Sudden Pressure Increase Research Articles

Ophthalmic manifestations of ruptured arachnoid cysts in children

Intracranial arachnoid cysts are relatively common in the pediatric population. Rarely, they rupture, leading to acute subdural fluid collections, which can cause a sudden increase in intracranial pressure. The purpose of this study was to characterize ophthalmic sequelae in a large cohort of these patients. The medical records of all children treated for ruptured arachnoid cysts who presented at a single tertiary pediatric hospital for initial assessment between 2009 and 2021 were reviewed retrospectively. Of 35 children treated for ruptured arachnoid cysts during the study period, 30 received ophthalmological examination. Papilledema was found in 57% of these children, abducens palsy in 20%, and retinal hemorrhages in 10%. Of the 30 children, 22 were seen in outpatient follow-up, of whom 5 had a best-corrected visual acuity of 20/40 or worse in one or both eyes at most recent follow-up. Cranial nerve palsies resolved in all cases without strabismus surgery. Given high rates of papilledema, cranial nerve palsies, and vision loss, all children with ruptured arachnoid cysts should be evaluated by pediatric ophthalmologists.

Гемофтальм после субарахноидального кровоизлияния (синдром Терсона)

Terson's syndrome is a combination of intraocular and intracranial (subarachnoid, subdural) hemorrhage resulting from a sudden increase in intracranial pressure. Purpose. To study the tactics of patients with hemorrhagic oculocerebral syndrome by the example of single clinical cases to help practicing ophthalmologists in the further clinical practice. Material and methods. The article describes a series of clinical cases of diagnosis and treatment of Terson syndrome in 46- and 36-year-old men after aneurysm of the right internal carotid artery and craniocerebral trauma, respectively. After stabilization of somatic condition and consultation with a neurosurgeon, the patients were admitted for surgical intervention. Results. In the postoperative period, anti-inflammatory and antibacterial therapy was prescribed, at the examination one year later, the patients had high visual function. Conclusion. Selection of timely correct treatment strategy helps to preserve high visual functions, quality of life of patients with Terson syndrome. Key words: Terson's syndrome, hemorrhagic oculocerebral syndrome, bilateral hemophtalmos

Recycling of waste tires to crude pyrolytic oil: Engine performance, combustion characteristics and emissions analysis of diesel-butanol-crude pyrolytic oil blends in CI diesel engines

In this study, crude pyrolytic oil (CPO) was blended with fossil diesel and butanol in different ratios. Following this strategy, engine performance, combustion characteristics and emissions analyses were experimentally examined in a CI diesel engine. Experiments were carried out with 7 blends at 1500 and 2000 rpm and 5 engine loads (0–12.5–25–37.5–50 Nm). Additionally, 1 % (by volume) cetane number improver was added to all blends except for D100 and PO50 in order to improve combustion. The main findings showed that even at 50 % blends of CPO, the engine still ran smoothly without causing any knocking in the engine. The highest BSFC was recorded with PO30Bu20CN1 with 425.35 g/kWh at 12.5 Nm load at 2000 rpm. On average, the lowest BTE was observed with PO30Bu20CN1 with an average reduction of 8.28 % compared to D100 at 1500. At all loads and engine speeds, ignition delay (ID) was prolonged and this caused a sudden increase in pressure and temperature in the cylinder for PO50 causing the highest NOx formation. The Pmax was achieved with PO50 fuel (64.19 bar at 25 Nm and 2000 rpm). This study supports the efforts to recycle waste tire. The study recommends further investigation of such developed alternative fuels.

Neuro-ophthalmologic symptoms after coronavirus disease 2019 vaccination: a retrospective study

