (P less than 0.002) whereas there was no change in forearm venous tone in the normotensive pregnant women and the non-pregnant women. There was no change in blood pressure in any of the women after 35 min of leg elevation. 4. These results demonstrate that the abnormal venous vasoconstriction that occurs in women with pregnancy-induced hypertension in the supine position is corrected by passive leg elevation, a manoeuvre which leads to an increase in central blood volume.

  3. Effect of Body Mass Index on Venous Sinus Pressures in Idiopathic Intracranial Hypertension Patients Before and After Endovascular Stenting.

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    Raper, Daniel M S; Ding, Dale; Buell, Thomas J; Crowley, R Webster; Starke, Robert M; Liu, Kenneth C

    2017-04-20

    Elevated body mass index (BMI) has been correlated with worse outcomes after treatment for idiopathic intracranial hypertension (IIH). Venous sinus stenting (VSS) has emerged as a safe and effective treatment for a subset of patients with IIH and evidence of venous sinus stenosis. However, the association between BMI and the efficacy of VSS remains poorly characterized. To determine, in a retrospective cohort study, the effect of BMI on preoperative mean intracranial venous pressure (MVP) and post-VSS outcomes. We performed a retrospective evaluation of a prospectively collected database of patients with IIH and intracranial venous sinus stenosis who underwent VSS. Patient demographics and treatment factors, including pre- and postprocedural trans-stenosis pressure gradients, were analyzed to identify the relationship between BMI and outcomes after VSS. Increasing BMI was significantly correlated with higher maximum MVP ( P = .013) and higher trans-stenosis pressure gradient ( P = .043) prior to treatment. The degrees of improvement in maximum MVP and pressure gradient after VSS were greatest for obese and morbidly obese patients (BMI > 30 kg/m 2 ). Maximum poststent MVP, clinical outcomes, and stent-adjacent stenosis requiring retreatment after VSS were not significantly associated with BMI. We provide direct evidence for a positive correlation between BMI and intracranial venous pressure in patients with IIH. VSS affords a significantly greater amelioration of intracranial venous hypertension and stenosis for IIH patients with higher BMIs. As such, obesity should not be a deterrent for the use of VSS in the management of IIH.

  4. Central Venous Catheter-related Fungemia Caused by Rhodotorula glutinis.

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    Miglietta, Fabio; Letizia Faneschi, Maria; Braione, Adele; Palumbo, Claudio; Rizzo, Adriana; Lobreglio, Giambattista; Pizzolante, Maria

    2015-01-01

    Bloodstream infection due to Rhodotorula glutinis is extremely rare and mostly associated with underlying immunosuppression or cancer. Vascular access devices provide the necessary surfaces for biofilm formation and are currently responsible for a significant percentage of human infections. In this work, we describe a rare case of central venous catheter-related Rhodotorula glutinis fungemia in a female patient with acute myelogenous leukemia in remission. The timely removal of central venous catheter was an essential element for overcoming this CVC-related Rhodotorula fungemia.

  5. Dural venous sinus stenting for medically and surgically refractory idiopathic intracranial hypertension.

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    Satti, Sudhakar R; Leishangthem, Lakshmi; Spiotta, Alejandro; Chaudry, M Imran

    2017-04-01

    Background Idiopathic intracranial hypertension (IIH) is a syndrome defined by elevated intracranial hypertension without radiographic evidence of a mass lesion in the brain. Dural venous sinus stenosis has been increasingly recognized as a treatable cause, and dural venous sinus stenting (DVSS) is increasingly performed. Methods A 5 year single-center retrospective analysis of consecutive patients undergoing DVSS for medically refractory IIH. Results There were 43 patients with a mean imaging follow-up of 6.5 months and a mean clinical follow-up period of 13.5 months. DVSS was performed as the first procedure for medically refractory IIH in 81.4% of patients, whereas 18.6% of patients included had previously had a surgical procedure (ventriculoperitoneal (VP) shunt or optic nerve sheath fenestration (ONSF)). Headache was present in all patients and after DVSS improved or remained stable in 69.2% and 30.8%, respectively. Visual acuity changes and visual field changes were present in 88.4% and 37.2% of patients, respectively. Visual field improved or remained unchanged in 92%, but worsened in 8% after stenting. There was a stent patency rate of 81.8%, with an 18.2% re-stenosis rate. Of the 43 procedures performed, there was a 100% technical success rate with zero major or minor complications. Conclusion Based on this single-center retrospective analysis, DVSS can be performed with high technical success and low complication rates. A majority of patients presented primarily with headache, and these patients had excellent symptom relief with DVSS alone. Patients presenting with visual symptoms had lower success rates, and this population, if stented, should be carefully followed for progression of symptoms.

  6. Pulmonary Hypertension Secondary to Partial Anomalous Pulmonary Venous Return in an Elderly

    Directory of Open Access Journals (Sweden)

    Stefan Koester

    2016-01-01

    Full Text Available Background. Partial anomalous pulmonary venous return (PAPVR is an uncommon congenital abnormality, which may present in the adult population. It is often associated with sinus venosus defect (SVD. The diagnosis and therapy for this condition may be challenging. Case Presentation. We describe a case of an elderly woman who presented with NYHA Class IV dyspnea and was suspected to have symptomatic pulmonary hypertension. She was later found to have anomalous right upper pulmonary vein return to the superior vena cava and associated SVD with bidirectional shunting. Therapeutic options were discussed and medical management alone with aggressive diuresis and sildenafil was adopted. Follow-up visits revealed success in the planned medical therapy. Conclusions. PAPVR is a rare congenital condition that may present during late adulthood. The initial predominant left-to-right shunting associated with this anomaly may go undetected for years with the gradual development of pulmonary hypertension and right heart failure due to right heart volume overload. Awareness of the condition is important, as therapy is time-sensitive with early detection potentially leading to surgical therapy as a viable option.

  7. Venous Sinus Stenting in the Management of Patients with Intracranial Hypertension Manifesting with Skull Base Cerebrospinal Fluid Leaks.

    Science.gov (United States)

    Iyer, Rajiv R; Solomon, David; Moghekar, Abhay; Goodwin, C Rory; Stewart, C Matthew; Ishii, Masaru; Gailloud, Philippe; Gallia, Gary L

    2017-10-01

    A subset of patients with skull base cerebrospinal fluid (CSF) leaks are found to have elevated intracranial pressure (ICP). In these patients, elevated ICP is thought to contribute to both the pathophysiology of the leak and postoperative leak recurrences. Current strategies for postoperative ICP control include medical therapy and shunting procedures. The aim of this study is to report the use of venous sinus stenting (VSS) in the management of patients with skull base CSF leaks caused by elevated ICP. We performed a retrospective investigation of 2 patients who underwent surgical repair of skull base CSF leaks and were found to have elevated ICP associated with venous sinus stenosis and subsequently treated with VSS. Two patients underwent successful surgical repair of skull base CSF leaks with perioperative ICP monitoring via temporary lumbar catheters. Postoperative CSF pressure measurement demonstrated elevated ICP. Both patients were found to have venous sinus stenosis on further workup and subsequently underwent VSS for treatment of intracranial hypertension. Both patients had improvement in their symptoms with no evidence of recurrent CSF leak at follow-up. Patients with skull base CSF leaks of unknown etiology should undergo CSF pressure monitoring postoperatively and, if found to be elevated, be treated for intracranial hypertension. In patients unresponsive to, or intolerant of, medical therapy, VSS can provide an alternative option to medical and surgical shunting procedures for treatment of intracranial hypertension in patients with skull base CSF leaks and venous sinus stenosis. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Obesity-Related Hypertension: Focus on Leptin

    DEFF Research Database (Denmark)

    Asferg, Camilla Lundegaard

    suggested to play a role in obesity-related hypertension such as the renin-angiotensin-aldosterone system, the sympathetic nervous system, inflammation, insulin resistance, physical inactivity, and abnormal production of adipocytokines. Of all adipocytokines, leptin and adiponectin have received most...... to be involved in overweight- and obesity-related hypertension Results: The principal findings of this PhD study were that leptin may be a mediator of hypertension in obese physically inactive subjects. Further, it was found that abnormal regulation of the renin-angiotensin-aldosterone system and increased...

  9. Long-term consequences of pregnancy-related venous thrombosis

    OpenAIRE

    Wik, Hilde Skuterud

    2013-01-01

    Background: Venous thrombosis (VT) is among the leading causes of maternal mortality in countries with high standards of perinatal care; however the long-term outcomes of pregnancy-related VT are unknown. Aims: To assess the long-term prevalence of post-thrombotic syndrome (PTS), a frequently occurring chronic complication after deep vein thrombosis (DVT), to identify possible predictors for PTS, and to evaluate disease specific quality of life (QOL) after pregnancy-related DVT as compare...

  10. Cardiopulmonary effects of enoximone or dobutamine and nitroglycerin on mitral valve regurgitation and pulmonary venous hypertension.

    Science.gov (United States)

    Hachenberg, T; Möllhoff, T; Holst, D; Hammel, D; Brüssel, T

    1997-06-01

    To compare the cardiovascular and pulmonary effects of the phosphodiesterase III inhibitor enoximone (EN) or a combination of dobutamine (DOB) and nitroglycerin (NTG) before and after mitral valve repair or replacement. Prospective, randomized, controlled clinical study. University hospital. Twenty patients with mitral regurgitation and pulmonary venous hypertension scheduled for elective mitral valve surgery. Patients fulfilling the inclusion criteria of the study were randomly allocated into a group treated with EN (group 1, n = 10) or DOB and NTG (group 2, n = 10). A cardiopulmonary status was obtained after induction of anesthesia and mechanical ventilation during stable hemodynamic conditions (control). Then the patients received either EN (bolus dose 1.0 mg/kg followed by a continuous infusion of 10 micrograms/kg/min) or DOB (8.0 micrograms/kg/min) and NTG (1.0 microgram/kg/min) according to the randomization. After a period of 20 minutes, all parameters were measured again. The study drugs were stopped, and cardiac surgery was performed. Infusions of EN (without additional loading dose) or DOB and NTG were started again in the above-described doses 10 minutes before separation from cardiopulmonary bypass (CPB). Respiratory and hemodynamic measurements were made 20 minutes after weaning from CPB and 60 minutes after admission of the patient to the intensive care unit. Both groups were comparable regarding preoperative and control data. Before mitral valve surgery, cardiac output (CO) and heart rate (HR) increased by 46% (p < 0.05) and 31% (p < 0.01) during infusion of EN with minor changes of mean systemic arterial pressure (PSA) and gas exchange. Mean pulmonary arterial pressure (PPA) decreased from 32 +/- 11 mmHg to 23 +/- 11 mmHg (p < 0.05). Similar alterations were observed in group 2 (delta CO + 26%, p < 0.05, delta HR + 39%, p < 0.01); however, PPA and calculated pulmonary vascular resistance remained unchanged. After separation from CPB, EN and DOB

  11. Tumor cerebri: Metastatic renal cell carcinoma with dural venous sinus compression leading to intracranial hypertension; a case report

    OpenAIRE

    Marvin, Eric; Synkowski, Jordan; Benko, Michael

    2017-01-01

    Background: Pseudotumor cerebri (PTC), also known as idiopathic intracranial hypertension (IIH), is a condition associated with increased intracranial pressure (ICP) in the absence of radiographic findings such as mass lesions or cerebral edema. Case Description: We describe a case of progressive headache and visual disturbances attributed to PTC that resulted from subacute superior sagittal sinus (SSS) stenosis by a metastatic tumor. Conclusions: Venous outflow obstruction often presents wit...

  12. Obesity-Related Hypertension in Children

    OpenAIRE

    Brady, Tammy M.

    2017-01-01

    Obesity and hypertension have both been on the rise in children. Each is associated with increased cardiovascular disease risk and both track into adulthood, increasing the prevalence of heart disease and related morbidity and mortality. All children should be screened for hypertension, but children with comorbid obesity may not only particularly benefit from the screening but may also prove the most challenging to screen. Increased arm circumference and conical arm shape are particularly pro...

  13. Predictive model of portal venous system thrombosis in cirrhotic portal hypertensive patients after splenectomy.

    Science.gov (United States)

    He, Shasha; He, Fangping

    2015-01-01

    This study is to investigate the risk factors of portal venous system thrombosis (PVT) in patients with cirrhotic portal hypertension after splenectomy and to establish a Logistic regression prediction model. A total of 119 patients with cirrhotic portal hypertension were enrolled. Their clinical data was retrospectively analyzed. They were divided into PVT group (n = 18) and non-PVT group (n = 101). One-way analysis and multivariate Logistic regression analysis were performed to analyze the independent risk factors of PVT. Logistic regression prediction model was established. The receiver operating characteristic curve was generated and correlation analysis was conducted. Platelet count (PLT), mean platelet volume (MPV) and D-Dimer were independent risk factors affecting PVT. Anticoagulation therapy (UAT) and usage of reducing portal pressure therapy (URPT) were independent protective factors of PVT. Logistic regression prediction model was expressed as Logit P = -9.165 + 0.664 × PLT (× 10(11)/L) + 0.413 × MPV (fL) + 0.662 × D-Dimer (mg/L) -1.674 × UAT (Yes = 1, No = 0) -1.518 × URPT (Yes = 1, No = 0). And, the cut-off value of Logit P was -1.14. The area under the receiver operating characteristic curve and the accuracy were 0.865 and 84.03%. The cut-off value of PLT, MPV and D-Dimer were 4.42 × 10(11)/L, 13.30 fL and 2.55 mg/L, respectively. MPV and D-Dimer were positively correlated. PLT, MPV and D-Dimer are independent risk factors while UAT and URPT are independent protective factors of PVT. Logistic regression prediction model can predict PVT with a high sensitivity, specificity and accuracy. It provides theoretical foundation and cut-off value for predicting PVT after splenectomy.

  14. The effect of flight-related behaviour on the risk of venous thrombosis after air travel

    NARCIS (Netherlands)

    Schreijer, Anja J.M.; Cannegieter, Suzanne C.; Doggen, Catharina Jacoba Maria; Rosendaal, Frits R.

    2009-01-01

    In a case–control study including 11 033 participants (The Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis study) on risk factors of venous thrombosis, we studied the effect of flight-related behaviour on the risk of venous thrombosis after air travel. Patients

  15. Tsukamurella catheter-related bloodstream infection in a pediatric patient with pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    Kristen A. Wendorf

    2010-03-01

    Full Text Available Catheter-related bloodstream infections (CR-BSI are important complications in patients with long-term indwelling central venous catheters. In this report, we present the case of a 14-year-old male with pulmonary hypertension treated with continuous treprostinil infusion, who presented with a CR-BSI caused by a Tsukamurella species. This case highlights the potential for this unusual organism to cause infection in immunocompetent patients.

  16. Obesity-related hypertension: possible pathophysiological mechanisms.

    Science.gov (United States)

    Vaněčková, Ivana; Maletínská, Lenka; Behuliak, Michal; Nagelová, Veronika; Zicha, Josef; Kuneš, Jaroslav

    2014-12-01

    Hypertension is one of the major risk factors of cardiovascular diseases, but despite a century of clinical and basic research, the discrete etiology of this disease is still not fully understood. The same is true for obesity, which is recognized as a major global epidemic health problem nowadays. Obesity is associated with an increasing prevalence of the metabolic syndrome, a cluster of risk factors including hypertension, abdominal obesity, dyslipidemia, and hyperglycemia. Epidemiological studies have shown that excess weight gain predicts future development of hypertension, and the relationship between BMI and blood pressure (BP) appears to be almost linear in different populations. There is no doubt that obesity-related hypertension is a multifactorial and polygenic trait, and multiple potential pathogenetic mechanisms probably contribute to the development of higher BP in obese humans. These include hyperinsulinemia, activation of the renin-angiotensin-aldosterone system, sympathetic nervous system stimulation, abnormal levels of certain adipokines such as leptin, or cytokines acting at the vascular endothelial level. Moreover, some genetic and epigenetic mechanisms are also in play. Although the full manifestation of both hypertension and obesity occurs predominantly in adulthood, their roots can be traced back to early ontogeny. The detailed knowledge of alterations occurring in the organism of experimental animals during particular critical periods (developmental windows) could help to solve this phenomenon in humans and might facilitate the age-specific prevention of human obesity-related hypertension. In addition, better understanding of particular pathophysiological mechanisms might be useful in so-called personalized medicine. © 2014 Society for Endocrinology.

  17. Evaluation of portal hypertension: a comparison of the use of liver perfusion CT with wedge hepatic venous pressure and hepatic

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Dong Jin; Kim, Young Joong; Park, Yong Sung; Lee, Tae Hee [University of Konyang College of Medicine, Daejeon (Korea, Republic of); Kim, Chong Soo; Kang, Heung Keun [Chonbuk National University Medical School, Jeonju (Korea, Republic of)

    2008-09-15

    We compared the hepatic perfusion indices obtained using hepatic perfusion CT with the wedge hepatic venous pressure (WHVP) and hepatic venous pressure gradient (HVPG) to determine the efficacy of the use of liver perfusion CT for the evaluation of portal hypertension. Thirty-five patients with liver cirrhosis underwent hepatic vein catheterization to measure WHVP and HVPG and underwent a liver perfusion CT examination. Arterial perfusion, portal perfusion, total perfusion and the hepatic perfusion index (HPI) were calculated by the methods described by Miles and Blomlely. The overall correlation coefficients (r) between the perfusion indices and WHVP and HVPG were calculated. An additional correlation coefficient of 23 alcoholic cirrhosis patients was calculated. Using Blomley's equation, HPI had a positive correlation with WHVP (r = .471; {rho} < .05) and HVPG (r = .482; {rho} < .05). For the alcoholic liver cirrhosis patients, HPI had a higher positive correlation with WHVP (r = .500; {rho} < .05) and HVPG (r = .539; {rho} < .05) than for the non-alcoholic cirrhosis patients. There was no statistical difference between the use of Miles' equation and Blomley's equation for the evaluation of portal hypertension. This preliminary study showed that HPI positively correlated with WHVP and HVPG, especially in alcoholic cirrhosis patients. Liver perfusion CT may be useful in the evaluation of portal hypertension.

  18. Tumor cerebri: Metastatic renal cell carcinoma with dural venous sinus compression leading to intracranial hypertension; a case report.

    Science.gov (United States)

    Marvin, Eric; Synkowski, Jordan; Benko, Michael

    2017-01-01

    Pseudotumor cerebri (PTC), also known as idiopathic intracranial hypertension (IIH), is a condition associated with increased intracranial pressure (ICP) in the absence of radiographic findings such as mass lesions or cerebral edema. We describe a case of progressive headache and visual disturbances attributed to PTC that resulted from subacute superior sagittal sinus (SSS) stenosis by a metastatic tumor. Venous outflow obstruction often presents with an acute symptomatology including infarcts, hemorrhages, and seizures, but only rarely does it cause the progressive development of raised ICP. The sinister presentation of our patient's pathology stemmed from local mass effect caused by a tumor that has hitherto not been reported to cause intracranial hypertension (IH) and was best elucidated using magnetic resonance venography (MRV).

  19. Adipocytes, aldosterone and obesity-related hypertension.

    Science.gov (United States)

    Dinh Cat, Aurelie Nguyen; Friederich-Persson, Malou; White, Anna; Touyz, Rhian M

    2016-07-01

    Understanding the mechanisms linking obesity with hypertension is important in the current obesity epidemic as it may improve therapeutic interventions. Plasma aldosterone levels are positively correlated with body mass index and weight loss in obese patients is reported to be accompanied by decreased aldosterone levels. This suggests a relationship between adipose tissue and the production/secretion of aldosterone. Aldosterone is synthesized principally by the adrenal glands, but its production may be regulated by many factors, including factors secreted by adipocytes. In addition, studies have reported local synthesis of aldosterone in extra-adrenal tissues, including adipose tissue. Experimental studies have highlighted a role for adipocyte-secreted aldosterone in the pathogenesis of obesity-related cardiovascular complications via the mineralocorticoid receptor. This review focuses on how aldosterone secretion may be influenced by adipose tissue and the importance of these mechanisms in the context of obesity-related hypertension. © 2016 Society for Endocrinology.

  20. Subclavian central venous catheter-related thrombosis in trauma patients: incidence, risk factors and influence of polyurethane type

    Science.gov (United States)

    2013-01-01

    Introduction The incidence of deep venous thrombosis (DVT) related to a central venous catheter varies considerably in ICUs depending on the population included. The aim of this study was to determine subclavian central venous catheter (SCVC)-related DVT risk factors in severely traumatized patients with regard to two kinds of polyurethane catheters. Methods Critically ill trauma patients needing a SCVC for their usual care were prospectively included in an observational study. Depending on the month of inclusion, patients received one of the two available products in the emergency unit: either an aromatic polyurethane SCVC or an aliphatic polyurethane SCVC. Patients were screened weekly by ultrasound for SCVC-related DVT. Potential risk factors were collected, including history-related, trauma-related and SCVC-related characteristics. Results A total of 186 patients were included with a median Injury Severity Sore of 30 and a high rate of severe brain injuries (21% of high intracranial pressure). Incidence of SCVC-related DVT was 37% (95% confidence interval: 26 to 40) in patients or 20/1,000 catheter-days. SCVC-related DVT occurred within 8 days in 65% of cases. There was no significant difference in DVT rates between the aromatic polyurethane and aliphatic polyurethane SCVC groups (38% vs. 36%). SCVC-related DVT independent risk factors were age >30 years, intracranial hypertension, massive transfusion (>10 packed red blood cell units), SCVC tip position in the internal jugular or in the innominate vein, and ipsilateral jugular catheter. Conclusion SCVC-related DVT concerned one-third of these severely traumatized patients and was mostly clinically silent. Incidence did not depend on the type of polyurethane but was related to age >30 years, intracranial hypertension or misplacement of the SCVC. Further studies are needed to assess the cost-effectiveness of routine screening in these patients in whom thromboprophylaxis may be hazardous. PMID:23718723

  1. Sigmoid Sinus Diverticulum, Dehiscence, and Venous Sinus Stenosis: Potential Causes of Pulsatile Tinnitus in Patients with Idiopathic Intracranial Hypertension?

    Science.gov (United States)

    Lansley, J A; Tucker, W; Eriksen, M R; Riordan-Eva, P; Connor, S E J

    2017-09-01

    Pulsatile tinnitus is experienced by most patients with idiopathic intracranial hypertension. The pathophysiology remains uncertain; however, transverse sinus stenosis and sigmoid sinus diverticulum/dehiscence have been proposed as potential etiologies. We aimed to determine whether the prevalence of transverse sinus stenosis and sigmoid sinus diverticulum/dehiscence was increased in patients with idiopathic intracranial hypertension and pulsatile tinnitus relative to those without pulsatile tinnitus and a control group. CT vascular studies of patients with idiopathic intracranial hypertension with pulsatile tinnitus (n = 42), without pulsatile tinnitus (n = 37), and controls (n = 75) were independently reviewed for the presence of severe transverse sinus stenosis and sigmoid sinus diverticulum/dehiscence according to published criteria. The prevalence of transverse sinus stenosis and sigmoid sinus diverticulum/dehiscence in patients with idiopathic intracranial hypertension with pulsatile tinnitus was compared with that in the nonpulsatile tinnitus idiopathic intracranial hypertension group and the control group. Further comparisons included differing degrees of transverse sinus stenosis (50% and 75%), laterality of transverse sinus stenosis/sigmoid sinus diverticulum/dehiscence, and ipsilateral transverse sinus stenosis combined with sigmoid sinus diverticulum/dehiscence. Severe bilateral transverse sinus stenoses were more frequent in patients with idiopathic intracranial hypertension than in controls (P intracranial hypertension group. Sigmoid sinus dehiscence (right- or left-sided) was also more common in patients with idiopathic intracranial hypertension compared with controls (P = .01), but there was no significant association with pulsatile tinnitus within the idiopathic intracranial hypertension group. While our data corroborate previous studies demonstrating increased prevalence of sigmoid sinus diverticulum/dehiscence and transverse sinus stenosis in

  2. Orbital venous pattern in relation to extraorbital venous drainage and superficial lymphatic vessels in rats.

    Science.gov (United States)

    Maloveska, Marcela; Kresakova, Lenka; Vdoviakova, Katarina; Petrovova, Eva; Elias, Mario; Panagiotis, Artemiou; Andrejcakova, Zuzana; Supuka, Peter; Purzyc, Halina; Kissova, Viktoria

    2017-01-01

    The purpose of this study was to demonstrate the normal and variant anatomy of extraorbital and intraorbital venous drainage together with retroorbital communication, and determine the lymphatic drainage from the superficial orbital region with a potential outlet of lymphatic vessel into the venous bloodstream. The study of the venous system was carried out on 32 Wistar rats by using corrosion casts methods and radiography, while the lymphatic system was studied in 12 Wistar rats following ink injection. Superficially, orbital veins are connected with extraorbital veins running through angular vein of the eye and the superficial temporal vein, and via the pterygoid plexus with the maxillary vein, which provide readily accessible communication routes in the spread of infection. The extent of intraorbital and periorbital venous drainage was ensured by the dorsal and ventral external ophthalmic vein through the infraorbital vein, which together formed the principal part of the ophthalmic plexus. Venous drainage of the eyeball was carried out mainly by the vortex veins, ciliary veins and internal ophthalmic vein. The highest variability, first presented by differences in structural arrangement and formation of anastomoses, was observed within the ventral external ophthalmic vein (22 cases) and the medial vortex vein (10 cases). Four vortex veins, one vein in each quadrant of the eye, were observed in rats. The vortex vein located on the ventral side of the eyeball was occasionally found as two veins (in four cases) in the present study. The lymphatic vessel from the lower eyelid entered into the mandibular lymph centre, and from the upper eyelid entered into the superficial cervical lymph centre, but both drained into the deep cranial cervical lymph node. The direct entry of lymph entering the veins without passing through lymph nodes was not observed.

  3. Central Venous Catheter (CVC related infections: a local retrospective study

    Directory of Open Access Journals (Sweden)

    Manuela Fresu

    2008-06-01

    Full Text Available Background. Central venous catheter (CVC related infection is associated with significant increases in morbidity, mortality, and health care cost.This local surveillance study was carry out to monitor the frequency of occurrence of CVC-related blood stream infections. Materials and methods. During the period January – December 2005, 226 CVC specimens were analyzed (quantitative method and microrganism identification from positive samples was performed by Vitek II. In 53 patients it was possible to compare quantitative results with those obtained from blood cultures. Results. Positive CVC samples were 125 (55% and 130 microrganisms were isolated: 109 Gram-positives (84%, 4 Gram-negatives (3%, and 17 mycetes (13%. Among pathogens collected simultaneously from CVC and blood samples, the most frequently isolated were Staphylococcus spp. (30% coagulase-negative staphylococci and 20%. S. aureus and Candida spp. (45%. In the group of patients that presented positive CVC and negative blood samples the most frequently recovered microrganisms were staphylococci. Many isolates (33% were polymicrobial. Conclusions. Catheter-related infections occurred in those patients who presented the same pathogen in both CVC and blood cultures. These infections were principally caused by staphylococci and Candida spp. On the contrary, a possible CVC contamination could be suspected when positive CVC and negative blood cultures were found.

  4. Venous sinus stenting using transcranial access for the treatment of idiopathic intracranial hypertension in a pediatric patient

    Directory of Open Access Journals (Sweden)

    Thomas J Buell

    2017-01-01

    Full Text Available A 4-year-old male with headaches, papilledema, intracranial hypertension, and bilateral transverse sinus (TS stenosis underwent attempted percutaneous placement of a right TS stent. Stent deployment was not technically feasible due to the stiffness of the stent and tortuosity of the patient's jugular bulb. Therefore, the patient underwent hybrid endovascular stenting of the right TS using neuronavigation and direct access of the TS following a single burr hole craniectomy. Two Express 8 mm × 17 mm balloon-mounted stents were deployed into the right TS, which resulted in obliteration of the preexisting trans-stenosis pressure gradient and decreased intracranial parenchymal pressure as monitored through an intracranial pressure bolt. The patient's headaches and papilledema resolved, and follow-up imaging demonstrated no in-stent or stent-adjacent stenosis. This case demonstrates the feasibility of combining minimally invasive open surgical access to allow direct cannulation for venous sinus stenting.

  5. Borderline Intracranial Hypertension Manifesting as Chronic Fatigue Syndrome Treated by Venous Sinus Stenting

    OpenAIRE

    Higgins, Nicholas; Pickard, John; Lever, Andrew

    2015-01-01

    Chronic fatigue syndrome and cases of idiopathic intracranial hypertension without signs of raised intracranial pressure can be impossible to distinguish without direct measurement of intracranial pressure. Moreover, lumbar puncture, the usual method of measuring intracranial pressure, can produce a similar respite from symptoms in patients with chronic fatigue as it does in idiopathic intracranial hypertension. This suggests a connection between them, with chronic fatigue syndrome representi...

  6. Borderline Intracranial Hypertension Manifesting as Chronic Fatigue Syndrome Treated by Venous Sinus Stenting.

    Science.gov (United States)

    Higgins, Nicholas; Pickard, John; Lever, Andrew

    2015-11-01

    Chronic fatigue syndrome and cases of idiopathic intracranial hypertension without signs of raised intracranial pressure can be impossible to distinguish without direct measurement of intracranial pressure. Moreover, lumbar puncture, the usual method of measuring intracranial pressure, can produce a similar respite from symptoms in patients with chronic fatigue as it does in idiopathic intracranial hypertension. This suggests a connection between them, with chronic fatigue syndrome representing a forme fruste variant of idiopathic intracranial hypertension. If this were the case, then treatments available for idiopathic intracranial hypertension might be appropriate for chronic fatigue. We describe a 49-year-old woman with a long and debilitating history of chronic fatigue syndrome who was targeted for investigation of intracranial pressure because of headache, then diagnosed with borderline idiopathic intracranial hypertension after lumbar puncture and cerebrospinal fluid drainage. Further investigation showed narrowings at the anterior ends of the transverse sinuses, typical of those seen in idiopathic intracranial hypertension and associated with pressure gradients. Stenting of both transverse sinuses brought about a life-changing remission of symptoms with no regression in 2 years of follow-up. This result invites study of an alternative approach to the investigation and management of chronic fatigue.

  7. Percutaneous transluminal angioplasty (PTA) and venous stenting in hemodialysis patients with vascular access-related venous stenosis or occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Christidou, Fotini P. [Renal Unit, G.H. ' G. Papanikolaou' , Thessaloniki (Greece); Kalpakidis, Vasilios I. [Department of Radiology, G.H. ' G. Papanikolaou' , Thessaloniki (Greece); Iatrou, Kostas D. [Department of Radiology, G.H. ' G. Papanikolaou' , Thessaloniki (Greece); Zervidis, Ioannis A. [Department of Radiology, G.H. ' G. Papanikolaou' , Thessaloniki (Greece); Bamichas, Gerasimos I. [Renal Unit, G.H. ' G. Papanikolaou' , Thessaloniki (Greece); Gionanlis, Lazaros C. [Renal Unit, G.H. ' G. Papanikolaou' , Thessaloniki (Greece); Natse, Taisir A. [Renal Unit, G.H. ' G. Papanikolaou' , Thessaloniki (Greece); Sombolos, Kostas J. [Renal Unit, G.H. ' G. Papanikolaou' , Thessaloniki (Greece)]. E-mail: sobolos@spark.net.gr

    2006-05-15

    Aim of the study: To present our experience with PTA and venous stenting in hemodialysis patients with vascular access (VA) related venous stenosis or occlusion. Patients - methods: We studied retrospectively 22 hemodialysis patients with VA-related venous stenosis or occlusions that were treated with PTA and subsequent stenting. The following lesions were detected by digital subtraction venography: occlusion of the brachiocephalic and/or subclavian veins in four patients, stenosis (80-90%) of the same veins in 10 patients, stenosis (80-95%) of the axillary vein in four patients, brachial vein stenosis in two patients, and cephalic vein stenosis in two patients. The follow-up period ranged from 3 to 29 months (mean 15.4 {+-} 9.8 months). Primary and cumulative stent patency was recorded. Results: Twenty-two primary venous PTA-stent implantation procedures were performed using 25 stents. The initial deployment of these 25 stents was technically successful, with complete opening (>80%) of the vein's lumen in all but one patient (95.4%). The patency of the vein immediately after the stenting procedure was greater than 90% in 13 patients, 80-90% in eight patients, and less than 40% in the case involving failure. Seventeen episodes of re-obstruction occurred in 13 patients (59%), and all were treated with the same PTA-stent procedures. At the end of the study period 47 stents had been placed in patients. The 3, 6, 12 and 24-month primary patency rates were 88.3%, 65.3%, 45.6% and 25.5%, respectively. Overall cumulative stent patency was 95.4% after 3 months, 79% after 6 months, 74% after 12 months, and 62.8% after 24 months. Conclusion: PTA with primary venous stenting is an effective method for the treatment of VA-related stenosis or occlusion. However, repeat and sometimes multiple interventions are usually needed for the treatment of re-stenosis or re-occlusion episodes.

  8. Patterns of flap loss related to arterial and venous insufficiency in the rat pedicled TRAM flap.

    Science.gov (United States)

    Qiao, Q; Moon, W; Zhang, F; Chen, S G; Kunda, L; Lineaweaver, W C; Buncke, H J

    1999-08-01

    Vascular supply to the contralateral portion of the conventional transverse rectus abdominis musculocutaneous (TRAM) flap (zone IV) may become compromised, resulting in partial flap loss and requiring segmental excision. The etiology of this necrosis is not clear. This study determines skin necrosis patterns on a superiorly pedicled caudal TRAM flap during conditions of venous and arterial insufficiency, and determines whether cutaneous venous outflow can sustain a flap with venous insufficiency. Twenty-eight adult male Sprague-Dawley rats underwent superior pedicled TRAM flap elevation, and the zones were marked on the skin paddle. The animals were divided into four groups: control (group A, N = 6), arterial ligation (group B, N = 6), venous ligation (group C, N = 8), and venous ligation with cutaneous venous outflow (group D, N = 8). After 10 days, the skin paddle was photographed and the areas of necrotic skin were measured. Results showed that group B (selective arterial ligation) had 51.7 +/- 2.8% and 40.0 +/- 2.0% skin necrosis in zones I and II respectively. Zone I necrosis was significantly greater in group B compared with the control (p < 0.05). Group C (selective venous ligation) resulted in 73.8 +/- 16.4% and 93.8 +/- 33.4% skin necrosis in zones III and IV respectively. This necrosis was significantly greater compared with the control (p < 0.001). Group D rats' lateral skin necrosis compared significantly less with group C (p < 0.001). These results demonstrate that the patterns of flap necrosis in rat TRAM flaps with poor arterial inflow differ from those with venous stasis. Necrosis of the contralateral portion (zone IV) of human TRAM flaps may be related to problems with venous stasis; thus, a cutaneous venous outflow may prevent this problem.

  9. Incidence and predictors of dural venous sinus pressure gradient in idiopathic intracranial hypertension and non-idiopathic intracranial hypertension headache patients: results from 164 cerebral venograms.

    Science.gov (United States)

    Levitt, Michael R; Hlubek, Randall J; Moon, Karam; Kalani, M Yashar S; Nakaji, Peter; Smith, Kris A; Little, Andrew S; Knievel, Kerry; Chan, Jane W; McDougall, Cameron G; Albuquerque, Felipe C

    2017-02-01

    OBJECTIVE Cerebral venous pressure gradient (CVPG) from dural venous sinus stenosis is implicated in headache syndromes such as idiopathic intracranial hypertension (IIH). The incidence of CVPG in headache patients has not been reported. METHODS The authors reviewed all cerebral venograms with manometry performed for headache between January 2008 and May 2015. Patient demographics, headache etiology, intracranial pressure (ICP) measurements, and radiographic and manometric results were recorded. CVPG was defined as a difference ≥ 8 mm Hg by venographic manometry. RESULTS One hundred sixty-four venograms were performed in 155 patients. There were no procedural complications. Ninety-six procedures (58.5%) were for patients with IIH. The overall incidence of CVPG was 25.6% (42 of 164 procedures): 35.4% (34 of 96 procedures) in IIH patients and 11.8% (8 of 68 procedures) in non-IIH patients. Sixty procedures (36.6%) were performed in patients with preexisting shunts. Seventy-seven patients (49.7%) had procedures preceded by an ICP measurement within 4 weeks of venography, and in 66 (85.7%) of these patients, the ICP had been found to be elevated. CVPG was seen in 8.3% (n = 5) of the procedures in the 60 patients with a preexisting shunt and in 0% (n = 0) of the 11 procedures in the 77 patients with normal ICP (p < 0.001 for both). Noninvasive imaging (MR venography, CT venography) was assessed prior to venography in 112 (68.3%) of 164 cases, and dural venous sinus abnormalities were demonstrated in 73 (65.2%) of these cases; there was a trend toward CVPG (p = 0.07). Multivariate analysis demonstrated an increased likelihood of CVPG in patients with IIH (OR 4.97, 95% CI 1.71-14.47) and a decreased likelihood in patients with a preexisting shunt (OR 0.09, 95% CI 0.02-0.44). CONCLUSIONS CVPG is uncommon in IIH patients, rare in those with preexisting shunts, and absent in those with normal ICP.

  10. Novel Rat Model of Repetitive Portal Venous Embolization Mimicking Human Non-Cirrhotic Idiopathic Portal Hypertension

    DEFF Research Database (Denmark)

    Klein, Sabine; Hinüber, Christian; Hittatiya, Kanishka

    2016-01-01

    BACKGROUND: Non-cirrhotic idiopathic portal hypertension (NCIPH) is characterized by splenomegaly, anemia and portal hypertension, while liver function is preserved. However, no animal models have been established yet. This study assessed a rat model of NCIPH and characterized the hemodynamics......, and compared it to human NCIPH. METHODS: Portal pressure (PP) was measured invasively and coloured microspheres were injected in the ileocecal vein in rats. This procedure was performed weekly for 3 weeks (weekly embolization). Rats without and with single embolization served as controls. After four weeks (one...... in the weekly embolization group. Fibrotic markers αSMA and Desmin were upregulated in weekly embolized rats. DISCUSSION: This study establishes a model using repetitive embolization via portal veins, comparable with human NCIPH and may serve to test new therapies....

  11. Catheter related venous thrombosis with cooling and warming catheters: two case reports.

    Science.gov (United States)

    Prunet, Bertrand; Lacroix, Guillaume; Bordes, Julien; Poyet, Raphael; D'Aranda, Erwan; Goutorbe, Philippe

    2009-09-08

    Intravascular cooling and warming catheters are among a range of proliferating technologies used for temperature control. Complications related to the use of these devices are few, and no definitive evidence has been presented thus far to indicate any differences in complication rates between these balloon catheters and other central vein catheters. We report two cases of cooling and warming catheter-related venous thrombosis. They are the both first ones report of this kind in the literature. The first case was a 17-year-old man admitted with severe head trauma. On day 6, he presented with severe intracranial hypertension, requiring increased medical treatment: mannitol osmotherapy, barbiturate-induced coma, and mild therapeutic hypothermia. A double-lumen Alsius CoolLine catheter was placed in the inferior veina cava via the left femoral vein and active cooling was begun. On day 10, physical examination of the left inguinal area and echo-doppler revealed catheter-related thrombophlebitis with left iliocaval vein occlusion. The second case was a 42-year-old man admitted with a severe burn. On day 2, the patient was taken to the operating room for the first staged excision of his burn wounds. A triple lumen Alsius Icy catheter was placed in the inferior vena cava via the right femoral vein and active core warming of the patient was begun. From day 2 to day 7, active core warming of the patient was maintained. On day 7, he presented with a septic thrombophlebitis. Echo-doppler revealed a 4-cm-long thrombus at the femoral catheter site with complete blood flow obstruction and blood cultures and catheter tip were positive for methicillin-resistant Staphylococcus aureus. Although generally considered safe, cooling and warming catheters can be associated with mechanical complications such as catheter-related venous thrombosis. Intensivists who use these devices should be aware of this possible complication. Finally, as with any other invasive catheter, to reduce the

  12. Hypertensive Crisis

    Science.gov (United States)

    ... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Hypertensive Crisis: When You Should Call 9-1-1 for ... the Facts About HBP • Know Your Numbers Introduction Hypertensive Crisis Monitoring Your Blood Pressure At Home • Understand Symptoms ...

  13. Prothrombin time and relative plasma viscosity of hypertensive ...

    African Journals Online (AJOL)

    A study of the prothrombin time and relative plasma viscosity of hypertensive patients attending University of Calabar Teaching Hospital was conducted. Three hundred (300) male and female subjects aged 25 - 65 years were enrolled for the study. Two hundred (200) subjects were hypertensive, while 100 apparently ...

  14. Transient elastography versus hepatic venous pressure gradient for diagnosing portal hypertension: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Gaeun Kim

    2017-03-01

    Full Text Available Background/Aims Transient elastography (TE has been proposed as a promising noninvasive alternative to hepatic venous pressure gradient (HVPG for detecting portal hypertension (PH. However, previous studies have yielded conflicting results. We gathered evidence from literature on the clinical usefulness of TE versus HVPG for assessing PH. Methods We conducted a systematic review by searching databases for relevant literature evaluating the clinical usefulness of non-invasive TE for assessing PH in patients with cirrhosis. A literature search in Ovid Medline, EMBASE and the Cochrane Library was performed for all studies published prior to December 30, 2015. Results Eight studies (1,356 patients met our inclusion criteria. For the detection of PH (HVPG ≥6 mmHg, the summary sensitivity and specificity were 0.88 (95% confidence interval [CI] 0.86-0.90 and 0.74 (95% CI 0.67-0.81, respectively. Regarding clinically significant PH (HVPG ≥10 mmHg, the summary sensitivity and specificity were 0.85 (95% CI 0.63-0.97 and 0.71 (95% CI 0.50-0.93, respectively. The overall correlation estimate of TE and HVPG was large (0.75, 95% CI: 0.65; 0.82, P<0.0001. Conclusions TE showed high accuracy and correlation for detecting the severity of PH. Therefore, TE shows promise as a reliable and non-invasive procedure for the evaluation of PH that should be integrated into clinical practice.

  15. Transient resolution of venous sinus stenosis after high-volume lumbar puncture in a patient with idiopathic intracranial hypertension.

    Science.gov (United States)

    Buell, Thomas J; Raper, Daniel M S; Pomeraniec, I Jonathan; Ding, Dale; Chen, Ching-Jen; Taylor, Davis G; Liu, Kenneth C

    2017-08-25

    Stenosis of the transverse sinus (TS) and sigmoid sinus (SS), with a trans-stenosis pressure gradient, has been implicated in the pathophysiology of idiopathic intracranial hypertension (IIH). MRI has shown improvement in TS and SS stenosis after high-volume lumbar puncture (HVLP) in a subset of patients with IIH. The authors present the first report of an IIH patient with immediate post-HVLP TS and SS trans-stenosis pressure gradient reduction and an attendant increase in TS and SS cross-sectional area confirmed using intravascular ultrasonography (IVUS). Recurrence of the patient's TS-SS stenosis coincided with elevated HVLP opening pressure, and venous sinus stent placement resulted in clinical improvement. This report suggests that TS and SS stenosis may be a downstream effect of elevated intracranial pressure in IIH, rather than its principal etiological mechanism. However, the authors hypothesize that endovascular stenting may obliterate a positive feedback loop involving trans-stenosis pressure gradients, and still benefit appropriately selected patients.

  16. Catheter Fracture and Embolization Related to an Arm Venous Port

    Directory of Open Access Journals (Sweden)

    Brent E. Burbridge

    2011-01-01

    Full Text Available This 55-year-old female had a chest X-ray during a follow-up visit for the management of her breast cancer. The chest X-ray demonstrated an embolized venous catheter superimposed upon the mediastinum. It was determined that the catheter of the patient's arm port had fractured and embolized to the pulmonary circulation. The catheter was retrieved, in the interventional radiology suite, under fluoroscopic guidance. The patient suffered no ill effects. Subsequently, one day later, the old vein port was removed and a new arm port and associated catheter were implanted to facilitate the delivery of the patient's ongoing chemotherapy.

  17. Myocardial ultrasonic backscatter in hypertension: relation to aldosterone and endothelin.

    Science.gov (United States)

    Kozàkovà, Michaela; Buralli, Simona; Palombo, Carlo; Bernini, Giampaolo; Moretti, Angelica; Favilla, Stefania; Taddei, Stefano; Salvetti, Antonio

    2003-02-01

    A disproportionate accumulation of fibrillar collagen is a characteristic feature of hypertensive heart disease, but the extent of myocardial fibrosis may differ in different models of hypertension. In experimental studies, aldosterone and endothelins emerge as important determinants of myocardial fibrosis. Changes in myocardial extracellular matrix and collagen deposition can be estimated noninvasively by analysis of the ultrasonic backscatter signal, which arises from tissue heterogeneity within the myocardium and describes myocardial texture. This study was designed to investigate the relations between myocardial integrated backscatter and circulating aldosterone and immunoreactive endothelin in human hypertension. The study population consisted of 56 subjects: 14 healthy normotensive volunteers and 42 hypertensive patients (14 with primary aldosteronism, 7 with renovascular hypertension, and 21 with essential hypertension). The patients with essential and secondary hypertension were matched for age, gender, body mass index, and blood pressure. Myocardial integrated backscatter at diastole was 19.8+/-2.0 and 20.8+/-2.9 decibels in normotensive control subjects and patients with essential hypertension and significantly higher in patients with primary aldosteronism (27.4+/-3.8 decibels, P<0.01) and renovascular hypertension (26.8+/-4.8 decibels, P<0.01). In the population as a whole, as well as in the hypertensive subpopulation, myocardial integrated backscatter was directly related to plasma aldosterone (r=0.73 and 0.71, P<0.01 for both) and immunoreactive endothelin (r=0.60 and 0.56, P<0.01 for both). The data of this study suggest that in human hypertension, circulating aldosterone and immunoreactive endothelin may induce alterations in left ventricular myocardial texture, possibly related to increased myocardial collagen content.

  18. Identification of the Upward Movement of Human CSFIn Vivoand its Relation to the Brain Venous System.

    Science.gov (United States)

    Dreha-Kulaczewski, Steffi; Joseph, Arun A; Merboldt, Klaus-Dietmar; Ludwig, Hans-Christoph; Gärtner, Jutta; Frahm, Jens

    2017-03-01

    CSF flux is involved in the pathophysiology of neurodegenerative diseases and cognitive impairment after traumatic brain injury, all hallmarked by the accumulation of cellular metabolic waste. Its effective disposal via various CSF routes has been demonstrated in animal models. In contrast, the CSF dynamics in humans are still poorly understood. Using novel real-time MRI, forced inspiration has been identified recently as a main driving force of CSF flow in the human brain. Exploiting technical advances toward real-time phase-contrast MRI, the current work analyzed directions, velocities, and volumes of human CSF flow within the brain aqueduct as part of the internal ventricular system and in the spinal canal during respiratory cycles. A consistent upward CSF movement toward the brain in response to forced inspiration was seen in all subjects at the aqueduct, in 11/12 subjects at thoracic level 2, and in 4/12 subjects at thoracic level 5. Concomitant analyses of CSF dynamics and cerebral venous blood flow, that is, in epidural veins at cervical level 3, uniquely demonstrated CSF and venous flow to be closely communicating cerebral fluid systems in which inspiration-induced downward flow of venous blood due to reduced intrathoracic pressure is counterbalanced by an upward movement of CSF. The results extend our understanding of human CSF flux and open important clinical implications, including concepts for drug delivery and new classifications and therapeutic options for various forms of hydrocephalus and idiopathic intracranial hypertension. SIGNIFICANCE STATEMENT Effective disposal of brain cellular waste products via CSF has been demonstrated repeatedly in animal models. However, CSF dynamics in humans are still poorly understood. A novel quantitative real-time MRI technique yielded in vivo CSF flow directions, velocities, and volumes in the human brain and upper spinal canal. CSF moved upward toward the head in response to forced inspiration. Concomitant

  19. Hypertension, diuretics and antihypertensives in relation to bladder cancer

    Science.gov (United States)

    Jiang, Xuejuan; Castelao, J.Esteban; Yuan, Jian-Min; Groshen, Susan; Stern, Mariana C.; Conti, David V.; Cortessis, Victoria K.; Coetzee, Gerhard A.; Pike, Malcolm C.; Gago-Dominguez, Manuela

    2010-01-01

    The aim of this study is to investigate the relationships between hypertension, hypertension medication and bladder cancer risk in a population-based case–control study conducted in Los Angeles. Non-Asians between the ages of 25 and 64 years with histologically confirmed bladder cancers diagnosed between 1987 and 1996 were identified through the Los Angeles County Cancer Surveillance Program. A total of 1585 cases and their age-, gender- and race-matched neighborhood controls were included in the analyses. Conditional logistic regression models were used to examine the relationship between history of hypertension, medication use and bladder cancer risk. A history of hypertension was not related to bladder cancer; however, among hypertensive individuals, there was a significant difference in bladder cancer risk related to the use of diuretics or antihypertensive drugs (P for heterogeneity = 0.004). Compared with individuals without hypertension, hypertensive individuals who regularly used diuretics/antihypertensives had a similar risk [odds ratio (OR) 1.06; 95% confidence interval (CI) 0.86–1.30], whereas untreated hypertensive subjects had a 35% reduction in risk (OR: 0.65; 95% CI: 0.48–0.88). A greater reduction in bladder cancer risk was observed among current-smokers (OR: 0.43; 95% CI: 0.27–0.71) and carriers of GSTM1-null (homozygous absence) genotypes (OR: 0.43; 95% CI: 0.22–0.85). Similarly, among smokers with GSTM1-null genotype, levels of 4-aminobiphenyl-hemoglobin adducts were significantly lower among untreated hypertensive individuals (45.7 pg/g Hb) compared with individuals without hypertension (79.8 pg/g Hb) (P = 0.009). In conclusion, untreated hypertension was associated with a reduced risk of bladder cancer. PMID:20732908

  20. The Role of Aldosterone in Obesity-Related Hypertension.

    Science.gov (United States)

    Kawarazaki, Wakako; Fujita, Toshiro

    2016-04-01

    Obese subjects often have hypertension and related cardiovascular and renal diseases, and this has become a serious worldwide health problem. In obese subjects, impaired renal-pressure natriuresis causes sodium retention, leading to the development of salt-sensitive hypertension. Physical compression of the kidneys by visceral fat and activation of the sympathetic nervous system, renin-angiotensin systems (RAS), and aldosterone/mineralocorticoid receptor (MR) system are involved in this mechanism. Obese subjects often exhibit hyperaldosteronism, with increased salt sensitivity of blood pressure (BP). Adipose tissue excretes aldosterone-releasing factors, thereby stimulating aldosterone secretion independently of the systemic RAS, and aldosterone/MR activation plays a key role in the development of hypertension and organ damage in obesity. In obese subjects, both salt sensitivity of BP, enhanced by obesity-related metabolic disorders including aldosterone excess, and increased dietary sodium intake are closely related to the incidence of hypertension. Some salt sensitivity-related gene variants affect the risk of obesity, and together with salt intake, its combination is possibly associated with the development of hypertension in obese subjects. With high salt levels common in modern diets, salt restriction and weight control are undoubtedly important. However, not only MR blockade but also new diagnostic modalities and therapies targeting and modifying genes that are related to salt sensitivity, obesity, or RAS regulation are expected to prevent obesity and obesity-related hypertension. © American Journal of Hypertension, Ltd 2016. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  1. Decreased brain venous vasculature visibility on susceptibility-weighted imaging venography in patients with multiple sclerosis is related to chronic cerebrospinal venous insufficiency

    Directory of Open Access Journals (Sweden)

    Hojnacki David

    2011-10-01

    Full Text Available Abstract Background The potential pathogenesis between the presence and severity of chronic cerebrospinal venous insufficiency (CCSVI and its relation to clinical and imaging outcomes in brain parenchyma of multiple sclerosis (MS patients has not yet been elucidated. The aim of the study was to investigate the relationship between CCSVI, and altered brain parenchyma venous vasculature visibility (VVV on susceptibility-weighted imaging (SWI in patients with MS and in sex- and age-matched healthy controls (HC. Methods 59 MS patients, 41 relapsing-remitting and 18 secondary-progressive, and 33 HC were imaged on a 3T GE scanner using pre- and post-contrast SWI venography. The presence and severity of CCSVI was determined using extra-cranial and trans-cranial Doppler criteria. Apparent total venous volume (ATVV, venous intracranial fraction (VIF and average distance-from-vein (DFV were calculated for various vein mean diameter categories: .9 mm. Results CCSVI criteria were fulfilled in 79.7% of MS patients and 18.2% of HC (p Conclusions MS patients with higher number of venous stenoses, indicative of CCSVI severity, showed significantly decreased venous vasculature in the brain parenchyma. The pathogenesis of these findings has to be further investigated, but they suggest that reduced metabolism and morphological changes of venous vasculature may be taking place in patients with MS.

  2. Obesity-related hypertension: epidemiology, pathophysiology, and clinical management.

    Science.gov (United States)

    Kotchen, Theodore A

    2010-11-01

    The prevalence of obesity, including childhood obesity, is increasing worldwide. Weight gain is associated with increases in arterial pressure, and it has been estimated that 60-70% of hypertension in adults is attributable to adiposity. Centrally located body fat, associated with insulin resistance and dyslipidemia, is a more potent determinant of blood pressure elevation than peripheral body fat. Obesity-related hypertension may be a distinct hypertensive phenotype with distinct genetic determinants. Mechanisms of obesity-related hypertension include insulin resistance, sodium retention, increased sympathetic nervous system activity, activation of renin-angiotensin-aldosterone, and altered vascular function. In overweight individuals, weight loss results in a reduction of blood pressure, however, this effect may be attenuated in the long term. An increasing number of community-based programs (including school programs and worksite programs) are being developed for the prevention and treatment of obesity. Assessment and treatment of the obese hypertensive patient should address overall cardiovascular disease (CVD) risk. There are no compelling clinical trial data to indicate that any one class of antihypertensive agents is superior to others, and in general the principles of pharmacotherapy for obese hypertensive patients are not different from nonobese patients. Future research directions might include: (i) development of effective, culturally sensitive strategies for the prevention and treatment of obesity; (ii) clinical trials to identify the most effective drug therapies for reducing CVD in obese, hypertensive patients; (iii) continued search for the genetic determinants of the obese, hypertensive phenotype.

  3. Role of the sympathetic nervous system in hypertension and hypertension-related cardiovascular disease.

    Science.gov (United States)

    Seravalle, Gino; Mancia, Giuseppe; Grassi, Guido

    2014-06-01

    A number of cardiovascular disease have been shown to be characterized by a marked increase in sympathetic drive to the heart and the peripheral circulation. This is the case for essential hypertension, congestive heart failure, cardiac arrhythmias, obesity, metabolic syndrome, obstructive sleep apnea, and chronic renal disease. This review focuses on the most recent findings documenting the role of sympathetic neural factors in the development and progression of the hypertensive state as well as in the pathogenesis of hypertension-related target organ damage. It also reviews the role of sympathetic neural factors in the development of cardiovascular diseases not necessarily strictly related to the hypertensive state, such as congestive heart failure, cardiac arrhythmias, obesity, metabolic syndrome and renal failure. The paper will finally review the pharmacological and non-pharmacological interventions acting on the sympathetic drive. Emphasis will be given to the new approaches, such as renal nerves ablation and carotid baroreceptor stimulation, which have been shown to exert sympathoinhibitory effects.

  4. Association of hypertension-related distress with lack of self-care among hypertensive patients.

    Science.gov (United States)

    Doubova, Svetlana V; Martinez-Vega, Ingrid Patricia; Aguirre-Hernandez, Rebeca; Pérez-Cuevas, Ricardo

    2017-01-01

    Research on factors associated with poor adherence to self-care focuses primarily on psychiatric emotional disorders such as depression and anxiety, whereas non-psychiatric chronic-disease-related emotional distress has received little attention in hypertensive patients. The objective of this study was to evaluate the association of hypertension-related distress with the lack of self-care including low adherence to pharmacological treatment, lack of regular physical activity, low intake of fruits and vegetables and frequent intake of high-salt foods. A cross-sectional survey was conducted in 2014 in two family medical units affiliated with the Mexican Institute of Social Security. The study included 487 hypertensive patients >19 years of age. The conceptual framework for the study was based on the Health Promotion Model. The analysis included multiple Poisson regression models. We found that 21.1% of participants had hypertension-related distress. Low adherence to pharmacological treatment was identified in 45.8% of patients, whereas 46.8% lacked regular physical activity, 30.8% reported a low consumption of fruits and vegetables, and 54.6% frequently consumed foods high in salt content. Hypertension-related distress was associated with lack of regular physical activity and low intake of fruits and vegetables. These findings highlight the importance of addressing distress in order to improve self-care of hypertensive patients.

  5. Obesity-related hypertension: possible pathophysiological mechanisms

    Czech Academy of Sciences Publication Activity Database

    Vaněčková, Ivana; Maletínská, Lenka; Behuliak, Michal; Nagelová, Veronika; Zicha, Josef; Kuneš, Jaroslav

    2014-01-01

    Roč. 223, č. 3 (2014), R63-R78 ISSN 0022-0795 R&D Projects: GA ČR(CZ) GAP304/12/0259 Institutional support: RVO:67985823 ; RVO:61388963 Keywords : obesity * hypertension * sympathetic nervous system * renin-angiotensin system * critical developmental periods * epigenetics * rat Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery Impact factor: 3.718, year: 2014

  6. Deep Venous Thrombosis with Pulmonary Embolism Related to IVIg Treatment: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Michael T. Flannery

    2015-01-01

    Full Text Available IVIg therapy has potentially been related to arterial and venous therapy. We performed an Ovid review focusing on IVIg and thrombotic events. While a few case reports were reviewed case series and case control studies were particularly reviewed in relation to thrombotic events. Outcomes demonstrate a correlation between underlying cardiovascular risk factors with predominately arterial events which typically occurred within 4–24 hours of infusion. While venous events occurred less commonly they were associated with traditional risk factors and occurred later, typically, 1–7 days following infusion of IVIg. Potential causation of thrombotic events was discussed.

  7. Effect of postthrombotic syndrome on health-related quality of life after deep venous thrombosis.

    Science.gov (United States)

    Kahn, Susan R; Hirsch, Andrew; Shrier, Ian

    2002-05-27

    Postthrombotic syndrome (PTS) is a frequent chronic complication of deep venous thrombosis, yet its impact on health-related quality of life has not been well characterized. We compared generic and venous disease-specific quality of life in patients with and without PTS, and assessed whether quality of life correlated with severity of PTS. Subjects with previous deep venous thrombosis were participants in a study of the effects of exercise after deep venous thrombosis. We ascertained PTS and its severity using a validated clinical scale. Subjects completed generic (the 36-Item Short-Form Health Survey) and disease-specific (Venous Insufficiency Epidemiologic and Economic Study quality-of-life questionnaire [VEINES-QOL] and its validated subscale of 10 items on venous symptoms [VEINES-Sym]) quality-of-life measures. Age- and sex-adjusted mean quality-of-life scores were compared in patients with and without PTS, and by severity of PTS. Of the 41 subjects (mean age, 51.2 years), 19 (46%) had PTS. Subjects with PTS had significantly worse disease-specific quality-of-life scores than those without PTS (mean +/- SD VEINES-QOL score, 44.5 +/- 11.6 vs 54.8 +/- 5.4, respectively [Pdisease-specific quality of life that may not be captured by generic quality-of-life measures. Patient-based quality-of-life measures correlated well with physician-assessed PTS. Further research is indicated to assess the value of including quality of life as a routine measure of outcome in clinical studies of patients with deep venous thrombosis and PTS.

  8. Microvascular changes in venous hypertension due to varicose veins after standardized application of Essaven gel--a placebo-controlled, randomized study.

    Science.gov (United States)

    Cesarone, M R; De Sanctis, M T; Incandela, L; Belcaro, G; Griffin, M

    2001-12-01

    The involvement of the microvascular structure in chronic venous insufficiency (CVI) causes venous hypertensive microangiopathy (VHM), which leads to venous ulceration. VHM is characterized by enlarged and ramified capillaries, increased flux and capillary permeability, edema, and altered function of microlymphatics. TcPO2 is decreased and CO2 increased. This perfusional paradox is caused by hyperperfusion in the deep skin layers with hypoperfusion of superficial nutritional capillaries. Exchanges in the capillary bed are altered. Nutritional skin alterations eventually lead to venous ulceration. Edema is the consequence of increased capillary pressure, reduced clearance, and by an increased exchange surface of capillaries. The aim of this randomized, placebo-controlled study was to evaluate the effect of local treatment with Essaven gel (EG) in 22 subjects with VHM due to severe varicose veins, treated with a single application. Measurements of flux, PO2 and PCO2 in standardized conditions of application indicated a significant decrease of the abnormally increased flux and CO2; PO2 increased in the treatment group. Essaven gel, in comparison with placebo and controls acutely improves the microcirculation in VHM even with a single application.

  9. Angiographic suppression of the artery of Adamkiewicz by venous hypertension resolving after embolization in a case of spinal epidural arteriovenous fistula

    Science.gov (United States)

    Eckart Sorte, Danielle; Pardo, Carlos A; Gailloud, Philippe

    2014-01-01

    A case of complete angiographic suppression of the artery of Adamkiewicz and anterior spinal artery in a patient with a spinal epidural arteriovenous fistula (AVF) is reported. Slow flow AVFs typically present with progressive myelopathy secondary to spinal venous hypertension (SVH). The lack of a normal venous phase during angiography and its restoration after treatment is commonly observed with these lesions, yet a similar phenomenon seems exceptional at the arterial level. Right T11 intercostal artery angiograms obtained before and after treatment of a left L4 epidural AVF documented the initial suppression of the artery of Adamkiewicz and anterior spinal artery, and their normal appearance immediately after correction of the SVH by embolization. This report confirms that SVH can angiographically suppress prominent and functionally important spinal arteries, re-emphasizing the potential role played by secondary arterial changes in SVH induced myelopathy. This hemodynamic phenomenon also represents a potential pitfall during diagnostic and therapeutic endovascular procedures. PMID:25028420

  10. Venous air embolism related to the use of central catheters revisited: with emphasis on dialysis catheters

    Science.gov (United States)

    Kwaan, Hau C; Ing, Todd S

    2017-01-01

    Abstract Venous air embolism is a dreaded condition particularly relevant to the field of nephrology. In the face of a favourable, air-to-blood pressure gradient and an abnormal communication between the atmosphere and the veins, air entrance into the circulation is common and can bring about venous air embolism. These air emboli can migrate to different areas through three major routes: pulmonary circulation, paradoxical embolism and retrograde ascension to the cerebral venous system. The frequent undesirable outcome of this disease entity, despite timely and aggressive treatment, signifies the importance of understanding the underlying pathophysiological mechanism and of the implementation of various preventive measures. The not-that-uncommon occurrence of venous air embolism, often precipitated by improper patient positioning during cervical catheter procedures, suggests that awareness of this procedure-related complication among health care workers is not universal. This review aims to update the pathophysiology of venous air embolism and to emphasize the importance of observing the necessary precautionary measures during central catheter use in hopes of eliminating this unfortunate but easily avoidable mishap in nephrology practice. PMID:29225809

  11. Arterial Hypertension and Health-Related Quality of Life

    Directory of Open Access Journals (Sweden)

    Vasiliki Katsi

    2017-12-01

    Full Text Available PurposeTo investigate the effect of awareness of arterial hypertension on quality of life in hypertensive patients in Greece.Materials and methodsThis was a prospective observational study that included 189 aware hypertensive patients on treatment with antihypertensive therapy. Patients were ambulatory men or women ≥18 years old, with diagnosed essential hypertension. The administration and fulfillment of the questionnaires was given at the outpatient hypertensive clinic starting with the SF-36 and continuing with the BDI-I test.ResultsThe mean BDI score was 9.9 ± 6.9, and 58, 25, 8.9, and 7.3% were identified as without, with minimal, moderate, and 0.8% with severe depression, respectively. The mean score for physical component summary (PCS-36 was 48.9 ± 7.6, and the mean score for mental component summary (MCS-36 was 46.0 ± 10.6. The stage of hypertension was not an independent predictor for any of the SF-36 dimensions. Dippers had not different levels of health-related quality of life (HRQOL as compared with non-dippers. LV hypertrophy was associated with lower scores on bodily pain (p < 0.05 and kidney failure was associated with lower scores on general health perception (p < 0.05. Female gender, increased age, and the presence of COPD were independently associated with lower physical and mental health scores (p < 0.05. Score on BDI independently correlated with all dimensions of SF-36, indicating that greater depression levels are associated with lower levels of HRQOL.ConclusionThe stage as well as awareness of arterial hypertension does not affect physical and mental health. The fact that arterial hypertension per se is not a symptomatic disease may explain these results at least in patients with uncomplicated hypertension.

  12. Early pregnancy angiogenic proteins levels and pregnancy related hypertensive disorders.

    Science.gov (United States)

    Jakovljevic, Ana; Bogavac, Mirjana; Lozanov-Crvenkovic, Zagorka; Milosević-Tosic, Mirjana; Nikolic, Aleksandra; Mitic, Gorana

    2017-03-01

    Normal placental vascular development depends on multiple interactions of many regulatory molecules including pro and antiangiogenic proteins. It is considered that these vascular modulators might be one of the factors responsible for development hypertensive disorders in pregnancy. To evaluate and compare the early pregnancy (11-14 week of gestation) serum level of angiogenic proteins sFlt1, VEGF i PIGF between different types of pregnancy related hypertensive disorders. The study included 177 pregnant women between 11 and 14 weeks of gestation, divided into four study subgroups (preeclampsia group-41, gestational hypertension group-31, chronic hypertension group-32 and miscarriage group-19) and control group-54. Blood samples (serum) were taken for measuring sFlt1, VEGF i PIGF by a quantitative ELISA technique and measuring other biochemical and hematological parameters. Significantly higher levels of sFlt1 were in the subgroups with preeclampsia and miscarriages, significantly lower level of VEGF in the all study subgroups and lover level of PIGF were in miscarriage group. In the groups with chronic and gestational hypertension there were higher level of sFlt1 and lover level of VEGF than in the control group, but the differences did not reach statistical significance. Early pregnancy imbalance between antiangiogenic protein sFlt1 and proangiogenic molecules VEGF and PIGF could have impact on pathophysiology of placental disorders which leads to development of pregnancy related hypertensive disorders.

  13. Colloid osmotic pressure in decompensated cirrhosis. A 'mirror image' of portal venous hypertension

    DEFF Research Database (Denmark)

    Henriksen, J H

    1985-01-01

    Colloid osmotic pressure in plasma (IIP) and ascitic fluid (IIA) and hydrostatic pressures in the hepatoportal system were measured simultaneously in 20 patients with decompensated cirrhosis. IIP was significantly decreased (mean, 21 mm Hg, versus normal, 30 mm Hg; P less than 0.01), and IIA....../IIP (r = -0.77, P less than 0.001). WHV--IVCP was in most patients in the same order as and closely correlated to effective colloid osmotic pressure (IIP--IIA) (r = 0.88, P less than 0.001). No relationship was found between WHV--IVCP and IIP. The results indicate that a fall in colloid osmotic pressure...... in the interstitial space and ascitic fluid is related to and most likely secondary to the elevated portal pressure in decompensated cirrhosis. Effective colloid osmotic pressure may therefore be regarded as a 'mirror image' of transmural portal pressure. The role of colloid osmotic pressure in the genesis...

  14. Classification tree analysis of race-specific subgroups at risk for a central venous catheter-related bloodstream infection.

    Science.gov (United States)

    Studnicki, James; Ekezue, Bola F; Tsulukidze, Maka; Honoré, Peggy; Moonesinghe, Ramal; Fisher, John

    2014-03-01

    Studies of racial disparities in patient safety events often do not use race-specific risk adjustment and do not account for reciprocal covariate interactions. These limitations were addressed by using classification tree analysis separately for black patients and white patients to identify characteristics that segment patients who have increased risks for a venous catheter-related bloodstream infection. A retrospective, cross-sectional analysis of 5,236,045 discharges from 103 Florida acute hospitals in 2005-2009 was conducted. Hospitals were rank ordered on the basis of the black/white Patient Safety Indicator (PSI) 7 rate ratio as follows: Group 1 (white rate higher), Group 2, (equivalent rates), Group 3, (black rate higher), and Group 4, (black rate highest). Predictor variables included 26 comorbidities (Elixhauser Comorbidity Index) and demographic characteristics. Four separate classification tree analyses were completed for each race/hospital group. Individual characteristics and groups of characteristics associated with increased PSI 7 risk differed for black and white patients. The average age for both races was different across the hospital groups (p < .01). Weight loss was the strongest single delineator and common to both races. The black subgroups with the highest PSI 7 risk were Medicare beneficiaries who were either < or = 25.5 years without hypertension or < or = 39.5 years without hypertension but with an emergency or trauma admission. The white subgroup with the highest PSI 7 risk consisted of patients < or = 45.5 years who had congestive heart failure but did not have either hypertension or weight loss. Identifying subgroups of patients at risk for a rare safety event such as PSI 7 should aid effective clinical decisions and efficient use of resources and help to guide patient safety interventions.

  15. Central venous device-related thrombosis as imaged with MDCT in oncologic patients: prevalence and findings

    Energy Technology Data Exchange (ETDEWEB)

    Catalano, Orlando; Castelguidone, Elisabetta de Lutio di; Granata, Vincenza; D' Errico, Adolfo Gallipoli (Dept. of Radiology, National Cancer Institute ' Fondazione G Pascale' (Italy)), email: orlandcat@tin.it; Sandomenico, Claudia (Dept. of Esophago-gastro-bilio-pancreatic Oncology, National Cancer Institute ' Fondazione G Pascale' (Italy)); Petrillo, Mario (Dept. of Radiology, Second Univ. of Naples (Italy)); Aprea, Pasquale (Dept. of Critical Illness and Anaesthesiology, National Cancer Institute ' Fondazione G Pascale' , Naples, (Italy))

    2011-02-15

    Background: Venous thrombosis is a common occurrence in cancer patients, developing spontaneously or in combination with indwelling central venous devices (CVD). Purpose: To analyze the multidetector CT (MDCT) prevalence, appearance, and significance of catheter related thoracic venous thrombosis in oncologic patients and to determine the percentage of thrombi identified in the original reports. Material and Methods: Five hundred consecutive patients were considered. Inclusion criteria were: presence of a CVD; availability of a contrast-enhanced MDCT; and cancer history. Exclusion criteria were: direct tumor compression/infiltration of the veins; poor image quality; device tip not in the scanned volume; and missing clinical data. Seventeen (3.5%) out of the final 481 patients had a diagnosis of venous thrombosis. Results: Factors showing the highest correlation with thrombosis included peripherally-inserted CVD, right brachiocephalic vein tip location, patient performance status 3, metastatic stage disease, ongoing chemotherapy, and longstanding CVD. The highest prevalence was in patients with lymphoma, lung carcinoma, melanoma, and gynecologic malignancies. Eleven out of 17 cases had not been identified in the original report. Conclusion: CVD-related thrombosis is not uncommon in cancer patients and can also be observed in outpatients with a good performance status and a non-metastatic disease. Thrombi can be very tiny. Radiologists should be aware of the possibility to identify (or overlook) small thrombi

  16. Portal hypertension in patients with cirrhosis: indirect assessment of hepatic venous pressure gradient by measuring azygos flow with 2D-cine phase-contrast magnetic resonance imaging.

    Science.gov (United States)

    Gouya, Hervé; Grabar, Sophie; Vignaux, Olivier; Saade, Anastasia; Pol, Stanislas; Legmann, Paul; Sogni, Philippe

    2016-07-01

    To measure azygos, portal and aortic flow by two-dimensional cine phase-contrast magnetic resonance imaging (2D-cine PC MRI), and to compare the MRI values to hepatic venous pressure gradient (HVPG) measurements, in patients with cirrhosis. Sixty-nine patients with cirrhosis were prospectively included. All patients underwent HVPG measurements, upper gastrointestinal endoscopy and 2D-cine PC MRI measurements of azygos, portal and aortic blood flow. Univariate and multivariate regression analyses were used to evaluate the correlation between the blood flow and HVPG. The performance of 2D-cine PC MRI to diagnose severe portal hypertension (HVPG ≥ 16 mmHg) was determined by receiver operating characteristic curve (ROC) analysis, and area under the curves (AUC) were compared. Azygos and aortic flow values were associated with HVPG in univariate linear regression model. Azygos flow (p cine PC MRI is a promising technique to evaluate significant portal hypertension in patients with cirrhosis. • Noninvasive HVPG assessment can be performed with MRI azygos flow. • Azygos MRI flow is an easy-to-measure marker to detect significant portal hypertension. • MRI flow is more specific that varice grade to detect portal hypertension.

