Paraganglioma of the cauda equina – Case Report and Literature Review

Paragangliomas of the cauda equina are tumors of rare incidence, with ∼ 220 cases described in the world literature. They are benign lesions, grade I by the World Health Organization (WHO), whose definitive diagnosis can only be made by immunohistochemical analysis. Its neuroendocrine nature is evidenced by the presence of chromogranin. The relevance of reporting this case is because paragangliomas of the cauda equina should be included among the differential diagnoses of intradural and extramedullary tumors, and especially because they can cause perioperative and intraoperative hypertensive crises by adrenergic discharge.The present study presents the case of a 36-year-old male patient diagnosed with a lumbar spine tumor located in the central spinal canal that presented as cauda equina syndrome involving 4 months of bilateral sciatica, paraparesis, urinary and fecal retention. The diagnosis of paraganglioma was confirmed by immunohistochemical positivity for chromogranin after microsurgical resection of the tumor.

Association of Serum Magnesium with Blood Pressure in Patients with Hypertensive Crises: A Retrospective Cross-Sectional Study

The role of magnesium in blood pressure has been studied among hypertensive patients; however, there is a dearth of studies exploring the role of magnesium in hypertensive crises. The primary objective of this study was to evaluate the relationship between serum magnesium and blood pressure in patients with hypertensive crises. This was a single-center, retrospective, chart review, cross-sectional study of patients with hypertensive crises. Patients were included if they were eighteen years of age or older, with an international classification disease ninth revision (ICD-9) code of 401.9 (hypertensive crises: emergency or urgency) and a documented magnesium level on their electronic medical record. The primary outcome of the study was the correlation between serum magnesium and blood pressure (systolic blood pressure and diastolic blood pressure) in patients with hypertensive crises. Two hundred and ninety-three patients were included in the study. The primary outcome result showed that serum magnesium was positively correlated with systolic blood pressure (r = 0.143, p = 0.014), but not diastolic blood pressure. Conclusion: This study found a significant positive association between magnesium and systolic blood pressure, but not diastolic blood pressure, among patients with hypertensive crises. This positive association of serum magnesium with systolic blood pressure was maintained after adjusting for covariates. This study’s findings suggest a potential role of magnesium in blood pressure among patients with hypertensive crises.

Preoperative factors associated with intraoperative maximum arterial pressures in patients with pheochromocytoma and paraganglioma: a single-center retrospective study

Surgery for pheochromocytoma and paraganglioma (PPGL) can lead to life-threatening complications, such as intraoperative hypertensive crises, even when adequate doses of preoperative α-receptor blockades are administered. The aim of this study was to identify preoperative factors associated with maximum arterial pressure (AP) during surgery in patients with PPGL. We retrospectively reviewed the cases of 61 PPGL patients who underwent surgical resection in our hospital between 2006 and 2020. The primary outcome was intraoperative maximum AP as a single index for continuous variables. The normal distribution of the results was confirmed by the Kolmogorov–Smirnov test. Simple and multiple linear regression model were used for statistical analysis. The median maximum systolic AP during surgery was 165 mmHg (interquartile range: 150–180 mmHg). Although the 24-h urinary-fractionated metanephrine (MN) and normetanephrine (NMN) (mg/day) was not normally distributed, the logarithmic representation (base = 10) of the combination of these continuous variables showed a normal distribution (p = 0.549). Log24 − h urinary−fractionated MN and NMN was correlated with intraoperative maximum AP (R = 0.481, p < 0.001). Multiple regression analyses showed that diabetes mellitus (β = 15.835, standard error [SE] = 7.550, t statistic = 2.097, P = 0.040), the classic triad (β = 14.081, SE = 5.668, t statistic = 2.484, P = 0.016), and log24 − h urinary−fractionated MN and NMN (β = 14.641, SE = 5.842, t statistic = 2.506, P = 0.015) were independent factors associated with intraoperative maximum AP. Patients with PPGL accompanied by diabetes mellitus, the classic triad, and high log 24−h urinary−fractionated MN and NMN values may be at risk for hypertensive crises during surgery regardless of whether preoperative α-receptor blockades are used. Clinicians should manage these patients more carefully and effectively.

