Hypertension in pregnancy: classification, diagnosis and treatment

Hypertension in Pregnancy (HTNP) is defined as systolic blood pressure ≥ 140mmHg or diastolic blood pres­sure ≥ 90mmHg in at least two different measurements during pregnancy. According to guidelines, HTNP is classified into four or more individual categories. These categories include chronic hypertension, gestational hypertension, pre-existing hypertension plus superimposed gestational hypertension with proteinuria, antenatally unclassified hypertension and preec­lampsia. Although the exact causes and pathogenetic mechanisms of HTNP are not fully elucidated, the severity of the pos­sible complications, including eclampsia and HELLP syndrome, require the maximum alertness. Physicians should consider HTNP as a crucial maternal, fetal and neonatal morbidity and mortality factor. Early detection and treatment are of major importance and should be provided in every case. In the present review the potential pathogenetic mechanisms, categories and therapeutic interventions for HTNP are discussed, according to up-to-date data

Effects of Lifestyle Measures, Antiobesity Agents, and Bariatric Surgery on Serological Markers of Inflammation in Obese Patients

Overweight and obesity are highly prevalent in developed countries and are also becoming more frequent in the developing world. Overweight and obese patients have elevated levels of several inflammatory markers and this inflammatory state might contribute to their increased vascular risk. We summarize the effects of lifestyle changes, antiobesity agents, and bariatric surgery on serological inflammatory markers in overweight and obese patients. Most studies showed a decrease in inflammation with all 3 interventions. However, it remains to be established whether the decrease in inflammatory markers induced by lifestyle changes or (where indicated) with antiobesity agents or bariatric surgery will translate into reduced vascular morbidity and mortality in overweight and obese patients

Long-term radiotherapy related complications in children with head and neck cancer: Another era for pediatric oncologic pathology

Long-term radiotherapy-related complications in children with head and neck cancer have been frequently reported, especially facial growth disorders and dental abnormalities. We report on two male children (8 and 14 years old) with head and neck cancer, who were successfully treated with chemoradiotherapy and presented with growth deficiency of middle face and mandible hypoplasia, eight years and one year later, respectively. These severe growth complications attributed to chemoradiotherapy, while the patients survived primary malignancy. Patient age at irradiation was significantly correlated with the severity of disorders. We consider late sequelae in children with head and neck cancer due to chemoradiotherapy another era for pediatric oncologic pathology for prevention, if possible, or to manage them efficiently

Rectus Sheath Hematoma: A Simplified Emergency Surgical Approach

Rectus sheath hematoma (RSH) is an uncommon clinical event usually associated with trauma or coagulation disorders. It can also occur spontaneously. RSH usually runs a benign course but it can present with hypovolemic shock. When conservative management fails, surgical exploration becomes mandatory. We propose a technique of emergency ligation of the inferior epigastric artery. This is a simple approach as this artery originates at the posterior rectus sheath above the inguinal ligament. This safe technique provides immediate hemodynamic stabilization

Evaluation of cardiotoxicity five years after 2D planned, non-simulated, radiation therapy for left breast cancer

Kyriaki Pistevou-Gompaki1, Apostolos Hatzitolios2, Nikos Eleftheriadis2, Evaggelos Boultoukas2, George Ntaios2, Ioannis Andronikidis2, Ioannis Tzitzikas11Department of Radiation Oncology; 2First Propedeutic Department of Internal Medicine, AHEPA Hospital, Aristotle University, Thessaloniki, GreeceIntroduction: Radiation treatment has been associated with radiation induced cardiotoxicity, especially with older, long-outdated, techniques. Such complications include pericarditis, myocardial fibrosis, valvular injury, ischemic heart disease, and myocardial infarction.Aim: To assess the effect of outdated breast radiation therapy (RT) – using a diagnostic CT scanner in the absence of a CT simulator – on cardiac function in women with stage II left breast cancer.Patients and Methods: Sixty-two women under 65 with stage II left breast cancer who received post-operative RT using a diagnostic computed tomography scanner were studied between 1997 and 2001. Participants underwent a clinical interview, ECG, and echocardiography before and 6 months and 5 years after RT.Results: There was no serious cardiotoxicity at 6 months and 5 years after radiotherapy. A 23% increase in hypertensive patients, and a slight decrease (2.3%) in ejection fraction was observed after 5 years, with 3 patients (5%) developing abnormalities. Two patients presented abnormal electrocardiographic findings within 6 months of RT.Conclusion: Our study showed that RT for left breast cancer was not associated with significant alteration in heart morbidity or mortality within 5 years of treatment, despite the lack of a simulator.Keywords: radiotherapy, breast cancer, cardiotoxicity, acute myocardial infraction, ischemic heart diseas

Efficacy of Administration of an Angiotensin Converting Enzyme Inhibitor for Two Years on Autonomic and Peripheral Neuropathy in Patients with Diabetes Mellitus

Aim. To evaluate the effect of quinapril on diabetic cardiovascular autonomic neuropathy (CAN) and peripheral neuropathy (DPN). Patients and Methods. Sixty-three consecutive patients with diabetes mellitus [43% males, 27 with type 1 DM, mean age 52 years (range 22–65)], definite DCAN [abnormal results in 2 cardiovascular autonomic reflex tests (CARTs)], and DPN were randomized to quinapril 20 mg/day (group A, n=31) or placebo (group B, n=32) for 2 years. Patients with hypertension or coronary heart disease were excluded. To detect DPN and DCAN, the Michigan Neuropathy Screening Instrument Questionnaire and Examination (MNSIQ and MNSIE), measurement of vibration perception threshold with biothesiometer (BIO), and CARTs [R-R variation during deep breathing [assessed by expiration/inspiration ratio (E/I), mean circular resultant (MCR), and standard deviation (SD)], Valsalva maneuver (Vals), 30 : 15 ratio, and orthostatic hypotension (OH)] were used. Results. In group A, E/I, MCR, and SD increased (p for all comparisons < 0.05). Other indices (Vals, 30 : 15, OH, MNSIQ, MNSIE, and BIO) did not change. In group B, all CART indices deteriorated, except Vals, which did not change. MNSIQ, MNSIE, and BIO did not change. Conclusions. Treatment with quinapril improves DCAN (mainly parasympathetic dysfunction). Improved autonomic balance may improve the long-term outcome of diabetic patients