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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

By means of 386 comparative cystometries hypertensive reactions were recorded from the urinary bladder both following total and radical vaginal hysterectomy. Hypertension was most strongly pronounced over the first two weeks after operation and receded spontaneously during the third and fourth weeks. That increased intravesical pressure, therefore, was attributed primarily to the surgical trauma and its inevitably accompanying irritation of the bladder. Predominant parasympathetic denervation of the bladder by radical surgery was found to be relevant, first of all, during micturation. Reduced sense of emptying the bladder and sympathetically induced disturbances in the correlations between detrusor and the urethrovesical region favoured the formation of residual urine. Its early therapy, using cholinergics, is becoming increasingly problematic. Intensive control of infections and persistent continuation of catheterisation, until the autonomously functioning bladder has got adjusted to its changed conditions, so far remain to be the most dependable approaches to prophylaxis and therapy of micturation disorders following radical surgery. In severe cases more recent pharmacological and neurohistochemical findings regarding selective effectiveness of alpha-receptor blockers and beta-stimulators in neurogenic bladder may open new therapeutic ways.
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PMID:[Advances in the prevention and control of urologic complications of cervix cancer. 2. Bladder-function disorders]. 72 30

The authors reported the clinical course and the postmortem examination of a unique case of neurocutaneous melanosis with numerous anomalies and complications, which included congenital dislocation of lenses, hypogonadism, ectopia of prostatic duct, genuine phimose, retentio testis, psina bifida and neurogenic bladder. This 13-year-old boy with a large hairy nevus in a bathing trunk configulation and multiple small nevi over the whole body since his birth was admitted to our hospital for evaluation of headache and vomiting. Neurological examination showed bilateral papilledema and slight left hemiparesis. A CT scan revealed a large right frontal mass and craniotomy was performed with subtotal removal of this tumor which was confirmed as a malignant leptomeningeal melanoma. He initially made uneventful postoperative recovery, and two courses of chemotherapy with DTIC, ACNU and VCR were given; however, the currence of brain tumor ensued shortly thereafter, and he died in approximately six months after the onset of intracranial symptoms despite of the third course of chemotherapy. Thirty five cases of neurocutaneous melanosis associated with or without malignant melanoma have been reported in Japan. Twenty-eight cases were male and 7 female. Two cases showed the evidence of primary malignant melanoma outside of the central nervous system, whereas twenty eight leptomeningeal melanoma, in which 22 were solid and 6 diffuse, were shown intracranially. Other 5 cases had epileptic seizure and/or hydrocephalus caused by wide spreaded leptmeningeal melanosis. This high incidence of intracranial malignant melanoma in this disorder was remarkable compaired with the previous reports in other countries. Mean duration between deaths and the onset of symptoms of intracranial hypertension or focal neurological signs was 7 months, ranging from 1 to 24 months, showing the rapidly deteriorating course in this disorder.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[An autopsy case of neurocutaneous melanosis associated with intracerebral malignant melanoma]. 332 33

In a series of 400 transplantations, 8 children presented a severe lesion of the lower urinary tract requiring an intestinal graft to divert the urine or to replace the useless bladder: 4 cases of posterior urethral valves and 4 cases of neurogenic bladder. Four permanent urinary diversions and 4 bladder enlargements, including 3 temporary diversions, were performed. The sigmoid colon was used in 5 cases and the ileum was used in 3 cases. The preparation of the intestinal graft was always performed prior to the transplantation. The uretero-intestinal anastomosis included an antireflux device in 3 of the 8 cases. There were no deaths in this series. Three occlusions and 2 lymphoceles occurred in the immediate post-transplantation period, but were corrected by re-operation. Two cases of calculi occurred in the long term, one of which required operation. Moderate stenosis of the renal artery in one case resulted in systemic hypertension which was well controlled by medical treatment. An episode of acute pyelonephritis resolved rapidly with antibiotic treatment. Two cases of acidosis were corrected by salt supplementation. There was one case of early graft rejection on the 15th day and a delayed rejection after 18 months, leading to removal of the transplant. At the present time, 6 renal grafts function normally (75%) with a follow-up of 1 to 8 years.
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PMID:[Urinary diversions and intestinal grafts in renal transplantation in children. Report of 8 cases]. 355 89

We analyzed retrospectively 177 consecutive staghorn calculus patients to determine risk factors for ultimate renal deterioration and renal cause specific death. Mean followup was 7.7 years. Overall rate of renal deterioration was 28%. Renal deterioration was associated more frequently among patients with solitary versus nonsolitary kidneys (77% versus 21%, p < 0.001), previous versus initial stones (39% versus 14%, p = 0.03), recurrent versus nonrecurrent calculi (39% versus 22%, p = 0.07), hypertension versus normotension (50% versus 22%, p = 0.006), complete versus partial staghorn calculi (34% versus 13%, p = 0.02), diversion versus no diversion (58% versus 19%, p < 0.001) and neurogenic bladder versus normal voiding (47% versus 21%, p = 0.006), as well as those who refused treatment versus treated patients (100% versus 28%, p < 0.001). No patient with complete clearance of fragments died of renal related causes compared to 3% of those without clearance of fragments and 67% of those who refused treatment (p < 0.001). Our study suggests that long-term renal preservation in the staghorn calculus patient may depend on normal blood pressure, staghorn size, absence of diversion or voiding dysfunction, and complete stone eradication.
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PMID:Long-term renal fate and prognosis after staghorn calculus management. 771 52