  17. CT perfusion imaging of the liver and the spleen in patients with cirrhosis: Is there a correlation between perfusion and portal venous hypertension?

    Energy Technology Data Exchange (ETDEWEB)

    Talakic, Emina; Schoellnast, Helmut [Medical University of Graz, Division of General Radiology, Department of Radiology, Graz (Austria); Schaffellner, Silvia; Kniepeiss, Daniela; Mueller, Helmut [Medical University of Graz, Department of Surgery, Division of Transplantation Surgery, Graz (Austria); Stauber, Rudolf [Medical University of Graz, Department of Internal Medicine, Division of Gastoenterology and Hepatology, Graz (Austria); Quehenberger, Franz [Medical University of Graz, Institute for Medical Informatics, Statistics and Documentation, Graz (Austria)

    2017-10-15

    To correlate hepatic and splenic CT perfusion parameters with hepatic venous pressure gradient (HVPG) measurements in patients with cirrhosis. Twenty-one patients with cirrhosis (males, 17; females, 4; mean ± SD age, 57 ± 7 years) underwent hepatic and splenic perfusion CT on a 320-detector row volume scanner as well as invasive measurement of HVPG. Different CT perfusion algorithms (maximum slope analysis and Patlak plot) were used to measure hepatic arterial flow (HAF), portal venous flow (PVF), hepatic perfusion index (HPI), splenic arterial flow (SAF), splenic blood volume (SBV) and splenic clearance (SCL). Hepatic and splenic perfusion parameters were correlated with HVPG, and sensitivity and specificity for detection of severe portal hypertension (≥12 mmHg) were calculated. The Spearman correlation coefficient was -0.53 (p < 0.05) between SAF and HVPG, and -0.68 (p < 0.01) between HVPG and SCL. Using a cut-off value of 125 ml/min/100 ml for SCL, sensitivity for detection of a HVPG of ≥12 mmHg was 94%, and specificity 100%. There was no significant correlation between hepatic perfusion parameters and HVPG. CT perfusion in patients with cirrhosis showed a strong correlation between SCL and HVPG and may be used for detection of severe portal hypertension. (orig.)

  18. The effect of flight-related behaviour on the risk of venous thrombosis after air travel.

    Science.gov (United States)

    Schreijer, Anja J M; Cannegieter, Suzanne C; Doggen, Carine J M; Rosendaal, Frits R

    2009-02-01

    In a case-control study including 11,033 participants (The Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis study) on risk factors of venous thrombosis, we studied the effect of flight-related behaviour on the risk of venous thrombosis after air travel. Patients and control subjects received a questionnaire on risk factors for venous thrombosis, including recent travel history and details of their last flight. From this population, 80 patients and 108 control subjects were selected who had recently (travelled for more than 4 h by aeroplane. Window seating compared to aisle seating increased the risk twofold [odds ratio (OR) 2.2; 95% confidence interval (CI): 1.1-4.4], particularly in those who were obese (OR 6.1; 95% CI: 0.5-76.2). Anxiety (OR 2.5; 95% CI: 0.9-7.0) and sleeping (OR 1.5; 95% CI: 0.7-3.1) may increase the risk slightly. The risk was not affected by alcohol consumption (OR 1.1; 95% CI: 0.5-2.4). Flying business class may lower the risk (OR 0.7; 95% CI: 0.2-1.8). We did not find a protective effect for several measures currently part of standard advice from airlines and clinicians, i.e. drinking non-alcoholic beverages, exercising or wearing stockings. The effect of behavioural factors during flying on the risk of venous thrombosis after air travel is limited. Current advice on prevention of travel-related thrombosis may have to be reconsidered.

  19. A complex network analysis of hypertension-related genes

    Science.gov (United States)

    Wang, Huan; Xu, Chuan-Yun; Hu, Jing-Bo; Cao, Ke-Fei

    2014-01-01

    In this paper, a network of hypertension-related genes is constructed by analyzing the correlations of gene expression data among the Dahl salt-sensitive rat and two consomic rat strains. The numerical calculations show that this sparse and assortative network has small-world and scale-free properties. Further, 16 key hub genes (Col4a1, Lcn2, Cdk4, etc.) are determined by introducing an integrated centrality and have been confirmed by biological/medical research to play important roles in hypertension.

  20. The impact of hypertension and hypertension-related left ventricle hypertrophy on right ventricle function.

    Science.gov (United States)

    Tumuklu, M Murat; Erkorkmaz, Unal; Ocal, Arslan

    2007-04-01

    The aim of our study is to determine the effect of hypertension and hypertension-related left ventricle hypertrophy on right ventricle (RV) morphology and function by using RV standard Doppler echocardiographic indices, myocardial Doppler imaging, and strain/strain rate imaging indices. We studied 35 patients with arterial hypertension and 30 age- and sex-adjusted control subjects who had no other pathological conditions. Standard transthoracic Doppler echocardiographical measurements, pulsed-wave tissue Doppler from tricuspid anulus (Peak systolic-st, peak early diastolic-et, peak late diastolic velocity-at), reconstructed spectral pulsed-wave tissue Doppler velocities (peak systolic-S, peak early-E, peak late diastolic velocity-A), and strain/strain rate imaging of RV free wall mid region (peak systolic strain-in, peak systolic strain rate-SR) were obtained. Age, body surface area, blood pressure, and heart rate were comparable between two groups. Hypertensive subjects had significantly increased LV end-diastolic septal and posterior wall thickness, left atrial diameter, LV mass, LV mass index, and relative wall thickness during diastole. At the level of right ventricular lateral tricuspid annulus without systolic changes, the majority of diastolic measurements were altered in hypertensives (early diastolic velocity et; 13 +/- 2 vs. 18 +/- 4 m/sec, P < 0.0001, late diastolic velocity at; 20 +/- 4 vs. 14 +/- 3 m/sec, P < 0.0001, early to late diastolic velocity ratio; 0.69 +/- 0.14 vs. 1.32 +/- 0.38, P < 0.0001). The velocity data from two-dimensional color myocardial imaging at the level of RV free wall mid region again showed altered diastolic measurements in hypertensives (E; 8.01 +/- 2.6 vs. 10.4 +/- 3.14 m/sec, P < 0.001, A; 11.5 +/- 2.6 vs. 9.12 +/- 3.7 m/sec, P < 0.0001, E/A ratio; 0.75 +/- 0.41 vs. 1.87 +/- 0.48, P < 0.00). The peak systolic strain of RV free wall mid region was significantly lower in hypertensive individuals than controls (25.666 +/- 5

  1. [Thrombosis of the cerebral venous sinuses in the differential diagnosis of idiopathic intracranial hypertension in young obese females: is it a real problem?].

    Science.gov (United States)

    Cabrera-Naranjo, Fernando; Gonzalez-Hernandez, Ayoze; Lagoa-Labrador, Iria; Fabre-Pi, Óscar

    2013-04-16

    Idiopathic intracranial hypertension (IICH) typically presents in young women with obesity or a recent weight increase. The differential diagnosis of IICH includes thrombosis of the cerebral venous sinuses (TCVS), which can also present as an isolated intracranial hypertension syndrome. We review the frequency with which patients with a typical IICH profile presented TCVS as their diagnosis. The study consisted in a retrospective review of all the admissions due to intracranial hypertension syndromes in our centre between 2000 and 2011. The cases selected were those with a normal cerebrospinal fluid study and computerised axial tomography scan of the head that presented as an isolated intracranial hypertension syndrome; those who manifested a focal neurological picture, however, were excluded. From the patients that were included, a subgroup made up of females between 16 and 35 years of age with a body mass index of above 25 were selected. A total of 37 cases were obtained. Of these, 35 (94.6%) were cases of IICH and two (5.4%) were TCVS. The time elapsed between the onset of symptoms and diagnosis was less than seven days in both cases of TCVS (100%) and in two cases (5.4%) of IICH. Up to 5.4% of patients with a typical IICH profile that present with an intracranial hypertension syndrome can present TCVS. The presence of prothrombotic factors and a high D-dimer can suggest this possibility, although there is still a need for well-established parameters that allow decisions to be made in emergencies in the absence of any chance of performing an urgent MR phlebography scan.

  2. Central venous access related adverse events after trabectedin infusions in soft tissue sarcoma patients; experience and management in a nationwide multi-center study

    NARCIS (Netherlands)

    Verboom, M.C.; Ouwerkerk, J.; Steeghs, N.; Lutjeboer, J.; Kerst, J.M.; Graaf, W.T.A. van der; Reyners, A.K.; Sleijfer, S.; Gelderblom, H.

    2017-01-01

    BACKGROUND: Trabectedin has shown efficacy against soft tissue sarcomas (STS) and has manageable toxicity. Trabectedin is administered through central venous access devices (VAD), such as subcutaneous ports with tunneled catheters, Hickman catheters and PICC lines. Venous access related adverse

  3. Investigation of Homocysteine-Pathway-Related Variants in Essential Hypertension

    Directory of Open Access Journals (Sweden)

    Javed Y. Fowdar

    2012-01-01

    Full Text Available Hyperhomocysteinemia (hHcy has been associated with an increased risk of cardiovascular disease and stroke. Essential hypertension (EH, a polygenic condition, has also been associated with increased risk of cardiovascular related disorders. To investigate the role of the homocysteine (Hcy metabolism pathway in hypertension we conducted a case-control association study of Hcy pathway gene variants in a cohort of Caucasian hypertensives and age- and sex-matched normotensives. We genotyped two polymorphisms in the methylenetetrahydrofolate reductase gene (MTHFR C677T and MTHFR A1298C, one polymorphism in the methionine synthase reductase gene (MTRR A66G, and one polymorphism in the methylenetetrahydrofolate dehydrogenase 1 gene (MTHFD1 G1958A and assessed their association with hypertension using chi-square analysis. We also performed a multifactor dimensionality reduction (MDR analysis to investigate any potential epistatic interactions among the four polymorphisms and EH. None of the four polymorphisms was significantly associated with EH and although we found a moderate synergistic interaction between MTHFR A1298C and MTRR A66G, the association of the interaction model with EH was not statistically significant (P=0.2367. Our findings therefore suggest no individual or interactive association between four prominent Hcy pathway markers and EH.

  4. Brain Slump Caused by Jugular Venous Stenoses Treated by Stenting: A Hypothesis to Link Spontaneous Intracranial Hypotension with Idiopathic Intracranial Hypertension.

    Science.gov (United States)

    Higgins, Nicholas; Trivedi, Rikin; Greenwood, Richard; Pickard, John

    2015-07-01

    Spontaneous intracranial hypotension, of which brain slump is an extreme expression, is caused by a cerebrospinal fluid leak. The reason the leak develops in the first place, however, is unknown, and some cases can be very difficult to manage. We describe a patient with severe symptoms of spontaneous intracranial hypotension and brain slump documented by magnetic resonance imaging whose clinical syndrome and structural brain anomaly resolved completely after treatment directed exclusively at improving cranial venous outflow. Diagnostics included computed tomography (CT) venography, catheter venography, and jugular venoplasty. CT venography showed narrowing of both internal jugular veins below the skull base. Catheter venography confirmed that these were associated with pressure gradients. Jugular venoplasty performed on two separate occasions as a clinical test gave temporary respite. Lasting remission (2 years of follow-up) was achieved by stenting the dominant internal jugular vein. These findings and this outcome suggest a mechanism for the development of spontaneous intracranial hypotension that would link it to idiopathic intracranial hypertension and have cranial venous outflow obstruction as the underlying cause.

  5. Hypertension

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — These datasets provide de-identified insurance data for hypertension hyperlipidemia. The data is provided by three managed care organizations in Allegheny County...

  6. hypertension

    Directory of Open Access Journals (Sweden)

    Emine Hatipoglu

    2013-05-01

    Full Text Available Hypertension is a common disease associated with important cardiovascular complications. Persistent blood pressure of 140/90 or higher despite combined use of a reninangiotensin system blocker, calcium channel blocker and a diuretic at highest tolerated doses constitutes resistant hypertension. Excess sympathetic activity plays an important pathogenic role in resistant hypertension in addition to contributing to the development of metabolic problems, in particular diabetes. Reduction of renal sympathetic activity by percutaneous catheter-based radiofrequency ablation via the renal arteries has been shown in several studies to decrease blood pressure in patients with resistant hypertension, and importantly is largely free of significant complications. However, longer term follow-up is required to confirm both long-term safety and efficacy.

  7. High risk of pregnancy-related venous thromboembolism in women with multiple thrombophilic defects

    NARCIS (Netherlands)

    Folkeringa, Nienke; Leendert, Jan; Brouwer, P.; Korteweg, Fleurisca J.; Veeger, Nic J. G. M.; Erwich, Jan Jaap H. M.; van der Meer, Jan

    Pregnancy is associated with an increased risk of venous thromboembolism, which probably varies according to the presence of single or multiple thrombophilic defects. This retrospective family cohort study assessed the risk of venous thromboembolism during pregnancy and puerperium, and the

  8. Smart central venous port for early detection of bacterial biofilm related infections.

    Science.gov (United States)

    Paredes, J; Alonso-Arce, M; Schmidt, C; Valderas, D; Sedano, B; Legarda, J; Arizti, F; Gómez, E; Aguinaga, A; Del Pozo, J L; Arana, S

    2014-06-01

    Central venous catheters (CVC) are commonly used in clinical practice to improve a patient's quality of life. Unfortunately, there is an intrinsic risk of acquiring an infection related to microbial biofilm formation inside the catheter lumen. It has been estimated that 80 % of all human bacterial infections are biofilm-associated. Additionally, 50 % of all nosocomial infections are associated with indwelling devices. Bloodstream infections account for 30-40 % of all cases of severe sepsis and septic shock, and are major causes of morbidity and mortality. Diagnosis of bloodstream infections must be performed promptly so that adequate antimicrobial therapy can be started and patient outcome improved. An ideal diagnostic technology would identify the infecting organism(s) in a timely manner, so that appropriate pathogen-driven therapy could begin promptly. Unfortunately, despite the essential information it provides, blood culture, the gold standard, largely fails in this purpose because time is lost waiting for bacterial or fungal growth. This work presents a new design of a venous access port that allows the monitoring of the inner reservoir surface by means of an impedimetric biosensor. An ad-hoc electronic system was designed to manage the sensor and to allow communication with the external receiver. Historic data recorded and stored in the device was used as the reference value for the detection of bacterial biofilm. The RF communication system sends an alarm signal to the external receiver when a microbial colonization of the port occurs. The successful in vitro analysis of the biosensor, the electronics and the antenna of the new indwelling device prototype are shown. The experimental conditions were selected in each case as the closest to the clinical working conditions for the smart central venous catheter (SCVC) testing. The results of this work allow a new generation of this kind of device that could potentially provide more efficient treatments for

  9. Infection related to implantable central venous access devices in cancer patients: epidemiology and risk factors.

    Science.gov (United States)

    Freire, Maristela P; Pierrotti, Ligia C; Zerati, Antônio E; Araújo, Pedro H X N; Motta-Leal-Filho, J M; Duarte, Laiane P G; Ibrahim, Karim Y; Souza, Antonia A L; Diz, Maria P E; Pereira, Juliana; Hoff, Paulo M; Abdala, Edson

    2013-07-01

    To describe the epidemiology of infections related to the use of implantable central venous access devices (CVADs) in cancer patients and to evaluate measures aimed at reducing the rates of such infections. Prospective cohort study. Referral hospital for cancer in São Paulo, Brazil. We prospectively evaluated all implantable CVADs employed between January 2009 and December 2011. Inpatients and outpatients were followed until catheter removal, transfer to another facility, or death. Outcome measures were bloodstream infection and pocket infection. We also evaluated the effects that the creation of a multidisciplinary team for CVAD care, avoiding in-hospital implantation of CVADs, and limiting CVAD insertion in neutropenic patients have on the rates of such infections. During the study period, 966 CVADs (mostly venous ports) were implanted in 933 patients, for a combined total of 243,792 catheter-days. We identified 184 episodes of infection: 154 (84%) were bloodstream infections, 21 (11%) were pocket infections, and 9 (5%) were surgical site infections. During the study period, the rate of CVAD-related infection dropped from 2.2 to 0.24 per 1,000 catheter-days ([Formula: see text]). Multivariate analysis revealed that relevant risk factors for such infection include surgical reintervention, implantation in a neutropenic patient, in-hospital implantation, use of a cuffed catheter, and nonchemotherapy indication for catheter use. Establishing a multidisciplinary team specifically focused on CVAD care, together with systematic reporting of infections, appears to reduce the rates of infection related to the use of these devices.

  10. Antimicrobial-impregnated central venous catheters for prevention of catheter-related bloodstream infection in newborn infants.

    Science.gov (United States)

    Balain, Munisha; Oddie, Sam J; McGuire, William

    2015-09-27

    Central venous catheter-related bloodstream infection is an important cause of mortality and morbidity in newborn infants cared for in neonatal units. Potential strategies to prevent these infections include the use of central venous catheters impregnated with antimicrobial agents. To determine the effect of antimicrobial-impregnated central venous catheters in preventing catheter-related bloodstream infection in newborn infants. We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 8), MEDLINE (1966 to September 2015), EMBASE (1980 to September 2015), CINAHL (1982 to September 2015), conference proceedings and previous reviews. Randomised or quasi-randomised controlled trials comparing central venous catheters impregnated or coated with any antibiotic or antiseptic versus central venous catheters without antibiotic or antiseptic coating or impregnation in newborn infants. We extracted data using the standard methods of the Cochrane Neonatal Group, with independent evaluation of risk of bias and data extraction by two review authors. We found only one small trial (N = 98). This trial found that silver zeolite-impregnated umbilical venous catheters reduced the incidence of bloodstream infection in very preterm infants (risk ratio 0.11, 95% confidence interval 0.01 to 0.87; risk difference -0.17, 95% CI -0.30 to -0.04; number needed to treat for benefit 6, 95% CI 3 to 25]. Although the data from one small trial indicates that antimicrobial-impregnated central venous catheters might prevent catheter-related bloodstream infection in newborn infants, the available evidence is insufficient to guide clinical practice. A large, simple and pragmatic randomised controlled trial is needed to resolve on-going uncertainty.

  11. Venous ulcer: what is new?

    Science.gov (United States)

    Raffetto, Joseph D; Marston, William A

    2011-01-01

    The pathophysiology of venous dermal abnormality in chronic venous ulcers is reflective of a complex interplay that involves sustained venous hypertension, inflammation, changes in the microcirculation, cytokine and matrix metalloproteinase activation, and altered cellular function. Red blood cells and macromolecules extravasate into the interstitium and activate endothelial cells. Endothelial expression of specific adhesion molecules recruits leukocytes and causes diapedesis of these cells into the dermal microvasculature, promoting an inflammatory response with activation of cytokines and proteinases. Altered cell function enhances a state of vulnerability in the surrounding tissues, initiating specific changes associated with venous disease. Ultimately, the persistent inflammatory-proteinase activity leads to advanced chronic venous insufficiency and ulcer formation. The mainstay of therapy in venous ulcer abnormality is correction of the underlying venous hypertension through compression therapy and/or surgery. Understanding the science involved in the pathophysiology of venous ulcer formation has led to the development of adjunctive treatment directed at the dysregulated molecular pathways. Randomized clinical trials are critical for determining the most effective evidence-based treatments for venous ulcer, and this review discusses important trials that have had a significant impact on venous ulcer healing. In addition, the authors have included subsections referred to as "Translational Implications for Therapy" in the basic science sections of the review to help bridge the basic science knowledge with clinical applications that may help to modulate the molecular abnormalities in the pathophysiologic cascade leading to venous ulcers.

  12. Assessment of liver circulation by quantitative scintiangiography: Evaluation of the relative contribution of the hepatic arterial and portal venous blood flows to liver perfusion

    Energy Technology Data Exchange (ETDEWEB)

    Molino, G.; Squadrone, E.; Baccegal, M.; Magnani, C.

    1989-04-01

    Quantitative hepatic scintiangiography was previously used for evaluating the relative contribution of hepatic arterial and portal venous blood flows to the hepatic circulation. The present study compares 3 different procedures (automatic and manual integration, and slope fitting methods) for analyzing the hepatic time activity curves obtained after bolus i.v. injection of 370 MBq /sup 99m/Tc-diethylentriaminopentacetic acid. Twenty five subjects were studied: Five controls, ten cirrhotics, and ten portal hypertensive patients previously submitted to side to side portacaval anastomosis. The correspondence between results given by the different methods was satisfactory only in shunted patients, and the reproducibility of computed parameters was quite poor for all procedures. Accordingly, none of the methods can be considered as supporting reliable quantitative pathophysiological evaluations. However, the hepatic arterial/portal venous flow ratio was found to be increased in liver cirrhosis and in shunted patients and therefore, in spite of the limitations underlined before and of the absence of data on the reproducibility of consecutive injections, hepatic scintiangiography may be of some clinical utility.

  13. Venous reserve capacity & autonomic function in formerly preeclamptic women

    NARCIS (Netherlands)

    Krabbendam, I.

    2009-01-01

    Formerly preeclamptic women with pre-pregnant low plasma volume have a three-fold higher chance to develop recurrent gestational hypertensive disease than women with normal plasma volume. Previous studies have suggested that those women with low plasma volume have relatively low venous capacitance

  14. Central venous catheter-related bloodstream infections in the intensive care unit

    Science.gov (United States)

    Patil, Harsha V.; Patil, Virendra C.; Ramteerthkar, M. N.; Kulkarni, R. D.

    2011-01-01

    Context: Central venous catheter-related bloodstream infection (CRBSI) is associated with high rates of morbidity and mortality in critically ill patients. Aims: This study was conducted to determine the incidence of central venous catheter-related infections (CRIs) and to identify the factors influencing it. So far, there are very few studies that have been conducted on CRBSI in the intensive care unit in India. Settings and Design: This was a prospective, observational study carried out in the medical intensive care unit (MICU) over a period of 1 year from January to December 2004. Materials and Methods: A total of 54 patients with indwelling central venous catheters of age group between 20 and 75 years were included. The catheters were cultured using the standard semiquantitative culture (SQC) method. Statistical analysis used SPSS-10 version statistical software. Results: A total of 54 CVC catheters with 319 catheter days were included in this study. Of 54 patients with CVCs studied for bacteriology, 39 (72.22%) catheters showed negative SQCs and also negative blood cultures. A total of 15 (27.77%) catheters were positive on SQC, of which 10 (18.52%) were with catheter-associated infection and four (7.41%) were with catheter-associated bacteremia; the remaining one was a probable catheter-associated bacteremia. CRIs were high among catheters that were kept in situ for more than 3 days and emergency procedures where two or more attempts were required for catheterization (P catheter in situ for >3 days, inexperienced venupucturist, more number of attempts and emergency CVC were associated with more incidence of CVCBSIs, with P catheter in situ was negatively correlated (-0.53) and number of attempts required to put CVC was positively correlated (+0.39) with incidence of CVCBSIs. Sixty-five percent of the isolates belonged to the CONS group (13/20). Staphylococcus epidermidis showed maximum susceptibility to amikacin, doxycycline and amoxycillin with clavulanic

  15. Central Venous Catheter-Related Bloodstream Infection with Kocuria kristinae in a Patient with Propionic Acidemia

    Directory of Open Access Journals (Sweden)

    Masato Kimura

    2017-01-01

    Full Text Available Kocuria kristinae is a catalase-positive, coagulase-negative, Gram-positive coccus found in the environment and in normal skin and mucosa in humans; however, it is rarely isolated from clinical specimens and is considered a nonpathogenic bacterium. We describe a case of catheter-related bacteremia due to K. kristinae in a young adult with propionic acidemia undergoing periodic hemodialysis. The patient had a central venous catheter implanted for total parenteral nutrition approximately 6 months prior to the onset of symptoms because of repeated acute pancreatitis. K. kristinae was isolated from two sets of blood cultures collected from the catheter. Vancomycin followed by cefazolin for 16 days and 5-day ethanol lock therapy successfully eradicated the K. kristinae bacteremia. Although human infections with this organism appear to be rare and are sometimes considered to result from contamination, physicians should not underestimate its significance when it is isolated in clinical specimens.

  16. Central Venous Catheter-Related Bloodstream Infection with Kocuria kristinae in a Patient with Propionic Acidemia.

    Science.gov (United States)

    Kimura, Masato; Kawai, Eichiro; Yaoita, Hisao; Ichinoi, Natsuko; Sakamoto, Osamu; Kure, Shigeo

    2017-01-01

    Kocuria kristinae is a catalase-positive, coagulase-negative, Gram-positive coccus found in the environment and in normal skin and mucosa in humans; however, it is rarely isolated from clinical specimens and is considered a nonpathogenic bacterium. We describe a case of catheter-related bacteremia due to K. kristinae in a young adult with propionic acidemia undergoing periodic hemodialysis. The patient had a central venous catheter implanted for total parenteral nutrition approximately 6 months prior to the onset of symptoms because of repeated acute pancreatitis. K. kristinae was isolated from two sets of blood cultures collected from the catheter. Vancomycin followed by cefazolin for 16 days and 5-day ethanol lock therapy successfully eradicated the K. kristinae bacteremia. Although human infections with this organism appear to be rare and are sometimes considered to result from contamination, physicians should not underestimate its significance when it is isolated in clinical specimens.

  17. Tricuspid valve endocarditis following central venous cannulation: The increasing problem of catheter related infection

    Directory of Open Access Journals (Sweden)

    Suresh Babu Kale

    2013-01-01

    Full Text Available A central venous catheter (CVC is inserted for measurement of haemodynamic variables, delivery of nutritional supplements and drugs and access for haemodialysis and haemofiltration. Catheterization and maintenance are common practices and there is more to the technique than routine placement as evident when a procedure-related complication occurs. More than 15% of the patients who receive CVC placement have some complications and infectious endocarditis involving the tricuspid valve is a rare and serious complication with high morbidity and mortality. Overenthusiastic and deep insertion of the guide wire and forceful injection through the CVC may lead to injury of the tricuspid valve and predispose to bacterial deposition and endocarditis. We report a case of tricuspid valve endocarditis, probably secondary to injury of the anterior tricuspid leaflet by the guide wire or the CVC that required open heart surgery with vegetectomy and repair of the tricuspid valve.

  18. Differential combinatorial regulatory network analysis related to venous metastasis of hepatocellular carcinoma

    Science.gov (United States)

    2012-01-01

    Background Hepatocellular carcinoma (HCC) is one of the most fatal cancers in the world, and metastasis is a significant cause to the high mortality in patients with HCC. However, the molecular mechanism behind HCC metastasis is not fully understood. Study of regulatory networks may help investigate HCC metastasis in the way of systems biology profiling. Methods By utilizing both sequence information and parallel microRNA(miRNA) and mRNA expression data on the same cohort of HBV related HCC patients without or with venous metastasis, we constructed combinatorial regulatory networks of non-metastatic and metastatic HCC which contain transcription factor(TF) regulation and miRNA regulation. Differential regulation patterns, classifying marker modules, and key regulatory miRNAs were analyzed by comparing non-metastatic and metastatic networks. Results Globally TFs accounted for the main part of regulation while miRNAs for the minor part of regulation. However miRNAs displayed a more active role in the metastatic network than in the non-metastatic one. Seventeen differential regulatory modules discriminative of the metastatic status were identified as cumulative-module classifier, which could also distinguish survival time. MiR-16, miR-30a, Let-7e and miR-204 were identified as key miRNA regulators contributed to HCC metastasis. Conclusion In this work we demonstrated an integrative approach to conduct differential combinatorial regulatory network analysis in the specific context venous metastasis of HBV-HCC. Our results proposed possible transcriptional regulatory patterns underlying the different metastatic subgroups of HCC. The workflow in this study can be applied in similar context of cancer research and could also be extended to other clinical topics. PMID:23282077

  19. Hypertension-related organ damage and vascular disease

    NARCIS (Netherlands)

    Vernooij, J.W.P.

    2012-01-01

    Hypertension is a very common condition with an overall prevalence of 42% in the general population in the Netherlands, rising to a prevalence of 60-70% beyond the seventh decade of life. Usually, hypertension is asymptomatic, but as a risk factor attributes to approximately 2/3 of stroke and 1/2 of

  20. Evaluation of mupirocin ointment in control of central venous catheter related infections: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Rezaei J

    2009-09-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Central venous catheter (CVC related infections are important complications of cathter application. This study assessed the usefulness of mupirocin in prevention and control of these infections."n"nMethods: In this randomized clinical trial, consecutive surgical patients requiring central venous catheter (for more than 2 days in Amir-Alam Hospital from 2006-2008 were enrolled. Patients were divided in two groups; in "case group" patients received topical mupirocin 2% every 48 hours at the time of insertion of catheter and dressing change and for "control group" mupirocin was not used. All of the patients received chlorhexidine and enoxoparin as complementary treatments. Two groups were comparable in regard of age, sex and risk factors."n"nResults: One hundred eighteen patients enrolled in the study (57 in case and 61 in control group completed the study. 84 catheters in case group and 88 catheters in control group were inserted. The catheters in 90% of patients were inserted in jugular vein. At the end of study 29(16.8% patients (16 in control versus 13 in case group had catheter colonization (p=NS. Catheter related bloodstream infection was observed in 16(9.3% patients (6 in

  1. HYPERTENSION-RELATED ALTERATIONS IN WHITE MATTER MICROSTRUCTURE DETECTABLE IN MIDDLE AGE

    Science.gov (United States)

    McEvoy, Linda K.; Fennema-Notestine, Christine; Eyler, Lisa T.; Franz, Carol; Hagler, Donald J.; Lyons, Michael J.; Panizzon, Matthew S.; Rinker, Daniel A; Dale, Anders M.; Kremen, William S.

    2015-01-01

    Most studies examining associations between hypertension and brain white matter microstructure have focused on older adults or on cohorts with a large age range. Since hypertension effects on the brain may vary with age it is important to focus on middle age, when hypertension becomes more prevalent. We used linear mixed effect models to examine differences in white matter diffusion metrics as a function of hypertension in a well-characterized cohort of middle-aged men (N=316, mean 61.8 years; range 56.7–65.6). Diffusion metrics were examined in nine tracts reported to be sensitive to hypertension in older adults. Relative to normotensive individuals, individuals with longstanding hypertension (> 5.6 years) showed reduced fractional anisotropy or increased diffusivity in most tracts. Effects were stronger among carriers than non-carriers of the apolipoprotein E ε4 allele for two tracts connecting frontal regions with other brain areas. Significant differences were observed even after adjustment for potentially-related lifestyle and cardiovascular risk factors. Shorter duration of hypertension or better blood pressure control among hypertensive individuals did not lessen the adverse effects. These findings suggest that microstructural white matter alterations appear early in the course of hypertension and may persist despite adequate treatment. Although longitudinal studies are needed to confirm these findings, the results suggest that prevention—rather than management—of hypertension may be vital to preserving brain health in aging. PMID:26056337

  2. Rubidium uptake of mononuclear leukocytes from normotensive and borderline hypertensive first degree relatives to patients with essential hypertension

    DEFF Research Database (Denmark)

    Johansen, Torben; Nielsen, J R; Poulsgård, L

    1985-01-01

    Uptake of 86Rubidium of mononuclear leukocytes (MNL) was used as a measure of cellular sodium-potassium pump activity. 86Rb-uptake was determined with the pump stimulated mainly from inside the cells by sodium as well as with a combined stimulation from inside by sodium and from outside by Rb....... In the first case there was an increased pump activity in MNL from borderline hypertensive offspring of hypertensive patients (BHO), and this may be related to an increased number of pump sites observed previously (10). Estimation of maximal pump activity (Vmax) of MNL suggested that Vmax of each pump site...

  3. Prolonged work- and computer-related seated immobility and risk of venous thromboembolism.

    Science.gov (United States)

    Healy, Bridget; Levin, Erik; Perrin, Kyle; Weatherall, Mark; Beasley, Richard

    2010-11-01

    To determine the risk of venous thromboembolism (VTE) associated with prolonged work- and computer-related seated immobility. Case-control study in which cases were patients aged 18-65 years attending outpatient VTE clinics, and controls were patients aged 18-65 years admitted to CCU with a condition other than VTE. Interviewer-administered questionnaires obtained detailed information on VTE risk factors and clinical details. VTE Clinics and Coronary Care Unit (CCU), Wellington and Kenepuru Hospitals, Wellington between February 2007 and February 2009. The relative risk of VTE associated with prolonged work- and computer-related seated immobility, defined as being seated at work and on the computer at home, at least 10 hours in a 24-hour period and at least 2 hours at a time without getting up, during the four weeks prior to the onset of symptoms that led to VTE diagnosis or CCU admission. There were 197 cases and 197 controls. Prolonged work- and computer-related seated immobility was present in 33/197 (16.8%) and 19/197 (9.6%) cases and controls, respectively. In multivariate analyses, prolonged work- and computer-related seated immobility was associated with an increased risk of VTE, odds ratio 2.8 (95% CI 1.2-6.1, P=0.013). The maximum and average number of hours seated in a 24-hour period were associated with an increased risk of VTE, with odds ratios of 1.1 (95% CI 1.0-1.2, P=0.008) and 1.1 (95% CI 1.0-1.2, P=0.014) per additional hour seated. Prolonged work- and computer-related seated immobility increases the risk of VTE. We suggest that there needs to be both a greater awareness of the role of prolonged work-related seated immobility in the pathogenesis of VTE, and the development of occupational strategies to decrease the risk.

  4. Pulmonary venous hypertension and mechanical strain stimulate monocyte chemoattractant protein-1 release and structural remodelling of the lung in human and rodent chronic heart failure models.

    Science.gov (United States)

    Park, John E S; Lyon, Alexander R; Shao, Dongmin; Hector, Lauren R; Xu, Hua; O'Gara, Peter; Pinhu, Liao; Chambers, Rachel C; Wort, S John; Griffiths, Mark J D

    2014-12-01

    The burden of chronic heart failure (HF) is rising owing to an increased survivorship after myocardial infarction (MI). Pulmonary structural remodelling in patients with HF may protect against oedema while causing dyspnoea, the predominant symptom associated with HF. The cellular and molecular mechanisms underlying these processes in HF are poorly understood. We hypothesised that pulmonary venous hypertension (PVH) following MI provides a mechanical stimulus for structural remodelling of the lung via monocyte chemoattractant protein-1 (MCP-1). Human lung microvascular endothelial cells (HLMVEC) and Ea.Hy 926 cells exposed to cyclic mechanical strain (CMS) in vitro were analysed for MCP-1 expression and activation of signalling intermediates. HF was induced in Sprague-Dawley rats 16 weeks after MI; a cohort was rescued with AAV9.SERCA2a gene therapy to reduce PVH. HLMVEC and Ea.Hy 926 cells exposed to CMS upregulated MCP-1 gene expression and protein release in an extracellular-signal-regulated kinase (ERK) 1/2 dependent manner. Supernatants from these experiments stimulated fibroblast (human fetal lung fibroblast -1) and pulmonary artery smooth muscle cell proliferation and differentiation. Total lung collagen, a marker of structural remodelling, and MCP-1 gene expression were increased in the lungs of rats with post-MI HF. SERCA2a gene therapy that attenuated PVH after MI was associated with lower levels of lung collagen and MCP-1 gene expression in the lung. Mechanical strain associated with PVH may stimulate pulmonary structural remodelling through ERK 1/2 dependent induction of MCP-1. These findings provide insights into the pathophysiology of lung remodelling in HF and highlight novel, potential therapeutic targets. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  5. ABO blood group related venous thrombosis risk in patients with peripherally inserted central catheters.

    Science.gov (United States)

    Koo, Chung Mo; Vissapragada, Ravi; Sharp, Rebecca; Nguyen, Phi; Ung, Thomas; Solanki, Chrismin; Esterman, Adrian

    2018-02-01

    To investigate the association between ABO blood group and upper limb venous thrombosis (VT) risk in patients with peripherally inserted central catheters (PICC). Single centre retrospective cohort study. A cohort of patients who underwent PICC insertion from September 2010 to August 2014 were followed up for symptomatic VT presentations diagnosed by ultrasound. Blood group status was identified from hospital information systems. 2270 participants had 3020 PICCs inserted. There were 124 cases of symptomatic VT, an incident rate of 4% [95% confidence interval, CI (3-5%)]. Univariate analysis adjusting for the clustered sample showed that having chemotherapy, two or more previous PICCs, a larger catheter size, a diagnosis of cancer and having a blood group B were all associated with an increased risk of a VT. In the multivariate analysis, PICC diameter, cancer diagnosis and blood group B were all independently associated with increased risk of VT. Patients undergoing PICC insertion with a blood group B appear to have a higher risk of VT, independent of risks attached to the PICC procedure and cancer diagnosis. Without any existing guidelines for PICC-related VT, this investigation creates a platform for further research to be conducted in order to establish guidelines. Advances in knowledge: Previous studies investigating VT risk associated with blood group status related to large heterogeneous populations. In this article, we look at patients specifically with PICC, which reduces the heterogeneity in the cohort. In addition, due to the substantial number of patients enrolled, we had a chance to perform multivariate analyses with statistical significance.

  6. Are Alzheimer's disease, hypertension, and cerebrocapillary damage related?

    NARCIS (Netherlands)

    Farkas, E; De Vos, RAI; Steur, ENHJ; Luiten, PGM

    2000-01-01

    Alzheimer's disease (AD) patients are often subject to vascular dysfunction besides their specific CNS pathology, which warrants further examination of the interaction between vascular factors and the development of dementia. The association of decreased cerebral blood flow (CBF) or hypertension

  7. Differing pattern of sympathoexcitation in normal-weight and obesity-related hypertension.

    Science.gov (United States)

    Lambert, Elisabeth; Straznicky, Nora; Schlaich, Markus; Esler, Murray; Dawood, Tye; Hotchkin, Elodie; Lambert, Gavin

    2007-11-01

    Hypertension in normal-weight and obese individuals is characterized by activation of the sympathetic nervous system. Measurement of spillover of the sympathetic transmitter, norepinephrine, to plasma indicates that the regional pattern of sympathetic activation in the 2 "variants" of essential hypertension differs, excluding the heart in obesity-related hypertension. Whether sympathetic nerve firing characteristics also differ is unknown. We studied multiunit and single fiber sympathetic nerve firing properties in patients with normal-weight hypertension and obesity-related hypertension, comparing these with nerve characteristics in normal-weight and obese people with normal blood pressure. Both normal-weight hypertensive (n=10) and obese hypertensive (n=14) patients had increased total multiunit muscle sympathetic nerve activity compared with the normal-weight (n=11) and obese (n=11) people with normal blood pressure (65+/-4 versus 47+/-6 bursts per 100 heartbeats, Pweight groups and 68+/-4 versus 53+/-3 bursts per 100 beats, Pweight hypertension was characterized by increased firing rate of single vasoconstrictor fibers (70+/-8 versus 28+/-3 spikes per 100 beats; Pheartbeat (39+/-3% versus 20+/-3%; Pheartbeat (30+/-4% versus 17+/-4%; Prate. The pattern of sympathetic activation in normal-weight and obesity-related hypertension differs in terms of both the firing characteristics of individual sympathetic fibers and the sympathetic outflows involved. The underlying central nervous system mechanism and the adverse consequences of the 2 modes of sympathetic activation may differ.

  8. [Duplexsonography investigation in patients with venous ulcer].

    Science.gov (United States)

    Jeanneret-Gris, Christina

    2011-03-01

    Venous hypertension due to venous insufficiency causes venous ulcers. Duplexsonography is a widely accepted non invasive method to assess venous insufficiency with venous reflux measurements. Retrograde venous flow is defined as venous reflux. The testing of venous reflux is reliable if transvalvular pressure is sufficiently high and transvalvular flow velocity exceeds 30 cm/s. Reflux testing in the proximal leg veins (V. femoralis communis, V. femoralis, V. saphena magna) is done using a standardised Valsalva Manoeuvre (exspiration into a tube up to a pressure of 30 mmHg, pressure established within 0.5 seconds, pressure hold for 3 seconds). Distal leg vein testing (V. poplitea, V. tibialis posterior, V. saphena parva) is recommended with a two handed - compression distally to the tested veins. The most important parameter is venous reflux time, a cut off of > 2 seconds is recommended.

  9. [A Case of Delayed Vascular Injury as a Complication Related to Implanted Central Venous Port Catheter].

    Science.gov (United States)

    Sumiyoshi, Tetsuya; Kondo, Tomohiro; Fujii, Ryoji; Minagawa, Takeyoshi; Fujie, Shinya; Kimura, Tomohiro; Ihara, Hideyuki; Yoshizaki, Naohito; Kondo, Hitoshi; Kitayama, Hiromitsu; Sugiyama, Junko; Hirayama, Michiaki; Tsuji, Yasushi; Yamamoto, Kazuyuki; Kawarada, You; Okushiba, Shunichi; Nishioka, Noriko; Shimizu, Tadashi

    2015-12-01

    A 74-year-old woman with advanced gastric cancer was admitted to our hospital. A central venous (CV) port catheter was implanted into the right subclavian vein for preoperative chemotherapy and parenteral nutritional management. On the 35th day after implantation, she complained of diarrhea, fever and dyspnea. The chest radiograph showed a right-sided massive pleural effusion. As the patient progressively fell into severe respiratory distress, endotracheal intubation was performed for management of respiration by mechanical ventilation. Initially, given the patient's symptoms, she was diagnosed with septic shock. Therefore, after placement of a CV catheter through the right femoral vein, in consideration of the possibility of a port infection, she was treated with thoracentesis and infusion of antibiotics. The patient gradually recovered, and again received parenteral nutrition through the CV port catheter. After the infusion was administered, she complained of dyspnea. A CT scan of the chest revealed a right pleural effusion and displacement of the tip of the CV port catheter out of the wall of the superior vena cava. We diagnosed delayed vascular injury (DVI), and the CV port catheter was removed. She soon recovered with conservative treatment. We speculated that the initial respiratory symptoms such as the pleural effusion were caused by DVI. DVI should therefore be recognized as a complication related to implanted CV port catheters.

  10. Incidence and risk factors of infections complications related to implantable venous-access ports

    Energy Technology Data Exchange (ETDEWEB)

    Shim, Ji Sue; Seo, Tae Seok; Song, Myung Gyu; Cha, In Ho; Kim, Jun Suk; Choi, Chul Won; Seo, Jae Hong; Oh, Sang Cheul [Korea University Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of)

    2014-08-15

    The purpose of this study was to determine the incidence and risk factors of infections associated with implantable venous access ports (IVAPs.) From August 2003 through November 2011, 1747 IVAPs were placed in our interventional radiology suite. One hundred forty four IVAPs were inserted in patients with hematologic malignancy and 1603 IVAPs in patients with solid tumors. Among them, 40 ports (23 women and 17 men; mean age, 57.1 years; range, 13-83) were removed to treat port-related infections. We evaluated the incidence of port-related infection, patient characteristics, bacteriologic data, and patient progress. Univariable analyses (t test, chi-square test, and Fisher's exact test) and multiple logistic regression analyses were used to determine the risk factors for IVAP related infection. Overall, 40 (2.3%) of 1747 ports were removed for symptoms of infection with an incidence rate of 0.067 events/1000 catheter-days. According to the univariable study, the incidences of infection were seemingly higher in the patients who received the procedure during inpatient treatment (p = 0.016), the patients with hematologic malignancy (p = 0.041), and the patients receiving palliative chemotherapy (p = 0.022). From the multiple binary logistic regression, the adjusted odds ratios of infection in patients with hematologic malignancies and those receiving palliative chemotherapy were 7.769 (p = 0.001) and 4.863 (p = 0.003), respectively. Microorganisms were isolated from 26 (65%) blood samples, and two of the most causative organisms were found to be Staphylococcus (n = 10) and Candida species (n = 7). The underlying hematologic malignancy and the state of receiving palliative chemotherapy were the independent risk factors of IVAP-related infection.

  11. Etiopathogenetic Mechanisms of Pulmonary Hypertension in Sleep-Related Breathing Disorders

    Directory of Open Access Journals (Sweden)

    Ayodeji Adegunsoye

    2012-01-01

    Full Text Available Obstructive sleep apnea syndrome is a common disorder with significant health consequences and is on the rise in consonance with the obesity pandemic. In view of the association between sleep-disordered breathing and pulmonary hypertension as depicted by multiple studies, current clinical practice guidelines categorize obstructive sleep apnea as a risk factor for pulmonary hypertension and recommend an assessment for sleep disordered breathing in evaluating patients with pulmonary hypertension. The dysregulatory mechanisms associated with hypoxemic episodes observed in sleep related breathing disorders contribute to the onset of pulmonary hypertension and identification of these potentially treatable factors might help in the reduction of overall cardiovascular mortality.

  12. Incidence of Hypertension-Related Emergency Department Visits in the United States, 2006 to 2012.

    Science.gov (United States)

    McNaughton, Candace D; Self, Wesley H; Zhu, Yuwei; Janke, Alexander T; Storrow, Alan B; Levy, Phillip

    2015-12-01

    Hypertension is a common chronic condition, but the burden of emergency department (ED) visits due to hypertension and associated patient and hospital characteristics are not well described. The goals of this study were to (1) establish the burden of hypertension-related ED visits, estimated by the total number, proportion of adult visits, and population-based rate, (2) evaluate for change over time, and (3) identify associated patient and hospital characteristics. The Nationwide Emergency Department Sample from 2006 to 2012 was used to identify hypertension-related ED visits (International Classification of Diseases, Ninth Revision, Clinical Modification codes 401 to 405, inclusive, and 437.2), and this was linked to US Census Bureau July population estimates to determine population-based rates for each study year. Negative binomial regression was performed to determine whether rates of hypertension-related ED visits changed over time. A total of 165,946,807 hypertension-related ED visits occurred during the 7-year study period (23.6% of all adult ED visits), and hypertension was the primary diagnosis for 6,399,088 (0.9% of all adult ED visits). The estimated yearly incidence rate increased 5.2% per year (incident rate ratio, 1.052; 95% confidence interval, 1.044 to 1.061; p safety net hospitals and among uninsured patients. In conclusion, these data indicate that hypertension-related ED visits are common and increasing. Published by Elsevier Inc.

  13. Central Venous Catheter-Related Tachycardia in the Newborn: Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Aya Amer

    2016-01-01

    Full Text Available Central venous access is an important aspect of neonatal intensive care management. Malpositioned central catheters have been reported to induce cardiac tachyarrhythmia in adult populations and there are case reports within the neonatal population. We present a case of a preterm neonate with a preexisting umbilical venous catheter (UVC, who then developed a supraventricular tachycardia (SVT. This was initially treated with intravenous adenosine with transient reversion. Catheter migration was subsequently detected, with the UVC tip located within the heart. Upon withdrawal of the UVC and a final dose of adenosine, the arrhythmia permanently resolved. Our literature review confirms that tachyarrhythmia is a rare but recognised neonatal complication of malpositioned central venous catheters. We recommend the immediate investigation of central catheter position when managing neonatal tachyarrhythmia, as catheter repositioning is an essential aspect of management.

  14. Central Venous Catheter-Related Tachycardia in the Newborn: Case Report and Literature Review.

    Science.gov (United States)

    Amer, Aya; Broadbent, Roland S; Edmonds, Liza; Wheeler, Benjamin J

    2016-01-01

    Central venous access is an important aspect of neonatal intensive care management. Malpositioned central catheters have been reported to induce cardiac tachyarrhythmia in adult populations and there are case reports within the neonatal population. We present a case of a preterm neonate with a preexisting umbilical venous catheter (UVC), who then developed a supraventricular tachycardia (SVT). This was initially treated with intravenous adenosine with transient reversion. Catheter migration was subsequently detected, with the UVC tip located within the heart. Upon withdrawal of the UVC and a final dose of adenosine, the arrhythmia permanently resolved. Our literature review confirms that tachyarrhythmia is a rare but recognised neonatal complication of malpositioned central venous catheters. We recommend the immediate investigation of central catheter position when managing neonatal tachyarrhythmia, as catheter repositioning is an essential aspect of management.

  15. Associations between polymorphisms in coagulation-related genes and venous thromboembolism

    Science.gov (United States)

    Jiang, Jun; Liu, Kang; Zou, Junjie; Ma, Hao; Yang, Hongyu; Zhang, Xiwei; Jiao, Yuanyong

    2017-01-01

    Abstract Background: Recently, several studies showed that the polymorphisms in the coagulation-related genes might be associated with venous thromboembolism (VTE); however, the results were still controversial. We performed a meta-analysis with trial sequential analysis to investigate the associations between the endothelial cell-activated protein C receptor (EPCR) rs9574, F11 rs2289252, F11 rs2036914, FGG rs2066865, FGG rs1049636, CYP4V2 rs13146272, SERPINC1 rs2227589, and GP6 rs1613662 polymorphisms with the risk of VTE. Methods: We searched both the common English-language databases and the Chinese literature databases. Two authors selected studies according to inclusion and exclusion criteria. Crude odds ratios with 95% confidence intervals (CI) were calculated to estimate the strength of this association. Between-study heterogeneity was assessed with the chi-square-based Q test and the I2 statistic. Results: Overall, a total of 20 studies were included. The meta-analysis revealed that the F11 rs2289252, F11 rs2036914, FGG rs2066865, and CYP4V2 rs13146272 polymorphisms were closely related to the development of VTE in the white race under the best genetic models after multiple testing adjustments. The EPCR rs9574, FGG rs1049636, SERPINC1 rs2227589, and GP6 rs1613662 polymorphisms might be potential candidates in the pathogenesis of VTE, but trial sequential analyses and sensitivity analyses indicated that the evidences were limited. Larger scale studies were demanded to avoid false-positive outcomes. Conclusions: Finally, our study demonstrated the important role of rs2289252, rs2036914, rs2066865, and rs13146272 polymorphisms in the development of VTE in the white race. Rs9574, rs1049636, rs2227589 and rs1613662 polymorphisms might be risk factors of VTE. However, more studies involving diverse races are needed to probe the ethnic difference and the underlying mechanisms of significant associations. PMID:28353616

  16. Sleep Quality: A Pilot Study Comparing Patients With and Without Injection-Related Venous Ulcers.

    Science.gov (United States)

    Pieper, Barbara; Templin, Thomas N

    2016-01-01

    The purposes of this study were to (a) compare sleep quality of persons with and without injection-related venous ulcers (VU) and (b) examine associations between global sleep quality with age, sex, comorbidities, pain, nutrition, physical health rating, fatigue, emotional problems, health-related quality of life, attitude toward physical activity, and number of ulcers. This study used a cross-sectional design. The participants included 31 patients with VU and 30 without VU (men [n = 35] and women; mean age = 54 years) who were attending an indigent clinic for wound care or general health. Participants were recruited from an urban clinic when they came for primary care or wound care. Questionnaires were administered at that time and included the Pittsburgh Sleep Quality Index (PSQI), Mini Nutrition Assessment, Patient Reported Outcomes Measurement Information System (PROMIS) questions about general physical health, fatigue, emotional problems, and quality of life, Brief Pain Inventory worst pain rating, Positive Attitude and Motivation for Physical Activity Scale, wound assessment, and demographic factors. The 2 groups did not differ on the PSQI in terms of time going to bed, minutes to fall asleep, time awakening, hours slept, and time in bed. Those with VU compared to without VU took more medications to help sleep (P≤ .03). There were no significant differences in PSQI correlations across groups. All study variables except age, gender, and quality of life were significantly related to Global sleep disturbance score. A higher number of comorbid conditions, worse pain, poorer nutrition, poor physical health rating, greater fatigue, more emotional problems, and poor attitude toward physical activity were related to greater sleep disturbances for all participants. Both groups had mean Global PSQI scores greater than 5 (with VU = 7.83 and without VU = 8.2), indicating sleep problems. Study findings suggest that sleep disturbances may be a concern in persons with VU

  17. Central venous catheters as a source of hemodialysis-related bacteremia.

    Science.gov (United States)

    Taylor, G D; McKenzie, M; Buchanan-Chell, M; Caballo, L; Chui, L; Kowalewska-Grochowska, K

    1998-09-01

    To describe investigations into an increase in hemodialysis-related bacteremia that occurred in our hospital in the first 6 months of 1996. Hemodialysis unit in a tertiary-care medical center. Prospective surveillance for hemodialysis bacteremia has been performed for several years. Cases that occurred in 1995 were compared to cases in the first 6 months of 1996. Unit data on dialysis runs and method of dialysis access were used to calculate rates. Nested polymerase chain reaction (PCR) was used to type 18 Staphylococcus aureus isolates from 1996. A case-control study comparing 80 randomly selected hemodialysis patients from 1995 and 1996 was performed to examine infection risk factors. The hemodialysis bacteremia rate was 1.2 per 1,000 runs in 1995 and 2.8 per 1,000 in the first 6 months of 1996 (P=.0009). The 25 cases in 1995 and 32 in the first half of 1996 were similar in age, gender, means of vascular access, and microbial etiology. Central venous catheter (CVC) access accounted for >90% of cases in both time periods. S aureus was the most common microbial etiology (53% of the 1996 cases). PCR typing of S aureus isolates from 1996 demonstrated five different strains, the most common having six isolates. The use of CVCs as a means of vascular access abruptly increased in the unit in January 1996, from 40% in 1996 (P<.001), associated with structural changes in healthcare delivery in the region resulting in delays in performing surgical procedures, such as creation of vascular grafts and fistulae. A marked increase in hemodialysis bacteremia occurred in 1996, associated with increased reliance on CVCs for vascular access in hemodialysis patients during a period of healthcare restructuring.

  18. Prematurity-Related Hypertension in Children and Adolescents

    Directory of Open Access Journals (Sweden)

    Karolina Poplawska

    2012-01-01

    Full Text Available Due to the functional and structural immaturity of different organ systems, preterms have a higher rate of morbidity and mortality. The prevention and treatment of the complications of prematurity is a major challenge in perinatal health care. Recently, there have been several multicenter research trials analysing the impact of prematurity or low birth weight on the health problems of children and adolescents. Many of these studies deal with the issue of pediatric hypertension. An analysis of 15 studies conducted in the years 1998–2011, in which blood pressure values in ex-preterm children were measured, was performed. Comparison was based on several issues: measurement method, cohorts age, size, and birthweight. It has been proven that hypertension occurs more often in former preterm infants; however the etiologic pathways that cause this condition still remain unclear. Moreover, pediatric hypertension is a significant problem, because of its transformation into adult hypertension and increased cardiovascular risk later in life. Therefore it is crucial to introduce wide-spread screening and detection of elevated blood pressure, especially among prematurely born children.

  19. Are Alzheimer’s disease, hypertension, and cerebrocapillary damage related?

    NARCIS (Netherlands)

    Farkas, Eszter; Vos, Rob A.I. de; Jansen Steur, Ernst N.H.; Luiten, Paul G.M.

    2000-01-01

    Alzheimer’s disease (AD) patients are often subject to vascular dysfunction besides their specific CNS pathology, which warrants further examination of the interaction between vascular factors and the development of dementia. The association of decreased cerebral blood flow (CBF) or hypertension

  20. Hypertension and hypertension-related disease in Mongolia; findings of a national knowledge, attitudes and practices study

    DEFF Research Database (Denmark)

    Demaio, Alessandro R; Otgontuya, Dugee; de Courten, Maximilian

    2013-01-01

    Mongolia has a high and increasing burden of hypertension and related disease, with cardiovascular diseases among the leading causes of death. Yet little is known about the knowledge, attitudes and practices of the Mongolian population with regards to blood pressure. With this in mind, a national...... Non-Communicable Diseases knowledge, attitudes and practices survey on blood pressure was implemented in late 2010. This paper reports on the findings of this research....

  1. Pregnancy-related venous thromboembolism: Risk and the effect of thromboprophylaxis

    NARCIS (Netherlands)

    Lussana, Federico; Coppens, Michiel; Cattaneo, Marco; Middeldorp, Saskia

    2012-01-01

    Venous thromboembolism (VTE) is a leading cause of maternal mortality and morbidity during pregnancy in developed countries. The incidence of VTE per pregnancy-year increases about 4-fold during pregnancy and at least 14-fold during the puerperium. Risk factors include a personal history of VTE,

  2. Obesity-related hypertension: epidemiology, pathophysiology, treatments, and the contribution of perivascular adipose tissue.

    Science.gov (United States)

    Aghamohammadzadeh, Reza; Heagerty, Anthony M

    2012-06-01

    The advent of the obesity epidemic has highlighted the need to re-assess more closely the pathophysiology of obesity-related hypertension with the aim of identifying new therapies. In this article, we review the role of the renin-angiotensin-aldosterone system, sympathetic nervous system, and inflammation in relation to the pathophysiology of this condition. We also discuss the potential role of the perivascular adipose tissue in the context of obesity-related hypertension.

  3. Models of the venous system

    DEFF Research Database (Denmark)

    Mehlsen, J

    2000-01-01

    of the venous system require at least three elements: a resistor, a capacitor and an inductor, with the latter being of more importance in the venous than in the arterial system. Non-linearities must be considered in pressure/flow relations in the small venules, during venous collapse, or low flow conditions...

  4. Mechanisms of Altered Renal Sodium Handling in Age-Related Hypertension.

    Science.gov (United States)

    Frame, Alissa A; Wainford, Richard David

    2018-02-14

    The prevalence of hypertension rises with age to approximately two out of three adults over the age of 60 in the United States. Although the mechanisms underlying age-related hypertension are incompletely understood, sodium homeostasis is critical to the long-term regulation of blood pressure and there is strong evidence that aging is associated with alterations in renal sodium handling. This mini-review focuses on recent advancements in our understanding of the vascular, neurohumoral, and renal mechanisms that influence sodium homeostasis and promote age-related hypertension.

  5. Analyses of placental gene expression in pregnancy-related hypertensive disorders

    Directory of Open Access Journals (Sweden)

    Shuenn-Dyh Chang

    2011-09-01

    Conclusion: Our results support the fact that ENG is the culprit for the development of preeclampsia. In addition, this study identifies several other genes in the placenta, which are transcriptionally regulated in pregnancy-related hypertensions.

  6. What Is Pulmonary Hypertension?

    Science.gov (United States)

    ... Matter Find HBP Tools & Resources Stroke Vascular Health Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Pulmonary ... five groups of pulmonary hypertension. Group 1 pulmonary arterial ... chronic obstructive pulmonary disease (COPD) and interstitial lung disease, as ...

  7. Detection of venous needle dislodgement during haemodialysis using fractional order shape index ratio and fuzzy colour relation analysis.

    Science.gov (United States)

    Lin, Chia-Hung; Chen, Wei-Ling; Kan, Chung-Dann; Wu, Ming-Jui; Mai, Yi-Chen

    2015-12-01

    Venous needle dislodgement (VND) is a life-threatening complication during haemodialysis (HD) treatment. When VND occurs, it only takes a few minutes for blood loss in an adult patient. According to the ANNA (American Nephrology Nurses' Association) VND survey reports, VND is a concerning issue for the nephrology nurses/staff and patients. To ensure HD care and an effective treatment environment, this Letter proposes a combination of fractional order shape index ratio (SIR) and fuzzy colour relation analysis (CRA) to detect VND. If the venous needle drops out, clinical examinations show that both heart pulses and pressure wave variations have a low correlation at the venous anatomic site. Therefore, fractional order SIR is used to quantify the differences in transverse vibration pressures (TVPs) between the normal condition and meter reading. Linear regression shows that the fractional order SIR has a high correlation with the TVP variation. Fuzzy CRA is designed in a simple and visual message manner to identify the risk levels. A worst-case study demonstrated that the proposed model can be used for VND detection in clinical applications.

  8. Soluble CD163, a marker of Kupffer cell activation, is related to portal hypertension in patients with liver cirrhosis

    DEFF Research Database (Denmark)

    Grønbaek, H; Sandahl, T D; Mortensen, C

    2012-01-01

    , as a biomarker for portal hypertension in patients with liver cirrhosis. METHODS: We measured sCD163 concentration and the hepatic venous pressure gradient (HVPG) by liver vein catheterisation in 81 cirrhosis patients (Child-Pugh CP-A: n = 26, CP-B: n = 29, CP-C: n = 26) and 22 healthy subjects. We also measured...... in steps by CP-score (P

  9. ENDOVASCULAR TREATMENT FOR DISORDERS OF THE VENOUS SYSTEM

    Directory of Open Access Journals (Sweden)

    A. G. Osiev

    2015-01-01

    Full Text Available The annual rate of deep vein thrombosis in general population is from 5 to 9 cases per 10 000, whereas for venous thromboembolism (deep vein thrombosis and pulmonary embolism taken together amounts to 14 cases per 10 000. To improve longterm results of therapy for thrombosis of deep veins of the lower extremities, it is important to restore venous function and outflow. Anticoagulant therapy with low weight or non-fractionated heparin preparations remains the most widely used method of management. However, total or partial thrombosis resolution under anticoagulant treatment is achieved only in 4 and 14% of cases, respectively. Thrombolysis allows for early resorption of the thrombus by means of a minimally invasive procedure with lower risk of complication. After the venous flow is restored, the aim of treatment is to prevent damage to the venous valves, venous hypertension and repeated thrombosis with development of the post-thrombotic syndrome. Compared to anticoagulation, systemic thrombolysis has the benefit of more rapid clot resorption and less damage to the venous valve. One of its serious limitations is a high bleeding risk related to higher doses of the drug administered through a peripheral vein catheter. Therefore, selective intra-clot administration of thombolytics (direct catheter thrombolysis has been suggested as an alternative. For more effective therapy with the use of lower doses of thrombolytics, the so called pharmaco-mechanical thrombectomy has been developed. Venous stenosis hindering the venous outflow is frequently seen after direct catheter or pharmaco-mechanical thrombolysis. Angioplasty with stent placement is recommended in the cases with residual venous abnormality after successful thrombolysis and thrombectomy. 

  10. Are Alzheimer’s disease, hypertension, and cerebrocapillary damage related?

    OpenAIRE

    Farkas, Eszter; de Vos, Rob A.I.; Jansen Steur, Ernst N.H.; Luiten, Paul G. M.

    2000-01-01

    Alzheimer’s disease (AD) patients are often subject to vascular dysfunction besides their specific CNS pathology, which warrants further examination of the interaction between vascular factors and the development of dementia. The association of decreased cerebral blood flow (CBF) or hypertension with AD has been a target of growing interest. Parallel with physiological changes, the cerebral capillaries in AD are also prone to degenerative processes. The microvascular abnormalities that are th...

  11. L-lysine escinat, thiotriazolin, gordox and mydocalm influence on oxygen tension in the intestinal wall and acid-base balance and limited proteolysis in intestinal venous blood in terms of intraabdominal hypertension modeling

    Directory of Open Access Journals (Sweden)

    Sapegin V.I.

    2014-11-01

    Full Text Available In acute experiments on rabbits there were studied changes in oxygen tension in the intestinal wall tissues, acid-base balance and limited proteolysis and its inhibitors in intestinal venous blood, protective action of L-lysine escinat (0,15 mg/kg / single dose, thiotriazolin (25 mg/kg / single dose, aprotinin (gordox (10,000 units/kg / single dose in sequential modeling of standard levels increasing of intra-abdominal hypertension (IAH — 50, 100, 150, 200, 250, 300, 350 m H2O, and also of tolperison (mydocalm (5 mg/kg / single dose on modeling of stable 3-hour IAH 200 m H2O. The IAH modeling was performed by means of stand of our construction. Under the influence of IAH the compensated metabolic acidosis in intestinal venous blood with a compensative hyperpnoe develops, decline of oxygen tension in tissues and activating of a limited proteolysis as well as decline of its inhibitors activity in intestinal venous blood occur. By the degree of metabolic acidosis prevention investigational preparations were distributed as follows gordox > thiotriazolin = L-lysine escinat = mydocalm, and by prevention of decline of oxygen tension in tissues — thiotriazolin > L-lysine escinat > mydocalm > gordox, it is is connected with different rate of methabolic products excretion into the blood, due to the influence on blood circulation and transcapilary exchange. By the degree of prevention of proteolytic activity and inhibitory potential changes, investigational preparations were distributed as follows: gordox > mydocalm > thiotriazolin > L-lysine escinat, this is connected with inhibition of proteolysis in gordox, and in other ones – with reduction of ischemic damage of tissues. Owing to different mechanism of action thiotriazolin, L-lysine escinat and mydocalm may be simultaneously recommended for a conservative treatment of patients with intraabdominal hypertension syndrome.

  12. Update on idiopathic intracranial hypertension.

    Science.gov (United States)

    Bruce, Beau B; Biousse, Valérie; Newman, Nancy J

    2011-08-01

    To provide an update on various features of idiopathic intracranial hypertension. Perspective. Selected articles on the epidemiology, clinical and imaging features, natural history, pathophysiology, and treatment of idiopathic intracranial hypertension were reviewed and interpreted in the context of the authors' clinical and research experience. Idiopathic intracranial hypertension primarily is a disease of obese women of childbearing age, but it can affect patients of any weight, sex, and age. Although a relatively rare disorder, idiopathic intracranial hypertension's associated costs in the United States entail hundreds of millions of dollars. Even after treatment, headaches frequently are persistent and may require the continued involvement of a neurologist. Quality-of-life reductions and depression are common among idiopathic intracranial hypertension patients. However, visual dysfunction, especially visual field abnormalities, represents the major morbidity of this disorder, and serial automated perimetry remains the primary method of patient monitoring. Patients who are men, black, very obese, or anemic are at higher risk of visual loss. Vitamin A metabolism, adipose tissue as an actively secreting endocrine tissue, and cerebral venous abnormalities are areas of active study regarding the pathophysiology of idiopathic intracranial hypertension. Treatment studies show that lumbar puncture is a valuable treatment (in addition to its crucial diagnostic role), and that weight management is critical. However, open questions remain regarding the efficacy of acetazolamide, cerebrospinal fluid diversion procedures, and cerebral venous stenting. Many questions remain unanswered about idiopathic intracranial hypertension. Ongoing studies, especially an ongoing National Institutes of Health-funded clinical trial of acetazolamide, should provide more insight into this important, yet poorly understood, syndrome of isolated intracranial hypertension. Copyright © 2011

  13. Ulcer pain in patients with venous leg ulcers related to antibiotic treatment and compression therapy.

    Science.gov (United States)

    Akesson, Nina; Oien, Rut Frank; Forssell, Henrik; Fagerström, Cecilia

    2014-09-01

    The aim of this study was to compare venous leg ulcer patients with and without ulcer pain to see whether ulcer pain affected the use of antibiotic treatment and compression therapy throughout healing. A total of 431 patients with venous leg ulcers were included during the study period. Every patient was registered in a national quality registry for patients with hard-to-heal leg, foot, and pressure ulcers. A high incidence of ulcer pain (57%) was found when the patients entered the study. Patients with ulcer pain had been treated more extensively with antibiotics both before and during the study period. Throughout healing there was a significant reduction of antibiotic use among patients in the 'no pain' group, from 44% to 23% (P=0.008). There was no significant difference between the two groups concerning compression therapy (85% vs. 88%), but 12% of patients in the 'pain' group did not get their prescribed compression compared with 6% of patients in the 'no pain' group. The groups did not differ significantly in terms of ulcer duration, ulcer size or healing time. This study shows a high incidence of ulcer pain, confirming that pain has a great impact on patients with venous leg ulcers. Results further suggest that the presence of ulcer pain increases the prescription of antibiotics but does not affect the use of compression therapy. Several advantages were found from using a national quality registry. The registry is a valuable clinical tool showing the importance of accurate diagnosis and effective treatment.

  14. [Venous ulcer].

    Science.gov (United States)

    Böhler, Kornelia

    2016-06-01

    Venous disorders causing a permanent increase in venous pressure are by far the most frequent reason for ulcers of the lower extremity. With a prevalence of 1 % in the general population rising to 4 % in the elderly over 80 and its chronic character, 1 % of healthcare budgets of the western world are spent on treatment of venous ulcers. A thorough investigation of the underlying venous disorder is the prerequisite for a differenciated therapy. This should comprise elimination of venous reflux as well as local wound management. Chronic ulcers can successfully be treated by shave therapy and split skin grafting. Compression therapy is a basic measure not only in venous ulcer treatment but also in prevention of ulcer recurrence. Differential diagnosis which have to be considered are arterial ulcers, vasculitis and neoplasms.

  15. PREVALENCE, RISK FACTORS AND SOCIO DEMOGRAPHIC CO-RELATES OF ADOLESCENT HYPERTENSION IN DISTRICT GHAZIABAD

    Directory of Open Access Journals (Sweden)

    Gajendra Kumar Gupta

    2013-12-01

    Full Text Available Background: Hypertension is a chronic condition of concern due to its role in the causation of coronary heart disease, stroke and other  complications. It is one of the major risk factors for cardio-vascular mortality accounting for 20-50% of all deaths. Children with higher blood pressure tend to maintain those levels during adulthood also. Objectives:  Assess the prevalence of hypertension in adolescents (11-18 years, its risk factors and their socio-demographic co-relates. Material and Method:  Prevalence of adolescent hypertension in previous studies was 7% and the sample size accordingly came to be 1314 with a relative precision of 20%. Multistage sampling technique was used. Half each of the sample size was covered in urban and rural areas . Households in the selected colonies in the urban areas and villages were randomly selected and the adolescents interviewed and examined. Their responses were recorded on a pretested questionnaire and results drawn. Data were analysed using Epi-info and SPSS and chi-square test applied. Results:   Prevalence of adolescent hypertension was found to be 5.3% (72 out of 1340; significantly associated with type of family (P<0.001, educational status (P<0.001, occupation (P<0.001, BMI (P<0.01, and smoking habit (P<0.05. However, no relationship of hypertension was found with salt intake, type of diet, exercise, alcohol consumption, stress and family history of hypertension. Conclusion: Socio-demographic factors certainly influence the prevalence and probability of occurrence of adolescent hypertension but the effect of established risk factors (for adult hypertension needs to be further evaluated for adolescent hypertension and more studies are required in this area.

  16. Doppler ultrasound evaluation of pattern of venous incompetance and relation with skin changes in varicose vein patients

    Directory of Open Access Journals (Sweden)

    HP Pant

    2015-06-01

    Full Text Available BACKGROUND Varicosity of lower limb is a common problem in agricultural country like Nepal. Doppler ultrasound is a standard investigation modality for confirmation of diagnosis, evaluation of severity and venous mapping to plan treatment. We aim to find out the epidemiology, common pattern of incompetance, severity assessment by doppler and association of the important doppler variables with skin changes. METHODOLOGY Doppler venous study was done in 56 patients from june 2013 to july 2014. Patients with deep vein thrombosis and peripheral arterial disease were excluded. Altogether 56 patients, 96 limbs were studied. Data was entered in preformed proforma. Doppler study was conducted by senior radiologist with linear probes. Data was entered in SPSS software version 16 and statistical significance was calculated using chi square test. RESULTS Bilateral limb involvement was seen in 40 patients and unilateral in 16 patuents only. Skin related changes were seen in 58 limbs. Saphenofemoral junction incompetance was seen in 79(82.2% limbs and was most common pattern of incompetance. Overall, superficial veins were involved in 88(91.7% limbs and deep in 30(31.2% limbs. Prolonged duration of varicosity (>9 year (p=0.000, bilateral limb involvement(p=0.024, reflux in deep venous system(p=0.002, larger Greater Saphenous Vein (GSV size(p=0.003, prolonged duration of reflux(p=0.000 and perforator incompetence (p=0.002 were associated with skin changes. GSV diameter more than 7 mm was associated with reflux significantly (P=0.002. CONCLUSION Superficial vein incompetance is common pattern compared to deep venous system. Sapheno Femoral Junction (SFJ incompetance is the commonest pattern. Larger caliber of vein, prolonged duration of reflux, reflux in deep venous system and perforator insufficiency are significantly associated with skin changes.DOI: http://dx.doi.org/10.3126/jcmsn.v10i3.12770 Journal of College of Medical Sciences-Nepal, 2014, Vol-10, No-3

  17. [Analysis of factors related to pulmonary hypertensive crisis in patients with idiopathic pulmonary arterial hypertension].

