Past History Of Hypertension Research Articles

A0703 The influence of antecedent arterial hypertension on possible heart failure development in patients with acute myocardial infarction

Objectives: To determine the changes of functional heart parameters (FHP) and brain natriuretic peptide (BNP) levels in patients with acute myocardial infarction (AMI) and antecedent hypertension (AH). Methods: 35 hypertensive patients (duration of AH 9.8 + 3.7 years) and 31 normotensive patients with their first AMI were examined. Groups were comparable in age and gender. Cardiac ultrasound was done to all patients on 3rd and 28th day after AMI. BNP levels were assessed 64 ± 7 hours after onset of chest symptoms. Results: Patients of the hypertensive group had the following dynamics of FHP from 3rd to 28th day: left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) showed a tendency to increase (+ 4.1%; 63.82 ± 5.13 mm; +13.9%; 58.16 ± 6.73 mm, respectively) as well as the ejection fraction (EF) +12.8%; 44.85 ± 2.93%, (p ≥ 0.05). Normotensive group: a decrease of LVEDV was observed (−15.3%; 52.75 ± 4.23 mm; p = 0.027), as well as LVESV (−19.7%; 38.64 ± 3.48 mm; p = 0.031); EF increased to 23% (49.53 ± 2.76%; p = 0.008). The analysis of indexes on 28th day showed increase of EF in both groups (68.85 % and 85.66% of patients respectively, p = 0.039); the decrease of contractile ability was determined in 25.2% and 14.29% of patients respectively, p = 0.034). Patients with AMI and AH demonstrated higher levels of BNP compared to controls (812.46 pg/ml vs 487.68 pg/ml, p ≤ 0.05). Also, a positive correlation was found between BNP and LVEDV (r = 0.319, p ≤ 0.05), BNP and peak troponin levels (r = 0.406, p ≤ 0.05). Conclusion: Significantly higher levels of BNP and worse dynamics of FHP in patients with AMI and AH suggest increased probability of the left ventricle dysfunction, heart failure development and poorer prognosis than in patients with AMI without past history of hypertension.

Intraoperative angioedema induced by angiotensin II receptor blocker: a case report

BackgroundAngiotensin II receptor blockers are a class of antihypertensive agent that is developed to exclude the adverse effects of angiotensin converting enzyme inhibitors. However, as angiotensin II receptor blockers have begun to be more widely prescribed, cases of angiotensin II receptor blocker-induced angioedema have been reported. Rare cases of angioedema following surgery in patients using angiotensin converting enzyme inhibitors have been published.Case presentationA 38-year-old man with past history of hypertension was admitted for an elective lumbosacral spine surgery. He had been taking Valsartan 160 mg a day for the past 4 years.At the end of the surgical procedure and turning the patient into supine position, we noticed severe swelling in the neck and the face with.an edematous tongue, floor of the mouth, glottis, and supraglottic areas. A diagnosis of drug induced angioedema was made and intravenous dexamethasone, diphenhydramine and ranitidine were given. The patient remained intubated and was transferred to the intensive care unit. The valsartan was suspected to be the precipitating factor for the angioedema and was therefore discontinued.The swelling started to regress after 2 h, and resolved completely by the third day.ConclusionThe precise mechanism of angiotensin II receptor blocker-induced angioedema is still unknown and should be thoroughly investigated. This report demonstrates a unique case of intraoperative angiotensin II receptor blocker-induced angioedema. Potential differential diagnoses of postoperative facial edema are discussed in detail, including the prolonged prone positioning for posterior spine surgery. Anesthesiologists should be aware of such rare, but potentially dangerous, perioperative adverse reaction that can occur with angiotensin II receptor blockers use.

Risk of Type 2 Diabetes Among the Pakistani Population: Results of a Cross-sectional Survey.

IntroductionDiabetes is a global issue. The aim of this study was to identify the high-risk population and factors associated with the future development of type 2 diabetes mellitus (T2DM).MethodsA cross-sectional study was conducted in the Family Medicine clinics of a tertiary care hospital in Karachi, Pakistan, from July 2016 to February 2017. Patients or patient care attendants aged 21 to 85 years visiting the clinics were included. Individuals with known diabetes or with serious comorbid conditions were excluded. A total of 600 participants were consecutively approached. QDiabetes (an online diabetes risk calculator) was used to measure the risk of developing T2DM. IBM SPSS Statistics for Windows, Version 19.0 (IBM Corp., Armonk, NY) was used for data analysis.ResultsInformation from a total of 522 participants was included in the final analysis. Roughly 53% of them were between 25 and 44 years of age. There was a predominance of females (63%). Thirty-eight percent of patients were at high-risk. The factors associated with high risk of T2DM were as follows: age 65 years or greater (Relative risk [RR]: 5.81; 95% confidence interval [CI]: 2.01 to 16.76); female (RR: 1.86; 95% CI: 1.05 to 3.28, p = 0.03); a past history of hypertension (RR: 5.11; 95% CI: 2.49 to 10.49); a family history of diabetes (RR: 9.76; 95% CI: 5.49 to 13.35).ConclusionControlling glucose levels and preventing hyperglycemia is a challenging task due to the increasing trend of a sedentary lifestyle and changes in dietary patterns. Counseling should be provided to caregivers and high-risk patients on the prevention of T2DM including lifestyle modifications.

