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[en] Stomal variceal bleeding can develop in patients with underlying cirrhosis and portal hypertension. Most patients are best treated with transjugular intrahepatic portosystemic shunt (TIPS) creation because this addresses the underlying problem of portal hypertension. However, some patients are not good candidates for TIPS creation because they have end-stage liver disease or encephalopathy. We describe such a patient who presented with recurrent bleeding stomal varices, which was successfully treated with percutaneous coil embolization. The patient had bleeding-free survival for 1 month before death from unrelated causes.
[en] Influence of aging on plasma renin activity was evaluated in healthy normotensive subjects(age range 21-63 years, 413 males) devoid of cardiorenal or endocrinological problems. The age-related decrease of plasma renin activity in the subjects between 21-28 years group and 36-42 years group was slight, but over the 43 years groups was significantly different. The age-related suppression of plasma renin activity was much more smooth and continuous all over the age ranges evaluated. The sexual difference in plasma renin activity was noticed between the subjects of 22 years old group (34 males) and 19 years group (34 females) (p<0.003). The data suggest that the age-related suppression of plasma renin activity appeared in healthy normotensive subjects should be considered in the case of evaluation of low renin essential hypertension.
[en] Highlights: • Roles of exosomes on regulation of essential hypertension remain to be determined. • Plasma exosomes modulated systemic blood pressure in normotensive and hypertensive rats. • Plasma exosomes modestly changed structure and function of cardiovascular tissues. • Present findings indicate exosomes are potential target for treatment of essential hypertension. Exosomes, the smallest extracellular vesicle, contain various molecules and mediate cell-cell communication. A number of studies demonstrate exosomes are involved in important physiological and pathological processes. Moreover, microRNA (miRNA) regulating hypertension development through the suppression of certain translation was recently reported. However, roles of exosomes containing various molecules including miRNA on development of essential hypertension have not been examined. We tested the hypothesis that plasma exosomes regulate systemic blood pressure in normotensive and spontaneously hypertensive rats (SHR). Normotensive Wistar Kyoto rats (WKY) and SHR (5-10-week-old) were intraperitoneally administrated with exosomes derived from plasma in WKY or SHR weekly for 6 weeks. Exosomes were isolated by an ultracentrifuge method. SHR-derived exosomes significantly increased systolic blood pressure in WKY, while WKY-derived exosomes decreased it in SHR. In WKY, SHR-derived exosomes induced modest structural changes of thoracic aorta, such as wall thickening and decreased abundance of collagen, which were similar to the changes observed in SHR. On the contrary, WKY-derived exosomes tended to reverse the changes in SHR. WKY-derived exosomes significantly suppressed the increased prostaglandin F2α-induced contraction of mesenteric arterial smooth muscle in SHR. In addition, wet weight and perivascular fibrosis of left ventricles in WKY were significantly increased by SHR-derived exosomes, while the fibrosis but not ventricular weight was significantly decreased by WKY-derived exosomes in SHR. We for the first time demonstrated that plasma exosomes can modulate systemic blood pressure as well as structure and function of cardiovascular tissues in both normotensive and hypertensive rats.
[en] The presence of dilatation of the right descending pulmonary artery is a reliable roentgenologic sign of pulmonary hypertension, though no linear correlation exists between pulmonary artery widths and pulmonary artery pressure. And so, at the first, the author measured the right descending pulmonary artery on both inspiratory and expiratory chest roentgenograms of 200 normal male adults and 200 normal female adults, using Chang's method, to obtain normal value of measurement in Korean. The results were as follows; 1. In males, the range of the right descending pulmonary pulmonary artery measurements was 9-16 mm in inspiration and 8-15 mm in expiration. The mean inspiratory measurement was 14.0 mm as compared to 12.1 mm for the expiratory measurement. The range of difference between inspiratory and expiratory measurement was 1-3 mm (1 mm in 44 cases, 2 mm in 138 cases, and 3 mm in 18 cases). The mean difference was 1.9 mm. 2. In females, the range of measurement of the right descending pulmonary artery 9-16 mm with a mean measurement of 12.9 mm in inspiration. The expiratory measurements showed a range of 8-14 mm, with a mean measurement of 11.1 mm. The range of difference between inspiratory and expiratory measurements was 1-3 mm (1 mm in 62 cases, 2 mm in 114 cases, and 3 mm in 24 cases). The mean difference was 1.8 mm. 3. There are apparent changes in the measurement of the descending pulmonary artery during respiration in normal adults. The size of the right descending pulmonary artery increases during inspiration and decreases during expiration. There were 1-3 mm difference between inspiratory and expiratory measurements. In 252 cases (63%). The difference was 2 mm.