phenylephrine-hydrochloride and Hypertension

Topics: Chronic Disease; Diagnosis, Differential; Emergency Medical Services; Epistaxis; Follow-Up Studies; Humans; Hypertension; Nose; Recurrence

There is increasing evidence that obstructive sleep apnea (OSA) is an independent risk factor for arterial hypertension. Because there are no controlled studies showing a substantial effect of nasal continuous positive airway pressure (nCPAP) therapy on hypertension in OSA, the impact of treatment on cardiovascular sequelae has been questioned altogether. Therefore, we studied the effect of nCPAP on arterial hypertension in patients with OSA.. Sixty consecutive patients with moderate to severe OSA were randomly assigned to either effective or subtherapeutic nCPAP for 9 weeks on average. Nocturnal polysomnography and continuous noninvasive blood pressure recording for 19 hours was performed before and with treatment. Thirty two patients, 16 in each group, completed the study. Apneas and hypopneas were reduced by approximately 95% and 50% in the therapeutic and subtherapeutic groups, respectively. Mean arterial blood pressure decreased by 9.9+/-11.4 mm Hg with effective nCPAP treatment, whereas no relevant change occurred with subtherapeutic nCPAP (P=0.01). Mean, diastolic, and systolic blood pressures all decreased significantly by approximately 10 mm Hg, both at night and during the day.. Effective nCPAP treatment in patients with moderate to severe OSA leads to a substantial reduction in both day and night arterial blood pressure. The fact that a 50% reduction in the apnea-hypopnea index did not result in a decrease in blood pressure emphasizes the importance of highly effective treatment. The drop in mean blood pressure by 10 mm Hg would be predicted to reduce coronary heart disease event risk by 37% and stroke risk by 56%.

Topics: Blood Pressure; Female; Humans; Hypertension; Kinetics; Male; Middle Aged; Nose; Polysomnography; Pressure; Sleep Apnea, Obstructive

Blood pressure and pulse rate measurements were recorded in 35 patients undergoing endotracheal intubation during general anaesthesia (Group A), and 35 patients who had an awake fibreoptic intubation under local anaesthesia (Group B). The mean arterial pressure in Group A rose by a mean of 35 mmHg immediately after intubation, compared with a mean fall of 9 mmHg in Group B. The mean pulse rate in Group A rose by 24 beats per minute (b.p.m.) immediately after intubation, compared with a rise of 3 b.p.m. in Group B. Both these differences were statistically significant (P less than 0.0001 and P less than 0.001 respectively, Mann Whitney U test). Postoperative discomfort was assessed 24 h later by means of linear analogue scales. There was a statistically higher mean score in relation to nose discomfort in Group B (P less than 0.002). Awake fibreoptic intubation successfully reduces the pressor response to endotracheal intubation in normotensive adults. It is suitable for use in those patients who are at risk from the pressor response.

Topics: Anesthesia, General; Anesthesia, Local; Blood Pressure; Bronchoscopy; Deglutition; Female; Fiber Optic Technology; Humans; Hypertension; Intubation, Intratracheal; Laryngoscopy; Male; Middle Aged; Nose; Pain; Pharynx; Prospective Studies; Pulse

To demonstrate the efficacy of identification of bleeding source with nasal endoscopy and cauterization (bipolar or radiofrequency) without nasal packing in adults with posterior epistaxis unable to be treated with nasal packing.. The average age of patients was 56.16 ± 12.6 (38-72) years, and female-male ratio was 1/5. The average systolic blood pressure was found to be 150 ± 30, while diastolic blood pressure was 90 ± 20 mmHg. Average hemoglobin concentration was 11.2 ± 3.1 (7-15). The bleeding was on the left side in 8 patients and on the right in 4 patients. Probable etiology was considered hypertension crisis (33.3%), use of nasal steroids (8.3%), nasal surgery (8.3%), however in half (50%) of the cases the cause was unidentified. Of the cases, 6 had hypertension, 4 COPD, 10 tobacco use and 5 alcohol use. The source of epistaxis was anterior ethmoidal artery in 2 cases and spheopalatine artery in 10 cases. Two of the cases were treated with radiofrequency coagulation, and ten with bipolar cauterization. Only one of the cases was administered 2 units of packed red blood cells, and one of the cases had postoperative recurrent bleeding. The patients were hospitalized in average 3.2 (2-5) days and no reccurence of hemorrhage was seen in 3 month follow up.. Dundee epistaxis menagement protocol described by Barnes and Spielman may be applied in adults. Endoscopical detection of the bleeding site and cauterizing the arterial feed source is highly successful in the treatment. Nasal packing may more commonly lead to complication especially in the elderly and in patients with heart and respiratory problems.