The Relationship Between Renal Artery Involvement in Stanford B-Type Aortic Dissection and the Short-Term Prognosis: A Single-Centre Retrospective Cohort Study

Renal artery involvement has not received sufficient attention despite the fact that aortic computed tomography angiography (CTA) examinations of Stanford B-type aortic dissection patients usually show renal artery involvement [3]. To study the influence of renal artery involvement on aortic dissection, we performed a retrospective study on acute Stanford B-type aortic dissection patients with or without renal artery involvement to investigate its effect on the prognosis of aortic dissection. A total of 221 patients with acute Stanford-B type aortic dissection between January 2012 and January 2014 were enrolled. The patients were divided into a renal artery involvement group and a non-renal artery involvement group based on aortic computed tomography angiography (CTA) results. The clinical data of the two groups were compared. Univariate analyses and multiple logistic regression analyses were performed to determine risk factors related to in-hospital mortality. The effect of renal artery involvement on the prognosis of Stanford B-type aortic dissection patients was analysed. Among the 221 patients with acute Stanford type-B aortic dissection, 100 patients (45.2%) exhibited renal artery involvement. The percentage of patients with a past history of hypertension in the renal artery involvement group was significantly higher than that in the non-renal artery involvement group (84.0% vs. 74.8%, p=0.025). The estimated glomerular filtration rate (eGFR), creatinine level, and urea nitrogen level at admission were not significantly different between the renal artery involvement group and the non-renal artery involvement group. The in-hospital mortality rate in the renal artery involvement group was higher than that in the non-renal artery involvement group; the difference in the percentage of in-hospital mortality between these two groups was statistically significant (12.0% vs. 4.1%, p<0.05). The results of multiple logistic regression analysis showed that renal artery involvement was a risk factor for in-hospital mortality in acute Stanford B-type aortic dissection patients (odds ratio (OR)=3.536 (1.127∼11.095)). In the renal artery involvement group, the in-hospital mortality rate in the conservative treatment group was significantly higher than that in the interventional treatment group (30.8% vs. 5.4%, p=0.001). Although renal artery involvement was not associated with short-term renal function damage, it was a risk factor for in-hospital mortality after acute Stanford B-type aortic dissection.

Uterine leiomyomata: a retrospective study of correlations with hypertension and diabetes mellitus from the Japan Nurses’ Health Study

We performed a scrutiny survey of self-reported uterine leiomyomata (UL) to investigate the associations of parental history with hypertension and personal history of hypertension in the UL cases in Japanese women. Questionnaires that included items on the sites of UL determined by imaging techniques and surgical procedure were mailed to 2015 women with a self-reported UL at a baseline survey of the Japan Nurses’ Health Study (n = 15,019). We found that women with a past history and a maternal history of hypertension had an increase in their risk of UL. A maternal history of hypertension was significantly associated with an increase in the risk of UL in women without a past history of hypertension but not in the women with a past history of hypertension. A past history and a parental history of diabetes mellitus were not associated with an increase in the risk of UL. Women of reproductive age with a maternal history of hypertension may be at a higher risk for hypertension and UL.Impact StatementWhat is already known on this subject? A positive association of uterine leiomyomata (UL) with a past history of hypertension has been found but the association of a parental history of hypertension with UL has not yet been clarified.What do the results of this study add? Maternal hypertension, as well as a personal history of hypertension, was associated with an increased risk of UL and a past history and a parental history of diabetes mellitus were not associated with an increase in the risk of UL.What are the implications of these findings for clinical practice and/or further research? Women of a reproductive age with a maternal history of hypertension may be at a higher risk for hypertension and UL.

