Hypertension associated with endothelin-secreting malignant hemangioendothelioma

Article Abstract:

Endothelin-1 is a small protein that constricts blood vessels and is involved in certain blood vessel disorders. This substance was recently isolated from endothelial cells (flat cells lining blood vessels) of the pig aorta. Malignant hemangioendothelioma is a rare cancer of the blood vessels characterized by the overgrowth of abnormal endothelium. The tumor usually metastasizes to the lungs and brain and affects the blood vessels supplying the brain and heart. The blood levels of endothelin-1 were measured in two patients with hemangioendothelioma before and after surgical removal of the tumor. These two cases are the first reports of an endothelin-secreting tumor. Endothelin-1 levels were increased tenfold with malignant hemangioendothelioma and sevenfold with hypertension, or high blood pressure, compared with normal health subjects. The blood levels of endothelin-1 decreased after removal of the tumor, but increased in one patient with recurrence of the tumor. Endothelin levels in the removed tumor of one patient was eight times greater than normal. In addition, the activity of the messenger ribonucleic acid (mRNA), which is the nucleic acid responsible for production of this protein, was greater in the tumor than in normal tissue. It was concluded that the tumor released excessive amounts of endothelin-1; levels of this protein corresponded with increases in blood pressure. These findings suggest that endothelin-1 contributes to the rise in blood pressure associated with malignant hemangioendothelioma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Hypertension, Endothelin, Hemangioendothelioma, Angiosarcoma

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Coronary artery bypass surgery in patients on chronic hemodialysis: a case-control study

Article Abstract:

Sixteen consecutive renal dialysis patients underwent cardiac catheterization and coronary artery bypass. The results of their treatments were compared with those of a similar group of patients who were not kidney dialysis patients; an additional control group was a series of 34 consecutive patients who underwent the diagnostic procedure and surgery. In the kidney dialysis group, no major complications of cardiac catheterization occurred. Seven of these patients underwent urgent surgery within 24 hours of the catheterization procedure. One dialysis patient and three of the consecutive control group died. Complications after surgery were more numerous for the dialysis group as determined by various clinical measures. Four dialysis patients, compared to two of the case-matched control groups, ultimately suffered heart attacks (myocardial infarction). The complications of the procedure are greater in the dialysis patients, but the outcome for all but one of these patients was good. Thus bypass surgery is an acceptable treatment for patients with advanced coronary artery disease who are on dialysis. Because urgent surgery is often needed for this group of patients, early evaluation of the need for bypass surgery may improve the ultimate clinical results.

Surgery, Coronary heart disease, Coronary artery bypass

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Increased nitric oxide production in patients with hypotension during hemodialysis

Article Abstract:

Increases in heparin-induced nitric oxide may be linked to episodes of hypotension during hemodialysis, a blood purification procedure used for treating kidney failure. Hypotension, which is abnormally low blood pressure, is a serious complication that often interferes with the completion of hemodialysis. Researchers measured metabolites of nitric oxide in the blood of 13 patients with kidney failure. The patients received 2,000 units of heparin at the beginning of hemodialysis followed by 1,000 units per hour during the procedure. Nitric oxide production increased only in the six patients who had episodes of hypotension during hemodialysis. No apparent change in nitric oxide levels occurred in the seven patients who had no evidence of hypotension. Although the exact mechanism of increased nitric oxide remains to be established, increases in nitric oxide seem to contribute to hypotension during hemodialysis.

Health aspects, Measurement, Nitric oxide, Vasodilators, Vasodilator agents, Heparin, Hypotension

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