    Science.gov (United States)

    Zhang, Chen; Li, Qiangqiang; Zhu, Yan; Gu, Hong

    2014-06-10

    To explore the risk and protective factors for pulmonary hypertensive crisis (PHC) in patients with idiopathic pulmonary arterial hypertension (IPAH). A retrospective study was performed for 65 patients with a diagnosis of IPAH between January 2010 and December 2013. According to clinical manifestations, they were divided into two groups of susceptibility and non-susceptibility to PHC. Clinical and hemodynamic parameters were analyzed in univariate and multivariate manners. Among them, there were 32 males and 33 females with a mean age of (14.4 ± 12.3) (10/12-47.3) years. Twenty-three patients had typical manifestations of PHC and 18 of them were induced by exercises.Univariate analysis revealed that the proportion of patients with World Health Organization (WHO) functional class III-IV in PHC-susceptible group was significantly higher than PHC-nonsusceptible group (60.9% vs 23.8%, P = 0.003) while the percentage of patent foramen ovale in PHC-susceptible group was significantly lower than PHC-nonsusceptible group (8.7% vs 45.2%, P = 0.003).In patients with WHO functional classI-II, hemodynamic variables including the decline of pulmonary arterial pressure and positive rate in vasoreactivity testing in PHC-susceptible group were significantly higher than PHC-nonsusceptible group.In patients with WHO functional class III-IV, baseline pulmonary arterial pressure and mean right atrial pressure in PHC-susceptible group were significantly higher than those in PHC-nonsusceptible group. Multivariate Logistic regression analysis revealed that, for those with WHO functional class III-IV (OR = 23.45, 95%CI: 2.85-193.09) and the decline of systolic pulmonary arterial pressure in vasoreactivity testing (OR = 1.12, 95%CI: 1.04-1.22) were independent risk factors for PHC in IPAH patients while patent foramen ovale (OR = 0.01, 95%CI: 0.00-0.52) was a protective factor. PHC in IPAH patients is correlated with WHO functional class, pulmonary vascular reactivity, baseline pulmonary

  18. Biomarkers of lipid peroxidation related to hypertension in aging.

    Science.gov (United States)

    Yavuzer, Hakan; Yavuzer, Serap; Cengiz, Mahir; Erman, Hayriye; Doventas, Alper; Balci, Huriye; Erdincler, Deniz Suna; Uzun, Hafize

    2016-05-01

    The aim of this clinical study was to evaluate the influence of aging on the levels of lipid peroxidation (quantified as thiobarbituric acid-reactive substances (TBARS) content), lipid hydroperoxide (LOOH), hexanoyl lysine (HEL), 8-iso-prostaglandin F2α (8-iso-PGF2α) and total antioxidant capacity (TAC), and determine their relationships to the demographic and cardiovascular risk factors in elderly hypertensive (HT) patients. This study consisted of four groups: two elderly groups with 30 HT patients (11 males, 19 females) and 30 normotensive healthy volunteers (15 males, 15 females), and two young groups with 30 HT patients (13 males, 17 females) and 30 normotensive healthy volunteers (12 males, 18 females). In the elderly control group, the TBARS, LOOH, HEL and 8-iso-PGF2α levels, and the carotid intima media thickness (CIMT) were significantly higher than in the young control group. The TBARS, LOOH, HEL and 8-iso-PGF2α levels and the CIMT measurements were significantly higher in the elderly HT group than in the young HT group. In addition, the TAC levels were significantly lower in the elderly and young HT groups than in the elderly and young control groups. The CIMT was significantly positively correlated with TBARS (r=0.40, Plipid peroxidation in hypertension in terms of sensitivity. In all of the HT groups, 8-iso-PGF2α had the highest sensitivity. Hypertension is associated with lipid peroxidation due to an impaired oxidant/antioxidant status. Increased lipid peroxidation and decreased antioxidants with aging indicate that peroxidative damage further increases with higher blood pressure and the aging process.

  19. Aerosolized iloprost in CREST syndrome related pulmonary hypertension.

    Science.gov (United States)

    Launay, D; Hachulla, E; Hatron, P Y; Goullard, L; Onimus, T; Robin, S; Fauchais, A L; Queyrel, V; Michon-Pasturel, U; Hebbar, M; Saulnier, F; Devulder, B

    2001-10-01

    To assess the outcome of patients with CREST syndrome associated severe pulmonary hypertension treated by aerosolized iloprost in a noncomparative study. Five patients with CREST syndrome associated severe pulmonary hypertension were treated with 100 microg/day of aerosolized iloprost. New York Heart Association functional class and exercise tolerance (6 min walk test) were assessed at baseline, after one month, and then every 6 months. A right heart catheterization was performed at baseline in all but one patient. Systolic pulmonary artery pressure (PAP) was measured with Doppler echocardiography after one month and every 6 months. The mean followup was 13.2 +/- 8.8 months (median 6, range 6-24). Subjective quality of life improved in all patients. NYHA functional class decreased from Class III to II in 3 patients, from Class III to I in one patient, and from Class IV to III in one patient. At 6 months, the distance walked in 6 min had increased from 352 +/- 48 to 437 +/- 56 m (p = 0.06). At one month the mean systolic PAP was 58 +/- 13 vs 81 +/- 9 mm Hg at baseline (p = 0.04). At 6 months the mean systolic PAP was 57 +/- 13 mm Hg (p = 0.06). The improvement of both clinical and hemodynamic status was maintained in the 2 patients treated for 2 years. Neither adverse effects nor need to increase the daily dose of iloprost were observed. One patient died of right heart failure and one patient did not experience any improvement of exercise tolerance and hemodynamics. Aerosolized iloprost might be potentially useful as treatment for CREST syndrome associated pulmonary hypertension. However, patients who could benefit from this treatment will probably have to undergo careful criteria selection.

  20. Cohort Study: Central Venous Catheter-Related Complications in Children with Hematologic Diseases at a Single Center

    Science.gov (United States)

    Pektaş, Ayhan; Kara, Ateş; Gurgey, Aytemiz

    2015-01-01

    Objective: This study aims to document and analyze the central venous catheter (CVC)-related complications in children with hematological diseases who were treated within a single institution. Materials and Methods: A retrospective investigation was conducted in 106 pediatric patients in whom 203 CVCs were inserted. A total of 175 catheter-related complications occurred in 5 years. Results: The rates of clinical catheter infections, local catheter infections, venous thromboembolism, bleeding, and mechanical complications were 2.6, 1.1, 0.2, 0.2, and 0.2 per 1000 catheter days. Methicillin-resistant Staphylococcus epidermidis was the predominant infectious organism in blood and catheter cultures. The children with leukemia had a significantly higher frequency of clinical catheter infections (p=0.046). The children who underwent bone marrow transplantation had a significantly lower frequency of clinical catheter infections (p=0.043) and higher frequency of local catheter infections (p=0.003). The children with implanted catheters had a significantly lower frequency of clinical catheter infections (p=0.048). The children with thrombocytopenia had significantly fewer local catheter infections and significantly more clinical catheter infections and catheter-related bleeding (respectively p=0.001, p=0.042, and p=0.024). Conclusion: Leukemia, bone marrow transplantation, and thrombocytopenia are risk factors for CVC-associated complications. The relatively higher number of interventions performed via permanent catheters may be responsible for the significantly increased incidence of systemic infections and mechanical injury. PMID:26316482

  1. Cohort Study: Central Venous Catheter-Related Complications in Children with Hematologic Diseases at a Single Center

    Directory of Open Access Journals (Sweden)

    Ayhan Pektaş

    2015-06-01

    Full Text Available INTRODUCTION: This study aims to document and analyze the central venous catheter (CVC-related complications in children with hematological diseases who were treated within a single institution. METHODS: A retrospective investigation was conducted in 106 pediatric patients in whom 203 CVCs were inserted. A total of 175 catheter-related complications occurred in 5 years. RESULTS: The rates of clinical catheter infections, local catheter infections, venous thromboembolism, bleeding, and mechanical complications were 2.6, 1.1, 0.2, 0.2, and 0.2 per 1000 catheter days. Methicillin-resistant Staphylococcus epidermidis was the predominant infectious organism in blood and catheter cultures. The children with leukemia had a significantly higher frequency of clinical catheter infections (p=0.046. The children who underwent bone marrow transplantation had a significantly lower frequency of clinical catheter infections (p=0.043 and higher frequency of local catheter infections (p=0.003. The children with implanted catheters had a significantly lower frequency of clinical catheter infections (p=0.048. The children with thrombocytopenia had significantly fewer local catheter infections and significantly more clinical catheter infections and catheter-related bleeding (respectively p=0.001, p=0.042, and p=0.024. DISCUSSION AND CONCLUSION: Leukemia, bone marrow transplantation, and thrombocytopenia are risk factors for CVC-associated complications. The relatively higher number of interventions performed via permanent catheters may be responsible for the significantly increased incidence of systemic infections and mechanical injury.

  2. Multidetector row CT angiography of living related renal donors: Is there a need for venous phase imaging?

    Energy Technology Data Exchange (ETDEWEB)

    Namasivayam, Saravanan [Department of Radiology, Division of Abdominal Imaging, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322 (United States); Kalra, Mannudeep K. [Department of Radiology, Division of Abdominal Imaging, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322 (United States); Waldrop, Sandra M. [Department of Radiology, Division of Abdominal Imaging, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322 (United States); Mittal, Pardeep K. [Department of Radiology, Division of Abdominal Imaging, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322 (United States); Small, William C. [Department of Radiology, Division of Abdominal Imaging, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322 (United States)]. E-mail: wsmall@emory.edu

    2006-09-15

    Objective: To prospectively evaluate whether renal venous anatomy can be detected from arterial phase images of multidetector row CT (MDCT) of renal donors. Material and methods: Institutional review board approved our study protocol with waiver of consent. Forty-eight consecutive renal donors (age range, 21-56 years; M:F, 20:28) referred for MDCT evaluation were included. Two sub-specialty radiologists performed an independent and separate evaluation of renal venous anatomy in arterial and venous phase images. Opacification of renal venous structures was scored on a five-point scale (1-not seen; 3-minimal opacification; 5-excellent opacification). Arterial and venous phase opacification scores were compared by Wilcoxon signed rank test. Results: Both readers detected all renal venous anomalies in arterial as well as venous phase images. Each reader detected accessory right renal veins (n = 14), retroaortic left renal vein (n = 2), circumaortic left renal vein (n = 1), and left renal hilar arteriovenous malformation (n = 1) in arterial phase images. Retroaortic left renal venous branch was difficult to differentiate from lumbar vein (reader-1, n = 1; reader-2, n = 2) in both arterial and venous phase images. Sensitivity of detection of renal veins, left adrenal, gonadal and lumbar veins in arterial phase images was 100, 83-88, 100, and 85-90%, respectively. As expected, venous phase images showed significantly greater opacification of renal veins, left gonadal, adrenal and lumbar veins (p < .05). However, this did not substantially limit the evaluation of renal venous anatomy in arterial phase images. Both readers had substantial interobserver agreement (kappa coefficient, 0.7; p < 0.05). Conclusions: Arterial phase MDCT images alone can be used to detect renal venous anomalies, and to identify small left renal venous branches namely, the left gonadal, adrenal and lumbar veins in renal donors. Venous phase MDCT acquisition is not necessary for evaluation of renal

  3. Is immune system-related hypertension associated with ovarian hormone deficiency?

    Science.gov (United States)

    Sandberg, Kathryn; Ji, Hong; Einstein, Gillian; Au, April; Hay, Meredith

    2016-03-01

    What is the topic of this review? This review summarizes recent data on the role of ovarian hormones and sex in inflammation-related hypertension. What advances does it highlight? The adaptive immune system has recently been implicated in the development of hypertension in males but not in females. The role of the immune system in the development of hypertension in women and its relationship to ovarian hormone production are highlighted. The immune system is known to contribute to the development of high blood pressure in males. However, the role of the immune system in the development of high blood pressure in females and the role of ovarian hormones has only recently begun to be studied. In animal studies, both the sex of the host and the T cell are critical biological determinants of susceptibility and resistance to hypertension induced by angiotensin II. In women, natural menopause is known to result in significant changes in the expression of genes regulating the immune system. Likewise, in animal models, ovariectomy results in hypertension and an upregulation in T-cell tumour necrosis factor-α-related genes. Oestrogen replacement results in decreases in inflammatory genes in the brain regions involved in blood pressure regulation. Together, these studies suggest that the response of the adaptive immune system to ovarian hormone deficiency is a significant contributor to hypertension in women. © 2015 The Authors. Experimental Physiology © 2015 The Physiological Society.

  4. [Idiopathic intracranial hypertension: a rare case related to pregnancy].

    Science.gov (United States)

    Drissi, Jihad; Hachi, Ayman; Adlani, Laila; Kouach, Jaouad; Moussaoui, Driss; Dehayni, Mohamed

    2017-01-01

    We report the case of a 25-year old primipara whose pregnancy was complicated by idiopathic intracranial hypertension (ICHT) associated with visual impairment in the first quarter. She underwent lumboperitoneal shunt without obstetric consequences. This study aimed to determine the features of this rare pathological entity whose pathophysiological mechanism is poorly elucidated. It would be caused by poor absorption of cerebrospinal fluid (CSF) through the arachnoid granulations. Major risk factors are: obesity, polycystic ovary syndrome, thrombophilia and hyperfibrinolyse. Diagnosis is based on modified Dandy criteria after negative clinico-biological and radiological assessment. Visual prognosis is compromised, as in the case of « classical » ICHT. However, there is no risk for cerebral involvements which could be life-threatening. In addition, this disease does not influence pregnancy outcome. This said, rapid and effective treatment should be implemented in order to preserve visual function in these patients.

  5. Parenchymal abnormalities associated with developmental venous anomalies

    Energy Technology Data Exchange (ETDEWEB)

    San Millan Ruiz, Diego; Gailloud, Philippe [Johns Hopkins Hospital, Division of Interventional Neuroradiology, Baltimore, MD (United States); Delavelle, Jacqueline [Geneva University Hospital, Neuroradiology Section, Department of Radiology and Medical Informatics, Geneva (Switzerland); Yilmaz, Hasan; Ruefenacht, Daniel A. [Geneva University Hospital, Section of Interventional Neuroradiology, Department of Clinical Neurosciences, Geneva (Switzerland); Piovan, Enrico; Bertramello, Alberto; Pizzini, Francesca [Verona City Hospital, Service of Neuroradiology, Verona (Italy)

    2007-12-15

    To report a retrospective series of 84 cerebral developmental venous anomalies (DVAs), focusing on associated parenchymal abnormalities within the drainage territory of the DVA. DVAs were identified during routine diagnostic radiological work-up based on magnetic resonance imaging (MRI) (60 cases), computed tomography (CT) (62 cases) or both (36 cases). Regional parenchymal modifications within the drainage territory of the DVA, such as cortical or subcortical atrophy, white matter density or signal alterations, dystrophic calcifications, presence of haemorrhage or a cavernous-like vascular malformation (CVM), were noted. A stenosis of the collecting vein of the DVA was also sought for. Brain abnormalities within the drainage territory of a DVA were encountered in 65.4% of the cases. Locoregional brain atrophy occurred in 29.7% of the cases, followed by white matter lesions in 28.3% of MRI investigations and 19.3% of CT investigations, CVMs in 13.3% of MRI investigations and dystrophic calcification in 9.6% of CT investigations. An intracranial haemorrhage possibly related to a DVA occurred in 2.4% cases, and a stenosis on the collecting vein was documented in 13.1% of cases. Parenchymal abnormalities were identified for all DVA sizes. Brain parenchymal abnormalities were associated with DVAs in close to two thirds of the cases evaluated. These abnormalities are thought to occur secondarily, likely during post-natal life, as a result of chronic venous hypertension. Outflow obstruction, progressive thickening of the walls of the DVA and their morphological organization into a venous convergence zone are thought to contribute to the development of venous hypertension in DVA. (orig.)

  6. Social media in communicating health information: an analysis of Facebook groups related to hypertension.

    Science.gov (United States)

    Al Mamun, Mohammad; Ibrahim, Hamza M; Turin, Tanvir Chowdhury

    2015-01-29

    We studied Facebook groups related to hypertension to characterize their objectives, subject matter, member sizes, geographical boundaries, level of activity, and user-generated content. We performed a systematic search among open Facebook groups using the keywords "hypertension," "high blood pressure," "raised blood pressure," and "blood pressure." We extracted relevant data from each group's content and developed a coding and categorizing scheme for the whole data set. Stepwise logistic regression was used to explore factors independently associated with each group's level of activity. We found 187 hypertension-related Facebook groups containing 8,966 members. The main objective of most (59.9%) Facebook groups was to create hypertension awareness, and 11.2% were created primarily to support patients and caregivers. Among the top-displayed, most recent posts (n = 164), 21.3% were focused on product or service promotion, whereas one-fifth of posts were related to hypertension-awareness information. Each Facebook group's level of activity was independently associated with group size (adjusted odds ratio [AOR], 1.02; 95% confidence interval [CI], 1.01-1.03), presence of "likes" on the most recent wall post (AOR, 3.55, 95% CI, 1.41-8.92), and presence of attached files on the group wall (AOR, 5.01, 95% CI, 1.25-20.1). The primary objective of most of the hypertension-related Facebook groups observed in this study was awareness creation. Compared with the whole Facebook community, the total number of hypertension-related Facebook groups and their users was small and the groups were less active.

  7. Circulating levels of p,p'-DDE are related to prevalent hypertension in the elderly

    Energy Technology Data Exchange (ETDEWEB)

    Lind, P. Monica, E-mail: monica.lind@medsci.uu.se [Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Ulleråkersvägen 40, 751 85 Uppsala (Sweden); Penell, Johanna [Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Ulleråkersvägen 40, 751 85 Uppsala (Sweden); Salihovic, Samira; Bavel, Bert van [MTM Research Center, School of Science and Technology, Örebro University, Örebro (Sweden); Lind, Lars [Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala (Sweden)

    2014-02-01

    Background: Polychlorinated biphenyls (PCBs) and dioxin given to experimental animals increase the blood pressure. We therefore investigated if circulating levels of persistent organic pollutants (POPs) were related to hypertension in a population-based sample of men and women. Methods: One thousand and sixteen subjects aged 70 years were investigated in the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. Twenty-three POPs were analyzed using high-resolution gas chromatography/high-resolution mass spectrometry (HRGC/HRMS). Hypertension was defined as a systolic blood pressure ≥140 mmHg or a diastolic blood pressure ≥90 mmHg, and/or use of antihypertensive medication. Results: Seven hundred and thirty-two subjects (72%) showed hypertension. When the POPs were treated as continuous variables and adjusted for gender only, two PCBs with a low number of chlorine atoms (PCB 105 and 118) were related to prevalent hypertension. Also the OC pesticide p,p'-DDE was related to hypertension. The strongest of these associations was seen for p,p'-DDE (OR 1.35 for a 1 SD change, 95% CI 1.17–1.56, p<0.0001). Following further adjustment also for BMI, smoking status, education level and exercise habits, only p,p'-DDE was still significantly related to hypertension (OR 1.23 for a 1 SD change, 95% CI 1.06–1.43, p=0.006). Conclusion: In this cross-sectional analysis of an elderly population, high levels of circulating levels of p,p'-DDE were associated with prevalent hypertension, further strengthening the experimental findings that POPs might influence blood pressure. - Highlights: • We evaluated the relation between POPs and hypertension. • Cross sectional data from a cohort of elderly men and women were analyzed. • The main exposure was circulating levels of 23 different POPs. • Hypertension was defined as ≥140/90 mmHg and/or antihypertensive treatment. • High levels of p,p'-DDE were associated with

  8. Obesity-related hypertension: pathogenesis, cardiovascular risk, and treatment: a position paper of The Obesity Society and the American Society of Hypertension.

    Science.gov (United States)

    Landsberg, Lewis; Aronne, Louis J; Beilin, Lawrence J; Burke, Valerie; Igel, Leon I; Lloyd-Jones, Donald; Sowers, James

    2013-01-01

    In light of the worldwide epidemic of obesity, and in recognition of hypertension as a major factor in the cardiovascular morbidity and mortality associated with obesity, The Obesity Society and the American Society of Hypertension agreed to jointly sponsor a position paper on obesity-related hypertension to be published jointly in the journals of each society. The purpose is to inform the members of both societies, as well as practicing clinicians, with a timely review of the association between obesity and high blood pressure, the risk that this association entails, and the options for rational, evidenced-based treatment. The position paper is divided into six sections plus a summary as follows: pathophysiology, epidemiology and cardiovascular risk, the metabolic syndrome, lifestyle management in prevention and treatment, pharmacologic treatment of hypertension in the obese, and the medical and surgical treatment of obesity in obese hypertensive patients. © 2012 Wiley Periodicals, Inc.

  9. Calcitonin gene-related peptide (CGRP receptors are important to maintain cerebrovascular reactivity in chronic hypertension.

    Directory of Open Access Journals (Sweden)

    Zhenghui Wang

    Full Text Available Cerebral blood flow autoregulation (CA shifts to higher blood pressures in chronic hypertensive patients, which increases their risk for brain damage. Although cerebral vascular smooth muscle cells express the potent vasodilatatory peptides calcitonin gene-related peptide (CGRP and adrenomedullin (AM and their receptors (calcitonin receptor-like receptor (Calclr, receptor-modifying proteins (RAMP 1 and 2, their contribution to CA during chronic hypertension is poorly understood. Here we report that chronic (10 weeks hypertensive (one-kidney-one-clip-method mice overexpressing the Calclr in smooth muscle cells (CLR-tg, which increases the natural sensitivity of the brain vasculature to CGRP and AM show significantly better blood pressure drop-induced cerebrovascular reactivity than wt controls. Compared to sham mice, this was paralleled by increased cerebral CGRP-binding sites (receptor autoradiography, significantly in CLR-tg but not wt mice. AM-binding sites remained unchanged. Whereas hypertension did not alter RAMP-1 expression (droplet digital (dd PCR in either mouse line, RAMP-2 expression dropped significantly in both mouse lines by about 65%. Moreover, in wt only Calclr expression was reduced by about 70% parallel to an increase of smooth muscle actin (Acta2 expression. Thus, chronic hypertension induces a stoichiometric shift between CGRP and AM receptors in favor of the CGRP receptor. However, the parallel reduction of Calclr expression observed in wt mice but not CLR-tg mice appears to be a key mechanism in chronic hypertension impairing cerebrovascular reactivity.

  10. High altitude-related hypertensive crisis and acute kidney injury in an asymptomatic healthy individual.

    Science.gov (United States)

    Gilbert-Kawai, Edward; Martin, Daniel; Grocott, Michael; Levett, Denny

    2016-01-01

    High-altitude exposure causes a mild to moderate rise in systolic and diastolic blood pressure. This case report describes the first documented case of a hypertensive crisis at altitude, as well as the first report of the occurrence of acute kidney injury in the context of altitude-related hypertension. A healthy, previously normotensive 30-year old, embarked on a trek to Everest Base Camp (5300 m). During his 11-day ascent the subject developed increasingly worsening hypertension. In the absence of symptoms, the individual initially elected to remain at altitude as had previously been the plan. However, an increase in the severity of his hypertension to a peak of 223/119 mmHg resulted in a decision to descend. On descent he was found to have an acute kidney injury that subsequently resolved spontaneously. His blood pressure reverted to normal at sea level and subsequent investigations including a transthoracic echocardiogram, cardiac magnetic resonance imaging, renal ultrasound, and urinary catecholamines were normal. This report challenges the view that transient rises in blood pressure at altitude are without immediate risk. We review the evidence that altitude induces hypertension and discuss the implications for the management of hypertension at altitude.

  11. Relation of red cell distribution width with dipper and non-dipper hypertension

    Directory of Open Access Journals (Sweden)

    Eyup Buyukkaya

    2016-08-01

    Full Text Available Aim Red cell distribution width (RDW, an index of erythrocyte size, is associated with high risk for cardiovascular disease. Nondipping hypertension (HT is lack of nocturnal fall in blood pressure (BP. The association between RDW and non-dipping BP in normotensive and hypertensive patients was investigated. Methods A total of 170 patients were categorized into 4 groups: Normotensive-Dipper (NT-D, Normotensive-Non-dipper (NTND, Hypertensive-Dipper (HT-D and Hypertensive-Non-dipper (HT-ND. RDW and hs-CRP levels were measured. Results Hypertensive patients had higher RDW and hs-CRP levels (14.5 ± 0.87 vs.12.7 ± 0.66, p<0.001 for RDW; 0.99 ± 0.52 vs.0.63 ± 0.43, p<0.001 for hs-CRP. Besides, the RDW levels were higher in non-dippers (13.0 ± 0.63 vs.12.4 ± 0.55, p<0.001 for NT-ND and NT-D; 14.9 ± 0.78 vs.14.2 ± 0.82, p<0.001 for HT-ND and HT-D Conclusion RDW is elevated in non-dipping BP both in normotensive and hypertensive subjects, which may be related with increased inflammatory state.

  12. Venous thrombosis: an overview

    Energy Technology Data Exchange (ETDEWEB)

    Peterson, C.W.

    1986-07-01

    Venous thromboembolic disease contributes to morbidity and mortality in certain groups of hospitalized patients, particularly those who have undergone surgery. Although principles of treatment have changed relatively little during the past 20 years, significant advances have been made in the diagnosis of deep vein thrombosis (DVT). Venography, once the only reliable diagnostic technique, has been largely replaced by noninvasive tests: impedance plethysmography, venous Doppler, /sup 125/I-radiofibrinogen-uptake test, and phleborheography. Virchow's triad of stasis, vessel injury, and hypercoagulability remains a valid explanation of the pathogenesis of thrombus formation, but laboratory and clinical data have refined our knowledge of how these factors interact to result in clinically significant disease. Knowledge of the natural history of venous thrombosis, plus heightened awareness of the long-term morbidity and expense associated with the postphlebitic syndrome, have led to increased interest in preventing DVT. Clinically and economically, venous thrombosis is best managed by prevention. 61 references.

  13. Nutrition and health-related quality of life among people with hypertension

    OpenAIRE

    Patrícia Costa dos Santos da Silva; Silvana Maria Coelho Leite Fava; Juliana Pereira Machado; Simone Maria Muniz da Silva Bezerra; Michelle Pita Tavares Gonçalves; Eugenia Velludo Veiga

    2015-01-01

    Aimed at analyzing the association between diet and health-related quality of life of people with systemic arterial hypertension. A descriptive-analytic study of 397 hypertensive people conducted from April to July 2013 attended by a family health strategy center unit in south Minas Gerais, MG, Brazil. The Minichal instrument was used for evaluating health-related quality of life and another instrument was used for nutrition. The average value found in the Minichal instrument was 4.2 in the m...

  14. The risk of catheter-related bloodstream infection with femoral venous catheters as compared to subclavian and internal jugular venous catheters: a systematic review of the literature and meta-analysis.

    Science.gov (United States)

    Marik, Paul E; Flemmer, Mark; Harrison, Wendy

    2012-08-01

    Catheter-related bloodstream infections are an important cause of morbidity and mortality in hospitalized patients. Current guidelines recommend that femoral venous access should be avoided to reduce this complication (1A recommendation). However, the risk of catheter-related bloodstream infections from femoral as compared to subclavian and internal jugular venous catheterization has not been systematically reviewed. A systematic review of the literature to determine the risk of catheter-related bloodstream infections related to nontunneled central venous catheters inserted at the femoral site as compared to subclavian and internal jugular placement. MEDLINE, Embase, Cochrane Register of Controlled Trials, citation review of relevant primary and review articles, and an Internet search (Google). Randomized controlled trials and cohort studies that reported the frequency of catheter-related bloodstream infections (infections per 1,000 catheter days) in patients with nontunneled central venous catheters placed in the femoral site as compared to subclavian or internal jugular placement. Data were abstracted on study design, study size, study setting, patient population, number of catheters at each insertion site, number of catheter-related bloodstream infections, and the prevalence of deep venous thrombosis. Studies were subgrouped according to study design (cohort and randomized controlled trials). Meta-analytic techniques were used to summarize the data. Two randomized controlled trials (1006 catheters) and 8 cohort (16,370 catheters) studies met the inclusion criteria for this systematic review. Three thousand two hundred thirty catheters were placed in the subclavian vein, 10,958 in the internal jugular and 3,188 in the femoral vein for a total of 113,652 catheter days. The average catheter-related bloodstream infections density was 2.5 per 1,000 catheter days (range 0.6-7.2). There was no significant difference in the risk of catheter-related bloodstream

  15. A rare association of cerebral dural arteriovenous fistula with venous aneurysm and contralateral flow-related middle cerebral artery aneurysm.

    Science.gov (United States)

    Onu, David O; Hunn, Andrew W; Harle, Robin A

    2013-09-19

    The association of cerebral dural arteriovenous fistula (DAVF) and ipsilateral flow related aneurysm has infrequently been reported. We describe a male patient who presented with an acute haemorrhagic stroke and was found to have a large right fronto-parietal intra-parenchymal haemorrhage from the ruptured Borden type II DAVF in addition to a large venous aneurysm and a flow related intraosseous aneurysm of the contralateral middle meningeal artery (MMA) all clearly delineated by CT and DSA. He underwent emergency stereotactic evacuation of the intraparenchymal haemorrhage and successful surgical treatment of all the vascular lesions at the same time with residual neurological deficit. To our knowledge, this is the first such reported case. We discuss the challenging surgical treatment, emphasising the role of CT/DSA in management, and provide a literature review.

  16. Patient-related barriers to hypertension control in a Nigerian population

    Directory of Open Access Journals (Sweden)

    Okwuonu CG

    2014-07-01

    Full Text Available Chimezie Godswill Okwuonu,1 Nnamdi Ezekiel Ojimadu,2 Enajite Ibiene Okaka,3 Fatai Momodu Akemokwe41Nephrology Unit, Department of Internal Medicine, 2Department of Family Medicine, Federal Medical Center Umuahia, Abia State, 3Renal Unit, 4Neurology Unit, Department of Internal Medicine University of Benin Teaching Hospital, Benin City, NigeriaBackground: Hypertension control is a challenge globally. Barriers to optimal control exist at the patient, physician, and health system levels. Patient-related barriers in our environment are not clear. The aim of this study was to identify patient-related barriers to control of hypertension among adults with hypertension in a semiurban community in South-East Nigeria.Methods: This was a cross-sectional descriptive study of patients with a diagnosis of hypertension and on antihypertensive medication.Results: A total of 252 participants were included in the survey, and comprised 143 males (56.7% and 109 females (43.3%. The mean age of the participants was 56.6±12.7 years, with a diagnosis of hypertension for a mean duration of 6.1±3.3 years. Among these patients, 32.9% had controlled blood pressure, while 39.3% and 27.8%, respectively, had stage 1 and stage 2 hypertension according to the Seventh Report of the Joint National Committee on Prevention, Detection and Evaluation of High Blood Pressure. Only 23.4% knew the consequences of poor blood pressure control and 64% were expecting a cure from treatment even when the cause of hypertension was not known. Furthermore, 68.7% showed low adherence to medication, the reported reasons for which included forgetfulness (61.2%, financial constraints (56.6%, high pill burden (22.5%, side effects of medication (17.3%, and low measured blood pressure (12.1%. Finally, knowledge and practice of the lifestyle modifications necessary for blood pressure control was inadequate among the participants.Conclusion: Poor knowledge regarding hypertension, unrealistic

  17. Venous Ulcers

    Science.gov (United States)

    Caprini, J.A.; Partsch, H.; Simman, R.

    2013-01-01

    Venous leg ulcers are the most frequent form of wounds seen in patients. This article presents an overview on some practical aspects concerning diagnosis, differential diagnosis and treatment. Duplex ultrasound investigations are essential to ascertain the diagnosis of the underlying venous pathology and to treat venous refluxes. Differential diagnosis includes mainly other vascular lesions (arterial, microcirculatory causes), hematologic and metabolic diseases, trauma, infection, malignancies. Patients with superficial venous incompetence may benefit from endovenous or surgical reflux abolition diagnosed by Duplex ultrasound. The most important basic component of the management is compression therapy, for which we prefer materials with low elasticity applied with high initial pressure (short-stretch bandages and Velcro-strap devices). Local treatment should be simple, absorbing and not sticky dressings keeping adequate moisture balance after debridement of necrotic tissue and biofilms are preferred. After the ulcer is healed compression therapy should be continued in order to prevent recurrence. PMID:26236636

  18. Central venous catheter-related infection in a prospective and observational study of 2,595 catheters

    Science.gov (United States)

    Lorente, Leonardo; Henry, Christophe; Martín, María M; Jiménez, Alejandro; Mora, María L

    2005-01-01

    Introduction Central venous catheterization is commonly used in critically ill patients and may cause different complications, including infection. Although there are many studies about CVC-related infection, very few have analyzed it in detail. The objective of this study was to analyze the incidence of catheter-related local infection (CRLI) and catheter-related bloodstream infection (CRBSI) with central venous catheters (CVCs) according to different access sites. Methods This is a prospective and observational study, conducted in a 24-bed medical surgical intensive care unit of a 650-bed university hospital. All consecutive patients admitted to the ICU during 3 years (1 May 2000 and 30 April 2003) were included. Results The study included 2,018 patients. The number of CVCs and days of catheterization duration were: global, 2,595 and 18,999; subclavian, 917 and 8,239; jugular, 1,390 and 8,361; femoral, 288 and 2,399. CRLI incidence density was statistically higher for femoral than for jugular (15.83 versus 7.65, p < 0.001) and subclavian (15.83 versus 1.57, p < 0.001) accesses, and higher for jugular than for subclavian access (7.65 versus 1.57, p < 0.001). CRBSI incidence density was statistically higher for femoral than for jugular (8.34 versus 2.99, p = 0.002) and subclavian (8.34 versus 0.97, p < 0.001) accesses, and higher for jugular than for subclavian access (2.99 versus 0.97, p = 0.005). Conclusion Our results suggest that the order for punction, to minimize the CVC-related infection risk, should be subclavian (first order), jugular (second order) and femoral vein (third order). PMID:16280064

  19. Diabetes mellitus and hypertension have comparable adverse effects on health-related quality of life

    Directory of Open Access Journals (Sweden)

    Metelko Željko

    2010-01-01

    Full Text Available Abstract Background We aimed to assess health-related quality of life (HRQoL among people with diabetes or hypertension, estimate the effect of cardiovascular comorbidities on HRQoL as well as compare HRQoL in these groups with that of healthy individuals. Methods A total of 9,070 respondents aged 18 years and over were assessed for HRQoL. Data were obtained from the Croatian Adult Health Survey. Respondents were divided into five groups according to their medical history: participants with hypertension (RR, hypertension and cardiovascular comorbidities (RR+, diabetes mellitus (DM, diabetes and cardiovascular comorbidities (DM+ and participants free of these conditions (healthy individuals, HI. HRQoL was assessed on 8 dimensions of the SF-36 questionnaire. Results Participants with diabetes and those with hypertension reported comparably limited (p > 0.05 HRQoL in all dimensions of SF-36, compared with healthy individuals (p 0.05 than participants without such comorbidities (p Conclusion Diabetes and hypertension seem to comparably impair HRQoL. Cardiovascular comorbidities further reduce HRQoL in participants with both chronic conditions. Future research of interventions aimed at improving these participants' HRQoL is needed.

  20. Hypertension and related risk factors in type 2 diabetes mellitus (DM ...

    African Journals Online (AJOL)

    Introduction: This cross sectional study was done in Gaborone City Council clinics in Botswana. Objective: The aim of the study was to determine the prevalence of hypertension and related cardiovascular risk factors among DM patients. Methods: A total of 401 patients were included in a cross sectional study during a ...

  1. Plasma Parathyroid Hormone Is Independently Related to Nocturnal Blood Pressure in Hypertensive Patients : The Styrian Hypertension Study

    NARCIS (Netherlands)

    Verheyen, Nicolas D; Kienreich, Katharina; Gaksch, Martin; van Ballegooijen, Adriana J; Grübler, Martin R; Hartaigh, Briain Ó; Schmid, Johannes; Fahrleitner-Pammer, Astrid; Kraigher-Krainer, Elisabeth; Colantonio, Caterina; Belyavskiy, Evgeny; Treiber, Gerlies; Catena, Cristiana; Brussee, Helmut; Pieske, Burkert; März, Winfried; Tomaschitz, Andreas; Pilz, Stefan

    High parathyroid hormone (PTH) has been linked with high blood pressure (BP), but the relationship with 24-hour ambulatory blood pressure monitoring is largely unknown. The authors therefore analyzed cross-sectional data of 292 hypertensive patients participating in the Styrian Hypertension Study

  2. Relation between exercise-induced hypertension and sustained hypertension in adult patients after successful repair of aortic coarctation

    NARCIS (Netherlands)

    Vriend, Joris W. J.; van Montfrans, Gert A.; Romkes, Hans H.; Vliegen, Hubert W.; Veen, Gerrit; Tijssen, Jan G. P.; Mulder, Barbara J. M.

    2004-01-01

    Objectives To investigate whether exercise-induced hypertension in successfully repaired adult post-coarctectomy patients is associated with hypertension on 24-h blood pressure measurement and increased left ventricular mass. Methods One hundred and forty-four consecutive postcoarctectomy patients

  3. [Incident and related risk factors of hypertension in women with a history of preeclampsia].

    Science.gov (United States)

    Zhou, Yuheng; Niu, Jianmin; Duan, Dongmei; Wen, Jiying; Lin, Xiaohong; Lei, Qiong; Lyu, Lijuan

    2014-07-01

    To investigate the prevalence of hypertension in women with a history of preeclampsia (PE) and to estimate related risk factors. In this prospective case-control study, we collected clinical data from 809 women with a history of PE and 3 421 women with normal pregnancy from January 2008 to June 2012. Between November 2012 and April 2013, 651 women in PE group and 2 684 women with normal pregnancy group were recruited at the same time for collecting postpartum data including blood pressure, blood glucose and blood lipid. Binary logistic regression analysis was applied to analyze the relative factors of postpartum blood pressure. Prevalence of hypertension in PE group was higher than those with normal pregnancy (17.2% (112/651) vs. 1.1% (30/2 684), P hypertension in severe PE and mild PE patients was similar (20.1% (58/289) vs. 15.2% (55/362), P = 0.103). Binary logistic regression analysis indicated that progestational body mass index (OR = 1.379, 95% CI: 1.257-1.510, P blood pressure (OR = 1.025, 95%CI:1.012-1.040, P blood glucose (OR = 1.733, 95% CI: 1.047-2.870, P blood pressure difference between antepartum and postpartum (OR = 1.024, 95% CI :1.011-1.037, P hypertension after pregnancy. Women with history of PE are associated with higher risk of postpartum hypertension. Increased blood pressure, abnormal glucose and lipid metabolism during pregnancy are major risk factors for postpartum hypertension.

  4. [Research on potential interaction between mitochondrial DNA copy number and related factors on risk of hypertension in coal miners].

    Science.gov (United States)

    Guo, J Y; Lei, L J; Qiao, N; Fan, G Q; Sun, C M; Huang, J J; Wang, T

    2017-01-10

    Objective: To investigate the effects of mitochondrial DNA (mtDNA) copy number in peripheral blood and related factors on the risk of hypertension in coal miners. Methods: A case-control study was conducted in 378 coal miners with hypertension and 325 healthy coal miners recruited from Datong Coal Mine Group. A standard questionnaire was used to collect their general information, such as demographic characteristics, habits and occupational history. Fluorescence quantitative PCR was performed to detect the copy number of mtDNA. Logistic regression model was applied for identifying the related risk factors of hypertension and analyzing the interaction between mtDNA copy number and risk factors. Results: The prevalence of hypertension of high mtDNA copy number was lower than mtDNA copy numberin 0-5.67 group, but the difference was not statistically significant (P=0.414). Alcohol drinking (OR=1.80, 95% CI: 1.26-2.56), family history of hypertension (OR=1.74, 95% CI: 1.20- 2.50), work shifts (OR=0.69, 95% CI: 0.48-0.99), education level (P=0.012) and family monthly income level (P=0.001) were related to the prevalence of hypertension. There were potential interactions between mtDNA copy number and alcohol drinking, family monthly income level, family history of hypertension, respectively. Alcohol drinking was a risk factor for hypertension [1.77 (1.25-2.50)]. Potential interactions between mtDNA copy number and alcohol drinking reduced the risk of hypertension (OR=1.20, 95% CI: 1.07-1.35). Family history of hypertension was a risk factor for hypertension [1.81(1.26-2.59)]. Potential interactions between mtDNA copy number and family history of hypertension reduced the risk of hypertension (OR=1.24, 95%CI: 1.09-1.41). Family monthly income level was a protect factor for hypertension [0.55(0.46-0.66)]. Potential interactions between mtDNA copy number and family monthly income level increased the protection role of hypertension (OR=0.90, 95% CI: 0.86-0.94). Conclusion: mt

  5. An instrument for measuring health-related quality of life in patients with Deep Venous Thrombosis (DVT: development and validation of Deep Venous Thrombosis Quality of Life (DVTQOL questionnaire

    Directory of Open Access Journals (Sweden)

    Stigendal Lennart

    2004-06-01

    Full Text Available Abstract Background Few studies have evaluated patient-reported outcomes in connection with a primary event of deep venous thrombosis, partly due to a lack of disease-specific measures. The aim here was to develop a disease-specific health-related quality of life (HRQL measure, the deep venous thrombosis quality of life questionnaire (DVTQOL, for patients with recent exposition and treatment of proximal deep venous thrombosis. Methods A total of 121 consecutive outpatients (50 % males; mean age 61.2 ± 14 years treated with warfarin (Waran® for symptomatic proximal deep venous thrombosis were included in the study. Patients completed the SF-36, EQ-5D and the pilot version of the DVTQOL. Results Items having: high ceiling and floor effect, items with lower factor loadings than 0.50 and items loading in several factors were removed from the pilot version of DVTQOL. In addition, overlapping and redundant items identified by the Rasch analysis were excluded. The final DVTQOL questionnaire consists of 29 items composing six dimensions depicting problems with: emotional distress; symptoms (e.g. pain, swollen ankles, cramp, bruising; limitation in physical activity; hassle with coagulation monitoring; sleep disturbance; and dietary problems. The internal consistency reliability was high (alpha value ranged from 0.79 to 0.93. The relevant domains of the SF-36 and EQ-5D significantly correlated with DVTQOL, thereby confirming its construct validity. Conclusions The DVTQOL is a short and user-friendly instrument with good reliability and validity. Its test-retest reliability and responsiveness to change in clinical trials, however, must be explored.

  6. Traditional Long-Term Central Venous Catheters Versus Transhepatic Venous Catheters in Infants and Young Children.

    Science.gov (United States)

    Marshall, Amanda Marie; Danford, David A; Curzon, Christopher L; Anderson, Venus; Delaney, Jeffrey W

    2017-10-01

    Children with congenital heart disease may require long-term central venous access for intensive care management; however, central venous access must also be preserved for future surgical and catheterization procedures. Transhepatic venous catheters may be an useful alternative. The objective of this study was to compare transhepatic venous catheters with traditional central venous catheters regarding complication rate and duration of catheter service. Retrospective review of 12 congenital heart disease patients from September 2013 to July 2015 who underwent placement of one or more transhepatic venous catheters. Single freestanding pediatric hospital located in the central United States. Pediatric patients with congenital heart disease who underwent placement of transhepatic venous catheter. Cohort's central venous catheter complication rates and duration of catheter service were compared with transhepatic venous catheter data. Twelve patients had a total of 19 transhepatic venous lines. Transhepatic venous lines had a significantly longer duration of service than central venous lines (p = 0.001). No difference between the two groups was found in the number of documented thrombi, thrombolytic burden, or catheter sites requiring wound care consultation. A higher frequency of infection in transhepatic venous lines versus central venous lines was found, isolated to four transhepatic venous lines that had a total of nine infections. All but one was successfully managed without catheter removal. The difference in the proportion of infections to catheters in transhepatic venous lines versus central venous lines was significant (p = 0.0001), but no difference in the rate of infection-related catheter removal was found. Without compromising future central venous access sites, transhepatic venous lines had superior duration of service without increased thrombosis, thrombolytic use, or insertion site complications relative to central venous lines. Transhepatic venous

  7. Age- and sex-related differences in diastolic function and cardiac dimensions in a hypertensive population.

    Science.gov (United States)

    Hoshida, Shiro; Shinoda, Yukinori; Ikeoka, Kuniyasu; Fukuoka, Hidetada; Inui, Hirooki; Watanabe, Tetsuya

    2016-12-01

    The prevalence of left ventricular diastolic dysfunction increases with age, particularly in hypertensive women. We aimed to determine the age- and sex-related differences in diastolic function, and its relation to alterations of cardiac dimensions in a hypertensive population. We enrolled 479 hypertensive patients with a left ventricular ejection fraction (LVEF) ≥50% (men/women, 267/212) and their echocardiographic parameters regarding LV performance and vascular function were measured. Left atrial volume index (LAVI) and operant diastolic elastance (EdI: E/e'/stroke volume index), but not LV mass index (LVMI), correlated weakly with age in both sexes. The arterial elastance index (EaI) and EdI did not differ significantly between sexes in any of the three age groups (A, age ≥75 years). The EdI indexed to EaI, EdI/EaI = E/e'/(0.9 × systolic blood pressure), was significantly more impaired in women than in men only in group C. There were significant differences in LAVI, LVMI, and EdI/EaI between groups B and C only in women. Impairment of diastolic function relative to arterial elasticity, EdI/EaI, occurred in elderly hypertensive women and was coincident with the alteration of cardiac dimensions. The coincidence with the changes in diastolic function and the alterations of cardiac dimensions occurred in a different time point between the sexes.

  8. Job stressors and other risk factors related to the risk of hypertension among selected employees in Jakarta

    Directory of Open Access Journals (Sweden)

    Feni Krisnawati

    2006-09-01

    Full Text Available Almost everyone, including employees, may develop hypertension. Several risk factors, including stresses in the work environment, are related to hypertension. The aim of this study is to identify these work-related risk factors in hypertension. A nested case-control study was conducted among office employees in Jakarta during May 2004. Employees with stage 1 or stage 2 hypertension (based on the United States of America Joint National Committee on high blood pressure 2003, or those taking antihypertensive drugs were designated as cases. As controls were employees with no history of hypertension. One case was randomly matched by gender with two controls. All risk factors for cases and controls were counted as of the reference date of diagnosis for cases. There were 70 cases and 140 controls aged 25 to 65 years. Hypertension was found to be related to the qualitative and quantitative increase in the workload, career development, age, obesity, current and past smoking habits, and a family history of hypertension. However, it was noted that role of ambiguity, role of conflict, and personal responsibility did not increase the risk of hypertension. Compared to those with low qualitative job stressor, those who had moderate or high qualitative job stressor had a seven-fold risk to be hypertensive [adjusted odds ratio (ORa = 7.47; 95% confidence interval (CI = 1.40-39.76]. In addition, relative to those who had low quantitative job stressor, those with moderate or high stressors were four times at risk to be hypertensive (ORa = 4.10; 95% CI = 1.06-15.90. In conclusion moderate or high qualitative and quantitative job stressors as well as career development increased risk hypertension. Therefore these stressors need to be prevented. (Med J Indones 2006; 15:177-84 Keywords: hypertension, qualitative job stressor, quantitative job stressor, career development

  9. Levels of prolactin in relation to coagulation factors and risk of venous thrombosis Results of a large population-based case-control study (MEGA-study)

    NARCIS (Netherlands)

    Stuijver, Danka J. F.; Debeij, Jan; van Zaane, Bregje; Dekkers, Olaf M.; Smit, Jan W. A.; Büller, Harry R.; Rosendaal, Frits R.; Gerdes, Victor E. A.; Cannegieter, Suzanne C.

    2012-01-01

    The pituitary hormone prolactin is thought to influence coagulation. We aimed to study the relation between prolactin levels, coagulation factors and risk of venous thrombosis (VT). We used data from a large population based case-control study into aetiology of first VT (MEGA-study). Prolactin

  10. Levels of prolactin in relation to coagulation factors and risk of venous thrombosis. Results of a large population-based case-control study (MEGA-study)

    NARCIS (Netherlands)

    Stuijver, D.J.; Debeij, J.; Zaane, B. van; Dekkers, O.M.; Smit, J.W.A.; Buller, H.R.; Rosendaal, F.R.; Gerdes, V.E.; Cannegieter, S.C.

    2012-01-01

    The pituitary hormone prolactin is thought to influence coagulation. We aimed to study the relation between prolactin levels, coagulation factors and risk of venous thrombosis (VT). We used data from a large population based case-control study into aetiology of first VT (MEGA-study). Prolactin

  11. Thrombophilic Gene Mutations in Relation to Different Manifestations of Venous Thromboembolism: A Single Tertiary Center Study.

    Science.gov (United States)

    Bezgin, Tahir; Kaymaz, Cihangir; Akbal, Özgür; Yılmaz, Fatih; Tokgöz, Hacer Ceren; Özdemir, Nihal

    2018-01-01

    Venous thromboembolism (VTE) is a common and potentially lethal disorder that manifests mainly as deep vein thrombosis (DVT) of the extremities or pulmonary embolism (PE) and occurs as a consequence of genetic and environmental risk factors. We aimed to assess the role of inherited thrombophilia as a causative or additive factor in the development of VTE. The study included 310 patients (female: 154; mean age: 52.3 ± 16.9 years) with a first episode of VTE and 289 age- and sex-matched healthy controls. All participants underwent screening for thrombophilia-associated polymorphisms including factor V Leiden (FVL), prothrombin G20210A (PTG), factor V H1299 R (factor V HR2), factor XIII V34 L, β-fibrinogen-455 G>A, plasminogen activator inhibitor-1 4G/5G, human platelet antigen-1 a/b, methylene tetrahydrofolate reductase (MTHFR) C677 T, MTHFR A1298C, angiotensin-converting enzyme I/D, apolipoprotein B R3500Q, and apolipoprotein E (Apo E). In addition, serum homocysteine (Hcy) levels were measured. In the patient group, 247 (80%) had isolated DVT, 43 (14%) had DVT plus PE, and 20 (6%) had isolated PE. The mean Hcy levels were similar in VTE subgroups and controls. Compared to controls, patients with isolated DVT, DVT plus PE, and isolated PE showed significantly higher frequencies for the following-heterozygous FVL mutation, isolated DVT (28.3%), DVT plus PE (44.2%), isolated PE (50%), controls (8.3%; P < .001); heterozygous PTG mutation, isolated DVT (11.3%), DVT plus PE (20.9%), isolated PE (25%), controls (5.9%; P < .01); Apo E 2/4, isolated DVT (9.7%), DVT plus PE (9.3%), isolated PE (5%), controls (1%; P < .01).The MTHFR A1298C mutation showed a significantly higher frequency in isolated patients with PE than in those with isolated DVT ( P = .006) and in controls ( P = .008). The frequencies of other genetic mutations or polymorphisms showed similar frequencies in all comparisons. In logistic regression analysis, heterozygous FVL mutation was the only

  12. A pathway-based network analysis of hypertension-related genes

    Science.gov (United States)

    Wang, Huan; Hu, Jing-Bo; Xu, Chuan-Yun; Zhang, De-Hai; Yan, Qian; Xu, Ming; Cao, Ke-Fei; Zhang, Xu-Sheng

    2016-02-01

    Complex network approach has become an effective way to describe interrelationships among large amounts of biological data, which is especially useful in finding core functions and global behavior of biological systems. Hypertension is a complex disease caused by many reasons including genetic, physiological, psychological and even social factors. In this paper, based on the information of biological pathways, we construct a network model of hypertension-related genes of the salt-sensitive rat to explore the interrelationship between genes. Statistical and topological characteristics show that the network has the small-world but not scale-free property, and exhibits a modular structure, revealing compact and complex connections among these genes. By the threshold of integrated centrality larger than 0.71, seven key hub genes are found: Jun, Rps6kb1, Cycs, Creb312, Cdk4, Actg1 and RT1-Da. These genes should play an important role in hypertension, suggesting that the treatment of hypertension should focus on the combination of drugs on multiple genes.

  13. The Effect of Simulation Teaching on Baccalaureate Nursing Students' Self-confidence Related to Peripheral Venous Catheterization in Children: A Randomized Trial.

    Science.gov (United States)

    Valizadeh, Leila; Amini, Abolghasem; Fathi-Azar, Eskandar; Ghiasvandian, Shahrzad; Akbarzadeh, Bahareh

    2013-06-01

    In recent decades, nursing instructors have tended to use simulation rather than traditional methods due to benefits such as increased self-confidence. However, little academic literature is available to verify this claim. The procedure of establishing peripheral venous catheterization in pediatric patients is of great importance. Therefore, the researchers attempted to review the effect of the simulation teaching method on nursing students' self-confidence related to peripheral venous catheterization in pediatric patients. In this trial, 45 students in the 5(th) and 6(th) semester of nursing school in the first half of school year 2012 from the Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Iran, were randomly assigned to three groups (a control group, and two intervention groups). They were trained in establishing peripheral venous catheterization in pediatric patients through simulation teaching method and practical training. The students' self-confidence was assessed by C-Scale before and after the intervention. The students' self-confidence score showed a significant increase in the simulation group after the intervention in comparison to other groups (p = 0.03). RESULTS revealed a significant increase in self-confidence of nursing students related to peripheral venous catheterization in pediatric patients by simulation. This substantiates the assertion that simulation can improve self-confidence. Due to the low sample size, further studies with larger population are suggested.

  14. The standing heel-rise test: relation to chronic venous disorders and balance, gait, and walk time in injection drug users.

    Science.gov (United States)

    Pieper, Barbara; Templin, Thomas N; Birk, Thomas J; Kirsner, Robert S

    2008-09-01

    Injection drug use can impair mobility. When mobility is impaired in combination with other potential pathologic changes to the veins, muscles, and joints of the lower legs, chronic venous disorders can develop. The heel-rise test, an assessment of eccentric-concentric muscle action of calf muscle function with regard to plantar flexion, can be used to measure ankle mobility. To examine the test-retest reliability and construct validity of the heel-rise test in relation to chronic venous disorders in persons with a history of injection drug use (N = 104), a test-retest study (M = 45.9+/-12.9 days from first to second test) was conducted. Participants were assessed for chronic venous disorders of the legs and walk time; they also completed the heel-rise and Tinetti Balance and Gait tests. Test-retest reliability was found to be good for full heel rise of right and left legs (ICC = .66 and .67, respectively). Heel-rise performance was positively correlated with balance (r = .38 to .47) and gait (r = .38 to .45) and negatively related to walk time (r = -.30 to -.35) (P test as a measure of calf muscle function is supported by these results, implicating the role of mobility restriction in the etiology of venous disease. Although more research is needed regarding its performance, the heel-rise test may be a low-cost, noninvasive screening or assessment tool in a variety of outpatient settings.

  15. Lercanidipine/enalapril combination in the management of obesity-related hypertension

    Directory of Open Access Journals (Sweden)

    Grassi G

    2016-04-01

    Full Text Available Guido Grassi1,2 1Internal Medicine, Department of Health Science, Università Milano-Bicocca, Milano, Italy; 2Istituto di Ricerche a Carattere Scientifico (IRCCS Multimedica, Sesto San Giovanni, Milano, ItalyAbstract: Obesity-related hypertension represents a condition frequently observed in current clinical practice characterized by a complex pathophysiological background and a very high cardiovascular risk profile, particularly in severely obese individuals. This explains, on the one hand, the difficulty in reducing elevated blood pressure values in this pathological state and, on the other, the need to achieve this goal in a relatively short-time period to prevent the occurrence of fatal and nonfatal cardiovascular events. Both nonpharmacological and pharmacological measures are available in the therapeutic approach for this condition. Among the pharmacological interventions, a combination of two antihypertensive drugs represents the most common recommended strategy aimed at achieving blood pressure control. This paper, after briefly examining the main pathophysiological features of obesity-related hypertension, will review the importance in the treatment of this condition of the drug combination based on a calcium channel blocker and an angiotensin-converting enzyme inhibitor, with specific focus on lercanidipine/enalapril. Following an analysis of the main pharmacological properties of the combination, the results of the studies based on this pharmacological approach in obesity-related hypertension will be critically discussed. The efficacy, safety, and tolerability profile of the lercanidine/enalapril drug combination as well as its potential limitations will also be examined.Keywords: obesity-related hypertension, antihypertensive drug treatment, combination drug, lercanidipine/enalapril

  16. Related factors of serum uric acid in patients with primary hypertension and hyperhomocysteinemia.

    Science.gov (United States)

    Wang, Bei; Lin, Ling; Zhao, Chang

    2016-01-01

    To investigate the related factors of serum uric acid in patients with primary hypertension and hyperhomocysteinemia. One hundred and ten patients with primary hypertension and hyperhomocysteinemia (homocysteine levels >10 μmol/L) were enrolled into this study, ages from 18 years to 75 years. They were divided into the normal serum uric acid group which contained 74 cases patients (41 cases of male and 33 cases of female) and the hyperuricemia group which contained 36 cases patients (20 cases of male and 16 cases of female). Plasma concentrations of homocysteine, serum uric acid, serum folic acid, blood sugar, triglyceride, total cholesterol, serum low density lipoprotein cholesterol, serum high density lipoprotein cholesterol, blood urea nitrogen, and creatinine were detected in these patients, and the deference of them between the two groups was compared. And then the risk factors of serum uric acid with univariate analysis and multivariate analysis by logistic regression analysis were analyzed. The result of multivariate analysis showed that the incidence of serum uric acid in patients with primary hypertension and hyperhomocysteinemia had significant relationships with systolic blood pressure (OR [odds ratio]: 1.132, 95%CI [confidence interval]: 1.003~1.290, p = 0.043), diastolic blood pressure (OR: 1.353 95%CI: 1.023~1.789, p = 0.034, homocysteine (OR: 1.264, 95%CI: 1.016~1.573, p = 0.035), triglyceride (OR: 9.726, 95%CI: 1.288~73.466, p = 0.027), and creatinine (OR: 1.031, 95%CI: 1.005~1.508, p = 0.018). The indices of systolic blood pressure, diastolic blood pressure, homocysteine, triglyceride, and creatinine were important risk factors of serum uric acid in patients with primary hypertension and hyperhomocysteinemia. It is of great significance to measure multiple risk factors in patients with primary hypertension and hyperhomocysteinemia.

  17. Sympathetic nervous system in obesity-related hypertension: mechanisms and clinical implications

    Science.gov (United States)

    Kalil, Graziela Z; Haynes, William G

    2013-01-01

    Obesity markedly increases the risk of hypertension and cardiovascular disease, which may be related to activation of the sympathetic nervous system (SNS). Sympathetic overactivity directly and indirectly contributes to blood pressure (BP) elevation in obesity, including stimulation of the renin–angiotensin–aldosterone system (RAAS). The adipocyte-derived peptide leptin suppresses appetite, increases thermogenesis, but also raises SNS activity and BP. Obese individuals exhibit hyperleptinemia but are resistant to its appetite-suppressing actions. Interestingly, animal models of obesity exhibit preserved sympathoexcitatory and pressor actions of leptin, despite resistance to its anorexic and metabolic actions, suggesting selective leptin resistance. Disturbance of intracellular signaling at specific hypothalamic neural networks appears to underlie selective leptin resistance. Delineation of these pathways should lead to novel approaches to treatment. In the meantime, treatment of obesity–hypertension has relied on antihypertensive drugs. Although sympathetic blockade is mechanistically attractive in obesity–hypertension, in practice its effects are disappointing because of adverse metabolic effects and inferior outcomes. On the basis of subgroup analyses of obese patients in large randomized clinical trials, drugs such as diuretics and RAAS blockers appear superior in preventing cardiovascular events in obesity–hypertension. An underused alternative approach to obesity–hypertension is induction of weight loss, which reduces circulating leptin and insulin, partially reverses resistance to these hormones, decreases sympathetic activation and improves BP and other risk factors. Though weight loss induced by lifestyle is often modest and transient, carefully selected pharmacological weight loss therapies can produce substantial and sustained antihypertensive effects additive to lifestyle interventions. PMID:22048570

  18. Nutrition and health-related quality of life among people with hypertension

    Directory of Open Access Journals (Sweden)

    Patrícia Costa dos Santos da Silva

    2015-02-01

    Full Text Available Aimed at analyzing the association between diet and health-related quality of life of people with systemic arterial hypertension. A descriptive-analytic study of 397 hypertensive people conducted from April to July 2013 attended by a family health strategy center unit in south Minas Gerais, MG, Brazil. The Minichal instrument was used for evaluating health-related quality of life and another instrument was used for nutrition. The average value found in the Minichal instrument was 4.2 in the mental state domain and 3.4 in the domain of somatic manifestations. Most participants had partially adequate nutrition; 67.8% mentioned not receiving any advice or treatment for weight loss; obesity was present in 35.5%. It was concluded that diet is significantly associated with mental state.

  19. Assessment of CSF dynamics and venous flow in the superior sagittal sinus by MRI in idiopathic intracranial hypertension: a preliminary study

    DEFF Research Database (Denmark)

    Gideon, P; Sørensen, P S; Thomsen, C

    1994-01-01

    A velocity-sensitive magnetic resonance imaging (MRI) phase-mapping method was used for non-invasive study of cerebrospinal fluid (CSF) flow in the cerebral aqueduct, for indirect calculation of supratentorial CSF production, and for measurement of blood flow in the superior sagittal sinus (SSS......). We examined 12 patients with idiopathic intracranial hypertension (IIH; pseudotumour cerebri), and 10 healthy volunteers. The peak caudal and rostral CSF flow in the aqueduct during the cardiac cycle did not differ significantly between the patients and the volunteers. A significant correlation...

  20. Targeting on Asymmetric Dimethylarginine-Related Nitric Oxide-Reactive Oxygen Species Imbalance to Reprogram the Development of Hypertension

    Directory of Open Access Journals (Sweden)

    You-Lin Tain

    2016-12-01

    Full Text Available Adult-onset diseases, including hypertension, can originate from early life, known as the developmental origins of health and disease (DOHaD. Because the developing kidney is vulnerable to early-life insults, renal programming is considered key in the developmental programming of hypertension. Asymmetric dimethylarginine (ADMA, an endogenous nitric oxide (NO synthase inhibitor, can regulate the NO–reactive oxygen species (ROS balance, and is involved in the development of hypertension. Reprogramming interventions aimed at NO-ROS balance can be protective in both genetic and developmentally programmed hypertension. Here we review several emergent themes of the DOHaD approach regarding the impact of ADMA-related NO-ROS imbalance on programmed hypertension. We focus on the kidney in the following areas: mechanistic insights to interpret programmed hypertension; the impact of ADMA-related NO-ROS imbalance in both genetic and acquired animal models of hypertension; alterations of the renal transcriptome in response to ADMA in the developing kidney; and reprogramming strategies targeting ADMA-related NO-ROS balance to prevent programmed hypertension.

  1. Flow confirmation study for central venous port in oncologic outpatient undergoing chemotherapy: Evaluation of suspected system-related mechanical complications

    Energy Technology Data Exchange (ETDEWEB)

    Sofue, Keitaro, E-mail: ksofue@ncc.go.jp [Divisions of Diagnostic Radiology, National Cancer Center Hospital (Japan); Department of Radiology, Kobe University, Graduate School of Medicine (Japan); Arai, Yasuaki; Takeuchi, Yoshito [Divisions of Diagnostic Radiology, National Cancer Center Hospital (Japan); Sugimura, Kazuro [Department of Radiology, Kobe University, Graduate School of Medicine (Japan)

    2013-11-01

    Purpose: To evaluate the efficacy and outcome of a flow confirmation study (FCS) in oncologic outpatients undergoing chemotherapy suspected of a central venous port (CVP) system-related mechanical complication. Materials and methods: A total of 66 patients (27 men, 39 women; mean age, 60 years) received FCS for the following reasons: prolonged infusion time during chemotherapy (n = 32), inability to inject saline fluid (n = 15), lateral neck and/or back pain (n = 6), subcutaneous extravasation of anticancer drug (n = 5), arm swelling (n = 4), and inability to puncture the port (n = 4). FCS consisted of examining the position of CVP, potential secondary shifts or fractures, and integrity of the system using contrast material through the port. Results: Of the 66 patients, 43 had an abnormal finding uncovered by FCS. The most frequent abnormal findings was catheter kinking (n = 22). Explantation and reimplantation of the CVP system was required in 21 of the 66 patients. Remaining 45 patients were able continue using the CVP system after the FCS without any system malfunction. Conclusion: FCS was effective for evaluating CVP system-related mechanical complications and was useful for deciding whether CVP system explantation and reimplantation was required.

  2. Work stress related lipid disorders and arterial hypertension in professional drivers: A cross-sectional study

    OpenAIRE

    Đinđić, Nataša; Jovanović, Jovica; Đinđić, Boris; Jovanović, Milan; Pešić, Milica; Jovanović, Jovana J.

    2013-01-01

    Background/Aim. Occupational stress is a term used to define ongoing stress that is related to the workplace. The study was conducted to determine association of occupational stress index (OSI) and its aspects with arterial hypertension and lipid disorders using data from a cross-sectional survey of male professional drivers. Methods. The cross-sectional study was performed in 439 professional drivers divided into groups (city- and intercity bus drivers, truck and taxi drivers). The OSI...

  3. Chronic Complications After Femoral Central Venous Catheter-related Thrombosis in Critically Ill Children

    NARCIS (Netherlands)

    Sol, Jeanine J.; Knoester, Hennie; de Neef, Marjorie; Smets, Anne M. J. B.; Betlem, Aukje; van Ommen, C. Heleen

    2015-01-01

    Prescription of thromboprophylaxis is not a common practice in pediatric intensive care units. Most thrombi are catheter-related and asymptomatic, without causing acute complications. However, chronic complications of these (a)symptomatic catheter-related thrombi, that is, postthrombotic syndrome

  4. Incidence of catheter-related bloodstream infections in neonates following removal of peripherally inserted central venous catheters.

    Science.gov (United States)

    Casner, Michael; Hoesli, Sandra J; Slaughter, James C; Hill, Melissa; Weitkamp, Jörn-Hendrik

    2014-01-01

    Catheter-associated bloodstream infections are a significant source of morbidity and healthcare cost in the neonatal ICU. Previous studies examining the prevalence of bloodstream infections after removal of peripherally inserted central venous catheters in neonates are equivocal. A retrospective cohort study. All infants with peripherally inserted central venous catheters treated at the Vanderbilt neonatal ICU between 2007 and 2009. We evaluated the following outcomes: 1) bloodstream infections, 2) culture-negative sepsis, 3) number of sepsis evaluations, and 4) number of significant apnea/bradycardia events comparing odds ratios between 72 hours before and 72 hours after peripherally inserted central venous catheter removal. We analyzed a total of 1,002 peripherally inserted central venous catheters in 856 individual infants with a median (interquartile range) gestational age of 31 weeks (28-37 wk) and a median birth weight of 1,469 g (960-2,690 g). Comparing 72 hours before with 72 hours after peripherally inserted central venous catheter removal did not show a difference in the prevalence of bloodstream infections (9 vs 3, p = 0.08), prevalence of culture-negative sepsis (37 vs 40, p = 0.73), number of sepsis evaluations (p = 0.42), or number of apnea/bradycardia events (p = 0.32). However, in peripherally inserted central venous catheter not used for delivery of antibiotics, there was a 3.83-fold increase in odds for culture-negative sepsis following peripherally inserted central venous catheter removal (95% confidence interval, 1.48-10.5; p = 0.001). For infants less than 1,500 g birth weight (very low birth weight), odds for culture-negative sepsis increased to 6.3-fold following removal of peripherally inserted central venous catheters not used for antibiotic delivery (95% confidence interval, 1.78-26.86; p central venous catheter removal, they suggests that very low birth weight infants not recently exposed to antibiotics are at increased odds for

  5. A systematic review of health-related quality of life instruments used for people with venous ulcers: an assessment of their suitability and psychometric properties.

    Science.gov (United States)

    Palfreyman, Simon J; Tod, Angela M; Brazier, John E; Michaels, Jonathan A

    2010-10-01

    To review the quality of life questionnaires used to measure the impact of venous ulceration and to evaluate their psychometric properties. Venous leg ulcers have a negative impact on quality of life. Health-related quality of life can be measured using structured questionnaires. Nurses are the primary care providers for patients with venous ulceration and are ideally placed to assess and develop these types of questionnaires. There may also be an opportunity to use such quality of life instruments to measure the impact of nursing interventions in other areas where nurses are the key care providers. Systematic review. Studies were sought that used quality of life instruments to evaluate the impact of venous ulceration. Fourteen electronic bibliographical databases and 11 Internet-based health services research related resources were searched. In addition, grey literature was sought and the reference lists of relevant articles checked. Data were extracted regarding the type of instrument used, sample, number of items and domains and psychometric performance of the instrument. The initial search identified a total of 338 potential citations. After review, a total of 31 studies were included: 17 used generic and 14 used disease-specific instruments. Five different types of generic and seven disease-specific instruments were identified. There was significant heterogeneity between the studies in terms of study design, aetiology of ulceration and times of assessment. The disease-specific instruments showed limitations in relation to their applicability to venous ulcer patients because of flaws in design or validation. The literature on quality of life related to venous ulceration failed to sufficiently distinguish between those with different causes of leg ulceration. There appeared to be problems with the ability of current quality of life instruments to detect changes in quality of life related to ulcer healing. Relevance to clinical practice.  There appears to be an

  6. Sodium-to-Potassium Ratio and Blood Pressure, Hypertension, and Related Factors12

    Science.gov (United States)

    Perez, Vanessa; Chang, Ellen T.

    2014-01-01

    The potential cost-effectiveness and feasibility of dietary interventions aimed at reducing hypertension risk are of considerable interest and significance in public health. In particular, the effectiveness of restricted sodium or increased potassium intake on mitigating hypertension risk has been demonstrated in clinical and observational research. The role that modified sodium or potassium intake plays in influencing the renin-angiotensin system, arterial stiffness, and endothelial dysfunction remains of interest in current research. Up to the present date, no known systematic review has examined whether the sodium-to-potassium ratio or either sodium or potassium alone is more strongly associated with blood pressure and related factors, including the renin-angiotensin system, arterial stiffness, the augmentation index, and endothelial dysfunction, in humans. This article presents a systematic review and synthesis of the randomized controlled trials and observational research related to this issue. The main findings show that, among the randomized controlled trials reviewed, the sodium-to-potassium ratio appears to be more strongly associated with blood pressure outcomes than either sodium or potassium alone in hypertensive adult populations. Recent data from the observational studies reviewed provide additional support for the sodium-to-potassium ratio as a superior metric to either sodium or potassium alone in the evaluation of blood pressure outcomes and incident hypertension. It remains unclear whether this is true in normotensive populations and in children and for related outcomes including the renin-angiotensin system, arterial stiffness, the augmentation index, and endothelial dysfunction. Future study in these populations is warranted. PMID:25398734

  7. Ultraviolet-C Irradiation for Prevention of Central Venous Catheter Related Infections: An In-vitro Study

    Science.gov (United States)

    Dai, Tianhong; Tegos, George P.; St. Denis, Tyler G.; Anderson, Don; Sinofsky, Ed; Hamblin, Michael R.

    2010-01-01

    Central venous catheters (CVC) are widely used in the United States and are associated with 250,000 to 500,000 CVC-related infections in hospitals annually. We used a catheter made from ultraviolet-C (UVC) transmissive material to test whether delivery of UVC from the lumen would allow inactivation of microorganisms on the outer surface of CVC. When the catheter was exposed to UVC irradiation from a cold cathode fluorescent lamp (CCFL) inside the catheter lumen at a radiant exposure of 3.6 mJ/cm2, more than 6-log10 of drug-resistant Gram-positive bacteria adhered to the outer surface of the catheter were inactivated. Three to 7-log10 of drug-resistant Gram-negative bacteria and 2.8 log10 of fungi were inactivated at a radiant exposure of 11 mJ/cm2. UVC irradiation also offered a highly selective inactivation of bacteria over keratinocytes under exactly comparable conditions. After 11 mJ/cm2 UVC light had been delivered, over 6 log10 of bacteria were inactivated while the viability loss of the keratinocytes was only about 57%. PMID:21073470

  8. Left phrenic nerve anatomy relative to the coronary venous system: Implications for phrenic nerve stimulation during cardiac resynchronization therapy.