A 65-year-old man visited our hospital with complaints of tingling sensation in the distal parts of his extremities and dysuria, which first appeared 2 months before admission. He had no abnormal findings on physical examination. Neurological examination revealed sensory impairment of glove and stocking type, mild motor weakness and muscular atrophy in the proximal parts of arms and legs, and absent tendon reflexes in knees and ankles. Fasciculation was observed on his shoulders and upper extremities, and myokymia on the abdominal wall and bilateral calves. He had hyponatremia, which was proved to be caused by SIADH. Anti-acetylcholine receptor antibody, anti-GM1 ganglioside antibody and anti-galactocerebroside antibody were detected in the serum. Chest X-ray showed mass shadows in the mediastinum, which were confirmed as malignant thymoma by needle biopsy. Orthostatic hypotension, neurogenic bladder and anhidrosis were observed by the autonomic function tests. Lesions responsible for orthostatic hypotension and SIADH were suspected in the afferent fibers from baroreceptors, since an reactive increase of plasma arginine vasopressin to orthostatic hypotension was blunted and reflex hypertension in the cold pressor test was well-preserved, while overshoot in Valsalva's maneuver was absent. It is important that afferent baroreceptor dysfunction may be associated with paraneoplastic neurological syndrome, since lesions in acute autonomic neuropathy are usually in the efferent fibers.
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PMID:[A case of paraneoplastic autonomic and sensorimotor neuropathy with dysfunction in the afferent limb of baroreflex arc]. 840 86

Between May 1, 1986 and May 31, 1992 at the University of Minnesota, we interpreted 129 renal allograft biopsy specimens (done in 48 grafts during the first 6 months posttransplant) as showing changes consistent with chronic rejection. For this retrospective analysis, we reexamined these biopsies together with clinical information to determine: (a) whether a diagnosis other than chronic rejection would have been more appropriate, (b) how early posttransplant any chronic rejection changes occurred, and (c) if the diagnosis correlated with outcome. We found that (1) chronic rejection is uncommon in the first 6 months posttransplant; it was documented in only 27 (2.4%) of 1117 renal allografts and was preceded by acute rejection in all but 3 recipients (for these 3, the first biopsy specimen showed both acute and chronic rejection). (2) Chronic vascular rejection was seen in 1 recipient as early as 1 month posttransplant; the incidence increased over time and was associated with an actual graft survival rate of only 35%. (3) The most frequent cause of arterial intimal fibrosis in the first 6 months posttransplant was arteriosclerotic nephrosclerosis (ASNS) of donor origin. Long-term graft function for recipients with ASNS was 67%. (4) Early-onset ischemia or thrombosis was seen in 14 recipients and predicted poor outcome: only 35.7% of these recipients had long-term graft function. (5) Cyclosporine (CsA) toxicity was implicated in only 3 recipients, who had mild diffuse interstitial fibrosis in association with elevated CsA levels. Other variables (including systemic hypertension, urinary tract infection, obstructive uropathy, neurogenic bladder, cobalt therapy, and recurrent disease) were not significantly associated with chronic renal lesions in the first 6 months posttransplant. A significant number of biopsies were originally interpreted as showing chronic rejection, but the diagnosis was changed upon reevaluation in conjunction with clinical data. We conclude that many factors coexist to produce chronic lesions in biopsies during the first 6 months posttransplant, so clinical correlation is needed before establishing a diagnosis of chronic rejection.
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PMID:Chronic renal allograft rejection in the first 6 months posttransplant. 854 66

Senile dementia of the Binswanger's type is a term used to describe a dementia syndrome characterized by onset in the sixth or seventh decade of life, subcortical neurologic deficits, psychiatric disorders and evidence of hypertension or systemic vascular disease. The status of senile dementia of the Binswanger's type as a distinct entity is a matter of some controversy. The array of neuroimaging abnormalities and clinical findings attributed to this condition overlap with a number of other neuropathologies. Leukoaraiosis, or attenuation of subcortical white matter, seen on computed tomographic scans or magnetic resonance imaging of the brain, is a hallmark of senile dementia of the Binswanger's type. The clinical findings associated with Binswanger's disease are varied but typically include a progressive dementia, depression and "subcortical" dysfunction such as gait abnormalities, rigidity and neurogenic bladder. Treatment is largely supportive and includes a discussion about advanced directives, social support and antidepressant therapy. Control of hypertension and aspirin prophylaxis may help prevent further progression of white matter disease.
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PMID:Senile dementia of the Binswanger's type. 986 80