External ventricular drainage for intraventricular hemorrhage

Abstract Background: Intervention to reduce intracranial pressure using External Ventricular Drain (EVD) is a common life saving measure in a neurosurgery intensive care unit(ICU). Objective: The present study was undertaken to assess the outcome of patients who underwent external ventricular drainage for intraventricular hemorrhage(IVH). Methods: The available data of the patients who underwent placement of external ventricular drain from February 2012 to May 2016 for intraventricular hemorrhage (IVH) at Narayana Medical College and Hospital, Nellore, was retrieved from the hospital case records and analyzed. Results: Total of 69 patients were included in this study. Mean age was 53.7 ±11.6 years. Clinical presentation included altered sensorium in 66 patients (96%), hemiparesis in 62 patients (90%) , vomiting in 40 patients (58%) and seizures in 9 patients (13%). Fifty two patients (75%) were known hypertensives and 10 patients (15%) were diabetic. Past history of smoking was recorded in 16(23%) patients and alcohol intake in 17 patients (25%). GCS at the time of admission was 3-8 (low) in 39 patients (57%), 9-12 in 23 patients(33%) and 13-15 in 7 patients (10%). At the time of admission, 60 patients ( 87%) had diastolic blood pressure more than 90 mmHg, 63 patients (91%) had systolic blood pressure more than 140 mmHg. Major site of hemorrhage was basal ganglia in 24 (35%), thalamus in 13 (19%), cerebellum in 5 (7%), brain stem in 3, frontal/temporal in 2 patients. SAH with IVH was noted in 12 patients (17%) and only IVH was noted in 10 patients (14%). Mean duration of external ventricular drainage was 4.6+1.7 days (Range 1-9 days). Mean hospital stay was 11.3±7.5 days and mean ICU stay was 8+5.4 days. Thirty eight patients (55%) died during hospital stay. At the time of discharge, poor out come (Glagow out come score 1-3) was noted in 52 patients (75%) and good out come (Glagow out come score-4,5) was noted in 17 patients. Among various parameters analyzed , poor GCS (3-8) at admission, history of smoking and alcohol intake were found to correlate significantly with poor outcome. None of the other factors like old age, site of bleed, pupillary asymmetry at admission, high blood pressure at admission, past history of hypertension and diabetes were found to correlate with poor outcome. Conclusions: Majority of the patients with intracranial hematomas with intraventricular extension presented in poor neurological condition (GCS= 3-8). Poor neurological condition at the time of admission, past history of smoking and alcohol intake were associated with poor outcome.

Abstract TP336: Acute Stroke in CADASIL: Emphasising on Intracerebral Haemorrhage

Introduction: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a common genetic cause of cerebral small vessel disease. In addition to ischemic stroke (IS), patients with CADASIL may also suffer from intracerebral hemorrhage (ICH). This study aimed to clarify the acute stroke presentation among CADASIL patients in Taiwan. Methods: We enrolled 106 genetically confirmed CADASIL patients (49 from a single university hospital; 57 from positive screening results of NOTCH3 R544C hotspot mutation in a national stroke registry). Acute stroke events with well-documented clinical and neuroimaging features of were included for further analysis. Results: There were 25 (38%) ICH among 66 patients with well-documented acute stroke events. The mean ICH volume was 12.4 ml, and 39% had intraventricular hemorrhage. The most common ICH location was thalamus (56%) and putamen (20%). Among ICH patients, those with past history of hypertension (88%) had larger ICH volume (13.7 ml vs 3.6 ml) and worse functional outcome at discharge (modified Rankin scale, mRS, 3.5 vs 1.0). While in 41 IS events, subcortical white matter was the most common location (49%), and small vessel occlusion type was the predominant pattern (68%). Patients with ICH had significantly higher stroke severity (mean NIHSS score, 14.0 vs 4.4, P &lt;0.01), worse function outcome at discharge (mRS 3.3 vs 2.1, P =0.02), and higher mortality rate (28% vs 2.4% P &lt;0.01) then IS. Higher age (OR 1.11, 95% CI 1.02 - 1.21) and NIHSS score at admission (OR 1.44, 1.12 - 1.83) were predictors of poor function outcome (mRS &gt;2) at discharge. Of 47 patients with available follow-up information, 22 (47%) of them had at least one recurrent stroke, and the recurrent events can be either ICH or IS in spite of the first stroke type. Conclusions: We found a high proportion of ICH among CADASIL patients with acute stroke events, and those with ICH had significant worse outcome than IS counterpart.

Fortuitous Splenic Rupture: An Unusual Presentation of Pancreatic Cancer

Early diagnosis of pancreatic ductal adenocarcinoma (PDAC) is difficult. Multifocal pancreatic masses are not common when it comes to PDAC. This especially holds true for cancer of the pancreatic body and tail that do not manifest with jaundice. We present a case of pancreatic cancer involving the head and tail A 52-year-old Caucasian male with past history of hypertension, gout and osteoarthritis presented to the hospital with acute left upper quadrant pain radiating to the back after sustaining a fall. Examination revealed severe tenderness to palpation of the left upper quadrant. Initial laboratory data showed hemoglobin of 10.4 g/dl, AST of 166 U/L, ALT of 352 U/L, ALP of 368 U/L and serum lipase level of 869 U/L. CT abdomen showed splenic laceration with hemoperitoneum. The patient was vigorously resuscitated, and subsequently underwent emergency laparotomy. Operative findings revealed splenic laceration with hemoperitoneum. Intraoperatively, the pancreatic tail was hard and abutted the mesocolon and omentum. Short gastric vessels were engorged suggestive of splenic vein thrombosis. Irregular masses were noticed in the head of the pancreas without involvement of superior mesenteric vasculature. Histopathology of the mass revealed PDAC. The patient underwent Whipple surgery with adjuvant FOLFIRINOX therapy. Post-operative pathology showed T3N1 disease with perineural and lymphovascular invasion. The patient is currently undergoing surveillance for recurrence. Splenic rupture is extremely rare presenting feature of pancreatic cancer. Only ten prior cases have been reported in literature. Most of those cases reported rupture of splenic artery aneurysm secondary to direct vascular invasion of PDAC. Cancer of the pancreatic tail can invade the splenic hilum causing splenic ischemia and vein occlusion which may culminate in splenic rupture. Another rare finding in our case was the multifocal nature of pancreatic cancer. Only around 50 cases have been reported so far as per our literature review. Most of the cases that have been reported in literature present as contiguous masses. Surgical removal is recommended in the absence of distant metastatic disease and local vascular invasion. Overall prognosis continues to remain grim for all stages.Figure: Splenic rupture is a rare presenting feature of pancreatic cancer. It can however present an opportunity for early stage discovery that may lead to improvement in prognosis by earlier initiation of treatment.

