Arteriovenous fistula of the kidney: a case report of 47-year-old female patient treated by embolisation.

Arteriovenous fistulas of the kidney are rare. They may be acquired, idiopathic or arise in congenital arteriovenous malformations. There are only few reports in the current literature describing the successful embolisation of idiopathic arteriovenous fistulas. We report a 47-year-old hypertensive female patient with a successfully embolised arteriovenous fistula. Diagnosis was made on the basis of colour duplex Doppler examination and this method enabled further successful embolisation of the fistula.

Clinical evaluation of 24 h ambulatory monitoring of blood pressure under various environmental conditions (home and work versus hospital).

OBJECTIVE: To assess the effects of activity and environment on the spontaneous changes in 24 h blood pressure monitoring (BPM) and how these factors influenced the diagnosis of white-coat hypertension in the hypertensive subjects. PATIENTS AND METHODS: We examined 44 white-collar workers with untreated, uncomplicated mild hypertension, mean age 35 years, twice using 24 h BPM: on the day of natural activity, at home and at work (work-day 24 h BPM); and on the fourth day of hospitalization (hospital-day 24 h BPM). RESULTS: The mean value of blood pressure during activity period in hospital (hospital-day blood pressure) wqas significantly lower than that for ambulatory monitoring day (work-day blood pressure; 132/82 versus 138/85 mmHg). For work-day 24 h BPM the mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) from the period 0800-1600 h were substantially higher than the values from 1600-2300 h; for hospital-day 24 h BPM the mean SBP and DBP from two parallel activity periods did not differ significantly. The average office blood pressure of outpatients was 147.9 mmHg for SBP and 92.4 mmHg for DBP. Using the same threshold value of work-day and hospital-day blood pressures < 135/85 mmHg, the prevalence of white-coat hypertension was higher during a hospital day than it was on the work day. Basing our analysis of work-day 24 h BPM, white-coat hypertension was diagnosed in 28% of patients; basing our analysis on hospital-day 24 h BPM it was diagnosed in 49% of patients. mean night SBP and DBP at home and at hospital did not differ significantly. The correlation coefficients for relationship between home-night and hospital-night blood pressures were higher than those for work-day and hospital-day blood pressures (0.6 versus 0.44 for SBP; 0.63 versus 0.56 for DBP).CONCLUSIONS: Modification of the environmental conditions during activity period of men with mild hypertension causes an essential change in values and rhythm of blood pressure during this period, but does not influence the mean night blood pressure. Disregarding this fact during clinical interpretation of the results of 24 h BPM, especially with this group of patients, might be the main cause of a significant mistake in diagnosing white-coat hypertension.

[A difficult diagnostic case of malignant hypertension]. / Trudny diagnostycznie przypadek nadcisnienia zlosliwego.

A case of a 62-year old male with malignant hypertension was described. The clinical picture was dominated by the presence of cachexia, polyuria and polyneuropathy. Laboratory examinations revealed highly elevated sedimentation rate, hyponatremia and hypokalemia. Secondary hypertension as well as other diseases with similar clinical symptoms were excluded basing in diagnostic procedures. The authors discuss pathophysiological mechanisms on the base of abnormally elevated activity of the renin-angiotensin-aldosterone system. Unusual body weight loss (approximately 20 kgs), polyneuropathy and irreversible lesion of renal tubules without renal function impairment are emphasized.

[2 cases of Sneddon syndrome]. / Dwa przypadki zespolu Sneddona.

Two cases of Sneddon syndrome (S.s.) in a 33 and 53-year-old women who developed arterial hypertension, cerebral ischaemic signs and who have livedo reticularis or livedo racemosa, are reported. The authors describe clinical, radiological and biological features of this rare disease, as well as diagnostic investigations including the measurements of the antiphospholipid antibodies (APA). The possible role of APA in the pathogenesis of S.s. is discussed.

[Individual reactions and psychophysiologic reactions in patients with mild primary hypertension]. / Reakcje osobowosci i psychofizjologiczne reakcje u chorych na lagodne nadcisnienie tetnicze pierwotne.

Fourteen male patients with mild hypertension, aged between 20 and 46 years (mean = 32.4 years) measured their arterial blood pressure thrice daily for 6 weeks. Prior to and after this period psychological tests were carried out, including Gough's ACL test and Spielberger's STAI questionnaire. All patients underwent also Kraeplin's test under stress conditions twice during the experiment. It was found that there is significant correlation of personality response syndromes such as: need for acceptance, inferiority complex, need for success, trust to themselves, anger and some values of blood pressure. So-called personality syndrome related to hypertension was established. Psychophysiological picture accompanying emotional stress was discussed and relationship between blood pressure values (prior to and after emotional stress) and personality syndromes were defined.