simpsonstent924's Space http://simpsonstent924.posterous.com Most recent posts at simpsonstent924's Space posterous.com Fri, 06 Jul 2012 23:29:00 -0700 Essential Hypertension and Hypertensive Emergencies http://simpsonstent924.posterous.com/essential-hypertension-and-hypertensive-emerg http://simpsonstent924.posterous.com/essential-hypertension-and-hypertensive-emerg During abdominal examination, no bruit or mass is found and the neurologic and other systems are unremarkable.
How should blood pressure be measured?
What is the most likely cause of this patient's hypertension?
What laboratory tests are indicated?
Will lifestyle changes improve his blood pressure?
Is drug therapy indicated at this time?
What is the target blood pressure with treatment?
Case Discussion
How should blood pressure be measured?
The patient should be seated in a chair with his feet on the floor in a quiet place for at least 5 minutes. At least two measurements should be made with a calibrated instrument. Systolic blood pressure is defined as the blood pressure at which the first sound is heard and diastolic pressure is defined as the pressure at the disappearance of the sounds.
What is the most likely cause of this patient's hypertension?
The most likely cause of this patient's hypertension is essential hypertension.
What laboratory tests are indicated?
The laboratory investigation should include chest radiography (normal), ECG (sinus rhythm with increased voltage but no ST-T–wave changes), urinalysis, hematocrit, calcium (all normal), and measurement of the fasting blood sugar (normal), blood urea nitrogen, serum creatinine, electrolytes (normal), cholesterol [total and low-density lipoprotein (LDL) and high-density lipoprotein (HDL)], and triglyceride (total cholesterol is 240 with LDL of 170, HDL of 40, and normal triglycerides).
Will lifestyle changes improve his blood pressure?
Lifestyle modifications are an important part of blood pressure management. Beneficial lifestyle modifications include weight reduction in overweight or obese people, regular exercise, adoption of theDASH (Dietary Approaches to Stop Hypertension) diet which is high in calcium and potassium, limitation of sodium intake, and moderation of alcohol consumption.
Is drug therapy indicated at this time?
Medical therapy is indicated in this patient who has demonstrated stage 2 hypertension (Table 2-1 and Fig. 2-1). The plan of management should commence medical bookshop
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with instruction in lifestyle changes and oral antihypertensive drugs with the aim of maintaining blood pressure at less than 140/90 mm Hg. Eliminating coexisting cardiovascular risk factors (especially smoking) and treating the elevated cholesterol will not lower the blood pressure but will lower his risk of subsequent cardiovascular events.

Figure 2-1 Algorithm for treatment of hypertension. BP, blood pressure; ACE, angiotensin-converting enzyme; ARB, angiotensin-receptor blocker; CCB, calcium channel blocker. (From Chobanian AV, Bakris GL, Black GL, etal. The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. JAMA 2003;289:2560–2572.)

What is the target blood pressure with treatment?
The target blood pressure with treatment is less than 140/90 mm Hg. If the patient had diabetes or chronic kidney disease the recommended target blood pressure would be less than 130/80 mm Hg.
You instruct your patient in lifestyle changes and start him on lisinopril 10 mg once daily. In 2 weeks you increase the lisinopril to 20 mg daily because the blood pressure is still 160/98 mm Hg. Electrolytes and creatinine levels are unchanged. The increased lisinopril does not significantly alter the pressure and you add chlorthalidone at 25 mg daily. In 4 weeks his blood pressure is 139/88 mm Hg
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Fri, 18 May 2012 03:46:00 -0700 Human Birth Defects, and Disease? http://simpsonstent924.posterous.com/human-birth-defects-and-disease http://simpsonstent924.posterous.com/human-birth-defects-and-disease An important advance in the past decade is the demonstration that genes
that regulate developmental processes in invertebrate species have important
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the molecular genetic processes that regulate development in various animals
demonstrates that developmental programs and biological processes are high-
ly conserved, albeit not identical, from yeast to human. Indeed, the Human
Genome Project has made it possible to identify the homologues in humans
and demonstrate that many of these regulatory genes underlie human develop-
mental disorders and aspects of adult diseases in which differentiation pro-
cesses go awry. Currently, researchers are studying the fundamentals of online classes
developmental processes in the appropriate animal model and screening
humans for mutations in the genes identified by the basic research to be likely
causative candidates. Researchers are mutagenizing vertebrate animal models
and screening for mutants that resemble known human syndromes. This
cross-fertilization of fields is also impacting concepts in evolutionary biology,
xii PREFACEleading to a better understanding of “ancestral” species via gene expression
profiles, and paradigms in stem cell biology in which naı ¨ve cells may be direct-
ed to “designer” lineages. download medical book
Most recently, there have been significant technological advances in
genetic, genomic, and protein expression analyses that are having a major
impact on experimental approaches and analytic design. The intersection of
developmental biology with these technologies offers a new view of develop-
mental genetics that is only beginning to be exploited. It is this new intersec-
tion at the onset of the genomic era that is the focus of this book. The book is
organized into sections focused on different aspects of developmental genetics.
Section I discusses the impact of new genetic and genomic technologies on
development, stem cell biology, evolutionary biology, and understanding
human birth defects. Section II discusses several major events in early embryo-
genesis, fate determination, and patterning, including cellular determinants
(Boveri revisited?), gene cascades regulating embryonic axis formation, signal-
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the induction of the primary germ layers (ectoderm, mesoderm, and endo- clinical cases
derm). Section III describes the reorganization of the embryo via different
types of morphogenetic and cellular movements that result in the foundation
of organ systems, and discusses the many signaling and adhesion molecules
that are involved in regulating these complex processes. The final three sec-
tions focus on the signaling cascades and transcriptional pathways that regu-
late organogenesis in representative systems derived from the embryonic
ectoderm, mesoderm, and endoderm. These chapters illustrate how embryonic
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cesses can result in congenital defects or disease. Each chapter demonstrates
the usefulness of studying model organisms and discusses how this informa-
tion applies to normal human development and clinical disorders. Several
chapters also discuss the utility of stem cells to repair damaged organs and
the application of developmental genetics to the manipulation of stem cells
for regenerative medicine. undergraduate medical

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