Topics: Adult; Aged; Endoscopy; Epistaxis; Female; Humans; Hypertension; Male; Middle Aged; Nose; Postoperative Period; Tampons, Surgical

Topics: Aged; Arteries; Diagnosis, Differential; Electrocoagulation; Emergencies; Epistaxis; Humans; Hypertension; Male; Nose

Epistaxis is one of the commonest ENT emergencies. It affects people of all ages, more commonly males. Bleeding may be due to local nasal pathology, systemic diseases, or sometimes no specific cause is found, which is called idiopathic epistaxis. This descriptive study was designed to evaluate role of nasal endoscopy for diagnosis and management of epistaxis in a tertiary care hospital. Sixty-two selected patients with active epistaxis or with history of epistaxis within last 24 hours were evaluated and underwent nasal endoscopy. Patients were managed following standard protocols. This study demonstrated a bimodal distribution with incidence peaks in below 20 years and above 50 years age groups. Males were affected nearly twice commonly as females. Anterior nasal bleeding was noted in majority. Most common cause was found to be hypertension closely followedby trauma. Nasal endoscopy helped to localise bleeding points in majority of the cases. Cases were managed accurately with the help of endoscopes and any local disease was eradicated thoroughly. During follow-up, endoscopy helped in early detection of recurrences and thereby prevented complications. Epistaxis can be controlled very efficiently by electro or chemical cauterisation with the help of endoscopes, the source can be localised more efficiently. In cases of failure to localise or access of bleeding points, anterior and/or posterior nasal packing can control majority of nosebleeds. In majority of cases non-surgical interventions were sufficient.

Topics: Adult; Cautery; Electrocoagulation; Endoscopy; Epistaxis; Female; Humans; Hypertension; Male; Middle Aged; Nose; Nose Neoplasms; Young Adult

A fifty years old woman hailing from Purbadhala of Netrokona district complaining of gradual enlargement of hands, feet, nose and other acral parts of the body for about last eight years. She noticed coarsening of the skin and gradual protrusion of her lower jaw. She complained of headache, vertigo, frequent passage of urine, increased thirst, weight loss and fatiguability. She was found hypertensive having blood pressure 200/110 mm of Hg. Her appearance was coarse with rough skin. There were enlargement of hands, feet, nose, lower jaw with prognathism and enlargement of other acral parts. Investigations revealed high plasma glucose level, both fasting and 2 hrs. after glucose, high level of growth hormone, failure of suppression of growth hormone during OGTT. Thyroid function tests of the patient were found normal with increased heel pad size and enlarged sella turcica in all diameters. She was diagnosed as a case of acromegaly due to growth hormone hypersecretion.

Topics: Acromegaly; Blood Glucose; Female; Foot; Hand; Humans; Hypertension; Middle Aged; Nose; Prognathism; Radiography; Skin; Skull

The present study comprises 300 cases of epistaxis. The analysis of these cases revealed a higher incidence in young males. Unilateral bleeding was seen in almost 60% each of indoor and outdoor cases. Litte's area was the most common site responsible for epistaxis in 28.8% of the indoor and 26.2% of the outdoor patients. Hypertension was the most common systemic cause among indoor patients (62.2%) and sickle cell disorder among the outdoor patients (37.5%). Atrophic rhinitis with myiasis was the local cause of epistaxis in maximum (27%) of the indoor patients and traumatic epistaxis was the commonest cause (33%) among outdoor patients-fingernail trauma in 75.9% of them. Idiopathic epistaxis contributed for 16.5% indoor and 26.1% of outdoor cases. Intractable epistaxis was seen in one case following accidental facial trauma.

