Malignant hypertension affects less than 1% of people with high blood pressure, and is a hypertensive emergency. It is rare for patients to present initially with this form of elevated blood pressure, which is almost always associated with acute target organ damage, which can manifest in many forms including ocular, neurological, cardiac and renal. This treatable condition is associated with a high rate of morbidity and mortality therefore, early detection and immediate management is of paramount importance.
A 33-year old Malay woman with undiagnosed systemic lupus erythematosus (SLE) and other comorbids presented with acute glomerularnephritis, hypertensive emergency and later acute confusional state. Cranial MRI revealed features consistent with posterior reversible encephalopathy syndrome (PRES).
Phakomatosis pigmentovascularis (PPV) is a rare congenital syndrome characterized predominantly by cutaneous vascular malformations and pigmentary naevi. The most frequently reported form, Type II b, is associated with systemic involvement. Sturge-Weber Syndrome (SWS) with concomitant glaucoma, Klippel-Trenaunay Syndrome (KTS) and naevus of Ota have been frequently described, but there have only been two case reports with asymptomatic renal anomalies.
A total of 12 severely hypertensive patients were treated with a once daily dose ofNadolol. There was a drop in diastolic pressure to a mean of 105 mm Hg standing within two weeks and this was well maintained up to 12 months of therapy, the lowest diastolic pressure being 94 mm Hg standing at six months of therapy. Nadolol produced no significant side effects and bradycardia was not a problem during treatment. Of the eleven patients who were resistant to previous therapy because of various reasons all except two responded excellently. One of the non responders has real resistance to therapy and the other is non compliant. Nadolol is found to be an effective once daily treatment for severe and resistant hypertension.
Pancreatic carcinoid tumours are rare, particularly within the paediatric population. The clinical presentation is largely dependent on the functionality of the tumour. Although the tumour is generally slow-growing, surgical resection is still the mainstay of curative treatment. Morbidity is, however, significantly contributed by secretion of excess hormones; in view of this, biotherapy is an important treatment strategy. Octreotide, a somatostatin analogue, has been shown to be successful in both symptomatic control and stability of tumour progression. We report a 12-year-old girl, who presented with hypertensive crisis, and showed good response to a combination of chemotherapy and octreotide.