Diospyros rhodocalyx (Tako-Na), a Thai folk medicine, associated with hypokalemia and generalized muscle weakness: a case series

Introduction: Diospyros rhodocalyx (Tako-Na) is a Thai folk medicine purported to promote longevity, treat impotence, etc. We present patients with hypokalemia, weakness and hypertension after consuming Tako-Na tea.Case series: Case 1: A 61-year-old man was brought in nine hours after drinking 400–500 mL of Tako-Na tea. One handful of Tako-Na bark was boiled in water to make tea. He had vomiting and watery diarrhea six hours after drinking it. He took no medications and had no history of hypertension. The only remarkable vital sign was BP 167/90 mmHg. Physical examination revealed generalized muscle weakness. Laboratory findings were potassium 2.7 mmol/L, bicarbonate 24 mmol/L, and transtubular potassium gradient (TTKG) 5.6. He was discharged the next day with a BP 140/90 mmHg and potassium 4.2 mmol/L. Case 2: A 78-year-old man, a friend of case 1, also drank Tako-Na tea from the same pot at the same time as case 1. He also had vomiting and diarrhea six hours later. He took no medications despite past history of hypertension (baseline SBP 140–160). Initial BP was 230/70 mmHg. He also had muscle weakness. Laboratory findings were potassium 3.3 mmol/L, bicarbonate 24 mmol/L, TTKG 7.37 and normal thyroid function. He was also discharged the next day with a BP 148/70 mmHg and potassium 4.2 mmol/L. Case 3–7: These were patients reported to a poison center and their potassium concentrations were 1.4, 1.4, 3.3, 1.3 and 1.2 mmol/L, respectively. Three of them were intubated and case 3 died.Conclusions: Tako-Na contains betulin, betulinic acid, taraxerone, lupeol, and lupenone. Their structures are similar to glycyrrhetic acid, the active metabolite of glycyrrhizic acid found in licorice which is well known to cause pseudoaldosteronism. Glycyrrhetic acid is potent in inhibiting 11-beta-hydroxysteroid dehydrogenase, and causes pseudoaldosteronism. We hypothesize that the compounds in Tako-Na act in the same way as glycyrrhetic acid in producing pseudoaldosteronism.

Cardiovascular disease and ABO blood-groups in Africans. Are blood-group A individuals at higher risk of ischemic disease?: A pilot study.

BackgroundSince the discovery of the ABO blood group system by Karl Landsteiner in 1901, several reports have suggested an important involvement of the ABO blood group system in the susceptibility to thrombosis. Assessing that non-O blood groups in particular A blood group confer a higher risk of venous and arterial thrombosis than group O.Epidemiologic data are typically not available for all racial and ethnics groups.The purpose of this pilot study was to identify a link between ABO blood group and ischemic disease (ID) in Africans, and to analyze whether A blood group individuals were at higher risk of ischemic disease or not.MethodsA total of 299 medical records of patients over a three-year period admitted to the cardiology and internal medicine department of military hospital of Ouakam in Senegal were reviewed. We studied data on age, gender, past history of hypertension, diabetes, smoking, sedentarism, obesity, hyperlipidemia, use of estrogen-progestin contraceptives and blood group distribution.In each blood group type, we evaluated the prevalence of ischemic and non-ischemic cardiovascular disease. The medical records were then stratified into two categories to evaluate incidence of ischemic disease: Group 1: Patients carrying blood-group A and Group 2: Patients carrying blood group non-A (O, AB and B).ResultsOf the 299 patients whose medical records were reviewed, 92 (30.8%) were carrying blood group A, 175 (58.5%) had blood group O, 13 (4.3%) had blood group B, and 19 (6.4%) had blood group AB.The diagnosis of ischemic disease (ID) was higher in patients with blood group A (61.2%) than in other blood groups, and the diagnosis of non-ischemic disease (NID) was higher in patients with blood group O (73.6%) compared to other groups. In patients with blood group B or AB compared to non-B or non-AB, respectively there was no statistically significant difference in ID incidence.Main risk factor for ID was smoking (56.5%), hypertension (18.4%) and diabetes (14.3%).In our study, there was no statistical difference between blood group A and non-A in myocardial infarction (MI) incidence (p = 0.09, 95% CI = 0.99–2.83) but a statistically significant difference between blood group A and non-A in stroke and coronary artery disease (CAD) incidence (p < 0.0001, 95% CI = 1.80–3.37 and p < 0.0001 95% CI = 1.82–3.41 respectively) was found.The incidence of ID in men was significantly higher in blood group A (95% CI = 2.26–4.57, p < 0.0001) compared with non-A group, while there was no statistically significant difference in women (p = 0.35). However, an overall effect was detected to be statistically significant regardless of gender (p < 0.0001).ConclusionOur study suggests an association between blood group A and ID in sub-Sahara Africans.In African countries, where most of health facilities are understaffed, more rigorous studies with a larger population are needed to give a high level of evidence to confirm this association in order to establish the need to be more aggressive in risk factor control in these individuals.