BackgroundThere have been several studies on inflammatory ophthalmic diseases; however, few studies have reported neuro-ophthalmological symptoms, such as diplopia and ocular motor nerve palsy, after coronavirus disease 2019 (COVID-19) vaccination. Therefore, this study aimed to report neuro-ophthalmological symptoms in patients after COVID-19 vaccination.MethodsThis was a retrospective study based on the medical records of 10 patients who visited our ophthalmology clinic in 2021 with symptoms, such as diplopia (nine patients) and decreased visual acuity (one patient), and showed findings, such as ocular motor nerve palsy, after vaccination against COVID-19.ResultsOne patient had third nerve palsy, two had sixth nerve palsy, and five had fourth nerve palsy. One patient complained of subjective binocular diplopia but all test results were normal. One patient presented with decreased visual acuity accompanied by a sudden increase in intraocular pressure and orbital cellulitis in the other eye. The symptoms improved gradually in most patients. Compared with previous studies, this study reported three cases of antiplatelet therapy that was initiated due to the older age of the patients and underlying diseases.ConclusionAs COVID-19 vaccines can cause neuro-ophthalmological diseases, such as ocular motor nerve palsy, patients’ age and underlying diseases should be considered while administering them.

Rigicon ContiClassic and ContiReflex artificial urinary sphincter devices.

The modern AMS 800 artificial urinary sphincter (AUS) is often considered the standard of care for the treatment of moderate to severe stress urinary incontinence in male patients. Nonetheless, the AMS 800 device has several inherent limitations, and these factors can potentially impact its clinical utility and impede excellent clinical outcomes. The new Rigicon AUS devices such as ContiClassic and ContiReflex urinary sphincters are designed to overcome some of the existing issues pertaining to the AMS 800 device. The ContiClassic device is similar in terms of device design to the AMS 800 apart from the inclusion of a hydrophilic coating, has a greater range of cuff sizes with 0.25-cm diameter increments, and an Easy Clink Connectors which negates the need for an assembly tool. In contrast, The ContiReflex device differs from the ContiClassic model in that it features an extra stress relief balloon (SRB) to provide a safeguard on the urethral occlusive mechanism against any sudden increase in intra-abdominal pressure, and a larger pump system that is responsible to cycle fluid between the higher pressure two-balloon system and the sphincteric cuff. The following brief report evaluates the current device design and technology of the Rigicon ContiClassic and ContiReflex AUS devices.

Probabilistic Soil Liquefaction Assessment: A Case Study for Agartala City in Tripura in North-East India

A sudden increase in pore water pressure causes the effective stress to decrease significantly, which in turn causes a loss of shear strength and the subsequent outcome of allowing the soil to behave as a liquid, resulting in soil liquefaction. Agartala, the capital of Tripura, is located in northeastern India, and the entire region is considered seismically active according to the seismic zoning map of India as per IS 1893:2002 (Part 1); the entire region is classified as Zone-V. Significant earthquakes have struck this region, including the 1897 Shillong and 1950 Assam earthquakes. The city is vulnerable to liquefaction due to alluvial soil and a low groundwater table. Several parameters are involved in assessing liquefaction potential in the deterministic method and have different input parameter uncertainties, resulting in inconsistent outcomes. As a result, evaluating liquefaction susceptibility requires a thorough probability approach that considers parameter uncertainty. In this work, the soil liquefaction potential of Agartala City is assessed using fuzzy logic and compared to the conventional Reliability technique using the first-order second-moment method. Soil liquefaction potential was properly calculated using both approaches for the 71 boreholes in and around Agartala city. The outcomes are shown as contour maps representing spatial variations of the probability of liquefaction at different depths. In this study, Fuzzy logic is used to model the relationships between different soil parameters, which can help better understand the soil\'s behaviour during liquefaction. This developed method can assess the vulnerability of liquefaction potential and select appropriate materials and construction processes.

Mallory-Weiss Syndrome in Pregnancy

Mallory-Weiss syndrome (MWS), which is characterized by bleeding due to mucosal rupture at the gastroesophageal junction, accounts for 1% to 4% of cases with upper gastrointestinal system (GIS) bleeding. Mallory-Weiss tear (MWS) is characterized by longitudinal mucosal lacerations (intra-mural dissection) in the distal esophagus and proximal stomach. These tears usually result from a sudden increase in intra-abdominal pressure. During pregnancy, MWS can develop because of hyperemesis gravidarum in the first trimester, and the volume of bleeding is such that it can be controlled through spontaneous hemostasis. However, reports of third trimester pregnancies complicated by MWS are rare

