Secreting Benign Paraganglioma of the Prostatic Urethra

1983 ◽  
Vol 69 (1) ◽  
pp. 79-82 ◽  
Author(s):  
Giuseppe Altavilla ◽  
Luigi Cavazzini ◽  
Rosario Russo
Keyword(s):  
Prostatic Urethra ◽  
Systemic Hypertension ◽  
Hyperplastic Gland

A case of benign paraganglioma of the prostatic urethra, incidentally discovered in a hyperplastic gland, is reported. Presurgical mild systemic hypertension, which suggested the paraganglioma secreting activity, became normal in the postoperative follow-up.

Myocardial work analysis in screening of familial dilated cardiomyopathy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Triantafyllou ◽  
R Monteiro ◽  
A Protonotarios ◽  
T Gossios ◽  
P Elliott ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Dilated Cardiomyopathy ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Systemic Hypertension ◽  
Work Efficiency ◽  
Work Analysis ◽  
Significant Difference ◽  
Global Work

Abstract Introduction Early detection of affected family relatives of patients with dilated cardiomyopathy (DCM) is essential in order to guide follow up, outcomes and initiate early treatment. Myocardial work analysis is a novel method which integrated strain imaging and blood pressure and has the potential to identify patients with subclinical disease. Purpose We analysed myocardial work in family relatives of DCM patients with positive genotype but negative phenotype in order to identify whether myocardial work can identify early changes. Methods Seventy-four family relatives of DCM patients attending for screening were examined. All individuals were asymptomatic with either positive (45/74, G+) or negative (29/74, G-) genotype and no echocardiographic evidence of left ventricular dilatation or systolic impairment. Non-invasive myocardial work analysis using two-dimensional (2D) speckle tracking echocardiography was analysed. Global longitudinal strain (GLS) was measured by the same vendor specific software used for myocardial work analysis. Left ventricular (LV) ejection fraction (EF) was measured with the Simpson's biplane method. The peak systolic arm cuff blood pressure (BP) measurement at the time of echocardiography was used for the myocardial work study. Results In total we included 74 individuals (37±15 years old, 50.7% women) with mean systolic and diastolic BP of 121.3±14 and 73.2±10 mmHg respectively, mean EF was 58±5% and mean GLS at 18.4±2.5%. G+ individuals had pathogenic and very likely pathogenic mutations in 8 different genes (TTN, BAG3, DSP, FLNC, LMNA, DMD, RBM20, TPM1). There was no difference in age, systemic hypertension, diabetes or medical treatment between the 2 groups. No significant difference was found among G+ and G- individuals in mean systolic and diastolic BP (121.2±14.7 vs 121.2±15.2 mmHg), mean EF (57.3±5 vs 59.1±4%), GLS (−18.2±1.5 vs −18.6±2.9%), mean global work index (1818±403 vs 1928±295 mmHg%) and global constructive work (2192±464 vs 2260±318 mmHg%). However, we found significant reduction of the global work efficiency (GWE) with a GWE of 94.4±2.7% in the G+ versus 95.9±1.6% in the G- individuals (p 0.02). Moreover, the global wasted work (GWW) was increased in the G+ with a GWW of 111±58 mmHg% versus 82±41 mmHg% in the G- individuals (p 0.03). Conclusion DCM gene carriers show, early on, decreased myocardial work efficiency and increased wasted work compared to unaffected family members, which appears to be earlier than other parameters such as EF and GLS. Myocardial work analysis could potentially recognize individuals showing early cardiac involvement and guide closer follow up and early initiation of treatment. Funding Acknowledgement Type of funding source: None

Nemaline Myopathy as a Cause of Sleep Hypoventilation

PEDIATRICS ◽  
1986 ◽  
Vol 77 (3) ◽  
pp. 390-395
Author(s):  
Ch. Maayan ◽  
C. Springer ◽  
Y. Armon ◽  
E. Bar-Yishay ◽  
V. Shapira ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Ventilatory Response ◽  
Nemaline Myopathy ◽  
Cor Pulmonale ◽  
Systemic Hypertension ◽  
Older Patient ◽  
And Function ◽  
Ventilatory Response To Co2