Successful long-term effects of direct renin inhibitor aliskiren in a patient with atherosclerotic renovascular hypertension.

A 64-year-old man visited our hospital with complaints of misty vision and ophthalmalgia. On admission, his blood pressure (BP) was high at 220/135mmHg with no past history of hypertension, and he had choked discs. He was tentatively diagnosed as having idiopathic intracranial hypertension, and was later found to have atherosclerotic unilateral renovascular hypertension (RVH) based upon the extremely high plasma renin activity together with the radiological image tests. On day 3, combined antihypertensive therapies consisting of oral angiotensin II receptor blocker (ARB) and Ca channel blocker (CCB) along with intravenous CCB induced an abrupt BP lowering which led to deterioration of his renal function, progressing into acute kidney injury (AKI). Cessation of the ARB and reduction of the CCB dose ameliorated the AKI-related decline in renal function. On day 17, as he was reluctant to receive surgical intervention, he was treated with a direct renin inhibitor, aliskiren, combined with a half-dose CCB as a maintenance antihypertensive therapy. The therapy has proven not only successful to chronically maintain his renal function but was also capable of controlling his BP in the neighborhood of 130/85mmHg over a period of 2 years. The present case suggests that the direct renin inhibition with aliskiren can be a safe and useful antihypertensive option to control hypertension and to preserve renal function in patients with atherosclerotic unilateral RVH.

Early Detection of Superior Mesenteric Artery Dissection by Ultrasound: Two Case Reports

Superior mesenteric artery (SMA) dissection is a rare disease. Some of the cases are isolated type, the others are associated with aortic dissection. Most of the cases are diagnosed by contrast-enhanced computed tomography (CECT). The use of emergent bedside ultrasound has been described to diagnose aortic dissection. However, there is limited literature regarding the use of bedside ultrasound to identify superior mesenteric artery dissection, a known high-risk feature of aortic dissection. We present one case of isolated SMA dissection and one case of SMA dissection complicated with aortic dissection. Both of them were diagnosed by bedside ultrasound first and confirmed by CECT Case report and literature review. Case one: A 46-year-old male patient without past history of hypertension. He suffered from intermittent epigastralgia for 3 days. Laboratory data, ECG, KUB showed no specific finding. Bedside ultrasound found faint intimal flap in SMA. The diameter of SMA was 15.4mm. Color duplex revealed thrombosis or false lumen in SMA. Cardiovascular specialist was informed and SMA dissection was proved by CECT. Patient’s symptom improved after anticoagulant usage. Case two: A 46-year-old male patient with past history of hypertension and old ischemic stroke. He had sudden onset of consciousness change and recurrent stroke was impressed initially. However, due to relative low systolic blood pressure (97mmHg), we performed bedside ultrasound to the patient and found intimal flap in abdominal aorta and SMA. The diameter of SMA was 10.5mm. Cardiovascular specialist was consulted immediately. Patient’s consciousness recovery to clear after endografting surgery. These two cases illustrate that bedside ultrasound can be used to early detect SMA dissection. The normal diameter of SMA was reported as 5.7-7.3mm. The aneurysm is considered more than 1.5 times of normal diameter. Intimal flap of SMA dissection may not be easily seen in ultrasound due to poor image quality. However, the diameter of SMA > 10 mm should warrant clinician the high suspicion of SMA dissection and further image study or specialist consultation should be considered.

Abstract 11417: Elevated Serum Osteoprotegerin is Associated With Increased Left Ventricular Mass Index and Left Ventricular Diastolic Stiffness in African Americans: Insights From the Genetic Epidemiology Network of Arteriopathy (GENOA) Study

