1/70. The combination of risk factors for sudden death in a resuscitated elderly patient with an exceptional cause of left ventricular hypertrophy.The work-up of a previously asymptomatic 72-year-old man presenting with sudden cardiac death revealed a coarctation of the aorta as the cause of arterial hypertension, severe left ventricular hypertrophy, in combination with coronary artery disease with an apical myocardial infarction, severe autonomic dysfunction, and AV-nodal reentrant tachycardia. All these elements and their complex, probably synergistic interactions might have been involved in the development of sudden cardiac death.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
2/70. pheochromocytoma and clear-cell renal carcinoma in a child with von hippel-lindau disease: a patient report.A 6 year-old boy with von Hippel-Lindau (VHL) disease presented with hypertension due to bilateral pheochromocytomas. At age 13 he developed a renal carcinoma and bilateral paragangliomas. His mother had retinal angiomas, bilateral pheochromocytomas and a cerebellar hemangioblastoma. This unusual presentation illustrates the complexity and difficulties associated with the management of VHL disease.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
3/70. amphotericin b lipid complex (ABLC)-associated hypertension: case report and review.amphotericin b (AmB) continues to be the mainstay of therapy for serious fungal infections, despite its relatively toxic side-effect profile. Lipid preparations of the medication have been marketed in the past few years in an attempt to reduce some of these side effects, especially nephrotoxicity. Although 6 cases of severe hypertension associated with the use of AmB deoxycholate have been reported in the literature, no cases of hypertension associated with a lipid-containing preparation of the medication have been reported. We report here the first case of severe hypertension associated with the infusion of AmB lipid complex (ABLC) in a patient with multiple intraperitoneal and urinary fungal pathogens. We also provide a brief review of the previously reported cases of hypertension associated with the deoxycholate formulation of AmB.- - - - - - - - - - ranking = 5keywords = complex (Clic here for more details about this article) |
4/70. Bilateral ovarian steroid cell tumor in congenital adrenal hyperplasia due to classic 11beta-hydroxylase deficiency.An 8.7 year-old patient, raised as a boy, presented with premature appearance of pubic hair and accelerated growth since 2 years of age and ambiguous genitalia noted at birth. There was first degree consanguinity between his parents. A similar problem was reported in a cousin. Examination of the external genitalia revealed complete scrotal fusion, a 5 cm long phallus, urogenital sinus at base of phallus with no gonads palpable. pigmentation was increased. His blood pressure was 150/100 mm Hg. Pubic and axillary hair were at stage 3. Bone age was 17 years. Adrenal ultrasound was normal. Pelvic ultrasound showed relatively enlarged uterus and ovaries with normal echogenicity. karyotype was 46,XX. Hormone profile was compatible with congenital adrenal hyperplasia (CAH) due to 11beta-hydroxylase deficiency (11-deoxycortisol: 11.5 nmol/l [400 ng/dl] [normal: 0.6-4.5 nmol/l [20-155 ng/ml]], androstenedione: 17.4 nmol/l [5 ng/ml] [normal: 0.1-1.2 nmol/l [0.03-0.35 ng/ml]]). prednisolone and antihypertensive drugs were started. The patient underwent bilateral salpingo-oophorectomy and hysterectomy at 9.1 years. Histopathological examination of both ovaries revealed steroid cell tumor. The type of the tumor was "not otherwise specified" (NOS). Basal hormone levels and ACTH test performed 10 months after the operation and 7 days off treatment reconfirmed the diagnosis of 11beta-hydroxylase deficiency. Steroid cell tumors are extremely rare forms of steroid hormone-reducing ovarian neoplasms in childhood and may coexist with or imitate virilizing CAH.- - - - - - - - - - ranking = 1.3920297168356keywords = neoplasm (Clic here for more details about this article) |
5/70. Malignant pheochromocytoma lacking clinical features of catecholamine excess until the late stage.A malignant pheochromocytoma is described in a 71-year-old man. Osseous metastases became manifest 12 years after successful removal of the primary tumor which originated in paraganglionic tissue near the right adrenal gland. Although the patient had no symptoms of catecholamine excess initially, hypertension, tachycardia and excessive sweating appeared several months before his death, concomitantly with a sharp increase in noradrenaline secretion due to an accelerated growth of metastatic tumors. Since there is no histologic criterion of malignancy in this neoplasm, it would be prudent to consider every case of pheochromocytoma as potentially malignant and to follow-up carefully for a long time after removal of the primary tumor.- - - - - - - - - - ranking = 1.3920297168356keywords = neoplasm (Clic here for more details about this article) |
6/70. polyarteritis nodosa mimicking prostatic cancer.We describe a 72-year-old man with prostate enlargement, prostate-specific antigen level of 35 ng/dl, mild polyarthritis, and constitutional symptoms. Prostatic ultrasonography suggested neoplasm; however, transrectal biopsy revealed findings consistent with polyarteritis nodosa (PAN). The patient went on to develop leg paresthesia and dysesthesia, increased serum creatinine, and systemic hypertension. steroids and intravenous cyclophosphamide were administered, followed by improvement. Our case emphasizes the protean onset of PAN, and provides a new differential diagnosis of prostatic diseases related to elevated prostate-specific antigen.- - - - - - - - - - ranking = 1.3920297168356keywords = neoplasm (Clic here for more details about this article) |
