RESUMO
It is difficult to determine the etiology of hypertension during pregnancy on the basis of clinical criteria alone. The purpose of the present study is to emphasize the impact of the postpartum reclassification of the hypertensive disorders in gestation. One hundred and fifty eight patients with an initial diagnosis of preeclampsia were prospectively studied. The follow-up included a reclassification of their hypertensive disorder at 4, 8 and 12 weeks postpartum. Such reclassification was based on renal function test and values of blood pressure. Among 158 patients, 118 had an initial diagnosis of preeclampsia during pregnancy, and only in 39 cases (33%) such diagnosis was confirmed postpartum. At the time of reclassification the rest of the patients belonged to the following conditions: gestational hypertension without proteinuria 35%, chronic hypertension 16%, nephropathy (7 with renal biopsy) 11%, and 4% with chronic hypertension and superimposed preeclampsia. There was no significative difference in perinatal morbidity between patients with chronic and gestational hypertension. A total of 10% of perinatal mortality rate was found. We concluded that the reclassification postpartum of the hypertensive disorders in pregnancy is essential to avoid errors in diagnosis and to establish adequate maternal and perinatal outcomes in future pregnancies.
Assuntos
Hipertensão/etiologia , Pré-Eclâmpsia/classificação , Adulto , Doença Crônica , Feminino , Humanos , Hipertensão/classificação , Hipertensão/complicações , Nefropatias/etiologia , Pré-Eclâmpsia/complicações , Gravidez , Resultado da Gravidez , Prognóstico , Proteinúria/etiologiaRESUMO
The results of the treatment with surgery and percutaneous transluminal angioplasty of the renal artery were evaluated in 63 adult patients of both sex, from 16 to 60 years old with renovascular hypertension due to fibromuscular dysplasia in 48 and to atherosclerosis in 15. The stenosis of the renal artery was unilateral in 47 patients and bilateral in 16. The surgical procedures more used were the aorto-renal bypass with saphenous vein in 22 patients and unilateral nephrectomy in 16. From 41 patients treated with surgery, the arterial hypertension was cure or improved after one year in 30 (73.1%). From 22 patients treated with angioplasty, cure or improved was obtained in 17 (77.2%). Satisfactory results were obtained in patients with fibromuscular dysplasia and unilateral stenosis, and poor results in atherosclerosis and bilateral stenosis, with both methods. It is concluded, that surgery and angioplasty are satisfactory therapeutic methods in the renovascular hypertension, principally when is unilateral and due to fibromuscular dysplasia.
Assuntos
Angioplastia com Balão , Hipertensão Renovascular/terapia , Adolescente , Adulto , Arteriosclerose/complicações , Estudos de Avaliação como Assunto , Feminino , Displasia Fibromuscular/complicações , Humanos , Hipertensão Renovascular/diagnóstico por imagem , Hipertensão Renovascular/etiologia , Hipertensão Renovascular/cirurgia , Masculino , Pessoa de Meia-Idade , RadiografiaAssuntos
Anti-Hipertensivos/uso terapêutico , Hemodinâmica/efeitos dos fármacos , Hipertensão Portal/tratamento farmacológico , Propanolaminas/uso terapêutico , Adulto , Idoso , Feminino , Humanos , Hipertensão Portal/etiologia , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Nadolol , Propanolaminas/farmacologiaRESUMO
Se estudio el efecto del nadolol, un nuevo bloqueador betaadrenergico no cardioselectivo, sobre la presion portal en siete pacientes con cirrosis hepatica con hipertension portal. Se encontro que el nadolol disminuye significativamente la presion portal cuando se administra a dosis suficientes para disminuir la frecuencia cardiaca basal en 20 a 25 por ciento
Assuntos
Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Antagonistas Adrenérgicos beta , Hipertensão Portal , Cirrose HepáticaAssuntos
Adolescente , Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Hipertensão , Sódio , EspironolactonaRESUMO
Two patients with pheochromocytoma predominantly secreting noradrenaline, were studied. Intravenous glucose tolerance tests were performed: in the preoperatory period, under alpha adrenergic blockade with pentolamine and one month after the tumor was removed. Serum glucose and insulin concentrations were determined. Proinsulin was separated from the insulin in Sephadex G-50 fine columns. In the preoperatory study, insulin secretion was less during the first 10 minutes after glucose administration, when comparing to that observed in two other studies. During pentolamine blockade, insulin secretion was at least three times higher than the preoperatory test; however, hypoglycemia was not observed. Proinsulin levels were similar to the observed in a normal individual in the pre and postoperatory test during pentolamine blockade, and were found significantly elevated. It is postulated that hypoglycemia was not produced during the late test because more than 50 per cent of immunoreactivity measured as insulin, corresponded to proinsulin whose biological activity is 10 times less than that of insulin.
Assuntos
Neoplasias das Glândulas Suprarrenais/metabolismo , Insulina/metabolismo , Norepinefrina/metabolismo , Feocromocitoma/metabolismo , Proinsulina/metabolismo , Neoplasias das Glândulas Suprarrenais/cirurgia , Adulto , Feminino , Teste de Tolerância a Glucose , Humanos , Secreção de Insulina , Masculino , Feocromocitoma/cirurgiaRESUMO
Se estudiaron dos pacientes con feocromocitoma cuya secrecion predominante era noradrenalina. Se les practicaron pruebas de tolerancia endovenosa a la glucosa en el periodo preoperatorio, bajo bloqueo alfa adrenergico con pentolamina, y un mes despues de haber extirpado el tumor. Durante estas pruebas se determinaron las concentraciones sericas de glucosa e insulina. La proinsulina se separo de la insulina en columnas de Sephadex G=50 fino. Durante el estudio preoperatorio la secrecion de insulina fue menor durante los primeros 10 minutos despues de la administracion de glucosa, en comparacion con la observada en los otros dos estudios. Durante el bloqueo con pentolamina se produjo una secrecion de insulina por lo menos tres veces superior a la prueba preoperatoria a pesar de lo cual no se produjo hipoglucemia.Los porcentajes de proinsulina fueron normales en las pruebas pre y postoperatorias, en tanto que se encontraron anormalmente elevados durante el bloqueo con pentolamina. Se postula que no se produjo hipoglucemia durante esta ultima prueba porque mas de 50 por ciento de la inmunorreactividad medida como insulina correspondia a proinsulina cuya actividad biologica es 10 veces menor que la de la insulina