Background: Osteoprotegerin (OPG) associates with a poor prognosis in patients that have already developed heart failure with preserved ejection fraction (HFpEF). OPG also associates with fibrosis and collagen cross-linking which increase diastolic stiffness in the left ventricle (LV). Little is known about the relationship of OPG and LV structure and function in African Americans who are disproportionately affected by HFpEF. We hypothesized that OPG may serve as an early indicator of developing LV hypertrophy and stiffening which are prominent precursors to HFpEF. Methods and Results: Our analysis included 1172 participants with preserved LV ejection fraction (EF &gt;50%) from the African American (Jackson) cohort of the Genetic Epidemiology Network of Arteriopathy (GENOA) Study (mean age 62.9 years, 72% female). LV diastolic stiffness was assessed by echocardiography using the recently developed diastolic wall strain (DWS) indicator calculated as (LV posterior wall thickness at end-systole - LV posterior wall thickness at end-diastole) / LV posterior wall thickness at end-systole. Associations between serum OPG levels and indices of LV structure and function were evaluated using a generalized linear mixed models (GLMM) accounting for clustering in siblings, and adjusted for possible confounders including age, gender, past history of hypertension and diabetes, current smoking status and estimated glomerular filtration rate (eGFR). OPG levels correlated with age, female sex, presence of hypertension and diabetes, lower eGFR, and higher N-terminal prohormone brain natriuretic peptide levels (p &lt;0.05 for all). Thus, higher OPG levels were associated with characteristics common in patients with HFpEF. Multivariable linear regression analysis revealed that after adjustment for covariates, higher OPG levels were associated with greater LV mass index and increased LV diastolic stiffness (p &lt;0.05, for all). Conclusions: Higher OPG levels associated with characteristics common in patients with HFpEF in African Americans. The serum OPG levels also significantly associated with known precursors to HFpEF, indicating a potential pathophysiologic role for OPG in the development of HFpEF in African Americans.

A Rare Discovery of Colonic Amyloidosis

75 year old female with a past history of hypertension, recurrent melena and breast cancer who presents from her PCP for evaluation of anemia, fatigue, anorexia, and weight loss She was previously evaluated for gross hematochezia requiring blood transfusion. On admission, the patient underwent an abdominal CT scan significant for a diffuse reactive/infiltrative process with adenopathy along the aorta and iliac veins. Serum protein electrophoresis revealed a monoclonal spike in the gamma region corresponding to an IgM kappa paraprotein. Colonoscopy was performed showing diverticulosis and multiple polyps with a large mass in the sigmoid colon. Biopsies were significant for colonic amyloidosis. Amyloidosis is a generic term that refers to the extracellular tissue deposition of a variety of serum proteins, many of which circulate as constituents of plasma. The most common causes of systemic amyloid deposition are AL amyloid caused by a plasma cell dyscrasia and AA amyloidosis due to ongoing or recurring inflammation from chronic disease. Patients with symptomatic gastrointestinal amyloidosis usually present with one of four syndromes: gastrointestinal bleeding, malabsorption, protein-losing gastroenteropathy, and, less often, gastrointestinal dysmotility. While patients with AA amyloidosis usually present with diarrhea and weight loss, patients with AL amyloidosis usually present with constipation, mechanical obstruction, or chronic intestinal pseudo-obstruction. The diagnosis of gastrointestinal amyloid requires a tissue biopsy with positive staining of amyloid by Congo red or the presence of amyloid fibrils on electron microscopy. Although the gastrointestinal complications can result in significant morbidity, they are not usually the cause of death, which is most often due to renal failure, restrictive cardiomyopathy, or ischemic heart disease. Therapy is directed at the gastrointestinal manifestations and at the underlying cause of amyloidosis.Figure 1Figure 2Figure 3

Association of insulin treatment versus oral hypoglycaemic agents with diabetic retinopathy and its severity in type 2 diabetes patients in Cameroon, sub-Saharan Africa.

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease associated with multiple macro and microvascular complications, diabetic retinopathy (DR) being the commonest one. Recent literature has reported an increased risk of DR with insulin use. We carried out a cross-sectional study at the Ophthalmology Department of the Douala General Hospital (DGH) during a 2-year period to explore the association between insulin treatment and both DR and its severity as compared with oral hypoglycemic agents (OHAs) in Cameroonian T2DM patients aged ≥35 years, and who were all screened for DR through eye examination including exhaustive retinal evaluation. In total, medical files of 134 T2DM patients were analyzed. The frequency of DR was 54.1% among patients on OHA and 73.9% among those on insulin treatment, giving an overall frequency of 57.5%. There were significantly more OHA treated patients than insulin treated patients (82.8% vs. 17.2%, P<0.001). As expected, both the OHA and insulin groups were comparable by age, sex, duration of diabetes, past history of hypertension, alcohol misuse, and current tobacco smoking. DR was almost significantly more frequent in T2DM patients under insulin regimen than in patients under OHA [73.9% vs. 54.1%; odds ratio (OR) 2.4; 95% confidence interval (CI), 0.9-6.6; P=0.06]. Proliferative diabetic retinopathy (PDR) was significantly more observed in insulin treated patients than in OHA treated patients (34.8% vs. 15.3%; OR 2.95; 95% CI, 1.1-8; P=0.035). Irrespective of staging, the frequency of diabetic macular edema (DME) was significantly higher in the insulin group than in the OHA group (43.5% vs. 19.8%; OR 3.1; 95% CI, 1.2-8; P=0.019). Compared with OHA, insulin therapy may be associated with DR, DR severity and DME in these T2DM sub-Saharan African patients.

