hypertension crisis 3

CAUSES AND RISK FACTORS
Although the causes of the crisis relatively low blood pressure, but hypertension is a disorder of pervasive and highly significant effect for men. Most of hypertension is essential or primary (no other cause), and hypertensive crisis appears more frequently in patients who have a history of previous hypertension. Hypertensive crisis may also arise because the disease that causes hypertension or any other cause:
  kidney disease parenkhim chronic pyelonephritis, preimer glomerulonephritis, tubulointerstitial nephritis (approximately 80% of all secondary causes).
 systemic disorders involving the kidney erimatosus  systemic lupus, systemic sclerosis, vasculitides.
Renovascular disease   atherosklerotik disease, displasi fibromuskuler, poliartritis nodosa.
Endocrine   pheokromositoma, Cushing syndrome, primary hiperaldosteronism.
  drugs cocaine, amphetamines, cyclosporin, dismissal klonidin, phensiklidin, diet pills, oral contraceptive pill.
  drug interactions Monoamine oxidase inhibitors with Tricyclic antidepressants, antihistamines, or tyramine-containing foods.
  central nervous system CNS trauma or spinal disorders, for example Guillain-Barré syndrome.
Aortic Koarktasio 
 Preeclampsia - eklamsia
Hypertension  post-surgery.
Hypertensive crisis can occur at any time. Hypertensive crisis may occur in neonates with congenital renal artery hipoplasi, children with acute glomerulonephritis, a young pregnant woman with eklamsia, or parents with atherosclerosis and renal artery stenosis. Some individuals may not be used to increase blood pressure significantly, and the symptoms and clinical manifestations of hypertensive crises arise in blood pressure are lower than those with chronic hypertension. However, treatment must be provided.
In the United States, approximately 50 million people stricken with hypertension. Prevalence increases with age. More than half of people aged between 60-69 years and about three-quarters of people aged 70 years or older who attacked hypertension. According to Mc Cowan, 2006, the crisis of hypertension attacked about 500,000 U.S. residents, or about 1% of adults who suffer from hypertension. And approximately one billion people worldwide suffer from hypertension.
Death due to ischemic heart disease and stroke increases with increasing blood pressure. For every increase in blood pressure 20 mmHg 10 mmHg systole and diastole, the risk of death due to ischemic heart disease and stroke would double.
When compared to existing inter-racial, African-American race is a race that has the greatest risk factor for hypertension crisis stricken. Hypertensive crisis appears more frequently in patients with advanced age. And overall, the prevalence and incidence of hypertension incidence is greater in men than women. The frequency of occurrence of hypertension crisis also two times more in men than women.
From a research note that blood pressure control is less effective in terms of systole blood pressure measurement is an independent risk factor for hypertension crisis cases that appeared in the ER.
But instead of that, mobilities and mortality due to hypertensive crisis, depending on the number of infected target organs and the extent of blood pressure can be controlled.

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Dermatitis 5

Handling
To treat dermatitis numularis, we must explore possible causes first or factors that influence the occurrence of this dermatitis. When dry skin moisturizer, or can be emolien. Topical lesi can be treated with drugs such as antiinflamasi; pitch preparation, glukokortikoid, takrolimus or pimekrolimus. If lesi still exudate, it is compressed first, for example with potassium permanganate 1:10.000. When suspected secondary infection can occur are given antibiotics according to the type of bacterial, used can be either systemic. Antibiotic selection for this case is either erythromycin, tetrasiklin with 20-40mg/Kg BB/day dose in 4 divided doses for 7-14 days, amoxisilin 4 X 500mg/hari for 7-10 days. Systemic Corticosteroid given only in case of heavy or refract, in the short term. If very heavy, can be given corticosteroid intralesi as triamsolon asetonide 0.1 mg / ml (0.1 ml each injection). Complaints itch can be used antihistamine the H1.

Prognosis
Disease recurrence is relaps. From an observation of a number of patients followed for 2 years was found, 22% cured, 25% never recover for some weeks to months, while 53% are never free from lesi, except in the treatment period.

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Dermatitis 4

Diagnosis
To diagnose dermatitis numularis based on the description klinis:

D. For Numularis:
not known. Only explore the causes of infection / broadcaster through culture.
Predileksi: on the back foot, back hand, extensors the extremity, buttocks and shoulder.
Efloresensi: makula eritematosa, numular to the size of the bill, sometimes hiperpigmentasi, likenifikasi rigid boundary of a coin.

D. For contact:
allergen / sensitizers, be with the examination of blood eosinofil edge, IgE, test (patch test), stroke (scrat test), pin (prick test)
Predileksi: all parts of the body can be affected.
Efloresensi: eritema numular, until the bill, papula, vesicle, accompanied by erosion numular groups up to poster. Sometimes only makula hiperpigmentasi fine with squama

D. Atopik
For: possible factors offspring. Historical atopi. Asetilkolin be the test that will vasokonstriksi on the skin that appear pale line for 1 hour.
Predileksi:
1. the form of a baby, and babies who are crawling: the second cheek, folding elbow, knee fold (ektensor).
2. of children: occiput, folding elbow, knee fold (fleksura).
3. adult form: cervix folding elbow, knee fold, the back foot (fleksura).
Efloresensi:
1. the form of a baby, and babies who are crawling: eritem firm boundary, papula / vesicle accompanied by erosion, eksudasi, and krusta.
2. of children: papula milier, not exudate.
3. adult form: sometimes papula, hiperpigmentasi, dry and likenifikasi.