HYPERTENSIVE ENCEPHALOPATHY: TO BE DIAGNOSED AND TREATED IMMEDIATELY

It is important to have a good understanding of the pat­hogenetic diagnosis and treatment features of the severe complication with high mortality – hypertensive encepha­lopathy (HE) because of the amount of people suffering from chronic arterial hypertension is constantly increa­sing. Thus, this article briefly reviews the mechanism of cerebral blood flow autoregulation, HE pathophysiology, and the main aspects of diagnosis and treatment. An HE episode is caused by a sudden and significant increase in arterial blood pressure, when the autoregulatory mecha­nism of cerebral blood flow becomes ineffective. Along with increased blood pressure, the patient gradually deve­lops neurological symptoms ranging from intense heada­che to vision loss, loss of consciousness, and convulsions. The diagnosis of HE is based on the clinical signs – acute arterial hypertension and the subsequent neurological symptoms. Also, the diagnosis of HE can be determined retrospectively when the neurological symptoms rapi­dly disappear with effective antihypertensive treatment. Computed tomography is important in differentiating HE from intracerebral hemorrhage and ischemic stroke. In management of HE it is recommended to return to the limits of cerebral blood flow autoregulation by immedi­ately reducing mean arterial blood pressure by 20-25%. In order to achieve the maximum rapid antihyperten­sive effect, it is suggested to administer the medication only intravenously. Labetalol and sodium nitroprusside are currently recommended first-line drugs for the treat­ment of HE. Patients with HE should be hospitalized in the intensive care unit for continuous control of decre­asement of arterial blood pressure while observing the cautious dynamics of the neurological condition. The outcome of patients depends on the urgency and effici­ency of treatment in returning arterial blood pressure to the limits of cerebral blood flow autoregulation, as well as on comorbidities, the severity of the condition and possible complications.

Numerical and experimental analysis of fluid force for nuclear valve

Nuclear safety valve is a critical piece of equipment in a nuclear power plant, which is used to prevent irreversible damage caused by a sudden increase in pressure. However, there are some instances wherein valves may fail to function properly, which can have significantly impact the safety of the entire pressure/energy system. The main causes behind this phenomenon is the effect of fluid-structure coupling between the fluid force and valve disc. To better understand the fluid force, a high-fidelity computational fluid dynamics (CFD) model is established to predict the behavior of fluid forces and the location of vortices in the valve. Moreover, a visual fluid force test rig is used to verify the accuracy of the CFD model. Based on the validated CFD model, the mechanism of fluid force differences for two typical valve discs are analyzed in detail, together with the univariate effects of groove depth and valve opening on the fluid force. Based on the univariate analysis results, the coupling effect of groove depth and valve opening on fluid force is quantified using the supervised learning algorithm and Sobol sensitivity analysis. The study provides a new perspective on the characteristics of valve fluid force, and highlights the significant potential of dynamic control and energy conservation of valves.

A case of esophageal perforation caused by suicidal caffeine poisoning in a teenager

Spontaneous esophageal perforation (also known as Boerhaave syndrome) is associated with sudden increase in intra-esophageal pressure by vomiting, coughing or straining at stool. This case describes a 13-year-old girl who developed the perforation after consuming 270 mg/kg of caffeine tablets for a suicide attempt. Presumably, the perforation was caused primarily by caffeine-induced severe vomiting, and secondarily by caffeine-induced gastric acid secretion with smooth muscle relaxation and by the large amount of caffeine-induced sudden increase in intra-esophageal pressure.