MPS 10-09 Degree of nocturnal blood pressure in pregnancy might be associated with enlargement of the left atrial volume

Objective: Few studies have been accessed the association between diastolic function and dipping pattern in pregnancy. The aims of this study access the association between diastolic function and dipping pattern in pregnancy. Design and Method: The study was a retrospective analysis of the findings in 125 pregnant patients performed 24hr ambulatory blood pressure monitoring (ABPM) and echocardiography. All pregnant patients were referred for initial evaluation of high BP and dyspnea in late third trimester of pregnancy. We enrolled the pregnant patients with normal ABPM result (mean ABPM < 130/80 mmHg) between 20 and 34 years. We exclude the pregnant patients with antihypertensive medication or past history of hypertension. Degree of night BP reduction was calculated as (1- (Mean SBP in night time/Mean SBP in day time) x 100. Results: The patients were mean gestational age of 29 ± 3 months. Mean ABPM was 123.4/84.5 mmHg (mean day ABPM: 126.3/84.1 mmHg, mean night ABPM: 117.5/75.6 mmHg). Mean degree of night BP reduction was 8.8 ± 6.1. In echocardiography, mean left ventricular ejection fraction and E/E′ was 61.8% and 8.9, respectively. In addition, mean LAV index and LVM index were 29.3 mL/m2 and 114.9 g/ m2. And mean E/E′ and deceleration time (DT) were 8.9 and 192.4 ms. In relation of diastolic function and degree of night BP reduction, LVM index was not correlated with degree of night BP reduction, However, E/E′ was mildly negative correlation with degree of night BP reduction. (r = −0.257, p = 0.004) DT was mildly positive correlation with degree of night BP reduction. (r = 0.236, p = 0.009) In addition, LAV index was strongly negative correlation with degree of night BP reduction. (r = −0.637, p < 0.001). Conclusions: In late third trimester of pregnancy, degree of nocturnal blood pressure in pregnancy might be associated with enlargement of the LAV.

21 White coat hypertension in pregnancy: High incidence rates of gestational hypertension and preeclampsia

Aim (1) To investigate what fraction of hypertension (HT) is white coat hypertension (WCH) in pregnant women without a past history of HT, (2) to compare the incidence rates of preeclampsia (PE) among normal pregnant women showing normal blood pressure (controls), WCH, and chronic hypertension (CH), and (3) to compare the incidence rates of gestational hypertension (GH) between controls and WCH. Methods This is a retrospective cohort study in 2934 pregnant women, who sought maternal checkup at Results (1) In 2934 women, 41 women had a past history of WCH ( n =3), and CH ( n =38). In the remaining 2893 women, 2837 women (98.1%) were normal blood pressure, 36 women (1.2%) were WCH, and 20 women (0.7%) were CH, thus, the prevalence of WCH in newly diagnosed HT in pregnancy was 64% (36/56). (2) The incidence rates of PE in controls, WCH, and CH were 1.7% (48/2,837), 15% (6/39), and 21% (12/58), respectively; the incidence rates of PE in WCH and CH were significantly higher than in controls ( p p p =0.600). (3) The incidence rate of GH in WCH was significantly higher than in controls (23% (9/39) vs. 1.3% (37/2,837), p Conclusions Almost two-third of the newly diagnosed HT in pregnancy was WCH. Therefore, the precise diagnosis of WCH is essential to avoid unnecessary anti-hypertensive therapy. The incidence rate of hypertensive disorders of pregnancy (PE plus GH) in women with WCH was 38%. Therefore, we should recognize WCH as very high risk for GH or PE, and should monitor women with WCH by HBP very carefully.

The clinical manifestations and thrombotic risk factors in primary antiphospholipid syndrome

To investigate the clinical characteristics in patients with primary antiphospholipid syndrome (PAPS) and to identify potential predictors of thrombotic events. A total of 107 patients with PAPS were enrolled in our study, who were admitted in Peking Union Medical College Hospital from January 2004 to December 2014. Demographic data, age at onset, disease duration, past history of hypertension and regular cigarette smoking, clinical manifestations, imaging characteristics, management and prognosis were retrospectively collected. Bivariate statistical analysis and logistical regression test were performed to compare the discrepancy between patients with or without thromboembolic events. In 107 patients, there were 65 female and 42 male patients, with mean age (39.8±15.8) years old, median disease duration 10.5 (2.0, 48.0) months. A total of 72(67.3%) patients reported episodes of thromboembolic events, including 72 venous thromboses and 29 arterial thromboses. The most frequent venous thromboses were deep vein thromboses (35.5%), pulmonary embolism the second common (29.9%), with cranial venous sinus thromboses the following (8.4%). In arterial thromboembolic events, the incidence of transient ischemic attack (TIA) and ischemic stoke was the highest(14.0%), embolism of lower extremities the second (6.5%), and 4 patients (3.7%) with acute myocardial infarction. Sixty seven patients(62.6%)had positive lupus anticoagulant, 60 patients(56.1%)with positive anticardiolipin antibody, 32 patients(29.9%, 32/74) with positive β2 glycoprotein Ⅰ(β2GPⅠ). Forty patients(37.4%)had double positive antibodies, while 19 cases(17.8%)with triple positive. In logistical regression, aging (per 10 years) and hypocomplementemia were significantly related to venous thrombosis (OR=1.421, 95%CI 1.066-1.894, P<0.05, and OR=6.435, 95%CI 1.374-30.130, P<0.05, respectively). Cigarette smoking and triple positive antibodies were independent risk factors of arterial thrombosis (OR=3.996, 95%CI 1.079-14.795, P<0.05 and OR=3.166, 95%CI 1.102-9.097, P<0.05, respectively). APS is an autoimmune disorder characterized by recurrent arterial and venous thromboembolic events. Venous thromboembolism is more common than the arterial. Age and hypocomplementemia are predictors of venous thromboembolism; while smoking and triple positive antibodies are independent risk factors of arterial thromboembolism.