There are now four types of opioid receptors. The new designations OP(1), OP(2) and OP(3) correspond, respectively, to the classic delta-, kappa- and micro-nomenclature. OP(4) was previously known as ORL(1), the receptor for the endogenous heptadecapeptide nociceptin/orphanin FQ. Although the cellular effects of nociceptin resemble those of conventional OP(1), OP(2), and OP(3) opioid agonists, its effects on nociceptive processes are quite different. Nociceptin produces spinal analgesia but appears to antagonize the effects of opioids. Following the recent synthesis of the nonpeptide OP(4) agonist Ro-64-6198 by Hoffmann-La Roche and the nonpeptide OP(4) antagonist J-113397 by Banyu, the nociceptin-OP(4) system now represents a viable and intriguing new target for drug design. OP(4) agonists may be of use in the management of neuropathic pain, anxiety, anorexia, epilepsy, drug dependence, male impotence, hypertension, cerebral ischemia and neurogenic bladder. They may also serve as novel diuretics and to help to reduce gastrointestinal motility. OP(4) antagonists may be of use as general analgesics and in the improvement of memory function. This review covers the recent exciting progress in this field, compares the actions of OP(4) agonists and antagonists with those of classic opioids, and seeks to predict some of the untoward effects that may be seen with such drugs.
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PMID:The nociceptin receptor as a potential target in drug design. 1281 96

Lower urinary tract dysfunction can lead to renal failure, owing to chronic infection and hypertension resulting from incomplete bladder drainage. These complications can recur after grafting. We compared the outcome of renal transplantation between patients with lower urinary tract dysfunction (group A) and upper urinary tract dysfunction (group B). One hundred twenty-seven kidney transplants were performed in 118 children in our institution between November 1988 and October 2005. Thirty-four patients had urinary tract anomalies (17 in group A, 17 in group B). The disorders in group A included posterior urethral valves (11 cases), neurogenic bladder (4 cases), bladder extrophy (1 case), and the Prune-Belly syndrome (1 case). We reviewed infectious and surgical complications, patient and graft survival, and graft function based on serum creatinine levels at 1, 5 and 10 years. Statistical analysis was based on the Mann-Whitney test. In group A, 5 patients had augmented bladder, 2 had incontinent urinary conduit, and 1 was transplanted on a pre-existing cutaneous ureterostomy. In nine cases, transplantation was performed on the native bladder, with no preparation. Seven complications were noted in group A, consisting of recurrent pyelonephritis (2 cases), renal abscess (1 case), upper urinary tract dilation (3 cases), lithiasis (1 case) and urinary tract incrustation by Corynebacterium in the ureterocutaneous conduit (1 case). Three complications occurred in group B, consisting of acute pyelonephritis (2 cases) and urinary tract infection with prostatitis and epididymitis (1 case). Complications tended to be more frequent in group A, but the difference was not significant (p=0.246). Mean graft survival is 5.29 years in group A and 5.97 years in group B (p=0.76). There was no difference between the two groups as regards the serum creatinine level at 1 year (p=0.77 ; Mann-Whitney test), 5 years (p=0.81) or at the end of follow-up (p=0.75). These results suggest that renal transplantation is similarly feasible in children with upper and lower urinary tract dysfunction. Indeed, we found no significant difference between the groups in terms of patient survival or graft survival and function.
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PMID:[Renal transplantation in children with lower urinary tract dysfunction]. 1807 54

A 32-year-old man with a residual spastic quadriparesis from a traumatic C5-C6 fracture experienced a severe thunderclap headache. The medical history revealed an episode of autonomic dysreflexia (AD) due to neurogenic bladder/urinary tract infection (UTI). Blood pressure monitoring at admission revealed hypertension; blood pressure reaching 160/100 mmHg (average blood pressure in these patients and also in this patient being 90/60 mmHg). CT scan of the head, cerebrospinal fluid examination, CT angiography and MR angiography of the brain vessels were normal. Another UTI and a subsequent spell of AD were diagnosed. The patient continued to experience recurrent thunderclap headaches. Selective catheter cerebral angiography revealed multiple calibre changes in the intracranial blood vessels. A diagnosis of reversible cerebral vasoconstriction syndrome (RCVS) due to AD was considered. A magnetic resonance imaging (MRI) of the brain after 2 weeks revealed ischaemic changes in the left hemisphere. Follow-up brain MRI after 3 weeks showed reduction in size of the ischaemic changes, and catheter angiography after 6 weeks demonstrated improvement/normalization. A diagnosis of RCVS could be established. Repeated MRI/CT of the brain after 6 months demonstrated a large infarction in the left hemisphere. RCVS has been reported to occur in various clinical settings. It can occur in the setting of AD in patients with traumatic cervical cord injury. Prompt recognition of RCVS may be of vital importance to avoid further morbidity in patients with spinal cord injury.
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PMID:Reversible cerebral vasoconstriction syndrome associated with autonomic dysreflexia. 2018 62


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