Two siblings, a 14.5-year-old boy and his 11.5-year-old sister, with congenital nemaline myopathy presented with severe respiratory failure and, in the case of the older patient, with cor pulmonale and systemic hypertension. The children were treated initially by continuous mechanical ventilation, but after a few weeks they only required ventilation at night. At the start of treatment, both were found to have a decreased ventilatory response to CO2 which apparently improved during 4 to 5 years of follow-up treatment. It has not been possible to wean them from nocturnal mechanical ventilation, but during the daytime they attend school and function almost normally. It is postulated that respiratory failure in nemaline myopathy may not be related to the severity of the muscle weakness but may result from a disturbance of the feedback required for normal control of breathing.

A case of nodular episcleritis mimicking a solitary giant episcleral mass

2021 ◽  
pp. 112067212110528
Author(s):  
Lan Zhou ◽  
Juanjuan Wang ◽  
Guihua Xu ◽  
Dingding Wang ◽  
Xiaoyi Wang ◽  
...  
Keyword(s):  
Topical Steroid ◽  
Inflammatory Cells ◽  
Systemic Hypertension ◽  
Eye Drops ◽  
Definite Diagnosis ◽  
Imaging Studies ◽  
Immunohistochemical Examination ◽  
History Of ◽  
Inflammatory Drugs

Purpose To describe an atypical nodular episcleritis mimicking a solitary giant episcleral mass, which is not attributed to any systemic diseases and identified only after immunohistochemical examination. Case report A sixty-year-old Chinese woman with systemic hypertension presented with 6-month history of giant, solitary and redness epibulbar mass arising from the superior aspect of her left eye. The lesion gradually enlarged, even with 6-month history of irregular topical steroid eye drops treatment. Imaging studies and laboratory test revealed a 10 mm × 8 mm episcleral mass absence of any infection indicator and autoimmune antibody changes. The mass was completely removed before its extension through the deep scleral, histopathologic examination revealed a nodular episcleritis composed of various chronic inflammatory cells infiltration. Topical steroid eye drops treatment combined with oral steroidal anti-inflammatory drugs was then administrated regularly for 1 month, and no recurrence occurred after 1-year follow-up. Conclusion Nodular anterior episcleritis is characterized by underlying chronic inflammation of the anterior episclera and can be presented as asymptomatic episcleral mass. Besides a thorough investigation systemically, tissue biopsy is required for definite diagnosis.

Risk of Ischemic Stroke in High Risk Atrial Fibrillation Patients during Periods of Warfarin Discontinuation for Surgical Procedures

2016 ◽  
Vol 42 (5-6) ◽  
pp. 346-351 ◽  
Author(s):  
Adnan I. Qureshi ◽  
Nauman Jahangir ◽  
Ahmed A. Malik ◽  
Mohammad Rauf Afzal ◽  
Fayyaz Orfi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
High Risk ◽  
Surgical Procedures ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Systemic Hypertension ◽  
Ventricular Ejection Fraction

Importance: The risk of ischemic stroke during periods of warfarin discontinuation for surgical procedures is recognized but not well characterized. Objective: The study aimed to quantitate the risk of ischemic stroke associated with high risk atrial fibrillation during periods of warfarin discontinuation. Design, Setting and Participants: A cohort of 4,060 patients (mean follow-up period of 3.5 ± 1.3 years) were randomized into the Atrial Fibrillation Follow-Up Investigation of Rhythm Management study. Patients enrolled in the study had atrial fibrillation plus at least one other risk factor for stroke or death: age ≥65 years', systemic hypertension, diabetes mellitus, congestive heart failure, transient ischemic attack, prior stroke, left atrium >50 mm, left ventricular fractional shortening <25% or left ventricular ejection fraction <40%. Exposure: Warfarin discontinuation for procedure. Main Outcome and Measures: The association of warfarin discontinuation with the incidence of ischemic stroke using pooled repeated measures and Cox proportional hazards analyses during follow-up after adjusting for age, gender, obesity, diabetes mellitus, hypercholesterolemia, cigarette smoking and study period. Results: Warfarin discontinuation for procedure occurred in 265 (0.4%) of the 71,355 person observations. Compared with those without warfarin discontinuation, the rate of ischemic stroke was higher among participants with surgery-related warfarin discontinuation (1.1% of 265 person observations vs. 0.2% of 71,090 person observations, p = 0.001). Warfarin discontinuation was associated with an increased risk for ischemic stroke (relative risk 5.8; 95% CI 1.8-18.4) after adjusting for potential confounders. The population-attributable risk associated with surgery-related warfarin discontinuation was estimated to be 23.1% (95% CI 15.2-30.9%) for ischemic stroke. Conclusions and Relevance: The 6-fold higher risk of ischemic stroke associated with discontinuation of warfarin for surgical procedures must be recognized in high risk atrial fibrillation patients and considered in the risk-benefit analysis of any procedure.