Topics: Adolescent; Adult; Child; Diagnosis, Differential; Epistaxis; Facial Injuries; Female; Hematologic Diseases; Humans; Hypertension; Incidence; India; Male; Neoplasms; Nose; Prospective Studies; Retrospective Studies; Rhinitis, Atrophic

Dural arteriovenous fistulae (AVF) represent abnormal communication between the meningeal arteries and the dural sinuses. Clinically, this condition appears more frequently in post-menopausal and pregnant women than in the general population. Oestrogen is believed to play an important role in the development of dural AVF; however, its exact role has not been clearly defined. We have previously reported that by surgically creating a carotid-jugular shunt in male rats, which then induces venous hypertension, spontaneous arteriovenous fistulae can result. To examine the specific role that oestrogen may have in the development of AVF induced by venous hypertension, we performed the following experimental procedure.. Ninety-four Sprague-Dawley female rats (250-300 grams in weight) were randomly assigned to four different groups. Group 1 (n = 20): control (bilateral ovariectomy only). Group 2 (n = 19): bilateral ovariectomy and implantation of the oestrogen pellet (17-beta oestradiol 0.75 mg/pellet, 60 days release). Group 3 (n = 17): bilateral ovariectomy and venous hypertension (left carotid-jugular shunt with proximal jugular vein occlusion). Group 4 (n = 38): bilateral ovariectomy and oestrogen pellet implantation and venous hypertension. All of the groups were examined by angiography 60 days after treatment. In Groups 1 and 2, bilateral common carotid angiography was performed via a transfemoral route. In Groups 3 and 4, angiography was done after surgical ligation of the carotid-jugular shunt to examine for any newly developed AVF.. No newly developed AVF were found in either Groups 1, 2, or 3. In Group 4, 2 rats (5.3%) developed newly formed AVF which occurred in the nose and neck. Our previous study demonstrated that AVF appeared in 3 of 22 (13.6%) venous hypertensive male rats. Therefore, no statistical difference in the appearance rate of newly formed AVF was found among groups 1, 2, 3 or 4 and between our previously reported group of male venous hypertensive rats.. In this experimental study, ovariectomy with or without oestrogen did not affect the development of spontaneous AVF induced by venous hypertension.

Topics: Animals; Arteriovenous Fistula; Cerebral Angiography; Drug Implants; Estradiol; Female; Hypertension; Neck; Nose; Ovariectomy; Rats; Rats, Sprague-Dawley; Veins

Topics: Administration, Intranasal; Arrhythmias, Cardiac; Child; Cocaine; Female; Humans; Hypertension; Hypophysectomy; Male; Norepinephrine; Nose; Ointments; Ventricular Fibrillation

Topics: Adult; Blood Pressure; Body Mass Index; Humans; Hypertension; Male; Middle Aged; Nose; Positive-Pressure Respiration; Sleep Apnea Syndromes

Two groups of 12 patients were studied to determine the causes of hypertension during trans-sphenoidal resection of pituitary microadenomas. Two concentrations of lidocaine, 0.5 and 1.0 per cent with epinephrine 1/200,000, were used to infiltrate the nose and upper gingiva. Heart rate, electrocardiogram lead II and systolic and diastolic arterial blood pressures were monitored. Three stages were observed for changes in above parameters: nasal infiltration, nasal dissection and sellar exploration. Highly significant reductions in arterial blood pressure and pulse rate responses to infiltration and nasal dissection were achieved by increasing the lidocaine concentration used for infiltration from 0.5 to 1.0 per cent (p < 0.05). Our findings implicate reflex from nasal stimulation as the main cause of the adverse cardiovascular effects. Only minimal changes accompanied the progress of the intrasellar dissection in both groups.

