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

With improving standards of antenatal care, severe pre-eclampsia dn eclampsia are becoming less common and experience in the management of these conditions is lessening. Co-ordinated plans for the care of patients should be established by obstetricians and anaesthetists working as a team. A suitable regime for drug therapy in severe pre-eclampsia or eclampsia is the following: Initial management Diazepam 10 mg slowly i.v. Pethidine 100-150 mg i.m. or i.v. in incremental dosage, or extradural blocks, if analgesia is also required. Hydrallazine 20 mg i.v. initially, followed by 5 mg at intervals of 20 min until the diastolic pressure is less than 110 mm Hg. Then, preferably by syringe pump in a concentration of 2 mg/ml, at a rate of 2-20 mg/h. If vomiting occurs this can be controlled by administration of atropine. Subsequent management Sedation and anticonvulsant therapy. Continue diazepam and, in severe cases, institute chlormethiazole infusion. Continue analgesia with pethidine or extradural block. Control of hypertension by adjusting the dose of hydrallazine. If tachycardia exceeds 120 beat/min give propanolol 2-4 mg i.v. Plasma protein depletion with groww oedema is treated by administration of salt-free albumin or plasma protein fraction. Diuretic therapy is indicated if there is gross oedema or signs suggestive of acute renal failure. Oliguria associated with increased blood urea may be a result of renal failure or dehydration. The latter should be evident from the patient's condition and central venous pressure, but i.v. fluids and frusemide 20-40 mg can be used as a therapeutic test. Mannitol reduces cerebral oedema and may be given if diuresis has been first produced with frusemide. Potassium chloride is given if the plasma potassium decreases to less than 3 mmol/litre. Heparin therapy is considered if there is clinical evidence of disseminated intravascular coagulation.
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PMID:The management of severe pre-eclampsia and eclampsia. 83 44

84 of 89 cases were traced 18 to 27 years after Swenson's operation. Seven had long segments. All were alive and in good general health except one who had renal transplant for hypertension due to pyelonephritis in a residual solitary kidney. 61 are married of whom 34 have children. None of the children have Hirshsprung's disease. 48 were fully normal within one year of operation. 29 had constipation enough to require treatment. Seven had diarrhoea which in three required hospitalisation for electrolyte disturbances and dehydration. 39 had some degree of soiling, but in only nine was this troublesome. Recovery of normal bowel control was more rapid in those with a good social background. Eight had postoperative strictures, but treatment has remained successful in the long-term in seven of these. Five patients had inadequate resections and are well after further surgery. Nine had urinary incontinence of which seven had only nocturnal enuresis. All are fully recovered. Two male patients have absence of ejaculation and two females are infertile with scarred Fallopian tubes. 83 of the 84 now have normal bowel control and good health. One has a permanent ileostomy.
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PMID:Long-term results of Swenson's operation for Hirschsprung's disease. 86 91

In 46 patients of the chronic hemodialysis program blood pressure regulation was studied according to variations of sodium and fluid balance. A strong relationship was observed between blood pressure and the amount of exchangeable sodium. In the hypertensive patients exchangeable sodium was increased depite fulfilled clinical signs of sufficient dehydration. The blood volume was found to be small and the plasma renin activity increased in those hypertensive patients, in which sufficient fluid depletion was inhibited by extreme fluctuations of the blood pressure during dialysis. A diminution of the sodium concentration keeping the fluid balance constant induced an increase of blood pressure and deteriorated the subjective feeling of the patients. By an increase of the sodium concentration up to 155 mEq/l severe blood pressure fluctuations during during dialysis could be prevented, although further fluid was taken off by ultrafiltration. This effect seemed to be mediated--at least partly--by an increase of the low blood volume and a suppression of plasma renin activity. After the patients became normotensive, dialysis procedure could be continued with normal sodium concentration. By a temporary high sodium regimen of the dialysis procedure some patients with renal failure and 'uncontrollable hypertension' can be preserved from bilateral nephrectomy.
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PMID:Role of sodium and water in hypertensive patients on maintenance hemodialysis. 89 Dec 7

The general features and problems of renal vein thrombosis in children are first discussed. The records of 11 children with this condition, 7 ill neonates and 4 older children with burns, are then reviewed, indicating the clinical course of the disease, how they were treated, the results, and pathological findings. From this study, the natural history is assembled and a protocol for treatment is proposed. Supportive therapy is necessary in all cases to correct dehydration and sepsis. Many children will develop a consumptive coagulopathy. Others will develop pulmonary emboli associated with thrombosis of the inferior vena cava. Anticoagulation should be achieved for these two conditions. Nonvisualization of affected renal units upon initial urographic examination virtually assures an atrophic, functionless kidney later. Nephrectomy will be required because of hypertension, persistent infection, and scarring. Thrombectomy may be attempted when bilateral nonvisualization on urography is associated with a positive venacavogram.
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PMID:Natural history and treatment of renal vein thrombosis in children. 91 51

A series of 30 patients (28 females : 2 males) presenting with benign intracranial hypertension is reported. It is shown that the papilloedema may be resolved in as little as six weeks by the use of dehydration therapy. Evidence is presented that this method can restore to normal a visual acuity which is as low as 6/24 or even 6/36. It is concluded that surgery is never required in the management of this condition. It is strongly recommended that serial blind-spot measurements should be used routinely to assess the effectiveness of therapy. Fluorescein angiography has a place in diagnosis among a small proportion of these patients.
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PMID:Treatment of benign intracranial hypertension by dehydrating agents with particular reference to the measurement of the blind spot area as a means of recording improvement. 99 95

