Rhazes and an Early Case With Possible Hypertensive or Reversible Encephalopathy.

In one of Rhazes' medical treatises, Tales and Stories of Patients, descriptions, medical manifestations, and treatment approaches of 34 patients were mentioned. Among those, an epileptic patient with a florid face and congested veins was cured by performing venesection on his saphenous and basilic veins. Signs and symptoms of the case might correspond to hypertensive or reversible encephalopathy.

Hypertension and hypertensive encephalopathy.

The definition of hypertension has continuously evolved over the last 50 years. Hypertension is currently defined as a blood pressure greater than 140/90mmHg. One in every four people in the US has been diagnosed with hypertension. The prevalence of hypertension increases further with age, affecting 75% of people over the age of 70. Hypertension is by far the most common risk factor identified in stroke patients. Hypertension causes pathologic changes in the walls of small (diameter<300 microns) arteries and arterioles usually at short branches of major arteries, which may result in either ischemic stroke or intracerebral hemorrhage. Reduction of blood pressure with diuretics, ß-blockers, calcium channel blockers, and angiotensin-converting enzyme (ACE) inhibitors have all been shown to markedly reduce the incidence of stroke. Hypertensive emergency is defined as a blood pressure greater than 180/120mmHg with end organ dysfunction, such as chest pain, shortness of breath, encephalopathy, or focal neurologic deficits. Hypertensive encephalopathy is believed to be caused by acute failure of cerebrovascular autoregulation. Hypertensive emergency is treated with intravenous antihypertensive agents to reduce blood pressure by 25% within the first hour. Selective inhibition of cerebrovascular blood vessel permeability for the treatment of hypertensive emergency is beginning early clinical trials.

Wolfgang Amadeus Mozart--controversies regarding his illnesses and death: a bibliographic review.

More has been written about Mozart's illnesses and death than for any other composer. An exploration of PAMA's Bibliography of Performing Arts Medicine provides the data for this review. The bibliography contained 136 entries that pertained to Wolfgang Amadeus Mozart. Of these, 81 were available to the author, either in printed or electronic copy. In order to provide a clearer historical perspective on this topic, this review assembles information pertaining to illnesses and other medical problems that occurred during Mozart's life as well as those purportedly contributing to his death.

[Arterial hypertension in extreme situations].

Wartime arterial hypertension (AH) is AH that debuts or changes its character under the influence of specific wartime factors or military labor. The features of wartime AH were determined. They included the following: AH incidence during war grows; AH incidence in the battlefront servicemen is higher than in those who serve on the home front; there is a direct correlation between AH prevalence and how often the person participates in the battles; the patients are relatively young. Acute AH forms usually debuted as a result of extremely strong of lingering stressful factors. Acute AH development was characteristic of subjects having family predisposition to hypertensive reactions. The clinical picture of acute AH had features of a hypertensive crisis, frequent complications of which were acute cardiac insufficiency and/or acute hypertensive encephalopathy, which required urgent medical aid. AH was resistant to pharmacotherapy. Further on, high AH level remained, crises occurred, and lesions of target organs progressed. The features of AH in military operators were characterized by medium, high, and very high risk of complications. II and III degrees of AH prevailed. The main risk factors in patients with workplace arterial hypertension (WAH), in addition to emotional tension, often were smoking, family background, hyperlipidemia, excessive body weight (metabolic syndrome). In 87% of patients with WPAH behavioral type A was revealed, mostly with medium or prominent elevation of the level of personal, reactive, and total anxiety. Persons with prognostically unfavorable 24-hour profiles of BP--non-dippers and night-peakers--prevailed (p < 0.001). Imidazoline receptor agonists (moxonidine) in patients with WAH normalized BP level. Twenty-four-hour BP profiles became normal in 90% of the WAP patients. Positive antihypertensive effects of moxonidine in patients with WAP become clear after 12 weeks of drug application; the psychological status becomes normal too.