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

Although corticosteroid treatment is clearly beneficial to patients with temporal arteritis, its exact risk/benefit ratio in these old and side effects-prone patients is unknown. We have thus surveyed that available French and English literature, in order to pool the published series and to evaluate the iatrogenic potential of corticosteroids in this situation. We selected 11 series, yielding a total of 1008 patients. A treatment failure resulted in the death of the patient in five cases. Twenty-seven patients became blind, but only 2 under treatment. The side-effects involved 29% of the patients and are responsible of 29 deaths (2.9%): osteoporosis was the main problem, followed by femoral head necrosis and muscle wasting. Gastroduodenal ulcers were uncommon and generally benign; sigmoid colon diverticulitis was infrequent but dangerous; some infectious complications were noted (herpes zoster, tuberculosis, etc...); high blood pressure and diabetes were common problems. Psychiatric side-effects were rare. Thus, the unwanted effects of corticosteroids in the treatment of temporal arteritis are relatively infrequent and generally not severe, except osteoporosis. They should be systematically prevented by appropriate diet and treatments (e.g., calcium, potassium, and vitamin D supplements).
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PMID:[Benefits of corticosteroids in the treatment of Horton's disease and rhizomelic pseudopolyarthritis: advantages and inconveniences. A meta-analysis]. 134 39

While hypertension is observed in only two of the three major subtypes of congenital adrenal hyperplasia (CAH), 11 beta- and 17 alpha-hydroxylase deficiencies, deoxycorticosterone (DOC) production is increased in all. The elevated zona fasciculata (ZF) DOC produces mineralocorticoid hypertension with suppressed renin and reduced potassium concentrations. The DOC levels in 21-hydroxylase deficiency are in part produced by renin stimulation of the Zona glomerulosa (ZG) along with aldosterone. Assessment of the mineralocorticoid hormones of the ZF and ZF (17-deoxy steroids) provides additional unique characteristics of each subtype. Dissociation of DOC from cortisol is not unique to CAH. This dissociation is seen in other disorders and contrived conditions. There is a strong suggestion of a non-ACTH regulator of 17-deoxy steroids (DOC) that may contribute significantly to DOC production in general and effect DOC levels in CAH.
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PMID:Mineralocorticoids in congenital adrenal hyperplasia. 195 51

Percutaneous nerve excitability testing using the Hilger facial nerve stimulator was introduced about 25 years ago. The test is reliable, easy to use, and inexpensive; it continues to be the most frequently used method for predicting prognosis of facial nerve disorders. Between 1966 and 1974, we recorded 10,243 nerve excitability tests on 865 patients with a mean of 3.29 tests for each peripheral branch and 3.43 for the trunk. Using a multiple regression model, we determined the effect on nerve stimulation values of age, sex, race, diabetes, hypertension, partial or complete clinical paralysis, diagnosis of herpes zoster, year of testing, and eventual facial paralysis recovery profile. We discuss statistical reliability, provide a table of interpretive results, and offer "tips and traps" invaluable to the practitioner. A prospective study of 25 patients with residual facial paralysis was evaluated by two separate otolaryngologists to determine intertester reliability.
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PMID:Hilger facial nerve stimulator: a 25-year update. 198 55

The clinical feature of isolated unilateral peripheral facial nerve paralysis (PFP), seen in 153 consecutive Nigerians over a 14-year period at the University College Hospital (UCH), Ibadan, are presented. The hospital incidence rate was 2.67 per 10,000 with a mean annual rate of 11 per 100,000. Although males (61%) were more frequently affected than females (39%), the peak incidence for both sexes was in the third decade, and 53% of the cases were between 20 years old and 39 years old. Bell's palsy (ninety-three cases) was the most common type encountered. Hypertension (eleven cases) was associated with PFP only in patients above 50 years old. Herpes zoster infection (six cases) and otogenous (eight patients) were not uncommon. Although conjunctivitis (8%) was the most frequent complication, post-paralytic motor features in the form of synkinesia (eight cases), hemispasmas or contractures, and autonomic disturbances such as the crocodile-tear phenomenon (three cases) and auriculo-temporal syndrome (one case) were rare.
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PMID:Clinical study of unilateral peripheral facial nerve paralysis in Nigerians. 283 Jul 81