The disturbances of water and electrolyte metabolism in the body can be subdivided into three large groups: 1) disturbances of free water which are related to the whole body water and are always coupled with changes in the osmolality of the internal environment and also of the interior of the cells (hypertension due to loss of water, hypotension in water intoxication); 2) isotonic changes of the volume of the extracellular fluid-oedema or extracellular dehydration. The latter are always coupled with a hypovolaemia and with a danger to the circulation which may end in shock. There is also a cumulative loss of potassium as a result of the dehydration reaction; 3) disturbances of the intracellular water metabolism which are associated with disturbances of the potassium metabolism. These may have grave consequences for the function of striated and smooth muscles, for the function of the nerves and various enzyme systems. Since the disorders of the extracellular water balance are generally best known, the attention is principally drawn in this paper to the hypertonic dehydration and the status of the potassium metabolism. The symptomatology of both conditions is discussed, and also their diagnosis with the simplest laboratory effort not associated with great loss of time (which is essential if valuable time is not to be lost before the laboratory results can be obtained). The theoretical considerations are supplemented with clinical examples and explanations of the treatment.
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PMID:[Water and potassium metabolism changes]. 99 7

1. The rate of renal excretion of arginine-vasopressin was determined during unrestricted fluid intake for 24 h and in response to fluid deprivation for 18 h in nine young men with very mild essential hypertension and compared with that in sixteen normotensive men of similar age. 2. Despite an equivalent osmolar stimulus, excretion of arginine-vasopressin was significantly greater in the reference group than in the reference group. This difference increased progressively with increasing dehydration. 3. We suggest that these findings are mainly due to an increased rate of secretion of arginine-vasopressin in response to mild hydropenia in hypertensive patients and that a moderate increase of release of arginine-vasopressin during periods of fluid deprivation may exert vascular effects and thus influence the perpetuation of hypertension.
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PMID:Increased renal excretion of arginine-vasopressin during mild hydropenia in young men with mild essential benign hypertension. 107 11

Hemodynamic data were collected in 42 patients with pulmonary edema (P.E.) due to altered permeability of various causes. Pulmonary artery wedge pressure (PWP) was normal, whatever the time of the study and the severity of the P.E. Pulmonary artery hypertension was present in the cases with severe hypoxemia, but disappeared with hypoxemia correction. In some cases, a hyperkinetic or a hypovolemic syndrome was found, being induced by the cause of P.E. Although within normal limits, PWP was significantly higher at the first hours of P.E. than after the 6th hour. Perfusion of colloid solutes worsened P.E., although increasing PWP by only a few mmHg. Dehydration using diuretics markedly improved the venous admixture, although PWP was previously normal. These data document the production of P.E. in many causes-such as severe sepsis, drowning, fat embolism, barbiturate overdose-by impaired alveolo-capillary permeability, PWP and blood protein content remaining within normal limits. They also demonstrate the noxious effects of overperfusion and the efficiency of dehydration in such pulmonary edemas.
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PMID:[Hemodynamic study of pulmonary edemas due to the increase of alveolo-capillary permeability]. 119 58

The authors present their experiences concerning the effect of extrarenal factors on the results of radionuclide examination. Functional and functional-morphological examinations of the kidneys and urinary tract can be negatively affected particularly by emotional stress, orthostasis, dehydration, increased kidney motility, address administered drugs during examination (diuretics), drug treatment of the primary disease, muscular strain, cold, pain, increased pressure in the vicinity of the kidney, hypertension, hypotension, as well as further conditions. Radionuclide methods can objectify these processes, the given negative effects can however be presumed to occur also at other examination procedures of the kidney and urinary tract. The conditions of examinations have thus to be optimized and standardized. The examining physician has to know which drugs the patient is receiving and he has to know their effect on renal function.
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PMID:[The effect of extrarenal factors on certain functions of the kidney and urinary tract. A radionuclide study]. 139 43

A retrospective analysis of the medical charts of 117 patients (50 men and 67 women) with multi-infarct dementia took place. All patients admitted to the psychogeriatric nursing home 'Joachim en Anna' in Nijmegen between 1980 and 1989 were studied. The aim of the study was to obtain epidemiological information and to investigate the prevalence of comorbid conditions, prognosis and mortality. The results were compared with patients with Alzheimer's disease. The patients remained in the institute for 1.4 years and the mean total duration of the disease was 5.3 years. About twenty-five percent died in the first three months of admission. Life expectation, counted from time of admission, was 6 years shorter in comparison with Dutch mortality tables. Morbidity frequently seen at admission included circulatory system diseases and cerebrovascular accidents. The risk factor hypertension was seen in a smaller percentage of patients than expected. During the stay the diseases most frequently diagnosed were respiratory and urinary tract infections, adverse effects of drugs, constipation and chronic ulcers of the skin. About twenty percent of the patients were struck by a (recurrent) cerebrovascular accident or a transient ischaemic attack. Most patients died of dehydration or bronchopneumonia. There was, apart from the diagnosis of multi-infarct dementia, no single patient aspect that could predict a poor prognosis. Nursing home patients with multi-infarct dementia are clearly different from patients with Alzheimer's disease. Time spent in the nursing home and duration of disease are shorter. They have more comorbid conditions, especially of a cardiovascular nature, and they have a poor life expectation.
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PMID:[Multi-infarct dementia in nursing home patients; more comorbidity and shorter life expectancy than in Alzheimer's disease]. 143 2


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