Traumatic Maculopathies Associated with Closed-Globe Injury

Traumatic maculopathies due to closed-globe injury are commotio retinae (Berlin’s edema), choroidal rupture, traumatic macular hole, retinitis sclopetaria, shaken baby syndrome, Valsalva retinopathy, and Purtscher retinopathy. The main pathology in commotio retinae is in the outer retinal layers and usually resolves spontaneously. Blunt eye traumas coming from the anterior aspect can cause choroidal ruptures. These are mainly due to the rupture of inelastic Bruch membrane and adjacent structures. If they involve fovea, visual loss can occur. Late choroidal neovascularisation may develop in 1/10 of the cases. Traumatic macular holes develop in less than 2% of the blunt ocular traumas. Early macular holes result from tangential traction whereas late holes from anteroposterior vitreoretinal traction. They can be closed spontaneously within 4 months, especially in young patients. Retinitis sclopetaria is rare. It results from high-velocity pellets that hit but do not penetrate the globe. Shock waves can cause the rupture of the choroid and overlie the neurosensory retina. The shaken baby syndrome is a result of the violence in the family. It must be reported to the police. Retinal hemorrhages, cotton wool spots, and hemorrhagic retinoschisis areas are the prominent features. The sudden increase in intrathoracic or abdominal pressure may lead to the rupture of the retinal capillaries and usually a sub-internal limiting membrane hemorrhage in Valsalva retinopathy. If it is larger than 3-disc diameters and persists for more than 3 weeks; it may be drained into vitreous with an Nd-YAG laser. Purtscher retinopathy is an occlusive microvasculopathy resulting from severe head trauma or compression injuries of the thorax. Intraretinal hemorrhages, geometric white areas (Purtscher flecken), and cotton wool spots are typical features. Usually fades within 1-2 months. Medicolegal aspects as well as ocular and systemic associations are also important in closed globe injuries and should not be neglected.

Abstract P322: 2-year Morbidity And Mortality Due To Hypertensive Crisis In A Predominantly African American Population

Title: 2-Year Morbidity and Mortality due to Hypertensive Crisis in a Predominantly African American Population Hypertensive crisis (HTNC) is a complication of Hypertension with a prevalence of 1-2%. HTNC is defined by a sudden and unpredictable increase in systolic blood pressure of ≥180 mmHg or diastolic blood pressure of ≥120 mmHg. HTNC may present as hypertensive urgency (HTNU) if asymptomatic, or hypertensive emergency (HTNE) if there are signs of end organ damage (EOD) eg: stroke (CVA), congestive heart failure (CHF), acute kidney injury (AKI), acute myocardial infarction (AMI) and death. A 2y retrospective cohort study of 1100 participants: 550 cases and 550 hypertensive controls BP >140/90) but < 200/120, matched for race, sex, and age, was conducted to determine the incidence of EOD, and the 2year mortality. The population was: Blacks 481/550 (87.4%), White 18/550 (3.3%), Asian 2/550 (0.4%) and other 49 /550 (8.9%). The mean SBP for cases was SBP 209.7 (SD=23.1), controls 147.8(SD=22.8) p=0.239; DBP cases 115.5 (SD=22.4), controls 84.2 (SD=14.1) p<.001. The incidence of new EOD for CHF: HTNE=39/440 (9.8%), HTNU=8/150 (5.3%), controls=6/550 (1.1%), p<.001; AKI HTNE=27/400 (6.8%), HTNU=5/150 (6.7 %), controls=17/550 (3.1%) p<0.001; AMI HTNE=6.5% and HTNU=2.7% controls=6/550 (1.1%) p<.001. There was no significant difference in the incidence of hemorrhagic and ischemic CVA, but the trend was higher in HTNE and HTNC for ischemic CVA: HTNE=4/400 (1%), HTNU=1/150 (0.7%), controls=(0.2%) p=.234. The 2y mortality for HTNE=82/400 (20.5%), HTNU=16/150 (10.6%), controls= 36/550 (6.5 %). The odds of dying was 3.5 times greater in the HTNU (OR 3.5, 95% CI 1.78-6.98), p<.001) and 4.3 times in the HTNE population (OR 4.3, 95% CI 2.65-7.01), p<.001). The study reveals a high morbidity and mortality associated with hypertensive crisis, with 1/5 of the population of HTNE dying in two years, mostly from related cardiovascular disease and renal failure.

Malignant Hypertension and the Role of Ophthalmologists: A Review Article.

Malignant hypertension (MHT) is a sudden and severe increase in systemic blood pressure (BP) associated with advanced bilateral retinopathy. It comes under a broader term, called hypertensive emergency, where an acute rise in BP results in end-organ damage. The condition usually requires hospital admission and intensive care management. Although there are lots of sophisticated machines and laboratory tests present to diagnose various organ damage, the role of ophthalmologists will still be at the top. A record of the acute rise of BP to a defining level and simple ophthalmoscopy with high clinical suspicion can save a patient’s life and preserve target organ function by timely referral. So, every ophthalmologist should be aware of this dangerous condition. In this review, we have tried to compile all the current knowledge regarding malignant hypertension that an ophthalmologist may require in day-to-day practice.

