scholarly journals Typical Hemodialysis in India: A Case Report

2017 ◽  
Vol 44 (Suppl. 1) ◽  
pp. 26-30
Author(s):  
Georgi Abraham ◽  
Madhusudan Vijayan ◽  
Milly Mathew
Keyword(s):  
Hypertensive Crisis ◽  
Large City ◽  
Volume Overload ◽  
Pressure Control ◽  
Ancillary Services ◽  
Team Approach ◽  
Medical Problems ◽  
Dietary Compliance ◽  
Good Blood Pressure Control ◽  
Ckd Stage

We report here a typical case of a patient on hemodialysis (HD) for end-stage renal disease (ESRD) in India that highlights some of the management issues encountered in a country with an enormous burden of ESRD and major challenges of underdialysis and management of comorbidities. The patient, a 42-year-old multiparous woman with chronic kidney disease (CKD) stage V, type 2 diabetes mellitus, and hypertension is a homemaker from a middle-class family, living in a large city, with no family history of CKD. From May 2013 to December 2016, she has been receiving twice-weekly maintenance HD for 4 h (intermittent HD); access was via an internal jugular line initially and then via a left brachiocephalic arteriovenous fistula (AVF) from late June 2013. Medical problems in this patient included poor medication and dietary compliance, underdialysis, anemia, volume overload, congestive cardiac failure with recurrent pulmonary edema, and hypertensive crisis. In December 2016, she complained of pain in the fistula arm during dialysis, and in January 2017, she developed edema of the arm. Specific endovascular intervention with balloon angioplasty resulted in a resolution of the stenosis of the venous side of the AVF and the edema. Counselling for dietary compliance and drug adherence resulted in good blood pressure control. Unlike in most other dialysis units, we have been able to increase her HD to thrice weekly and institute several ancillary services, including skilled dietary counselling, cardiac care, and regular bioimpedance analysis with favorable outcomes. Thus, a multidisciplinary team approach offering such ancillary services would allow for better management and improved outcomes in patients with ESRD in resource-poor settings.

The Expanding Role of Echocardiography in Interventional Cardiology

2010 ◽  
Vol 6 (2) ◽  
pp. 71 ◽  
Author(s):  
Lindsay A Smith ◽  
Amit Bhan ◽  
Mark J Monaghan ◽  
◽  
◽  
...  
Keyword(s):  
Interventional Procedures ◽  
Imaging Modality ◽  
Interventional Cardiology ◽  
Design And Technology ◽  
Team Approach ◽  
Medical Problems ◽  
Multidisciplinary Team Approach ◽  
Case Selection ◽  
Optimal Imaging

Echocardiography provides excellent realtime imaging of the heart, making it the imaging modality of choice immediately before, during and after cardiac interventional procedures. It helps to guide case selection and execution of the intervention, evaluates the effects of the intervention and enables early detection of complications. Advances in the design and technology of medical devices and delivery systems, coupled with demand for alternative non-surgical therapies for common medical problems, have led to an increase in the volume, variety and complexity of non-coronary cardiac interventional procedures performed. Many of these procedures require a multidisciplinary team approach and demand optimal imaging to ensure successful outcomes. The aim of this article is to review the expanding role of echocardiography in non-coronary interventional cardiology in adults.

scholarly journals The importance of good blood pressure control in the prevention of stroke recurrence in hypertensive patients

1981 ◽  
Vol 57 (673) ◽  
pp. 690-693 ◽  
Author(s):  
J. H. Johnston ◽  
F. G. Dunn ◽  
D. G. Beevers ◽  
H. Larkin ◽  
D. M. Titterington
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Stroke Recurrence ◽  
Hypertensive Patients ◽  
Good Blood Pressure Control

Atrial fibrillation and hypertension

ESC CardioMed ◽  
2018 ◽  
pp. 2227-2229
Author(s):  
Hung-Fat Tse ◽  
Jo-Jo Hai
Keyword(s):  
Oxidative Stress ◽  
Risk Factors ◽  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Pressure Control ◽  
Hypertensive Patients ◽  
Good Blood Pressure Control ◽  
Increased Risk ◽  
Independent Risk Factors ◽  
Stress Activation