    Science.gov (United States)

    Spencer, Julianne H; Goff, Ryan P; Iaizzo, Paul A

    2015-07-01

    The objective of this study was to quantitatively characterize anatomy of the human phrenic nerve in relation to the coronary venous system, to reduce undesired phrenic nerve stimulation during left-sided lead implantations. We obtained CT scans while injecting contrast into coronary veins of 15 perfusion-fixed human heart-lung blocs. A radiopaque wire was glued to the phrenic nerve under CT, then we created three-dimensional models of anatomy and measured anatomical parameters. The left phrenic nerve typically coursed over the basal region of the anterior interventricular vein, mid region of left marginal veins, and apical region of inferior and middle cardiac veins. There was large variation associated with the average angle between nerve and veins. Average angle across all coronary sinus tributaries was fairly consistent (101.3°-111.1°). The phrenic nerve coursed closest to the middle cardiac vein and left marginal veins. The phrenic nerve overlapped a left marginal vein in >50% of specimens. © 2015 Wiley Periodicals, Inc.

  9. Disparity in race-specific comorbidities associated with central venous catheter-related bloodstream infection (AHRQ-PSI7).

    Science.gov (United States)

    Studnicki, James; Ekezue, Bola F; Tsulukidze, Maka; Honoré, Peggy; Moonesinghe, Ramal; Fisher, John

    2013-01-01

    Studies of racial disparities in hospital-level patient safety outcomes typically apply a race-common approach to risk adjustment. Risk factors specific to a minority population may not be identified in a race-common analysis if they represent only a small percentage of total cases. This study identified patient comorbidities and characteristics associated with the likelihood of a venous catheter-related bloodstream infection (Agency for Healthcare Research and Quality Patient Safety Indicator 7 [PSI7]) separately for blacks and whites using race-specific logistic regression models. Hospitals were ranked by the racial disparity in PSI7 and segmented into 4 groups. The analysis identified both black- and white-specific risk factors associated with PSI7. Age showed race-specific reverse association, with younger blacks and older whites more likely to have a PSI7 event. These findings suggest the need for race-specific covariate adjustments in patient outcomes and provide a new context for examining racial disparities.

  10. The impact of drug related problems on health-related quality of life among hypertensive patients in Jordan

    Directory of Open Access Journals (Sweden)

    Abu Farha R

    2017-09-01

    Full Text Available Background: Hypertension is a major cause of cardiovascular diseases with a high prevalence in Jordan. No previous studies have been carried out to determine the effect of the presence of drug-related problems (DRPs on the health-related quality of life (HRQOL among hypertensive patients. Objectives: The purpose of this study was to identify the influence of different types of DRPs on the HRQOL of hypertensive patients. Methods: A total of 200 hypertensive patients were recruited in this cross-sectional correlation study that was conducted across the cardiac outpatient clinic at Jordan University Hospital. Ethical approval was obtained and patients were recruited using convenience sampling technique. During the study period, patients’ data was used to evaluate their quality of life using RAND-12 scale and to identify DRPs utilizing a systematic evidence based approach. Results: 200 hypertensive patients (mean age 59.7 years (SD=10.2 were recruited in this study. Patients showed a poor quality of life on both the physical and mental domains of the RAND-12 scale. The average number of DRPs was 5.1 (SD=2.3. Multiple linear regression analysis showed that among DRPs categories, non-adherence to medications, non-adherence to non-pharmacological therapies and inadequate knowledge about medications were among the main predictors of the poor physical domain of the RAND-12 (Beta= -0.149, -0.226 and -0.230 respectively, p-value < 0.05 for all. On the other hand, only non-adherence to medication and non-adherence to non-pharmacological therapies were significantly associated with poor mental domain of the RAND-12 (Beta= -0.208 and -0.191 respectively, p-value < 0.05 for both. Conclusion: Prevalence of DRPs among hypertensive patients is a concern that needs attention. These DRPs were associated with poor HRQOL on both the physical and mental domain of the RAND-12 scale. The pharmaceutical care service delivered by pharmacists is needed to identify

  11. Splanchnic venous thrombosis driven by a constitutively activated ...

    African Journals Online (AJOL)

    Introduction: Splanchnic venous thrombosis (SVT) has varied etiology with Philadelphia-negative myeloproliferative neoplasms (MPNs) being the most frequent underlying prothrombotic factor. Hematological indices often remain within normal range because of portal hypertension and its sequelae, causing diagnostic ...

  12. Splanchnic venous thrombosis driven by a constitutively activated ...

    African Journals Online (AJOL)

    Abstract. Introduction: Splanchnic venous thrombosis (SVT) has varied etiology with Philadelphia- negative myeloproliferative neoplasms (MPNs) being the most frequent underlying prothrombotic factor. Hematological indices often remain within normal range because of portal hypertension and its sequelae, causing ...

  13. Is hypertension in adult age related to unemployment at a young age? Results from the Northern Swedish Cohort.

    Science.gov (United States)

    Nygren, Karina; Gong, Weidan; Hammarström, Anne

    2015-02-01

    The aim of this study was to analyse the relationship between early unemployment (ages 16-21 years) and adult hypertension after controlling for earlier hypertension, unemployment in adult life, risk factors for hypertension and confounders. A cohort of 927 (86.6% of the original cohort) 9th grade school-leavers was followed from 1981 until 2008. Data were collected through questionnaires, health examinations, and national registers. Univariate and multivariate logistic regression were used as primary statistical methods. At ages 21 and 43, hypertension was significantly more prevalent among men than women (p Unemployment between the ages of 16 and 21 was related to hypertension at age 43 among women but not men. The odds ratio (OR) was persistently high (OR 3.16 [95% confidence interval 1.45-6.89]) after controlling for late unemployment, hypertension at age 16, risk factors for hypertension and confounders. There was no significant relationship between exposure to early unemployment and hypertension at age 21 for women or men. From a public health perspective, youth unemployment is a societal problem in need of more attention and intervention in order to prevent long-term adverse health outcomes. © 2014 the Nordic Societies of Public Health.

  14. Cancer-related venous thromboembolic disease: current management and areas of uncertainty.

    Science.gov (United States)

    Radhakrishna, G; Berridge, D

    2012-01-01

    The relationship between cancer and venothromboembolic events is a complex, multifactorial process which is still not fully understood and therefore the use of current generic guidelines may be inadequate. Current management of cancer-related VTE may be suboptimal because of the lack of cancer-specific studies into the role of primary prophylaxis in both ambulant and non-ambulant cancer patients. Further research into developing cancer-specific risk assessment tools and the choice, dose and duration of prophylaxis is required. The management of confirmed symptomatic VTE in cancer patients is outlined but certain controversies remain. Areas for further research include the management of asymptomatic unsuspected VTE events, recurrent VTE events on treatment and the role of IVC filters and other treatment options are required. This paper attempts to cover some of the recent developments and areas of uncertainty surrounding the management of cancer-related VTE.

  15. [Pathologic markers for evaluation of reversibility in pulmonary hypertension related to congenital heart disease].

    Science.gov (United States)

    Li, Li; Huang, Li; Chen, Guo; Huang, Shian; Liu, Chao; Wang, Hongyue; Duan, Xuejin; Wang, Qingzhi; Zhao, Ranxu; He, Jianguo

    2016-01-01

    To assess the pathologic markers for evaluation of reversibility in pulmonary hypertension (PAH) related to congenital heart disease. Twenty-eight patients with congenital heart disease complicated by PAH were subclassified into reversible pulmonary hypertension (RPAH) and irreversible pulmonary hypertension (IPAH), according to post-operative mean pulmonary artery pressure (MPAP). Pulmonary vascular lesion was analyzed according to Ruan's method. Mean medium thickness percent, mean medium area percent and pulmonary arteriolar density were measured by quantitative morphometry. Immunohistochemical study for transgelin and filamin A was carried out. Amongst the 28 cases studied, 24 were RPAH and 4 were IPAH. Of the 24 patients with RPAH, 13 (54.2%, 13/24) had pulmonary vascular lesion of grade 0, 9 (37.5%, 9/24) of grade 1 and 2 (8.3%, 2/24) of grade 2. Of the 4 patients with IPAH, 1 had lesion of grade 1, 1 of grade 2 and 2 of grade 3. Both preoperative and postoperative MPAP were higher in IPAH patients than that in RPAH patients[(53.3±23.4) mmHg versus (34.1±12.7) mmHg, P=0.020 and (35.0±8.8) mmHg versus (17.8±3.9) mmHg, Pheart disease. Mean medium thickness percent, mean medium area percent and immunoreactivity for transgelin and filamin A are useful parameters.

  16. Gender-related differences in adolescent hypertension and in target organ effects.

    Science.gov (United States)

    Juhász, Mária; Katona, Eva; Settakis, Georgios; Paragh, György; Molnár, Csilla; Fülesdi, Béla; Páll, Dénes

    2010-04-01

    To assess whether a gender difference exists in adolescent hypertension and its target organ damage and to compare potential confounding factors and target organ damage in hypertensive and normotensive adolescent girls. From the Debrecen Hypertension Study, the anthropometric, blood pressure, and laboratory data as well as intima-media thickness (IMT) and left ventricular mass index (LVMI) of 58 hypertensive boys, 56 hypertensive girls, and 30 normotensive girls were analyzed. Both systolic and mean blood pressure values were higher in adolescent hypertensive boys than in girls. This difference was also present when comparing 24-hour average blood pressure values. Plasma concentrations of nitric oxide (NO) and endothelin-1 were not different in the two gender groups. IMT of the carotid arteries were similar in hypertensive boys and girls, but a significantly higher LVMI was detected in boys. A significant difference was detected in anthropometric data (height, weight, and body mass index [BMI]), plasma concentration of NO (lower levels in hypertensives), and IMT in hypertensive and normotensive girls (higher IMT in hypertensive girls). There is a difference between the severity of hypertension between hypertensive adolescent girls and boys. Hypertensive girls differ from normotensive girls not only in blood pressure values but also in risk factors and subclinical target organ effects. Further studies are needed to explain the gender differences in adolescent hypertension. The potential role of sex hormones in hypertensive teenagers also needs to be clarified in future works.

  17. Age, homocysteine, and oxidative stress: relation to hypertension and type 2 diabetes mellitus.

    Science.gov (United States)

    Dominguez, Ligia J; Galioto, Antonio; Pineo, Antonella; Ferlisi, Anna; Ciaccio, Marcello; Putignano, Ernesto; Belvedere, Mario; Costanza, Giuseppe; Barbagallo, Mario

    2010-02-01

    Hyperhomocysteinemia and oxidative stress are independent risk factors for cardiovascular events, which occur more frequently in old age. We evaluated these parameters in relation to age and the presence of hypertension and type 2 diabetes mellitus. Two hundred eighty-two subjects (female/male: 142/140; 141 were >65 years and 141 were age 73.9 +/- 6.6 years and 52.5 +/- 8.2 years, respectively) were randomly recruited from those attending our institution. Blood pressure, anthropometric parameters, oxidative stress parameters (reactive oxygen species [ROS] and malondialdehyde [MDA]), and homocysteine levels were evaluated in participants. Homocysteine (2.9 +/- 0.06 vs. 2.3 +/- 0.03 micromol/L, p oxidative stress (ROS: 10.8 +/- 0.3 vs. 8.1 +/- 0.3 mmol/L, p diabetes. However, homocysteine and MDA were not significantly different in older vs. younger hypertensive subjects (homocysteine: 3.0 +/- 0.03 vs. 2.9 +/- 0.04 micromol/L, p = NS; MDA: 1.7 +/- 0.07 vs. 1.4 +/- 0.06 nmol/mL, p = NS) and in older vs. younger diabetic hypertensive subjects (homocysteine: 3.02 +/- 0.05 vs. 2.9 +/- 0.05 micromol/L, p = NS; ROS: 10.7 +/- 0.7 vs. 9.7 +/- 0.8 mmol/L, p = NS; MDA: 1.6 +/- 0.10 vs. 1.5 +/- 0.12 nmol/mL, p = NS). Aging is accompanied by elevated homocysteine and oxidative stress levels similar to those observed in younger subjects with hypertension or diabetes mellitus, independent of age. Hence, these conditions appear to accelerate the age-dependent increase in homocysteine and oxidative stress.

  18. Dispersion of ventricular repolarization in relation to cardiovascular risk factors in hypertension.

    Science.gov (United States)

    Ciobanu, A; Gheorghe, G S; Ababei, M; Deaconu, M; Ilieşiu, A M; Bolohan, M; Păun, N; Nicolae, C; Nanea, I T

    2014-01-01

    Hypertension associates with sudden cardiac death, its relationship with ventricular arrhythmias being demonstrated by multiple studies, an increased dispersion of repolarization being an important arrhythmogenesis mechanism. Only a small percentage of hypertensive patients presents increased blood pressure values exclusively as risk factor, most of them presenting additional risk factors that reinforce each other leading to increased total cardiovascular risk. to analyze the dispersion of repolarization parameters (QT interval, QT dispersion, Tpeak-Tend interval (Tpe), Tpe/QT, Tpe dispersion) in relation to cardiovascular risk factors, as well as total cardiovascular risk estimated by SCORE model, in mild to moderate essential hypertension. 62 consecutive patients, mean age 55±11 years, were evaluated by 24 hours Holter electrocardiography monitoring. Manual measurement of dispersion of repolarization parameters was performed. Based on SCORE model, 33.9% patients presented low risk, 40.3% moderate risk, 16.1% high risk and 9.1% very high risk. Age had a positive correlation with QT and reverse correlations with QT dispersion, Tpe and Tpe/QT in lead V1. Tpe/QT showed significantly higher values in men versus women. Glucose metabolism disorders associated with higher values of QT and Tpe dispersion were present. However, dispersion of repolarization parameters was similar between risk categories assessed by SCORE model, Tpe in lead V3 correlated significantly with SCORE score. In mild to moderate hypertension, the dispersion of repolarization parameters is influenced by age, gender and glucose metabolism disorders. Among these, Tpe in lead V3 correlates with total cardiovascular risk assessed by SCORE model.

  19. Elevated uric acid and obesity-related cardiovascular disease risk factors among hypertensive youth.

    Science.gov (United States)

    Reschke, Lauren D; Miller, Edgar R; Fadrowski, Jeffrey J; Loeffler, Lauren F; Holmes, Kathryn W; Appel, Lawrence J; Brady, Tammy M

    2015-12-01

    Uric acid (UA) is associated with high blood pressure in adolescents and with left ventricular hypertrophy (LVH) and cardiovascular disease (CVD) in adults. We sought to determine if UA is independently associated with CVD risk factors and left ventricular mass (LVM) over time in hypertensive youth. This was a 1-year prospective observational study of hypertensive children aged 3-19 years. Cross-sectional and longitudinal associations of serum UA with CVD risk factors and LVM were explored. Of the 49 children who completed both the baseline and 12-month assessments, at baseline the mean age was 13.8 years and mean UA was 5.5 mg/dL; 24% had elevated UA, 51% were overweight/obese and 39% had LVH. Measures of adiposity, low high-density lipoprotein cholesterol, high-sensitivity C-reactive protein, LVM and LVH were all significantly associated with elevated UA at baseline, but not with change over time. Each 1 mg/dL increase in baseline UA was associated with a 2.5 g/m(2.7) increase in the LVM index at follow-up (95% confidence interval 0.64, 4.39; p = 0.01); after adjustment for age, sex, race, body mass index z-score, change in UA, time, blood pressure and medication use, this association was no longer significant. Hypertensive children with elevated UA have a higher prevalence of obesity-related CVD risk factors. Among hypertensive children, UA may be a marker of adiposity and not an independent CVD risk factor.

  20. Role of angiotensin II-mediated AMPK inactivation on obesity-related salt-sensitive hypertension.

    Science.gov (United States)

    Deji, Naoko; Kume, Shinji; Araki, Shin-ichi; Isshiki, Keiji; Araki, Hisazumi; Chin-Kanasaki, Masami; Tanaka, Yuki; Nishiyama, Akira; Koya, Daisuke; Haneda, Masakazu; Kashiwagi, Atsunori; Maegawa, Hiroshi; Uzu, Takashi

    2012-02-17

    Salt-sensitive hypertension is a characteristic of the metabolic syndrome. Given the links to cardiovascular events, the mechanisms underlying sodium metabolism may represent an important therapeutic target for this disorder. Angiotensin II (AII) is a key peptide underlying sodium retention. However, 5'AMP-activated protein kinase (AMPK) has also been reported to participate in the regulation of ion transport. In this study we examined the relationship between AII and AMPK on the development of hypertension in two salt-sensitive mouse models. In the first model, the mice were maintained on a high-fat diet (HFD) for 12 weeks, in order to develop features similar to the metabolic syndrome, including salt-sensitive hypertension. HFD-induced obese mice showed elevated systolic blood pressure and lower sodium excretion in response to salt loading, along with an increase in AII contents and inactivation of AMPK in the kidney, which were significantly improved by the treatment of an angiotensin II antagonist, losartan, for 2 weeks. To clarify the effects of AII, a second group of mice was infused with AII via an osmotic pump, which led to higher systolic blood pressure, and decreases in urinary sodium excretion and the expression of AMPK, in a manner similar to those observed in the HFD mice. However, treatment with an AMPK activator, metformin, improved the changes induced by the AII, suggesting that AII induced sodium retention works by acting on AMPK activity. Finally, we evaluated the changes in salt-sensitivity by performing 2-week salt loading experiments with or without metformin. AII infusion elevated blood pressure by salt loading but metformin prevented it. These findings indicate that AII suppresses AMPK activity in the kidney, leading to sodium retention and enhanced salt-sensitivity, and that AMPK activation may represent a new therapeutic target for obesity-related salt-sensitive hypertension. Copyright © 2012 Elsevier Inc. All rights reserved.

  1. Associations between polymorphisms in coagulation-related genes and venous thromboembolism: A meta-analysis with trial sequential analysis.

    Science.gov (United States)

    Jiang, Jun; Liu, Kang; Zou, Junjie; Ma, Hao; Yang, Hongyu; Zhang, Xiwei; Jiao, Yuanyong

    2017-03-01

    Recently, several studies showed that the polymorphisms in the coagulation-related genes might be associated with venous thromboembolism (VTE); however, the results were still controversial. We performed a meta-analysis with trial sequential analysis to investigate the associations between the endothelial cell-activated protein C receptor (EPCR) rs9574, F11 rs2289252, F11 rs2036914, FGG rs2066865, FGG rs1049636, CYP4V2 rs13146272, SERPINC1 rs2227589, and GP6 rs1613662 polymorphisms with the risk of VTE. We searched both the common English-language databases and the Chinese literature databases. Two authors selected studies according to inclusion and exclusion criteria. Crude odds ratios with 95% confidence intervals (CI) were calculated to estimate the strength of this association. Between-study heterogeneity was assessed with the chi-square-based Q test and the I statistic. Overall, a total of 20 studies were included. The meta-analysis revealed that the F11 rs2289252, F11 rs2036914, FGG rs2066865, and CYP4V2 rs13146272 polymorphisms were closely related to the development of VTE in the white race under the best genetic models after multiple testing adjustments. The EPCR rs9574, FGG rs1049636, SERPINC1 rs2227589, and GP6 rs1613662 polymorphisms might be potential candidates in the pathogenesis of VTE, but trial sequential analyses and sensitivity analyses indicated that the evidences were limited. Larger scale studies were demanded to avoid false-positive outcomes. Finally, our study demonstrated the important role of rs2289252, rs2036914, rs2066865, and rs13146272 polymorphisms in the development of VTE in the white race. Rs9574, rs1049636, rs2227589 and rs1613662 polymorphisms might be risk factors of VTE. However, more studies involving diverse races are needed to probe the ethnic difference and the underlying mechanisms of significant associations.

  2. Incidence of catheter-related complications in patients with central venous or hemodialysis catheters: a health care claims database analysis

    Science.gov (United States)

    2013-01-01

    Background Central venous catheter (CVC) and hemodialysis (HD) catheter usage are associated with complications that occur during catheter insertion, dwell period, and removal. This study aims to identify and describe the incidence rates of catheter-related complications in a large patient population in a United States-based health care claims database after CVC or HD catheter placement. Methods Patients in the i3 InVision DataMart® health care claims database with at least 1 CVC or HD catheter insertion claim were categorized into CVC or HD cohorts using diagnostic and procedural codes from the US Renal Data System, American College of Surgeons, and American Medical Association’s Physician Performance Measures. Catheter-related complications were identified using published diagnostic and procedural codes. Incidence rates (IRs)/1000 catheter-days were calculated for complications including catheter-related bloodstream infections (CRBSIs), thrombosis, embolism, intracranial hemorrhage (ICH), major bleeding (MB), and mechanical catheter–related complications (MCRCs). Results Thirty percent of the CVC cohort and 54% of the HD cohort had catheter placements lasting Catheter-related complications occurred most often during the first 90 days of catheter placement. IRs were highest for CRBSIs in both cohorts (4.0 [95% CI, 3.7-4.3] and 5.1 [95% CI, 4.7-5.6], respectively). Other IRs in CVC and HD cohorts, respectively, were thrombosis, 1.3 and 0.8; MCRCs, 0.6 and 0.7; embolism, 0.4 and 0.5; MB, 0.1 and 0.3; and ICH, 0.1 in both cohorts. Patients with cancer at baseline had significantly higher IRs for CRBSIs and thrombosis than non-cancer patients. CVC or HD catheter–related complications were most frequently seen in patients 16 years or younger. Conclusions The risk of catheter-related complications is highest during the first 90 days of catheter placement in patients with CVCs and HD catheters and in younger patients (≤16 years of age) with HD catheters

  3. Central venous catheter-related bloodstream infection caused by Staphylococcus aureus: microbiology and risk factors

    Directory of Open Access Journals (Sweden)

    Geraldo Sadoyma

    Full Text Available Although central vascular catheters (CVC are indispensable in modern medicine, they are an important risk factor for primary bacteremias. We examined the incidence and risk factors associated with catheter-related bloodstream infection (CR-BSI caused by Staphylococcus aureus in surgical patients. A prospective study was carried out in the Hospital das Clínicas da Universidade Federal de Uberlândia (HC-UFU from September 2000 to December 2002. The skin insertion site, catheter tip, and blood were microbiologically analyzed. Demographics and risk factors were recorded for each patient, and cultures were identified phenotypically. Staphylococcus aureus was the most frequent pathogen, with an incidence rate of 4.9 episodes of CR-BSIs per 1,000 catheter/days. Based on logistic regression, the independent risk factors were: colonization on the insertion site =200 colony forming units (CFU/20 cm² (p=0.03; odds ratio (OR =6.89 and catheter tip (p=0.01; OR=7.95. The CR-BSI rate was high; it was mainly associated with S. aureus, and skin colonization at the insertion site and on the catheter tip were important risk factors for CR-BSI.

  4. [Analysis on the prevalence of central venous catheter-related infection in burn patients and its risk factors].

    Science.gov (United States)

    Fang, Li; Wang, Fan; Sun, Kedai; Zhou, Tao; Gong, Yali; Peng, Yizhi

    2016-04-01

    To investigate the prevalence of central venous catheter-related infection (CRI) in burn patients and its risk factors, so as to guide the clinical practice. Clinical data of 5 026 days of 480 cases of central venous catheterization altogether in 228 burn patients admitted to our ward from June 2011 to December 2014, conforming to the study criteria, were retrospectively analyzed. (1) The incidence of CRI and that of catheter-related bloodstream infection (CRBSI) in patients (the infection rates per thousand days were calculated) and mortality due to them, and detection of concerning bacteria were recorded after each case of catheterization. (2) The incidence of CRI after each case of catheterization in patients was recorded according to the classification of their gender, age, total burn area, full-thickness burn area, cause of injury, severity of inhalation injury, location of catheterization, whether catheterization through wound or not, duration of catheterization, and the data were processed with chi-square test. Indexes with statistically significant differences were selected, and they were processed with multivariate logistic stepwise regression analysis to screen the independent risk factors of CRI. (3) To all cases of catheterization and cases with catheterization through wound, incidence of CRI after each case of catheterization in patients at each time period was recorded according to the sorting of duration of catheterization. Data were processed with chi-square test and Fisher's exact test, and the values of P were adjusted by Bonferroni. (1) Infection rate of CRI per thousand days was 50.14‰ (252/5 026), resulting in the mortality rate of 3.51% (8/228). Infection rate of CRBSI per thousand days was 18.70‰ (94/5 026), resulting in the mortality rate of 2.19% (5/228). Respectively 319 and 105 strains of pathogens were detected in CRI and CRBSI, in which the top four bacteria detected were Acinetobacter baumannii, Pseudomonas aeruginosa

  5. Cerebral venous thrombosis.

    Science.gov (United States)

    Ferro, José Manuel; Canhão, Patrícia; Aguiar de Sousa, Diana

    2016-12-01

    Cerebral venous thrombosis (CVT) has an incidence of 1.32/100,000/years in high-income countries, and higher in middle- and low-income countries. CVT is more frequent in infants and children young adults and females, especially during pregnancy/puerperium. CVT are now being diagnosed with increasing frequency because of the increased awareness and higher use of magnetic resonance imaging (MR) for investigating patients with acute and subacute headaches and new onset seizures. CVT rarely present as a stroke syndrome. Their most frequent presentations are isolated headache, intracranial hypertension syndrome, seizures, a lobar syndrome and encephalopathy. The confirmation of the diagnosis of CVT relies on the demonstration of thrombi in the cerebral veins and/or sinuses by MR/MR venography or veno CT. The more frequent risk factors/associated conditions for CVT are genetic prothrombotic conditions, antiphospholipid syndrome and other acquired prothrombotic diseases, including cancer, oral contraceptives, puerperium and pregnancy, infections and trauma. The prognosis of CVT is in general favorable, as acute death rate is below 5% and only 15% of the patients remain dependent or die. Treatment in the acute phase includes management of the associated condition, anticoagulation with either low molecular weight or unfractionated heparin, treatment of intracranial hypertension, prevention of recurrent seizures and headache relief. In patients in severe condition on admission or who deteriorate despite anticoagulation, local thrombolysis or thrombectomy is an option. Decompressive surgery is lifesaving in patients with large venous infarcts or hemorrhage with impending herniation. After the acute phase, patients should anticoagulated for a variable period of time, depending on their inherent thrombotic risk. CVT patients may experience recurrent seizures. Prophylaxis with anti-epileptic drugs is recommended after the first seizure, in those with hemispheric lesions. There

  6. Diabetes mellitus is associated with early chronic venous disorder of the lower extremities in Chinese patients with cardiometabolic risk factors.

    Science.gov (United States)

    Zhong, Jian; Chen, Jing; Zhao, Zhi-gang; He, Hong-bo; Yan, Zhen-cheng; Liu, Dao-yan; Zhu, Zhi-ming; Ni, Yin-xing

    2014-09-01

    Metabolic syndrome has received great attention because it poses a potential cardiovascular hazard, which increases the risk of lower extremity atherosclerosis. However, the relationship between the components of metabolic syndrome and the onset of chronic venous disorder of the lower extremities remains unexplained. This study investigated the characteristics of cardiometabolic risk factors of early chronic venous disorder of the lower extremities in subjects with cardiometabolic risk. The characteristics of risk factors and diabetes-related complications in diabetic patients with early chronic venous disorder of the lower extremities were also investigated. In addition, the association between early chronic venous disorder and atherosclerosis of the lower extremities was analysed. The study examined 782 subjects with cardiometabolic risk factors, including obesity, hypertension, diabetes mellitus and dyslipidaemia. Lower extremity venous function was measured by digital photoplethysmography. Women had a higher prevalence of early chronic venous disorder than did men (p blood pressure than those with normal venous function (p blood glucose level and triglyceride status. Copyright © 2014 John Wiley & Sons, Ltd.

  7. What Is Pulmonary Hypertension?

    Science.gov (United States)

    ... Artery Disease Venous Thromboembolism Aortic Aneurysm More Pulmonary Hypertension - High Blood Pressure in the Heart-to-Lung System Updated:Jan ... Pressure" This content was last reviewed October 2016. High Blood Pressure • Home • Get the Facts About HBP Introduction What ...

  8. Adjudication-related processes are underreported and lack standardization in clinical trials of venous thromboembolism: a systematic review.

    Science.gov (United States)

    Stuck, Anna K; Fuhrer, Evelyn; Limacher, Andreas; Méan, Marie; Aujesky, Drahomir

    2014-03-01

    Although the use of an adjudication committee (AC) for outcomes is recommended in randomized controlled trials, there are limited data on the process of adjudication. We therefore aimed to assess whether the reporting of the adjudication process in venous thromboembolism (VTE) trials meets existing quality standards and which characteristics of trials influence the use of an AC. We systematically searched MEDLINE and the Cochrane Library from January 1, 2003, to June 1, 2012, for randomized controlled trials on VTE. We abstracted information about characteristics and quality of trials and reporting of adjudication processes. We used stepwise backward logistic regression model to identify trial characteristics independently associated with the use of an AC. We included 161 trials. Of these, 68.9% (111 of 161) reported the use of an AC. Overall, 99.1% (110 of 111) of trials with an AC used independent or blinded ACs, 14.4% (16 of 111) reported how the adjudication decision was reached within the AC, and 4.5% (5 of 111) reported on whether the reliability of adjudication was assessed. In multivariate analyses, multicenter trials [odds ratio (OR), 8.6; 95% confidence interval (CI): 2.7, 27.8], use of a data safety-monitoring board (OR, 3.7; 95% CI: 1.2, 11.6), and VTE as the primary outcome (OR, 5.7; 95% CI: 1.7, 19.4) were associated with the use of an AC. Trials without random allocation concealment (OR, 0.3; 95% CI: 0.1, 0.8) and open-label trials (OR, 0.3; 95% CI: 0.1, 1.0) were less likely to report an AC. Recommended processes of adjudication are underreported and lack standardization in VTE-related clinical trials. The use of an AC varies substantially by trial characteristics. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. Is diabetes a risk factor for central venous access port-related bloodstream infection in oncological patients?

    Science.gov (United States)

    Touré, A; Vanhems, P; Lombard-Bohas, C; Souquet, J-C; Lauverjat, M; Chambrier, C

    2013-01-01

    It was a dogma that patients with diabetes mellitus (DM) are at increased risk of infection or death associated with an infection. However, in cancer patients, this has not been well investigated. The aim was to investigate whether diabetic patients with cancer are at high risk of central venous access port (CVAP)-related bloodstream infection (BSI), and to analyse mortality after CVAP-BSI. A total of 17 patients with type 1 DM (T1DM), 66 with type 2 DM (T2DM) and 307 non-diabetic patients were included. Each patient was followed up until the first late CVAP-BSI or for a maximum for 1 year in the absence of a CVAP-BSI. Fifty-three CVAP-BSIs occurred in 66,528 catheter-days. The cumulative incidence of CVAP-BSI was not higher in T1DM (5.9 %; p = 0.17) and T2DM (19.7 %; p = 0.70) compared with the non-diabetic patients (12.7 %). However, in patients with CVAP-BSI, the 1-month crude mortality rate was higher in DM patients (42.9 % vs. 15.4 %; p = 0.04), whereas the mortality in patients without CVAP-BSI was similar in both groups of patients (19.8 % vs. 17.1 %; p = 0.58). Of the 12 deaths that occurred within 1 month of CVAP-BSI, 16.66 % was attributable to CVAP-BSI. The predictive factor of 1-month mortality was DM (p = 0.04). Parenteral nutrition (PN) was independently associated with CVAP-BSI in diabetic patients (p = 0.001). In this study, diabetes did not increase the risk of CVAP-BSI, but mortality was higher in diabetic patients who had a CVAP-BSI. This suggests, in addition to medical treatment, CVAP should be withdrawn after infection onset.

  10. Changing epidemiology of central venous catheter-related bloodstream infections: increasing prevalence of Gram-negative pathogens.

    Science.gov (United States)

    Marcos, Miguel; Soriano, Alex; Iñurrieta, Amaia; Martínez, José A; Romero, Alberto; Cobos, Nazaret; Hernández, Cristina; Almela, Manel; Marco, Francesc; Mensa, Josep

    2011-09-01

    Gram-positive microorganisms have been the predominant pathogens in central venous catheter-related bloodstream infections (CRBSIs). Recent guidelines recommend empirical therapy according to this and restrict coverage for Gram-negatives to specific circumstances. This study aimed to analyse the epidemiological changes in CRBSIs over the 1991-2008 period and to analyse predictors of Gram-negative CRBSIs. A prospectively collected cohort of patients with confirmed CRBSIs was analysed. Strains isolated and antimicrobial susceptibility, as well as clinical and demographic variables were recorded. Differences observed during the study period were analysed by means of a χ² trend test and factors associated with Gram-negative CRBSIs by means of multivariable analysis. Between 1991 and 2008, 1129 episodes of monomicrobial CRBSIs were recorded. There was an increase in the incidence of CRBSIs, from 0.10 (1991-92) to 0.31 (2007-08) episodes/1000 patient-days. A significant increase in the number of Gram-negative strains among the total isolates was also found, from 3 (4.7%) in 1991-92 to 70 (40.23%) in 2007-08, with a parallel decrease in the percentage of Gram-positives. Solid organ transplantation, prior use of penicillins and hospital stay longer than 11 days were independently associated with a significantly higher risk of Gram-negative CRBSIs, while cirrhosis, diabetes and use of quinolones were associated with a higher risk of Gram-positives. Gram-negative strains are an increasing cause of CRBSIs, reaching a prevalence of 40% in the 2007-08 period in our hospital. If this trend is confirmed in other centres, a broad-spectrum empirical therapy should be considered in managing these infections.

  11. [Characteristics of hypertension prevalence and related factors in rural area in Sichuan].

    Science.gov (United States)

    Wu, Xianping; Li, Liming; Chen, Xiaofang; Luo, Guojin; Que, Xiangsan; Chen, Xiaofang; Zhang, Ningmei; Chen, Zhengming; Guo, Yu

    2015-11-01

    To understand the prevalence, awareness, treatment and control of hypertension in rural area in Sichuan province. The cross-sectional data of 55 687 subjects who were enrolled into the China Kadoorie Biobank study from Pengzhou in southwestern China were used to analyze the prevalence, awareness, treatment and control of hypertension among local residents. The prevalence of hypertension among population aged 30-79 years old was 25.2%. The awareness rate of self hypertension status, the treatment rate and the control rate of hypertension were 24.7%, 14.7% and 3.7%, respectively. The prevalence of hypertension, the awareness rate of self hypertension status, the treatment rate and the control rate of hypertension were associated with the socio-demographic characteristics of the subjects. The prevalence of hypertension in winter (70%-80%) was higher than that in summer, while the awareness rate, the treatment rate and the control rate of hypertension in winter were much lower than those in summer. Among the hypertension patients, the rates of smoking and alcohol use were high, the dietary habit was bad, physical activities were less and the prevalence of obesity was higher. The lifestyles of the hypertension patients were improved in those who know about their disease status. The prevalence of hypertension was high, but the awareness rate of self hypertension status, the treatment rate and the control rate of hypertension were low in rural area in Sichuan. It is necessary to strengthen the health education in young population and the treatment and control of hypertension in old population. Meanwhile, the management of hypertension patients should be standardized.

  12. Maximal exercise capacity is related to cardiovascular structure in patients with longstanding hypertension. A LIFE substudy. Losartan Intervention For Endpoint-Reduction in Hypertension

    DEFF Research Database (Denmark)

    Olsen, M H; Wachtell, K; Hermann, K L

    2001-01-01

    BACKGROUND: Cardiovascular hypertrophy and remodeling in patients with never-treated hypertension has been associated with impaired exercise capacity, but whether this relationship remains in patients with longstanding hypertension and target organ damage is less elucidated. METHODS: In 43...... the predicted maximal workload. This impaired exercise capacity was associated with lower common carotid distensibility and lower oxygen reserve. The latter was independently related to LV hypertrophy, low systemic vascular compliance and peripheral vascular remodeling, suggesting that cardiovascular......[129-163] v 162[146-179] Watt, P = .01). This impaired exercise capacity, calculated as the ratio between achieved and predicted maximal workload, was in simple regression analyses related to lower distensibility of the common carotid artery (r = 0.38, P = .01) and lower oxygen reserve (r = 0.68, P

  13. Prognosis of white-coat and masked hypertension: International Database of HOme blood pressure in relation to Cardiovascular Outcome.

    Science.gov (United States)

    Stergiou, George S; Asayama, Kei; Thijs, Lutgarde; Kollias, Anastasios; Niiranen, Teemu J; Hozawa, Atsushi; Boggia, José; Johansson, Jouni K; Ohkubo, Takayoshi; Tsuji, Ichiro; Jula, Antti M; Imai, Yutaka; Staessen, Jan A

    2014-04-01

    Home blood pressure monitoring is useful in detecting white-coat and masked hypertension and is recommended for patients with suspected or treated hypertension. The prognostic significance of white-coat and masked hypertension detected by home measurement was investigated in 6458 participants from 5 populations enrolled in the International Database of HOme blood pressure in relation to Cardiovascular Outcomes. During a median follow-up of 8.3 years, 714 fatal plus nonfatal cardiovascular events occurred. Among untreated subjects (n=5007), cardiovascular risk was higher in those with white-coat hypertension (adjusted hazard ratio 1.42; 95% CI [1.06-1.91]; P=0.02), masked hypertension (1.55; 95% CI [1.12-2.14]; Phypertension (2.13; 95% CI [1.66-2.73]; Phigh office and low home blood pressure (white-coat) and treated controlled subjects (low office and home blood pressure; 1.16; 95% CI [0.79-1.72]; P=0.45). However, treated subjects with masked hypertension (low office and high home blood pressure; 1.76; 95% CI [1.23-2.53]; P=0.002) and uncontrolled hypertension (high office and home blood pressure; 1.40; 95% CI [1.02-1.94]; P=0.04) had higher cardiovascular risk than treated controlled patients. In conclusion, white-coat hypertension assessed by home measurements is a cardiovascular risk factor in untreated but not in treated subjects probably because the latter receive effective treatment on the basis of their elevated office blood pressure. In contrast, masked uncontrolled hypertension is associated with increased cardiovascular risk in both untreated and treated patients, who are probably undertreated because of their low office blood pressure.

  14. Perspective: Update on Idiopathic Intracranial Hypertension

    Science.gov (United States)

    Bruce, Beau B.; Biousse, Valérie; Newman, Nancy J.

    2011-01-01

    Purpose Provide an update on various features of idiopathic intracranial hypertension. Design Perspective. Methods Selected articles on the epidemiology, clinical and imaging features, natural history, pathophysiology, and treatment of idiopathic intracranial hypertension were reviewed and interpreted in the context of the authors’ clinical and research experience. Results Idiopathic intracranial hypertension is primarily a disease of obese women of childbearing age, but it can affect patients of any weight, sex, and age. Although a relatively rare disorder, idiopathic intracranial hypertension’s associated costs in the U.S. entail hundreds of millions of dollars. Even following treatment, headaches are frequently persistent and may require the continued involvement of a neurologist. Quality of life reductions and depression are common among idiopathic intracranial hypertension patients. However, visual dysfunction, especially visual field abnormalities, represents the major morbidity of this disorder, and serial automated perimetry remains the primary mode of patient monitoring. Patients who are men, black, very obese, or anemic are at higher risk of visual loss. Vitamin A metabolism, adipose tissue as an actively secreting endocrine tissue, and cerebral venous abnormalities are areas of active study regarding idiopathic intracranial hypertension’s pathophysiology. Treatment studies show that lumbar puncture is a valuable treatment (in addition to its crucial diagnostic role) and that weight management is critical. However, open questions remain regarding the efficacy of acetazolamide, CSF diversion procedures, and cerebral venous stenting. Conclusions Many questions remain unanswered about idiopathic intracranial hypertension. Ongoing studies, especially an ongoing NIH-funded clinical trial of acetazolamide, should provide more insight into this important, yet poorly understood syndrome of isolated intracranial hypertension. PMID:21696699

  15. Analyses of placental gene expression in pregnancy-related hypertensive disorders

    OpenAIRE

    Chang, Shuenn-Dyh; Chao, An-Shine; Peng, Hsiu-Huei; Chang, Yao-Lung; Wang, Chao-Ning; Cheng, Po-Jen; Lee, Yun-Shien; Chao, Angel; Wang, Tzu-Hao

    2011-01-01

    Objective: To explore the changes in placental gene expression between women with preeclampsia and those with superimposed preeclampsia on chronic hypertension. Materials and Methods: In Taiwanese population, we compared gene expression between the placentas from preeclamptic patients and those with superimposed preeclampsia on chronic hypertension. Results: Although top-ranked activated genes between preeclampsia and superimposed preeclampsia on chronic hypertension were different, fun...

  16. Prolonged Q-T(c) interval in mild portal hypertensive cirrhosis

    DEFF Research Database (Denmark)

    Ytting, Henriette; Henriksen, Jens Henrik; Fuglsang, Stefan

    2005-01-01

    BACKGROUND/AIMS: The Q-T(c) interval is prolonged in a substantial fraction of patients with cirrhosis, thus indicating delayed repolarisation. However, no information is available in mild portal hypertensive patients. We therefore determined the Q-T(c) interval in cirrhotic patients with hepatic...... venous pressure gradient (HVPG) portal hypertension (HVPG> or = 12 mmHg) and controls without liver disease. RESULTS......), values which are significantly above that of the controls (0.410 s(1/2), P portal hypertensive group, the Q-T(c) interval was inversely related to indicators of liver function, such as indocyanine green clearance (r = -0.34, P

  17. Heritability of chronic venous disease

    OpenAIRE

    Fiebig, Andreas; Krusche, Petra; De Wolf, Andreas; Krawczak, Michael; Timm, Birgitt; Nikolaus, Susanna; Frings, Norbert; Schreiber, Stefan

    2010-01-01

    Varicose veins without skin changes have a prevalence of approximately 20% in Northern and Western Europe whereas advanced chronic venous insufficiency affects about 3% of the population. Genetic risk factors are thought to play an important role in the aetiology of both these chronic venous diseases (CVD). We evaluated the relative genetic and environmental impact upon CVD risk by estimating the heritability of the disease in 4,033 nuclear families, comprising 16,434 individuals from all ove...

  18. The role of diabetes and aging in the determinism of hypertension and the related cerebrovascular complications.

    Science.gov (United States)

    Malaguarnera, Michele; Vacante, Marco; Frazzetto, Paola Mariangela; Motta, Massimo

    2012-01-01

    Epidemiological studies carried out on a large sample (3191 elderly and 640 centenarians) with identical criteria and applying the actual diagnostic standards, have evidenced a high, statistically significant prevalence of diabetes mellitus type 2 (DMT2) (18.84%) in the elderly, as compared to the centenarians (7.50%). This aspect is correlated with the major frequency of maturity onset diabetes in elderly (MODE), compared to the centenarians, correlated also to the mortality of diabetes mellitus (DM) of long duration. The DMT2 and the aging interact in the determinism of vascular alterations, i.e., of the hypertension, and related cardio-cerebrovascular complications. The most frequently occurring hypertension in both the elderly and centenarians was always the systolic-isolated one. The prevalence of hypertension and acute myocardial infarction (AMI) was statistically significantly higher in diabetics, compared to the normoglycemic patients, in both the elderly and the centenarians. In addition, in a group of 914 elderly patients, being diabetics or normoglycemic at the start of the studies, but having neither AMI nor stroke at the baseline studies, after 5 years, these complications were more prevalent, significantly in statistical terms, in the diabetic subjects, compared to the normoglycemic ones. The increase of life-span causes an increase of the age when the aging phenomena appear, resulting in that the equal-age elderly people today are of better clinical conditions, compared to the previous periods. The increased life span with a consequent progressive aging of the population causes a worse general clinical state of the elderly population, characterized by polypathologies, frailty, and appearance of cognitive deficits or incapabilities for performing manual or instrumental activities. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  19. Potential cognitive decline linked to angiotensin-converting enzyme gene but not hypertension: Evidence from cognitive event-related potentials.

    Science.gov (United States)

    Liou, Li-Min; Yang, Yuan-Han; Lu, Shiang-Ru; Hsu, Chung-Yao; Liu, Ching-Kuan; Lai, Chiou-Lian

    2015-12-01

    The aims of the present study were to investigate the effect of hypertension and angiotensin-converting enzyme (ACE) genotypes on cognitive event-related potentials (ERPs), and whether the impact of ACE genotypes on P300 is related to the influence of hypertension. Using the Cognitive Abilities Screening Instrument (CASI), we recruited 97 mentally healthy middle-aged and older adults. Medical histories were collected, and blood pressure, ACE insertion/deletion polymorphisms and ERPs in an auditory oddball task were measured for all participants. When the participants were stratified according to the presence or absence of hypertension, there were no differences in CASI score, percentage of ACE genotypes and ERPs. The subjects with the D/D homozygote displayed lower amplitude and longer latency of P300, although there were no differences in CASI score and the percentage of hypertension. The subjects with the D/D genotype tended to have decreased amplitude and prolonged latency of P300 ERPs which reflected subtle cognitive impairment. There were no associations between hypertension, CASI score and P300 measurements. Using ERPs, potential cognitive decline was linked to ACE genotypes, independently of the effect of hypertension. Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  20. Neurological recovery after coma related to diffuse cerebral venous sinus thrombosis. Interest in thrombi-aspiration with Penumbra system.

    Science.gov (United States)

    Gariel, Florent; Berge, Jerome; Dousset, Vincent

    2015-04-01

    We report a young man with a history of deep coma secondary to an extensive superior sagittal sinus thrombosis despite full systemic anticoagulation. Endovascular treatment combining a 5 Max ACE reperfusion catheter (Penumbra) and Solitaire (Covidien) retrieval device permitted revascularization of the superior sagittal sinus with restoration of anterograde venous flow. This treatment led to the disappearance of cytotoxic edema on MRI and to a neurological improvement with a modified Rankin scale score of 2 after two months. Our experience shows that this technique provides a useful and safe tool after failure of anticoagulation in cerebral venous sinus thrombosis. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  1. Ethnic, gender, and age-related differences in treatment and control of dyslipidemia in hypertensive patients.

    Science.gov (United States)

    Hendrix, Katharine H; Riehle, Jessica E; Egan, Brent M

    2005-01-01

    Demographic differences in management of concomitant lipid disorders among hypertensive patients may contribute to health disparities. Assess demographic differences in lipid control rates and treatment patterns among dyslipidemic hypertensive patients in primary care. Demographic information, blood pressure, LDL-cholesterol, and medications were obtained on 72,351 hypertensive patients from 262 primary care providers at 69 sites in the Southeast. Analysis focused on a dyslipidemic hypertensive subset. Among 72,351 hypertensives, 38,116 were dyslipidemic. Fifty-two percent of patients did not have a cholesterol measurement documented in the past year. Women and patients guide education and policy interventions to improve outcomes and reduce disparities.

  2. EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies), 2014. Scientific Opinion on the substantiation of a health claim related to a combination of diosmin, troxerutin and hesperidin and maintenance of normal venous tone pursuant to Article 13(5) of Regulation (EC) No 1924/2006

    DEFF Research Database (Denmark)

    Tetens, Inge

    2014-01-01

    claim related to a combination of diosmin, troxerutin and hesperidin and maintenance of normal venous tone. The food that is a subject of the health claim, a combination of diosmin, troxerutin and hesperidin, is sufficiently characterised. The claimed effect, maintenance of normal venous tone...... of diosmin, troxerutin and hesperidin and the maintenance of normal venous tone....

  3. Work stress related lipid disorders and arterial hypertension in professional drivers: A cross-sectional study

    Directory of Open Access Journals (Sweden)

    Đinđić Nataša

    2013-01-01

    Full Text Available Background/Aim. Occupational stress is a term used to define ongoing stress that is related to the workplace. The study was conducted to determine association of occupational stress index (OSI and its aspects with arterial hypertension and lipid disorders using data from a cross-sectional survey of male professional drivers. Methods. The cross-sectional study was performed in 439 professional drivers divided into groups (city- and intercity bus drivers, truck and taxi drivers. The OSI and OSI aspects (high demands, strictness, underload, extrinsic time pressure, noxious exposure, avoidance and conflict were calculated using the standardized questionnaire. Determination of serum lipids, blood pressure (BP and cardiovascular risk factors were done. Results. A significant difference in prevalence of diagnosed hypertension and dyslipidemia was found along with a difference in total OSI and OSI aspects among examined subgroups of drivers. A total OSI was highest in city, high in intercity bus drivers, and the lowest one in truck and taxi drivers (82.79 ± 3.5, 81.28 ± 3.7, 73.75 ± 3.5, 71.61 ± 4.4, respectively; p < 0.01. Similar pattern showed triglycerides (TG, total cholesterol (TC and LDL cholesterol and BP, while HDL-cholesterol showed reverse order (p < 0.01. Logistic regression analyses with multiple OSI aspects adjusted for age and years of exposure showed associations of total OSI with arterial hypertension [OR 5.5; 95% CI (2.24-7.95] and dyslipidemia [OR 1.43 95% CI (1.09-2.80]. Underload was the most important OSI aspect associated with the arterial hypertension [OR 1.18; 95% CI (1.04-2.58] and elevated LDL cholesterol [1.26; 95 CI (1.19-2.1]. A total OSI had a significant association with elevated LDL cholesterol [2.64; 95% CI (1.19- 7.7], triglycerides [OR 3.27; 95% CI (1.20-5.1] and low HDL cholesterol [OR 3.29; 95% CI (1.8-5.8] (p < 0.01. Conclusion. The study provides the evidence for the significant association of total OSI and

  4. Hypertension Subtypes among Hypertensive Patients in Ibadan

    Directory of Open Access Journals (Sweden)

    Abiodun M. Adeoye

    2014-01-01

    Full Text Available Background. Certain hypertension subtypes have been shown to increase the risk for cardiovascular morbidity and mortality and may be related to specific underlying genetic determinants. Inappropriate characterization of subtypes of hypertension makes efforts at elucidating the genetic contributions to the etiology of hypertension largely vapid. We report the hypertension subtypes among patients with hypertension from South-Western Nigeria. Methods. A total of 1858 subjects comprising 76% female, hypertensive, aged 18 and above were recruited into the study from two centers in Ibadan, Nigeria. Hypertension was identified using JNCVII definition and was further grouped into four subtypes: controlled hypertension (CH, isolated systolic hypertension (ISH, isolated diastolic hypertension (IDH, and systolic-diastolic hypertension (SDH. Results. Systolic-diastolic hypertension was the most prevalent. Whereas SDH (77.6% versus 73.5% and IDH (4.9% versus 4.7% were more prevalent among females, ISH (10.1% versus 6.2% was higher among males (P=0.048. Female subjects were more obese (P<0.0001 and SDH was prevalent among the obese group. Conclusion. Gender and obesity significantly influenced the distribution of the hypertension subtypes. Characterization of hypertension by subtypes in genetic association studies could lead to identification of previously unknown genetic variants involved in the etiology of hypertension. Large-scale studies among various ethnic groups may be needed to confirm these observations.

  5. Prevalence, awareness, treatment and control of hypertension in Galicia (Spain) and association with related diseases.

    Science.gov (United States)

    Perez-Fernandez, R; Mariño, A F; Cadarso-Suarez, C; Botana, M A; Tome, M A; Solache, I; Rego-Iraeta, A; Mato, A J

    2007-05-01

    The present study evaluated the prevalence of hypertension (HT) and its possible relationships with various risk factors in a representative sample (n=2884) of the adult population (>18 years old) of Galicia, a region of Spain. Subjects were selected by a two-step cluster sampling procedure from the Galician public health service database, which covers more than 95% of the population (2.7 million inhabitants). The overall prevalence of HT, defined as BP >140/90 mm Hg and/or current treatment with antihypertensive medication, was 25.5%, higher in men (31.1%) than in women (20.7%). Of the hypertensive subjects 50.6% were aware of the HT; of these, 72.0% were receiving treatment and 36.4% were treated and controlled. The prevalence of HT increased with age and was higher in subjects from urban areas than rural areas and higher in subjects with low educational level. Surprisingly, people with low educational level more frequently showed awareness of HT than people with high education level. Increased body mass index was related to increased prevalence of HT and close associations were observed between HT and cardiovascular diseases. Our data also show a linear upward trend in blood pressure from normal glucose metabolism to diabetes mellitus. Surprisingly, the prevalence of HT among people with known diabetes was higher than among people with undetected diabetes, which may indicate poor control of HT in diabetic subjects.

  6. Mutational screening in genes related with porto-pulmonary hypertension: An analysis of 6 cases.

    Science.gov (United States)

    Pousada, Guillermo; Baloira, Adolfo; Valverde, Diana

    2017-04-07

    Portopulmonary hypertension (PPH) is a rare disease with a low incidence and without a clearly-identified genetic component. The aim of this work was to check genes and genetic modifiers related to pulmonary arterial hypertension in patients with PPH in order to clarify the molecular basis of the pathology. We selected a total of 6 patients with PPH and amplified the exonic regions and intronic flanking regions of the relevant genes and regions of interest of the genetic modifiers. Six patients diagnosed with PPH were analyzed and compared to 55 healthy individuals. Potentially-pathogenic mutations were identified in the analyzed genes of 5 patients. None of these mutations, which are highly conserved throughout evolution, were detected in the control patients nor different databases analyzed (1000 Genomes, ExAC and DECIPHER). After analyzing for genetic modifiers, we found different variations that could favor the onset of the disease. The genetic analysis carried out in this small cohort of patients with PPH revealed a large number of mutations, with the ENG gene showing the greatest mutational frequency. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  7. Different Impact of Essential Hypertension on Structural and Functional Age-Related Vascular Changes.

    Science.gov (United States)

    Bruno, Rosa Maria; Duranti, Emiliano; Ippolito, Chiara; Segnani, Cristina; Bernardini, Nunzia; Di Candio, Giulio; Chiarugi, Massimo; Taddei, Stefano; Virdis, Agostino

    2017-01-01

    We evaluated whether vascular remodeling is present in physiological aging and whether hypertension accelerates the aging process for vascular function and structure. Small arteries from 42 essential hypertensive patients (HT) and 41 normotensive individuals (NT) were dissected after subcutaneous biopsy. Endothelium-dependent vasodilation (pressurized myograph) was assessed by acetylcholine, repeated under the nitric oxide synthase inhibitor N-nitro-l-arginine methylester or the antioxidant tempol. Structure was evaluated by media-lumen ratio (M/L). Intravascular oxidative generation and collagen deposition were assessed. Inhibition by N-nitro-l-arginine methylester on ACh was inversely related to age in both groups (Phypertension interaction occurred (P=0.0009). In NT, intravascular superoxide emerged in the oldest subgroup, whereas it appeared earlier among HT. Among NT, aged group displayed an increment of collagen fibers versus young group. In HT, collagen deposition was already evident in youngest, with a further enhancement in the aged group. In small arteries, ageing shows a eutrophic vascular remodeling and a reduced nitric oxide availability. Oxidative stress and fibrosis emerge in advanced age. In HT, nitric oxide availability is early reduced, but the progression rate with age is similar. Structural alterations include wide collagen deposition and intravascular reactive oxygen species, and the progression rate with age is steeper. © 2016 American Heart Association, Inc.

  8. Work stress related lipid disorders and arterial hypertension in professional drivers - a cross-sectional study.

    Science.gov (United States)

    Djindjić, Natasa; Jovanović, Jovica; Djindjić, Boris; Jovanović, Milan; Pesić, Milica; Jovanović, Jovana J

    2013-06-01

    Occupational stress is a term used to define ongoing stress that is related to the workplace. The study was conducted to determine association of occupational stress index (OSI) and its aspects with arterial hypertension and lipid disorders using data from a cross-sectional survey of male professional drivers. The cross-sectional study was performed in 439 professional drivers divided into groups (city- and intercity bus drivers, truck and taxi drivers). The OSI and OSI aspects (high demands, strictness, underload, extrinsic time pressure, noxious exposure, avoidance and conflict) were calculated using the standardized questionnaire. Determination of serum lipids, blood pressure (BP) and cardiovascular risk factors were done. A significant difference in prevalence of diagnosed hypertension and dyslipidemia was found along with a difference in total OSI and OSI aspects among examined subgroups of drivers. A total OSI was highest in city, high in intercity bus drivers, and the lowest one in truck and taxi drivers (82.79 +/- 3.5, 81.28 +/- 3.7, 73.75 +/- 3.5, 71.61 +/- 4.4, respectively; p stress and coronary heart disease. Regular periodical examinations and workplace interventions aimed to decrease total OSI and underload are important aspects in primary prevention and additional reduction of cardiovascular risk.

  9. The role of hypertension in bromocriptine-related puerperal intracranial hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Kirsch, C. [Dept. of Radiology, University Hospital, Newark, NJ (United States); Iffy, L. [Dept. of Obstetrics, Gynecology and Womens Health, University Hospital, Newark, NJ (United States); Zito, G.E. [Dept. of Neurology, University Hospital, Newark, NJ (United States); McArdle, J.J. [Dept. of Pharmacology, University Hospital, Newark, NJ (United States)

    2001-04-01

    The spate of medicolegal inquiries following the disqualification of Parlodel (bromocriptine mesylate) by the Food and Drug Administration for postpartum ablactation, uncovered previously unreported side effects associated with its postpartum administration. In 1994, bromocriptine mesylate was withdrawn from the market as a milk suppressant. Since this time, over a dozen cases of postpartum intracranial hemorrhages associated with its use have been reported. We describe three additional cases of postpartum intracranial hemorrhage related to bromocriptine usage. One patient, previously normotensive, developed hypertension and a headache; initial CT was normal, but CT 24 h later demonstrated intracranial hemorrhage. This suggests that the blood-pressure elevation was drug-induced and was the cause, rather than the consequence, of bromocriptine-related intracranial hemorrhage. (orig.)

  10. Prevalence of self-reported hypertension and its relation to dietary habits, in adults; a nutrition & health survey in Greece

    Directory of Open Access Journals (Sweden)

    Xenaki Dimitra

    2006-08-01

    Full Text Available Abstract Background Hypertension leads to many degenerative diseases, the most common being cardiovascular in origin. This study has been designed to estimate the prevalence of self-reported hypertension in a random nationwide sample of adult Greek population, while focus was set to the assessment of participants' nutritional habits in relation to their hypertension status. Methods A random-digit dialed telephone survey. Based on a multistage, stratified sampling, 5003 adults (18 – 74 yr participated (men: 48.8%, women: 51.2%. All participants were interviewed via telephone by trained personnel who used a standard questionnaire. The questionnaire included demographic and socioeconomic characteristics, medical history, lifestyle habits and nutritional assessment. Results The prevalence of self-reported hypertension was 13.3% in men and 17.7% in women (P Conclusion Hypertension seems to be a serious public health problem in Greece. It is encouraging that hypertensives may have started adopting some more healthy nutritional behaviour compared to normotensive ones. However, they can gain significant benefits regarding to blood pressure control, if they increase the level of compliance with dietary recommendations.

  11. Antimicrobial dressings for the prevention of catheter-related infections in newborn infants with central venous catheters.

    Science.gov (United States)

    Lai, Nai Ming; Taylor, Jacqueline E; Tan, Kenneth; Choo, Yao Mun; Ahmad Kamar, Azanna; Muhamad, Nor Asiah

    2016-03-23

    Central venous catheters (CVCs) provide secured venous access in neonates. Antimicrobial dressings applied over the CVC sites have been proposed to reduce catheter-related blood stream infection (CRBSI) by decreasing colonisation. However, there may be concerns on the local and systemic adverse effects of these dressings in neonates. We assessed the effectiveness and safety of antimicrobial (antiseptic or antibiotic) dressings in reducing CVC-related infections in newborn infants. Had there been relevant data, we would have evaluated the effects of antimicrobial dressings in different subgroups, including infants who received different types of CVCs, infants who required CVC for different durations, infants with CVCs with and without other antimicrobial modifications, and infants who received an antimicrobial dressing with and without a clearly defined co-intervention. We used the standard search strategy of the Cochrane Neonatal Review Group (CNRG). We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2015, Issue 9), MEDLINE (PubMed), EMBASE (EBCHOST), CINAHL and references cited in our short-listed articles using keywords and MeSH headings, up to September 2015. We included randomised controlled trials that compared an antimicrobial CVC dressing against no dressing or another dressing in newborn infants. We extracted data using the standard methods of the CNRG. Two review authors independently assessed the eligibility and risk of bias of the retrieved records. We expressed our results using risk difference (RD) and risk ratio (RR) with 95% confidence intervals (CIs). Out of 173 articles screened, three studies were included. There were two comparisons: chlorhexidine dressing following alcohol cleansing versus polyurethane dressing following povidone-iodine cleansing (one study); and silver-alginate patch versus control (two studies). A total of 855 infants from level III neonatal intensive care units (NICUs) were evaluated, 705 of

  12. Venous ulcers of the lower limb: Where do we stand?

    Science.gov (United States)

    Chatterjee, Sasanka S.

    2012-01-01

    Venous ulcers are the most common ulcers of the lower limb. It has a high morbidity and results in economic strain both at a personal and at a state level. Chronic venous hypertension either due to primary or secondary venous disease with perforator paucity, destruction or incompetence resulting in reflux is the underlying pathology, but inflammatory reactions mediated through leucocytes, platelet adhesion, formation of pericapillary fibrin cuff, growth factors and macromolecules trapped in tissue result in tissue hypoxia, cell death and ulceration. Duplex scan with colour flow is the most useful investigation for venous disease supplying information about patency, reflux, effects of proximal and distal compression, Valsalva maneuver and effects of muscle contraction. Most venous disease can be managed conservatively by leg elevation and compression bandaging. Drugs of proven benefit in venous disease are pentoxifylline and aspirin, but they work best in conjunction with compression therapy. Once ulceration is chronic or the patient does not respond to or cannot maintain conservative regime, surgical intervention treating the underlying venous hypertension and cover for the ulcer is necessary. The different modalities like sclerotherapy, ligation and stripping of superficial varicose veins, endoscopic subfascial perforator ligation, endovenous laser or radiofrequency ablation have similar long-term results, although short-term recovery is best with radiofrequency and foam sclerotherapy. For deep venous reflux, surgical modalities include repair of incompetent venous valves or transplant or transposition of a competent vein segment with normal valves to replace a post-thrombotic destroyed portion of the deep vein. PMID:23162226

  13. Venous ulcers of the lower limb: Where do we stand?

    Directory of Open Access Journals (Sweden)

    Chatterjee S Sasanka

    2012-01-01

    Full Text Available Venous ulcers are the most common ulcers of the lower limb. It has a high morbidity and results in economic strain both at a personal and at a state level. Chronic venous hypertension either due to primary or secondary venous disease with perforator paucity, destruction or incompetence resulting in reflux is the underlying pathology, but inflammatory reactions mediated through leucocytes, platelet adhesion, formation of pericapillary fibrin cuff, growth factors and macromolecules trapped in tissue result in tissue hypoxia, cell death and ulceration. Duplex scan with colour flow is the most useful investigation for venous disease supplying information about patency, reflux, effects of proximal and distal compression, Valsalva maneuver and effects of muscle contraction. Most venous disease can be managed conservatively by leg elevation and compression bandaging. Drugs of proven benefit in venous disease are pentoxifylline and aspirin, but they work best in conjunction with compression therapy. Once ulceration is chronic or the patient does not respond to or cannot maintain conservative regime, surgical intervention treating the underlying venous hypertension and cover for the ulcer is necessary. The different modalities like sclerotherapy, ligation and stripping of superficial varicose veins, endoscopic subfascial perforator ligation, endovenous laser or radiofrequency ablation have similar long-term results, although short-term recovery is best with radiofrequency and foam sclerotherapy. For deep venous reflux, surgical modalities include repair of incompetent venous valves or transplant or transposition of a competent vein segment with normal valves to replace a post-thrombotic destroyed portion of the deep vein.

  14. Association of a New Measure of Obesity with Hypertension and Health-Related Quality of Life.

    Science.gov (United States)

    Chung, Wankyo; Park, Chun Gun; Ryu, Ohk-Hyun

    2016-01-01

    Despite its shortcomings, body mass index (BMI) has traditionally been used to define obesity. Another recently introduced obesity measure, A Body Shape Index (ABSI), has been introduced to focus on abdominal obesity, but its applicability remains limited. We analyzed the statistical properties of the ABSI and propose a modified ABSI, the z-score of the log-transformed ABSI (LBSIZ), to improve its applicability. We also examined the sensitivity of the newly introduced index in diagnosing obesity based on the percentage of body fat and its ability to predict hypertension and impaired health-related quality of life (HRQOL). We transformed the ABSI to the LBSIZ in order to create a standard normalized obesity measure. All available data from the Korea National Health and Nutrition Examination Survey (KNHANES) (1998-2012) have shown BMI to be highly correlated with weight (r = 0.85 for women, r = 0.87 for men) and waist circumference (WC) (r = 0.86 for women, r = 0.85 for men), but the LBSIZ was found to be weakly correlated with weight (r = 0.001 for women, r = 0.0001 for men) and moderately correlated with WC (r = 0.51 for women, r = 0.52 for men). BMI showed an inverted U-shaped pattern when plotted against age, but a linear pattern was observed for the LBSIZ, indicating they are different kinds of obesity measures. Logistic regression showed that the odds ratio of obesity for the LBSIZ was 1.86 (95% confidence interval [CI] = 1.73-2.00) for males and 1.32 (95% CI = 1.24-1.40) for females after adjusting for weight, height, age, and year of participation in the KNHANES. While both BMI and the LBSIZ were significantly related to hypertension, the LBSIZ alone was significantly associated with impaired HRQOL. The LBSIZ is a standard normalized obesity measure independent of weight, height, and BMI. LBSIZ is a new measure of abdominal obesity with the ability to predict hypertension and impaired HRQOL, irrespective of BMI.

  15. A role for peripherally inserted central venous catheters in the prevention of catheter-related blood stream infections in patients with hematological malignancies.

    Science.gov (United States)

    Sakai, Toshiro; Kohda, Kyuhei; Konuma, Yuichi; Hiraoka, Yasuko; Ichikawa, Yukari; Ono, Kaoru; Horiguchi, Hiroto; Tatekoshi, Ayumi; Takada, Kouichi; Iyama, Satoshi; Kato, Junji

    2014-12-01

    Central venous catheter-related blood stream infections (CR-BSIs) are a serious complication in patients with hematological malignancies. However, it remains unclear whether there is a difference in the rate of CR-BSI associated with the conventional type of central venous catheters (cCVCs) and peripherally inserted CVCs (PICCs) in such patients. To address this question, we retrospectively investigated the incidence of CR-BSIs associated with PICCs versus cCVCs in patients with hematological malignancies. We used PICCs in all consecutive patients requiring CVC placement between February 2009 and February 2013. We compared the CR-BSI rate in patients with PICCs with that in patients with cCVCs treated between September 2006 and January 2009 (control group). Eighty-four patients received PICCs and 85 received cCVCs. The most common reason for removal due to catheter-related complications was CR-BSI. The CR-BSI rate in the PICC group was significantly lower than that in the cCVC group (PICCs: 1.23/1000 catheter days; cCVCs: 5.30/1000 catheter days; P Catheter-related complications other than CR-BSIs occurred at an extremely low rate in the PICC group. The median catheter-related complication-free survival duration was significantly longer in the PICC group than in the cCVC group. Our study shows that PICCs are useful in patients with hematological malignancies.

  16. Left Ventricular Myocardial Function in Children With Pulmonary Hypertension: Relation to Right Ventricular Performance and Hemodynamics.

    Science.gov (United States)

    Burkett, Dale A; Slorach, Cameron; Patel, Sonali S; Redington, Andrew N; Ivy, D Dunbar; Mertens, Luc; Younoszai, Adel K; Friedberg, Mark K

    2015-08-01

    Through ventricular interdependence, pulmonary hypertension (PH) induces left ventricular (LV) dysfunction. We hypothesized that LV strain/strain rate, surrogate measures of myocardial contractility, are reduced in pediatric PH and relate to invasive hemodynamics, right ventricular strain, and functional measures of PH. At 2 institutions, echocardiography was prospectively performed in 54 pediatric PH patients during cardiac catheterization, and in 54 matched controls. Patients with PH had reduced LV global longitudinal strain (LS; -18.8 [-17.3 to -20.4]% versus -20.2 [-19.0 to -20.9]%; P=0.0046) predominantly because of reduced basal (-12.9 [-10.8 to -16.3]% versus -17.9 [-14.5 to -20.7]%; Pright ventricular free-wall LS (r=0.64; Pright ventricular strain, and functional PH measures. © 2015 American Heart Association, Inc.

  17. Risk factors related to hypertension among patients in a cohort living with HIV/AIDS

    Directory of Open Access Journals (Sweden)

    Evanizio Roque de Arruda Junior

    Full Text Available INTRODUCTION: Studies disagree as to whether there is a greater prevalence of hypertension among HIV/AIDS patients and the role of antiretroviral therapy. OBJECTIVE: Evaluate the prevalence of hypertension and risk factors in a cohort of HIV-infected patients, with emphasis on antiretroviral therapy. METHOD: Case-control study conducted at baseline of a cohort, between June/2007 and December/2008 in Pernambuco/Brazil. Blood pressure was classified as normal, prehypertension, and hypertension. RESULTS: Of 958 patients, 245 (25.6% had hypertension (cases, 325 (33.9% had prehypertension, and 388 (40.5% were normotensive (controls. Comparison between hypertensive and normotensive patients showed that traditional factors, such as age > 40 (OR = 3.06, CI = 1.91-4.97, male gender (OR = 1.85, CI = 1.15-3.01, BMI > 25 (OR = 5.51, CI = 3.36-9.17, and triglycerides > 150 mg/dL (OR = 1.69, CI = 1.05-2.71, were independently associated with hypertension. Duration of antiretroviral therapy and CD4 > 200 cells/mm³ were associated with hypertension in univariate analysis, but did not remain in final model. Type of antiretroviral schema and lipodystrophy showed no association with hypertension. CONCLUSION: Hypertension in HIV/AIDS patients is partially linked to invariable factors, such as age and sex. Efforts should be directed toward controlling reversible factors, particularly excessive weight gain and unsuitable diet.

  18. Venous ulcers of the lower extremity: Definition, epidemiology, and economic and social burdens.

    Science.gov (United States)

    Lal, Brajesh K

    2015-03-01

    Venous ulcer is a common vascular condition affecting 1% of the population, and a prevalence that increases with age. Venous ulcer is defined by the American Venous Forum as "a full-thickness defect of skin, most frequently in the ankle region, that fails to heal spontaneously and is sustained by chronic venous disease, based on venous duplex ultrasound testing." The economic and social burden of this condition is significant to both the affected individual and the health care system. The recurrent nature of venous ulcers underscore the need for treatment of the underlying pathophysiology, that is, ambulatory venous hypertension produced by venous valve reflux alone or in conjunction with venous obstruction. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Sagittal venous sinus thrombosis after cesarean section: a case report

    Directory of Open Access Journals (Sweden)

    Farideh Keypour

    2013-07-01

    Full Text Available Background: Cerebral venous thrombosis (CVT is uncommon after cesarean section. Although it can be a leading cause of maternal mortality. CVT may occur during pregnancy because of hypercoagulable states such as preeclampsia, thrombophilias, antiphospholipid antibody syndrome and sepsis.Case presentation: A 31 years old woman G2 Ab1 at 37 weeks gestational age with  premature rupture of membrane underwent cesarean section because breech presentation and preeclampsia. Spinal anesthesia was done for emergent cesarean section. On the second day after cesarean section, she developed headache, vomiting, focal neurologic deficits, paresthesia, blurred vision. Brain magnetic resonance imaging (MRI showed thrombosis in anterior half of superior sagittal sinus. Treatment consisted of anticoagulation.  Conclusion: Thrombophilias, pregnancy-related hypertension and cesarean section are the predisposing factors for thromboembolism. Unfractionated heparin and low molecular weight heparin (LMWs are effective drugs for thromboprophylaxis. It is vital to prevent venous thrombosis to reduce mortality during both intrapartum and postpartum periods. Consideration of cerebral venous thrombosis in similar cases is recommended.