DMSO is a clear odorless liquid, inexpensively produced as a by-product of the paper industry. It is widely available in the USA as a solvent but its medical use is currently restricted by the FDA to the palliative treatment of interstitial cystitis and to certain experimental applications. Cutaneous manifestations of scleroderma appear to resolve (albeit equivocally) following topical applications of high concentrations of DMSO. A limited number of small clinical trials indicate that intravenous DMSO may be of benefit in the treatment of amyloidosis, possibly by mobilizing amyloid deposits out of tissues into urine. Dermal application of DMSO seems to provide rapid, temporary, relief of pain in patients with arthritis and connective tissue injuries. However, claims for antiinflammatory effects or acceleration of healing are currently unwarranted. There is no evidence that DMSO can alter progression of degenerative joint disease, and, for this reason, DMSO may be considered for palliative treatment only and not to the exclusion of standard antiinflammatory agents. The safety of DMSO in combination with other drugs has not been established; neurotoxic interactions with sulindac have been reported. In experimental animals, intravenous DMSO is as effective as mannitol and dexamethasone in reversing cerebral edema and intracranial hypertension. An initial clinical trial in 11 patients tends to support this latter application. DMSO enhances diffusion of other chemicals through the skin, and, for this reason, mixtures of idoxuridine and DMSO are used for topical treatment of herpes zoster in the UK. Adverse reactions to DMSO are common, but are usually minor and related to the concentration of DMSO in the medication solution. Consequently, the most frequent side effects, such as skin rash and pruritus after dermal application, intravascular hemolysis after intravenous infusion and gastrointestinal discomfort after oral administration, can be avoided in large part by employing more dilute solutions. Most clinical trials of DMSO have not incorporated the components of experimental design necessary for objective, statistical evaluation of efficacy. Randomized comparisons between DMSO, placebo and known active treatments were rarely completed. Final approval of topical DMSO for treatment of rheumatic diseases in particular will require a multi-center, randomized comparison between high and low concentrations of DMSO and an orally-active, nonsteroidal antiinflammatory agent.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Medical use of dimethyl sulfoxide (DMSO). 391 2

The authors report the results from the follow-up of 14 patients with transplanted kidney, three out of them with a lethal end--mycotic sepsis--1, purulent peritonitis--1 and of transplant lung-syndrome--1. The rest (11-78,5%) were in a good condition during 1 year and 8 months to 6,5 years (an average of 4 years and 10 days by April 30, 1980). Eleven of the patients had their transplantations performed by Prof. Sumakov--Prof. Levizkii in Moscow and three--by Prof. Hamburger, Prof. Crosnier, Prof. Lacomb in Necker Hospital, Paris. During the follow-up period those 14 patients had the following complications: 15 acute crises of rejection, successfully coped, with residual phenomena in 4 of them; 10--uroinfections, 7--other infections, one mycotic sepsis and one purulent peritonitis with a lethal end; three with epidermic hepatitis, one--Herpes zoster, two bronchopneumonias, one perinephritis, 6--with arterial hypertension that necessitated binephrectomy in two, three patients with steroid diabetes--cured, four with aseptic osteonecrosis of the head of the femur, necessitating prosthesis of the femoral joint in one patient, 5--with surgical complications, corrected at the transplantation centers. Furthermore, one case with transplant lung-syndrome, successfully restored to health as reported by the authors. All those 11 patients with transplantations are in good health (one with a chronic rejection crisis) and 8 of them--work. The authors stress upon the follow-up of the renal patients with transplantation as an important step, consolidating the remote results of renal transplantation.
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PMID:[Our experience with the dispensary observation and treatment of kidney transplant patients]. 701 86

The zona glomerulosa cells of the adrenal gland have an intrinsic renin-angiotensin system that appears to modulate the aldosterone response to potassium and corticotropin. The actions of circulating angiotensin II (Ang II) are mediated by the activation of the Ang II type 1 (AT1) receptor on the adrenal cortex. In this study we examined the effects of the AT1 receptor antagonist DuP 753 and other antagonists on aldosterone secretion in cultured bovine zona glomerulosa cells. Zona glomerulosa cells were cultured in PFMR-4 medium containing 10% fetal calf serum for 72 hours, and the medium was replaced with serum-free medium for the next 24-hour experimental period. DuP 753 (10 mumol/L) inhibited basal aldosterone secretion (from 88.6 +/- 7.1 to 54.8 +/- 9.6 pg/10(6) cells per hour; 38% inhibition). EXP 3174, an active metabolite of DuP 753, also inhibited aldosterone dose dependently (from 88.6 +/- 7.1 to 55.9 +/- 8.4 at 1 mumol/L and 88.6 +/- 7.1 to 21.7 +/- 3.3 at 100 mumol/L; 37% and 75% inhibition, respectively). Another and more potent AT1 receptor antagonist, L158,809, showed significant inhibition at 100 nmol/L, and at 10 mumol/L it inhibited basal aldosterone secretion (from 144.7 +/- 18.2 to 83.4 +/- 17.1 pg/10(6) cells per hour; 42% inhibition). DuP 753 inhibited Ang II (100 nmol/L)-stimulated aldosterone production in a dose-dependent fashion, with a 30% reduction at 100 nmol/L and complete inhibition at 100 mumol/L. DuP 753 also inhibited potassium (12 nmol/L) and corticotropin (1 nmol/L) stimulation of aldosterone in a dose-dependent fashion.(ABSTRACT TRUNCATED AT 250 WORDS)
Hypertension 1995 Mar
PMID:Locally generated angiotensin II in the adrenal gland regulates basal, corticotropin-, and potassium-stimulated aldosterone secretion. 787 70