7/70. Post exertional broad complex tachycardia in a normotensive patient: a rare presentation of phaeochromocytoma.Phaeochromocytomas are rare cause of secondary hypertension with significant morbidity and mortality, if left untreated. Paroxysms with hypertension are considered as "textbook" presentations but atypical forms represent considerable diagnostic challenge. We report an unusual association between phaeochromocyotoma and post-exertional malignant arrhythmia in a normotensive subject.- - - - - - - - - - ranking = 4keywords = complex (Clic here for more details about this article) |
8/70. Comprehensive management of patients with type 2 diabetes: establishing priorities of care.Type 2 diabetes is a complex metabolic disorder characterized by elevated blood glucose levels and a marked increase in the risk of cardiovascular disease (CVD). The increased CVD risk is caused by a unique cluster of metabolic abnormalities, including dyslipidemia, hypertension, insulin resistance, and hyperglycemia. To reduce the risk of cardiovascular complications in patients with type 2 diabetes, comprehensive management of risk factors is essential. Aggressive treatment of dyslipidemia and hypertension is known to benefit patients with type 2 diabetes. In addition, intensive glycemic control and targeted treatment of insulin resistance can further reduce the enormous burden of CVD in this high-risk population. Increasing evidence suggests that insulin resistance is one of the earliest markers of risk for both CVD and diabetes, and it is known that insulin resistance alone can significantly increase the risk of CVD. Type 2 diabetes and insulin resistance are both associated with disordered lipid metabolism, manifest in elevated triglyceride levels, low levels of high-density lipoprotein cholesterol, and small, dense low-density lipoprotein cholesterol particles. patients with type 2 diabetes and insulin resistance have an increased risk of hypertension, which further contributes to their CVD risk. Each of these factors can also contribute to the risk of microvascular disease. To ensure that patients with type 2 diabetes receive comprehensive, high-quality care, specific standards have been developed. These standards can help providers establish clear treatment targets, identify specific priorities of care, and use therapies of known efficacy to reduce the risk of complications. This review summarizes the current standards of care for patients with type 2 diabetes, with an emphasis on treatments that reduce the cardiovascular risk factors. Using a case study approach, it reviews the essential components of diabetes care and proposes a rational approach to these complex cases--an approach that should result in consistent, high-quality care.- - - - - - - - - - ranking = 2keywords = complex (Clic here for more details about this article) |
9/70. Adverse neurologic events associated with rebound hypertension after using short-acting nifedipine in childhood hypertension.INTRODUCTION: Short-acting nifedipine (SA-NIF) is widely prescribed for acute hypertension (HTN) in children despite reports of ischemic complications in adults. We describe two children with neurologic events caused by rebound hypertension following SA-NIF use. CASES: Patient 1 is a 7-year-old with acute nephritis and blood pressure (BP) of 185/130. She received SA-NIF which decreased BP to 114/79. When BP rebounded to 160/103, she developed severe cortical visual impairment. head CT demonstrated edema and petechial hemorrhages in the watershed region. Patient 2 is a 10-year-old renal transplant recipient who received SA-NIF for a BP of 155/98, which resulted in a prompt decrease to 114/74. Two hours later he developed aphasia and right-sided neglect. His BP increased to 168/88 and he developed partial complex seizures. brain MRI showed high signal intensity in the watershed areas with early gadolinium enhancement. DISCUSSION: The temporal association of the neurologic events with the rebound increase in BP suggests a possible role for the SA-NIF, consistent with its pharmacokinetic profile. Although the adult literature has focused on the unpredictable decline in BP after SA-NIF treatment, these cases suggest that rapid increases in BP following the maximal SA-NIF effect may be associated with impaired cerebral autoregulation and encephalopathy in children. These cases underscore the need for frequent blood pressure determinations and therapy to prevent rebound hypertension.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
10/70. Antinuclear antibody-negative, drug-induced lupus caused by lisinopril.The clinical symptoms of drug-induced lupus (DIL) are similar to those of idiopathic systemic lupus erythematosus. The literature indicates that in patients with DIL, sera generally contain antinuclear antibodies (ANAs); however, ANA-negative DIL has been reported. The list of medications implicated as etiologic agents in DIL continues to grow. This list includes two different types of angiotensin-converting enzyme inhibitors--captopril and enalapril. We report the first case of DIL caused by lisinopril. Our patient had negative results on ANA testing and had histone antibodies (IgG anti-[H2A-H2B]-dna) mirroring the disease course. antibodies to the (H2A-H2B)-dna complex are seen in more than 90% of patients with active DIL, excluding those with DIL due to hydralazine. Thus, it is important to recognize the clinical significance of IgG anti-(H2A-H2B)-dna antibodies and that negative ANA test results do not preclude the diagnosis of DIL.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
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