Anesthetic management by combined spinal and epidural anesthesia for a case of ectopic bladder pheochromocytoma

Background: We report a safe anesthetic management of a patient with preoperatively diagnosed ectopic pheochromocytoma who underwent bladder tumor resection with combined spinal subarachnoid anesthesia and epidural anesthesia (CSEA). Case presentation: The patient was an 85-year-old male, 152 cm in height and weighing 65 kg. The patient was admitted to our hospital with a complaint of anemia. Ectopic pheochromocytoma was suspected because of the different shape of the tumor and increased rerum noradrenaline. Due to complications of interstitial pneumonia, we planned to perform CSEA for this case. When surgical manipulation was applied to the bladder, a sudden increase in blood pressure above systolic pressure of 200mmHg was observed, and nicardipine 1 mg was administered. Afterwards, the surgery was completed without any major circulatory changes and postoperative course was uneventful. Conclusion: In patients with appropriate preoperative diagnosis and blood pressure control, spinal anesthesia or CSEA may be an alternative for ectopic pheochromocytoma in the bladder.

CLINICAL SPECTRUM OF HYPERTENSIVE EMERGENCIES WITH SPECIAL REFERENCE TO FASTING LIPID PROFILE

Background: Hypertensive emergencies are severe clinical condition in which sudden increase in arterial blood pressure can lead to acute vascular damage of vital organs. Hypertension and dyslipidemia often co-exist. Dyslipidemia worsens the prognosis in hypertensive emergency patients. So this study aimed to study the clinical profile and spectrum of target organ involved in patients with hypertensive emergencies with special reference to fasting lipid profile. Materials and method: This study is a hospital based cross sectional study carried in 60 patients admitted in medicine ward of JMCH fulfilling the eligible criteria. All patients are subjected to clinical workout with detailed history, examination and also lipid profile value. Lipid profile of study group are compared with lipid profile of 60 normotensive patients Results: The most common presenting complaint in the study is weakness of limbs (75%) followed by headache (46.66%), vomiting, dyspnoea. The most common spectrum of neurological end organ damage is ICH (46.66%) followed by cerebral infarct (23.33%), least common is SAH. Triglyceride, cholesterol, LDL and VLDL level in hypertensive emergencies are significantly higher (p<0.05) than in normotensive patients. Conclusion: The commonest clinical presentation in hypertensive emergency is neurological deficit. Fasting lipid profile is significantly deranged in hypertensive emergencies.

POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME: DIVERSE ETIOLOGIES

Objective: Posterior Reversible Encephalopathy, called PRES, is a clinico-radiological entity individualized for the first time in 1996 as a special form of hypertensive encephalopathy. Design and method: We collected retrospectively 8 cases of PRES Syndrome either on-specific or followed in Internal Medicine service. All patients had a confirmed diagnosis by brain MRI. Results: There were 5 women and 3 men, mean age was 30 years (range 16–66 years). Three patients had a past history of arterial hypertension. Two patients had moderate chronic renal failure, three had a chronic renal failure on hemodialysis, one had normal renal function and the two others were transplanted. Hypertension with diastolic blood pressure greater than 120 mmHg was noted in two patients. For the others, it was an acute and sudden increase of blood pressure usually well balanced. Neurological manifestations are on-specific, such as confusion, a prolonged critical post coma or seizure initially focal (Braved-Jacksonian) limited to brain lobe affected by the PRES which become generalized secondarily. All patients had seizures, one presented a status epilepticus. They all underwent magnetic resonance imaging (MRI). Typical imaging findings characteristically involve the white matter bilaterally in the parieto-occipital regions. Involvement of the white matter is constant. To equilibrate the systemic blood pressure, we used calcium channel blockers in all cases (nicardipine in the electric syringe pump in one case). The therapeutic goal was to maintain a mean arterial pressure between 105 and 125 mmHg. Conclusions: PRES is highly diverse in terms of etiologies. Our series is particular by the large number of cases of PRES compared to the literature but especially by the diversity of the etiologies of PRES. All our patients had chronic renal failure and / or underlying nephropathy.

