RESUMEN
Cerebrospinal fluid opening pressure values are associated with various neurologic diseases; however, numerous factors can modify this measurement. This study aims to describe factors related to modifications in opening pressure measurements in pediatric patients. Methods: A retrospective analysis of lumbar punctures in pediatric patients conducted by the neuropediatrics group with institutional standardization. Bivariate and linear regression analyses were performed to determine the association between opening pressure and variables included in the study. Results: 544 events, median age 107 months, median opening pressure 19.7â cm H2O. Bivariate analysis found no association with medication use; anesthetics that increased opening pressure were remifentanil (P = .02) and propofol (P = .05), along with a positive linear correlation between opening pressure and age (P < .0001). Multiple linear regression analysis revealed that age, BMI, male gender, and remifentanil use were associated with an increase in opening pressure, whereas corticosteroid withdrawal was associated with a reduction in opening pressure. There is an interaction between age and headache, with an association with increased opening pressure up to around 140 months. Conclusion: This study identifies factors associated with changes in opening pressure, crucial for estimating normal opening pressure values in children. Headaches, anesthetic use, and corticosteroid withdrawal are confirmed as significant factors.
Asunto(s)
Presión del Líquido Cefalorraquídeo , Cefalea , Punción Espinal , Humanos , Masculino , Femenino , Niño , Estudios Retrospectivos , Presión del Líquido Cefalorraquídeo/fisiología , Preescolar , Adolescente , Cefalea/fisiopatología , Lactante , Punción Espinal/métodos , Factores de EdadRESUMEN
UNLABELLED: Resistant hypertensive (RHTN) patients have endothelial dysfunction and aldosterone excess, which contribute to the development of resistance to antihypertensive treatment and cardiovascular complications. Biophysical forces within the arterial wall provide functional regulation of arterial stiffness. Carotid-femoral pulse wave velocity (PWV) and flow-mediated brachial artery dilation (FMD) can be used to evaluate vascular stiffness and endothelial function. Although both techniques have been used in several studies in hypertensive patients, it is unknown whether endothelial dysfunction is also associated with vascular stiffness in RHTN patients. METHODS: One hundred and ninety-three consecutive subjects were divided in three groups: 44 RHTN, 35 well-controlled hypertensive patients (HTN) and 25 normal healthy volunteers (NT). FMD was measured by high-resolution ultrasound and PWV was calculated from measurements of the pulse transit time and the distance traveled by the pulse between carotid and femoral arteries. RESULTS: No significant differences were observed in respect to body mass index, age or other biochemical variables among the three groups. FMD (NO-dependent) values were statistically different when comparing RHTN and well controlled HTN patients (respectively, 8.3 ± 4.7% and 10.1 ± 5.9%) and 12.3 ± 6.3% in normal subjects (p < 0.05). One-way analysis of variance (ANOVA) showed a significant difference in BP-adjusted PWV between RHTN and HTN (13.9 ± 1.0 and 11.5 ± 1.1 m/s, respectively; p < 0.05). FMD (NO-dependent) and PWV-adjusted values were strongly correlated in well-controlled HTN and NT subjects (r = - 0.74 and - 0.83, respectively). Although statistically significant, this correlation was lower in RHTN patients (r = - 0.43). CONCLUSION: We found a close relationship among high BP levels, endothelial dysfunction and vascular rigidity in hypertensive patients, demonstrated by a significantly higher increase in carotid-femoral PWV and a decrease in brachial artery FMD in RHTN when compared with well-controlled hypertensive patients. Although this study was not designed to test the prognostic, the vascular damage differences observed between patients with controlled vs uncontrolled hypertension suggest that the latter group may have a worse cardiovascular prognosis, requiring prospective assessment tests.
Asunto(s)
Arteria Braquial/fisiopatología , Arterias Carótidas/fisiopatología , Endotelio Vascular/fisiopatología , Arteria Femoral/fisiopatología , Hipertensión/fisiopatología , Rigidez Vascular , Adulto , Anciano , Análisis de Varianza , Antihipertensivos/administración & dosificación , Antihipertensivos/uso terapéutico , Velocidad del Flujo Sanguíneo , Presión Sanguínea , Determinación de la Presión Sanguínea , Arteria Braquial/diagnóstico por imagen , Arterias Carótidas/diagnóstico por imagen , Estudios de Casos y Controles , Endotelio Vascular/diagnóstico por imagen , Femenino , Arteria Femoral/diagnóstico por imagen , Humanos , Hipertensión/diagnóstico por imagen , Hipertensión/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Óxido Nítrico/metabolismo , Estudios Prospectivos , Flujo Pulsátil , UltrasonografíaRESUMEN
Aldosterone excess or "escape" can occur after treatment with medications that block the renin-angiotensin-aldosterone system or in undiagnosed primary aldosteronism. Spironolactone is thought to be an important addition to resistant hypertension (RH) treatment. In this study, resistant (RH) and controlled (CH) hypertensives and normotensive patients were submitted to echocardiography, flow-mediated vasodilation, carotid intima-media wall thickness studies, renin plasma activity, and aldosterone plasma levels and plasma and urinary sodium and potassium concentrations at baseline (pre-spironolactone phase). Subsequently, for only RH and CH groups, 25 mg/d spironolactone was added to preexisting treatments over 6 months. Afterwards, these parameters were reassessed (post-spironolactone phase). The RH and CH groups achieved reductions in blood pressure (P<.001), decreases in left ventricular hypertrophy (P<.001), improved diastolic function (Kappa index RH: 0.219 and Kappa index CH: 0.392) and increases in aldosterone concentrations (P<.05). The RH group attained improved endothelium-dependent (P<.001) and independent (P=.007) function. Optimized RH treatment with spironolactone reduces blood pressure and improves endothelial and diastolic function and left ventricular hypertrophy despite the presence of aldosterone excess or escape.