  20. Hepatic venous pressure gradients measured by duplex ultrasound

    Energy Technology Data Exchange (ETDEWEB)

    Tasu, J.-P.; Rocher, L.; Peletier, G.; Kuoch, V.; Kulh, E.; Miquel, A.; Buffet, C.; Biery, M

    2002-08-01

    AIMS: The hepatic venous pressure gradient is a major prognostic factor in portal hypertension but its measurement is complex and requires invasive angiography. This study investigated the relationship between the hepatic venous pressure gradient and a number of Doppler measurements, including the arterial acceleration index. METHOD: We measured the hepatic venous pressure gradient in 50 fasting patients at hepatic venography. Immediately afterwards, a duplex sonographic examination of the liver was performed at which multiple measurements and indices of the venous and arterial hepatic vasculature were made. RESULTS: Hepatic arterial acceleration was correlated directly with the hepatic venous pressure gradient (r = 0.83, P < 0.0001) and with the Child-Pugh score (r = 0.63, P < 0.0001). An acceleration index cut-off value of 1 m.s{sup -2} provided a positive predictive value of 95%, a sensitivity of 65% and a specificity of 95% for detecting patients with severe portal hypertension (hepatic venous pressure gradient > 12 mmHg). A correlation between the hepatic venous pressure gradient and the congestion index of the portal vein velocity (r = 0.45,P = 0.01) and portal vein velocity (r = 0.40,P = 0.044), was also noted. CONCLUSION: Measuring the hepatic arterial acceleration index may help in the non-invasive evaluation of portal hypertension. Tasu, J.-P. et al. (2002)

  1. Pulmonary hypertension and cardiac hypertrophy in children recipients of orthotopic living related liver transplantation

    Directory of Open Access Journals (Sweden)

    Magd A. Kotb

    2017-11-01

    Full Text Available Surgical stress, liberation of cytokines associated with re-perfusion injury, and long standing use of immune suppressive medications in children recipients of orthotopic living related liver transplantation (OLRLT pose cardiovascular risk. Reported cardiovascular adverse effects vary from left ventricular wall thickening, hypertrophic cardiomyopathy to resting ECG abnormalities, asymptomatic ST depression following increased heart rate and ventricular arrhythmias. Twenty-five consecutive children recipients of OLRLT were assessed by conventional 2-D, M-mode echocardiography and Doppler. The mean age ± SD at transplantation and at enrollment in study was 6.3 ± 4.5 and 13.5 ± 5.6 years respectively. All children were on immunosuppressive medications, with tacrolimus being constant among all. Long-term post-transplant echocardiography revealed statistically significant interventricular septal hypertrophy among all (mean thickness 0.89 ± 0.16 cm, (P = 0.0001 in comparison to reference range for age, 24 had pulmonary hypertension (mean mPAP 36.43 ± 5.60 mm Hg, P = 0.0001, and early diastolic dysfunction with a mean Tei index of 0.40 ± 0.10. However cardiac function was generally preserved. Children recipients of OLRLT have cardiac structural and functional abnormalities that can be asymptomatic. Pulmonary hypertension, increased cardiac mass, de novo aortic stenosis and diastolic heart failure were among abnormalities encountered in the studied population. Echocardiography is indispensible in follow-up of children recipients of OLRLT.

  2. The metabolic syndrome in black hypertensive women - Waist circumference more strongly related than body mass index

    NARCIS (Netherlands)

    Rheeder, P; Stolk, RP; Veenhouwer, JF; Grobbee, DE

    Objective. To examine the association between measures of. obesity and features of the metabolic syndrome in treated. black female hypertensive subjects. Design. Cross-sectional study. Setting. An urban primary health care centre in Mamelodi, Pretoria. Subjects. Women with hypertension and without

  3. Is immune system‐related hypertension associated with ovarian hormone deficiency?

    National Research Council Canada - National Science Library

    Sandberg, Kathryn; Ji, Hong; Einstein, Gillian; Au, April; Hay, Meredith

    2016-01-01

    ... associated with an increased frequency of hypertension in women. The adaptive immune system has recently been implicated in the development of high blood pressure in males, and activation and infiltration of T cells into the kidney, peripheral vasculature and CNS have been shown to contribute to the development of hypertension (Guzik et al . ; Harrison et al ....

  4. Knowledge related to nutrition and hypertension management practices of adults in Ga-Rankuwa day clinics

    Directory of Open Access Journals (Sweden)

    N.G. Nkosi

    2010-09-01

    Full Text Available Hypertension is a global, non-communicable chronic disease being asymptomatic and known as the silent killer with signs and symptoms only occurring when a target organ is damaged. Being a condition common in South Africa, hypertension is also a risk factor for cerebro-vascular incidents, myocardial infarction, left ventricular hypertrophy, renal disease and retinopathy. Black adults in an urban environment appear to be especially vulnerable to excessive increases in blood pressure. The research question explored was what was the knowledge of hypertensive adults attending day clinics in Ga-Rankuwa regarding nutrition and hypertension management practices. An exploratory strategy was used as no similar research had previously been conducted in Ga-Rankuwa. A cross sectional survey design was used to investigate hypertensive adults attending the three primary health clinics in Ga-Rankuwa. The sampling method was convenient and the sample size 101 participants. Two data gathering methods were used, these being physical measurements and self-report. For the self-report, a structured interview was conducted. The data were analysed using descriptive statistics. The results indicated a lack of knowledge regarding nutrition and management of hypertension. The proportion of participants with uncontrolled hypertension was high (58.6% and non-compliance with medication occurred frequently (58.1%. A third (28.7% of the sample lacked knowledge of the complications of hypertension (28.7%. A community-based intervention, based on the results of the study, is recommended.

  5. Knowledge related to nutrition and hypertension management practices of adults in Ga-Rankuwa day clinics.

    Science.gov (United States)

    Nkosi, N G; Wright, S C D

    2010-06-01

    Hypertension is a global, non-communicable chronic disease being asymptomatic and known as the silent killer with signs and symptoms only occurring when a target organ is damaged. Being a condition common in South Africa, hypertension is also a risk factor for cerebro-vascular incidents, myocardial infarction, left ventricular hypertrophy, renal disease and retinopathy. Black adults in an urban environment appear to be especially vulnerable to excessive increases in blood pressure. The research question explored was what was the knowledge of hypertensive adults attending day clinics in Ga-Rankuwa regarding nutrition and hypertension management practices. An exploratory strategy was used as no similar research had previously been conducted in Ga-Rankuwa. A cross sectional survey design was used to investigate hypertensive adults attending the three primary health clinics in Ga-Rankuwa. The sampling method was convenient and the sample size 101 participants. Two data gathering methods were used, these being physical measurements and self-report. For the self-report, a structured interview was conducted. The data were analysed using descriptive statistics. The results indicated a lack of knowledge regarding nutrition and management of hypertension. The proportion of participants with uncontrolled hypertension was high (58.6%) and non-compliance with medication occurred frequently (58.1%). A third (28.7%) of the sample lacked knowledge of the complications of hypertension (28.7%). A community-based intervention, based on the results of the study, is recommended.

  6. Maximal exercise capacity is related to cardiovascular structure in patients with longstanding hypertension. A LIFE substudy. Losartan Intervention For Endpoint-Reduction in Hypertension

    DEFF Research Database (Denmark)

    Olsen, M H; Wachtell, K; Hermann, K L

    2001-01-01

    BACKGROUND: Cardiovascular hypertrophy and remodeling in patients with never-treated hypertension has been associated with impaired exercise capacity, but whether this relationship remains in patients with longstanding hypertension and target organ damage is less elucidated. METHODS: In 43 unmedi...

  7. CT-Guided Superior Vena Cava Puncture: A Solution to Re-Establishing Access in Haemodialysis-Related Central Venous Occlusion Refractory to Conventional Endovascular Techniques

    Energy Technology Data Exchange (ETDEWEB)

    Khalifa, Mohamed, E-mail: mkhalifa@nhs.net; Patel, Neeral R., E-mail: neeral.patel06@gmail.com; Moser, Steven, E-mail: steven.moser@imperial.nhs.uk [Hammersmith Hospital, Department of Radiology, Imperial College Healthcare NHS Trust (United Kingdom)

    2016-04-15

    PurposeThe purpose of this technical note is to demonstrate the novel use of CT-guided superior vena cava (SVC) puncture and subsequent tunnelled haemodialysis (HD) line placement in end-stage renal failure (ESRF) patients with central venous obstruction refractory to conventional percutaneous venoplasty (PTV) and wire transgression, thereby allowing resumption of HD.MethodsThree successive ESRF patients underwent CT-guided SVC puncture with subsequent tract recanalisation. Ultrasound-guided puncture of the right internal jugular vein was performed, the needle advanced to the patent SVC under CT guidance, with subsequent insertion of a stabilisation guidewire. Following appropriate tract angioplasty, twin-tunnelled HD catheters were inserted and HD resumed.ResultsNo immediate complications were identified. There was resumption of HD in all three patients with a 100 % success rate. One patient’s HD catheter remained in use for 2 years post-procedure, and another remains functional 1 year to the present day. One patient died 2 weeks after the procedure due to pancreatitis-related abdominal sepsis unrelated to the Tesio lines.ConclusionCT-guided SVC puncture and tunnelled HD line insertion in HD-related central venous occlusion (CVO) refractory to conventional recanalisation options can be performed safely, requires no extra equipment and lies within the skill set and resources of most interventional radiology departments involved in the management of HD patients.

  8. Mechanochemical endovenous ablation and new frontiers in venous intervention

    NARCIS (Netherlands)

    Boersma, D

    2017-01-01

    Venous insufficiency of the lower extremities is a common condition and related to various symptoms, including venous ulcers. The effect of venous insufficiency on patients’ health-related quality of life is substantial and comparable with other chronic diseases such as arthritis, diabetes, and

  9. Noncirrhotic Portal Hypertension

    Science.gov (United States)

    Rajekar, Harshal; Vasishta, Rakesh K; Chawla, Yogesh K; Dhiman, Radha K

    2011-01-01

    Portal hypertension is characterized by an increase in portal pressure (> 10 mmHg) and could be a result of cirrhosis of the liver or of noncirrhotic diseases. When portal hypertension occurs in the absence of liver cirrhosis, noncirrhotic portal hypertension (NCPH) must be considered. The prognosis of this disease is much better than that of cirrhosis. Noncirrhotic diseases are the common cause of portal hypertension in developing countries, especially in Asia. NCPH is a heterogeneous group of diseases that is due to intrahepatic or extrahepatic etiologies. In general, the lesions in NCPH are vascular in nature and can be classified based on the site of resistance to blood flow. In most cases, these disorders can be explained by endothelial cell lesions, intimal thickening, thrombotic obliterations, or scarring of the intrahepatic portal or hepatic venous circulation. Many different conditions can determine NCPH through the association of these various lesions in various degrees. Many clinical manifestations of NCPH result from the secondary effects of portal hypertension. Patients with NCPH present with upper gastrointestinal bleeding, splenomegaly, ascites after gastrointestinal bleeding, features of hypersplenism, growth retardation, and jaundice due to portal hypertensive biliopathy. Other sequelae include hyperdynamic circulation, pulmonary complications, and other effects of portosystemic collateral circulation like portosystemic encephalopathy. At present, pharmacologic and endoscopic treatments are the treatments of choice for portal hypertension. The therapy of all disorders causing NCPH involves the reduction of portal pressure by pharmacotherapy or portosystemic shunting, apart from prevention and treatment of complications of portal hypertension. PMID:25755321

  10. Impact of hepatitis C oral therapy in portal hypertension.

    Science.gov (United States)

    Libânio, Diogo; Marinho, Rui Tato

    2017-07-14

    Chronic hepatitis C is a leading cause of morbidity and mortality, mainly related to fibrosis/cirrhosis and portal hypertension. Direct antiviral agents are highly effective and safe and can now cure > 90% of the patients. Sustained viral response (SVR) after interferon-based regimens has been associated with improvement in liver function, fibrosis and portal hypertension in a significant proportion of patients, although a point of no return seems to exist from which viral elimination is no longer capable of preventing portal hypertension progression and liver decompensation. Indeed, although SVR is associated with improvement of hepatic venous pressure gradients and therefore a decreased risk of de novo esophageal varices, several studies show that viral clearance does not eliminate the risk of variceal progression, liver decompensation and death in patients with pre-established portal hypertension. Although evidence about the effects of direct antiviral agents (DAAs) on clinically significant outcomes is still scarce and with short follow-up, DAAs can decrease the burden of the disease if patients are timely treated before significant fibrosis and portal hypertension develops. Studies with longer follow-up are waited to establish the real magnitude of hepatitis C treatment on portal hypertension. Future studies should also focus on predictors of portal hypertension resolution since it can influence management and avoid unnecessary monitoring.

  11. Central venous catheter - flushing

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000157.htm Central venous catheter - flushing To use the sharing features on this page, please enable JavaScript. You have a central venous catheter. This is a tube that goes into a ...

  12. Reciprocal Roles of Angiotensin II and Angiotensin II Receptors Blockade (ARB in Regulating Cbfa1/RANKL via cAMP Signaling Pathway: Possible Mechanism for Hypertension-Related Osteoporosis and Antagonistic Effect of ARB on Hypertension-Related Osteoporosis

    Directory of Open Access Journals (Sweden)

    Ji-Yao Li

    2011-06-01

    Full Text Available Hypertension is a risk factor for osteoporosis. Animal and epidemiological studies demonstrate that high blood pressure is associated with increased calcium loss, elevated parathyroid hormone, and increased calcium movement from bone. However, the mechanism responsible for hypertension-related osteoporosis remains elusive. Recent epidemiological studies indicate the benefits of Angiotensin II Receptors Blockade (ARB on decreasing fracture risks. Since receptors for angiotensin II, the targets of ARB, are expressed in both osteoblasts and osteoclasts, we postulated that angiotensin II plays an important role in hypertension-related osteoporosis. Cbfa1 and RANKL, the important factors for maintaining bone homeostasis and key mediators in controlling osteoblast and osteoclast differentiation, are both regulated by cAMP-dependent signaling. Angiotensin II along with factors such as LDL, HDL, NO and homocysteine that are commonly altered both in hypertension and osteoporosis, can down-regulate the expression of Cbfa1 but up-regulate RANKL expression via the cAMP signaling pathway. We thus hypothesized that, by altering the ratio of Cbfa1/RANKL expression via the cAMP-dependent pathway, angiotensin II differently regulates osteoblast and osteoclast differentiation leading to enhanced bone resorption and reduced bone formation. Since ARB can antagonize the adverse effect of angiotensin II on bone by lowering cAMP levels and modifying other downstream targets, including LDL, HDL, NO and Cbfa1/RANKL, we propose the hypothesis that the antagonistic effects of ARB may also be exerted via cAMP signaling pathway.

  13. Quantifying the fall in mortality associated with interventions related to hypertensive diseases of pregnancy

    Directory of Open Access Journals (Sweden)

    Campbell Oona

    2011-04-01

    Full Text Available Abstract Background In this paper we review the evidence of the effect of health interventions on mortality reduction from hypertensive diseases in pregnancy (HDP. We chose HDP because they represent a major cause of death in low income countries and evidence of effect on maternal mortality from randomised studies is available for some interventions. Methods We used four approaches to review the evidence of the effect of interventions to prevent or treat HDP on mortality reduction from HDP. We first reviewed the Cochrane Library to identify systematic reviews and individual trials of the efficacy of single interventions for the prevention or treatment of HDP. We then searched the literature for articles quantifying the impact of maternal health interventions on the reduction of maternal mortality at the population level and describe the approaches used by various authors for interventions related to HDP. Third, we examined levels of HDP-specific mortality over time or between regions in an attempt to quantify the actual or potential reduction in mortality from HDP in these regions or over time. Lastly, we compared case fatality rates in women with HDP-related severe acute maternal morbidity with those reported historically in high income countries before any effective treatment was available. Results The Cochrane review identified 5 effective interventions: routine calcium supplementation in pregnancy, antiplatelet agents during pregnancy in women at risk of pre-eclampsia, Magnesium sulphate (MgS04 for the treatment of eclampsia, MgS04 for the treatment of pre-eclampsia, and hypertensive drugs for the treatment of mild to moderate hypertension in pregnancy. We found 10 studies quantifying the effect of maternal health interventions on reducing maternal mortality from HDP, but the heterogeneity in the methods make it difficult to draw uniform conclusions for effectiveness of interventions at various levels of the health system. Most authors

  14. Central venous line complications and tip detection

    Directory of Open Access Journals (Sweden)

    Ameneh Rezaee Gheshlaghi

    2015-06-01

    Full Text Available Central venous line is one of a creative instrument that saves human’s life in critical medical situation. Central venous line access is frequently involved in the disease management. It is used for rapid fluid therapy, transvenous pacemakers, infusion of some medications, hemodialysis or plasmapheresis and etc. Most of the emergency departments have some staffs that are trained for central venous line insertion but related complications occur during central venous line placement.Central venous line might have some complications and complication follow-up should be considered. Thromboembolism and infection are two important medical complications. Arterial puncture, hematoma, pneumothorax and hemothorax are mechanical Central venous line complications. Chest X-ray and some other techniques should be used for detecting these complications.Central venous line tip misplace is a considerable problem for emergency department staffs, previously chest X-ray has been used for central venous line misplace detection. In some recent studies, contrast-enhanced ultrasonography and intravascular electrocardiography have been used for central venous line misplace.

  15. Incidence of catheter-related thrombosis in acute leukemia patients: a comparative, retrospective study of the safety of peripherally inserted vs. centrally inserted central venous catheters.

    Science.gov (United States)

    Refaei, Mohammad; Fernandes, Bruna; Brandwein, Joseph; Goodyear, Marilyn Dawn; Pokhrel, Arun; Wu, Cynthia

    2016-12-01

    Central venous catheters are a leading cause of upper-extremity deep vein thrombosis. Concomitant severe thrombocytopenia makes anticoagulation for catheter-related thrombosis (CRT) in patients with acute leukemia (AL) a challenge. Incidence of CRT has been reported to be increased in those with peripherally inserted central catheters (PICC) vs. those with centrally inserted ones (CICC). Our objective is to compare the incidence rate of CRT in leukemia inpatients who received either a PICC vs. CICC. We retrospectively reviewed adult inpatients admitted to hematology wards with a new diagnosis of AL and who received either a PICC or a CICC. Baseline patient and catheter characteristics were recorded. Our primary outcome was the incidence rate of CRT in each group. The secondary outcomes included rates of infectious and mechanical complications. Six hundred sixty-three patients received at least one PICC (338) or CICC (325) insertion. A total of 1331 insertions were recorded, with 82 (11.7 %) and 41 (6.5 %) CRT in the PICC and CICC groups, respectively. The incidence rates were 1.89 and 0.52 per 1000 catheter day in the PICC and CICC groups, respectively. A PICC, when compared to CICC, was a significant risk factor for CRT (sHR 2.5, p central venous catheter.

  16. Idiopathic intracranial hypertension: case report

    Directory of Open Access Journals (Sweden)

    Iacob G.

    2015-12-01

    Full Text Available Idiopathic intracranial hypertension - IIH (synonymous old terms: benign intracranial hypertension - BIH, pseudotumor-cerebri - PTC it’s a syndrome, related to elevated intracranial pressure, of unknown cause, sometimes cerebral emergency, occuring in all age groups, especially in children and young obese womans, in the absence of an underlying expansive intracranial lesion, despite extensive investigations. Although initial symptoms can resolve, IIH displays a high risk of recurrence several months or years later, even if initial symptoms resolved. Results: A 20-year-old male, obese since two years (body mass index 30, 9, was admitted for three months intense headache, vomiting, diplopia, progressive visual acuity loss. Neurologic examination confirmed diplopia by left abducens nerve palsy, papilledema right > left. At admission, cerebral CT scan and cerebral MRI with angio MRI 3DTOF and 2D venous TOF was normal. Despite treatment with acetazolamide (Diamox, corticosteroid, antidepressants (Amitriptyline, anticonvulsivants (Topiramate three weeks later headache, diplopia persist and vision become worse, confirmed by visual field assessment, visual evoked potential (VEP. A cerebral arteriography demonstrate filling defect of the superior sagittal sinus in the 1/3 proximal part and very week filling of the transverse right sinus on venous time. Trombophylic profile has revealed a heterozygote V factor Leyden mutation, a homozygote MTHFR and PAI mutation justifying an anticoagulant treatment initiated to the patient. The MRI showed a superior sagittal sinus, right transverse and sigmoid sinus thrombosis, dilatation and buckling of the optic nerve sheaths with increased perineural fluid especially retrobulbar, discrete flattening of the posterior segment of the eyeballs, spinal MRI showed posterior epidural space with dilated venous branches, with mass effect on the spinal cord, that occurs pushed anterior on sagittal T1/T2 sequences cervical and

  17. Relative Atrial Natriuretic Peptide Deficiency and Inadequate Renin and Angiotensin II Suppression in Obese Hypertensive Men

    DEFF Research Database (Denmark)

    Asferg, Camilla L; Nielsen, Søren J; Andersen, Ulrik B

    2013-01-01

    Obesity is a strong risk factor for hypertension, but the mechanisms by which obesity leads to hypertension are incompletely understood. On this background, we assessed dietary sodium intake, serum levels of natriuretic peptides (NPs), and the activity of the renin-angiotensin system in 63 obese...... hypertensive men (obeseHT: body mass index, ≥30.0 kg/m(2); 24-hour ambulatory blood pressure, ≥130/80 mm Hg), in 40 obese normotensive men (obeseNT: body mass index, ≥30.0 kg/m(2); 24-hour ambulatory blood pressure,...

  18. Stenosis Before Thrombosis: Intracranial Hypertension from Jugular Foramen Stenosis Secondary to Renal Osteodystrophy.

    Science.gov (United States)

    Esfahani, Darian R; Alaraj, Ali; Birk, Daniel M; Thulborn, Keith R; Charbel, Fady T

    2018-01-01

    Venous outflow obstructions are rare anatomic findings that can appear with symptoms of elevated intracranial pressure, including headache and vision loss, and can be mistaken for more common diagnoses, such as idiopathic intracranial hypertension (IIH) or cerebral venous sinus thrombosis (CVST). Although venous outflow obstructions have been reported in rare bone dysplasias and congenital abnormalities, to date they have not been reported in renal osteodystrophy (ROD), a relatively common disorder seen in patients with chronic kidney disease. In this case, the authors describe a patient with marked intracranial hypertension from jugular foramen stenosis secondary to ROD. After diagnosis by CT and magnetic resonance venography, catheter venography confirmed an osseus band around the left jugular bulb, and a 40-mm Hg pressure gradient across the stenotic foramen. The patient subsequently underwent ventriculoperitoneal shunting and optic nerve sheath fenestration with symptom improvement. The postoperative course was significant for development of CVST, necessitating treatment. This report reviews the presentation, pathology, and neurosurgical treatment of patients with ROD and venous outflow obstructions, and explores the differential diagnoses of outflow obstructions, IIH, and CVST. To our knowledge, this is the first report of intracranial hypertension from jugular foramen stenosis secondary to renal osteodystrophy. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Prevalence, predictors, and survival in pulmonary hypertension related to end-stage chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Andersen, Kasper Hasseriis; Iversen, Martin Jes; Kjaergaard, Jesper

    2012-01-01

    The prevalence, prognostic importance, and factors that predict the presence and degree of pulmonary hypertension (PH) diagnosed with right heart catheterization (RHC) in patients with end-stage chronic obstructive pulmonary disease (COPD) remain unclear....

  20. Stress plays provoking role in hypertension-related stroke: injuries of blood-brain barrier function

    Science.gov (United States)

    Semyachkina-Glushkovskaya, O.; Shirokov, A.; Gekalyuk, A.; Abakumov, M.; Navolokin, N.; Abdurashitov, A.; Pavlov, A.; Ulanova, M.; Fedorova, V.; Razubaeva, V.; Saranceva, E.; Li, P.; Huang, Q.; Zhu, D.; Luo, Q.; Tuchin, V.; Kurths, J.

    2017-02-01

    Chronic hypertension itself does not cause stroke but significantly decreases the resistant to stroke induced by stress due to exhausting of adaptive capacity of cerebral endothelium and decrease resistance of blood-brain barrier to stress.

  1. Transient Receptor Potential Canonical Type 3 Channels - Their Evolving Role in Hypertension and Its Related Complications

    DEFF Research Database (Denmark)

    Wang, Peijian; Liu, Daoyan; Tepel, Martin

    2013-01-01

    ABSTRACT: Recent studies indicate that transient receptor potential canonical type 3 (TRPC3) channels contribute to the regulation of blood pressure, vascular and renal function. Several studies show that TRPC3 dysfunction is associated with hypertension, atherosclerosis, cardiac hypertrophy...

  2. Two-years therapy with bosentan of pulmonary arterial hypertension related to connective tissue diseases

    Directory of Open Access Journals (Sweden)

    M. Rizzo

    2011-09-01

    Full Text Available Objective: Pulmonary arterial hypertension (PAH is a rare but severe complication of connective tissue diseases (CTD, with a negative impact on patients survival. Bosentan, a receptor antagonist of endothelin, has been proved effective for the treatment of PAH. The aim of this study was to evaluate the effects and the safety of bosentan administered for 2 years in a group of patients with PAH related to CTD. Methods: Twelve patients with PAH related to systemic sclerosis (8 cases, SLE (2 cases, mixed connective tissue disease (1 case and polymyositis (1 case attending the Rheumatology Unit of Padova University were treated with bosentan for two years. Distance walked in 6 minutes, right ventricular systolic pressure and mean pulmonary artery pressure estimated by doppler echocardiography were evaluated at baseline and after 6, 12, 18 and 24 months of treatment. Safety was assessed by laboratory tests performed every two months. Results: During bosentan treatment, a significant decrease of right ventricular systolic pressure was observed after 6, 12, 18 and 24 months in comparison to baseline, whereas pulmonary artery mean pressure remained unchanged. Distance walked in 6 minutes slightly increased after 6 and 12 months, but significantly decreased after 18 and 24 months, mostly because complications of CTD which compromised the ability to walk arose in 4 patients. Adverse events related to bosentan were observed in 2 cases. Conclusions: Bosentan has been demonstrated effective in reducing pulmonary arterial pressure in a two-year period of treatment. Exercise capacity improved only in the first year of therapy and worsened thereafter, suggesting the opportunity of a combination therapy for a long-term treatment of PAH related to CTD.

  3. Knowledge related to nutrition and hypertension management practices of adults in Ga-Rankuwa day clinics

    OpenAIRE

    N.G. Nkosi; S.C.D. Wright

    2010-01-01

    Hypertension is a global, non-communicable chronic disease being asymptomatic and known as the silent killer with signs and symptoms only occurring when a target organ is damaged. Being a condition common in South Africa, hypertension is also a risk factor for cerebro-vascular incidents, myocardial infarction, left ventricular hypertrophy, renal disease and retinopathy. Black adults in an urban environment appear to be especially vulnerable to excessive increases in blood pressure. The resear...

  4. Differential modulation of AMPK/PPARα/UCP2 axis in relation to hypertension and aging in the brain, kidneys and heart of two closely related spontaneously hypertensive rat strains.

    Science.gov (United States)

    Rubattu, Speranza; Bianchi, Franca; Busceti, Carla Letizia; Cotugno, Maria; Stanzione, Rosita; Marchitti, Simona; Di Castro, Sara; Madonna, Michele; Nicoletti, Ferdinando; Volpe, Massimo

    2015-08-07

    We examined expression protein of AMPK/SIRT1/PGC1α/PhoxO3a/PPARα/UCP2 pathway in brain, kidneys and heart of stroke-prone spontaneously hypertensive rat (SHRSP) vs stroke-resistant SHR (SHRSR) at different weeks of age, up to one year, in order to test the hypothesis that abnormalities within this pathway could associate with higher susceptibility of SHRSP to develop hypertension-related vascular damage. SHRSP develops severe hypertension and related target organ damage. Marked reduction of uncoupling protein 2 (UCP2) expression upon high salt-low potassium diet associates with increased renal injury in SHRSP. UCP2 may represent a key mitochondrial protein involved in cardiovascular damage. At 2 months of age a significant down-regulation of UCP2 expression at both mRNA and protein levels was found, along with reduced protein expression of all components of UCP2 regulatory pathway, in tissues of SHRSP but not of SHRSR, that progressed with hypertension development and aging. A significant increase of both oxidative stress and inflammation was detected in tissues of SHRSP as a function of age. SBP levels were significantly higher in SHRSP than SHRSR at 3 months of age and thereafter. At one year of age, higher degree of renal damage, with proteinuria and severe glomerular and tubulo-interstitial fibrosis, of cerebral damage, with significant vessel extravasation and stroke occurrence, and of myocardial damage was detected in SHRSP than SHRSR.  The early significant reduced expression of the antioxidant AMPK/PPARα/UCP2 pathway that progressed throughout lifetime may contribute to explain higher predisposition of SHRSP to oxidative stress dependent target organ damage in the context of severe hypertension.

  5. Levels of prolactin in relation to coagulation factors and risk of venous thrombosis. Results of a large population-based case-control study (MEGA-study).

    Science.gov (United States)

    Stuijver, Danka J F; Debeij, Jan; van Zaane, Bregje; Dekkers, Olaf M; Smit, Jan W A; Büller, Harry R; Rosendaal, Frits R; Gerdes, Victor E A; Cannegieter, Suzanne C

    2012-09-01

    The pituitary hormone prolactin is thought to influence coagulation. We aimed to study the relation between prolactin levels, coagulation factors and risk of venous thrombosis (VT). We used data from a large population based case-control study into aetiology of first VT (MEGA-study). Prolactin levels were determined in 2,068 patients with VT and 2,785 age- and sex matched control subjects. The relation between levels of coagulation factors and prolactin was studied among the controls. In addition, odds ratios (OR) and 95% confidence intervals (95%CI) were calculated for the risk of VT for different cut-off points of prolactin levels based on percentiles determined in the controls. Restricted analysis was performed among cases in whom blood was sampled within six months after VT. We found a rise in factor VIII and von Willebrand factor with increasing levels of prolactin in the controls. An increased risk of VT was observed when blood was sampled within six months after thrombosis (OR 2.9, 95%CI 1.1-8.1) for prolactin levels above the 99th percentile (42.6 μg/l) relative to levels between the 20th to 80th percentile. When blood was sampled more than six months after VT no clear association could be observed (OR 1.3, 95%CI 0.7-2.3). In conclusion, we found a modest association between prolactin and symptomatic venous thromboembolism, particularly when blood was sampled close to the event. This may be explained by a causal relation or by prolactin being a marker of stress due to the thrombotic event.

  6. Analysis of experimental evidence that shows adverse effects of salt and its relation to hypertension

    Directory of Open Access Journals (Sweden)

    Ignacio Bravo A.

    2012-02-01

    Full Text Available The study by Taylor et al published in June 2010 in the American Journal of Hypertension questions the effectiveness of reducing salt intake in the diet in the prevention and treatment of high blood pressure and other cardiovascular conditions. The publication of this article has lead to great controversy and medical associations and learned societies responded promptly. The response criticized the results of the meta-analysis and pointed out its methodological shortcomings. In this review we critically appraise the experimental evidence that shows the importance of diet salt intake and its role as a determinant of blood pressure. We briefly describe the paradigm that explains the role of salt intake in contributing in the regulation of blood pressure (Guyton hypothesis and model and we mention the experimental evidence that supports this. We briefly comment on the classical studies that indicate that salt intake (NaCl contributes directly to the development of high blood pressure and target tissues. Finally, we briefly mention the experimental data that is related with the controversy on the role of salt (NaCl or sodium as prohypertensive agents.

  7. Role and Relevance of Blood Pressure Variability in Hypertension Related Co-morbidities.

    Science.gov (United States)

    Kumar, Ashok; Kalmath, B C; Abraham, Georgi; Christopher, Johann; Kaparthi, Pln; Fischer, Louie; Deshpande, Neeta; Mishra, N K; Raj, Praveen; Javerani, Rajesh; Goyal, Ramesh; Dsouza, Reefa; Joshi, Shashank R

    2017-12-01

    Despite maintaining mean blood pressure at optimal levels, cardiovascular complications still occur in hypertensive patients. Blood pressure variability (BPV) has been implicated as a prominent factor responsible for incurring this additional risk. In this review we attempted to generate a consensus on the importance of BPV in the hypertension management and to evaluate different therapeutic options available to reduce BPV. Panel comprising of 11 leading experts from India in different areas of clinical practice (including nephrology, diabetes and endocrinology, cardiology, and critical care medicine) was convened. The board reviewed up to date literature on BPV, shared personal experiences from their clinical practice, and debated their opinions on the significance of BPV in hypertension management and also on various therapeutic options available to control it. The reviewers agreed that BPV is frequently observed in hypertensive individuals and it is a critical factor in hypertension management. Blood pressure variability can be measured by ambulatory blood pressure monitoring, home blood pressure monitoring, and office blood pressure monitoring. Members concurred that variations in blood pressure that are 10 standard deviations above the mean blood pressure should be considered as pathologically significant and such variations should be reduced using pharmacological therapies. The board opined that Angiotensin II Receptor Blockers,Calcium Channel Blockers etc such as Olmesartan, Nifedipine can be used to reduce BPV. As a way forward, the panel recommends to bridge the evidence gap that establishes a possible direct relationship between BPV and cardiovascular complications. Blood pressure variability has paramount role in the current hypertension management scenario. To reduce disease burden and increase quality of life of hypertensive individuals, physicians should consider lowering BPV along with physiological BP levels. © Journal of the Association of

  8. Perioperative hypertension

    Directory of Open Access Journals (Sweden)

    G. Pinna

    2013-05-01

    Full Text Available BACKGROUND Perioperative hypertension is a situation whose management is suggested by the clinical judgement much more than clinical evidences. JNC 7 guidelines give a classification of blood pressure (BP, without any mention specifically dedicated to patients undergoing surgery. The ACC/AHA guidelines recommend deferring surgery if diastolic BP is above 110 mmHg and systolic BP is above 180 mmHg. AIM OF THE STUDY In this review we considered pathogenetic, clinical and therapeutic factors related to perioperative management of hypertensive patients. DISCUSSION In actual trend of the preoperative evaluation, alone hypertension is considered as a minor risk factor. BP values ≤ 180/110 mmHg do not influence the outcomes in patients who underwent noncardiac surgery. Therefore, in these conditions it’s not necessary to delay surgery. Hypertensive picks are possible during the operation, mostly because of the intubation, but, much more dangerous, falls of pressure are possible. The intraoperative arterial pressure should be maintained within 20% of the best estimated preoperative arterial pressure, especially in patients with markedly elevated preoperative pressures. After surgery the arterial BP can increase for stress factors, pain, hypoxia and hypercapnia, hypothermia and infusional liquids overload. For all these reasons a careful monitoring is mandatory. Anti-hypertensive medication should be continued during the postoperative period in patients with known and treated hypertension, as unplanned withdrawal of treatment can result in rebounded hypertension. The decision to give anti-hypertensive drugs must be made for each patient, taking into account their normal BP and their postoperative BP. With regard to the optimal treatment of the patient with poorly or uncontrolled hypertension in the perioperative evaluation, recent guidelines suggest that the best treatment may consider cardioselective β-blockers therapy, but also clonidin by

  9. Low Social Position, Periodontal Disease, and Poor Oral Health-Related Quality of Life in Adults With Systemic Arterial Hypertension.

    Science.gov (United States)

    Rebelo, Maria A B; de Castro, Pedro H D; Rebelo Vieira, Janete M; Robinson, Peter G; Vettore, Mario V

    2016-12-01

    There is little evidence on the association between periodontal disease and oral health-related quality of life (OHRQoL) in individuals with chronic diseases, including hypertension. The aim of this study is to identify relationships among sociodemographic characteristics, smoking, tooth loss, dental caries, periodontal status, and OHRQoL in adults with systemic arterial hypertension. A cross-sectional study involving 195 adults (mean age: 55.7 years) with systemic arterial hypertension used interviews and oral examinations to collect data on sociodemographic characteristics (age, sex, income); use of antihypertensive medication; smoking; tooth loss; dental caries; periodontal status (bleeding on probing, calculus, and attachment loss); and OHRQoL/oral health impact profile. The Wilson and Cleary (Wilson IB, Cleary PD. JAMA 1995;273:59-65) conceptual model was used to test direct and indirect relationships among variables using structural equation modeling. Lower age, male sex, smoking, and lower income directly predicted worse periodontal status. Tooth loss, dental caries, worse periodontal status, and smoking were directly linked to poor OHRQoL. Age was indirectly linked to worse periodontal status via income. Income and smoking indirectly predicted poor OHRQoL via periodontal status. Findings support an effect of periodontal disease on OHRQoL in people with systemic arterial hypertension. Periodontal status mediated associations of sociodemographic characteristics and smoking with OHRQoL through different pathways.

  10. Acceptable results after venous reconstructive surgery following iatrogenic injuries to the iliofemoral vein segment

    DEFF Research Database (Denmark)

    Larsen, Morten Bo; Bækgaard, Niels

    2012-01-01

    Venous reconstructions after iatrogenic injuries are rarely performed and are associated with a relatively high risk of complications. We present our experiences with venous reconstructive surgery to the iliofemoral vein segment.......Venous reconstructions after iatrogenic injuries are rarely performed and are associated with a relatively high risk of complications. We present our experiences with venous reconstructive surgery to the iliofemoral vein segment....

  11. Venous insufficiency

    Science.gov (United States)

    ... include: Age Family history of this condition Female gender (related to levels of the hormone progesterone) History of deep vein thrombosis in the legs Obesity Pregnancy Sitting or standing for long periods Tall ...

  12. Quality of life in patients with venous stasis ulcers and others with advanced venous insufficiency.

    Science.gov (United States)

    Tracz, Edyta; Zamojska, Ewa; Modrzejewski, Andrzej; Zaborski, Daniel; Grzesiak, Wilhelm

    2015-01-01

    The quality of life (QoL) in patients with advanced venous insufficiency (including venous stasis ulcers, skin discoloration, stasis eczema, and lipodermatosclerosis) assessed using the Clinical Etiological Anatomical Pathophysiological (CEAP) and Venous Clinical Severity Score (VCSS) classifications is presented. Also, disease features such as: intensity of pain, edema and inflammatory response that exerted the most profound effect on different domains of QoL are reported. The global QoL in patients with lower leg venous ulcerations was relatively similar to that observed in other patients with chronic venous insufficiency. The presence of venous ulcerations was associated with lower QoL in a Physical domain. Significant correlations were found between pain intensity and the values of Physical, Physiological, Level of Independence and Environmental domains, between edema intensity and Social domain as well as between the intensity of inflammatory response and Physical and Spiritual domains.

  13. [Local tissue hypoxia consequence in the trophic venous ulceration in elderly patients].

    Science.gov (United States)

    Losev, R Z; Zakharova, N B; Burov, Iu A; Iakusheva, E A; Nikitina, V V; Stepanova, T V; Mikul'skaia, E G

    2007-01-01

    This paper analyzes the data of examination and the results of the treatment of 25 patients aged over 80 years (mean age 68.5+/-7 years) suffering from varicosity with long nonhealing trophic ulcers of the distal limb segments (CVI CMP C6) and 20 patients of the same age groups with CVI CEAP stages 3-5. All patients with CVI underwent either full-scope phlebectomy (64.4%) or partial truncal phlebectomy (35.6%), in which the trunk of the greater saphenous vein was stripped up to the upper third of the leg. A TCM-3 outfit (RADIOmeter, Denmark) was employed to measure oxygen tension in limb tissues. Parameters of lipid peroxidation and antioxidant tissue defence were measured intraoperatively in the capillary blood of the fingers as well as in the venous blood withdrawn from the cubital vein and the greater saphenous vein in the lower third of the leg near ulcer). The data obtained evidenced that lipid peroxidation activity was most pronounced in the soft tissues of the lower third of the leg in the group of patients with remarkable chronic venous insufficiency without trophic venous ulcers (GVI CEAP C3-5) and was significantly depleted after formation of varicose ulcers (CVI CEAP C6) associated with remarkable tissue hypoxia (TepO2 1.7-7.0 mm Hg). In all patients with CVI, the syndrome of lipid peroxidation was associated with the lowering of antioxidant defence activity. Patients with trophic venous ulcers had the signs of active inflammation in the soft tissues of the leg. The data obtained in the course of the study made it possible to optimize the treatment policy for elderly patients with trophic venous ulcers. In addition to the lowering of venous hypertension, the treatment included correction of microcirculatory disorders related to local hypoxia. Of special importance was reperfusion attenuation in the postoperative period.

  14. Tardive akathisia related to the anti-hypertensive agent Sevikar-a case report.

    Science.gov (United States)

    Hsieh, Men-Ting; Lin, Pao-Yen; Tsai, Chia-Jen; Chang, Chiung-Chih; Lee, Yu

    2017-06-05

    Tardive akathisia (TA) is a subtype of tardive syndrome, and its etiology is still uncertain. Sevikar is an anti-hypertensive agent containing both amlodipine and olmesartan, and has never been reported to have an adverse reaction in patients with tardive syndrome. A 57-year-old woman who took Sevikar for hypertension for 10 years developed TA one and a half years before receiving any psychiatric treatment. After switching from Sevikar to bisoprolol, she reported obvious improvement in her akathisia. It is noteworthy that her TA developed before receiving any antidepressant medication, and that her TA improved after discontinuation of Sevikar. In light of these pharmacodynamic properties, it is therefore concluded that use of amlodipine and olmesartan might have caused TA in this patient. We reported this rare case to remind clinicians to be aware of possible akathisia when using amlodipine and olmesartan in combination as anti-hypertensive agents.

  15. Ocular Hypertension

    Science.gov (United States)

    ... Español Eye Health / Eye Health A-Z Ocular Hypertension Sections What Is Ocular Hypertension? Ocular Hypertension Causes ... Hypertension Diagnosis Ocular Hypertension Treatment What Is Ocular Hypertension? Leer en Español: ¿Qué Es la Hipertensión Ocular? ...

  16. Venous Sampling

    Science.gov (United States)

    ... neck to help locate abnormally functioning glands or pituitary adenoma . This test is most often used after an unsuccessful neck exploration. Inferior petrosal sinus sampling , in which blood samples are taken from veins that drain the pituitary gland to study disorders related to pituitary hormone ...

  17. Influence of Salt Intake on Association of Blood Uric Acid with Hypertension and Related Cardiovascular Risk.

    Directory of Open Access Journals (Sweden)

    Lei Hou

    Full Text Available A relationship of blood uric acid (UA with hypertension and cardiovascular risk is under debate thus salt intake is hypothesized to contribute to such associations.In this cross-sectional study, stratified cluster random sampling elicited a sample of 1805 Kazakhs with 92.4% compliance. Hypertension and moderate-or-high total cardiovascular risk (mTCR were defined according to guidelines. Sodium intake was assessed by urinary sodium excretion. Prevalence ratios (PRs were used to express associations of UA with hypertension and mTCR.In the highest tertile of sodium intake in women, the adjusted PRs (95% confidence intervals of low to high quartiles compared with the lowest quartile of UA, were 1.22(0.78-1.91, 1.18(0.75-1.85, and 1.65(1.09-2.51 for hypertension and 1.19(0.74-1.90, 1.39(0.91-2.11, and 1.65(1.10-2.47 for mTCR (P for trend <0.05. However, these findings were not shown for other sodium intake levels. There were similar results in men. PRs markedly increased with a concomitant increase in UA and sodium intake and there was a significant interaction (P = 0.010 for mTCR with PRs of 1.69(1.10-2.60 for men and 3.70(2.09-6.52 for women in those with the highest compared with the lowest quartile of UA and tertile of sodium intake. Similar findings were shown for hypertension.This study implied that a high salt intake may enhance the associations of UA with hypertension and cardiovascular risk.

  18. Ambulatory pulmonary arterial pressure in primary pulmonary hypertension: variability, relation to systemic arterial pressure, and plasma catecholamines.

    OpenAIRE

    Richards, A M; Ikram, H; Crozier, I G; Nicholls, M G; Jans, S

    1990-01-01

    The variability of pulmonary arterial pressure, the relation of pulmonary pressure to systemic pressure, pulmonary pressure responses to stimuli (exercise, hypoxia, smoking, free ambulation), and plasma catecholamine responses were assessed in five patients with primary pulmonary hypertension. Ambulatory monitoring techniques provided data for the computerised analysis of continuous, beat-to-beat, direct recordings of both pulmonary and systemic arterial pressures for 8 to 10 hours. The absol...

  19. Lyme disease-related intracranial hypertension in children: clinical and imaging findings.

    Science.gov (United States)

    Ramgopal, Sriram; Obeid, Rawad; Zuccoli, Giulio; Cleves-Bayon, Catalina; Nowalk, Andrew

    2016-03-01

    Lyme disease (LD) is a tick-borne infection that is endemic to multiple areas of the United States. Patients with LD may present with sign and symptoms of intracranial hypertension (IH). The objective of this study is to evaluate the history, clinical findings, CSF analysis, and brain imaging results in pediatric patients with increased intracranial pressure secondary to LD. A retrospective database search was performed using the International Classification of Diseases (ICD) 9/10 codes to identify patients diagnosed with LD and IH between 2004 and 2014 at a tertiary referral pediatric hospital. Clinical, laboratory and neuroimaging data for each patient were reviewed. Seven patients met inclusion criteria; mean age was 9.6 years (standard deviation 4.0 years); 4/7 patients were male. Average body mass index was 18.8 kg/m(2) (standard deviation 3.0 kg/m(2)). Fever was present in four patients. Four had a history of LD related erythema migrans. All had elevated CSF opening pressure with leukocytosis and lymphocytic predominance. MRI obtained in six patients showed contrast enhancement of various cranial nerves. Tentorial enhancement was noted in all patients. In addition, patients had widening of the optic nerve sheath (ONS), optic nerve protrusion, and flattening of the posterior globe consistent with increased intracranial pressure. All patients had resolution of their symptoms after initiation of antibiotic therapy. In endemic areas, LD should be included in the differential of IH. MRI can help distinguish IH due to LD from its idiopathic form due to the presence of tentorial and cranial nerve enhancement in the former in addition to abnormal CSF showing leukocytosis with lymphocyte predominance.

  20. Five-Lumen Antibiotic-Impregnated Femoral Central Venous Catheters in Severely Burned Patients: An Investigation of Device Utility and Catheter-Related Bloodstream Infection Rates.

    Science.gov (United States)

    Friedman, Bruce C; Mian, Mohammad A H; Mullins, Robert F; Hassan, Zaheed; Shaver, Joseph R; Johnston, Krystal K

    2015-01-01

    The objective of this study is to determine the catheter-related bloodstream infection (CRBSI) rate in a severely burned patient population, many of whom required prolonged use of central venous catheters (CVCs). Between January 2008 and June 2012, 151 patients underwent placement of 455 five-lumen minocycline/rifampin-impregnated CVCs. CRBSI was defined as at least one blood culture (>100,000 colonies) and one simultaneous roll-plate CVC tip culture (>15 colony forming units) positive for the same organism. Most patients had accidental burns (81.5%) with a mean TBSA of 50%. A mean of three catheters were inserted per patient (range, 1-25). CVCs were inserted in the femoral vein (91.2%), subclavian vein (5.3%), and internal jugular vein (3.3%). Mean overall catheter indwell time was 8 days (range, 0-39 days). The overall rate of CRBSI per 1000 catheter days was 11.2; patients with a TBSA >60% experienced significantly higher rates of CRBSI than patients with a TBSA ≤60% (16.2 vs 7.3, P = .01). CVCs placed through burned skin were four times more likely to be associated with CRBSI than CVCs placed through intact skin. The most common infectious organism was Acinetobacter baumannii. Deep venous thrombosis developed in eleven patients (7%). The overall rate of CRBSI was 11.2, consistent with published rates of CRBSI in burn patients. Thus, femoral placement of 5-lumen CVCs did not result in increased CRBSI rates. These data support the safety of femoral CVC placement in burn patients, contrary to the Centers for Disease Control recommendation to avoid femoral CVC insertion.

  1. Catheter related bloodstream infection (CR-BSI in ICU patients: making the decision to remove or not to remove the central venous catheter.

    Directory of Open Access Journals (Sweden)

    Rodrigo Octávio Deliberato

    Full Text Available BACKGROUND: Approximately 150 million central venous catheters (CVC are used each year in the United States. Catheter-related bloodstream infections (CR-BSI are one of the most important complications of the central venous catheters (CVCs. Our objective was to compare the in-hospital mortality when the catheter is removed or not removed in patients with CR-BSI. METHODS: We reviewed all episodes of CR-BSI that occurred in our intensive care unit (ICU from January 2000 to December 2008. The standard method was defined as a patient with a CVC and at least one positive blood culture obtained from a peripheral vein and a positive semi quantitative (>15 CFU culture of a catheter segment from where the same organism was isolated. The conservative method was defined as a patient with a CVC and at least one positive blood culture obtained from a peripheral vein and one of the following: (1 differential time period of CVC culture versus peripheral culture positivity of more than 2 hours, or (2 simultaneous quantitative blood culture with ≥ 5:1 ratio (CVC versus peripheral. RESULTS: 53 CR-BSI (37 diagnosed by the standard method and 16 by the conservative method were diagnosed during the study period. There was a no statistically significant difference in the in-hospital mortality for the standard versus the conservative method (57% vs. 75%, p = 0.208 in ICU patients. CONCLUSION: In our study there was a no statistically significant difference between the standard and conservative methods in-hospital mortality.

  2. A prospective cohort study on the absolute risks of venous thromboembolism and predictive value of screening asymptomatic relatives of patients with hereditary deficiencies of protein S, protein C or antithrombin

    NARCIS (Netherlands)

    Mahmoodi, B. K.; Brouwer, J-L P.; Ten Kate, M. K.; Lijfering, W. M.; Veeger, N. J. G. M.; Mulder, A. B.; Kluin-Nelemans, H. C.; van der Meer, J.

    Background: Absolute risks of venous thromboembolism (VTE) in protein S-, protein C-, or antithrombin-deficient subjects are mainly based on retrospective data. Screening asymptomatic relatives of these patients is disputed, though studies addressing this issue have yet to be conducted. Methods: We

  3. Venous hemodynamics in neurological disorders: an analytical review with hydrodynamic analysis

    Science.gov (United States)

    2013-01-01

    Venous abnormalities contribute to the pathophysiology of several neurological conditions. This paper reviews the literature regarding venous abnormalities in multiple sclerosis (MS), leukoaraiosis, and normal-pressure hydrocephalus (NPH). The review is supplemented with hydrodynamic analysis to assess the effects on cerebrospinal fluid (CSF) dynamics and cerebral blood flow (CBF) of venous hypertension in general, and chronic cerebrospinal venous insufficiency (CCSVI) in particular. CCSVI-like venous anomalies seem unlikely to account for reduced CBF in patients with MS, thus other mechanisms must be at work, which increase the hydraulic resistance of the cerebral vascular bed in MS. Similarly, hydrodynamic changes appear to be responsible for reduced CBF in leukoaraiosis. The hydrodynamic properties of the periventricular veins make these vessels particularly vulnerable to ischemia and plaque formation. Venous hypertension in the dural sinuses can alter intracranial compliance. Consequently, venous hypertension may change the CSF dynamics, affecting the intracranial windkessel mechanism. MS and NPH appear to share some similar characteristics, with both conditions exhibiting increased CSF pulsatility in the aqueduct of Sylvius. CCSVI appears to be a real phenomenon associated with MS, which causes venous hypertension in the dural sinuses. However, the role of CCSVI in the pathophysiology of MS remains unclear. PMID:23724917

  4. Cerebral venous angiomas

    Energy Technology Data Exchange (ETDEWEB)

    Agnoli, A.L.; Hildebrandt, G.

    1985-01-01

    Clinical symptoms and radiological signs in 15 patients with cerebral venous malformations are presented and the diagnostic problems discussed. The circulation time in combination with cerebral malformations and angiomas of the scalp are described. CT findings in cases of venous malformations of the brain stem are evaluated. Spot-like enhancement, as well as sharply demarcated round shaped enhancement are characteristic for venous angiomas. Cavernous angiomas usually present as homogenous or inhomogenous round shaped enhanced areas. (Author).

  5. Persistent portal venous gas.

    Science.gov (United States)

    Huurman, Volkert A L; Visser, Leo G; Steens, Stefan C A; Terpstra, Onno T; Schaapherder, Alexander F M

    2006-05-01

    This case report describes a patient diagnosed with ongoing portal venous gas, initiated by a rather common Campylobacter enterocolitis and maintained by septic thrombophlebitis and possibly by chronic cholecystitis. Cholecystectomy attenuated the patient's septic condition. The etiology of portal venous gas determines both the patient's prognosis and the choice for either conservative or surgical treatment. This report describes persistence of portal venous gas for a long period and a possible role for chronic cholecystitis as a cause.

  6. [Clinical, vegetative and cognitive disorders in hypertensive postmenopausal women in relation to menopause causes].

    Science.gov (United States)

    Kolbasnikov, S V; Bakhareva, O N

    2006-01-01

    To specify clinical, vegetative and cognitive disorders in hypertensive women depending on the type of menopause. A total of 195 hypertensive women were divided into three groups: group 1 (n = 50, age 45.6 +/- 4.5 years) consisted of premenopausal women, group 2 (n = 100, age 57.4 +/- 4.7 years) - of women with natural menopause, group 3 (n = 45, age 55.1 +/- 5.9 years)--with early and/or surgical menopause. Severity of the menopausal syndrome, anxiety, depression, alexitimia, mental performance, vegetative regulation of heart rhythm were examined. The premenopausal women were characterized by cardial and cerebral disorders, unaffected psychovegetative function and initial symptoms of lowering mental performance. Hypertensive women with natural menopause showed combination of cardial and cerebral symptoms with moderate anxio-depressive disorders, alexitimia, subnormal parasympathetic activity of the autonomic nervous system in high centralization of heart rhythm regulation and attention disturbances. Patients with surgical and/or early menopause had marked cardial and cerebral symptoms, moderate anxiodepressive disorders, alexitimia, inhibition of mental performance, vegetative dysfunction, overcentralization of heart rhythm control. With development of postmenopausal metabolic symptom complex, severity of hypertension grows with emergence of anxiodepressive disorders which combine with vegetative regulation disorders and attenuation of mental performance.

  7. Relation of maternal hypertension with infant growth in a prospective birth cohort: the ABCD study

    NARCIS (Netherlands)

    de Beer, M.; Vrijkotte, T. G. M.; van der Wal, M. F.; van Weissenbruch, M. M.; Gemke, R. J. B. J.

    2010-01-01

    The aim of this study was to investigate the assumed positive association of pre-existent and pregnancy-induced hypertension with the offspring's weight and length gain in the first 14 months of life. We studied 3994 pregnant women and their offspring in a prospective community-based cohort study,

  8. J-shaped relation between blood pressure and stroke in treated hypertensives

    NARCIS (Netherlands)

    Z. Voko (Zoltan); M.L. Bots (Michiel); P.J. Koudstaal (Peter Jan); J.C.M. Witteman (Jacqueline); M.M.B. Breteler (Monique); A. Hofman (Albert)

    1999-01-01

    textabstractThe objective of this study was to investigate the relationship between hypertension and risk of stroke in the elderly. The study was performed within the framework of the Rotterdam Study, a prospective population-based cohort study. The risk of first-ever

  9. Egr-1 identifies neointimal remodeling and relates to progression in human pulmonary arterial hypertension

    NARCIS (Netherlands)

    van der Feen, Diederik E; Dickinson, Michael G; Bartelds, Beatrijs; Borgdorff, Marinus A J; Sietsma, Hannie; Lévy, Marilyne; Berger, Rolf M F

    BACKGROUND: Pulmonary arterial hypertension (PAH) is hallmarked by the development of neointimal lesions. The transcription factor Egr-1 seems to play a critical role in neointimal formation in experimental PAH and was identified as a putative target for intervention. In this study we investigated

  10. Circulating CD34-positive cells, glomerular filtration rate and triglycerides in relation to hypertension.

    Science.gov (United States)

    Shimizu, Yuji; Sato, Shimpei; Koyamatsu, Jun; Yamanashi, Hirotomo; Nagayoshi, Mako; Kadota, Koichiro; Maeda, Takahiro

    2015-11-01

    Serum triglycerides have been reported to be independently associated with the development of chronic kidney disease (CKD), which is known to play a role in vascular disturbance. On the other hand, circulating CD34-positve cells, including endothelial progenitor cells, are reported to contribute to vascular repair. However, no studies have reported on the correlation between triglycerides and the number of CD34-positive cells. Since hypertension is well known factor for vascular impairment, the degree of correlation between serum triglycerides and circulating CD34-positve cells should account for hypertension status. We conducted a cross-sectional study of 274 elderly Japanese men aged ≥ 60 years (range 60-79 years) undergoing general health checkups. Multiple linear regression analysis of non-hypertensive subjects adjusting for classical cardiovascular risk factors showed that although triglyceride levels (1SD increments; 64 mg/dL) did not significantly correlate with glomerular filtration rate (GFR) (β = -2.06, p = 0.163), a significant positive correlation was seen between triglycerides and the number of circulating CD34-positive cells (β = 0.50, p = 0.004). In hypertensive subjects, a significant inverse correlation between triglycerides and GFR was observed (β = -2.66, p = 0.035), whereas no significant correlation between triglycerides and the number of circulating CD34-positive cells was noted (β = -0.004, p = 0.974). Since endothelial progenitor cells (CD34-positive cells) have been reported to contribute to vascular repair, our results indicate that in non-hypertensive subjects, triglycerides may stimulate an increase in circulating CD34-positive cells (vascular repair) by inducing vascular disturbance. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. Gestational related changes in the deep venous system of the lower limb on light reflection rheography in pregnancy and the puerperium

    Energy Technology Data Exchange (ETDEWEB)

    Calderwood, C.J. [St John' s Hospital, Livingston and Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh (United Kingdom)], E-mail: catherine.calderwood@luht.scot.nhs.uk; Jamieson, R. [Princess Royal Maternity Unit, Glasgow Royal Infirmary, Glasgow (United Kingdom); Greer, I.A. [Hull York Medical School, University of York, York (United Kingdom)

    2007-12-15

    Objective: To assess whether light reflection rheography testing is affected by the changes that occur in the deep venous system of the lower limb in pregnancy and the puerperium. Methods: Twenty five women with a singleton pregnancy were recruited to undergo duplex Doppler ultrasound examinations of the common femoral vein to measure the vessel diameter and the blood flow velocity. Light reflection rheography testing was subsequently performed and the rate of venous emptying in the lower limb calculated. Serial measurements using both techniques were made at 15, 28, 36 weeks, and term gestation and at 2 days and 6 weeks postpartum. Results: Duplex Doppler ultrasound confirmed that there is progressive dilatation of the deep venous system in pregnancy, which reaches a maximum at term and reverses after delivery. There is an accompanying reduction in blood flow velocity, which reaches a nadir at term and increases after delivery. The rate of venous emptying as measured by light reflection rheography decreases with increasing gestation, but did not fall to a level consistent with venous occlusion by a deep venous thrombosis. Conclusions: Light reflection rheography has been shown to provide reliable results in pregnancy and the puerperium. Therefore, it is a potential tool for screening for deep venous thrombosis in this population.

  12. Diabetes and Hypertension in Severe Obesity and Effects of Gastric Bypass-Induced Weight Loss

    Science.gov (United States)

    Sugerman, Harvey J.; Wolfe, Luke G.; Sica, Domenic A.; Clore, John N.

    2003-01-01

    Objective To evaluate the preoperative relationships of hypertension and diabetes mellitus in severe obesity and the effects of gastric bypass (GBP)-induced weight loss. Summary Background Data Severe obesity is associated with multiple comorbidities, particularly hypertension and type 2 diabetes mellitus, that may affect life expectancy. Methods The database of patients who had undergone GBP by one general surgeon at a university hospital between September 1981 and January 2000 was queried as to weight, body mass index (BMI), pre- and postoperative diabetes, hypertension, and other comorbidities, including sleep apnea, hypoventilation, gastroesophageal reflux, degenerative joint disease, urinary incontinence, venous stasis, and pseudotumor cerebri. Results Of 1,025 patients treated, 15% had type 2 diabetes mellitus and 51% had hypertension. Of those with diabetes, 75% also had hypertension. There was a progressive increase in age between patients who had neither diabetes nor hypertension, either diabetes or hypertension, or both diabetes and hypertension. At 1 year after GBP (91% follow-up), patients lost 66 ± 18% excess weight (%EWL) or 35 ± 9% of their initial weight (%WL). Hypertension resolved in 69% and diabetes in 83%. Patients who resolved their hypertension or diabetes had greater %EWL and %WL than those who did not. African-American patients had a higher risk of hypertension than whites before GBP and were less likely to correct their hypertension after GBP. There was significant resolution of other obesity comorbidity problems. At 5 to 7 years after GBP (50% follow-up), %EWL was 59 ± 24 and %WL was 31 ± 13; resolution of hypertension was 66% and diabetes 86%. Conclusions These data suggest that type 2 diabetes mellitus and hypertension may be indirectly related to each other through the effects of obesity, but not directly as to cause and effect. The longer a person remains severely obese, the more likely he or she is to develop diabetes

  13. Cerebral Venous Thrombosis with Migraine-Like Headache and the Trigeminovascular System

    Directory of Open Access Journals (Sweden)

    Fábio A. Nascimento

    2016-01-01

    Full Text Available Cerebral venous thrombosis- (CVT- associated headache is considered a secondary headache, commonly presenting as intracranial hypertension headache in association with seizures and/or neurological signs. However, it can occasionally mimic migraine. We report a patient presenting with a migraine-like, CVT-related headache refractory to several medications but intravenous dihydroergotamine (DHE. The response to DHE, which is considered to be an antimigraine medication, in addition to the neurovascular nature of migraine, points out to a probable similarity between CVT-headache and migraine. Based on experimental studies, we discuss this similarity and hypothesize a trigeminovascular role in the genesis of CVT-associated headache.

  14. Utilization of antihypertensive drugs in obesity-related hypertension: a retrospective observational study in a cohort of patients from Southern Italy.

    Science.gov (United States)

    Cataldi, Mauro; di Geronimo, Ornella; Trio, Rossella; Scotti, Antonella; Memoli, Andrea; Capone, Domenico; Guida, Bruna

    2016-03-16

    Although the pathophysiological mechanisms of arterial hypertension are different in obese and lean patients, hypertension guidelines do not include specific recommendations for obesity-related hypertension and, therefore, there is a considerable uncertainty on which antihypertensive drugs should be used in this condition. Moreover, studies performed in general population suggested that some antihypertensive drugs may increase body weight, glycemia and LDL-cholesterol but it is unclear how this impact on drug choice in clinical practice in the treatment of obese hypertensive patients. Therefore, in order to identify current preferences of practitioners for obesity-related hypertension, in the present work we evaluated antihypertensive drug therapy in a cohort of 129 pharmacologically treated obese hypertensive patients (46 males and 83 females, aged 51.95 ± 10.1 years) that came to our observation for a nutritional consultation. Study design was retrospective observational. Differences in the prevalence of use of the different antihypertensive drug classes among groups were evaluated with χ(2) square analysis. Threshold for statistical significance was set at p obesity of type I, II and III or between patients with or without metabolic syndrome. Our data show that no first choice protocol seems to be adopted in clinical practice for the treatment of obesity-related hypertension. Importantly, physicians do not seem to differentiate drug use according to the severity of obesity or to the presence of metabolic syndrome or to avoid drugs known to detrimentally affect body weight and metabolic profile in general population.

  15. Hypertension in pregnancy

    Directory of Open Access Journals (Sweden)

    Andrea Ungar

    2007-03-01

    Full Text Available Hypertension is the most common medical problem encountered during pregnancy, complicating 2-3% of pregnancies. Hypertensive disorders during pregnancy are classified into 4 categories: chronic hypertension, pre-eclampsia/eclampsia, pre-eclampsia superimposed on chronic hypertension, and gestational hypertension. A relative paucity of investigative data, as well as the frequent difficulty in making an etiological diagnosis, may lead to problems in its management. This case report analyses current concepts regarding the hypertensive disorders of gestation, focusing on chronic hypertension. Chronic hypertension is defined as blood pressure exceeding 140/90 mmHg before pregnancy or before 20 weeks gestation. Hypertensive disorders in pregnancy may cause maternal and fetal morbidity and remain a leading source of maternal mortality. A prompt diagnosis is needed also because hypertension may be an indicator of pre-eclampsia, a condition which can evolve into serious complications. Maintaining blood pressure below 140/90 mmHg is recommended, although treatment should be determined on an individual basis. Many anti-hypertensive agents appear to be safe for use during pregnancy: methildopa has been the most studied of the anti-hypertensive drugs and has the best safety record. Labetalol, idralazine and nifedipine also have been found to be safe; ACE-inhibitors are absolutely contraindicated, because they are associated with intrauterine growth retardation.

  16. Hypertension in diabetes as related to nephropathy. Early blood pressure changes

    DEFF Research Database (Denmark)

    Feldt-Rasmussen, B; Borch-Johnsen, K; Mathiesen, E R

    1985-01-01

    and elevated urinary albumin excretion rate 20 to 200 micrograms/min; and group 3, patients with Albustix-positive urine at the time of diagnosis of diabetic nephropathy, that is, proteinuria greater than 0.5 g/24 hr on four consecutive visits with an interval of more than 1 month. We also studied blood...... that arterial hypertension is an early feature in the developing of diabetic nephropathy, with blood pressure rising before the presence of clinical proteinuria....

  17. Is immune system-related hypertension associated with ovarian hormone deficiency?

    OpenAIRE

    Sandberg, Kathryn; Ji, Hong; Einstein, Gillian; Au, April; Hay, Meredith

    2015-01-01

    The immune system is known to contribute to the development of high blood pressure in males. However, the role of the immune system in the development of high blood pressure in females and the role of ovarian hormones has only recently begun to be studied. In animal studies, both the sex of the host and the T cell are critical biological determinants of susceptibility and resistance to hypertension induced by angiotensin II. In women, natural menopause is known to result in significant change...

  18. Lifestyle and venous thrombosis

    NARCIS (Netherlands)

    Pomp, Elisabeth Rebekka

    2008-01-01

    In the Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis (MEGA study), a large population-based case-control study, we investigated lifestyle factors as risk factors for venous thrombosis. Overweight, smoking and alcohol consumption were addressed and pregnancy and

  19. Expressed racial identity and hypertension in a telephone survey sample from Toronto and Vancouver, Canada: do socioeconomic status, perceived discrimination and psychosocial stress explain the relatively high risk of hypertension for Black Canadians?

    Science.gov (United States)

    Veenstra, Gerry

    2012-10-12

    Canadian research on racial health inequalities that foregrounds socially constructed racial identities and social factors which can explain consequent racial health inequalities is rare. This paper adopts a social typology of salient racial identities in contemporary Canada, empirically documents consequent racial inequalities in hypertension in an original survey dataset from Toronto and Vancouver, Canada, and then attempts to explain the inequalities in hypertension with information on socioeconomic status, perceived experiences with institutionalized and interpersonal discrimination, and psychosocial stress. Telephone interviews were conducted in 2009 with 706 randomly selected adults living in the City of Toronto and 838 randomly selected adults living in the Vancouver Census Metropolitan Area. Bivariate analyses and logistic regression modeling were used to examine relationships between racial identity, hypertension, socio-demographic factors, socioeconomic status, perceived discrimination and psychosocial stress. The Black Canadians in the sample were the most likely to report major and routine discriminatory experiences and were the least educated and the poorest. Black respondents were significantly more likely than Asian, South Asian and White respondents to report hypertension controlling for age, immigrant status and city of residence. Of the explanatory factors examined in this study, only educational attainment explained some of the relative risk of hypertension for Black respondents. Most of the risk remained unexplained in the models. Consistent with previous Canadian research, socioeconomic status explained a small portion of the relatively high risk of hypertension documented for the Black respondents. Perceived experiences of discrimination both major and routine and self-reported psychosocial stress did not explain these racial inequalities in hypertension. Conducting subgroup analyses by gender, discerning between real and perceived experiences

  20. Immune-related effects in hypertension and target-organ damage.

    Science.gov (United States)

    Muller, Dominik N; Kvakan, Heda; Luft, Friedrich C

    2011-03-01

    Several studies published in the past three decades have suggested that inflammation and activation of immunity are central features in the pathogenesis of atherosclerosis, ischemic myocardial injury, and also in hypertension-induced target organ damage. A better understanding of this field could help us to explain the increased cardiovascular risk in patients with chronic inflammation. Recent studies have demonstrated that macrophages and various T-cell subtypes play a pivotal role in the regulation of blood pressure and target organ damage. Hypertensive stimuli such as the effector molecule of the renin-angiotensin system, angiotensin II, not only regulate vascular tone and sodium balance, but also activate immune cells and promote cell infiltration into target organs. Experimental and clinical evidence show that adaptive transfer of immune cells, rendering mice deficient for a certain subset of immune cells, or immunosuppressive treatment affects blood pressure and ameliorates target organ damage. The aim of this review is to summarize and discuss some of the more recent insights as to how immune cells might affect the regulation of blood pressure and the pathogenesis of hypertension-induced target organ damage.

  1. Home blood pressure measurement in women with pregnancy-related hypertensive disorders.

    Science.gov (United States)

    Lan, Patrick G; Hyett, Jon; Gillin, Adrian G

    2017-10-01

    To determine if home blood pressure measurement (HBPM) provides comparable results to clinic blood pressure (BP) measurement. A prospective, single-centre study of 37 pregnant and early post-partum women with a hypertensive pregnancy or at high-risk of developing a hypertensive pregnancy were asked to perform HBPM for a minimum period of one week. This was subsequently compared to clinic BP measurement both before and after the period of home measurement. The accuracy of HBPM compared to clinic measurement, and the acceptability by patients for HBPM. The HBPM was comparable to clinic measurements [for the systolic blood pressure (SBP), the mean home reading was 123.4mmHg (122.0-124.9mmHg) versus 123.9mmHg (121.3-126.5mmHg) for the clinic reading (p=0.69); for the diastolic blood pressure (DBP) the mean home reading was 81.6mmHg (80.4-82.8mmHg) versus 84.4mmHg (82.6-86.2mmHg) for the clinic (pmeasurement. It is also an acceptable technique for pregnant and early post-partum women. However, it should be used as an adjunct to clinic measurement, and cannot at this present stage replace clinic visits or clinic BP measurement. Copyright © 2017 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.

  2. Prospective randomized study of carotid endarterectomy with Fluoropassiv thin wall carotid patch versus venous patch.

    Science.gov (United States)

    Meerwaldt, R; Lansink, K W W; Blomme, A M; Fritschy, W M

    2008-07-01

    The practice of carotid endarterectomy (CEA) with patch angioplasty is more effective compared to primary closure. However, the type of patch material remains a controversy. The Fluoropassiv thin wall carotid patch is a polyester patch with an interpenetrating, nanometer-scale, solvent-applied surface modification, based on a biocompatible fluoropolymer. The present pilot study is the first clinical trial evaluating results of CEA with Fluoropassiv versus venous patch. Eighty-seven patients were randomized to 42 Fluoropassiv patching and 45 venous patching. Patients were observed by a vascular surgeon and a neurologist and scanned using duplex ultrasound with a follow-up of 2 years. No patients were lost to follow-up. Restenosis was defined as a Peak Systolic Velocity ratio >2.6, lumen reduction >50%. Perioperative stroke rate was 2.4% in the Fluoropassiv group and 8.9% in the venous group (p=0.02; 1 regressive, 4 non-regressive strokes). Multivariate analysis showed that bilateral carotid stenosis and stroke as indication for CEA were related to perioperative stroke. There was no link between perioperative stroke and patch type after correction for these factors. Patch type had no influence on operation time, clamp time, cranial nerve damage, hypertension, hematoma, infections, time to discharge, or early thromboembolic events. There were no significant differences between the Fluoropassiv and the venous group for cumulative mortality (respectively 4.4 vs 4.8%), patch occlusion (4.8 vs 2.2%), or stroke rate during 2 year follow-up (2.2 vs 2.4%). This first clinical study with the Fluoropassiv thin wall carotid patch showed no enhanced thrombogenicity compared to a venous patch. The Fluoropassiv patch is not related to a higher rate of postoperative bleeding events either.

  3. Comparison of absolute fluid restriction versus relative volume redistribution strategy in low central venous pressure anesthesia in liver resection surgery: a randomized controlled trial.

    Science.gov (United States)

    Zatloukal, Jan; Pradl, Richard; Kletecka, Jakub; Skalicky, Tomas; Liska, Vaclav; Benes, Jan

    2017-10-01

    BACKGROUNDː Lowering central venous pressure (CVP) can decrease blood loss during liver resection and it is associated with improved outcomes. Multiple CVP reducing maneuvers have been described, but direct comparison of their effectiveness and safety has never been performed. METHODSː Patients undergoing resections of two or more liver segments were equally randomized to absolute fluid restriction (AR, N.=17) or relative volume redistribution group (RR, N.=17). The ease of reaching low CVP, blood loss, morbidity and mortality were assessed. Besides, the effect of Pringle maneuver and utility of stroke volume variation (SVV) were analyzed. RESULTSː Both methods of CVP reduction were equally effective (0.7±0.9 vs. 0.9±1.0 protocolized steps in the AR and RR group; P=0.356) and safe (no difference in observed blood loss, intraoperative hemodynamic parameters, lactate levels, morbidity and mortality). Patients in the AR group received smaller amount of fluids in the pre-resection period (120 (100-150) vs. 600 (500-700) mL; P10% with 81.4% sensitivity and 77.1% specificity. Reduced blood loss and transfusion rate was observed when Pringle maneuver was used. CONCLUSIONSː In our study, absolute fluid restriction and relative volume redistribution seemed to be equally effective and safe methods of lowering CVP in patients undergoing liver resection. According to our data high SVV might be considered as a low CVP replacement. Pringle maneuver reduced blood loss and transfusion requirement.