scholarly journals Screening and management of hypertension in a General Practice Outpatient Department of a tertiary level teaching hospital in eastern region of Nepal

2017 ◽  
Vol 13 (1) ◽  
pp. 58-67
Author(s):  
Ashok Kumar Yadav ◽  
OD Lewis ◽  
SK Sharma ◽  
IP Mahato ◽  
R Bhandari ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Life Style ◽  
Blood Pressure Level ◽  
Outpatient Department ◽  
Systemic Hypertension ◽  
Common Disease ◽  
Eastern Region ◽  
Lifestyle Education ◽  
Over Time

Background: Hypertension is a common disease affecting about 20% of the adult population, both in developed and developing world (WHO 2002). It is one of the serious public health problems. Timely detection, compliance with lifestyle modification and use of drugs are important for effective management of this condition. Objective: To find out the prevalence of systemic hypertension in the general outpatient department and to study the effect of drugs and lifestyle education on the blood pressure over time. Methods: This was an interventional series of cases involving diagnosis and management of patients with BP higher than 140/90 or with known hypertension. All the subjects included were given life style education to see the effect of change of life style on blood pressure over time. Results: A total of 258 subjects were screened and 145 (56%) were diagnosed as hypertensive. Of the total, 75 (29%) had a blood pressure level in pre- hypertensive range. Whereas, 42 (16.3%) had hypertension of stage 1, and 28 (11%) had hypertension of stage 2. Forty- nine patients came for first follow up, 40 patients for second and 10 patients for the third follow up. Blood pressure started to decrease with second follow up. Conclusion: This study demonstrated that the prevalence of hypertension is 56% in the general outpatient department. The lifestyle education can have positive impact on blood pressure control.Health Renaissance 2015;13 (1): 58-67

scholarly journals Therapeutic options for coarctation of the aorta

2021 ◽  
Vol 16 (2) ◽  
pp. 163-167
Author(s):  
Gabriela GANEA ◽  
◽  
Mihaela Adela IANCU ◽  
Dumitru MATEI ◽  
◽  
...  
Keyword(s):  
Congenital Heart ◽  
Heart Defects ◽  
Coarctation Of The Aorta ◽  
Systemic Hypertension ◽  
Interventional Treatment ◽  
Appropriate Treatment ◽  
Long Term Follow Up ◽  
Long Term Prognosis

Coarctation of the aorta is a relatively frequent congenital heart disease. Depending on the severity of the coarctation and the possible existence of other congenital heart defects, the symptoms may vary. In the neonatal period, the patients may have signs of heart failure, hypoperfusion or even shock. Coarctation of the aorta can be diagnosed incidentally in adolescence or adulthood, usually presented with mild symptoms. The patient’s anatomy, size, age, and clinical course are taken into consideration when choosing the appropriate treatment. Although associated morbidity and mortality risks regarding surgical or interventional treatment are relatively low, it is neccesary to etabilsh a long term follow-up, given the possible post-surgical complications that may occur: recoarctation, aortic aneurysm, aortic dissection and hypertension. Long term prognosis of these patients mostly depends on the presence of systemic hypertension with its consequences leading to premature cardiovascular events. Another factor is the severity of associated defects: aortic stenosis, mitral valve abnormalities. The purpose of this review is to describe the main treatmet methods, indications for intervention and possible complications of the surgical and interventional treatment.

