Relationships between blood pressure variability and left ventricular parameters in haemodialysis and renal transplant patients

SUMMARY: Blood pressure (BP) elevation and left ventricular hypertrophy (LVH) are important factors in the high cardiovascular mortality on the renal replacement programme. the relationship between these, predictable in essential hypertension, is less well defined in uraemia. We wished to examine the contribution of abnormal blood pressure variability (BPV) to the cardiovascular changes seen in uraemia and after renal transplantation. Twenty-four hour ambulatory blood pressure monitoring (ABPM), and simultaneous echocardiography, on a cohort of 35 long-term, long-hours haemodialysis survivors and 28 patients with stable renal transplants was undertaken. We also retrospectively compiled biochemical and clinical data. There were strong relationships between both diurnal and standard deviation measures of BPV and left ventricular cavity size and function: per cent fall in awake to asleep diastolic BP with fractional shortening index (FSI), r =0.28, P =0.039; with left ventricular mass index (LVMI), r =−0.35, P =0.011. This study suggests that reduced diurnal and short-term BP variability is cross-sectionally associated with a dilated, heavier left ventricle (LV) with worse systolic function. Thus, BPV may independently contribute to the abnormal LV structure and function commonly seen in uraemia.     

Atypical choristomatous cysts of the orbit

Background: The commonest choristomatous cysts of the orbit are dermoid and epidermoid cysts, which are lined by kerantinizing seuamous epithelium. They typically occur in the superior orbit, most commonly superotemporally. Other types, lined by different epithelia, and other orbital sites are much less common. Methods: Five cases of atypical orbital cystic choristomas that presented over the past 6 years are reported. The clinical and radiological features, surgical approach and findings, and histology are described. Similar cases from the literature are reviewed, and possible aetiology discussed. Results: Four of the cysts were lined by a non-keratinizing epithelium resembling conjunctiva; two had adnexal structures in their walls. Compared with typical dermoid and epidermoid cysts, these ‘conjunctival dermoids’ and ‘conjunctival cysts’ of the orbit tended to present later in life, none were associated with bony defects, and three of the four occurred in the superomedial quadrant. One case occurred inferiorly, a rare site for orbital conjunctival dermoids and cysts, or typical dermoids and epidermoids. The fifth case, also inferior; is an example of a cyst within choristomatous lacrimal tissue. Conclusion: Choristomatous cysts of the orbit may occur with non-keratinizing epithelial linings, and such cysts tend to differ clinically from the commoner dermoids and epidermoids. They may also occur in atypical sites such as the inferior orbit.     

The hypnic headache syndrome: report of three new cases

Three new cases compatible with hypnic headache syndrome (HHS) are presented. The patients were 70, 77, and 79 years of age (2F, 1M). They described a history of nocturnal headache ranging from 5 months to 7 years. One patient was afflicted with diffuse pain but the other two had unilateral pain. In one patient headache was clearly related with dreams, but in the other two this point could not be confirmed. Except for headache being unilateral in two cases, the remaining HHS criteria were present. It is noteworthy that pain responded to flunarizine in two patients.     

Phonophobia in migraine

Quantitative measurement of sound-induced discomfort and pain thresholds showed that migraineurs ( n =65) were significantly more sensitive than headache-free controls ( n =80), both during and outside attack ( p <0.0001). Patients tested with head pain had lower thresholds than those tested without pain ( p <0.01). Migraine with and without aura did not differ as to sound sensitivity. There were no significant differences in thresholds between the symptomatic and nonsymptomatic sides ( p ≥0.78). Patients with unilateral headache or pain of pulsating character were more sensitive than those with bilateral headache or pressing pain ( p <0.05). Phonophobia did not correlate significantly with duration, frequency, or severity of attacks. The main results were in accordance with a questionnaire study concerning subjective evaluation of sound sensitivity Similarities between phonophobia and photophobia in migraine provide evidence that both phenomena share a common pathophysiological mechanism in this condition.