Topics: Adenoma; Adult; Anesthesia; Blood Pressure; Epinephrine; Female; Humans; Hypertension; Lidocaine; Microsurgery; Middle Aged; Nose; Pituitary Neoplasms; Pulse; Sphenoid Sinus

Topics: Adult; Aged; Coronary Disease; Female; Humans; Hypertension; Male; Middle Aged; Nose; Pentaerythritol Tetranitrate; Reserpine; Respiration

Topics: Adolescent; Bandages; Blood Coagulation Disorders; Carotid Artery, External; Epistaxis; Female; Hemostasis; Humans; Hypertension; Hypnotics and Sedatives; Ligation; Male; Maxillary Artery; Middle Aged; Nasal Decongestants; Nose; Nose Neoplasms; Pressure; Recurrence; Telangiectasia, Hereditary Hemorrhagic; Wounds and Injuries

If arterial ligation is contemplated and the site of bleeding has not been identified it is reasonable to ligate the external carotid or maxillary artery, on the basis that this vessel supplies the major part of the nose. If bleeding persists in spite of ligation, this does not mean that the wrong vessel has been tied off but that arterial anastomoses are allowing blood to seep from the ethmoidal to the sphenopalatine area of the nose. If the anterior ethmoidal artery is to be ligated it is worth remembering that in 14-3 per cent of cases the anterior ethmoidal artery is absent unilaterally and in 2-4 per cent of cases absent bilaterally (Shaheen, 1967). The presence of a foramen with a periosteal cuff going through it does not necessarily mean that there is an artery present (Fig. 23). Finally, the blood vessel changes which occur and which are responisble for the persistence of nose bleeds in the elderly are a collagenous change in the muscle coat of medium and small arteries and calcification (not atheroma) in the larger feeding vessels.

Topics: Adult; Age Factors; Aged; Arteries; Blood Pressure; Carotid Artery, External; Epistaxis; Ethmoid Bone; Female; Humans; Hypertension; Ligation; Male; Maxillary Artery; Middle Aged; Nose; Regional Blood Flow; Rupture, Spontaneous; Sex Factors

Topics: Adolescent; Arteriosclerosis; Cautery; Child; Epistaxis; Humans; Hypertension; Ligation; Nose; Occlusive Dressings; Pressure

Topics: Aging; Anesthesia, General; Anesthesia, Local; Arteriosclerosis; Bronchitis; Cataract Extraction; Diabetes Complications; Diabetes Mellitus; Drug Interactions; Eye Diseases; Eye Injuries; Glaucoma; Hemorrhage; Humans; Hypertension; Hypoglycemic Agents; Intraocular Pressure; Intubation; Lacrimal Apparatus; Middle Aged; Monoamine Oxidase Inhibitors; Nose; Ophthalmologic Surgical Procedures; Preanesthetic Medication

Topics: Abnormalities, Multiple; Adult; Chromosome Aberrations; Chromosome Disorders; Chromosome Mapping; Chromosomes, Human, 21-22 and Y; Craniofacial Dysostosis; Dermatoglyphics; Female; Fibroblasts; Humans; Hypertension; Infant, Newborn; Intellectual Disability; Karyotyping; Lymphocytes; Male; Micrognathism; Microphthalmos; Microscopy, Fluorescence; Nose; Palate; Pregnancy; Quinacrine; Skin; Skull; Syndrome

Topics: Cryosurgery; Emergencies; Epistaxis; Humans; Hypertension; Intubation; Methods; Nose; Telangiectasia, Hereditary Hemorrhagic

Topics: Adult; Anticoagulants; Arteries; Blood Coagulation Disorders; Craniocerebral Trauma; Epistaxis; Hematologic Diseases; Hemostasis; Humans; Hypertension; Liver Diseases; Methods; Nose; Nose Diseases; Tampons, Surgical

Topics: Epistaxis; Humans; Hypertension; Nose