Hypertension is one of the most important independent risk factors for atrial fibrillation (AF). Conversely, AF is associated with an increased risk of stroke in hypertensive patients. While the pathophysiology linking the two conditions is not completely understood, it is likely attributed to interplay between mechanical stress, activation of the renin–angiotensin–aldosterone system, oxidative stress, and inflammatory response in hypertension to cause atrial electroanatomical remodelling, and thus AF. Management of hypertensive patients with AF encompasses lenient rate control, thromboprophylaxis, and good blood pressure control.

scholarly journals MON-205 Effectiveness of Pre-Op α-Blockade on Intra-Op Blood Pressure Control in Patients with Pheochromocytoma

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Julia Caroline Wingate Lake ◽  
Richard J Comi
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Cumulative Dose ◽  
Hypertensive Crisis ◽  
Pressure Control ◽  
Volume Replacement ◽  
Perioperative Outcomes ◽  
Preoperative Treatment ◽  
Blood Pressure Lowering ◽  
Pressure Lowering

Abstract Pheochromocytoma are rare tumors arising from catecholamine producing chromaffin tissue. Surgical manipulation of pheochromocytoma inevitably leads to supraphysiologic levels of circulating catecholamines. Such manipulation has the potential to lead to an intra-operative hypertensive crisis, cardiac arrhythmia, myocardial infarction, or pulmonary edema. When inadequately primed pre-operatively, a patient exposed to such surges may experience life-threatening consequences. Phenoxybenzamine is a non-competitive, non-selective α 1 and α 2 receptor antagonist that prevents blood pressure liability during surgical resection of pheochromocytoma. Previous literature has suggested that phenoxybenzamine affords more pronounced peri-operative systolic blood pressure control as compared to selective alpha-blockers. This superior control potentially is at the cost of postoperative hypotension owing to the irreversible nature of phenoxybenzamine.1 Our study compares the effects of pre-operative phenoxybenzamine on perioperative outcomes at a single tertiary medical center from 2004 to 2019. The cumulative pre-operative phenoxybenzamine dose was compared to the maximum intra-operative blood pressure, need for IV blood pressure lowering medications, duration of vasopressor need, volume replacement need, duration of time in the OR, duration of hospital stay, and pre-operative catecholamine levels. We speculate that increased phenoxybenzamine exposure will result in reduced peak intra-operative blood pressure and need for IV blood pressure lowering medications but may increase the need for post-resection intra-operative vasopressors and post-resection volume replacement. After IRB approval, (ID #00031606), we performed a data warehouse query for the ICD 9 and 10 codes of “pheochromocytoma” and “paraganglioma”. Patients who did not have confirmed pheochromocytoma on pathology were excluded. Data was collected retrospectively on 30 patients who underwent adrenalectomy for pheochromocytoma. 14 charts were excluded due to incomplete intra-operative anesthetic documentation. Our results suggest that there is no significant correlation between peak intra-operative MAP and cumulative phenoxybenzamine exposure. The cumulative dose of pre-operative phenoxybenzamine did not correlate with the number of anti-hypertensive medications used intra-operatively. An increased cumulative dose of pre-operative phenoxybenzamine was not associated with an increased duration of intra-operative vasopressor medications. Intra-operative volume replacement needs were surprisingly reduced with increased cumulative pre-operative phenoxybenzamine exposure. 1 P.A. van der Zee, A. de Boer. Pheochromocytoma: A review on preoperative treatment with phenoxybenzamine or doxazosin. The Netherlands Journal of Medicine. May 2014; Vol. 72 No 4, 190-201.

scholarly journals OR34-04 Efficiency of Adrenal Venous Sampling in the Treatment Choice of Primary Aldosteronism (AVSTAT Study)

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Mitsuhide Naruse ◽  
Felix Beuschlein ◽  
Mirko Parasiliti Caprino ◽  
Jaap Deinum ◽  
William Drake ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Clinical Decision ◽  
Pressure Control ◽  
Primary Objective ◽  
Adrenal Venous Sampling ◽  
Venous Sampling ◽  
Bilateral Disease ◽  
Good Blood Pressure Control ◽  
Number Of Patients ◽  
Unilateral Disease