Hypertensive retinopathy in a neonate

2020 ◽  
Vol 13 (10) ◽  
pp. e235720
Author(s):  
Prakhar Goyal ◽  
Komal Agarwal
Keyword(s):  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Female Child ◽  
Visual Development ◽  
Fundus Photography ◽  
Systemic Hypertension ◽  
Hypertensive Retinopathy ◽  
Long Term Effects ◽  
Hard Exudates

A 23-day-old female child diagnosed as having systemic hypertensive emergency was referred for retinal screening. The fundus examination showed bilateral intraretinal haemorrhages and hard exudates especially at the macula. Venous looping was noted. The ocular features were suggestive of hypertensive retinopathy. Control of systemic hypertension was advised and was managed conservatively with close follow-up. Widefield fundus photography was done at presentation and follow-up to document the change in retinopathy with control of hypertension.The haemorrhages and exudates resolved on follow-up but significant retinal pigment epithelium changes with beaten bronze appearance were noted at the area of previous oedema. Presence of hypertensive retinopathy in a neonate is rare and has long-term effects on visual development. This report describes the course of hypertensive retinopathy in a neonate.

Abstract 2552: Hypertrophic Cardiomyopathy in Children: Do Adult Risk Factors for Cardiac Death Apply

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Jamie A Decker ◽  
Joseph W Rossano ◽  
E. O’Brian Smith ◽  
Bryan C Cannon ◽  
Sarah K Clunie ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Hypertrophic Cardiomyopathy ◽  
Family History ◽  
Blood Pressure Response ◽  
Left Ventricular ◽  
Pressure Response ◽  
Systemic Hypertension ◽  
Response To Exercise

Introduction : Annual mortality in children with hypertrophic cardiomyopathy (HCM) has been reported to be 1– 6%. Risk factors for death in adult HCM patients have been characterized; their application to pediatric HCM is unknown. The purpose of this study was to correlate adult risk factors with outcomes in our pediatric population using a standard management strategy. Methods : A retrospective cohort study of children with HCM was performed. Death and cardiac transplant were the primary outcomes. Diagnosis was based on asymmetric septal or concentric hypertrophy as determined by echocardiography. Exclusion criteria included: genetic syndrome, mitochondrial or metabolic disorder, infants of diabetic mothers, congenital heart disease, systemic hypertension, diagnosis >18 years of age, or follow-up <1 year. Results : From 1/1/85 to 10/1/06, 96 patients met inclusion criteria. Mean age at diagnosis was 10.6 ± 5.4 years. Mean follow-up was 6.5 ± 5.2 years. 11 patients had an adverse outcome (7 deaths, 4 transplants). Kaplan-Meier analysis predicts an 82% survival over 20 years. Evidence of left ventricular outflow tract obstruction (LVOTO) occurred in =6% of patients, syncope in 23% and a family history for malignant HCM in 17%. Aborted sudden death occurred in 6%. 10% had non-sustained ventricular tachycardia. 58% of patients underwent at least one exercise treadmill test. All patients were restricted from strenuous activity. 95% of patients were on a β-blocker or calcium channel blocker, with 10% on both. Additional intervention depended on symptoms, family history, and degree of LVOTO. 17% had an implantable defibrillator (ICD). 10% were given a pacemaker due to LVOTO, and 5% underwent left ventricular myectomy. Only extreme LVH (>6 z-scores for BSA) and a blunted blood pressure response to exercise were statistically significant for worse outcomes (both p<0.02). Conclusions : A low mortality/transplantation rate occurred in children with isolated HCM whose management consisted of exercise restriction and medication, with or without an ICD. Management that included myectomy was uncommon. Patients with extreme LVH and a blunted blood pressure response to exercise are high-risk individuals.

