Лечение Эссенциальной Гипертензии – Essential hypertension treatment

After many years of recurring tonsillitis in a 7 year old girl, her parents had reached the point of desperation. This first manifested itself as snoring when the child was about 18 months old but a pediatrician assured the parents that the young girl would eventually grow into her large tonsils. Sleep related snoring and occasional episodes of tonsillitis marked the early years of her life until she was 4 years old when her mother became aware of times when the child seemed to be struggling for breath. In retrospect, judging by a description of events in the following years, the child had developed OSA, the consequences of which were to disrupt the life of parents and child for a further three years. Severity of the child’s airway obstruction no doubt reflected the status of the child’s tonsils. At best there was always a degree of snoring but a common cold or any inflammation of her tonsils would guarantee a succession of traumatic nights; traumatic for the child who would awake several times a night crying and further complicated by instances of bed-wetting and falling out of bed. It was also traumatic for the parents who were anxious about their daughter’s distress at night, not to mention the considerable disruption to their own sleep. Antibiotics probably helped to minimize the duration of these episodes but it was becoming increasingly clear that prescription of these medications was not addressing the underlying problem.

For a girl of above average ability, she was not progressing as well as could be expected and frustrated teachers would report on her tiredness and lack of application. The parents finally sought help from a pediatrician with some expertise in sleep apnoea. A hospital admission and overnight studies documented airway obstruction and oxygen desaturation consistent with OSA. Tonsils and adenoids were surgically removed a month later and the results were immediately apparent. Snoring was virtually abolished and her parents no longer had to comfort a distressed child at night, indicating an improvement in sleep quality and although she still experiences occasional colds and upper respiratory tract infections, heavy snoring and complete airway obstruction has never reoccurred.

Comment: Disruption of home and school life could have been avoided with earlier detection of OSA.

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In elderly people it is rare for brain tumours to present solely as a slowly progressive confusional state. Usually the confusion is accompanied by other symptoms and signs such as headache, weakness of the limbs (usually on one side only) and falls. Brain tumours are diagnosed in the same way as the collection of blood (via CT scan). Unfortunately most brain tumours in elderly people are malignant and are secondary deposits from a main tumour growing elsewhere (e.g. lung, breast etc.) Primary brain tumours of many types do occur but the prognosis for all of them is quite poor. Most tumours respond temporarily to radiotherapy or to high-dose steroids, both of which shrink the tumour and the associated swelling to stop it pressing on other vital brain structures.

Benign (non-malignant) brain tumours are quite rare. When they are detected as part of a screening procedure for chronic confusion they can be removed, depending on their size, position and on the physical state of the person concerned.

There is debate as to whether all cases of chronic confusion should have some form of brain scan (CT scan or the more recently developed MRI – magnetic resonance imaging). If all cases of chronic confusion are screened in this way the pick-up rate for brain tumours and collections of blood is low, however the general ‘cost’ to the individual and the real costs to the health service are very high when a treatable cause is missed. Accurate diagnosis would also be helped. The outcome in terms of type of care, prognosis and impact on carers between a diagnosis of dementia and that of brain secondaries is very different indeed. Current resources are severely rationed, however, and until that change it seems appropriate only to scan those people where the suspicion of a treatable or relievable cause is high, and to encourage discussion between GP, geriatrician and neurologist at every opportunity.

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