V11-02 BILATERAL ADRENALECTOMY AND MULTIPLE TUMORECTOMY IN VON HIPPEL–LINDAU DESEASE

You have accessJournal of UrologyAdrenal/Single Port Surgery/LESS/NOTES1 Apr 2016V11-02 BILATERAL ADRENALECTOMY AND MULTIPLE TUMORECTOMY IN VON HIPPEL–LINDAU DESEASE Juan Antonio Peña, Joan Palou, Andrés Kanashiro, Luis Miguel Sierra, Ivan Schwartzmann, and Humberto Villavicencio Juan Antonio PeñaJuan Antonio Peña More articles by this author , Joan PalouJoan Palou More articles by this author , Andrés KanashiroAndrés Kanashiro More articles by this author , Luis Miguel SierraLuis Miguel Sierra More articles by this author , Ivan SchwartzmannIvan Schwartzmann More articles by this author , and Humberto VillavicencioHumberto Villavicencio More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1819AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The von Hippel - Lindau disease is an autosomal dominant disease that courses with multifocal renal cell carcinoma in 65% of the affected individuals. The risk of developing pheochromocytomas in these patients reaches 20%. METHODS We present the case of a 50 year old man, obese with past history of hypertension; diagnosed by MRI performed prior to bariatric surgery, with a bilateral adrenal tumor (Left 7x7cm and right 5x4cm) and a double right renal tumor (posterior middle valve 3x2cm and lower pole 1.5cm). Given the high plasma and urinary levels of norepinephrine and the positive metaiodobenzylguanidine scintigraphy (MYBG), diagnosis of bilateral pheochromocytoma was confirmed. Simultaneous left nephron sparing surgery and adrenalectomy by retroperitoneoscopy approach after trasnperitoneal left adrenalectomy were proposed. RESULTS Following an alpha and beta-adrenergic blockade, a left transperitoneal laparoscopic adrenalectomy was performed without incident. (120 minutes - Estimated blood loss: 150 cc). One month later a retroperitoneal right adrenalectomy with off-clamp tumorectomy of the two right kidney tumors was undertaken. The pathology showed bilateral pheochromocytoma; while the right kidney tumorectomy report clear cell carcinoma, Fuhrman I, pT1a, with negative surgical margin in both tumours. The genetic studies confirmed VHL disease. The patient remained normotensive without medical treatment. CONCLUSIONS Simultaneous laparoscopic nephron sparing surgery and adrenalectomy is a suitable option for patients with Von Hippel-Lindau Disease affected by synchronic pheocromocytomas and renal tumors. Trans and Retroperitoneal approaches are both safe and effective procedures presenting low morbidity, and may both be used as an alternative, depending on the position of the renal tumors. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1003 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Juan Antonio Peña More articles by this author Joan Palou More articles by this author Andrés Kanashiro More articles by this author Luis Miguel Sierra More articles by this author Ivan Schwartzmann More articles by this author Humberto Villavicencio More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Platelet dysfunction in pre-eclamptic mothers

Background: Pre-eclampsia (PE) is a pregnancy-specific hypertensive disorder leading to a high proportion of hospital admission, labor induction, maternal as well as fetal morbidity and mortality. However it is fortunate that with timely detection and prompt management, this disease can often be ameliorated and eclampsia can be prevented. Objective: The objective of this study is to find out the changes in total platelet count (TPC), bleeding time (BT), and clotting time (CT) in pre-eclamptic pregnant women as compared with normal pregnant women. Material and Methods: This was a case–control study which included 60 pregnant women of more than 20 weeks of gestation. Out of these, 30 subjects were normotensive and 30 subjects were diagnosed with pre-eclamptic women. Patients having a past history of hypertension, renal diseases, diabetes during non-pregnant state, drug administration altering hematological profile, and autoimmune disorder were excluded from the study. Blood pressure was measured in all the cases and control subjects and three blood tests, i.e., BT, CT, and TPC were performed for each. Results: There was a significant fall in TPC in PE cases as compared with normal (P < 0.01). But there is significant increase in BT and CT (P < 0.01) in PE as compared with normal pregnant women. Conclusion: From this study, it was observed that BT, CT, and TPC can be used as predictive tests not only for disease process, but also for fetal outcome. This can also help us in early diagnosis and treatment of severe PE in which maternal mortality rate is very high.