Abstract BACKGROUND: Adrenal venous sampling (AVS) is strongly recommended for a subtype diagnosis of primary aldosteronism (PA) if adrenalectomy (ADX) is desired by the patient. Given various issues related to AVS such as technical demand, invasive nature, expensive cost and radiation exposure, AVS is expected to lead efficiently to the subtype diagnosis and ADX. Aim: Primary objective was to assess the performance of AVS to determine treatment of PA by investigating the ratio of unilateral disease and rate of ADX following AVS in patients with unilateral disease. Methods: Sixteen major referral centers in ENS@T (n=10) and Japan (n=6) participated in the study. Study period was from 2006 to 2018. Data on total number of PA patients, AVS (total number and number of successful procedures), number of patients with unilateral diseases, and number of patients that underwent ADX were collected by a questionnaire-based survey. In addition, reasons for not proceeding to ADX in patients with a unilateral diagnosis were investigated. The diagnosis of PA was based on the positive case detection and at least one positive result in confirmatory testing. Results: Total number of confirmed PA patients and conducted AVS showed a dramatic increase during the past decade (PA: 1061 pts/ 2006–2011 to 3718 pts/ 2012–2018; AVS: 720/ 2006–2011 to 2448/ 2012–2018). Success rate of AVS was improved from 79.0% (2006–2011) to 92.5% (2012–2018). Both rate of unilateral PA and ADX of successful procedures decreased from 42.7% (2006–2011) to 37.3% (2012–2018) and from 40.8% (2006–2011) to 34.9% (2012–2018), respectively. Of the patients with successful AVS, bilateral disease was diagnosed in 63.5% (1812/2854 pts). Of the unilateral PA patients, 11.9% (125/ 1054 pts) were not subjected to ADX. The rate of the patients not subjected to ADX was significantly higher in Japan than in ENS@T centers both in patients with successful AVS (75.8% vs. 53.4%) and with unilateral disease (19.9% vs. 8.6%). Clinical decision against ADX in unilateral disease was made by the physicians in 33.3%, the patients in 33.3%, and both in 33.3%. Medical factors for Dr.’s decision against ADX in unilateral disease included good blood pressure control, normokalemia, comorbidities (e.g. DM, CKD), non-lateralized CT findings (e.g. no tumor, contralateral tumor), and discordant results among different criteria of AVS. Conclusions: High prevalence of bilateral disease and change of treatment policy after implementation affected the efficiency of AVS as an essential diagnostic procedure prior to ADX. Development of non-invasive procedures to exclude bilateral PA and more strict indication of AVS are warranted.

Risk factors for intraoperative complications in pheochromocytomas

2021 ◽  
Author(s):  
Marta Araujo-Castro ◽  
Rogelio Garcia Centeno ◽  
María-Carmen López-García ◽  
Cristina Lamas ◽  
Cristina Alvarez-Escola ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Antihypertensive Drugs ◽  
Intraoperative Complications ◽  
Tumour Size ◽  
Hypertensive Crisis ◽  
Pressure Control ◽  
Hemodynamic Instability ◽  
Beta Blockade ◽  
Pre Treatment

We aimed to identify presurgical and surgical risk factors for intraoperative complications in patients with pheochromocytomas. A retrospective study of patients with pheochromocytomas who underwent surgery in ten Spanish hospitals between 2011 and 2021 was performed. One hundred and sixty-two surgeries performed in 159 patients were included. The mean age was 51.6±16.4 years-old and 52.8% were women. Median tumour size was 40 mm (range 10-110). Laparoscopic adrenalectomy was performed in 148 patients and open adrenalectomy in 14 patients. Presurgical alpha- and beta- blockade was performed in 95.1% and 51.9% of the surgeries, respectively. 33.3% of the patients (n=54) had one or more intraoperative complications. The most common complication was hypertensive crisis in 21.0%, followed by prolonged hypotension in 20.0% and hemodynamic instability in 10.5%. Patients pre-treated with doxazosin required intraoperative hypotensive treatment more commonly than patients pre-treated with other antihypertensive drugs (51.1% vs 26.5%, P=0.002). Intraoperative complications were more common in patients with higher levels of urine metanephrine (OR=1.01 for each 100 mcg/24h, P=0.026) and normetanephrine (OR=1.00 for each 100 mcg/24h, P=0.025), larger tumours (OR=1.4 for each 10mm, P<0.001), presurgical blood pressure >130/80mmHg (OR=2.25, P=0.027), pre-treated with doxazosin (OR= 2.20, P=0.023) and who had not received perioperative hydrocortisone (OR=3.95, P=0.008). In conclusion, intraoperative complications in pheochromocytoma surgery are common and can be potentially life-threatening. Higher metanephrine and normetanephrine levels, larger tumour size, insufficient blood pressure control before surgery, pre-treatment with doxazosin, and the lack of treatment with perioperative hydrocortisone are associated with higher risk of intraoperative complications.

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