  4. Multiple cerebral venous sinus thrombosis: Case report | Mogere ...

    African Journals Online (AJOL)

    Cerebral venous thrombosis (CVT) is an uncommon clinical problem and can be characterised by nonspecific and common symptoms of headaches and vomiting due to the intracranial hypertension. Alternate diagnoses are entertained especially when procoagulant factors are not elicited. We present a 35 year old female, ...

  5. Association of bariatric surgery with risk of acute care use for hypertension-related disease in obese adults: population-based self-controlled case series study.

    Science.gov (United States)

    Shimada, Yuichi J; Tsugawa, Yusuke; Iso, Hiroyasu; Brown, David F M; Hasegawa, Kohei

    2017-08-23

    Hypertension carries a large societal burden. Obesity is known as a risk factor for hypertension. However, little is known as to whether weight loss interventions reduce the risk of hypertension-related adverse events, such as acute care use (emergency department [ED] visit and/or unplanned hospitalization). We used bariatric surgery as an instrument for investigating the effect of large weight reduction on the risk of acute care use for hypertension-related disease in obese adults with hypertension. We performed a self-controlled case series study of obese patients with hypertension who underwent bariatric surgery using population-based ED and inpatient databases that recorded every bariatric surgery, ED visit, and hospitalization in three states (California, Florida, and Nebraska) from 2005 to 2011. The primary outcome was acute care use for hypertension-related disease. We used conditional logistic regression to compare each patient's risk of the outcome event during sequential 12-month periods, using pre-surgery months 13-24 as the reference period. We identified 980 obese patients with hypertension who underwent bariatric surgery. The median age was 48 years (interquartile range, 40-56 years), 74% were female, and 55% were non-Hispanic white. During the reference period, 17.8% (95% confidence interval [CI], 15.4-20.2%) had a primary outcome event. The risk remained unchanged in the subsequent 12-month pre-surgery period (18.2% [95% CI, 15.7-20.6%]; adjusted odds ratio [aOR] 1.02 [95% CI, 0.83-1.27]; P = 0.83). In the first 12-month period after bariatric surgery, the risk significantly decreased (10.5% [8.6-12.4%]; aOR 0.58 [95% CI, 0.45-0.74]; P bariatric surgery (12.9% [95% CI, 10.8-15.0%]; aOR 0.71 [95% CI, 0.57-0.90]; P = 0.005). By contrast, there was no significant reduction in the risk among obese patients who underwent non-bariatric surgery (i.e., cholecystectomy, hysterectomy, spinal fusion, or mastectomy). In this population-based study of

  6. The treatment of venous ulcers of the lower extremities

    Science.gov (United States)

    2007-01-01

    Venous hypertension from failure of proper venous valve function in the veins of thelower extremities causes changes over time in the microcirculation of the skin of the distal extremity. These changes set the stage for the development of a chronic nonhealing ulceration, which typically occurs at the ankle. The mainstay of treatment has been conservative, with compression dressings and elevation of the extremity. However, results have been less than satisfactory because of delay in healing and high recurrence rates after successful healing. Elimination of the venous hypertension should be the goal of therapy using more recent minimally invasive surgical techniques, including ablation of incompetent truncal veins with laser or radiofrequency energy and use of ultrasound-guided foam sclerosant injections to close incompetent perforator veins that are frequently found in or near the ulcer bed. This approach will shorten ulcer healing time and reduce recurrence rates as well as patient suffering and expense. PMID:17948110

  7. Effects of Nuclear Factor-E2-related factor 2/Heme Oxygenase 1 on splanchnic hemodynamics in experimental cirrhosis with portal hypertension.

    Science.gov (United States)

    Qin, Jun; He, Yue; Duan, Ming; Luo, Meng

    2017-05-01

    We explored the effects of Nuclear Factor-E2-related factor 2 (Nrf2) and Heme Oxygenase 1 (HO-1) on splanchnic hemodynamics in portal hypertensive rats. Experimental cirrhosis with portal hypertension was induced by intraperitoneal injection of carbon tetrachloride. The expression of proteins was examined by immunoblotting. Hemodynamic studies were performed by radioactive microspheres. The vascular perfusion system was used to measure the contractile response of mesentery arterioles in rats. Nrf2 expression in the nucleus and HO-1 expression in cytoplasm was significantly enhanced in portal hypertensive rats. Portal pressure, as well as regional blood flow, increased significantly in portal hypertension and can be blocked by tin protoporphyrin IX. The expression of endogenous nitric oxide synthase and vascular endothelial growth factors increased significantly compared to normal rats, while HO-1 inhibition decreased the expression of these proteins significantly. The contractile response of mesenteric arteries decreased in portal hypertension, but can be partially recovered through tin protoporphyrin IX treatment. The expression of Nrf2/HO-1 increased in mesenteric arteries of portal hypertensive rats, which was related to oxidative stress. HO-1was involved in increased portal pressure and anomaly splanchnic hemodynamics in portal hypertensive rats. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies), 2014. Scientific Opinion on the substantiation of a health claim related to a combination of diosmin, troxerutin and hesperidin and maintenance of normal venous-capillary permeability pursuant to Article 13(5) of Regulation

    DEFF Research Database (Denmark)

    Tetens, Inge

    2014-01-01

    claim related to a combination of diosmin, troxerutin and hesperidin and maintenance of normal venous-capillary permeability. The food that is a subject of the health claim, a combination of diosmin, troxerutin and hesperidin, is sufficiently characterised. The claimed effect, maintenance of normal...... the consumption of a combination of diosmin, troxerutin and hesperidin and the maintenance of normal venous-capillary permeability....

  9. Cerebral venous thrombosis: Update on clinical manifestations, diagnosis and management

    Directory of Open Access Journals (Sweden)

    Leys Didier

    2008-01-01

    Full Text Available Cerebral venous thrombosis (CVT has a wide spectrum of clinical manifestations that may mimic many other neurological disorders and lead to misdiagnoses. Headache is the most common symptom and may be associated with other symptoms or remain isolated. The other frequent manifestations are focal neurological deficits and diffuse encephalopathies with seizures. The key to the diagnosis is the imaging of the occluded vessel or of the intravascular thrombus, by a combination of magnetic resonance imaging (MRI and magnetic resonance venography (MRV. Causes and risk factors include medical, surgical and obstetrical causes of deep vein thrombosis, genetic and acquired prothrombotic disorders, cancer and hematological disorders, inflammatory systemic disorders, pregnancy and puerperium, infections and local causes such as tumors, arteriovenous malformations, trauma, central nervous system infections and local infections. The breakdown of causes differs in different parts of the world. A meta-analysis of the most recent prospectively collected series showed an overall 15% case-fatality or dependency rate. Heparin therapy is the standard therapy at the acute stage, followed by 3-6 months of oral anticoagulation. Patients with isolated intracranial hypertension may require a lumbar puncture to remove cerebrospinal fluid before starting heparin when they develop a papilloedema that may threaten the visual acuity or decompressive hemicraniectomy. Patients who develop seizures should receive antiepileptic drugs. Cerebral venous thrombosis - even pregnancy-related - should not contraindicate future pregnancies. The efficacy and safety of local thrombolysis and decompressive hemicraniectomy should be tested

  10. Hypertension-Related Gene Polymorphisms of G-Protein-Coupled Receptor Kinase 4 Are Associated with NT-proBNP Concentration in Normotensive Healthy Adults

    Directory of Open Access Journals (Sweden)

    Junichi Yatabe

    2012-01-01

    Full Text Available G protein-coupled receptor kinase 4 (GRK4 with activating polymorphisms desensitize the natriuric renal tubular D1 dopamine receptor, and these GRK4 polymorphisms are strongly associated with salt sensitivity and hypertension. Meanwhile, N-terminal pro-B-type natriuretic peptide (NT-proBNP may be useful in detecting slight volume expansion. However, relations between hypertension-related gene polymorphisms including GRK4 and cardiovascular indices such as NT-proBNP are not clear, especially in healthy subjects. Therefore, various hypertension-related polymorphisms and cardiovascular indices were analyzed in 97 normotensive, healthy Japanese adults. NT-proBNP levels were significantly higher in subjects with two or more GRK4 polymorphic alleles. Other hypertension-related gene polymorphisms, such as those of renin-angiotensin-aldosterone system genes, did not correlate with NT-proBNP. There was no significant association between any of the hypertension-related gene polymorphisms and central systolic blood pressure, cardioankle vascular index, augmentation index, plasma aldosterone concentration, or an oxidative stress marker, urinary 8-OHdG. Normotensive individuals with GRK4 polymorphisms show increased serum NT-proBNP concentration and may be at a greater risk of developing hypertension and cardiovascular disease.

  11. Radiologically-placed venous ports in children under venous anesthesia

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Joo Yeon; Jeon, Ung Bae; Choo, Ki Seok; Hwang, Jae Yeon; Kim, Yong Woo; Lee, Yun Jin; Nam, Sang Ool; Lim, Young Tak [Pusan National University School of Medicine, Yangsan (Korea, Republic of)

    2015-02-15

    To evaluate the efficacy and safety of radiologic venous port placement in children under venous anesthesia. Between April 2009 and July 2011, 44 ports were implanted in 41 children (24 boys, 17 girls). The age of patients ranged from 9 months to 19 years (mean, 6.5 years) and their body weights ranged from 6.8 kg to 56.3 kg (mean, 23.2 kg). Right internal jugular vein access was used in 42 ports, right subclavian vein in 1, and left subclavian in 1. Durability and complications of port implantation were reviewed. The technical success rate was 100%. The catheter life was 10-661 days (mean 246 days). Two patients died during the follow-up period, 21 and 6 ports were removed at the end of treatment or as a result of complications, respectively. One port was removed and replaced by a Hickmann catheter. Three ports were explanted due to port-related sepsis, one due to a catheter kink, and two for unexplained fever or insertion site pain. The overall port-related infection was 3 cases (6.8%, 0.28/1000 catheter days). Venous port placement by interventional radiologists in children under intravenous sedation is relatively safe, with a high rate of technical success and low rate of complications.

  12. Liver cirrhosis and arterial hypertension

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik; Møller, Søren

    2006-01-01

    blood pressure. This review considers the alterations in systemic hemodynamics in patients with cirrhosis in relation to essential hypertension and arterial hypertension of the renal origin. Subjects with arterial hypertension (essential, secondary) may become normotensive during the development...... of cirrhosis, and arterial hypertension is rarely manifested in patients with cirrhosis, even in cases with renovascular disease and high circulating renin activity. There is much dispute as to the understanding of homoeostatic regulation in cirrhotic patients with manifest arterial hypertension. This most...

  13. Obesity and its Relation With Diabetes and Hypertension: A Cross-Sectional Study Across 4 Geographical Regions.

    Science.gov (United States)

    Patel, Shivani A; Ali, Mohammed K; Alam, Dewan; Yan, Lijing L; Levitt, Naomi S; Bernabe-Ortiz, Antonio; Checkley, William; Wu, Yangfeng; Irazola, Vilma; Gutierrez, Laura; Rubinstein, Adolfo; Shivashankar, Roopa; Li, Xian; Miranda, J Jaime; Chowdhury, Muhammad Ashique Haider; Siddiquee, Ali Tanweer; Gaziano, Thomas A; Kadir, M Masood; Prabhakaran, Dorairaj

    2016-03-01

    The implications of rising obesity for cardiovascular health in middle-income countries has generated interest, in part because associations between obesity and cardiovascular health seem to vary across ethnic groups. We assessed general and central obesity in Africa, East Asia, South America, and South Asia. We further investigated whether body mass index (BMI) and waist circumference differentially relate to cardiovascular health; and associations between obesity metrics and adverse cardiovascular health vary by region. Using baseline anthropometric data collected between 2008 and 2012 from 7 cohorts in 9 countries, we estimated the proportion of participants with general and central obesity using BMI and waist circumference classifications, respectively, by study site. We used Poisson regression to examine the associations (prevalence ratios) of continuously measured BMI and waist circumference with prevalent diabetes and hypertension by sex. Pooled estimates across studies were computed by sex and age. This study analyzed data from 31,118 participants aged 20 to 79 years. General obesity was highest in South Asian cities and central obesity was highest in South America. The proportion classified with general obesity (range 11% to 50%) tended to be lower than the proportion classified as centrally obese (range 19% to 79%). Every standard deviation higher of BMI was associated with 1.65 and 1.60 times higher probability of diabetes and 1.42 and 1.28 times higher probability of hypertension, for men and women, respectively, aged 40 to 69 years. Every standard deviation higher of waist circumference was associated with 1.48 and 1.74 times higher probability of diabetes and 1.34 and 1.31 times higher probability of hypertension, for men and women, respectively, aged 40 to 69 years. Associations of obesity measures with diabetes were strongest in South Africa among men and in South America among women. Associations with hypertension were weakest in South Africa among

  14. Elevated levels of plasma Big endothelin-1 and its relation to hypertension and skin lesions in individuals exposed to arsenic

    Energy Technology Data Exchange (ETDEWEB)

    Hossain, Ekhtear; Islam, Khairul; Yeasmin, Fouzia [Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi-6205 (Bangladesh); Karim, Md. Rezaul [Department of Applied Nutrition and Food Technology, Islamic University, Kushtia-7003 (Bangladesh); Rahman, Mashiur; Agarwal, Smita; Hossain, Shakhawoat; Aziz, Abdul; Al Mamun, Abdullah; Sheikh, Afzal; Haque, Abedul; Hossain, M. Tofazzal [Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi-6205 (Bangladesh); Hossain, Mostaque [Department of Medicine, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka (Bangladesh); Haris, Parvez I. [Faculty of Health and Life Sciences, De Montfort University, Leicester, LE1 9BH (United Kingdom); Ikemura, Noriaki; Inoue, Kiyoshi; Miyataka, Hideki; Himeno, Seiichiro [Laboratory of Molecular Nutrition and Toxicology, Faculty of Pharmaceutical Sciences, Tokushima Bunri University, Tokushima 770–8514 (Japan); Hossain, Khaled, E-mail: khossain69@yahoo.com [Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi-6205 (Bangladesh)

    2012-03-01

    Chronic arsenic (As) exposure affects the endothelial system causing several diseases. Big endothelin-1 (Big ET-1), the biological precursor of endothelin-1 (ET-1) is a more accurate indicator of the degree of activation of the endothelial system. Effect of As exposure on the plasma Big ET-1 levels and its physiological implications have not yet been documented. We evaluated plasma Big ET-1 levels and their relation to hypertension and skin lesions in As exposed individuals in Bangladesh. A total of 304 study subjects from the As-endemic and non-endemic areas in Bangladesh were recruited for this study. As concentrations in water, hair and nails were measured by Inductively Coupled Plasma Mass Spectroscopy (ICP-MS). The plasma Big ET-1 levels were measured using a one-step sandwich enzyme immunoassay kit. Significant increase in Big ET-1 levels were observed with the increasing concentrations of As in drinking water, hair and nails. Further, before and after adjusting with different covariates, plasma Big ET-1 levels were found to be significantly associated with the water, hair and nail As concentrations of the study subjects. Big ET-1 levels were also higher in the higher exposure groups compared to the lowest (reference) group. Interestingly, we observed that Big ET-1 levels were significantly higher in the hypertensive and skin lesion groups compared to the normotensive and without skin lesion counterpart, respectively of the study subjects in As-endemic areas. Thus, this study demonstrated a novel dose–response relationship between As exposure and plasma Big ET-1 levels indicating the possible involvement of plasma Big ET-1 levels in As-induced hypertension and skin lesions. -- Highlights: ► Plasma Big ET-1 is an indicator of endothelial damage. ► Plasma Big ET-1 level increases dose-dependently in arsenic exposed individuals. ► Study subjects in arsenic-endemic areas with hypertension have elevated Big ET-1 levels. ► Study subjects with arsenic

  15. Comparative Analysis of Renin-Angiotensin System (RAS)-Related Gene Expression Between Hypertensive and Normotensive Rats.

    Science.gov (United States)

    Williamson, Chad R; Khurana, Sandhya; Nguyen, Phong; Byrne, Collin J; Tai, T C

    2017-01-31

    BACKGROUND The renal renin-angiotensin system (RAS) is physiologically important for blood pressure regulation. Altered regulation of RAS-related genes has been observed in an animal model of hypertension (spontaneously hypertensive rats - SHRs). The current understanding of certain RAS-related gene expression differences between Wistar-Kyoto rats (WKYs) and SHRs is either limited or has not been compared. The purpose of this study was to compare the regulation of key RAS-related genes in the kidneys of adult WKYs and SHRs. MATERIAL AND METHODS Coronal sections were dissected through the hilus of kidneys from 16-week-old male WKYs and SHRs. RT-PCR analysis was performed for Ace, Ace2, Agt, Agtr1a, Agtr1b, Agtr2, Atp6ap2 (PRR), Mas1, Ren, Rnls, and Slc12a3 (NCC). RESULTS Increased mRNA expression was observed for Ace, Ace2, Agt, Agtr1a, Agtr1b, and Atp6ap2 in SHRs compared to WKYs. Mas1, Ren, Slc12a3, and Rnls showed no difference in expression between animal types. CONCLUSIONS This study shows that the upregulation of several key RAS-related genes in the kidney may account for the increased blood pressure of adult SHRs.

  16. Propensity score analysis confirms the independent effect of parenteral nutrition on the risk of central venous catheter-related bloodstream infection in oncological patients.

    Science.gov (United States)

    Touré, Abdoulaye; Chambrier, Cécile; Vanhems, Philippe; Lombard-Bohas, Catherine; Souquet, Jean-Christophe; Ecochard, René

    2013-12-01

    Parenteral nutrition is known as a high-risk factor for central venous catheter-related bloodstream infection (CVC-RBSI) in cancer patients. Owing to ethical and technical problems, the studies in the literature have nonrandomized designs and are therefore often confounded by biases. We performed a propensity score analysis to estimate the effect of parenteral nutrition on CVC-RBSI in digestive cancer patients who underwent chemotherapy. Data were collected prospectively. A logistic regression model was used to calculate a propensity score, which was the probability of receiving parenteral nutrition. Kaplan-Meier survival and Cox regression model were used to estimate the effect of the parenteral nutrition on CVC-RBSI after adjustment for the propensity score. Before the propensity score analysis, the differences between patients with (n = 113) and without (n = 312) parenteral nutrition were identified including: male gender, body weight, weight loss, performance status, location of primary cancer, FOLFIRI, and previous long-term corticotherapy. After propensity score stratification, all of the covariates were balanced within each stratum. After adjustment, patients with parenteral nutrition were at a higher risk for CVC-RBSI. By using the propensity score analysis, this study confirmed that parenteral nutrition was an independent risk factor for CVC-RBSI in digestive cancer patients. Copyright © 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  17. Pharmacologic Treatment Reduces Pressure Times Time Dose and Relative Duration of Intracranial Hypertension.

    Science.gov (United States)

    Colton, Katharine; Yang, S; Hu, P F; Chen, H H; Bonds, B; Stansbury, L G; Scalea, T M; Stein, D M

    2016-05-01

    Past work has shown the importance of the "pressure times time dose" (PTD) of intracranial hypertension (intracranial pressure [ICP] > 19 mm Hg) in predicting outcome after severe traumatic brain injury. We used automated data collection to measure the effect of common medications on the duration and dose of intracranial hypertension. Patients >17 years old, admitted and requiring ICP monitoring between 2008 and 2010 at a single, large urban tertiary care facility, were retrospectively enrolled. Timing and dose of ICP-directed therapy were recorded from paper and electronic medical records. The ICP data were collected automatically at 6-second intervals and averaged over 5 minutes. The percentage of time of intracranial hypertension (PTI) and PTD (mm Hg h) were calculated. A total of 98 patients with 664 treatment instances were identified. Baseline PTD ranged from 27 (before administration of propofol and fentanyl) to 150 mm Hg h (before mannitol). A "small" dose of hypertonic saline (HTS; ≤250 mL 3%) reduced PTD by 38% in the first hour and 37% in the second hour and reduced the time with ICP >19 by 38% and 39% after 1 and 2 hours, respectively. A "large" dose of HTS reduced PTD by 40% in the first hour and 63% in the second (PTI reduction of 36% and 50%, respectively). An increased dose of propofol or fentanyl infusion failed to decrease PTD but reduced PTI between 14% (propofol alone) and 30% (combined increase in propofol and fentanyl, after 2 hours). Barbiturates failed to decrease PTD but decreased PTI by 30% up to 2 hours after administration. All reductions reported are significantly changed from baseline, P < .05. Baseline PTD values before drug administration reflects varied patient criticality, with much higher values seen before the use of mannitol or barbiturates. Treatment with HTS reduced PTD and PTI burden significantly more than escalation of sedation or pain management, and this effect remained significant at 2 hours after administration.

  18. Hypertension Impact on Health-Related Quality of Life: A Cross-Sectional Survey among Middle-Aged Adults in Chongqing, China

    Directory of Open Access Journals (Sweden)

    Xianglong Xu

    2016-01-01

    Full Text Available Hypertension is a major risk factor of cardiovascular disease in China, and yet little is known about health-related quality of life (HRQOL and its associations with demographic and social-economic characteristics in middle-aged patients with hypertension. A cross-sectional survey was undertaken in Chongqing, China, using a multistage stratified random sampling methodology. Data was collected on 1,224 eligible adults, aged between 45 and 53 years, including the Medical Outcomes Survey Short Form-36 to measure HRQOL. Hypertension was associated with poor state of physical functioning, role-physical, bodily pain, general health, vitality, and social function (p<0.05 for all. In multivariable analyses, education level, job conditions, average monthly income, smoking status, sleep quality, perception of relationship with family, childhood breastfeeding history, and body mass index were associated with domains of SF36 among those with hypertension (p<0.05 for all. Hypertensive respondents with high education, marital status, breastfeeding, higher incomes, good quality of sleep, positive relationship with family, and higher body mass index have better HRQOL in middle-aged people with hypertension. Those unemployed had a better state of general health and had a poorer state of social function. Nonsmokers had a poorer state of bodily pain than smokers. This study provides detailed information of the implications for health care providers to gain a more complete picture of their hypertension patients’ health.

  19. THE AZYGOS VENOUS SYSTEM AND ITS ANATOMICAL VARIATIONS

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    Madiki Sudhakara Rao

    2016-06-01

    Full Text Available AIMS AND OBJECTIVES Azygos veins are important cavocaval and portacaval junctions, which form a collateral circulation in caval vein occlusion and in portal hypertension, cirrhosis of liver. The unpaired azygos venous system consists of azygos vein, hemiazygos vein and accessory azygos vein. This system of veins, along with its mediastinal, bronchial and oesophageal tributaries drains most of the body wall of trunk, namely posterior abdominal and thoracic wall. Anatomical variations of this unpaired azygos venous system are clinically important. AIMS To study and report the occurrence of anatomical variations of the unpaired azygos venous system in the region of East Godavari District, Andhra Pradesh (India. METHODS The present study was carried out in the Department of Anatomy, KIMS & RF, Amalapuram and G.S.L. Medical College, Rajahmundry over a period of 2 years. The present study was conducted on 60 cadavers (irrespective of age and sex. The entire course of the azygos venous system in these 60 cadavers was carefully observed and documented. RESULTS Anatomical variations were present in 16.66% of cases, out of which three distinct types were identified. 6.6% exhibited two separate azygos venous systems with no communications, 5% with communication between the left brachiocephalic vein and the azygos vein and 5% presence of post-aortic venous channels. CONCLUSION Variations of azygos venous system may be wrongly dubbed as aneurysm, lymphadenopathy or other abnormalities while reporting a CT scan of mediastinum. Venous anomalies are also detected only during surgery. The most troublesome intraoperative hazard is haemorrhage, which is mainly of venous origin. To avoid such situations is to have an awareness and knowledge of the expected venous anomalies.

  20. Cerebral Venous Thrombosis Presenting with Subracnoid Hemorrhage

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    Esra Eruyar

    2015-08-01

    Full Text Available Subarachnoid hemorrhage (SAH associated with cerebral venous thrombosis (CVT is rarely reported. In our case, the initial CT shows with suspected lesions that SAH. After the initial diagnosis of SVT with history and neurological examination findings MRV taken and consistend with thrombus signal change. Dural sinus thrombosis with secondary venous hypertension may lead to SAH into the subarachnoid space due to the rupture of fragile, thin-walled cortical veins. Patients with non-traumatic, non-aneurysmal and non-perimesencephalic subaracnoid hemorrhage tend to have clots circumscribed along the cortical convexity, a condition referred as acute cortical SAH. CVT is a potential cause of cortical SAH. This case; SAH may be the first sign of SVT and especially SVT must do in etiologic research without the involvement of the basal sisterna in cases of SAH.

  1. Ulcer-related problems and health care needs in patients with venous leg ulceration: a descriptive, cross-sectional study.

    NARCIS (Netherlands)

    Heinen, M.M.; Persoon, A.; Kerkhof, P.C.M. van de; Otero, M.; Achterberg, T. van

    2007-01-01

    BACKGROUND: Patients with leg ulceration often have long lasting and recurrent wounds. The treatment exists mainly of wound-care and compression therapy. International literature shows several indications of problems in relation to leg ulceration, but no studies were performed to give a

  2. Differences in urinary prothrombin fragment 1 + 2 levels after total hip replacement in relation to venous thromboembolism and bleeding events

    DEFF Research Database (Denmark)

    Borris, L C; Breindahl, M; Lassen, M R

    2008-01-01

    events. PATIENTS/METHODS: This study was conducted in parallel with a prospective, dose-finding study evaluating the efficacy and safety of different doses of rivaroxaban (Xarelto, Bayer HealthCare AG, Wuppertal, Germany) for thromboprophylaxis, relative to enoxaparin. Deep vein thrombosis was diagnosed...

  3. Central venous catheter-related bacteremia caused by Kocuria kristinae: Case report and review of the literature

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    David Michael Z

    2011-08-01

    Full Text Available Abstract Kocuria species are unusual human pathogens isolated most commonly from immunocompromised hosts, such as transplant recipients and cancer patients undergoing chemotherapy, or from patients with chronic medical conditions. A case of catheter-related bacteremia with pulmonary septic emboli in a pregnant adult female without chronic medical conditions is described. A review of other reported Kocuria infections is provided.

  4. Predictors and Outcomes of Recurrent Venous Thromboembolism in Elderly Patients.

    Science.gov (United States)

    Lauber, Sandro; Limacher, Andreas; Tritschler, Tobias; Stalder, Odile; Méan, Marie; Righini, Marc; Aschwanden, Markus; Beer, Jürg Hans; Frauchiger, Beat; Osterwalder, Josef; Kucher, Nils; Lämmle, Bernhard; Cornuz, Jacques; Angelillo-Scherrer, Anne; Matter, Christian M; Husmann, Marc; Banyai, Martin; Staub, Daniel; Mazzolai, Lucia; Hugli, Olivier; Rodondi, Nicolas; Aujesky, Drahomir

    2018-01-04

    Little is known about predictors and outcomes of recurrent venous thromboembolism in elderly patients. We prospectively followed up 991 patients aged ≥65 years with acute venous thromboembolism in a multicenter Swiss cohort study. The primary outcome was symptomatic recurrent venous thromboembolism. We explored the association between baseline characteristics and treatments and recurrent venous thromboembolism using competing risk regression, adjusting for periods of anticoagulation as a time-varying co-variate. We also assessed the clinical consequences (case-fatality, localization) of recurrent venous thromboembolism. During a median follow-up period of 30 months, 122 patients developed recurrent venous thromboembolism, corresponding to a 3-year cumulative incidence of 14.8%. The case-fatality of recurrence was high (20.5%), particularly in patients with unprovoked (23%) and cancer-related venous thromboembolism (29%). After adjustment, only unprovoked venous thromboembolism (sub-hazard ratio [SHR] 1.67 compared to provoked venous thromboembolism; 95% confidence interval [CI] 1.00-2.77) and proximal deep vein thrombosis (SHR 2.41 compared to isolated distal deep vein thrombosis; 95% CI 1.07-5.38) were significantly associated with recurrence. Patients with initial pulmonary embolism were more likely to have another pulmonary embolism as a recurrent event than patients with deep vein thrombosis. Elderly patients with acute venous thromboembolism have a substantial long-term risk of recurrent venous thromboembolism and recurrence carries a high case-fatality rate. Only two factors, unprovoked venous thromboembolism and proximal deep vein thrombosis, were independently associated with recurrent venous thromboembolism, indicating that traditional risk factors for venous thromboembolism recurrence (e.g., cancer) may be less relevant in the elderly. Copyright © 2018. Published by Elsevier Inc.

  5. Serum VEGF levels are related to the presence of pulmonary arterial hypertension in systemic sclerosis

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    Sakkas Lazaros

    2009-05-01

    Full Text Available Abstract Background The association between systemic sclerosis and pulmonary arterial hypertension (PAH is well recognized. Vascular endothelial growth factor (VEGF has been reported to play an important role in pulmonary hypertension. The aim of the present study was to examine the relationship between systolic pulmonary artery pressure, clinical and functional manifestations of the disease and serum VEGF levels in systemic sclerosis. Methods Serum VEGF levels were measured in 40 patients with systemic sclerosis and 13 control subjects. All patients underwent clinical examination, pulmonary function tests and echocardiography. Results Serum VEGF levels were higher in systemic sclerosis patients with sPAP ≥ 35 mmHg than in those with sPAP LCO were independent predictors of systolic pulmonary artery pressure. Conclusion Serum VEGF levels are increased in systemic sclerosis patients with sPAP ≥ 35 mmHg. The correlation between VEGF levels and systolic pulmonary artery pressure may suggest a possible role of VEGF in the pathogenesis of PAH in systemic sclerosis.

  6. Angiotensin-related genes involved in essential hypertension: allelic distribution in an Italian population sample.

    Science.gov (United States)

    Mettimano, M; Lanni, A; Migneco, A; Specchia, M L; Romano-Spica, V; Savi, L

    2001-08-01

    Blood pressure is a quantitative multifactorial trait influenced by environmental and genetic determinants. Although several candidate genes have been associated with the development of essential hypertension, the mechanisms of individual susceptibility still remain unclear. Knowledge on the distribution of genetic polymorphisms in different populations is fundamental for the assessment of the predictive value of genetic variation. We genotyped 300 healthy normotensive subjects from the Italian population for three polymorphisms, at the angiotensinogen (AGT, M and T), angiotensin II type 1 receptor (ATIR, A and C) and angiotensin-converting enzyme (ACE, D and I) genes. Polymorphisms were analyzed by polymerase chain reaction and restriction enzyme digestion. Statistical analysis was performed to verify the agreement with the Hardy-Weinberg equilibrium. The observed allelic distribution was in accordance with estimates reported for Caucasian populations. Variant allelic frequencies were 0.36 for the T and C alleles at the AGT andAT1R locus and 0.47 for the I allele of the ACE gene. AT1R and ACE genotype frequencies were in Hardy-Weinberg equilibrium, while there was a deviation of the AGT genotypes from those predicted by the equation. The studied polymorphisms are largely distributed in the Italian population sample, with a frequency of homozygous subjects for mutant alleles ranging from 9 to 22%. Epidemiology of mutations in the genes involved in blood pressure regulation provides tools to evaluate susceptibility to hypertension.

  7. [Venous thromboembolic disease: presentation of a case].

    Science.gov (United States)

    Mirpuri-Mirpuri, P G; Álvarez-Cordovés, M M; Pérez-Monje, A

    2013-01-01

    Venous thromboembolic disease in its clinical spectrum includes both deep vein thrombosis and pulmonary thromboembolism, which is usually a complication of deep vein thrombosis. It is a relatively common disease with significant morbidity and requires an accurate diagnosis. They are numerous risk factors for venous thromboembolism, and there is evidence that the risk of thromboembolic disease increases proportionally to the number of predisposing risk factors present. The primary care physician should know the risk factors and suspect the presence of venous thromboembolic disease when there is a compatible clnical picture. The treatment for this pathology is anticoagulation. We report a patient with cardiovascular risk factors who was seen with pain in the right leg and shortness of breath and referred to the hospital with suspected venous thromboembolism, atrial fibrillation and pleural effusion. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  8. Portaltrykket skal måles ved mistanke om portal hypertension

    DEFF Research Database (Denmark)

    Møller, Søren; Bendtsen, Flemming

    2010-01-01

    Portal hypertension leads to serious complications such as oesophageal varices, ascites, and in some patients hepatocellular carcinoma (HCC). The importance of measurement of the hepatic venous pressure gradient (HVPG) has recently been substantiated as it independently predicts survival and deve......Portal hypertension leads to serious complications such as oesophageal varices, ascites, and in some patients hepatocellular carcinoma (HCC). The importance of measurement of the hepatic venous pressure gradient (HVPG) has recently been substantiated as it independently predicts survival...... hypertensive patients....

  9. The relation between health insurance and management of hypertension in Shanghai, China: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Xinji Zhang

    2016-09-01

    Full Text Available Abstract Background We aimed to investigate the management of hypertension in Shanghai, China and to examine whether there was any difference of hypertension management among people enrolled in different health insurances. Methods In this cross-sectional study, a total of 31,531 residents were selected in Shanghai, using a randomized, stratified, multi-stage sampling method, and were asked to provide their status of hypertension, condition of hypertension management, health insurances and other demographic information. A weighted propensity score model was used to adjust confounders and to analyze the differences on hypertension management among hypertension patients enrolled in different health insurances. Results In Shanghai, most hypertension patients achieved good management of hypertension. However, patients enrolled in the New Cooperative Medical Scheme or the Urban Resident Basic Medical Insurance scheme were more likely to achieve publicity of precautionary knowledge about hypertension (OR = 2.36 [95 % CI :1.96,2.85] and 1.28 [95 % CI:1.12,1.45], respectively and had their blood pressure under control (OR = 1.33 [95 % CI :1.09,1.62] and 1.22 [95 % CI:1.05,1.42], respectively than patients enrolled in the Urban Employee Basic Health Insurance scheme. Conclusion The study provided a comprehensive description of hypertension in Shanghai, China. To support the management of hypertension, publicity of hypertension prevention knowledge should be improved, especially to people enrolled in the Urban Employee Basic Health Insurance scheme.

  10. A Propensity-Matched Study of Hypertension and Increased Stroke-Related Hospitalization in Chronic Heart Failure

    NARCIS (Netherlands)

    G.S. Filippatos (Gerasimos); C. Adamopoulos (Chris); X. Sui (Xuemei); T.E. Love (Thomas); P.M. Pullicino (Patrick); J. Lubsen (Jacob); G. Bakris (George); S.D. Anker (Stefan); G. Howard (George); D.T. Kremastinos (Dimitrios); A. Ahmed (Ali)

    2008-01-01

    textabstractHypertension is a risk factor for heart failure and stroke. However, the effect of hypertension on stroke in patients with heart failure has not been well studied. In the Digitalis Investigation Group trial, 3,674 (47%) of the 7,788 patients had a history of hypertension. Probability or

  11. Central Venous Access Device-Related Bacillus Cereus Endocarditis: A Case Report and Review of the Literature

    Science.gov (United States)

    Wright, William F.

    2016-01-01

    Bacillus cereus typically presents as a gastrointestinal infection, but rarely manifests as systemic disease. This report describes a case of B. cereus-related endocarditis that presented as a sickle cell crisis and bacteremia. Initial clinical suspicion was for laboratory contamination of blood cultures. The case herein described is intended to demonstrate an uncommon presentation of B. cereus infection and highlights the value of an aggressive need to further investigate and interpret unexpected blood culture findings in clinical practice, early adequate antimicrobial therapy, prompt diagnosis, and consideration to urgent surgical interventions in such cases. PMID:27231118

  12. Relationship between chronic complications, hypertension, and health-related quality of life in Portuguese patients with type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Sepúlveda E

    2015-10-01

    Full Text Available Eduardo Sepúlveda,1,2 Rui Poínhos,2,3 Miguel Constante,4,5 José Pais-Ribeiro,1,2 Paula Freitas,6–8 Davide Carvalho6–8 1Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal; 2Associação de Prevenção e Apoio à Diabetes, Porto, Portugal; 3Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal; 4Institute of Psychiatry, King's College London, London, UK; 5Department of Psychiatry, Hospital Beatriz Ângelo, Loures, Portugal; 6Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal; 7Faculty of Medicine, University of Porto, Porto, Portugal; 8Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal Background: The aim of this study was to assess the relationship between health-related quality of life (HRQoL and the presence or absence of hypertension and diabetes-related chronic complications in type 2 diabetes, and also the association between HRQoL and the number of chronic complications. Methods: One hundred patients with type 2 diabetes were interviewed. HRQoL was evaluated using the age-adjusted Short-Form 36 dimensions (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. Results: The mean age of the study population was 62.7±8.7 years; 54.0% were male, and 51.0% were receiving only oral hypoglycemic agents. Chronic complications were related to worse HRQoL in different dimensions: peripheral neuropathy and cardiovascular disease (all, except bodily pain, retinopathy (physical functioning, general health, vitality, and mental health, peripheral arterial disease (physical functioning, role-physical, and general health, and nephropathy (general health and vitality. Hypertension was related to worse general health and vitality. An increased number of chronic complications was associated with worse HRQoL in all dimensions of Short

  13. Depression and Quality of Life in Relation to Decreased Glomerular Filtration Rate Among Adults with Hypertension in Rural Northeast China

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    Xiaofan Guo

    2015-02-01

    Full Text Available Background/Aims: We aim to investigate the extent to which depression and quality of life might be associated with decreased glomerular filtration rate (GFR in a large hypertensive population in rural Northeast China. Methods: A total of 5566 hypertensive participants aged 35 years and older were screened with a stratified cluster multistage sampling scheme in rural areas of Liaoning Province during 2012-2013. Decreased GFR was defined as estimated GFR 2. Results: The overall prevalence of decreased GFR was 3.2%. In the multivariable regression model, participants with moderate or greater depression had a greater risk for having a decreased GFR (OR: 1.739, 95%CI: 1.004 to 3.014 after full adjustment. Every 1-point increase of all the domains in WHOQOL-BREF, except for physical and environment domains, was significantly related to a lower risk for decreased GFR adjusting for age, gender and race. However, after fully adjustment, only social relations remained significant (OR: 0.899, 95%CI: 0.820 to 0.985. Increasing in total scores of WHOQOL-BREF was a protective factor against decreased GFR after fully adjustment. Conclusion: We found that moderate or greater depression and lower quality of life were associated with higher risks for developing decreased GFR.

  14. [Developmental venous anomaly (DVA)].

    Science.gov (United States)

    Zimmer, A; Hagen, T; Ahlhelm, F; Viera, J; Reith, W; Schulte-Altedorneburg, G

    2007-10-01

    As congenital anatomic variants of venous drainage, developmental venous anomalies (DVA) represent up to 60% of all cerebral vascular malformations. The prior term "venous angioma" is a misnomer implicating an abnormal vascular structure with an increased bleeding risk. They are often found incidentally and are hardly ever symptomatic. Their morphologic characteristics are dilated vessels in the white matter, which converge on a greater collector vein, forming the typical caput medusae. They drain into the superficial or deep venous system. The frequent association with other, potentially bleeding-prone vascular malformations is clinically relevant, in particular cavernous angioma, which might require therapeutic action. Therefore, coincident vascular lesions need to be actively sought by appropriate additional imaging techniques.

  15. Proceso de adaptación al castellano del Charing Cross Venous Ulcer Questionnaire (CCVUQ para medir la calidad de vida relacionada con la salud en pacientes con úlceras venosas Spanish adaptation process of the Charing Cross Venous Ulcer Questionnaire (CCVUQ to measure the quality of life related to health in patients with venous ulcers

    Directory of Open Access Journals (Sweden)

    Renata Virginia González-Consuegra

    2010-06-01

    quality of life related to health (HRQOL allows greatly contribute to improving the quality of care. It has been found that the HRQOL of persons with venous ulcers (UV is adversely affected. The specific instruments that measure HRQL in These people are not available in Spanish. Therefore, it is need for such an instrument adapted and validated in Spanish. The aim of this study is the cultural adaptation to Spanish in one of these instruments, namely the Charing Cross Venous Ulcer Questionnaire (CCVUQ. Materials and methods: the original version of the questionnaire CCVUQ, which includes 20 questions, has been adapted into Spanish following the methodology of translation and back-translation and the establishment of cultural semantic equivalences. In the adaptation process has involved a group of experts in chronic wounds and a group of patients with these lesions. Results: we obtained a satisfactory version of the questionnaire translated and adapted culturally CCVUQ Spain, with the realization of "minor adjustments to the original questions, but necessary for the understanding of the local population in order to save the semantic and conceptual equivalence of the original version. Discussion and conclusions: the Spanish version of CCVUQ is semantically and culturally equivalent to the original English version. It is an instrument with simple questions during the process has been altered from the contributions and suggestions from experts and patients, which did not affect their essence, and that has ensured an adequate pre-test version, adapted to the Spanish language and Spanish culture. At a later stage will be carried out an investigation to validate and test the psychometric properties adapted to Spanish.

  16. Comparative Efficacy of Antimicrobial Central Venous Catheters in Reducing Catheter-Related Bloodstream Infections in Adults: Abridged Cochrane Systematic Review and Network Meta-Analysis.

    Science.gov (United States)

    Chong, Huey Yi; Lai, Nai Ming; Apisarnthanarak, Anucha; Chaiyakunapruk, Nathorn

    2017-05-15

    The efficacy of antimicrobial central venous catheters (CVCs) remains questionable. In this network meta-analysis, we aimed to assess the comparative efficacy of antimicrobial CVC impregnations in reducing catheter-related infections in adults. We searched 4 electronic databases (Medline, the Cochrane Central Register of Controlled Trials, Embase, CINAHL) and internet sources for randomized controlled trials, ongoing clinical trials, and unpublished studies up to August 2016. Studies that assessed CVCs with antimicrobial impregnation with nonimpregnated catheters or catheters with another impregnation were included. Primary outcomes were clinically diagnosed sepsis, catheter-related bloodstream infection (CRBSI), and all-cause mortality. We performed a network meta-analysis to estimate risk ratio (RR) with 95% confidence interval (CI). Sixty studies with 17255 catheters were included. The effects of 14 impregnations were investigated. Both CRBSI and catheter colonization were the most commonly evaluated outcomes. Silver-impregnated CVCs significantly reduced clinically diagnosed sepsis compared with silver-impregnated cuffs (RR, 0.54 [95% CI, .29-.99]). When compared to no impregnation, significant CRBSI reduction was associated with minocycline-rifampicin (RR, 0.29 [95% CI, .16-.52]) and silver (RR, 0.57 [95% CI, .38-.86]) impregnations. No impregnations significantly reduced all-cause mortality. For catheter colonization, significant decreases were shown by miconazole-rifampicin (RR, 0.14 [95% CI, .05-.36]), 5-fluorouracil (RR, 0.34 [95% CI, .14-.82]), and chlorhexidine-silver sulfadiazine (RR, 0.60 [95% CI, .50-.72]) impregnations compared with no impregnation. None of the studies evaluated antibiotic/antiseptic resistance as the outcome. Current evidence suggests that the minocycline-rifampicin-impregnated CVC appears to be the most effective in preventing CRBSI. However, its overall benefits in reducing clinical sepsis and mortality remain uncertain

  17. Central or peripheral catheters for initial venous access of ICU patients: a randomized controlled trial.

    Science.gov (United States)

    Ricard, Jean-Damien; Salomon, Laurence; Boyer, Alexandre; Thiery, Guillaume; Meybeck, Agnes; Roy, Carine; Pasquet, Blandine; Le Mière, Eric; Dreyfuss, Didier

    2013-09-01

    The vast majority of ICU patients require some form of venous access. There are no evidenced-based guidelines concerning the use of either central or peripheral venous catheters, despite very different complications. It remains unknown which to insert in ICU patients. We investigated the rate of catheter-related insertion or maintenance complications in two strategies: one favoring the central venous catheters and the other peripheral venous catheters. Multicenter, controlled, parallel-group, open-label randomized trial. Three French ICUs. Adult ICU patients with equal central or peripheral venous access requirement. Patients were randomized to receive central venous catheters or peripheral venous catheters as initial venous access. The primary endpoint was the rate of major catheter-related complications within 28 days. Secondary endpoints were the rate of minor catheter-related complications and a composite score-assessing staff utilization and time spent to manage catheter insertions. Analysis was intention to treat. We randomly assigned 135 patients to receive a central venous catheter and 128 patients to receive a peripheral venous catheter. Major catheter-related complications were greater in the peripheral venous catheter than in the central venous catheter group (133 vs 87, respectively, p=0.02) although none of those was life threatening. Minor catheter-related complications were 201 with central venous catheters and 248 with peripheral venous catheters (p=0.06). 46% (60/128) patients were managed throughout their ICU stay with peripheral venous catheters only. There were significantly more peripheral venous catheter-related complications per patient in patients managed solely with peripheral venous catheter than in patients that received peripheral venous catheter and at least one central venous catheter: 1.92 (121/63) versus 1.13 (226/200), pcentral venous catheter-related complications per patient between patients initially randomized to peripheral

  18. Prevalence and reproducibility of differences between home and ambulatory blood pressure and their relation with hypertensive organ damage.

    Science.gov (United States)

    Gazzola, K; Cammenga, M; van der Hoeven, N V; van Montfrans, G A; van den Born, B J H

    2017-09-01

    Home and ambulatory blood pressure (BP) better predict cardiovascular disease than office BP, but are not interchangeable. We hypothesised that home BP may be higher than office BP because of anticipatory reactions to self-measurement and studied prevalence and reproducibility of incremental differences between home and daytime ambulatory BP and their relation with hypertensive organ damage. A total of 176 participants (mean age 57.1±12.8 years, 43.2% female) measured their BP for 2 weeks and received a 24-h ambulatory BP in between. Hypertensive organ damage was assessed by urinary albumin-to-creatinine ratio and electrocardiographic criteria for left ventricular hypertrophy. Thresholds of 10/5 and 20/10 mm Hg were used to define relevant systolic/diastolic differences between home and ambulatory BP. A higher home compared to ambulatory BP was present in 92 (52.3%) and 35 (19.1%) participants, while lower home BP values were present in 36 (20.4%) and 8 (4.5%) subjects for differences ⩾10/5 and ⩾20/10 mm Hg. Participants with higher home than ambulatory BP differences were older, had higher body mass index, higher office BP, more antihypertensive medication and lower glomerular filtration rate (Phome and ambulatory BP were highly reproducible (r=0.80 and 0.67 for systolic and diastolic BP, Phome and ambulatory BPs were associated with organ damage, but their difference was not. Many patients have a significantly higher home than ambulatory BP. Differences between home and ambulatory BP are reproducible, but not associated with hypertensive organ damage. Our findings suggest that ambulatory BP remains the standard of reference when positive differences between home and ambulatory BP exist.

  19. Prevalence, awareness, treatment, control and risk factors related to hypertension among urban adults in Inner Mongolia 2014: differences between Mongolian and Han populations

    Directory of Open Access Journals (Sweden)

    Guoju Li

    2016-04-01

    Full Text Available Abstract Background Han and Mongolian populations constitute approximately 96 % of the population of Inner Mongolia Autonomous Region, and the two ethnic groups have different genetic backgrounds and lifestyle. We aim to assess the prevalence, awareness, treatment, control, and related risk factors of hypertension among urban adults in Inner Mongolia, with the comparison of the differences between Mongolian and Han populations in this respect. Methods Three thousand two hundred fifty-one individuals aged 20–80 years (2326 Han and 925 Mongolian were selected using a multistage cluster sampling method from Inner Mongolia in 2014. The adjusted prevalence, awareness, treatment and control of hypertension were evaluated by the Logistic regression. In addition, possible interactions were also tested. When interactions were found significant, strata-specific analysis were performed. Multivariate logistic regression was used for estimating independent associations between risk factors and hypertension. Results The prevalence of hypertension was 27.47 % for Han population, 31.46 % for Mongolian population. The adjusted prevalence, awareness, treatment and control of hypertension were 26.45, 65.43, 78.24 and 48.28 % in Han, and 31.30, 68.22, 85.57 and 50.55 % in Mongolian, respectively. There was no significant difference in the adjusted awareness, treatment and control of hypertension among Mongolian and Han adult residents (all P >0.05. Lower prevalence of hypertension was associated with younger age and healthy weight in both Mongolian and Han adults. Within Han adults, high education, moderate physical activity and non-alcohol drinkers were additionally associated with lower prevalence of hypertension, whereas within Mongolian adults, lower prevalence was associated with being female. Among residents with medium education level, nondrinkers had 0.60 times lower odds of having hypertension than current drinkers (OR = 0.60, 95 % CI: 0.44–0

  20. Venous ulcer review

    Science.gov (United States)

    Bevis, Paul; Earnshaw, Jonothan

    2011-01-01

    Clinical question: What is the best treatment for venous ulcers? Results: Compression aids ulcer healing. Pentoxifylline can aid ulcer healing. Artificial skin grafts are more effective than other skin grafts in helping ulcer healing. Correction of underlying venous incompetence reduces ulcer recurrence. Implementation: Potential pitfalls to avoid are: Failure to exclude underlying arterial disease before application of compression.Unusual-looking ulcers or those slow to heal should be biopsied to exclude malignant transformation. PMID:21673869

  1. Venous ulcer review

    OpenAIRE

    Bevis, Paul; Earnshaw, Jonothan

    2011-01-01

    Paul Bevis, Jonothan Earnshaw Department of Vascular Surgery, Gloucestershire Royal Hospital, Great Western Road, Gloucester, UKDate of preparation: 3 February 2011Conflict of interest: None declared.Clinical question: What is the best treatment for venous ulcers?Results: Compression aids ulcer healing. Pentoxifylline can aid ulcer healing. Artificial skin grafts are more effective than other skin grafts in helping ulcer healing. Correction of underlying venous incompetence reduces ulcer recu...

  2. Non-cirrhotic portal hypertension.

    Science.gov (United States)

    Sarin, Shiv K; Khanna, Rajeev

    2014-05-01

    Non-cirrhotic portal hypertension (NCPH) encompasses a wide range of disorders, primarily vascular in origin, presenting with portal hypertension (PHT), but with preserved liver synthetic functions and near normal hepatic venous pressure gradient (HVPG). Non-cirrhotic portal fibrosis/Idiopathic PHT (NCPF/IPH) and extrahepatic portal venous obstruction (EHPVO) are two prototype disorders in the category. Etiopathogenesis in both of them centers on infections and prothrombotic states. Presentation and management strategies focus on repeated well tolerated episodes of variceal bleed and moderate to massive splenomegaly and other features of PHT. While the long-term prognosis is generally good in NCPF, portal biliopathy and parenchymal extinction after prolonged PHT makes outcome somewhat less favorable in EHPVO. While hepatic schistosomiasis, congenital hepatic fibrosis and nodular regenerative hyperplasia have their distinctive features, they often present with NCPH. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Study of Associated Genetic Variants in Indian Subjects Reveals the Basis of Ethnicity Related Differences in Susceptibility to Venous Thromboembolism

    Directory of Open Access Journals (Sweden)

    Babita Kumari

    2014-01-01

    Full Text Available The genetic variants linked with the susceptibility of individuals to VTE are well known; however, the studies explaining the ethnicity based difference in susceptibility to VTE are limited. Present study assesses mutations in six candidate genes contributing to the etiology of VTE in Indian subjects. The study comprised 93 VTE patients and 102 healthy controls. A PCR-RFLP based analysis was performed for nine mutations in the following genes associated with VTE: favtor V Leiden (FVL, prothrombin, tissue factor pathway inhibitor (TFPI, fibrinogen-beta, plasminogen activator inhibitor 1 (PAI-1, and methylene tetrahydrofolatereductase (MTHFR. All the subjects were found to be monomorphic for FVL 1691G/A, prothrombin 20210G/A and TFPI −536C/T mutations. The mutation in the MTHFR gene (677C/T was observed only in patients. Contrarily, higher frequency of mutation in the PAI-1 −844G/A and the fibrinogen-β −455G/A was observed in controls in comparison to the patients. This study suggests that the PAI-1 −844G/A and fibrinogen-β −455G/A could be protective variants against VTE in Indians. While MTHFR 677C/T mutation was found to be associated, in contrast to other populations, the established genetic variants FVL 1691G/A, prothrombin 20210G/A, and TFPI −536C/T may not be associated with VTE in Indians thus revealing the basis of ethnicity related differences in susceptibility of Indians to VTE.

  4. Analysis of direct costs of anesthesia-related materials between spinal and venous anesthesia with propofol associated with local perianal block in hemorrhoidectomy

    Directory of Open Access Journals (Sweden)

    Paulo Gustavo Kotze

    2011-09-01

    Full Text Available There is no consensus on the ideal anesthesia for hemorrhoidectomy in ambulatory facilities. Spinal anesthesia and venous propofol associated with local perianal block (combined anesthesia are frequently used, and their direct costs may be crucial for the anesthesia type selection. The objective of this study was to compare the direct costs of anesthesia-related materials in hemorrhoidectomy between these two anesthetic techniques.Retrospective and cross-section analysis, comparing the direct costs of the materials of spinal and venous anesthesia with propofol associated with local perianal block, in hemorrhoidectomy. Twenty patients were included, ten submitted to each anesthesia type (five from each gender. The mean age in the spinal anesthesia group was 46.5 years and in the combined anesthesia group, 42.5 years (p=0.334. The mean cost of anesthesia-related materials was R$ 58.50 (R$ 36.48 - R$ 85.79 in the first group versus R$ 190.31 (R$ 98.16 - R$ 358.51 in the second - 69.27% difference between them (pNão há consenso sobre a técnica anestésica de escolha para hemorroidectomias em regime ambulatorial. A raquianestesia e a anestesia combinada (venosa com propofol + local são frequentemente utilizadas, e os custos das mesmas podem ser determinantes na escolha do melhor tipo de anestesia. O objetivo deste trabalho foi avaliar e comparar os custos diretos dos materiais anestésicos utilizados em hemorroidectomias entre essas duas técnicas. Foi feito um estudo retrospectivo e transversal, comparativo entre os custos diretos dos materiais anestésicos entre a raquianestesia e a anestesia venosa com poropofol associada ao bloqueio perianal local, em hemorroidectomias. Foram analisados 20 pacientes, 10 operados com cada técnica anestésica (5 de cada gênero. A média de idade do grupo da raquianestesia foi de 46,5 anos e do grupo da anestesia combinada foi de 42,5 anos (p=0,334. O custo médio do procedimento anestésico no primeiro grupo

  5. Chlorhexidine and silver sulfadiazine coating on central venous catheters is not sufficient for protection against catheter-related infection: Simulation-based laboratory research with clinical validation

    Science.gov (United States)

    Choi, Yoon Ji; Lim, Jae Kwan; Park, Jeong Jun; Huh, Hyub; Kim, Dong-Joo; Gong, Chang-Hoon

    2017-01-01

    Objective The efficacy of chlorhexidine- and silver sulfadiazine-coated central venous catheters (CSS-CVC) against catheter-related infection remains controversial. We hypothesized that the loss of silver nanoparticles may reduce the antibacterial efficacy of CSS-CVCs and that this loss could be due to the frictional force between the surface of the CVC and the bloodstream. The objective of this study was to investigate whether the antimicrobial effect of CSS-CVCs decreases with increasing exposure time in a bloodstream model and quantitatively assay the antimicrobial effect of CSS-CVCs compared with polyurethane and antiseptic-impregnated CVCs. Methods Each CVC was subjected to 120 hours of saline flow and analyzed at intervals over 24 hours. The analyses included energy-dispersive X-ray spectroscopy, scanning electron microscopy, and optical density after a Staphylococcus aureus incubation test. Results The weight percentage of silver in the CSS-CVCs significantly decreased to 56.18% (44.10% ± 3.32%) with 48-hour catheterization and to 18.88% (14.82% ± 1.33%) with 120-hour catheterization compared with the initial weight percentage (78.50% ± 6.32%). In the S. aureus incubation test, the antibacterial function of CSS-CVCs was lost after 48 hours [3 (N/D) of OD]. Similar results were observed in a pilot clinical study using 18 CSS-CVCs. Conclusions We found that the efficacy of CSS-CVCs decreased over time and that the antibacterial function was lost after 48 hours of simulated wear-out. Therefore, antibiotic-impregnated CVCs may be a better option when longer (>48 hours) indwelling is needed. PMID:28534703

  6. Supermicrosurgical deep lymphatic vessel-to-venous anastomosis for a breast cancer-related arm lymphedema with severe sclerosis of superficial lymphatic vessels.

    Science.gov (United States)

    Yamamoto, Takumi; Yamamoto, Nana; Hayashi, Akitatsu; Koshima, Isao

    2017-02-01

    Lymphatic supermicrosurgery or supermicrosurgical lymphaticovenular anastomosis (LVA) is becoming popular for the treatment of compression-refractory upper extremity lymphedema (UEL) with its effectiveness and minimally invasiveness. In conventional LVA, superficial lymphatic vessels are used for anastomosis, but its treatment efficacy would be minimum when superficial lymphatic vessels are severely sclerotic. Theoretically, deep lymphatic vessels can be used for LVA, but no clinical case has been reported regarding deep lymphatic vessel-to-venous anastomosis (D-LVA). We report a breast cancer-related UEL case treated with D-LVA, in which a less-sclerotic deep lymphatic vessel was useful for anastomosis but superficial lymphatic vessels were not due to severe sclerosis. A 62-year-old female suffered from an 18-year history of compression-refractory right UEL after right breast cancer treatments, and underwent LVA under local infiltration anesthesia. Because superficial lymphatic vessels found in surgical fields were all severely sclerotic, a deep lymphatic vessel was dissected at the cubital fossa. A 0.50-mm deep lymphatic vessel running along the brachial artery was supermicrosurgically anastomosed to a nearby 0.40-mm vein. At postoperative 12 months, her right UEL index decreased from 134 to 118, and she could reduce compression frequency from every day to 1-2 days per week to maintain the reduced lymphedematous volume. D-LVA may be a useful option for the treatment of compression-refractory UEL, when superficial lymphatic vessels are severely sclerotic. © 2015 Wiley Periodicals, Inc. Microsurgery 37:156-159, 2017. © 2015 Wiley Periodicals, Inc.

  7. Opposing tissue-specific roles of angiotensin in the pathogenesis of obesity, and implications for obesity-related hypertension

    Science.gov (United States)

    Littlejohn, Nicole K.

    2015-01-01

    Metabolic disease, specifically obesity, has now become the greatest challenge to improving cardiovascular health. The renin-angiotensin system (RAS) exists as both a circulating hormone system and as a local paracrine signaling mechanism within various tissues including the brain, kidney, and adipose, and this system is strongly implicated in cardiovascular health and disease. Growing evidence also implicates the RAS in the control of energy balance, supporting the concept that the RAS may be mechanistically involved in the pathogenesis of obesity and obesity hypertension. Here, we review the involvement of the RAS in the entire spectrum of whole organism energy balance mechanisms, including behaviors (food ingestion and spontaneous physical activity) and biological processes (digestive efficiency and both aerobic and nonaerobic resting metabolic rates). We hypothesize that opposing, tissue-specific effects of the RAS to modulate these various components of energy balance can explain the apparently paradoxical results reported by energy-balance studies that involve stimulating, versus disrupting, the RAS. We propose a model in which such opposing and tissue-specific effects of the RAS can explain the failure of simple, global RAS blockade to result in weight loss in humans, and hypothesize that obesity-mediated uncoupling of endogenous metabolic rate control mechanisms can explain the phenomenon of obesity-related hypertension. PMID:26491099

  8. Opposing tissue-specific roles of angiotensin in the pathogenesis of obesity, and implications for obesity-related hypertension.

    Science.gov (United States)

    Littlejohn, Nicole K; Grobe, Justin L

    2015-12-15

    Metabolic disease, specifically obesity, has now become the greatest challenge to improving cardiovascular health. The renin-angiotensin system (RAS) exists as both a circulating hormone system and as a local paracrine signaling mechanism within various tissues including the brain, kidney, and adipose, and this system is strongly implicated in cardiovascular health and disease. Growing evidence also implicates the RAS in the control of energy balance, supporting the concept that the RAS may be mechanistically involved in the pathogenesis of obesity and obesity hypertension. Here, we review the involvement of the RAS in the entire spectrum of whole organism energy balance mechanisms, including behaviors (food ingestion and spontaneous physical activity) and biological processes (digestive efficiency and both aerobic and nonaerobic resting metabolic rates). We hypothesize that opposing, tissue-specific effects of the RAS to modulate these various components of energy balance can explain the apparently paradoxical results reported by energy-balance studies that involve stimulating, versus disrupting, the RAS. We propose a model in which such opposing and tissue-specific effects of the RAS can explain the failure of simple, global RAS blockade to result in weight loss in humans, and hypothesize that obesity-mediated uncoupling of endogenous metabolic rate control mechanisms can explain the phenomenon of obesity-related hypertension. Copyright © 2015 the American Physiological Society.

  9. Association of plasma free amino acids with hyperuricemia in relation to diabetes mellitus, dyslipidemia, hypertension and metabolic syndrome.

    Science.gov (United States)

    Mahbub, M H; Yamaguchi, Natsu; Takahashi, Hidekazu; Hase, Ryosuke; Ishimaru, Yasutaka; Sunagawa, Hiroshi; Amano, Hiroki; Kobayashi-Miura, Mikiko; Kanda, Hideyuki; Fujita, Yasuyuki; Yamamoto, Hiroshi; Yamamoto, Mai; Kikuchi, Shinya; Ikeda, Atsuko; Kageyama, Naoko; Nakamura, Mina; Tanabe, Tsuyoshi

    2017-12-15

    Previous studies demonstrated independent contributions of plasma free amino acids (PFAAs) and high uric acid (UA) concentrations to increased risks of lifestyle-related diseases (LSRDs), but the important associations between these factors and LSRDs remain unknown. We quantified PFAAs and UA amongst Japanese subjects without LSRDs (no-LSRD, n = 2805), and with diabetes mellitus (DM, n = 415), dyslipidemia (n = 3207), hypertension (n = 2736) and metabolic syndrome (MetS, n = 717). The concentrations of most amino acids differed significantly between the subjects with and without hyperuricemia (HU) and also between the no-LSRD and LSRD groups (p < 0.05 to 0.001). After adjustment, the logistic regression analyses revealed that lysine in DM, alanine, proline and tyrosine in dyslipidemia, histidine, lysine and ornithine in hypertension, and lysine and tyrosine in MetS demonstrated significant positive associations with HU among the patients with LSRDs only (p < 0.05 to 0.005). By contrast, arginine, asparagine and threonine showed significant inverse associations with HU in the no-LSRD group only (p < 0.05 to 0.01). For the first time, we provide evidence for distinct patterns of association between PFAAs and HU in LSRDs, and postulate the possibility of interplay between PFAAs and UA in their pathophysiology.

  10. Hypertension and diabetes-related morbidity and mortality trends in a municipality in the countryside of São Paulo.

    Science.gov (United States)

    Reis, Andreia Francesli Negri; Lima, Juliana Cristina; Beccaria, Lucia Marinilza; Ribeiro, Rita de Cassia Helú Mendonça; Ribeiro, Daniele Favaro; Cesarino, Claudia Bernardi

    2015-01-01

    To identify the main causes for hospital admissions and deaths related to systemic arterial hypertension and diabetes mellitus (DM), and to analyze morbidity and mortality trends, in a municipality in São Paulo's countryside, by comparing two three-years periods, 2002 to 2004 and 2010 to 2012. Cross-sectional study which used secondary data regarding deaths from the Information System on Mortality and concerning hospital admissions from the DataSus Hospital Information System. Univariate and multivariate statistical analyses were conducted. From 2002 to 2012, 325,439 people were admitted to hospitals, 14.7% of them due to circulatory system diseases (CSD) and 0.7% due to DM. The deaths distributed as the following: 29,027 deaths (31.5%) were due to CSD; 8.06% due to cerebrovascular diseases (CVD); and 2.75% due to DM. There was a significant association between admittance and death causes and patients' gender and age in the three-year periods (p<0.001). The highest lethality in hospital admissions was found to be due to CVD (10%). That trend showed that mortality rates dropped, younger patients were admitted due to DM, and older patients were admitted due to CVD - they were more often females. The main causes for hospital admissions were the CSDs; main mortality causes were the CVDs in hypertensive and diabetic women. Those findings can back public policies which prioritize the promotion of health.

  11. Hyperhomocysteinemia and venous thromboembolic disease.

    Science.gov (United States)

    D'Angelo, A; Mazzola, G; Crippa, L; Fermo, I; Viganò D'Angelo, S

    1997-01-01

    In spite of the large number of reports showing that hyperhomocysteinemia (HHcy) is an independent risk factor for atherosclerosis and arterial occlusive disease, this metabolite of the methionine pathway is measured in relatively few laboratories and its importance is not fully appreciated. Recent data strongly suggest that mild HHcy is also involved in the pathogenesis of venous thromboembolic disease. The aim of this paper is to analyze the most recent advances in this field. The material examined in the present review includes articles and abstracts published in journals covered by the Science Citation Index and Medline. In addition the authors of the present article have been working in the field of mild HHcy as cause of venous thromboembolic disease. The studies examined provide very strong evidence supporting the role of moderate HHcy in the development of premature and/or recurrent venous thromboembolic disease. High plasma homocysteine levels are also a risk factor for deep vein thrombosis in the general population. Folic acid fortification of food has been proposed as a major tool for reducing coronary artery disease mortality in the United States. Vitamin supplementation may also reduce recurrence of venous thromboembolic disease in patients with HHcy. At the present time, however, the clinical efficacy of this approach has not been tested. In addition, the bulk of evidence indicates that fasting total homocysteine determinations can identify up to 50% of the total population of hyperhomocysteinemic subjects. Patients with isolated methionine intolerance may benefit from vitamin B6 supplementation. Homocysteine-lowering vascular disease prevention trials are urgently needed. Such controlled studies, however, should not focus exclusively on fasting homocysteine determinations and folic acid monotherapy.

  12. [Significance age-related predictors of chronic heart failure in determining the risk of death in elderly patients with hypertension].

    Science.gov (United States)

    Medvedev, N V; Gorshunova, N K

    2014-01-01

    In order to establish the prognostic value of age-related pathogenesis and the development of heart failure related to lipid peroxidation, endogenous subclinical inflammation, apoptosis, sarcopenia, interstitial myocardial fibrosis in the risk of mortality and survival rates, for the first time the results of echocardiography, enzyme immunoassay, bioimpedansmetry with the scale of the Seattle model of heart failure performed in 84 elderly patients with arterial hypertension stage II (middle age 68,3 +/- 1,8 years) were compared. We found that the increased activity of markers of chronic heart failure progression was associated with an increased risk of death in patients. We identified the most important indicators in assessing the risk of death and prognosis of heart failure in elderly patients; their timely correction will imply an increase in life expectancy of older patients with chronic heart failure.

  13. Neonatal Venous Thromboembolism

    Directory of Open Access Journals (Sweden)

    Kristina M. Haley

    2017-06-01

    Full Text Available Neonates are the pediatric population at highest risk for development of venous thromboembolism (VTE, and the incidence of VTE in the neonatal population is increasing. This is especially true in the critically ill population. Several large studies indicate that the incidence of neonatal VTE is up almost threefold in the last two decades. Central lines, fluid fluctuations, sepsis, liver dysfunction, and inflammation contribute to the risk profile for VTE development in ill neonates. In addition, the neonatal hemostatic system is different from that of older children and adults. Platelet function, pro- and anticoagulant proteins concentrations, and fibrinolytic pathway protein concentrations are developmentally regulated and generate a hemostatic homeostasis that is unique to the neonatal time period. The clinical picture of a critically ill neonate combined with the physiologically distinct neonatal hemostatic system easily fulfills the criteria for Virchow’s triad with venous stasis, hypercoagulability, and endothelial injury and puts the neonatal patient at risk for VTE development. The presentation of a VTE in a neonate is similar to that of older children or adults and is dependent upon location of the VTE. Ultrasound is the most common diagnostic tool employed in identifying neonatal VTE, but relatively small vessels of the neonate as well as frequent low pulse pressure can make ultrasound less reliable. The diagnosis of a thrombophilic disorder in the neonatal population is unlikely to change management or outcome, and the role of thrombophilia testing in this population requires further study. Treatment of neonatal VTE is aimed at reducing VTE-associated morbidity and mortality. Recommendations for treating, though, cannot be extrapolated from guidelines for older children or adults. Neonates are at risk for bleeding complications, particularly younger neonates with more fragile intracranial vessels. Developmental alterations in the

  14. Hypertension og det metaboliske syndrom

    DEFF Research Database (Denmark)

    Olsen, Michael Hecht; Jeppesen, Jørgen; Larsen, Mogens Lytken

    2009-01-01

    The metabolic syndrome is a relatively prevalent condition characterized by co-existence of several metabolic and cardiovascular risk factors including hypertension. Patients with hypertension have an increased risk of developing the metabolic syndrome which, in turn, increases the cardiovascular...

  15. The Burden of Pulmonary Hypertension in Patients with ...

    African Journals Online (AJOL)

    sided heart disease resulting in venous pulmonary hypertension. Echocardiography allows for assessment of left ... Degenerative valvular heart diseases are the most common echocardiographic abnormalities in the .... present, pulmonary hypertension is a marker of poor outcome in valvular heart disease. Several studies ...

  16. Bacteriophage K antimicrobial-lock technique for treatment of Staphylococcus aureus central venous catheter-related infection: a leporine model efficacy analysis.

    Science.gov (United States)

    Lungren, Matthew P; Donlan, Rodney M; Kankotia, Ravi; Paxton, Ben E; Falk, Irene; Christensen, Diana; Kim, Charles Y

    2014-10-01

    To determine whether a bacteriophage antimicrobial-lock technique can reduce bacterial colonization and biofilm formation on indwelling central venous catheters in a rabbit model. Cuffed central venous catheters were inserted into the jugular vein of female New Zealand White rabbits under image guidance. Catheters were inoculated for 24 hours with broth culture of methicillin-sensitive Staphylococcus aureus. The inoculum was aspirated, and rabbits were randomly assigned to two equal groups for 24 hours: (i) untreated controls (heparinized saline lock), (ii) bacteriophage antimicrobial-lock (staphylococcal bacteriophage K, propagated titer > 10(8)/mL). Blood cultures were obtained via peripheral veins, and the catheters were removed for quantitative culture and scanning electron microscopy. Mean colony-forming units (CFU) per cm(2) of the distal catheter segment, as a measure of biofilm, were significantly decreased in experimental animals compared with controls (control, 1.2 × 10(5) CFU/cm(2); experimental, 7.6 × 10(3); P = .016). Scanning electron microscopy demonstrated that biofilms were present on the surface of five of five control catheters but only one of five treated catheters (P = .048). Blood culture results were not significantly different between the groups. In a rabbit model, treatment of infected central venous catheters with a bacteriophage antimicrobial-lock technique significantly reduced bacterial colonization and biofilm presence. Our data represent a preliminary step toward use of bacteriophage therapy for prevention and treatment of central venous catheter-associated infection. Copyright © 2014 SIR. All rights reserved.

  17. [Measurement of Rho-kinase in peripheral blood monocytes in patients with pulmonary arterial hypertension related to chronic obstructive pulmonary diseases].

    Science.gov (United States)

    Cai, Qian; Wu, Shangjie; Zhao, Xuefeng

    2012-05-01

    To determine effects of the RhoA/Rho kinase signaling pathway on patients with pulmonary arterial hypertension related to chronic obstructive pulmonary diseases by testing levels of Rho-associated coiled-coil containing protein kinase 1(ROCK1) in peripheral blood monocytes in healthy subjects, patients with chronic obstructive pulmonary diseases (COPD), and patients with pulmonary arterial hypertension related to COPD. Ten healthy subjects (Group A), 10 patients with COPD (Group B), and 10 patients with pulmonary arterial hypertension related to COPD (Group C) were enrolled, all of whom were hospitalized in the Third Hospital of Changsha between Dec. 2010 and Apr. 2011. Twenty milliliters of blood was collected from each subject. The peripheral blood mononuclear cells (PBMC) were separated by Percoll and, monocytes were incubated. Levels of ROCK1 in the three groups were measured by ELISA. The pulmonary function was measured by spirometric tests, and the pulmonary arterial systolic pressure (PASP) was detected by color Doppler echocardiogram. 1)The PASP in Group C was significantly higher than that of Groups A and B(P0.05). Rho kinase plays a key role in the pathogenesis of pulmonary arterial hypertension. The ROCK1 may be a marker of the severity of pulmonary arterial hypertension related to COPD.