Asunto(s)
Aldosterona/sangre , Resistencia a Medicamentos , Hipertensión/tratamiento farmacológico , Antagonistas de Receptores de Mineralocorticoides/uso terapéutico , Espironolactona/uso terapéutico , Bloqueadores del Receptor Tipo 1 de Angiotensina II/farmacología , Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/farmacología , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Endotelio Vascular/efectos de los fármacos , Humanos , Hipertensión/sangre , Hipertrofia Ventricular Izquierda/tratamiento farmacológico , Antagonistas de Receptores de Mineralocorticoides/farmacología , Potasio/sangre , Potasio/orina , Renina/sangre , Sistema Renina-Angiotensina/efectos de los fármacos , Sodio/sangre , Sodio/orina , Espironolactona/farmacologíaRESUMEN
The pathogenesis and clinical significance of cerebral white matter lesions (WML) is poorly understood. Most studies have shown that age and hypertension are the most important factors related to the presence of WML. In addition, there are some evidences suggesting that susceptibility to WML is largely determined by genetic factors. The aim of the present study was to evaluate the possible association between clinical, biological and genetic factors, and the presence of WML in middle-aged, asymptomatic essential hypertensive patients. A total of 71 individuals (43 men, 28 women), aged 50-60 years, with never-treated essential hypertension and without clinical evidence of target organ damage were studied. All patients underwent a 24h-ABPM, an echocardiography, a neuropsychologic test, and a genetic study of renin-angiotensin system polymorphisms. Patients were classified into two groups according to the presence or absence of WML in brain magnetic resonance imaging. A total of 28 (39.4%) hypertensive patients showed WML in brain-resonance. Compared with hypertensives without WML, patients with WML showed significantly higher values of both office and 24h-ABPM systolic, diastolic, and pulse pressure. No differences were observed in either the nocturnal fall of blood pressure, or in blood pressure variability. The prevalence of concentric left ventricular hypertrophy was significantly higher (p = 0.002) in patients with WML (54%) than in hypertensives without WML (11%). Patients with WML exhibited a significantly worse performance on digit span forward, a standardized measure of attention, than hypertensives without WML. The frequency of the DD genotype of the angiotensin converting enzyme (ACE) gene in patients with WML (64%) was significantly higher (p = 0.022) than that observed in patients without WML (28.6%). The presence of WML in middle-aged hypertensive patients is related to the severity of blood pressure elevation, and to concentric left ventricular hypertrophy and also to mild decline in basic attention. The presence of the DD genotype of the ACE gene may be a predisposing factor for developing WML in essential hypertensive patients.
El significado clínico y la patogénesis de las lesiones cerebrales de la sustancia blanca (LSB) no están aclarados. La mayoría de los estudios sugieren que la edad y la hipertensión arterial son los factores más importantes relacionados con la presencia de LSB. También se sugirió la existencia de factores genéticos en la susceptibilidad de desarrollar LSB. El objetivo del presente trabajo es evaluar posibles factores clínicos, biológicos y genéticos relacionados con la presencia de LSB en pacientes de mediana edad afectados por hipertensión arterial esencial. Se incluyeron 71 pacientes con hipertensión esencial de ambos sexos, de edades comprendidas entre 50 y 60 años, nunca tratados y sin evidencia de enfermedad cardiovascular. Se realizaron las siguientes exploraciones: MAPA de 24 horas, ecocardiograma, evaluación neuropsicológica y estudio de los polimorfismos genéticos del sistema renina-angiotensina mediante PCR. A todos los pacientes se les realizó resonancia magnética cerebral para valorar la presencia o ausencia de LSB. Veintiocho (39.4%) de los pacientes hipertensos mostraban LSB en la resonancia. Los pacientes con LSB tenían cifras de presión arterial (PA) sistólica, diastólica y presión de pulso, significativamente mayores que los pacientes hipertensos sin LSB, tanto en la clínica como en la MAPA. No se objetivó asociación entre el perfil circadiano y las LSB, como tampoco con la variabilidad de la PA. La presencia de hipertrofia del ventrículo izquierdo (HVI) concéntrica era significativamente mayor (p = 0.002) en pacientes con LSB (54%) que en hipertensos sin LSB (11%). Los pacientes con LSB mostraron una puntuación significativamente peor en la prueba de la serie de dígitos directa (medida estandarizada de la atención) que los pacientes sin lesiones. En referencia al estudio genético, se objetivó que los pacientes con LSB presentaban mayor frecuencia del genotipo DD del gen de la enzima de conversión de la angiotensina (ECA) (64% versus 28.6%; p = 0.022) en comparación con los pacientes sin LSB. La presencia de LSB en pacientes hipertensos de mediana edad está relacionada con la gravedad de la elevación de la PA y con la existencia de HVI concéntrica. Los pacientes hipertensos con LSB presentan un leve deterioro de la capacidad de atención. La presencia del genotipo DD del gen de la ECA podría ser un factor predisponente para el desarrollo de LSB en pacientes con hipertensión arterial.
Asunto(s)
Heridas y Lesiones , Sustancia Blanca , Hipertensión Arterial Pulmonar , Ecocardiografía , Hipertrofia Ventricular Izquierda , Factores de Riesgo de Enfermedad CardiacaRESUMEN
Os autores apresentam uma atualização sobre a etiopatogenia, diagnóstico e tratamento do zumbido. Por fim relatam suas experiências com o tratamento cognitivo com o qual curaram 11 pacientes que sofriam de zumbido refratário a vários tipos de tratamento