For LSK:
not known. Only search broadcaster infection via culture.
Predileksi: on the back, neck, and extremity, especially wrists, legs, and buttocks.
Efloresensi: papula miliare, likenifikasi, hiperpigmentasi, squama, sometimes eksoriasi.

T. Manus:
fungus infection, differentiated with microscopic examination of skin kerokan KOH and 10% visible elements of mushroom, so that Sabouraud media, and Wood rays.
Predileksi: start circle to the tip of the finger.
Efloresensi: makula eritema, active edge, polisiklik, firm boundaries, squama above lesi and sometimes there are vesicle.

For Psoriasis:
certainly not known, suspected of forming fast the epidermis. Different only find the causes of Psoriasis with the routine examination of blood, cholesterol, blood sugar, acid strand.
Predileksi: elbow, knee, scalp, hand and foot, back, leg up and down and nail.
Efloresensi: makula eritema with a large variety of milier until numular, with descriptions of a wide range, from the arsinar, sirsinar, polisiklis, geographic, firm boundary, covered squama smooth, white flash, which indicates when graze will marks wax drops, and if forwarded will arise bleeding point. Phenomena can also show Kobner.

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Dermatitis 3

Histopatologis Overview
Hiperkeratosis visible on the epidermis, akantosis, edema interselular, and at the end of the dermis occurs blood vessel dilation, and aggregate cells limfosit inflammation and monosit.

Clinical Overview
People with dermatitis numularis generally very eager to complain. Lesi acute form vesicle and papulovesikel (0,3-1.0 cm), which then swell with confluence or how widespread kesamping, form a lesi characteristics such as coin (coin), erimatosa, slightly edematosa, firm and boundary. Slowly going vesicle broken exudes which then dry out the colors become krusta. Lesi size diameter can reach 5 cm, rarely up to 10 cm. Form diskoid generally at the age of 60 years and over. Healing starts from the middle so that seemed like a lesi dermatomikosis. Lesi long form likenifikasi and squama. Lesi amount can be only one, and many can also spread, or bilaterally symmetrical, with varying sizes, ranging from billion to numular, even placard. This disease typically attacks the back foot, back hand, ekstensor the extremity, back and shoulders. Dermatitis tends to lose this arise, there is a constant, except in the period of treatment. When the going exacerbate generally occur in the first place, lesi can also occur in places that experienced trauma (Kobner phenomenon).

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Dermatitis 2

Definition
Dermatitis is inflammation Numularis on the skin lesi in the form of coin or currency somewhat oval, with a firm boundary efflorescence form papulovesikel, usually wet, so easily broken. Disease first found by Rayer in 1845 and introduced as the eczema numular by Devergie in the year 1857. Nummular derived from the Latin that is "nummus" which means "coin."

Pathogenesis
The cause of dermatitis numularis not clear, some authors believe that bacterial infection is the primary agent etiology, and many of the influence factors. Stafilokokus infection and possible mikrokokus involved, considering the increased number of participating even though clinical signs of infection are not visible. Exacerbate occur if the bacteria colonies increased over 10 million bactery/cm2. Or may also be due to reaction hypersensitivities.
Dermatitis contact role may participate in the cases of dermatitis numularis, for example, allergic to nickel, chrome, cobalt, and irritation of the wool and soap. Physical trauma, and the chemical is also likely involved, especially if it occurs on the hands, also in injury time in the form of network grater. In some cases, emotional stress, and drinking beverages that alkohol can evoke exacerbate. Environment that tends to dry also able to trigger exacerbate.
Dermatitis of the skin generally dry, hidrasi stratum corneum tends to be low. Number of SP (P subtansi), VIP (vasoaktive intestinal polypeptide), and CGRP (calcitonin related peptide genes) increased in the dermal nerve fiber sensoris skin, whereas in epidermal nerve fiber is the increased SP and CGRP. This indicates a potential neuropeptide mechanisms in the process degranulasi mast cells.
Usually dermatitis numularis adults not related to interference atopi, whereas in children associated with dermatitis atopik.

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Dermatitis 1

Skin is the organ of the body outer that have various functions. One of its main function is protection of the environment. Inflammation on the skin will result in reduced functionality to facilitate the occurrence of infection by disease germs. Inflammation on the skin or dermatitis occurs as a response to eksogen and endogen factors that could cause a deviation form the clinical efflorescence polymorphic (eritema, edema, papul, vesicle, skuama, likenifikasi) the complaint is usually accompanied by itching.
One type of dermatitis is a rare dermatitis numularis. In the United States, approximately 2 of every 1000 people infected dermatitis numularis (1). Compared with women, men more frequently affected, usually both men and women occurred at the age between 55 and 65 years. While the peak incidence age of young women can also occur in the age between 15 and 25 years (1,2). This disease is rarely available in the children. If there are more than a year. Figures dermatitis numularis events increased with increasing age.

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