  18. Central venous catheters and catheter locks in children with cancer

    DEFF Research Database (Denmark)

    Handrup, Mette Møller; Møller, Jens Kjølseth; Schrøder, Henrik

    2013-01-01

    To determine if the catheter lock taurolidine can reduce the number of catheter-related bloodstream infections (CRBSI) in pediatric cancer patients with tunneled central venous catheters (CVC).......To determine if the catheter lock taurolidine can reduce the number of catheter-related bloodstream infections (CRBSI) in pediatric cancer patients with tunneled central venous catheters (CVC)....

  19. Elevated levels of plasma uric acid and its relation to hypertension in arsenic-endemic human individuals in Bangladesh

    Energy Technology Data Exchange (ETDEWEB)

    Huda, Nazmul [Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi 6205 (Bangladesh); Department of Medicine, Rajshahi Medical College, Rajshahi 6000 (Bangladesh); Hossain, Shakhawoat; Rahman, Mashiur [Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi 6205 (Bangladesh); Karim, Md. Rezaul [Department of Applied Nutrition and Food Technology, Islamic University, Kushtia 7003 (Bangladesh); Islam, Khairul [Department of Biochemistry and Molecular Biology, Mawlana Bhashani Science and Technology University, Santosh, Tangail 1902 (Bangladesh); Mamun, Abdullah Al; Hossain, Md. Imam; Mohanto, Nayan Chandra; Alam, Shahnur; Aktar, Sharmin; Arefin, Afroza; Ali, Nurshad; Salam, Kazi Abdus; Aziz, Abdul; Saud, Zahangir Alam [Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi 6205 (Bangladesh); Miyataka, Hideki; Himeno, Seiichiro [Laboratory of Molecular Nutrition and Toxicology, Faculty of Pharmaceutical Sciences, Tokushima Bunri University, Tokushima 770-8514 (Japan); Hossain, Khaled, E-mail: khossainbio@gmail.com [Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi 6205 (Bangladesh)

    2014-11-15

    Blood uric acid has been recognized as a putative marker for cardiovascular diseases (CVDs). CVDs are the major causes of arsenic-related morbidity and mortality. However, the association of arsenic exposure with plasma uric acid (PUA) levels in relation to CVDs has not yet been explored. This study for the first time demonstrated the associations of arsenic exposure with PUA levels and its relationship with hypertension. A total of 483 subjects, 322 from arsenic-endemic and 161 from non-endemic areas in Bangladesh were recruited as study subjects. Arsenic concentrations in the drinking water, hair and nails of the study subjects were measured by inductively coupled plasma mass spectroscopy. PUA levels were measured using a colorimetric method. We found that PUA levels were significantly (p < 0.001) higher in males and females living in arsenic-endemic areas than those in non-endemic area. Arsenic exposure (water, hair and nail arsenic) levels showed significant positive correlations with PUA levels. In multiple regression analyses, arsenic exposure levels were found to be the most significant contributors on PUA levels among the other variables that included age, body mass index, blood urea nitrogen, and smoking. There were dose–response relationships between arsenic exposure and PUA levels. Furthermore, diastolic and systolic blood pressure showed significant positive correlations with PUA levels. Finally, the average PUA levels were significantly higher in the hypertensive group than those in the normotensive group in both males and females living in arsenic-endemic areas. These results suggest that arsenic exposure-related elevation of PUA levels may be implicated in arsenic-induced CVDs. - Highlights: • PUA levels were higher in arsenic-endemic subjects than in non-endemic subjects. • Drinking water, hair and nail arsenic showed significant associations with PUA levels. • Drinking water, hair and nail arsenic showed dose–response relationships with

  20. Core content for training in venous and lymphatic medicine.

    Science.gov (United States)

    Zimmet, Steven E; Min, Robert J; Comerota, Anthony J; Meissner, Mark H; Carman, Teresa L; Rathbun, Suman W; Jaff, Michael R; Wakefield, Thomas W; Feied, Craig F

    2014-10-01

    The major venous societies in the United States share a common mission to improve the standards of medical practitioners, the educational goals for teaching and training programs in venous disease, and the quality of patient care related to the treatment of venous disorders. With these important goals in mind, a task force made up of experts from the specialties of dermatology, interventional radiology, phlebology, vascular medicine, and vascular surgery was formed to develop a consensus document describing the Core Content for venous and lymphatic medicine and to develop a core educational content outline for training. This outline describes the areas of knowledge considered essential for practice in the field, which encompasses the study, diagnosis, and treatment of patients with acute and chronic venous and lymphatic disorders. The American Venous Forum and the American College of Phlebology have endorsed the Core Content. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  1. Intracranial dural arterio-venous fistula presenting with progressive myelopathy.

    LENUS (Irish Health Repository)

    Ogbonnaya, Ebere Sunny

    2011-01-01

    Spinal dural arterio-venous fistula (DAVF) is rare and usually involves the thoracic segments. The classical presentation is a slowly progressive ataxia. Clinical presentation of intracranial DAVF depends on the site of the DAVF, as well as the vessels involved. Patients may present with pulsatile tinnitus, occipital bruit, headache, dementia, visual impairment as well as neurological deterioration distant from the DAVF as a result of venous hypertension and cortical haemorrhage. The authors present a rare case of progressive myelopathy secondary to an intracranial DAVF.

  2. Drug treatment of hypertension in Sweden in relation to sex, age, and comorbidity.

    Science.gov (United States)

    Wallentin, Fredrik; Wettermark, Björn; Kahan, Thomas

    2017-12-08

    The authors investigated antihypertensive drug treatment in Sweden using the Stockholm Regional Healthcare Data Warehouse, providing information on all healthcare consultations, diagnoses, hospitalizations, dispensed prescription drugs, sex, and age in 2.1 million persons. This cross-sectional analysis identified 292 428 individuals 20 years or older with hypertension (mean age 68 ± 13 years, 53% women). About half had no diabetes mellitus or cardiovascular comorbidity. The number of dispensed drugs was lower in women than in men (1.9 ± 1.3 vs 2.1 ± 1.5, P < .001). Women more often used diuretics, angiotensin receptor blockers, and β-blockers, while men used more angiotensin-converting enzyme inhibitors and calcium channel blockers (all P < .01). In women, 66% with diabetes mellitus and 72% with heart failure used angiotensin-converting enzyme inhibitors/angiotensin receptor blockers vs 76% and 79% in men (all P < .001, adjusted for age and comorbidity). Thus, sex differences in treatment prevail. There is room for improvement, which could reduce cardiovascular complications. ©2017 Wiley Periodicals, Inc.

  3. Pulmonary arterial hypertension in rats due to age-related arginase activation in intermittent hypoxia.

    Science.gov (United States)

    Nara, Akina; Nagai, Hisashi; Shintani-Ishida, Kaori; Ogura, Sayoko; Shimosawa, Tatsuo; Kuwahira, Ichiro; Shirai, Mikiyasu; Yoshida, Ken-ichi

    2015-08-01

    Pulmonary arterial hypertension (PAH) is prevalent in patients with obstructive sleep apnea syndrome (OSAS). Aging induces arginase activation and reduces nitric oxide (NO) production in the arteries. Intermittent hypoxia (IH), conferred by cycles of brief hypoxia and normoxia, contributes to OSAS pathogenesis. Here, we studied the role of arginase and aging in the pathogenesis of PAH in adult (9-mo-old) and young (2-mo-old) male Sprague-Dawley rats subjected to IH or normoxia for 4 weeks and analyzed them with a pressure-volume catheter inserted into the right ventricle (RV) and by pulsed Doppler echocardiography. Western blot analysis was conducted on arginase, NO synthase isoforms, and nitrotyrosine. IH induced PAH, as shown by increased RV systolic pressure and RV hypertrophy, in adult rats but not in young rats. IH increased expression levels of arginase I and II proteins in the adult rats. IH also increased arginase I expression in the pulmonary artery endothelium and arginase II in the pulmonary artery adventitia. Furthermore, IH reduced pulmonary levels of nitrate and nitrite but increased nitrotyrosine levels in adult rats. An arginase inhibitor (N(ω)-hydroxy-nor-1-arginine) prevented IH-induced PAH and normalized nitrite and nitrate levels in adult rats. IH induced arginase up-regulation and PAH in adult rats, but not in young rats, through reduced NO production. Our findings suggest that arginase inhibition prevents or reverses PAH.

  4. Elevated levels of plasma uric acid and its relation to hypertension in arsenic-endemic human individuals in Bangladesh.

    Science.gov (United States)

    Huda, Nazmul; Hossain, Shakhawoat; Rahman, Mashiur; Karim, Md Rezaul; Islam, Khairul; Mamun, Abdullah Al; Hossain, Md Imam; Mohanto, Nayan Chandra; Alam, Shahnur; Aktar, Sharmin; Arefin, Afroza; Ali, Nurshad; Salam, Kazi Abdus; Aziz, Abdul; Saud, Zahangir Alam; Miyataka, Hideki; Himeno, Seiichiro; Hossain, Khaled

    2014-11-15

    Blood uric acid has been recognized as a putative marker for cardiovascular diseases (CVDs). CVDs are the major causes of arsenic-related morbidity and mortality. However, the association of arsenic exposure with plasma uric acid (PUA) levels in relation to CVDs has not yet been explored. This study for the first time demonstrated the associations of arsenic exposure with PUA levels and its relationship with hypertension. A total of 483 subjects, 322 from arsenic-endemic and 161 from non-endemic areas in Bangladesh were recruited as study subjects. Arsenic concentrations in the drinking water, hair and nails of the study subjects were measured by inductively coupled plasma mass spectroscopy. PUA levels were measured using a colorimetric method. We found that PUA levels were significantly (pareas than those in non-endemic area. Arsenic exposure (water, hair and nail arsenic) levels showed significant positive correlations with PUA levels. In multiple regression analyses, arsenic exposure levels were found to be the most significant contributors on PUA levels among the other variables that included age, body mass index, blood urea nitrogen, and smoking. There were dose-response relationships between arsenic exposure and PUA levels. Furthermore, diastolic and systolic blood pressure showed significant positive correlations with PUA levels. Finally, the average PUA levels were significantly higher in the hypertensive group than those in the normotensive group in both males and females living in arsenic-endemic areas. These results suggest that arsenic exposure-related elevation of PUA levels may be implicated in arsenic-induced CVDs. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Use of semi-quantitative and quantitative culture methods and typing for studying the epidemiology of central venous catheter-related infections in neonates on parenteral nutrition.

    Science.gov (United States)

    Mueller-Premru, M; Gubina, M; Kaufmann, M E; Primozic, J; Cookson, B D

    1999-05-01

    To study the epidemiology - especially the impact of contaminated stopcocks - on central venous catheter (CVC) infection and catheter-related sepsis (CRS), semi-quantitative (SQ) and quantitative (Q) culture methods and typing of coagulase-negative staphylococci (CNS) were employed in 49 neonates with clinical signs of sepsis while receiving parenteral nutrition in the paediatric intensive care unit. The patients were divided into two groups according to stopcock contamination: group A consisted of 18 patients (36%) with contaminated stopcocks and group B consisted of 31 patients (64%) with sterile stopcocks. Five specimens were obtained from each patient, in addition to that from the stopcock: a swab taken from the skin surrounding the catheter puncture site; the CVC tip; the intradermal segment (IDC); and samples of parenteral fluid and blood. A total of 294 specimens (392 sites) was cultured and micro-organisms were identified. All CNS isolated were typed by biotyping, antibiogram, plasmid analysis and pulsed-field gel electrophoresis (PFGE), and the discriminatory power of the typing methods was compared. The CVC tips were infected in 25 patients (51%); 15 (83%) in group A and 10 (32%) in group B. Sepsis was detected in 24 neonates (49%), 13 in group A and 11 in group B. This was catheter-related in 15 patients (63%), 12 in group A and 3 in group B. CNS were recovered from 13 (52%) of 25 infected CVCs, nine in group A and four in group B. Sixty-five CNS isolates were recovered from these patients and belonged to 14 biotypes, 22 antibiograms, 22 plasmid profiles and 26 PFGE types. Typing showed that in six of nine patients in group A, CNS of the same type were recovered from the catheter tip and the stopcock, in one patient the catheter tip and skin isolates were the same and in two others the catheter tip isolates were different from stopcock and skin isolates. In all four patients in group B, different CNS types were recovered from CVC tips and skin

  6. Non-vitamin K antagonist oral anticoagulants and major bleeding-related fatality in patients with atrial fibrillation and venous thromboembolism: a systematic review and meta-analysis.

    Science.gov (United States)

    Caldeira, Daniel; Rodrigues, Filipe B; Barra, Márcio; Santos, Ana Teresa; de Abreu, Daisy; Gonçalves, Nilza; Pinto, Fausto J; Ferreira, Joaquim J; Costa, João

    2015-08-01

    Non-vitamin K antagonist oral anticoagulants (NOACs) are efficacious and safe antithrombotic drugs but the non-availability of an antidote for potential fatal haemorrhagic events is clinically perceived as a strong limitation. We aimed at evaluating the risk of haemorrhage-related fatalities associated with NOACs in patients requiring long-term anticoagulation. MEDLINE, Cochrane Library and Web of Science databases were searched in November 2014 for atrial fibrillation (AF) or venous thromboembolism (VTE) phase III randomised controlled trials (RCT) comparing NOACs with vitamin K antagonists (VKAs) or low molecular weight heparin (LMWH) followed by VKAs. Pooled OR and 95% CIs were estimated through meta-analysis. Heterogeneity was assessed with the I(2) test. Eleven studies were included: 5 on AF and 6 on VTE. A total of 100 324 patients were evaluated in 4 rivaroxaban, 3 dabigatran, 2 apixaban and 2 edoxaban studies. NOAC-treated patients had a 47% odds reduction compared with VKA (OR 0.53; 95% CI 0.42 to 0.68; I(2)=0%; 3 events avoided per 1000 patients) and 64% odds reduction compared with LMWH-VKA (OR 0.36; 95% CI 0.15 to 0.84; I(2)=0%; 1 event avoided per 1000 patients) regarding fatal bleeding risk. Case fatality due to major bleeding was lower in NOAC-treated patients both in AF (OR 0.68; 95% CI 0.48 to 0.96; I(2)=37%; 1 death avoided per 39 major bleedings) and VTE (OR 0.54; 95% CI 0.22 to 1.32; I(2)=0%) patients. AF survivors of major bleeding events treated with NOACs had lower mortality compared with patients treated with VKAs (OR 0.57; 95% CI 0.45 to 0.73; I(2)=0%; 78 events avoided per 1000 survivors to major bleeding). These data suggest that NOACs decrease the risk of fatality cases related to major bleeding events, particularly in AF patients. These results support the safety profile of NOACs even without having a widely available drug-specific antidote. Published by the BMJ Publishing Group Limited. For permission to use (where not already

  7. Hypertensive crisis.

    Science.gov (United States)

    Rodriguez, Maria Alexandra; Kumar, Siva K; De Caro, Matthew

    2010-01-01

    Hypertension is a common chronic medical condition affecting over 65 million Americans. Uncontrolled hypertension can progress to a hypertensive crisis defined as a systolic blood pressure >180 mm Hg or a diastolic blood pressure >120 mm Hg. Hypertensive crisis can be further classified as a hypertensive urgency or hypertensive emergency depending on end-organ involvement including cardiac, renal, and neurologic injury. The prompt recognition of a hypertensive emergency with the appropriate diagnostic tests and triage will lead to the adequate reduction of blood pressure, ameliorating the incidence of fatal outcomes. Severely hypertensive patients with acute end-organ damage (hypertensive emergencies) warrant admission to an intensive care unit for immediate reduction of blood pressure with a short-acting titratable intravenous antihypertensive medication. Hypertensive urgencies (severe hypertension with no or minimal end-organ damage) may in general be treated with oral antihypertensives as an outpatient. Rapid and short-lived intravenous medications commonly used are labetalol, esmolol, fenoldopam, nicardipine, sodium nitroprusside, and clevidipine. Medications such as hydralazine, immediate release nifedipine, and nitroglycerin should be avoided. Sodium nitroprusside should be used with caution because of its toxicity. The risk factors and prognosticators of a hypertensive crisis are still under recognized. Physicians should perform complete evaluations in patients who present with a hypertensive crisis to effectively reverse, intervene, and correct the underlying trigger, as well as improve long-term outcomes after the episode.

  8. EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA); Scientific Opinion on the substantiation of a health claim related to Vitis vinifera L. seeds extract and maintenance of normal venous blood flow pursuant to Article 13(5) of Regulation (EC) No 1924/2006

    DEFF Research Database (Denmark)

    Tetens, Inge

    related to Vitis vinifera L. seeds extract and maintenance of normal venous blood flow. The Panel considers that the food constituent, which is the subject of the health claim, is sufficiently characterised. The claimed effect, maintenance of normal venous blood flow, is a beneficial physiological effect...... and did not measure venous blood flow, the Panel considers that no conclusions can be drawn from these studies for the scientific substantiation of the claim. The Panel concludes that a cause and effect relationship has not been established between the consumption of Vitis vinifera L. seeds extract...

  9. Spaceflight-Induced Intracranial Hypertension: An Overview

    Science.gov (United States)

    Traver, William J.

    2011-01-01

    This slide presentation is an overview of the some of the known results of spaceflight induced intracranial hypertension. Historical information from Gemini 5, Apollo, and the space shuttle programs indicated that some vision impairment was reported and a comparison between these historical missions and present missions is included. Optic Disc Edema, Globe Flattening, Choroidal Folds, Hyperopic Shifts and Raised Intracranial Pressure has occurred in Astronauts During and After Long Duration Space Flight. Views illustrate the occurrence of Optic Disc Edema, Globe Flattening, and Choroidal Folds. There are views of the Arachnoid Granulations and Venous return, and the question of spinal or venous compliance issues is discussed. The question of increased blood flow and its relation to increased Cerebrospinal fluid (CSF) is raised. Most observed on-orbit papilledema does not progress, and this might be a function of plateau homeostasis for the higher level of intracranial pressure. There are seven cases of astronauts experiencing in flight and post flight symptoms, which are summarized and follow-up is reviewed along with a comparison of the treatment options. The question is "is there other involvement besides vision," and other Clinical implications are raised,

  10. The present status of surgery of the superficial venous system in the management of venous ulcer and the evidence for the role of perforator interruption.

    Science.gov (United States)

    O'Donnell, Thomas F

    2008-10-01

    Superficial venous hypertension has been cited as the putative etiologic factor in advanced chronic venous insufficiency with venous ulcer (CEAP C 5/6). For over a century, influenced by this belief, surgeons have ablated the superficial venous system as a treatment for venous ulcer. Incompetent perforating veins (ICPVs) have become a particular focus of this therapeutic strategy. This review examines the evidence for the surgical approach. A MEDLINE search of the literature identified only four randomized controlled trials (RCTs) directed at the surgical reduction of superficial venous hypertension. Risk ratios for ulcer healing and prevention of recurrence were calculated to determine benefits for these four RCTs, while mortality and morbidity, where available, was used to determine risk from the procedure. In addition, the quality of the trials (design and outcomes) was assessed. While two trials compared ICPV ligation to compression, the great saphenous vein (GSV) was also treated in many of these limbs, which confounds the results. By contrast, two RCTs, which compared treatment of the GSV alone to compression, demonstrated a significant reduction in the incidence of ulcer recurrence. Case series that employed hemodynamic or surrogate outcomes showed little effect on the addition of ICPV treatment to GSV stripping, while GSV ablation alone was associated with a reduction in the number of ICPVs in several studies. This review suggests a grade 1A recommendation for the treatment of venous ulcer by GSV ablation to reduce ulcer recurrence. The role of ICPV ablation alone or concomitant with GSV treatment awaits results of properly conducted RCTs.

  11. Hormonal contraception and venous thromboembolism

    DEFF Research Database (Denmark)

    Lidegaard, Øjvind; Milsom, Ian; Geirsson, Reynir Tomas

    2012-01-01

    New studies about the influence of hormonal contraception on the risk of venous thromboembolism (VTE) have been published.......New studies about the influence of hormonal contraception on the risk of venous thromboembolism (VTE) have been published....

  12. Effect of testing for cancer on cancer- and venous thromboembolism (VTE)-related mortality and morbidity in patients with unprovoked VTE.

    Science.gov (United States)

    Robertson, Lindsay; Yeoh, Su Ern; Stansby, Gerard; Agarwal, Roshan

    2015-03-06

    Venous thromboembolism (VTE) is a collective term for two conditions: deep vein thrombosis (DVT) and pulmonary embolism (PE). A proportion of patients with VTE have no underlying or immediately predisposing risk factors and the VTE is referred to as unprovoked. Unprovoked VTE can often be the first clinical manifestation of an underlying malignancy. This has raised the question of whether patients with an unprovoked VTE should be investigated for an underlying cancer. Treatment for VTE is different in cancer and non-cancer patients and a correct diagnosis would ensure that patients received the optimal treatment for VTE to prevent recurrence and further morbidity. Furthermore, an appropriate cancer diagnosis at an earlier, potentially curative stage could avoid the risk of cancer progression and thus lead to improvements in cancer-related mortality and morbidity. To determine whether testing for undiagnosed cancer in patients with a first episode of unprovoked VTE (DVT or PE) is effective in reducing cancer and VTE-related mortality and morbidity and to establish which tests for cancer are most useful. The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched January 2015) and the Cochrane Register of Studies (CRS) (2014, Issue 12). Clinical trials databases were searched. The reference lists of relevant articles were also checked. Randomised and quasi-randomised trials in which patients with an unprovoked VTE were allocated to receive specific tests for cancer or clinically indicated tests only were eligible for inclusion in this review. Primary outcomes included all-cause mortality, cancer-related mortality and VTE-related mortality. Selection of the studies, quality assessment and data extraction were completed independently by two review authors. Any disagreements were resolved by discussion. Two studies with a combined total of 396 patients met the inclusion criteria for this review. Both

  13. Inhaled pulmonary vasodilators for persistent pulmonary hypertension of the newborn: safety issues relating to drug administration and delivery devices

    Directory of Open Access Journals (Sweden)

    Cosa N

    2016-04-01

    Full Text Available Nathan Cosa,1 Edward Costa Jr2 1Department of Respiratory Care, Banner Desert Medical Center, Cardon Children's Medical Center, Mesa, AZ, 2Department of Medical Affairs, Mallinckrodt Pharmaceuticals, Hampton, NJ, USA Abstract: Treatment for persistent pulmonary hypertension of the newborn (PPHN aims to reduce pulmonary vascular resistance while maintaining systemic vascular resistance. Selective pulmonary vasodilation may be achieved by targeting pulmonary-specific pathways or by delivering vasodilators directly to the lungs. Abrupt withdrawal of a pulmonary vasodilator can cause rebound pulmonary hypertension. Therefore, use of consistent delivery systems that allow for careful monitoring of drug delivery is important. This manuscript reviews published studies of inhaled vasodilators used for treatment of PPHN and provides an overview of safety issues associated with drug delivery and delivery devices as they relate to the risk of rebound pulmonary hypertension. Off-label use of aerosolized prostacyclins and an aerosolized prostaglandin in neonates with PPHN has been reported; however, evidence from large randomized clinical trials is lacking. The amount of a given dose of aerosolized drug that is actually delivered to the lungs is often unknown, and the actual amount of drug deposited in the lungs can be affected by several factors, including patient size, nebulizer used, and placement of the nebulizer within the breathing circuit. Inhaled nitric oxide (iNO is the only pulmonary vasodilator approved by the US Food and Drug Administration for the treatment of PPHN. The iNO delivery device, INOmax DSIR®, is designed to constantly monitor NO, NO2, and O2 deliveries and is equipped with audible and visual alarms to alert providers of abrupt discontinuation and incorrect drug concentration. Other safety features of this device include two independent backup delivery systems, a backup drug cylinder, a battery that provides up to 6 hours of

  14. Case of late-onset, relapsing surgical site infection related to a venous coupler placed during free flap reconstruction for major head and neck cancer.

    Science.gov (United States)

    Ren, Yin; Deschler, Daniel G; Sajed, Dipti; Durand, Marlene L

    2018-01-12

    Venous coupling devices are widely used during reconstructive surgery involving microvascular anastomosis but have not served as foreign bodies in head and neck surgical site infections. We conducted a case report. A patient underwent resection and free flap reconstruction for recurrent tongue squamous cell carcinoma. She developed a neck abscess due to Streptococcus intermedius 7 weeks postoperatively, days after starting chemoradiotherapy. The surgical site infection healed with drainage and antibiotics. Two surgical site infection relapses due to S. intermedius occurred 3 and 8 weeks after completing radiation, the second relapse after a prolonged course of i.v. antibiotics. Surgical exploration revealed a venous coupler within granulation tissue. The device was removed and no further surgical site infection relapses occurred. To the best of our knowledge, this is the first report of a delayed-onset head and neck surgical site infection in which a venous coupler served as a foreign body. An infected foreign body should be suspected in relapsing surgical site infections due to a single organism. © 2018 Wiley Periodicals, Inc.

  15. Pulmonary hypertension associated with connective tissue disease

    Directory of Open Access Journals (Sweden)

    Srinivas Rajagopala

    2017-01-01

    Full Text Available Pulmonary hypertension (PH is an important cause of morbidity and mortality in connective tissue diseases (CTDs. CTDs may cause PH due to several mechanisms; pulmonary arterial hypertension, associated interstitial lung disease, neuromuscular disease, and/or sleep disordered breathing leading to hypoxia, associated thromboembolic PH, and pulmonary venous hypertension due to left ventricular dysfunction. PH can be measured on echocardiography, but the gold standard for diagnosis is right heart catheterization. PH-specific therapy in addition to immunosuppression is the most common treatment used though data are scant. In this narrative review, we discuss the epidemiologic burden, clinical presentation, evaluation, and management of PH in CTDs.

  16. Noninvasive measurement of central venous pressure

    Science.gov (United States)

    Webster, J. G.; Mastenbrook, S. M., Jr.

    1972-01-01

    A technique for the noninvasive measurement of CVP in man was developed. The method involves monitoring venous velocity at a point in the periphery with a transcutaneous Doppler ultrasonic velocity meter while the patient performs a forced expiratory maneuver. The idea is the CVP is related to the value of pressure measured at the mouth which just stops the flow in the vein. Two improvements were made over the original procedure. First, the site of venous velocity measurement was shifted from a vein at the antecubital fossa (elbow) to the right external jugular vein in the neck. This allows for sensing more readily events occurring in the central veins. Secondly, and perhaps most significantly, a procedure for obtaining a curve of relative mean venous velocity vs mouth pressure was developed.

  17. Neural Programmatic Role of Leptin, TNFα, Melanocortin, and Glutamate in Blood Pressure Regulation vs Obesity-Related Hypertension in Male C57BL/6 Mice.

    Science.gov (United States)

    Yu, Bin; Cai, Dongsheng

    2017-06-01

    Continuous nutritional surplus sets the stage for hypertension development. Whereas moderate dietary obesity in mice is normotensive, the homeostatic balance is disrupted concurrent with an increased risk of hypertension. However, it remains unclear how the obesity-associated prehypertensive state is converted into overt hypertension. Here, using mice with high-fat-diet (HFD)-induced moderate obesity vs control diet (CD)-fed lean mice, we comparatively studied the effects of central leptin and tumor necrosis factor-α (TNFα) as well as the involvement of the neuropeptide melanocortin pathway vs the neurotransmitter glutamate pathway. Compared with CD-fed lean mice, the pressor effect of central excess leptin and TNFα, but not melanocortin, was sensitized in HFD-fed mice. The pressor effect of central leptin in HFD-fed mice was strongly suppressed by glutamatergic inhibition but not by melanocortinergic inhibition. The pressor effect of central TNFα was substantially reversed by melanocortinergic inhibition in HFD-fed mice but barely in CD-fed mice. Regardless of diet, the hypertensive effects of central TNFα and melanocortin were both partially reversed by glutamatergic suppression. Hence, neural control of blood pressure is mediated by a signaling network between leptin, TNFα, melanocortin, and glutamate and changes in dynamics due to central excess leptin and TNFα mediate the switch from normal physiology to obesity-related hypertension. Copyright © 2017 Endocrine Society.

  18. Association of Sleep Duration, Sleep Quality and Shift-Work Schedule in Relation to Hypertension Prevalence in Chinese Adult Males: A Cross-Sectional Survey.

    Science.gov (United States)

    Lu, Kai; Chen, Jia; Wang, Li; Wang, Changying; Ding, Rongjing; Wu, Shouling; Hu, Dayi

    2017-02-21

    Background: Previous studies indicated that measurement of sleep only by duration and quality may be biased. This study aimed to investigate the interactive association of self-reported sleep duration, quality and shift-work schedule with hypertension prevalence in Chinese adult males. Methods: A total of 4519 Chinese adult males (≥18 years) were enrolled into the cross-sectional survey. Sleep attributes were measured from the responses to the standard Pittsburgh Sleep Quality Index and relevant questions in a structured questionnaire survey. The association of sleep duration, quality and shift-work schedule with hypertension prevalence was analyzed using multivariate logistic regression, considering the interaction between them or not. Results: Taking the potential interaction of the three aspects of sleep into consideration, only short sleep duration combined with poor sleep quality was found to be related to hypertension prevalence in Chinese adult males (odds ratio (OR): 1.74, 95% confidence interval (CI): 1.31-2.31), which could be modified by occasional and frequent shift-work schedule (OR: 1.43, 95% CI: 1.05-1.95; OR: 1.97, 95% CI: 1.40-2.79). Conclusions: Short sleep duration was not associated with the prevalence of hypertension in Chinese adult males unless poor sleep quality exists, which could be further modified by shift-work schedule. Assessment of sleep by measuring sleep duration only was not sufficient when exploring the association of sleep with hypertension.

  19. Venous oxygen saturation.

    Science.gov (United States)

    Hartog, Christiane; Bloos, Frank

    2014-12-01

    Early detection and rapid treatment of tissue hypoxia are important goals. Venous oxygen saturation is an indirect index of global oxygen supply-to-demand ratio. Central venous oxygen saturation (ScvO2) measurement has become a surrogate for mixed venous oxygen saturation (SvO2). ScvO2 is measured by a catheter placed in the superior vena cava. After results from a single-center study suggested that maintaining ScvO2 values >70% might improve survival rates in septic patients, international practice guidelines included this target in a bundle strategy to treat early sepsis. However, a recent multicenter study with >1500 patients found that the use of central hemodynamic and ScvO2 monitoring did not improve long-term survival when compared to the clinical assessment of the adequacy of circulation. It seems that if sepsis is recognized early, a rapid initiation of antibiotics and adequate fluid resuscitation are more important than measuring venous oxygen saturation. Copyright © 2014 Elsevier Ltd. All rights reserved.

  20. Life-threatening Cerebral Venous Thrombosis: a case report

    Directory of Open Access Journals (Sweden)

    Daniel Agustin Godoy

    2016-06-01

    Full Text Available Cerebral venous sinus thrombosis (CVT can compromise dural sinus, cerebral veins or both. It is an uncommon condition and it is more prevalent in young women. Several prothrombotic states are the principal predisposing factors. Clinical spectrum of presentation is wide, so this entity requires a high suspect index for correct and prompt diagnosis. CVT may develop serious complications that can be life-threatening such as hemorrhagic venous infarctions, cerebral edema, and intracranial hypertension. This report describes the case of a woman who was in treatment for unspecific vaginal bleeding with oral contraceptives. Suddenly she deteriorated to coma with severe respiratory compromise. Neuroimaging showed thrombosis of multiple venous sinus. Physiological neuroprotection, osmotherapy, mechanical ventilation and anticoagulation therapy were the keystones of treatment. In a few months, the patient has recovered a good functional status, while maintaining a motor deficit on the right hand.

  1. Cerebral venous thrombosis presenting as multiple lower cranial nerve palsies.

    Science.gov (United States)

    Byju, N; Jose, James; Saifudheen, K; Gafoor, V Abdul; Jithendranath, P

    2012-10-01

    Cerebral venous thrombosis (CVT) is a well-recognized entity, but its clinical presentation is varied and often mimics many neurological disorders, making it a diagnostic challenge. Cerebral venous thrombosis has a wide spectrum of signs and symptoms, which may evolve suddenly or over weeks. It mimics many neurological conditions such as meningitis, encephalopathy, idiopathic intracranial hypertension, and stroke. Cerebral venous thrombosis presenting as multiple lower cranial nerve palsies, are rarely reported. We describe a pregnant lady who presented with sensorineural deafness of the right ear and paralysis of the 9(th), 10(th), and 12(th) cranial nerves on the right side. She was diagnosed to have thrombosis of the right transverse sinus and sigmoid sinus with extension to the jugular vein and confluence of sinuses. She improved with anticoagulant treatment.

  2. Blood pressure level and relation to other cardiovascular risk factors in male hypertensive patients without clinical evidence of ischemic heart disease

    DEFF Research Database (Denmark)

    Larsen, C T; Sørum, C; Hansen, J F

    2000-01-01

    was independently associated with DBP. Office SBP was above 140 mmHg in 83% and above 160 mmHg in 44% of patients. During ambulatory blood pressure monitoring (AMBP), SBP was above 135 mmHg in 40% and above 155 mmHg in 15% of patients. In addition to male sex and hypertension there was a high percentage of other...... and the blood pressure (BP), and to evaluate the percentage of patients who had achieved a BP level as recommended by the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). BP was evaluated in relation to age, body mass index......, duration of hypertension, cholesterol and triglyceride level, smoking status, information of regular exercise, a family history of ischemic heart disease (IHD) and drug treatment, in 220 men treated for arterial hypertension. In the univariate analyses we found a higher systolic blood pressure (SBP...

  3. Hypertension crisis.

    Science.gov (United States)

    Papadopoulos, Dimitris P; Mourouzis, Iordanis; Thomopoulos, Costas; Makris, Thomas; Papademetriou, Vasilios

    2010-12-01

    Hypertensive crises (76% urgencies, 24% emergencies) represented more than one fourth of all medical urgencies/emergencies. Hypertensive urgencies frequently present with headache (22%), epistaxis (17%), faintness, and psychomotor agitation (10%) and hypertensive emergencies frequently present with chest pain (27%), dyspnea (22%) and neurological deficit (21%). Types of end-organ damage associated with hypertensive emergencies include cerebral infarction (24%), acute pulmonary edema (23%) and hypertensive encephalopathy (16%), as well as cerebral hemorrhage (4.5%). The most important factor that limits morbidity and mortality from these disorders is prompt and carefully considered therapy. Unfortunately, hypertensive emergencies and urgencies are among the most misunderstood and mismanaged of acute medical problems seen today. The primary goal of intervention in a hypertensive crisis is to safely reduce BP. Immediate reduction in BP is required only in patients with acute end-organ damage (i.e. hypertensive emergency). This requires treatment with a titratable short-acting intravenous (IV) antihypertensive agent, while severe hypertension with no acute end-organ damage is usually treated with oral antihypertensive agents. Patients with hypertensive emergencies are best treated in an intensive care unit (ICU) with titratable IV hypotensive agents. The aim of this review is to summarize the details regarding the definition-impact, causes, clinical condition and management of hypertensive crises.

  4. Clinical features and risk factor analysis for lower extremity deep venous thrombosis in Chinese neurosurgical patients

    Directory of Open Access Journals (Sweden)

    Fuyou Guo

    2015-01-01

    Full Text Available Background: Deep venous thrombosis (DVT contributes significantly to the morbidity and mortality of neurosurgical patients; however, no data regarding lower extremity DVT in postoperative Chinese neurosurgical patients have been reported. Materials and Methods: From January 2012 to December 2013, 196 patients without preoperative DVT who underwent neurosurgical operations were evaluated by color Doppler ultrasonography and D-dimer level measurements on the 3rd, 7th, and 14th days after surgery. Follow-up clinical data were recorded to determine the incidence of lower extremity DVT in postoperative neurosurgical patients and to analyze related clinical features. First, a single factor analysis, Chi-square test, was used to select statistically significant factors. Then, a multivariate analysis, binary logistic regression analysis, was used to determine risk factors for lower extremity DVT in postoperative neurosurgical patients. Results: Lower extremity DVT occurred in 61 patients, and the incidence of DVT was 31.1% in the enrolled Chinese neurosurgical patients. The common symptoms of DVT were limb swelling and lower extremity pain as well as increased soft tissue tension. The common sites of venous involvement were the calf muscle and peroneal and posterior tibial veins. The single factor analysis showed statistically significant differences in DVT risk factors, including age, hypertension, smoking status, operation time, a bedridden or paralyzed state, the presence of a tumor, postoperative dehydration, and glucocorticoid treatment, between the two groups (P < 0.05. The binary logistic regression analysis showed that an age greater than 50 years, hypertension, a bedridden or paralyzed state, the presence of a tumor, and postoperative dehydration were risk factors for lower extremity DVT in postoperative neurosurgical patients. Conclusions: Lower extremity DVT was a common complication following craniotomy in the enrolled Chinese neurosurgical

  5. Prevention of hypertension.

    Science.gov (United States)

    Slama, Michel; Susic, Dinko; Frohlich, Edward D

    2002-09-01

    Hypertension is a major risk factor for many cardiovascular diseases including stroke, coronary heart disease, cardiac failure, and endstage renal disease. Therefore, prevention of hypertension becomes an important goal in overall efforts to control blood pressure and reduce the incidence of hypertension-related cardiovascular and renal complications and outcomes. Many risk factors underlying hypertension have been identified including nonmodifiable factors such as age, gender, genetic factors, and race, as well as modifiable factors including overweight, high sodium intake, low potassium intake, alcohol consumption, and reduced physical activity. A number of studies have demonstrated that interventions aimed at changing these modifiable factors might decrease blood pressure and even prevent the development of hypertension. Thus, present national recommendations and guidelines include lifestyle modifications ranging from weight loss in case of obesity, engagement in regular isotonic physical activity, reduced sodium diet (alcohol moderation (<1 ounce of ethanol or its equivalent per day).

  6. De novo formation of cerebral cavernous malformation adjacent to existing developmental venous anomaly - an effect of change in venous pressure associated with management of a complex dural arterio-venous fistula.

    Science.gov (United States)

    Chakravarthy, Hariprakash; Lin, Tzu-Kang; Chen, Yao-Liang; Wu, Yi-Ming; Yeh, Chin-Hua; Wong, Ho-Fai

    2016-12-01

    This is a case report of de novo development of two cerebral cavernous malformations adjacent to existing developmental venous anomalies. The development of cavernomas was noted over a follow-up period of 10 years. These developments happened during the course of staged endovascular management of a complex dural arterio-venous fistula along the right sphenoid wing. The patient presented with a proptosis secondary to lympho-haemangiomatous lesion of the fronto-orbital region and a high-flow right sphenoid wing dural arterio-venous fistula. During the initial period of conservative management of the dural arterio-venous fistula, he developed de novo cavernous malformations in the left mesial temporal lobe adjacent to a developmental venous anomaly in the temporal lobe, and along with this there was engorgement of deep veins related to another existing developmental venous anomaly in the brainstem. Later during the course of endovascular treatment of the dural arterio-venous fistula, a large brainstem cavernoma developed adjacent to the brainstem developmental venous anomaly. This case report discusses the cause-effect relationship of venous pressure changes related to management of dural arterio-venous fistula and de novo formation of cerebral cavernous malformations adjacent to existing developmental venous anomalies. © The Author(s) 2016.

  7. Inflammation, Immunity, and Hypertension

    National Research Council Canada - National Science Library

    Arisya Agita; M Thaha Alsagaff

    2017-01-01

    The immune system, inflammation and hypertension are related to each other. Innate and adaptive immunity system triggers an inflammatory process, in which blood pressure may increase, stimulating organ damage...

  8. A New Baroreceptor Sensitivity-Restoring Ca-Channel Blocker Diminishes Age-Related Morning Blood Pressure Increase in Hypertensive Patients: Open-Label Monitoring of Azelnidipine Treatment for Hypertension in the Early Morning (At-HOME Study

    Directory of Open Access Journals (Sweden)

    Mitsunori Sugiyama

    2010-01-01

    Full Text Available Background: Morning blood pressure (BP surge, which exhibits an age-related increase, is a risk factor for stroke in elderly hypertensive patients, independently of the 24-h BP level. We studied the effect of the new baroreceptor sensitivity (BRS-restoring Ca-channel blocker (CCB azelnidipine (AZ on this age-related morning BP increase. Methods: We conducted a 16-week prospective study to clarify the effect of morning dosing of AZ on home BPs measured in the morning and in the evening in 2,546 hypertensive patients (mean age, 65.1 years; female, 53.6%. Results: At baseline, ME-Dif (morning systolic BP [SBP]–evening SBP increased with age, independently of ME-Ave (average of the morning and evening SBPs. This age-related increase of ME-Dif was exaggerated by regular alcohol drinking and beta-blocker use. After AZ treatment (14.3 ± 3.6 mg/day, ME-AV and ME-Dif were significantly reduced independently of each other, with reductions of –18.1 ± 15.6 and –2.5 ± 13.2 mmHg, respectively (both p < 0.001. AZ treatment decreased age-related increase in ME-Dif particularly in patients who were regular consumers of alcohol and in beta-blocker users. Conclusions: The new BRS-restoring CCB AZ significantly reduced age-related increase in morning BP and had some potential benefit on cardiovascular protection in hypertension, particularly in elderly patients and/or consumers of alcohol.

  9. Work-related maternal risk factors and the risk of pregnancy induced hypertension and preeclampsia during pregnancy. The Generation R Study.

    Directory of Open Access Journals (Sweden)

    Jaap Jan Nugteren

    Full Text Available OBJECTIVE: To study the associations between physically demanding work and occupational exposure to chemicals and hypertensive disorders during pregnancy within a large birth cohort study, the Generation R Study. METHODS: Associations between occupational characteristics and hypertensive disorders during pregnancy were studied in 4465 pregnant woman participating in a population-based prospective cohort study from early pregnancy onwards in the Netherlands (2002-2006. Mothers who filled out a questionnaire during mid-pregnancy (response 77% of enrolment, were included if they conducted paid employment, had a spontaneously conceived singleton live born pregnancy, and did not suffer from pre-existing hypertension (n = 4465. Questions on physical demanding work were obtained from the Dutch Musculoskeletal Questionnaire and concerned questions on manually handling loads of 25 kg or more, long periods of standing or walking, night shifts, and working hours. To assess occupational exposure to chemicals, job titles and task descriptions were linked to a job-exposure-matrix (JEM, an expert judgment on exposure to chemicals at the workplace. Information on hypertensive disorders during pregnancy was obtained from medical records. RESULTS: We observed no consistent associations between any of the work related risk factors, such as long periods of standing or walking, heavy lifting, night shifts, and working hours, nor exposure to chemicals with hypertensive disorders during pregnancy. CONCLUSION: This prospective birth cohort study suggests that there is no association of hypertensive disorders during pregnancy with physically demanding work or exposure to chemicals. However, the low prevalence of PIH and PE, combined with the low prevalence of occupational risk factors limit the power for inference and larger studies are needed to corroborate or refute these findings.

  10. Intrahepatic portosystemic venous shunts: diagnosis by Doppler ultrasound; Cortocircuitos venosos portosistemicos intrahepaticos: diagnostico mediante ecografia Doppler

    Energy Technology Data Exchange (ETDEWEB)

    Garofano, M. P.; Medina, A.; Lopez, G.; Garrido, C. [Hospital Universitario Virgen de las Nieves. Granada (Spain)

    2001-07-01

    Intrahepatic portosystemic venous shunts are venous vascular lesions that allow intrahepatic portal vessels to communicate with hepatic veins. They may present in patients with portal hypertension or b discovered incidentally; it is considered that the latter may be congenital or acquired. A noninvasive methods. Doppler ultrasound aids in the diagnosis of these anomalous communications by providing images of the vessels and the direction, velocity and volume of the blood flow through the shunt. We present four cases of intrahepatic portosystemic venous shunt. (Author) 8 refs.

  11. Travel and venous thrombosis: a systematic review

    NARCIS (Netherlands)

    Kuipers, S.; Schreijer, A. J. M.; Cannegieter, S. C.; Bueller, H. R.; Rosendaal, F. R.; Middeldorp, S.

    2007-01-01

    In the past decade, numerous publications on the association between venous thrombosis (VT) and travel have been published. Relative and absolute risks of VT after travel, and particularly after travel by air, have been studied in case-control and observational follow-up studies, whereas the effect

  12. Study of the relationship of serum insulin-like growth factor-related indicators and interleukins with pregnancy-induced hypertension

    Directory of Open Access Journals (Sweden)

    Minawar.Aziz

    2016-08-01

    Full Text Available Objective: To study the relationship of serum insulin-like growth factor-related indicators and interleukins with pregnancy-induced hypertension. Methods: 34 patients with gestational hypertension, 27 patients with mild preeclampsia, 18 patients with severe preeclampsia and 50 healthy women were selected as the research subjects, serum was collected to determine serum IGF-I, IGF-II, IGFBP-1, IL-6, IL-8 and IL-18 content, and the placenta was collect to determine IGF-I, IGF-II, IGFBP-1, IL-6, IL-8 and IL-18 content. Results: IGF-I and IGFII levels in placenta tissue and serum of gestational hypertension group, mild preeclampsia group and severe preeclampsia group were significantly lower than those of control group, and IGFBP-1, IL-6, IL-8 and IL-18 levels were significantly higher than those of control group; serum IGF-I and IGF-II levels were negatively correlated with IL-6, IL-8 and IL-18 levels, and serum IGFBP-1 level was positively correlated with IL-6, IL-8 and IL-18 levels. Conclusion: decreased serum IGF-I, IGF-II levels and increased serum IGFBP-1, IL-6, IL-8 and IL-18 levels are associated with pregnancy-induced hypertension, and decreased IGF-I and IGF-II levels and increased IGFBP-1 level are closely related to increased levels of interleukins.

  13. Work-related stress perception and hypertension amongst health workers of a mission hospital in Oyo State, south-western Nigeria

    Directory of Open Access Journals (Sweden)

    Akinwumi O. Owolabi

    2012-02-01

    Full Text Available Background: Globalisation and changes in the nature of work have resulted in increasing work-related stress in people in developing countries. Work stress is at present already acknowledged as one of the epidemics of modern working life. It is associated with a number of disease conditions, such as hypertension, cardiovascular diseases, affective disorders, depression, disturbed metabolism (risk of Type II diabetes and musculoskeletal disorders.Objective: This study was a work site cross-sectional descriptive study carried out amongst the health workers at the Baptist Medical Centre Ogbomoso, Oyo State, south-western Nigeria. The aim of the study was to discern the prevalence of perceived work stress and to explore the relationship between perceived work stress and the presence of hypertension.Methods: A total of 324 consenting health workers of the institution were administered the job demand-control questionnaire to assess work stress. A standardised questionnaire was used to collect socio-demographic data and other personal data. Measurements of blood pressure, weight and height were carried out and body mass indices were calculated.Results: More than a quarter (26.2% of the subjects perceived themself as stressed at work. The single largest group of hypertensive subjects was seen amongst subjects with work stress.Conclusion: A significant number of health workers in this study is afflicted by work-related stress and perceived work stress was found to be significantly associated with higher hypertension prevalence.

  14. Familial Clustering of Venous Thromboembolism

    DEFF Research Database (Denmark)

    Sindet-Pedersen, Caroline; Oestergaard, Louise Bruun; Gundlund, Anna

    2016-01-01

    BACKGROUND: Identification of risk factors for venous thromboembolism (VTE) is of utmost importance to improve current prophylactic regimes and treatment guidelines. The extent to which a family history contributes to the risk of VTE needs further exploration. OBJECTIVES: To examine the relative...... rate of VTE in first-degree relatives compared with the general population. METHODS: By crosslinking Danish nationwide registries we identified patients with VTE between 1978 and 2012, and their familial relations. The first member in a family to acquire VTE was defined as the proband. All first...... regression models, with the general population as a fixed reference. RESULTS: We identified 70,767 children of maternal probands, 66,065 children of paternal probands, and 29,183 siblings to sibling probands. Having a maternal proband or a paternal proband were associated with a significantly increased VTE...

  15. Prevalence Rates of Self-Care Behaviors and Related Factors in a Rural Hypertension Population: A Questionnaire Survey

    Directory of Open Access Journals (Sweden)

    Huanhuan Hu

    2013-01-01

    Full Text Available The objective of this study was to investigate the self-care behaviors among hypertensive patients in primary care. A cross-sectional survey, with 318 hypertensive patients, was conducted in a rural area in Beijing, China, in 2012. Participants were mainly recruited from a community health clinic and completed questionnaires assessing their self-care behaviors, including data on adherence to a prescribed medication regimen, low-salt diet intake, smoking habits, alcohol consumption, blood pressure monitoring, and physical exercise. The logistic regression model was used for the analysis of any association between self-care behaviors and age, gender, duration of hypertension, self-rated health, marital status, education level, diabetes status, or body mass index. Subjects that adhered to their medication schedule were more likely to have hypertension for a long duration (OR, 3.44; 95% CI 1.99–5.97. Older participants (OR, 1.80; 95% CI 1.08–2.99 were more likely to monitor their blood pressure. Subjects who did not partake in physical exercise were more likely to be men, although the difference between genders was not significant (OR, 0.60; 95% CI 0.36–1.01. Patients with shorter history of hypertension, younger and being males have lower self-care behaviors. Primary care providers and public health practitioner should pay more attention to patients recently diagnosed with hypertension as well as younger male patients.

  16. Genetics in chronic venous disease.

    Science.gov (United States)

    Grant, Yasmin; Onida, Sarah; Davies, Alun

    2017-02-01

    Chronic venous disease is highly prevalent in the Western world, with varicose veins being the most common form of clinical manifestation. With recent developments in sequencing technology, clinicians and geneticists alike are embarking on a journey to identify and unravel the genetic candidates of chronic venous disease. There is now currently substantial evidence to suggest the presence of genetic influences in the aetiology and pathology of venous disease. Despite this, the precise nature and profile of the genes involved in chronic venous disease remain a poorly understood entity. Moreover, it is strikingly apparent that the majority of venous genetic studies conducted over the past decade do not adhere to fundamental research principles. The emergence of high-throughput genotyping platforms permits a more systematic search for inherited components of venous disease. Pursuing a genome-wide frontier has the potential to reveal novel critical metabolic pathways and explain the genetic susceptibility of chronic venous disease. An expedited knowledge of the genetic factors in the aetiology of venous disease may translate into better prevention or treatment, which would benefit patients suffering from its clinical sequelae. Researchers should be urged to foster collaborative links and design a genome-wide case-control association study as an international consortium to provide a statistically robust paradigm in the field of chronic venous disease genetics. This will carry promise for clinically relevant progress and represent a first step towards better understanding of the genetics of chronic venous disease aetiology.

  17. KCNA5 gene is not confirmed as a systemic sclerosis-related pulmonary arterial hypertension genetic susceptibility factor

    Science.gov (United States)

    2012-01-01

    Introduction Potassium voltage-gated channel shaker-related subfamily member 5 (KCNA5) is implicated in vascular tone regulation, and its inhibition during hypoxia produces pulmonary vasoconstriction. Recently, a protective association of the KCNA5 locus with systemic sclerosis (SSc) patients with pulmonary arterial hypertension (PAH) was reported. Hence, the aim of this study was to replicate these findings in an independent multicenter Caucasian SSc cohort. Methods The 2,343 SSc cases (179 PAH positive, confirmed by right-heart catheterization) and 2,690 matched healthy controls from five European countries were included in this study. Rs10744676 single-nucleotide polymorphism (SNP) was genotyped by using a TaqMan SNP genotyping assay. Results Individual population analyses of the selected KCNA5 genetic variant did not show significant association with SSc or any of the defined subsets (for example, limited cutaneous SSc, diffuse cutaneous SSc, anti-centromere autoantibody positive and anti-topoisomerase autoantibody positive). Furthermore, pooled analyses revealed no significant evidence of association with the disease or any of the subsets, not even the PAH-positive group. The comparison of PAH-positive patients with PAH-negative patients showed no significant differences among patients. Conclusions Our data do not support an important role of KCNA5 as an SSc-susceptibility factor or as a PAH-development genetic marker for SSc patients. PMID:23270786

  18. Salidroside attenuates chronic hypoxia-induced pulmonary hypertension via adenosine A2a receptor related mitochondria-dependent apoptosis pathway.

    Science.gov (United States)

    Huang, Xiaoying; Zou, Lizhen; Yu, Xiaoming; Chen, Mayun; Guo, Rui; Cai, Hui; Yao, Dan; Xu, Xiaomei; Chen, Yanfan; Ding, Cheng; Cai, Xueding; Wang, Liangxing

    2015-05-01

    Pulmonary arterial hypertension (PAH) is characterized by pulmonary arterial remodeling mainly due to excess cellular proliferation and apoptosis resistance of pulmonary arterial smooth muscle cells (PASMCs). Salidroside, an active ingredient isolated from Rhodiola rosea is proposed to exert protective effects against PAH. However, the function of salidroside in PAH has not been investigated systematically and the underlying mechanisms are not clear. To investigate the effects of salidroside on PAH, the mice in chronic hypoxia model of PAH were given by an increasing concentration of salidroside (0, 16 mg/kg, 32 mg/kg, and 64 mg/kg). After salidroside treatment, the chronic hypoxia-induced right ventricular hypertrophy and pulmonary arterial remodeling were attenuated, suggesting a protective role played by salidroside in PAH. To explore the potential mechanisms, the apoptosis of PASMCs after salidroside treatment under hypoxia conditions were determined in vivo and in vitro, and also the mitochondria-dependent apoptosis factors, Bax, Bcl-2, cytochrome C, and caspase 9 were examined. The results revealed that salidroside reversed hypoxia-induced cell apoptosis resistance at least partially via a mitochondria-dependent pathway. In addition, salidroside upregulated the expression of adenosine A2a receptor (A2aR) in lung tissues of mice and in PASMCs in vitro after hypoxia exposure. Combined the evidence above, we conclude that salidroside can attenuate chronic hypoxia-induced PAH by promoting PASMCs apoptosis via an A2aR related mitochondria dependent pathway. Copyright © 2015. Published by Elsevier Ltd.

  19. Heritability of chronic venous disease

    Science.gov (United States)

    Krusche, Petra; Wolf, Andreas; Krawczak, Michael; Timm, Birgitt; Nikolaus, Susanna; Frings, Norbert; Schreiber, Stefan

    2010-01-01

    Varicose veins without skin changes have a prevalence of approximately 20% in Northern and Western Europe whereas advanced chronic venous insufficiency affects about 3% of the population. Genetic risk factors are thought to play an important role in the aetiology of both these chronic venous diseases (CVD). We evaluated the relative genetic and environmental impact upon CVD risk by estimating the heritability of the disease in 4,033 nuclear families, comprising 16,434 individuals from all over Germany. Upon clinical examination, patients were classified according to the CEAP guidelines as either C2 (simple varicose veins), C3 (oedema), C4 (skin changes without ulceration), C5 (healed ulceration), or C6 (active ulcers). The narrow-sense heritability (h2) of CVD equals 17.3% (standard error 2.5%, likelihood ratio test P = 1.4 × 10−13). The proportion of disease risk attributable to age (at ascertainment) and sex, the two main risk factors for CVD, was estimated as 10.7% (Kullback–Leibler deviance R2). The heritability of CVD is high, thereby suggesting a notable genetic component in the aetiology of the disease. Systematic population-based searches for CVD susceptibility genes are therefore warranted. PMID:20354728

  20. [Central venous blood gas analysis].

    Science.gov (United States)

    Marano, Marco; D'Amato, Anna; Guiotto, Giovanna; Schiraldi, Fernando

    2015-01-01

    The hemodialysis might interfere with patients hemodynamic, as the technique allows a sophisticated game with extra and intravascular fluids. As the cardiocirculatory response could sometimes be unpredictable, it is interesting to collect valuable information by reaching a deep understanding of the tissue metabolism which is mirrored by the blood gas analysis of variations in arterial and central venous blood samples. Particularly interesting are the time course variations of the central venous hemoglobin saturation (ScvO2), which are directly related to the patient with O2-demand as well as to the O2-Delivery (DO2). The ScvO2 is determined by four parameters (cardiac output, Hb concentration, arterial Hb saturation and O2 consumption): If the fluids subtraction during dialysis was about to determine an occult hypoperfusion, the ScvO2 reduction would be a timely warning sign to be considered. Moreover, while the normal veno-arterial PCO2 difference is 2-4 mmHg, whenever a mismatch between O2-demand and DO2arise, a larger v-aPCO2 difference should be observed.

  1. Pulmonary Hypertension

    OpenAIRE

    Goetting, Michael; Schwarzer, Mario; Gerber, Alexander; Klingelhoefer, Doris; David A. Groneberg

    2017-01-01

    Pulmonary hypertension (PH) is characterized by the increase of the mean pulmonary arterial pressure in the lung circulation. Despite the large number of experimental and clinical studies conducted on pulmonary hypertension, there is no comprehensive work that analyzed the global research activity on PH so far. We retrieved the bibliometric data of the publications on pulmonary hypertension for two periods from the Web of science database. Here, we set the first investigation period from 1900...

  2. Which dressings reduce inflammation and improve venous leg ulcer healing.

    Science.gov (United States)

    Raffetto, Joseph D

    2014-05-01

    Chronic venous leg ulcers (VLU) affect around 1% of the adult population in the Western world. The impact of VLU is both social and economic, with significant expenditures on active venous ulcers to provide medical treatment and eventual healing. At the core of VLU is venous hypertension which affects the venous macrocirculation. The changes incurred in venous hemodynamics leads to microcirculatory changes affecting the postcapillary venule and surrounding tissues. Inflammation by leukocytes affecting the venous endothelium, promotes a complex cascade and activation of adhesion molecules expression, chemokines and cytokines released, altered growth factor responses, and activation of protease (e.g. tPA) and proteinase (e.g. MMPs) activity that causes dysregulation and compromise of tissue integrity with eventual dermal damage and ulcer development. A critical component to treating VLU is correcting the abnormal venous hemodynamics and compression therapy. Unfortunately, VLU recurrence ranges between 30-70%, and other modalities in therapy along with compression are required. The goal for adjuvant products is to restore the balance from an inflammatory chronic wound to that of a reparative wound that will promote provisional matrix and epithelialization. There are many products on the market that can be used as adjuvant to compression therapy, but it must be recognized that there is a paucity of clinical trials that have evaluated the clinical effectiveness of specific products with clearly defined end points, and most importantly a healed VLU with a low recurrence rate. This review will discuss the fundamentals of VLU inflammation, and evaluate the available literature that may have benefit in reducing inflammation and lead to effective VLU healing. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  3. Cardiovascular Risk in Hypertension in Relation to Achieved Blood Pressure Using Automated Office Blood Pressure Measurement.

    Science.gov (United States)

    Myers, Martin G; Kaczorowski, Janusz; Dolovich, Lisa; Tu, Karen; Paterson, J Michael

    2016-10-01

    The SPRINT (Systolic Blood Pressure Intervention Trial) reported that some older, higher risk patients might benefit from a target systolic blood pressure (BP) of <120 versus <140 mm Hg. However, it is not yet known how the BP target and measurement methods used in SPRINT relate to cardiovascular outcomes in real-world practice. SPRINT used the automated office BP technique, which requires the patient to be resting quietly and alone, with multiple readings being recorded automatically using an electronic oscillometric sphygmomanometer. We studied the relationship between achieved automated office BP at baseline and cardiovascular events in 6183 community-dwelling residents of Ontario aged ≥66 years who were receiving antihypertensive therapy and followed for a mean of 4.6 years. Adjusted hazard ratios (95% confidence intervals) were computed for 10 mm Hg increments in achieved automated office BP at baseline using Cox proportional hazards regression and the BP category with the lowest event rate as the reference category. Based on 904 fatal and nonfatal cardiovascular events, the nadir of cardiovascular events was at the systolic pressure category of 110 to 119 mm Hg, which was lower than the next highest category of 120 to 129 mm Hg (hazard ratio 1.30 [1.01, 1.66]). The hazard ratio for diastolic pressure was relatively unchanged above 60 mm Hg. Pulse pressure exhibited an increase in hazard ratio (1.33 [1.02, 1.72]) at ≥80 mm Hg. These results using automated office BP measurement in a usual treatment setting extend the finding in SPRINT of an optimum target systolic BP of <120 mm Hg to routine clinical practice. © 2016 American Heart Association, Inc.

  4. Compression for venous leg ulcers.

    Science.gov (United States)

    O'Meara, Susan; Cullum, Nicky A; Nelson, E Andrea

    2009-01-21

    extracted and summarised using a data extraction table. Data extraction was performed by one review author and verified independently by a second review author. Overall, 39 RCTs reporting 47 comparisons were included.Review question 1: there was reasonable evidence from seven RCTs that venous ulcers heal more rapidly with compression than without.Review question 2: findings from six trials of single-component compression suggested that this strategy was less effective than multi-component compression. Evidence from compression systems with two components (3 trials) and three components (4 trials) suggested better outcomes when an elastic component was included. Different versions of compression with four-components (based on the Charing Cross four-layer bandage system) have similar effectiveness (3 trials). Compression with four components (variants of the Charing Cross four-layer bandage) is more effective than multi-component compression that includes a short-stretch bandage (6 trials). It is difficult to determine the relative effectiveness of the four-layer bandage compared with paste bandage systems because of differences in the paste systems (5 trials). There was no difference in effectiveness between the adjustable compression boot and compression bandages (2 trials) or between single-layer compression stockings and paste bandages (2 trials). Two-layer stockings appeared more effective than the short-stretch bandage (2 trials). The relative effectiveness of tubular compression when compared with compression bandages was not clear from current evidence (2 trials).Three trials reported ulcer recurrence; because of sparseness of data and trials not being primarily designed to assess this outcome, firm conclusions could not be drawn. Although several trials included cost data, only one reported a rigorously conducted cost-effectiveness analysis with findings suggesting that the four-layer bandage was more cost-effective than multi-component compression comprising a short

  5. Solitary and combined negative influences of diabetes, obesity and hypertension on health-related quality of life of elderly individuals: A population-based cross-sectional study.

    Science.gov (United States)

    Hajian-Tilaki, K; Heidari, B; Hajian-Tilaki, A

    2016-01-01

    The health-related quality of life (HRQoL) is a matter of concern in elderly people with chronic diseases. The objective of this study was to investigate the impact of obesity, hypertension and diabetes on HRQoL among elderly. A population based cross sectional study was conducted with 750 representative sample of elderly people aged 60-90 years in Babol, the northern Iran. The demographic data and the measurement of blood pressure and other anthropometric measures were collected. The validated short form (SF-36) questionnaire was used to assess the HRQoL. A multiple linear regression model was applied to assess the impact of obesity, abdominal obesity, hypertension and diabetes on QoL. The mean age (SD) of participants was 68.0±7.6 and 67.7±7.9 years for men and women respectively. Diabetes exerted the most negative effect on QoL score (adjusted coefficient=-9.2, 95% CI: -11.7, -6.5 points) followed by abdominal obesity and hypertension. Whereas a combination of three conditions was associated with a greater significant reduction in QoL scores in both sexes(adjusted coefficient=-14.5, 95% CI: -19.0, -9.9 points). However, the negative influence of obesity and hypertension on QoL was significant only in women. Most components of the QoL is affected by diabetes, obesity and hypertension particularly in women. Diabetes alone or in combination with other conditions has a negative influence in both sexes with greater effect in women. These findings justify further professional support to compensate the negative influences chronic conditions on health-related QoL especially for older obese diabetic women. Copyright © 2016 Diabetes India. Published by Elsevier Ltd. All rights reserved.

  6. Effect of testing for cancer on cancer- and venous thromboembolism (VTE)-related mortality and morbidity in people with unprovoked VTE.

    Science.gov (United States)

    Robertson, Lindsay; Yeoh, Su Ern; Stansby, Gerard; Agarwal, Roshan

    2017-08-23

    Venous thromboembolism (VTE) is a collective term for two conditions: deep vein thrombosis (DVT) and pulmonary embolism (PE). A proportion of people with VTE have no underlying or immediately predisposing risk factors and the VTE is referred to as unprovoked. Unprovoked VTE can often be the first clinical manifestation of an underlying malignancy. This has raised the question of whether people with an unprovoked VTE should be investigated for an underlying cancer. Treatment for VTE is different in cancer and non-cancer patients and a correct diagnosis would ensure that people received the optimal treatment for VTE to prevent recurrence and further morbidity. Furthermore, an appropriate cancer diagnosis at an earlier, potentially curative stage could avoid the risk of cancer progression and thus lead to improvements in cancer-related mortality and morbidity. This is an update of a review first published in 2015. To determine whether testing for undiagnosed cancer in people with a first episode of unprovoked VTE (DVT of the lower limb or PE) is effective in reducing cancer and VTE-related mortality and morbidity and to determine which tests for cancer are best at identifying treatable cancers early. For this update, the Cochrane Vascular Information Specialist (CIS) searched the Specialised Register (16 February 2017). In addition, the CIS searched the Cochrane Register of Studies CENTRAL (2017, Issue 1). We searched trials registries (February 2017) and checked the reference lists of relevant articles. Randomised and quasi-randomised trials in which people with an unprovoked VTE were allocated to receive specific tests for cancer or clinically indicated tests only were eligible for inclusion in this review. Primary outcomes included all-cause mortality, cancer-related mortality and VTE-related mortality. Two review authors independently selected studies, assessed quality and extracted data. We resolved any disagreements by discussion. Four studies with 1644

  7. Imaging Features of Idiopathic Intracranial Hypertension in Children.

    Science.gov (United States)

    Hartmann, Alexander J P W; Soares, Bruno P; Bruce, Beau B; Saindane, Amit M; Newman, Nancy J; Biousse, Valérie; Peragallo, Jason H

    2017-01-01

    Magnetic resonance imaging (MRI) signs of elevated intracranial pressure and idiopathic intracranial hypertension have been well characterized in adults but not in children. The MRIs of 50 children with idiopathic intracranial hypertension and 46 adults with idiopathic intracranial hypertension were reviewed for optic nerve head protrusion, optic nerve head enhancement, posterior scleral flattening, increased perioptic cerebrospinal fluid, optic nerve tortuosity, empty or partially empty sella, tonsillar herniation, enlargement of Meckel's cave meningoceles, and transverse venous sinus stenosis(TSS). Compared to adolescents (11-17 years, n = 40) and adults (>17 years, n = 46), prepubescent children (intracranial hypertension have similar MRI findings as adults, but they are less frequent in prepubescent children.

  8. Hypertension and HIV infection.

    Science.gov (United States)

    Balt, Christine A

    2013-01-01

    As persons living with HIV infection (PLWH) live longer, primary health care and comorbidity issues have come to the forefront. The diagnosis and treatment of hypertension can affect a number of other comorbid conditions, including metabolic syndrome, lipid abnormalities, cardiovascular disease, and diabetes. Literature specific to hypertension and HIV is limited and most often presented in theory-based, rather than empirically based, articles, with hypertension-specific information presented in small sections of articles on cardiovascular disease. A systematic literature review was conducted to evaluate current research evidence to determine prevalence of hypertension in PLWH and its association with antiretroviral therapy (ART) and HIV-related and traditional risk factors. Evidence surrounding the cause and effect of HIV and ART on hypertension is conflicting and inconclusive; however, the importance of hypertension diagnosis and treatment is clear. Evidence supports use of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of Hypertension Guidelines when treating PLWH. Copyright © 2013 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

  9. Pulmonary hypertension in bronchopulmonary dysplasia.

    Science.gov (United States)

    Ambalavanan, Namasivayam; Mourani, Peter

    2014-03-01

    Pulmonary hypertension is common in bronchopulmonary dysplasia and is associated with increased mortality and morbidity. This pulmonary hypertension is due to abnormal microvascular development and pulmonary vascular remodeling resulting in reduced cross-sectional area of pulmonary vasculature. The epidemiology, etiology, clinical features, diagnosis, suggested management, and outcomes of pulmonary hypertension in the setting of bronchopulmonary dysplasia are reviewed. In summary, pulmonary hypertension is noted in a fifth of extremely low birth weight infants, primarily those with moderate or severe bronchopulmonary dysplasia, and persists to discharge in many infants. Diagnosis is generally by echocardiography, and some infants require cardiac catheterization to identify associated anatomic cardiac lesions or systemic-pulmonary collaterals, pulmonary venous obstruction or myocardial dysfunction. Serial echocardiography and B-type natriuretic peptide measurement may be useful for following the course of pulmonary hypertension. Currently, there is not much evidence to indicate optimal management approaches, but many clinicians maintain oxygen saturation in the range of 91 to 95%, avoiding hypoxia and hyperoxia, and often provide inhaled nitric oxide, sometimes combined with sildenafil, prostacyclin, or its analogs, and occasionally endothelin-receptor antagonists. Copyright © 2014 Wiley Periodicals, Inc.

  10. Urinary Prothrombin Fragment 1+2 in relation to Development of Non-Symptomatic and Symptomatic Venous Thromboembolic Events following Total Knee Replacement

    DEFF Research Database (Denmark)

    Borris, Lars Carl; Breindahl, Morten; Rud-Lassen, Michael

    2011-01-01

    Prothrombin fragment 1+2 is excreted in urine (uF1+2) as a result of in vivo thrombin generation and can be a marker of coagulation status after an operative procedure. This study compared uF1+2 levels in patients with symptomatic and non-symptomatic venous thromboembolism (VTE) after total knee...... replacement (TKR) and in event-free sex- and age-matched controls. Significantly higher median uF1+2 levels were seen in the VTE patients on days 1, 3, and the day of venography (mostly day 7) after TKR compared with controls. The uF1+2 levels tended to be high in some patients with symptomatic VTE; however...

  11. Understanding Guyton's venous return curves

    National Research Council Canada - National Science Library

    Beard, Daniel A; Feigl, Eric O

    2011-01-01

    ...) was experimentally increased the right atrial pressure decreased, Arthur Guyton and coworkers proposed an interpretation that right atrial pressure represents a back pressure restricting venous return...

  12. Obesity: A Perspective from Hypertension.

    Science.gov (United States)

    Susic, Dinko; Varagic, Jasmina

    2017-01-01

    The prevalence of obesity-related hypertension is high worldwide and has become a major health issue. The mechanisms by which obesity relates to hypertensive disease are still under intense research scrutiny, and include altered hemodynamics, impaired sodium homeostasis, renal dysfunction, autonomic nervous system imbalance, endocrine alterations, oxidative stress and inflammation, and vascular injury. Most of these contributing factors interact with each other at multiple levels. Thus, as a multifactorial and complex disease, obesity-related hypertension should be recognized as a distinctive form of hypertension, and specific considerations should apply in planning therapeutic approaches to treat obese individuals with high blood pressure. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Abnormal CD161+ immune cells and retinoic acid receptor-related orphan receptor γt-mediate enhanced IL-17F expression in the setting of genetic hypertension.

    Science.gov (United States)

    Singh, Madhu V; Cicha, Michael Z; Kumar, Santosh; Meyerholz, David K; Irani, Kaikobad; Chapleau, Mark W; Abboud, François M

    2017-09-01

    Hypertension is considered an immunologic disorder. However, the role of the IL-17 family in genetic hypertension in the spontaneously hypertensive rat (SHR) has not been investigated. We tested the hypothesis that enhanced TH17 programming and IL-17 expression in abundant CD161+ immune cells in SHRs represent an abnormal proinflammatory adaptive immune response. Furthermore, we propose that this response is driven by the master regulator retinoic acid receptor-related orphan receptor γt (RORγt) and a nicotinic proinflammatory innate immune response. We measured expression of the CD161 surface marker on splenocytes in SHRs and normotensive control Wistar-Kyoto (WKY) rats from birth to adulthood. We compared expression of IL-17A and IL-17F in splenic cells under different conditions. We then determined the functional effect of these cytokines on vascular reactivity. Finally, we tested whether pharmacologic inhibition of RORγt can attenuate hypertension in SHRs. SHRs exhibited an abnormally large population of CD161+ cells at birth that increased with age, reaching more than 30% of the splenocyte population at 38 weeks. The SHR splenocytes constitutively expressed more RORγt than those of WKY rats and produced more IL-17F on induction. Exposure of WKY rat aortas to IL-17F impaired endothelium-dependent vascular relaxation, whereas IL-17A did not. Moreover, in vivo inhibition of RORγt by digoxin decreased systolic blood pressure in SHRs. SHRs have a markedly enhanced potential for RORγt-driven expression of proinflammatory and prohypertensive IL-17F in response to innate immune activation. Increased RORγt and IL-17F levels contribute to SHR hypertension and might be therapeutic targets. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  14. [Arterial hypertension in relation to life style and other cardiovascular risk factors. Epidemiologic study of a population of blood donors. Project AVIS].