scholarly journals A Study of Prevalence and Predictors of Acute Ischemic CVA Patients Admitted to Manipal Teaching Hospital, Pokhara, Nepal

2020 ◽  
Vol 2 (1) ◽  
pp. 42-46
Author(s):  
Bishnu Jwarchan ◽  
Nikunja Yogi ◽  
Suman Adhikari ◽  
Prabin Bhandari ◽  
Subita Lalchan
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Statistical Significance ◽  
World Health ◽  
Systemic Hypertension ◽  
Female Ratio ◽  
History Of ◽  
Artery Disease ◽  
Health Organization

 Background: According to the World Health Organization (WHO), 15 million people suffer stroke worldwide each year. Of these, 5 million die, and another 5 million are left permanently disabled. Materials and methods: A retrospective hospital based observational study was carried out in patients with ischemic CVA. Modified Ranking Scale (MRS) on the follow up on 30 days after discharge was obtained. MRS 0-2 was categorized and good outcome and MRS 3-6 was categorized as poor outcome. Results: Out of 56 patients studied 33.9 % were less than 60 years of age and 63.1% were greater than 60 years of age. Male to female ratio was 1.55. MCA territory infarct was the most common with the frequency of 76.8%. There was significant association of HTN, DM, coronary artery disease and other factors as well with the outcome of the patients. Conclusion: On regards to clinic-social demographic parameters there was statistical significance between the gender of the patient, history of systemic hypertension, history of diabetes mellitus and coronary artery disease and outcome of the patient in 30 days follow up.

scholarly journals Predicting the development of normal tension glaucoma and related risk factors in normal tension glaucoma suspects

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hae-Young Lopilly Park ◽  
Da Young Shin ◽  
Soo Ji Jeon ◽  
Yong-Chan Kim ◽  
Younhea Jung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Optic Disc ◽  
Cox Regression ◽  
Normal Tension Glaucoma ◽  
Lamina Cribrosa ◽  
Baseline Risk ◽  
Systemic Hypertension ◽  
Fiber Layer ◽  
Neuroretinal Rim

AbstractThis study investigated the predicted risk factors for the development of normal-tension glaucoma (NTG) in NTG suspects. A total of 684 eyes of 379 NTG suspects who were followed-up for at least 5 years were included in the study. NTG suspects were those having (1) intraocular pressure within normal range, (2) suspicious optic disc (neuroretinal rim thinning) or enlarged cup-to-disc ratio (≥ 0.6), but without definite localized retinal nerve fiber layer (RNFL) defects on red-free disc/fundus photographs, and (3) normal visual field (VF). Demographic, systemic, and ocular characteristics were determined at the time of the first visit via detailed history-taking and examination of past medical records. Various ocular parameters were assess using spectral-domain optical coherence tomography and Heidelberg retinal tomography. Conversion to NTG was defined either by the presence of a new localized RNFL defect at the superotemporal or inferotemporal region on disc/fundus red-free photographs, or presence of a glaucomatous VF defect on pattern standard deviation plots on two consecutive tests. Hazard ratios were calculated with the Cox proportional hazard model. In total, 86 (12.6%) of the 684 NTG suspects converted to NTG during the follow-up period of 69.39 ± 7.77 months. Significant (P < 0.05, Cox regression) risk factors included medication for systemic hypertension, longer axial length, worse baseline VF parameters, thinner baseline peripapillary RNFL, greater disc torsion, and lamina cribrosa (LC) thickness < 180.5 μm (using a cut-off value obtained by regression analysis). Significant (P < 0.05, Cox regression) risk factors in the non-myopic NTG suspects included medication for systemic hypertension and a LC thinner than the cut-off value. Significant (P < 0.05, Cox regression) risk factors in the myopic NTG suspects included greater disc torsion. The results indicated that 12.6% of NTG suspects converted to NTG during the 5–6-year follow-up period. NTG suspects taking medication for systemic hypertension, disc torsion of the optic disc in the inferotemporal direction, and thinner LC of the optic nerve head at baseline were at greater risk of NTG conversion. Related baseline risk factors were different between myopic and non-myopic NTG suspects.

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