Abstract MP72: Remote Monitoring Reduces Blood Pressure And Crisis Hypertension In Post-acute Transitions Of Care For Medicare Patients

Introduction: The major benefits of remote physiologic monitoring (RPM) of blood pressure are usually observed in high-risk patients. Readmissions, return to acute care (RTA), is an undesirable outcome for post-acute care facilities (PACs). Transitions from PACS to ambulatory care have a high risk of RTA. We assessed RPM for hypertension (HTN) patients discharged from PACs. Hypothesis: We hypothesized that PAC discharged patients would benefit from RPM and it would lead to less hypertension during their transition to ambulatory care. Methods: Patients were enrolled in Medicare’s (CMS) RPM program that were being discharged from PACs in Tennessee. HTN RPM began at discharge from PACs. Blood pressure (BP) was measured with cellular-connected devices and a mobile-could application (Alertive, Seattle WA). Data was equally divided into 24-hour windows, classified to JNC8 hypertension classes. Results were reported to PAC and ambulatory clinicians on a monthly basis. Immediate alerts were delivered to physicians for patients with systolic BP > 180 mmHg for timely intervention. Events such as ED visits and hospital readmissions were tracked by the nursing team during their calls per CMS RPM criteria. Patients were telephoned once a month, coached on their BP data, adherence to medications, and upcoming medical visits. Mean comparison of BP data before and after RPM was performed using paired t-test. Results: BP readings from 20 patients (mean age=78.3 ±8.4) were collected between March and May, 2021. A total of 758 readings were analyzed. Twelve hypertensive crises in 6 unique patients were observed. Nine hypotensive instances in 5 patients were observed. Events led to intervention in all unique patients. One patient was hospitalized, and another was referred to the ED for abdominal pain vs 8 patients readmitted in the prior 90 days. Overall, there was a significant decrease in mean systolic BP (144.7 ± 23.1 mmHg at start of RPM vs. 135.2 ± 15.9 mmHg, post RPM; p=0.018) with a mean reduction of 9.5 mmHg at end of the program. Conclusions: After discharge from PAC’s patients monitored by CMS’ RPM achieved a significant reduction in BP. PAC hypotension is an area to evaluate in cardiovascular and renal patients. Future work to demonstrate reduction in RTA is merited.

Optimization of the Functional State of the Cardiovascular System in Women with A Complex of Dosage Physical Exertion

In the second mature age, women increase the prevalence of arterial hypertension, often complicating hypertensive crises. This circumstance requires improving the recovery options for this category of patients. It seems very promising to be used for this in women with arterial hypertension regular physical exertion for the purpose of their overall recovery, reducing the level of blood pressure and the prevention of hypertensive crises. To easily be the effects of the hypertensive crisis, a complex of muscular loads was developed, the effectiveness of which was estimated in comparison with traditionally appointed patients in such patients of the recovery. Women were examined 36-55 years, who had over a month ago, hypertensive crisis. The women who have been rehabilitated under the author's scheme, have been rejected in the study, have shown a more pronounced improvement of the indicators registered in the study. The optimization of the function of the cardiovascular system turned out to be more pronounced than as a result of traditional recovery. The tested version of regular muscle training provides optimization of processes in the heart and vessels of women suffering from arterial hypertension, lowering the risk of repetition of their hypertensive crisis.

Transcatheter closure of patent vertical vein after repair of total anomalous pulmonary venous connection: a case series

Background and objectives: Total anomalous pulmonary venous connection is a rare cyanotic CHD that requires surgical repair. An unligated vertical vein after total anomalous pulmonary venous connection surgery may help to decrease the episodes of post-operative pulmonary hypertensive crises, low cardiac output syndrome, and mortality. The aim was to assess long-term outcome and our post-operative transcatheter vertical vein closure experiences in five patients with repaired total anomalous pulmonary venous connection patients. Methods: A retrospective study was conducted in five cases with an unligated vertical vein following repair of supra-cardiac total anomalous pulmonary venous connection at our hospital from 2011 through 2018. Patients characteristics, cardiac catheterisation findings, surgical, and transcatheter procedural details were retrospectively analysed. Results: Transcatheter closure of the unligated vertical vein was technically successful in all the patients. Procedure-related complications were not observed in any of the patients. No long-term complication was found. Conclusions: We suggest that transcatheter closure of the patent vertical vein is an effective and well-tolerated alternative to the surgical approach.