Autonomic Dysreflexia following Spinal Cord Injury.

Autonomic dysreflexia (AD) is a potentially life-threatening condition of the autonomic nervous system following spinal cord injury at or above T6. One of the most common symptoms is a sudden increase in blood pressure induced by afferent sensory stimulation owing to unmodulated reflex sympathetic hyperactivity. Such episodes of high blood pressure might be associated with a high risk of cerebral or retinal hemorrhage, seizures, heart failure, or pulmonary edema. In-depth knowledge is, therefore, crucial for the proper management of the AD, especially for spine surgeons, who encounter these patients quite often in their clinical practice. Systematical review of the literature dealing with strategies to prevent and manage this challenging condition was done by two independent reviewers. Studies that failed to assess primary (prevention, treatment strategies and management) and secondary outcomes (clinical symptomatology, presentation) were excluded. A bibliographical search revealed 85 eligible studies that provide a variety of preventive and treatment measures for the subjects affected by AD. As these measures are predominantly based on noncontrolled trials, long-term prospectively controlled multicenter studies are warranted to validate these preventive and therapeutic proposals.

Wanita Usia 39 Tahun dengan Ensefalopati Hipertensi: Laporan Kasus

Hypertensive encephalopathy is an acute reversible syndrome caused by a sudden increase of blood pressure so crosses the limits of brain auto-regulation. The objective of writing this scientific paper was to present clinical manifestations of hypertensive encephalopathy and report the favorable clinical outcomes in hypertensive encephalopathy patients with comprehensive therapy. This paper is an empirical case study investigates the symptoms of Hypertensive Encephalopathy in real life. Female, 39 years old complaints of sudden seizures, before the seizure she felt of non-throbbing headache all over her head. There was an increase in blood pressure of 200/130 mmHg. On neurologic-ophthalmologic examination, her right eye had no light perception (NLP), while on other neurological functions there were no abnormalities. She was hospitalized and treated with antihypertensive drugs, that are Amlodipine and Lamipril, during inpatient the DASH diet was given. The patient showed improvement, then was discharged on the 5th day of treatment. Diagnosis of hypertensive encephalopathy was made in this patient built upon high blood pressure plus neurologic symptoms and the exclusion of other conditions that could cause similar symptoms. Antihypertensives were used carefully at a target blood pressure of 150/100 mmHg (20% of MAP). Application of DASH diet has an effect for lowering blood pressure due to the restriction of sodium intake from food. Management of hypertensive encephalopathy includes lowering blood pressure but it’s not recommended aggressively because it can cause ischemia. Preventive measures are very important, research is needed on predictive factors for hypertension encephalopathy and a high level of alertness in risk groups.

Ventricular septal rupture after blunt chest trauma: a case report

Cardiac injury, including myocardial contusion and valvular damage, is a common complication of blunt chest trauma; however, traumatic ventricular septal rupture is a rare complication. We encountered a rare case of ventricular septal rupture following blunt chest trauma that was successfully repaired by emergency surgery. The mechanism underlying rupture may involve acute compression of the heart between the sternum and the vertebral column when the ventricle is filled, thereby causing a sudden increase in intraventricular pressure and leading to septal rupture. Emergency operation should be considered in cases of large defects and hemodynamic instability.

An isolated left diaphragmatic injury due to blunt trauma abdomen: a rare case entity

Isolated diaphragmatic injury in blunt trauma occurs acutely and can be associated with other life-threatening organ injuries. A sudden increase in abdominal pressure causes injury in the membranous or muscular part of the diaphragm. Isolated left diaphragmatic injury after blunt trauma is rarely seen, its diagnosis can be overlooked frequently. Early diagnosis is the most important step in the treatment thereby reducing morbidity and mortality. The most critical point during the diagnosis is the suspicion for clinical diaphragm injury like respiratory distress. Single or serial plain chest radiographs with a high index of suspicion are diagnostic in most cases. Computed tomography of the abdomen and thorax can be a guide for identifying the size of diaphragmatic injury and the contents. In this case report, we presented an isolated left side diaphragmatic rupture after blunt abdominal trauma and treated with an urgent surgical operation.