Hemolytic uremic syndrome associated with pregnancy is a rare condition. Authors report a patient treated with corticosteroids for bronchial asthma who was afflicted by placental abruption at 24 weeks' gestation. The abruption was preceded by developing herpes zoster and by deteriorating respiratory symptoms. The induced labor was followed by anuria, acute renal failure, microangiopathic hemolytic anemia, thrombocytopenia then fever and hypertension. The patient was treated early with plasma infusion, transfusion and hemodialysis. She recovered completely after 7 weeks. This case seems to be unique inasmuch as the hemolytic uremic syndrome was preceded by prodromal illness during pregnancy and was associated with placental abruption.
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PMID:Postpartum hemolytic uremic syndrome following placental abruption. 840 36

It is apparent from published studies that corticosteroids do not prevent the development of postherpetic neuralgia. Earlier trials that indicated some benefit in both acute neuralgia and the prevention of postherpetic neuralgia are of limited use to clinicians due to problems with uncontrolled study designs, small sample sizes, and the absence of statistical analysis of the results. The lack of a consensus definition of postherpetic neuralgia, the variable agents and dosages used, and the different pain scales reported are of concern when trying to interpret the results of these studies for their clinical significance. In more recent larger and well-designed studies, similar rates of postherpetic neuralgia were observed in the corticosteroid and control groups. As a result of these findings, corticosteroids should not be recommended for the prevention of postherpetic neuralgia. Despite lack of efficacy in preventing postherpetic neuralgia, limited studies suggest corticosteroids such as prednisone (40-60 mg/d tapered over 3 wk) are well tolerated and may confer slightly significant benefits in reducing the duration of acute neuralgia and improving quality-of-life measures. However, the clinical significance and application of these findings remain to be addressed. If corticosteroids are used for acute neuralgia, clinicians are advised to select their patients carefully. The patients treated in these studies were generally healthy and free of comorbid diseases, such as hypertension, diabetes mellitus, and psychiatric disorders, which can be exacerbated in the presence of corticosteroids. Although dissemination of herpes zoster has been reported infrequently, it remains a potential risk with use of corticosteroids. Until the results of these studies are repeated in more diverse patient populations, corticosteroids appear to have a limited role in the management of acute neuralgia associated with herpes zoster.
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PMID:Oral corticosteroids for pain associated with herpes zoster. 979 4

We examined the prevalence of HIV, general medical, and psychiatric comorbidities by age based on a recent multisite cohort of HIV infected veterans receiving care: the Veterans with HIV/AIDS 3 Site Study (VACS 3). VACS 3 includes 881 adult patients with HIV infection enrolled between June 1999 and July 2000. Providers reported their patients' CDC-defined HIV comorbidities, general medical comorbidities (based on Duke and Charlson comorbidity scales), and psychiatric comorbidity. Mean age of participants was 49 years and 54% were African-American. The most common HIV comorbidities were oral candidiasis (21%), peripheral neuropathy (16%), and herpes zoster (16%). The most common general medical comorbidities included chemical hepatitis (53%), hypertension (24%), and hyperlipidemia (17%). The mean number of HIV and general medical comorbidities experienced by patients were respectively 1.1 and 1.4 (P < .001). Older (> or = 50 years) HIV-infected patients experienced a greater number of general medical comorbidities than those < 50 years (respectively 1.7 versus 1.2, P < .001). There was no significant difference in mean HIV comorbidity number by age. Based on patient report, 46% had significant depressive symptoms (> or = 10 on 10-item CES-D) and 21% reported at-risk drinking (> or = 8 on AUDIT). Providers reported 32% of patients had anxiety, 4% mania, 4% schizophrenia, and 11% cognitive impairment/dementia. General medical and psychiatric comorbidities constituted a higher disease burden for HIV-infected veterans than HIV comorbidities. Whether these comorbidities are due to antiretroviral drug toxicity or are age or lifestyle-associated conditions, the substantial prevalence of these "non-HIV" comorbidities suggest an important role for general medical and psychiatric management of HIV-infected patients.
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PMID:General medical and psychiatric comorbidity among HIV-infected veterans in the post-HAART era. 1175 Feb 6


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