    Science.gov (United States)

    Bellodi, G; Bernini, G; Manicardi, V; Veneri, L; Muratori, L; Magnanini, G; Rossi, G; Bossini, P; Descovich, G

    1994-03-01

    The objectives of this research were to determine the prevalence of essential and borderline hypertension in a population of blood donors and their families and to determine if there is a correlation between blood pressure and lifestyle and/or other cardiovascular risk factors. The study was comprised of 1976 individuals, of whom 1290 were men and 686 were women, aged 18-65 years. The prevalence of essential hypertension was 15.1% for males and 12.5% for females: the prevalence of borderline hypertension was 22.3% for males and 15.7% for females. The population was divided into two groups: the first group included only subjects (1170 men, 543 women) who did not regularly use drugs that could modify the blood pressure and the heart rate, the second group included the entire population. In the first group, the multiple regression analysis indicated, in order of importance: age, BMI (body mass index), and heart rate. These variables were important in determining the systolic blood pressure in both sexes, uricemia for males and glycemia for females. The diastolic blood pressure was dependent on BMI, heart rate, and alcohol in both sexes, and glycemia, LDL cholesterol, and uricemia in the men. In the second group, primary and borderline hypertension are significantly correlated with age, BMI, and uricemia in both sexes and glycemia in females. A program of health and nutritional education could modify some factors related to blood pressure, such as obesity and alcohol consumption. The result would be a reduction of the prevalence not only of essential and borderline hypertension, but also of metabolic diseases such as dyslipidaemias, diabetes and hyperuricemia, with a global reduction of the cardiovascular risk.

  15. Hepatic Encephalopathy due to Congenital Multiple Intrahepatic Portosystemic Venous Shunts Successfully Treated by Percutaneous Transhepatic Obliteration

    Directory of Open Access Journals (Sweden)

    Shinsuke Takenaga

    2016-11-01

    Full Text Available Hepatic encephalopathy due to intrahepatic portosystemic venous shunts (IPSVS in a non-cirrhotic condition is rare. Here we report a rare case of a patient with congenital multiple IPSVS successfully treated by percutaneous transhepatic obliteration. The patient was a 67-year-old woman who presented to our hospital with progressive episodes of consciousness disorder and vomiting. Laboratory tests revealed hyperammonemia (192.0 μg/dL, and computed tomography revealed multiple IPSVS in both lobes. There was no evidence of underlying liver disease or hepatic trauma. Transcatheter embolization for IPSVS was performed because conservative therapy was not sufficiently effective. After endovascular shunt closure, hepatic encephalopathy improved. The serum ammonia level normalized during the 5-year follow-up period. Thus, transcatheter embolization may be an effective therapy for patients with symptomatic and refractory IPSVS. Careful follow-up is necessary for portal hypertension-related complications after transcatheter embolization for IPSVS.

  16. Venous reflux on contrast-enhanced head and neck magnetic resonance angiography: Analysis of causative factors

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Dong Jae; Lee, Eun Ja [Dept. of Radiology, Dongguk University Ilsan Hospital, Goyang (Korea, Republic of); Bae, Jong Myon [Dept. of Preventive Medicine, Jeju National University School of Medicine, Jeju (Korea, Republic of)

    2016-12-15

    The purpose of this study was to analyze the causative factors of venous reflux on contrast-enhanced head and neck magnetic resonance angiography. We retrospectively reviewed 150 patients with right-arm injections and 150 patients with left-arm injections. We included the age, gender, body mass index, history of hypertension, and history of diabetes mellitus in the evaluation of all patients. We measured the shortest width of the left or right brachiocephalic vein (BCV), the diameter of the aortic arch, and the distance between the sternum and vertebral body. The relationship between these factors and the venous reflux was analyzed. In patients with venous reflux, we performed qualitative image scoring for suboptimal images. In patients with venous reflux, the image quality of the left-arm injection group was significantly inferior to the image quality of the right-arm injection group. The mean age and the male-to-female ratio of patients with venous reflux were significantly higher than those of patients without venous reflux. In patients receiving the left-arm injection, the mean shortest width of the left BCV was significantly narrower in patients with venous reflux than in patients without venous reflux. A left-arm injection should be avoided, especially in elderly patients, to acquire an optimal image.

  17. Imaging signs in idiopathic intracranial hypertension: Are these signs seen in secondary intracranial hypertension too?

    Directory of Open Access Journals (Sweden)

    Divyata R Hingwala

    2013-01-01

    Full Text Available Background: The purpose of this study was to evaluate the difference in the occurrence of the various "traditional" imaging signs of intracranial hypertension (IIH on magnetic resonance imaging (MRI in patients with idiopathic (IIH and secondary intracranial hypertension. Materials and Methods: In a retrospective analysis, the MRI findings of 21 patients with IIH and 60 patients with secondary intracranial hypertension (41 with tumors; 19 with intracranial venous hypertension were evaluated for the presence or absence of various "traditional" imaging signs of IIH (perioptic nerve sheath distention, vertical buckling of optic nerve, globe flattening, optic nerve head protrusion and empty sella using the Fisher′s exact test. Odds ratios were also calculated. Statistical Package for the Social Sciences version 17.0 was used for statistical analysis. Subgroup analysis of the IIH versus tumors and IIH versus venous hypertension were performed. Results: Optic nerve head protrusion and globe flattening were significantly associated with IIH. There was no statistically significant difference in the occurrence of rest of the findings. On subgroup analysis, globe flattening and optic nerve head protrusion occurred significantly more often in IIH than in tumors. However, there was no statistically significant difference in the occurrence of any of these findings in patients with IIH and venous hypertension. Conclusions: IIH is a diagnosis of exclusion. While secondary causes of raised intracranial pressure (ICP have obvious clinical findings on MRI, some conditions like cerebral venous thrombosis may have subtle signs and differentiating between primary and secondary causes may be difficult. In the absence of any evident cause of raised ICP, presence of optic nerve head protrusion or globe flattening can suggest the diagnosis of IIH.

  18. Hypertension hos gravide

    DEFF Research Database (Denmark)

    Mathiesen, Elisabeth R; Johansen, Marianne; Kamper, Anne Lise

    2009-01-01

    There are four major hypertensive disorders in pregnancy: chronic hypertension, gestational hypertension, preeclampsia and chronic hypertension with superimposed preeclampsia. The indications and efficacy of antihypertensive treatment of the different hypertensive disorders are assessed. Advantages...

  19. [Hypertension during pregnancy

    DEFF Research Database (Denmark)

    Mathiesen, E.R.; Johansen, M.; Kamper, A.L.

    2009-01-01

    There are four major hypertensive disorders in pregnancy: chronic hypertension, gestational hypertension, preeclampsia and chronic hypertension with superimposed preeclampsia. The indications and efficacy of antihypertensive treatment of the different hypertensive disorders are assessed. Advantages...

  20. Types of Pulmonary Hypertension

    Science.gov (United States)

    ... Home / Hypertension Pulmonary Hypertension What Is Pulmonary hypertension (PULL-mun-ary HI- ... are called pulmonary hypertension.) Group 1 Pulmonary Arterial Hypertension Group 1 PAH includes: PAH that has no ...

  1. Living with Pulmonary Hypertension

    Science.gov (United States)

    ... Home / Hypertension Pulmonary Hypertension What Is Pulmonary hypertension (PULL-mun-ary HI- ... are called pulmonary hypertension.) Group 1 Pulmonary Arterial Hypertension Group 1 PAH includes: PAH that has no ...

  2. Data supporting the angiotensin II activates MEL18 to deSUMOylate HSF2 for hypertension-related heart failure

    Directory of Open Access Journals (Sweden)

    Chih-Yang Huang

    2018-02-01

    Full Text Available In association with the published article “Inhibition of HSF2 SUMOylation via MEL18 upregulates IGF-IIR and leads to hypertension-induced cardiac hypertrophy” (Huang et al., 2017 [1], this data article contains information about deSUMOylation of HSF2 on lysine 82 on angiotensin II (ANG II -induced cardiac hypertrophy, which is mediated by MEL18. Isolated adult human whole heart tissue showed MEL18-mediated HSF2-IGF-IIR pathway is upregulated in hypertension human heart, compared to health human heart.

  3. Sarcoidosis-associated pulmonary hypertension: acute vasoresponsiveness to inhaled nitric oxide and the relation to long-term effect of sildenafil

    DEFF Research Database (Denmark)

    Milman, Nils; Svendsen, Claus Bo; Iversen, Martin

    2009-01-01

    Abstract Background: Severe pulmonary sarcoidosis is often complicated by pulmonary hypertension (PH) caused by different pathophysiological mechanisms. Objectives: To assess the acute vasoresponsiveness in patients with sarcoidosis and PH and the relation to the therapeutic effect of sildenafil....... Methods: A retrospective chart review of 25 patients with recalcitrant pulmonary sarcoidosis being evaluated for lung transplantation at our centre. Haemodynamics were evaluated by right heart catheterisation in 24 patients of whom 19 had PH. Eight of the 19 patients received vasodilator challenge...

  4. Longitudinal assessment of right ventricular myocardial strain in relation to transplant-free survival in children with idiopathic pulmonary hypertension.

    Science.gov (United States)

    Okumura, Kenichi; Humpl, Tilman; Dragulescu, Andreea; Mertens, Luc; Friedberg, Mark K

    2014-12-01

    Right ventricular (RV) function is an important determinant of mortality in patients with idiopathic pulmonary arterial hypertension (iPAH). The aim of this study was to serially evaluate global and regional RV two-dimensional strain and their relation to transplantation-free survival in children with iPAH. RV regional and global longitudinal strain was retrospectively assessed in children with iPAH. Serial echocardiograms at 3 to 6 months from presentation and then at yearly intervals were analyzed. Results were compared with those from controls and between iPAH survivors (group 1) and those who died or needed transplantation (group 2). Survival stratified by RV global longitudinal strain at presentation was analyzed. Seventeen patients with iPAH (mean age, 8.4 ± 4.8 years; seven male patients), of whom 11 were alive (group 1) and six had died or undergone transplantation (group 2), and 17 age-matched controls were studied. The median follow-up period was 1.5 years (range, 0.04-7.8 years). RV global longitudinal strain was significantly reduced in patients with iPAH compared with controls (-13.5 ± 5.9% vs -24.4 ± 3.9%, P  -14% predicted transplantation-free survival with 100% sensitivity and 54.5% specificity. RV strain imaging may be useful for serial follow-up and prognostication in children with iPAH. Copyright © 2014 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

  5. VENOUS INSUFFICIENCY AND THROMBOEMBOLIC DISEASE IN BARIATRIC SURGERY PATIENTS

    Directory of Open Access Journals (Sweden)

    Bonno van BELLEN

    2013-09-01

    Full Text Available Context Morbid obesity is associated with various co-morbidities, including chronic venous insufficiency. Bariatric surgery is the only effective treatment for morbid obesity, but with potential risks and possible complications, including venous thromboembolism. Objective To determine the prevalence of clinical and ultrasonographic signs of chronic venous insufficiency in morbid obese patients in preparation for bariatric surgery and the incidence of post-operative venous thromboembolic disease. Methods Patients on work-up for bariatric surgery of Centro Terapêutico Especializado em Fígado (CETEFI and Pro-Gastro surgical teams of the Hospital Beneficência Portuguesa de São Paulo were included. The analysed data were pre-operative findings for venous insufficiency (CEAP - clinical, etiological, anatomical, physiopathologic - classification and venous ultrassonographic findings, type of surgery (open or laparoscopic, abdominal circumference, body mass index (BMI and post-operative ultrassonography search for venous insufficiency and deep venous thrombosis. Results Between March 2007 and December 2009, 95 patients candidates for bariatric surgery had clinical and duplex scan evaluation of the lower limbs venous system. Of the 95 patients, 53 were submitted to the surgical procedure. There was a predominance of women (77.9%, the average age was 38.5 years, average preoperative weight 124.6 kg and average BMI of 45.5 kg/m2. Regarding obesity, 16.8% were obese, and 83.1% were morbidly obese. In relation to the venous findings, 86.3% of the patients did fit CEAP classification less than 3 and 13.7% greater than or equal to 3. Among the post-operative complications, there were four cases of wound infection. Three patients developed post-operative distal venous thrombosis (7.5%, but no one had clinically manifested pulmonary embolism. Conclusion No relation between BMI, CEAP classification and venous ultrassonographic findings were found. Although

  6. Venous function after pharmacomechanical thrombolysis for ...

    African Journals Online (AJOL)

    Background: Chronic venous insufficiency is an important complication following iliofemoral deep venous thrombosis. Early thrombus removal may preserve venous function and prevent this complication. This study represents the largest reported South African series of pharmacomechanical thrombolysis for iliofemoral ...

  7. Nurses' knowledge about venous leg ulcer care: a literature review.

    Science.gov (United States)

    Ylönen, M; Stolt, M; Leino-Kilpi, H; Suhonen, R

    2014-06-01

    There is an increasing prevalence of venous leg ulcers coinciding with increasing older people populations. They are therefore important health problems, which restrict daily activities and incur high costs. Efficient and comprehensive nursing care for people with venous leg ulcers requires knowledge of causes, presentations and characteristics, the effects that venous leg ulcers have on individuals and nursing care with evidence-based treatment. To identify the gaps between nurses' demonstrated knowledge of venous leg ulcers and the related nursing care treatment with evidence-based nursing care. A computerized search using MEDLINE, CINAHL the COCHRANE LIBRARY was conducted. The initial search yielded 174 citations from which 16 relevant articles were included in this review. Four themes in venous leg ulcer nursing care emerged demonstrating nurses' knowledge gaps: assessment, physiology and the healing process, nursing care and dressings, and compression treatment. This review suggests that there is a lack of knowledge related to venous leg ulcer physiology, the healing process and how this influences care and treatment. Nurses may not be using the evidence base sufficiently well to support ulcer healing and patient well-being. There is a need for a positive work culture development and ongoing educational programmes aimed at improving nurses' knowledge of venous leg ulcer treatment and care, which address the themes within the results of this review. © 2014 International Council of Nurses.

  8. Urine Levels of Phthalate Metabolites and Bisphenol A in Relation to Main Metabolic Syndrome Components: Dyslipidemia, Hypertension and Type 2 Diabetes. A Pilot Study.

    Science.gov (United States)

    Piecha, Roman; Svačina, Štěpán; Malý, Marek; Vrbík, Karel; Lacinová, Zdenka; Haluzík, Martin; Pavloušková, Jana; Vavrouš, Adam; Matějková, Dagmar; Müllerová, Dana; Mráz, Miloš; Matoulek, Martin

    2016-12-01

    Human exposure to organic pollutants (some of them also called endocrine disruptors) can be associated with adverse metabolic health outcomes including type 2 diabetes. The goal of this study was to compare the urine levels of bisphenol A and phthalate metabolites in subgroups of patients with metabolic syndrome composed of patients with and without three important components of metabolic syndrome (hypertension, dyslipidemia and diabetes). We have investigated 24 hr urine samples of 168 patients with metabolic syndrome from the Metabolic Outpatient Department of General University Hospital in Prague. Using standard metabolic syndrome criteria, we classified patients as dyslipidemic (n=87), hypertensive (n=96), and type 2 diabetic (n=58). Bisphenol A and 15 metabolites of phthalates were evaluated in relation to creatinine excretion. Samples were analysed with enzymatic cleavage of glucuronide using ultra-high-performance liquid chromatography-electrospray ionization tandem mass spectrometry in one laboratory with external quality control. Four metabolites, mono-n-butyl phthalate, mono-(2-ethyl-5-hydroxyhexyl) phthalate, mono-(2-ethyl-5-oxohexyl) phthalate, and mono-(2-ethyl-5-carboxypentyl) phthalate showed significantly higher levels in diabetic compared to non-diabetic patients (pbisphenol A level to diabetes, hypertension, dyslipidemia, age, and BMI. Urine levels of four phthalate metabolites were significantly higher in type 2 diabetics independently on specified predictors. Phthalate levels can be in relation to beta cell dysfunction in type 2 diabetic patients but this study is not able to show if the relation is causal.

  9. Role for Runt-related Transcription Factor 2 in Proliferative and Calcified Vascular Lesions in Pulmonary Arterial Hypertension.

    Science.gov (United States)

    Ruffenach, Grégoire; Chabot, Sophie; Tanguay, Virginie F; Courboulin, Audrey; Boucherat, Olivier; Potus, Francois; Meloche, Jolyane; Pflieger, Aude; Breuils-Bonnet, Sandra; Nadeau, Valérie; Paradis, Renée; Tremblay, Eve; Girerd, Barbara; Hautefort, Aurélie; Montani, David; Fadel, Elie; Dorfmuller, Peter; Humbert, Marc; Perros, Frédéric; Paulin, Roxane; Provencher, Steeve; Bonnet, Sébastien

    2016-11-15

    Pulmonary arterial hypertension (PAH) is characterized by excessive proliferation of pulmonary artery smooth muscle cells (PASMCs). This is sustained in time by the down-regulation of microRNA (miR)-204. In systemic vascular diseases, reduced miR-204 expression promotes vascular biomineralization by augmenting the expression of the transcription factor Runt-related transcription factor 2 (RUNX2). Implication of RUNX2 in PAH-related vascular remodeling and presence of calcified lesions in PAH remain unexplored. We hypothesized that RUNX2 is up-regulated in lungs of patients with PAH, contributing to vascular remodeling and calcium-related biomineralization. We harvested human lung tissues in which we assessed calcification lesions and RUNX2 expression. We also isolated PASMCs from these tissues for in vitro analyses. Using a bidirectional approach, we investigated the role for RUNX2 in cell proliferation, apoptosis, and calcification capacity. Ectopic delivery of small interfering RNA against RUNX2 was used in an animal model of PAH to evaluate the therapeutic potential of RUNX2 inhibition in this disease. Patients with PAH display features of calcified lesions within the distal pulmonary arteries (PAs). We show that RUNX2 is up-regulated in lungs, distal PAs, and primary cultured human PASMCs isolated from PAH and compared with patients without PAH. RUNX2 expression histologically correlates with vascular remodeling and calcification. Using in vitro gain- and loss-of-function approaches, we mechanistically demonstrate that miR-204 diminution promotes RUNX2 up-regulation and that sustained RUNX2 expression activates hypoxia-inducible factor-1α, leading to aberrant proliferation, resistance to apoptosis, and subsequent transdifferentiation of PAH-PASMCs into osteoblast-like cells. In the PAH Sugen/hypoxia rat model, molecular RUNX2 inhibition reduces PA remodeling and prevents calcification, thus improving pulmonary hemodynamic parameters and right ventricular

  10. Imaging of the complications of peripherally inserted central venous catheters

    Energy Technology Data Exchange (ETDEWEB)

    Amerasekera, S.S.H. [Department of Radiology, Good Hope Hospital, Sutton Coldfield, Birmingham (United Kingdom)], E-mail: steve.amerasekera@nhs.net; Jones, C.M.; Patel, R.; Cleasby, M.J. [Department of Radiology, Good Hope Hospital, Sutton Coldfield, Birmingham (United Kingdom)

    2009-08-15

    Peripherally inserted central catheters (PICC) are widely used to provide central venous access, often in chronically ill patients with long-term intravenous access requirements. There are a number of significant complications related to both insertion and maintenance of PICC lines, including catheter malposition, migration, venous thrombosis, and line fracture. The incidence of these complications is likely to rise as the number of patients undergoing intravenous outpatient therapy increases, with a corresponding rise in radiologist input. This paper provides an overview of the relevant peripheral and central venous anatomy, including anatomical variations, and outlines the complications of PICC lines. Imaging examples demonstrate the range of radiological findings seen in these complications.

  11. Renovascular hypertension.

    Science.gov (United States)

    Kanitkar, M

    2005-01-01

    Renovascular hypertension results from a lesion that impairs blood flow to a part or all, of one or both kidneys. 3-10% of children referred for the evaluation of severe hypertension are subsequently found to have clinically significant renovascular lesions Renovascular hypertension is the second most common cause of correctable hypertension in children second only to coarctation of the aorta. Specific therapeutic options now available, justify the often-invasive investigations required to confirm the diagnosis of renovascular hypertension. A systematic evaluation of the child with hypertension will help the pediatrician select correctly, the child most likely to have renovascular hypertension, thus reducing the number of children exposed to the risks involved with diagnostic but invasive investigations like renal arteriography which remains the gold standard Other non-invasive newer modalities like doppler ultrasonography, computed duplex sonography, ACE inhibited radionuclide imaging, and MR/CT/spiral CT angiography may be used depending on the availability of the facilities. Definite therapeutic options for renal artery stenosis include angioplasty, stenting and surgical re-vascularization using a bypass graft.

  12. Herbal and Alternative Medicine Use in Tanzanian Adults Admitted with Hypertension-Related Diseases: A Mixed-Methods Study

    Science.gov (United States)

    Roediger, Rebecca; Jaka, Hyasinta; Bougaila, Amina; Smart, Luke; Langwick, Stacey

    2017-01-01

    Background Hypertension is increasingly common in sub-Saharan Africa where traditional medicine use is also common. We conducted a hospital-based, mixed-methods study to determine prevalence, pattern, and correlates of herbal and alternative medicine use in Tanzanian adults hospitalized with hypertension. Methods A standardized questionnaire was administered. In-depth interviews were performed on a subset of participants. Factors associated with herbal medicine use were determined by logistic regression. The association between traditional medicine uses and allopathic medication adherence was determined using ordinal logistic regression. Qualitative data were analyzed according to grounded theory. Results Of 213 adults enrolled, 52 (24.4%) reported using herbs during the previous month and 47 (22.1%) reported concurrent use of herbs and allopathic medicines. Lower educational level, nonprofessional employment, and lack of health insurance were significantly associated with herbal medicine use. Alternative medicines use was not associated with lower medication adherence. Qualitative interviews identified several important themes including reasons for herbal medicine use. Conclusion The use of traditional medicines is very common among patients with hypertension. Adults from low socioeconomic status, those with misunderstandings about hypertension, and those without health insurance were more likely to take herbs. Open, nonjudgmental communication between healthcare workers and patients regarding use of traditional medicines must be encouraged in Africa. PMID:28634545

  13. Herbal and Alternative Medicine Use in Tanzanian Adults Admitted with Hypertension-Related Diseases: A Mixed-Methods Study

    Directory of Open Access Journals (Sweden)

    Anthony Liwa

    2017-01-01

    Full Text Available Background. Hypertension is increasingly common in sub-Saharan Africa where traditional medicine use is also common. We conducted a hospital-based, mixed-methods study to determine prevalence, pattern, and correlates of herbal and alternative medicine use in Tanzanian adults hospitalized with hypertension. Methods. A standardized questionnaire was administered. In-depth interviews were performed on a subset of participants. Factors associated with herbal medicine use were determined by logistic regression. The association between traditional medicine uses and allopathic medication adherence was determined using ordinal logistic regression. Qualitative data were analyzed according to grounded theory. Results. Of 213 adults enrolled, 52 (24.4% reported using herbs during the previous month and 47 (22.1% reported concurrent use of herbs and allopathic medicines. Lower educational level, nonprofessional employment, and lack of health insurance were significantly associated with herbal medicine use. Alternative medicines use was not associated with lower medication adherence. Qualitative interviews identified several important themes including reasons for herbal medicine use. Conclusion. The use of traditional medicines is very common among patients with hypertension. Adults from low socioeconomic status, those with misunderstandings about hypertension, and those without health insurance were more likely to take herbs. Open, nonjudgmental communication between healthcare workers and patients regarding use of traditional medicines must be encouraged in Africa.

  14. Additive Effect of Non-Alcoholic Fatty Liver Disease on Metabolic Syndrome-Related Endothelial Dysfunction in Hypertensive Patients

    Directory of Open Access Journals (Sweden)

    Maria Perticone

    2016-03-01

    Full Text Available Metabolic syndrome (MS is characterized by an increased risk of incident diabetes and cardiovascular (CV events, identifying insulin resistance (IR and endothelial dysfunction as key elements. Moreover, non-alcoholic fatty liver disease (NAFLD is bidirectionally linked with MS as a consequence of metabolic and inflammatory abnormalities. We addressed the question if the evolution in NAFLD might worsen endothelium-dependent vasodilating response in MS hypertensives. We recruited 272 Caucasian newly-diagnosed never-treated hypertensive outpatients divided into three groups according to the presence/absence of MS alone or in combination with NAFLD. MS and NAFLD were defined according to the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII and non-invasive fatty liver index, respectively. We determined IR by using the homeostasis model assessment (HOMA index. Vascular function, as forearm blood flow (FBF, was determined through strain-gauge plethysmography after intra-arterial infusion of acetylcholine (ACh and sodium nitroprusside. MS+NAFLD+ group showed worse metabolic, inflammatory and vascular profiles compared with MS−NAFLD− and MS+NAFLD−. HOMA resulted in being the strongest predictor of FBF both in the MS+NAFLD− and in the MS+NAFLD+ groups, accounting for 20.5% and 33.2% of its variation, respectively. In conclusion, we demonstrated that MS+NAFLD+ hypertensives show a worse endothelium-dependent vasodilation compared with MS+NAFLD−, allowing for consideration of NAFLD as an early marker of endothelial dysfunction in hypertensives.

  15. Genetic Interactions with Age, Sex, Body Mass Index, and Hypertension in Relation to Atrial Fibrillation: The AFGen Consortium

    NARCIS (Netherlands)

    L.-C. Weng; K.L. Lunetta (Kathryn); Müller-Nurasyid, M. (Martina); A.V. Smith (Albert Vernon); Thériault, S. (Sébastien); Weeke, P.E. (Peter E.); J. Barnard (John); J.C. Bis (Joshua); L.-P. Lyytikäinen (Leo-Pekka); M.E. Kleber (Marcus); Martinsson, A. (Andreas); Lin, H.J. (Henry J.); S.A. Rienstra; S. Trompet (Stella); Krijthe, B.P. (Bouwe P.); M. Dörr (Marcus); Klarin, D. (Derek); D.I. Chasman (Daniel); M.F. Sinner (Moritz); Waldenberger, M. (Melanie); L.J. Launer (Lenore); T.B. Harris (Tamara); E.Z. Soliman (Elsayed); A. Alonso (Alvaro); G. Pare (Guillame); Teixeira, P.L. (Pedro L.); J.C. Denny (Joshua C.); Shoemaker, M.B. (M. Benjamin); D.R. van Wagoner (David); J.D. Smith (Jonathan); B.M. Psaty (Bruce M.); N. Sotoodehnia (Nona); K.D. Taylor (Kent); M. Kähönen (Mika); K. Nikus (Kjell); G. Delgado; O. Melander (Olle); G. Engström; J. Yao (Jiefen); X. Guo (Xiuqing); Christophersen, I.E. (Ingrid E.); P.T. Ellinor (Patrick); Geelhoed, B. (Bastiaan); Verweij, N. (Niek); P.W. MacFarlane (Peter); I. Ford (Ian); J. Heeringa (Jan); Franco, O.H. (Oscar H.); A.G. Uitterlinden (André); U. Völker (Uwe); A. Teumer (Alexander); L.M. Rose (Lynda); S. Kääb (Stefan); V. Gudnason (Vilmundur); D.E. Arking (Dan); D. Conen (David); D.M. Roden (Dan); Chung, M.K. (Mina K.); S.R. Heckbert (Susan); E.J. Benjamin (Emelia); T. Lehtimäki (Terho); W. März (Winfried); J.G. Smith (J Gustav); J.I. Rotter (Jerome I.); Van Der Harst, P. (Pim); J.W. Jukema (Jan Wouter); B.H.Ch. Stricker (Bruno); S.B. Felix (Stephan); C.M. Albert (Christine); S.A. Lubitz (Steven)

    2017-01-01

    textabstractIt is unclear whether genetic markers interact with risk factors to influence atrial fibrillation (AF) risk. We performed genome-wide interaction analyses between genetic variants and age, sex, hypertension, and body mass index in the AFGen Consortium. Study-specific results were

  16. Genetic Interactions with Age, Sex, Body Mass Index, and Hypertension in Relation to Atrial Fibrillation : The AFGen Consortium

    NARCIS (Netherlands)

    Weng, Lu-Chen; Lunetta, Kathryn L.; Mueller-Nurasyid, Martina; Smith, Albert Vernon; Theriault, Sebastien; Weeke, Peter E.; Barnard, John; Bis, Joshua C.; Lyytikainen, Leo-Pekka; Kleber, Marcus E.; Martinsson, Andreas; Lin, Henry J.; Rienstra, Michiel; Trompet, Stella; Krijthe, Bouwe P.; Doerr, Marcus; Klarin, Derek; Chasman, Daniel I.; Sinner, Moritz F.; Waldenberger, Melanie; Launer, Lenore J.; Harris, Tamara B.; Soliman, Elsayed Z.; Alonso, Alvaro; Pare, Guillaume; Teixeira, Pedro L.; Denny, Joshua C.; Shoemaker, M. Benjamin; Van Wagoner, David R.; Smith, Jonathan D.; Psaty, Bruce M.; Sotoodehnia, Nona; Taylor, Kent D.; Kahonen, Mika; Nikus, Kjell; Delgado, Graciela E.; Melander, Olle; Engstrom, Gunnar; Yao, Jie; Guo, Xiuqing; Christophersen, Ingrid E.; Ellinor, Patrick T.; Geelhoed, Bastiaan; Verweij, Niek; Macfarlane, Peter; Ford, Ian; Heeringa, Jan; Franco, Oscar H.; Uitterlinden, Andre G.; Voelker, Uwe; Teumer, Alexander; Rose, Lynda M.; Kaeaeb, Stefan; Gudnason, Vilmundur; Arking, Dan E.; Conen, David; Roden, Dan M.; Chung, Mina K.; Heckbert, Susan R.; Benjamin, Emelia J.; Lehtimaki, Terho; Maerz, Winfried; Smith, J. Gustav; Rotter, Jerome I.; van der Harst, Pim; Jukema, J. Wouter; Stricker, Bruno H.; Felix, Stephan B.; Albert, Christine M.; Lubitz, Steven A.

    2017-01-01

    It is unclear whether genetic markers interact with risk factors to influence atrial fibrillation (AF) risk. We performed genome-wide interaction analyses between genetic variants and age, sex, hypertension, and body mass index in the AFGen Consortium. Study-specific results were combined using

  17. Effects of relative blood volume-controlled hemodialysis on blood pressure and volume status in hypertensive patients

    NARCIS (Netherlands)

    Dasselaar, J.J.; Huisman, R.M.; De Jong, P.E.; Burgerhof, J.G.M.; Franssen, C.F.M.

    2007-01-01

    In hypertensive hemodialysis (HD) patients, dry weight reduction to normalize blood pressure (BP) often results in increased frequency of HD hypotension. Because HD with blood volume tracking (BVT) has been shown to improve intra-HD hemodynamic stability, we performed a prospective, randomized study

  18. Central venous catheter - dressing change

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000156.htm Central venous catheter - dressing change To use the sharing features on this page, please enable JavaScript. You have a central venous catheter. This is a tube that goes into a ...

  19. Chronic Venous Disease under pressure

    NARCIS (Netherlands)

    S.W.I. Reeder (Suzan)

    2013-01-01

    textabstractIn chapter 1 we provide a general introduction of this thesis. Chronic venous disease (CVD) is a common medical condition that affects 2-64% of the worldwide population and leads to leg ulcers in 1% of the Western population. Venous leg ulceration (VLU) has an unfavorable prognosis with

  20. Racial Differences of Pediatric Hypertension in Relation to Birth Weight and Body Size in the United States.

    Directory of Open Access Journals (Sweden)

    Liwei Chen

    Full Text Available The prevalence of hypertension is known to differ by racial group in adults in the United States (US, but findings in children are scarce and inconsistent. The objective of this study was to assess the racial differences in pediatric hypertension and to explore whether these differences, if any, can be explained by low birth weight (LBW and obesity.Analyses were performed for participants aged 8-17 years (N = 9,250 included in the 1999-2010 National Health and Nutrition Examination Survey. Multivariate logistic regressions and weighted analysis were carried out considering the complex survey design.Compared to non-Hispanic White youth, the crude prevalence of hypertension was significantly higher in non-Hispanic Blacks (7.1% vs. 5.6%; P = 0.04, but not in Mexican Americans (5.4% vs. 5.6%; P = 0.77. Blacks also had higher rates of LBW (14.6% vs. 5.9%; P <0.001 and obesity (22.9% vs. 15.8%; P <0.001 than Whites. In stratified analysis by age-sex groups, the Black-White difference in hypertension prevalence was only significant in boys aged 13-17 (9.6% vs. 6.6%. After controlling for age, Black boys had a 51% higher odds of having hypertension (Odds ratio = 1.51; 95% confidence interval: 1.03, 3.43; P = 0.04 compared to White youth at ages 13-17. This racial difference persisted with additional adjustment for birth weight (odds ratio (OR = 2.00; P = 0.02 and for current body mass index (OR = 1.50; P = 0.04. Mexican American youth had no difference in hypertension prevalence as compared to White youth after adjusting for age, sex, birth weight and obesity (Odds ratio = 0.82; P = 0.16 and in age-sex stratified subgroups.Non-Hispanic Black adolescent boys have a significantly higher hypertension rate than their non-Hispanic White counterparts in the US. This racial difference cannot be explained by LBW and current obesity status within the Black population.

  1. Venous Thromboembolism in Adolescents

    Directory of Open Access Journals (Sweden)

    Aneta Samková

    2012-01-01

    Full Text Available The incidence of venous thromboembolism (VTE during childhood is low with two peaks – neonatal and adolescent age. This retrospective study is focused on clinical characteristics of VTE during adolescence. The main goals are to assess the most frequent inherited and acquired risk factors and to evaluate the benefit of D-dimers in diagnostics of venous thromboemblism. The data of 18 adolescents were analysed – 16 girls (88.9%, 2 boys (11.1%. In 9 patients (50% thrombosis of the lower limb deep veins was diagnosed, six patients (33.3% suffered from symptomatic pulmonary embolism (PE and 3 patients (16.7% from thrombosis at unusual sites. One patient had an idiopathic VTE, the mean number of the inherited and acquired risk factors was 2.6. The most frequent inherited risk factor was Leiden mutation of factor V (27.8%. The most frequent acquired risk factor was oral contraception (OC in 12 out of 16 girls (75%. All of our patients on oral contraception had one or more additional risk factors. 10 out of 18 (55.6% patients with VTE had elevated activity of factor VIII. The sensitivity of D-dimers was low (50% in patients with distal lower limb thrombosis, but very high (100% in patients with PE.

  2. Obesity and lower limb venous disease - The epidemic of phlebesity.

    Science.gov (United States)

    Davies, Huw Ob; Popplewell, Matthew; Singhal, Rishi; Smith, Neil; Bradbury, Andrew W

    2017-05-01

    Introduction Lower limb venous disease affects up to one half, and obesity up to one quarter, of the adult population. Many people are therefore affected by, and present to health services for the treatment of both conditions. This article reviews the available evidence of pathophysiological and clinical relationship between obesity and varicose veins, chronic venous insufficiency and ulceration and deep vein thrombosis. Methods A literature search of PubMed and Cochrane libraries was performed in accordance with PRISMA statement from 1946 to 2015, with further article identification from following cited references for articles examining the relationship between obesity and venous disease. Search terms included obesity, overweight, thrombosis, varicose veins, CEAP, chronic venous insufficiency, treatment, endovenous, endothermal, sclerotherapy, bariatric surgery and deep vein thrombosis. Results The proportion of the population suffering from lower limb venous disease and obesity is increasing. Obesity is an important risk factor for all types of lower limb venous disease, and obese patients with lower limb venous disease are more likely to be symptomatic as a result of their lower limb venous disease. The clinical diagnosis, investigation, imaging and treatment of lower limb venous disease in obese people present a number of challenges. The evidence base underpinning medical, surgical and endovenous management of lower limb venous disease in obese people is limited and such treatment may be associated with worse outcomes and increased risks when compared to patients with a normal body mass index. Conclusion Lower limb venous disease and obesity are both increasingly common. As such, phlebologists will be treating ever greater numbers of obese patients with lower limb venous disease, and clinicians in many other specialties are going to be treating a wide range of obesity-related health problems in people with or at risk of lower limb venous disease. Unfortunately

  3. Relative risk of diabetes, dyslipidaemia, hypertension and the metabolic syndrome in people with severe mental illnesses: Systematic review and metaanalysis

    Directory of Open Access Journals (Sweden)

    King Michael B

    2008-09-01

    Full Text Available Abstract Background Severe mental illnesses (SMI may be independently associated with cardiovascular risk factors and the metabolic syndrome. We aimed to systematically assess studies that compared diabetes, dyslipidaemia, hypertension and metabolic syndrome in people with and without SMI. Methods We systematically searched MEDLINE, EMBASE, CINAHL & PsycINFO. We hand searched reference lists of key articles. We employed three search main themes: SMI, cardiovascular disease, and each cardiovascular risk factor. We selected cross-sectional, case control, cohort or intervention studies comparing one or more risk factor in both SMI and a reference group. We excluded studies without any reference group. We extracted data on: study design, cardiovascular risk factor(s and their measurement, diagnosis of SMI, study setting, sampling method, nature of comparison group and data on key risk factors. Results Of 14592 citations, 134 papers met criteria and 36 were finally included. 26 reported on diabetes, 12 hypertension, 11 dyslipidaemia, and 4 metabolic syndrome. Most studies were cross sectional, small and several lacked comparison data suitable for extraction. Meta-analysis was possible for diabetes, cholesterol and hypertension; revealing a pooled risk ratio of 1.70 (1.21 to 2.37 for diabetes and 1.11 (0.91 to 1.35 of hypertension. Restricting SMI to schizophreniform illnesses yielded a pooled risk ratio for diabetes of 1.87 (1.68 to 2.09. Total cholesterol was not higher in people with SMI (Standardized Mean Difference -0.10 (-0.55 to 0.36 and there were inconsistent data on HDL, LDL and triglycerides with some, but not all, reporting lower levels of HDL cholesterol and raised triglyceride levels. Metabolic syndrome appeared more common in SMI. Conclusion Diabetes (but not hypertension is more common in SMI. Data on other risk factors were limited by poor quality or inconsistent research findings, but a small number of studies show greater prevalence

  4. Transposition of cephalic vein to rescue hemodialysis access arteriovenous fistula and treat symptomatic central venous obstruction

    Directory of Open Access Journals (Sweden)

    Felipe Jose Skupien

    2014-03-01

    Full Text Available It is known that stenosis or central venous obstruction affects 20 to 50% of patients who undergo placement of catheters in central veins. For patients who are given hemodialysis via upper limbs, this problem causes debilitating symptoms and increases the risk of loss of hemodialysis access. We report an atypical case of treatment of a dialysis patient with multiple comorbidities, severe swelling and pain in the right upper limb (RUL, few alternative sites for hemodialysis vascular access, a functioning brachiobasilic fistula in the RUL and severe venous hypertension in the same limb, secondary to central vein occlusion of the internal jugular vein and right brachiocephalic trunk. The alternative surgical treatment chosen was to transpose the RUL cephalic vein, forming a venous necklace at the anterior cervical region, bypassing the site of venous occlusion. In order to achieve this, we dissected the cephalic vein in the right arm to its junction with the axillary vein, devalved the cephalic vein and anastomosed it to the contralateral external jugular vein, providing venous drainage to the RUL, alleviating symptoms of venous hypertension and preserving function of the brachiobasilic fistula.

  5. Chronic Liver Disease: Noninvasive Subharmonic Aided Pressure Estimation of Hepatic Venous Pressure Gradient

    OpenAIRE

    Eisenbrey, John R.; Dave, Jaydev K.; Halldorsdottir, Valgerdur G.; Merton, Daniel A.; Miller, Cynthia; Gonzalez, José M.; Machado, Priscilla; Park, Suhyun; Dianis, Scott; Chalek, Carl L.; Kim, Christopher E.; Baliff, Jeffrey P.; Thomenius, Kai E.; Brown, Daniel B.; Navarro, Victor

    2013-01-01

    In this study, we correlated subharmonic aided pressure estimation data with the hepatic venous pressure gradient and found good overall agreement, indicating that this noninvasive technique may be a useful screening tool for predicting the presence of clinically important portal hypertension in patients undergoing transjugular liver biopsy.

  6. A case of chylothorax in a hemodialysis patient with left innominate venous stenosis

    Directory of Open Access Journals (Sweden)

    M Limesh

    2017-01-01

    Full Text Available Chylothorax is defined as accumulation of chyle-containing lymphatic fluid within the pleural space. Chylothorax is very rarely seen in hemodialysis patients. We report a case of a patient on hemodialysis who developed chylothorax secondary to left innominate vein stenosis, with other features of venous hypertension such as arm edema successfully treated with angioplasty and pigtail drainage.

  7. A new site for venous access: superficial veins of portal collateral circulation.

    Science.gov (United States)

    Turc, Jean; Gergelé, Laurent; Attof, Rachid; Mottard, Nicolas; Bérend, Michel; David, Jean-Stéphane

    2012-01-01

    In case of failure of peripheral vascular access, classical alternatives are central venous or intraosseous access. We report a new site of vascular access necessitating no specific material. A 53-year-old patient with cirrhosis-induced coagulopathy, portal hypertension, and collateral abdominal portosystemic circulation required parenteral antibiotherapy. After failure of peripheral vein catheterization, he was addressed to our resuscitation room for central venous access. To avoid the risks associated with this invasive procedure, we chose an alternative approach. After skin preparation, a 20-gauge peripheral venous catheter was inserted in a dilated subcutaneous vein of abdominal wall. To our knowledge, it is the first human report of insertion of a catheter in a superficial vein of abdominal wall. It could be an alternative approach for vascular access after failure of peripheral venipuncture in patients with portal hypertension.

  8. Hypertension og det metaboliske syndrom

    DEFF Research Database (Denmark)

    Olsen, Michael; Jeppesen, Jørgen; Larsen, Mogens

    2009-01-01

    The metabolic syndrome is a relatively prevalent condition characterized by co-existence of several metabolic and cardiovascular risk factors including hypertension. Patients with hypertension have an increased risk of developing the metabolic syndrome which, in turn, increases the cardiovascular...... syndrome is of clinical importance as it makes the treating physician test for other elements of the syndrome in patients with one of the elements, e.g. hypertension. Udgivelsesdato: 2009-Jun-15...

  9. Hypertension og det metaboliske syndrom

    DEFF Research Database (Denmark)

    Olsen, Michael Hecht; Jeppesen, Jørgen; Larsen, Mogens Lytken

    2009-01-01

    The metabolic syndrome is a relatively prevalent condition characterized by co-existence of several metabolic and cardiovascular risk factors including hypertension. Patients with hypertension have an increased risk of developing the metabolic syndrome which, in turn, increases the cardiovascular...... syndrome is of clinical importance as it makes the treating physician test for other elements of the syndrome in patients with one of the elements, e.g. hypertension. Udgivelsesdato: 2009-Jun...

  10. A rat model of central venous catheter to study establishment of long-term bacterial biofilm and related acute and chronic infections.

    Science.gov (United States)

    Chauhan, Ashwini; Lebeaux, David; Decante, Benoit; Kriegel, Irene; Escande, Marie-Christine; Ghigo, Jean-Marc; Beloin, Christophe

    2012-01-01

    Formation of resilient biofilms on medical devices colonized by pathogenic microorganisms is a major cause of health-care associated infection. While in vitro biofilm analyses led to promising anti-biofilm approaches, little is known about their translation to in vivo situations and on host contribution to the in vivo dynamics of infections on medical devices. Here we have developed an in vivo model of long-term bacterial biofilm infections in a pediatric totally implantable venous access port (TIVAP) surgically placed in adult rats. Using non-invasive and quantitative bioluminescence, we studied TIVAP contamination by clinically relevant pathogens, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Staphylococcus epidermidis, and we demonstrated that TIVAP bacterial populations display typical biofilm phenotypes. In our study, we showed that immunocompetent rats were able to control the colonization and clear the bloodstream infection except for up to 30% that suffered systemic infection and death whereas none of the immunosuppressed rats survived the infection. Besides, we mimicked some clinically relevant TIVAP associated complications such as port-pocket infection and hematogenous route of colonization. Finally, by assessing an optimized antibiotic lock therapy, we established that our in vivo model enables to assess innovative therapeutic strategies against bacterial biofilm infections.

  11. A Rat Model of Central Venous Catheter to Study Establishment of Long-Term Bacterial Biofilm and Related Acute and Chronic Infections

    Science.gov (United States)

    Chauhan, Ashwini; Lebeaux, David; Decante, Benoit; Kriegel, Irene; Escande, Marie-Christine; Ghigo, Jean-Marc; Beloin, Christophe

    2012-01-01

    Formation of resilient biofilms on medical devices colonized by pathogenic microorganisms is a major cause of health-care associated infection. While in vitro biofilm analyses led to promising anti-biofilm approaches, little is known about their translation to in vivo situations and on host contribution to the in vivo dynamics of infections on medical devices. Here we have developed an in vivo model of long-term bacterial biofilm infections in a pediatric totally implantable venous access port (TIVAP) surgically placed in adult rats. Using non-invasive and quantitative bioluminescence, we studied TIVAP contamination by clinically relevant pathogens, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Staphylococcus epidermidis, and we demonstrated that TIVAP bacterial populations display typical biofilm phenotypes. In our study, we showed that immunocompetent rats were able to control the colonization and clear the bloodstream infection except for up to 30% that suffered systemic infection and death whereas none of the immunosuppressed rats survived the infection. Besides, we mimicked some clinically relevant TIVAP associated complications such as port-pocket infection and hematogenous route of colonization. Finally, by assessing an optimized antibiotic lock therapy, we established that our in vivo model enables to assess innovative therapeutic strategies against bacterial biofilm infections. PMID:22615964

  12. Urinary Prothrombin Fragment 1+2 in relation to Development of Non-Symptomatic and Symptomatic Venous Thromboembolic Events following Total Knee Replacement

    Directory of Open Access Journals (Sweden)

    Lars C. Borris

    2011-01-01

    Full Text Available Prothrombin fragment 1+2 is excreted in urine (uF1+2 as a result of in vivo thrombin generation and can be a marker of coagulation status after an operative procedure. This study compared uF1+2 levels in patients with symptomatic and non-symptomatic venous thromboembolism (VTE after total knee replacement (TKR and in event-free sex- and age-matched controls. Significantly higher median uF1+2 levels were seen in the VTE patients on days 1, 3, and the day of venography (mostly day 7 after TKR compared with controls. The uF1+2 levels tended to be high in some patients with symptomatic VTE; however, the discriminatory efficacy of the test could not be evaluated. In conclusion, this study showed that patients with VTE tend to have significantly higher uF1+2 levels compared with patients without events between days 1 and 7 after TKR surgery. Measurement of uF1+2 could provide a simple, non-invasive clinical test to identify patients at risk of VTE.

  13. A rat model of central venous catheter to study establishment of long-term bacterial biofilm and related acute and chronic infections.

    Directory of Open Access Journals (Sweden)

    Ashwini Chauhan

    Full Text Available Formation of resilient biofilms on medical devices colonized by pathogenic microorganisms is a major cause of health-care associated infection. While in vitro biofilm analyses led to promising anti-biofilm approaches, little is known about their translation to in vivo situations and on host contribution to the in vivo dynamics of infections on medical devices. Here we have developed an in vivo model of long-term bacterial biofilm infections in a pediatric totally implantable venous access port (TIVAP surgically placed in adult rats. Using non-invasive and quantitative bioluminescence, we studied TIVAP contamination by clinically relevant pathogens, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Staphylococcus epidermidis, and we demonstrated that TIVAP bacterial populations display typical biofilm phenotypes. In our study, we showed that immunocompetent rats were able to control the colonization and clear the bloodstream infection except for up to 30% that suffered systemic infection and death whereas none of the immunosuppressed rats survived the infection. Besides, we mimicked some clinically relevant TIVAP associated complications such as port-pocket infection and hematogenous route of colonization. Finally, by assessing an optimized antibiotic lock therapy, we established that our in vivo model enables to assess innovative therapeutic strategies against bacterial biofilm infections.

  14. Secondary Hypertension

    Science.gov (United States)

    ... thyroid gland doesn't produce enough thyroid hormone (hypothyroidism) or produces too much thyroid hormone (hyperthyroidism), high ... pressure. All of these factors can cause hypertension. Pregnancy. Pregnancy can make existing high blood pressure worse, ...

  15. Pulmonary Hypertension

    Science.gov (United States)

    Pulmonary hypertension (PH) is high blood pressure in the arteries to your lungs. It is a serious condition. If you have ... that carry blood from your heart to your lungs become hard and narrow. Your heart has to ...

  16. Hypertension screening

    Science.gov (United States)

    Foulke, J. M.

    1975-01-01

    An attempt was made to measure the response to an announcement of hypertension screening at the Goddard Space Center, to compare the results to those of previous statistics. Education and patient awareness of the problem were stressed.

  17. Unilateral papilledema in cerebral venous sinus thrombosis

    Directory of Open Access Journals (Sweden)

    Girish Baburao Kulkarni

    2017-01-01

    Full Text Available In the majority of patients with raised intracranial pressure, the papilledema is bilateral. Unilateral papilledema is rare in conditions causing intracranial hypertension, and it has been described in Foster–Kennedy syndrome and in some cases of idiopathic intracranial hypertension. It has never been reported in cerebral venous thrombosis. We report a young lady presenting with features of subacute onset of headache with seizures, on evaluation she had superior sagittal and bilateral lateral sinus thrombosis. The risk factors found on evaluation were Vitamin B12 deficiency and hyperhomocysteinemia. On optic fundus examination, she had swollen optic disc on the right side with normal fundus on the left side, confirmed with the orbital ultrasound B-scan and optic coherence tomography. Her magnetic resonance imaging showed features of raised intracranial pressure with thrombosis of the superior sagittal and bilateral lateral sinus thrombosis. She was treated with anticoagulation (heparin followed by oral anticoagulants, antiedema measures, and vitamin supplementation for hyperhomocysteinemia. She improved over time and was asymptomatic during follow-up. We discuss the possible mechanisms described in the literature for unilateral papilledema. This report highlights the need for carefully performing bilateral fundus examination so as not to miss the vision or life-threatening causes of a headache.

  18. Idiopathic non-cirrhotic portal hypertension: a review

    OpenAIRE

    Schouten, Jeoffrey NL; Verheij, Joanne; Seijo, Susana

    2015-01-01

    Idiopathic non-cirrhotic portal hypertension (INCPH) is a rare disease characterized of intrahepatic portal hypertension in the absence of cirrhosis or other causes of liver disease and splanchnic venous thrombosis. The etiology of INCPH can be classified in five categories: 1) immunological disorders (i.e. association with common variable immunodeficiency syndrome, connective tissue diseases, Crohn?s disease, etc.), 2) chronic infections, 3) exposure to medications or toxins (e.g. azathiopri...

  19. Endokrin hypertension

    DEFF Research Database (Denmark)

    Poulsen, Per Løgstrup; Ibsen, Hans

    2009-01-01

    Endocrine hypertension is rare, but frequently refractory. Adenomas are common incidental findings. Biochemical tests confirm the diagnosis. Primary aldosteronism is the most common form. Hypokalaemia is an important sign, but 50% of patients may be normokalaemic. The plasma-aldosterone-to-renin ......Endocrine hypertension is rare, but frequently refractory. Adenomas are common incidental findings. Biochemical tests confirm the diagnosis. Primary aldosteronism is the most common form. Hypokalaemia is an important sign, but 50% of patients may be normokalaemic. The plasma...

  20. Pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    Lauro Martins Júnior

    2014-12-01

    Full Text Available Pulmonary hypertension is a pathological condition associated with various diseases, which must be remembered by the physicians, since early diagnosis may anticipate and avoid dangerous complications and even death if appropriate measures were not taken. The relationship with chronic obstructive pulmonary disease (COPD, important pathological process that is in increasing prevalence in developing countries, and leading position as cause of death, emphasizes its importance. Here are presented the classifications, pathophysiology, and general rules of treatment of pulmonary hypertension.

  1. Prospective study of Dietary Approaches to Stop Hypertension- and Mediterranean-style dietary patterns and age-related cognitive change: the Cache County Study on Memory, Health and Aging

    National Research Council Canada - National Science Library

    Wengreen, Heidi; Munger, Ronald G; Cutler, Adele; Quach, Anna; Bowles, Austin; Corcoran, Christopher; Tschanz, Joann T; Norton, Maria C; Welsh-Bohmer, Kathleen A

    2013-01-01

    .... We examined associations between Dietary Approaches to Stop Hypertension (DASH)- and Mediterranean-style dietary patterns and age-related cognitive change in a prospective, population-based study...

  2. Cumulative Evidence of Randomized Controlled and Observational Studies on Catheter-Related Infection Risk of Central Venous Catheter Insertion Site in ICU Patients: A Pairwise and Network Meta-Analysis.

    Science.gov (United States)

    Arvaniti, Kostoula; Lathyris, Dimitrios; Blot, Stijn; Apostolidou-Kiouti, Fani; Koulenti, Despoina; Haidich, Anna-Bettina

    2017-04-01

    Selection of central venous catheter insertion site in ICU patients could help reduce catheter-related infections. Although subclavian was considered the most appropriate site, its preferential use in ICU patients is not generalized and questioned by contradicted meta-analysis results. In addition, conflicting data exist on alternative site selection whenever subclavian is contraindicated. To compare catheter-related bloodstream infection and colonization risk between the three sites (subclavian, internal jugular, and femoral) in adult ICU patients. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled trials, CINAHL, and ClinicalTrials.gov. Eligible studies were randomized controlled trials and observational ones. Extracted data were analyzed by pairwise and network meta-analysis. Twenty studies were included; 11 were observational, seven were randomized controlled trials for other outcomes, and two were randomized controlled trials for sites. We evaluated 18,554 central venous catheters: 9,331 from observational studies, 5,482 from randomized controlled trials for other outcomes, and 3,741 from randomized controlled trials for sites. Colonization risk was higher for internal jugular (relative risk, 2.25 [95% CI, 1.84-2.75]; I = 0%) and femoral (relative risk, 2.92 [95% CI, 2.11-4.04]; I = 24%), compared with subclavian. Catheter-related bloodstream infection risk was comparable for internal jugular and subclavian, higher for femoral than subclavian (relative risk, 2.44 [95% CI, 1.25-4.75]; I = 61%), and lower for internal jugular than femoral (relative risk, 0.55 [95% CI, 0.34-0.89]; I = 61%). When observational studies that did not control for baseline characteristics were excluded, catheter-related bloodstream infection risk was comparable between the sites. In ICU patients, internal jugular and subclavian may, similarly, decrease catheter-related bloodstream infection risk, when compared with femoral. Subclavian could be suggested as the most

  3. Evaluation of microcirculation in elderly patients with venous trophic ulcers.

    Science.gov (United States)

    Losev, R Z; Burov, Iu A; Mikul'skaia, Ie G; Iakusheva, Ie A

    2005-01-01

    Altogether 112 patients over 50 years of age suffering from varicosity and chronic trophic ulcers of the distal limb segments were examined. The work was based on an analysis of the microcirculatory flow in lower limb tissues (laser Doppler flowmetry, BLF 21 system, Transonic Systems Inc., USA) and on the evaluation of tissue metabolism by measuring partial oxygen and carbon dioxide tension (percutaneous polarography; TCM-3 system, Radiometry Company, Denmark). The postischemic and orthostatic tests were used to assess the functional microcirculatory reserve. The data obtained indicate local tissue hypoxia in elderly patients with venous trophic ulcers associated with an increase of the basal flow only in the lower third of the leg. Venous trophic ulcers are marked by a significant reduction of partial oxygen tension in the tissues adjacent to the area of trophic ulcers to 4.3+/-0.5 mm Hg on the average in the presence of the low functional microcirculatory reserve. Local tissue hypoxia in the area of trophic ulcers, which develops despite an increase of blood inflow to the microcirculatory bed evidences inhibition of tissue flow and activation of the arterio-venular bypasses. The results obtained in the course of the study allow to optimize the treatment policy in elderly patients suffering from venous trophic ulcers. In addition to the measures lowering venous hypertension, the treatment should include correction of microcirculatory disorders, which is to be carried out in the pre- and postoperative periods.

  4. Central venous line associated osteomyelitis in children with intestinal failure

    Directory of Open Access Journals (Sweden)

    Teresa Yu

    2018-02-01

    Full Text Available Children with intestinal failure often require long-term central venous access for parenteral nutrition. Line-related complications often include liver dysfunction, sepsis, and loss of venous access. Osteomyelitis is a rare complication that has been reported in adults with intestinal failure. There has been little focus, however, on the development of osteomyelitis in the pediatric population. In this study we present 2 case studies of patients with intestinal failure requiring parenteral nutrition who subsequently developed acute osteomyelitis.

  5. Intracranial hemorrhage due to intracranial hypertension caused by the superior vena cava syndrome

    DEFF Research Database (Denmark)

    Bartek, Jiri; Abedi-Valugerdi, Golbarg; Liska, Jan

    2013-01-01

    We report a patient with intracranial hemorrhage secondary to venous hypertension as a result of a giant aortic pseudoaneurysm that compressed the superior vena cava and caused obstruction of the venous return from the brain. To our knowledge, this is the first patient reported to have an intracr......We report a patient with intracranial hemorrhage secondary to venous hypertension as a result of a giant aortic pseudoaneurysm that compressed the superior vena cava and caused obstruction of the venous return from the brain. To our knowledge, this is the first patient reported to have...... an intracranial hemorrhage secondary to a superior vena cava syndrome. The condition appears to be caused by a reversible transient rise in intracranial pressure, as a result of compression of the venous return from the brain. Treatment consisted of surgery for the aortic pseudoaneurysm, which led...

  6. Exercise and cardiovascular outcomes in hypertensive patients in relation to structure and function of left ventricular hypertrophy: the LIFE study

    DEFF Research Database (Denmark)

    Boman, Kurt; Gerdts, Eva; Wachtell, Kristian

    2009-01-01

    BACKGROUND: Exercise lowers blood pressure and improves cardiovascular function, but little is known about whether exercise impacts cardiovascular morbidity and mortality independent of left ventricular hypertrophy (LVH) and LV geometry. DESIGN: Observational analysis of prospectively obtained...... (never exercise), intermediate (30 min twice/week). During 4.8-year follow-up, 105 patients suffered the primary composite endpoint of myocardial infarction (MI), stroke, or cardiovascular death. MI occurred in 39, stroke in 60, and cardiovascular death in 33 patients. RESULTS: Sedentary individuals (n...... echocardiographic data within the context of a randomized trial of antihypertensive treatment. METHODS: A total of 937 hypertensive patients with ECG LVH were studied by echocardiography in the Losartan Intervention For Endpoint reduction in hypertension study. Baseline exercise status was categorized as sedentary...

  7. Taste and hypertension in humans

    DEFF Research Database (Denmark)

    Roura, Eugeni; Foster, Simon; Winklebach, Anja

    2016-01-01

    The association between salty taste and NaCl intake with hypertension is well-established, although it is far from completely understood. Other taste types such as sweet, umami or bitter have also been related to alterations in blood pressure. Here, we review the mutual relationship between taste...... and hypertension to identify potential avenues to better control blood pressure. This review focuses on published data involving humans, with the exception of a section on molecular mechanisms. There is compelling evidence to suggest that changes in salty taste sensitivity can be used to predict the onset...... of hypertension. This goes hand in hand with the medical concept of sodium sensitivity, which also increases with age, particularly in hypertensive patients. The association of hypertension with the loss of taste acuity less definitive with some data/conclusions masked by the use of anti-hypertensive drugs...

  8. Expression of glucose transporter-1 and aquaporin-4 in the cerebral cortex of stroke-prone spontaneously hypertensive rats in relation to the blood-brain barrier function.

    Science.gov (United States)

    Ishida, Hiroyuki; Takemori, Kumiko; Dote, Kensaku; Ito, Hiroyuki

    2006-01-01

    Cerebral edema is an important initial event in cases of stroke among humans. Although hypertension is a major risk factor for endothelial injury, the precise mechanisms regulating brain microvascular changes are still unknown. To elucidate the pathogenesis of increases in vascular permeability in the cerebral cortex, we investigated the expression of glucose transporter-1 (GLUT-1) in endothelial cells and aquaporin-4 (AQP4) in astrocytes in relation to blood-brain barrier (BBB) function. Using male stroke-prone spontaneously hypertensive rats (SHRSP) and normotensive Wistar-Kyoto rats (WKY), the particular localization of both GLUT-1 and AQP4 was investigated by immunohistochemistry. Quantitative changes in these molecules were examined by Western blot analysis in these rats at 6 weeks and 20 weeks of age. Furthermore, to investigate the expression of these molecules at the mRNA level, reverse transcriptase-polymerase chain reaction (RT-PCR) analysis was carried out using 20-week-old SHRSP and age-matched WKY. We confirmed the localization of GLUT-1 in endothelial cells and that of AQP4 in the end feet of astrocytes around microvessels, as determined by electron immunohistochemistry. No significant differences were found in the expression of these molecules in rats at 6 weeks of age, whereas GLUT-1 expression was lower, but that of AQP4 was higher, in SHRSP after the establishment of hypertension. Furthermore, GLUT-1 mRNA expression was lower in SHRSP, and AQP4 mRNA expression was also lower in SHRSP than in WKY at 20 weeks of age. These results indicate that AQP4 may play a much more important role in BBB function than GLUT-1, and thereby also in water distribution in the cerebral cortex of SHRSP with severe hypertension.

  9. Venous chest anatomy: clinical implications.

    Science.gov (United States)

    Chasen, M H; Charnsangavej, C

    1998-03-01

    This article provides a practical approach to the clinical implications and importance of understanding the collateral venous anatomy of the thorax. Routine radiography, conventional venography, computed tomography (CT), and magnetic resonance (MR) imaging studies provide correlative anatomic models for the demonstration of how interconnecting collateral vascular networks within the thorax maintain venous stability at all times. Five major systems comprise the collateral venous network of the thorax (Fig. 1). These include the paravertebral, azygos-hemiazygos, internal mammary, lateral thoracic, and anterior jugular venous systems (AJVS). The five systems are presented in the following sequence: (a) a brief introduction to the importance of catheter position and malposition in understanding access to the thoracic venous system, (b) the anatomy of the azygos-hemiazygos systems and their relationship with the paravertebral plexus, (c) the importance of the AJVS, (d) 'loop' concepts interconnecting the internal mammary and azygos-hemiazygos systems by means of the lateral thoracic and intercostal veins, and (e) the interconnecting venous networks on the thoracic side of the thoracoabdominal junction. Certain aspects of the venous anatomy of the thorax will not be discussed in this chapter and include (a) the intra-abdominal anastomoses between the superior and inferior vena cavae (IVC) via the internal mammary, lateral thoracic, and azygos-hemiazygos systems (beyond the scope of this article), (b) potential collateral vessels involving vertebral, parascapular, thyroidal, thymic, and other smaller veins that might anastomose with the major systems, and (c) anatomic variants and pitfalls that may mimic pathologic conditions (space limitations).

  10. Mesenteric venous thrombosis: multidisciplinary therapeutic approach

    Directory of Open Access Journals (Sweden)

    Stefano Pieri

    2007-08-01

    Full Text Available Mesenteric venous thrombosis is a particular form of intestinal ischemia related to high mortality. The lack of a characteristic clinical picture often leads to a difficult diagnostic and therapeutic classification. We report the case of a young woman, using estrogenic and progestinic oral therapy, affected by a severe form of mesenteric thrombosis and complicated by segmental post ischemic stenosis of small intestine.

  11. Pacientes assintomáticos apresentam infecção relacionada ao cateter venoso utilizado para terapia nutricional parenteral Asymptomatic patients present infection related to the central venous catheter used for total parenteral nutrition

    Directory of Open Access Journals (Sweden)

    Juliana Deh Carvalho Machado

    2009-12-01

    Full Text Available OBJETIVO: Avaliar a freqüência de infecção relacionada ao cateter venoso central em pacientes submetidos a terapia nutricional parenteral. MÉTODOS: Foram analisados os cateteres venosos centrais de pacientes em terapia nutricional parenteral que tiveram a indicação de retirada do cateter venoso central por infecção, alta hospitalar, ou trombose. Os pacientes com infecção foram denominados de Grupo 1 e os demais de Grupo 2. RESULTADOS: Não houve diferença estatisticamente significante quanto ao estado nutricional dos 18 pacientes analisados. Foram analisados 28 cateteres e destes 68% estavam infectados, sendo 72% do Grupo 1 e 28% do Grupo 2 (assintomáticos. No Grupo 1, houve infecção sistêmica em 70% dos casos, já no Grupo 2 a hemocultura foi positiva em 17% dos casos. A colonização por Staphylococcus sp. ocorreu em 48% dos casos, seguida de Candida sp. (21%, Enterococcus faecalis (16%, Pseudomonas aerurginosa (10% e Proteus sp.(5%. CONCLUSÃO: A contaminação de cateter venoso central utilizado para terapia nutricional parenteral é freqüente. Mesmo pacientes assintomáticos recebendo nutrição parenteral têm uma incidência maior de infecção por Candida sp. Portanto é necessária a criação de barreiras que impeçam a colonização destes cateteres venosos centrais, a fim de diminuir a morbimortalidade de pacientes dependentes deste tipo de terapia.OBJECTIVE: The aim of this study was to evaluate the frequency of central venous catheter-related infections in hospitalized patients receiving total parenteral nutrition. METHODS: Central venous catheters were analyzed immediately after removal due to infection, hospital discharge or thrombosis. The patients with catheter-related infection were named Group 1 and the other patients were named Group 2. RESULTS: Eighteen patients were studied. There was no statistically significant difference in nutritional status between the two groups. A total of 28 catheters were analyzed

  12. Global Pulmonary Vascular Remodeling in Pulmonary Hypertension Associated with Heart Failure and Preserved or Reduced Ejection Fraction.

    Science.gov (United States)

    Fayyaz, Ahmed U; Edwards, William D; Maleszewski, Joseph J; Konik, Ewa A; DuBrock, Hilary M; Borlaug, Barry A; Frantz, Robert P; Jenkins, Sarah M; Redfield, Margaret M

    2017-12-15

    Background -We hypothesized that pulmonary venous hypertension in heart failure (HF) leads to predominate remodeling of pulmonary veins and that the severity of venous remodeling is associated with the severity of pulmonary hypertension (PH) in HF. Methods -Patients with HF (n=108; 53 preserved and 55 reduced ejection fraction) with PH (HF-PH; pulmonary artery systolic pressure (PASP) ≥ 40 mmHg) were compared to normal Controls (n=12) and patients with primary pulmonary veno-occlusive disease (PVOD; n=17). In lung specimens from autopsy (Control, HF-PH and 7 PVOD) or surgery (10 PVOD), quantitative histomorphometry was performed in all analyzable arteries (n=4,949), veins (n=7,630) and small indeterminate vessels (IV, n=2,168) to define % medial thickness (%MT) [arteries] and % intimal thickness (%IT) [arteries, veins and IV] relative to external diameter. Results -The average arterial %MT (Control 6.9; HF-PH 11.0; PVOD 15.0); arterial %IT (Control 4.9; HF-PH 14.9; PVOD 31.1); venous %IT (Control 14.0; HF-PH 24.9; PVOD 43.9) and IV %IT (Control 10.6; HF-PH 25.8; PVOD 50.0) in HF-PH were higher than Controls (p<0.0001 for all) but lower than PVOD (p≤0.005 for all). PASP (mmHg) was lower in HF-PH (median 59 [IQR 50-70]) than PVOD (91 [82-103]). PASP correlated with arterial %MT (r=0.41) and arterial %IT (r=0.35) but more strongly with venous %IT (r=0.49) and IV %IT (r=0.55) (p<0.0001 for all). Associations between PASP and venous or IV %IT remained significant after adjusting for arterial %MT and %IT and did not vary by HF type. In patients with right heart catheterization (30 HF-PH; 14 PVOD) similar associations between the transpulmonary gradient and pulmonary vascular remodeling existed, with numerically stronger associations for venous and IV %IT. While the PASP was slightly higher in HF-PH patients with right ventricular dysfunction, pulmonary vascular remodeling was not more severe. Pulmonary vascular remodeling severity was associated with reductions in

  13. Cardiac arrhythmias associated with umbilical venous catheterisation in neonates

    Science.gov (United States)

    Verheij, Gerdina; Smits-Wintjens, Vivianne; Rozendaal, Lieke; Blom, Nico; Walther, Frans; Lopriore, Enrico

    2009-01-01

    Umbilical venous catheters (UVCs) are commonly used in the management of severely ill neonates. Several life-threatening complications have been described, including catheter-related infections, myocardial perforation, pericardial effusion and cardiac arrhythmias. This report describe two neonates with cardiac arrhythmias due to umbilical venous catheterisation. One neonate had a supraventricular tachycardia requiring treatment with intravenous adenosine administration. Another neonate had an atrial flutter and was managed successfully with synchronised cardioversion. The primary cause of cardiac arrhythmias after umbilical venous catheterisation is inappropriate position of the UVC within the heart and the first step to treat them should be to pull back or even remove the catheter. Cardiac arrhythmia is a rare but potentially severe complication of umbilical venous catheterisation in neonates. PMID:21691401

  14. Dutch guideline for the management of hypertensive crisis -- 2010 revision.

    Science.gov (United States)

    van den Born, B J H; Beutler, J J; Gaillard, C A J M; de Gooijer, A; van den Meiracker, A H; Kroon, A A

    2011-05-01

    Hypertensive crises are divided into hypertensive urgencies and emergencies. Together they form a heterogeneous group of acute hypertensive disorders depending on the presence or type of target organs involved. Despite better treatment options for hypertension, hypertensive crisis and its associated complications remain relatively common. In the Netherlands the number of patients starting renal replacement therapy because of 'malignant hypertension' has increased in the past two decades. In 2003, the first Dutch guideline on hypertensive crisis was released to allow a standardised evidence-based approach for patients presenting with a hypertensive crisis. In this paper we give an overview of the current management of hypertensive crisis and discuss several important changes incorporated in the 2010 revision. These changes include a modification in terminology replacing 'malignant hypertension' with 'hypertensive crisis with retinopathy and reclassification of hypertensive crisis with retinopathy under hypertensive emergencies instead of urgencies. With regard to the treatment of hypertensive emergencies, nicardipine instead of nitroprusside or labetalol is favoured for the management of perioperative hypertension, whereas labetalol has become the drug of choice for the treatment of hypertension associated with pre-eclampsia. For the treatment of hypertensive urgencies, oral administration of nifedipine retard instead of captopril is recommended as first-line therapy. In addition, a section on the management of hypertensive emergencies according to the type of target organ involved has been added. Efforts to increase the awareness and treatment of hypertension in the population at large may lower the incidence of hypertensive crisis and its complications.

  15. Doppler ultrasound study and venous mapping in chronic venous insufficiency.

    Science.gov (United States)

    García Carriazo, M; Gómez de las Heras, C; Mármol Vázquez, P; Ramos Solís, M F

    2016-01-01

    Chronic venous insufficiency of the lower limbs is very prevalent. In recent decades, Doppler ultrasound has become the method of choice to study this condition, and it is considered essential when surgery is indicated. This article aims to establish a method for the examination, including venous mapping and preoperative marking. To this end, we review the venous anatomy of the lower limbs and the pathophysiology of chronic venous insufficiency and explain the basic hemodynamic concepts and the terminology required to elaborate a radiological report that will enable appropriate treatment planning and communication with other specialists. We briefly explain the CHIVA (the acronym for the French term "cure conservatrice et hémodynamique de l'insuffisance veineuse en ambulatoire"=conservative hemodynamic treatment for chronic venous insufficiency) strategy, a minimally invasive surgical strategy that aims to restore correct venous hemodynamics without resecting the saphenous vein. Copyright © 2015 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

  16. What is hypertension in diabetes?