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

Fourteen wolves (Canis lupus L.) were singularly or repeatedly immobilized with 30 mg xylazine hydrochloride (HCl) and 400 mg ketamine HCl. Mean induction time was 5.3 +/- 4.6 min (mean +/- SD). Administration of 8.0 mg/kg tolazoline HCl as an antagonist significantly reduced immobilization times from 148.0 +/- 52.7 to 47.9 +/- 8.9 min (F = 63.69, df = 1,17, P less than 0.05). The average times from injection to ambulation for 2.0, 4.0, and 8.0 mg/kg tolazoline HCl were 35.2 +/- 31.8, 18.5 +/- 11.7, and 10.2 +/- 9.1 min. Tolazoline HCl increased heart rates significantly (P less than 0.001) from 75 +/- 14 to 120 +/- 23 beats/min, reversing a xylazine HCl-induced bradycardia. Respiratory rates also increased significantly (P less than 0.01) after tolazoline HCl injection from 19 +/- 7 to 28 +/- 8 breaths/min. Immobilization resulted in an initial hypertension which was normalized after tolazoline HCl administration. One female wolf had a single sinoatrial block within 1 min of receiving tolazoline HCl. Tolazoline HCl appears to be an effective antagonist for xylazine HCl-ketamine HCl immobilization of wolves.
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PMID:Xylazine hydrochloride-ketamine hydrochloride immobilization of wolves and its antagonism by tolazoline hydrochloride. 373 86

Forty-three patients taking chloroquine for systemic lupus erythematosus were followed by one ophthalmologist over a 5-year period. Visual field testing, color vision testing, and fluorescein angiography were performed. Retinopathy was detected in 7 patients (16%), none of whom had hypertension or diabetes mellitus. Retinal abnormalities included cotton-wool spots in 4 patients, microaneurysms in 3, and vascular tortuosity in 4. In 4 patients, these abnormalities were associated with retinal dysfunction, measured in terms of abnormal hue discrimination. In 6 of the 7 patients, the finding of retinopathy coincided with a flare of lupus activity. In 5 patients, retinopathy improved when the disease was controlled.
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PMID:Retinopathy in systemic lupus erythematosus: relationship to disease activity. 375 41

Adolescents constitute a particular group of patients because of their young age and incomplete or erroneous knowledge of contraception and reproduction. The physical condition of a young girl and the medical history of her close relatives must be assessed in the contraception consultation. In the absence of obvious contraindications such as hypertension, diabetes, hypercholesterolemia or renal insufficiency, oral contraceptives (OCs) are most often indicated, whether or not the menstrual cycle is well established. It has been demonstrated that the hypothalamus resumes its previous activity when OC use is discontinued. Standard-dosed combined OCs are usually recommended, because low-dose formulations do not always sufficiently block the hypothalamus and may induce a state of relative hyperestrogenism. Girls with benign breast disease or whose mothers have histories of breast cancer may benefit from the antigonadotropic properties of a 19-nortestosterone derivative progestin administered from the 8th to the 25th cycle days. Some 19-nortestosterone derivatives can cause seborrhea, acne, or hair loss. Sequential OCs may be indicated at this age for temporary use in exceptional cases. Low-dose progestins are not completely effective and cause worrisome menstrual problems. In cases of renal insufficiency, lupus, or hypertension, derivatives of 17-OH progesterone can be used. Cyproterone acetate is indicated for adolescents with hirsutism. Barrier methods are not used by adolescents as often as the less reliable but simpler ovules or jellies. The diaphragm with jelly or the condom correctly used are the most reliable, but they have a bad reputation. Information campaigns have successfully promoted use in some countries. IUDs are strongly contraindicated for all young girls because of increased risks of infection and sexually transmitted diseases. In extreme necessity they may be used for mentally ill adolescents unable to use any other method.
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PMID:[Contraceptive methods for adolescents]. 385 20

Early reports on SLE were too small in number to determine that pregnancy was contraindicated in patients with renal involvement. Later reports show that patients with lupus nephropathy can have successful pregnancies provided certain preconditions are established. Optimal preconditions include prepregnancy remission of at least 6 months, renal function with serum creatinine 1.5 mg/dl or less or creatinine clearance of 60 ml/min or more or proteinuria of 3 g/24 hr or less. Successful pregnancies have been recorded in some patients with more severe renal impairment. Renal function will remain unchanged in approximately 60% of pregnancies; and although deterioration may occur, it is only severe or permanent in less than 10%. In 26% of patients, mild to severe renal impairment was transient, with recovery to prepregnancy levels of renal function. Proteinuria with good creatinine clearance may not be dangerous. Hypertension or superimposed preeclampsia jeopardizes the outcome. Fetal outcome averaged approximately 70% (range, 41-77%) live births, 17.8% (range, 5.1-40%) spontaneous abortions, 19.7% (range, 3.0-38.5%) prematurity, and 8.2% SGA. Therapeutic abortion is not a modality of treatment of lupus nephropathy. Management of patients with lupus nephropathy is twofold and includes suppression of underlying lupus activity as well as the serial evaluation of chronic renal disease. In chronic lupus nephropathy with inactive SLE maternal and fetal outcome is the same as for pregnant patients with chronic renal disease of other causes. Strict fetal surveillance must be performed to decrease the stillbirth rate. The concomitant increase in prematurity demands the services of a tertiary care neonatal unit. Management necessitates the team approach of the obstetrician, nephrologist, rheumatologist, and neonatologist working in collaboration. The reports which contain large numbers of patients now allow better counseling of these patients who are contemplating pregnancy.
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PMID:Lupus nephropathy and pregnancy. 389 19

SLE affects most aspects of cardiac function, and recent studies have reported increasing cardiovascular morbidity and mortality. Pathologically, SLE is characterized by a pancarditis involving pericardium, myocardium, endocardium, and coronary arteries. In autopsy series, pericarditis has been found in 43% to 100% (mean 62%, Table I), and myocarditis was found in 8% to 78% (mean 40%, Table II), but both have been underdiagnosed clinically. Libman-Sacks lesions have been noted in 25% to 100% (mean 43%) and infective endocarditis in 1.1% to 4.9% of clinical and autopsy studies (Table III). Coronary disease may be due to arteritis, which should be treated with high-dose steroids, or it may be due to atherosclerosis, which is amenable to medical or surgical therapy. Valvular disease has been treated surgically, but with a combined surgical mortality as high as 25%. Aortic insufficiency and mitral regurgitation are the most common valvular problems, although aortic and mitral stenosis have also been reported. Hypertension has been noted in 14% to 69%, and heart failure in 5% to 44%. Evidence for a lupus cardiomyopathy, which may be subclinical, is reviewed. While steroids may ameliorate SLE pancarditis, they have also been associated with hypertension, LV hypertrophy, purulent and constrictive pericarditis, mitral regurgitation, and perhaps accelerated atherosclerosis. It remains to be seen if improved diagnosis and treatment of the cardiovascular manifestations of SLE can enhance survival.
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PMID:Cardiovascular manifestations of systemic lupus erythematosus. 390 17

A clinicopathologic autopsy study of the vascular changes in the kidneys of 100 patients with systemic lupus erythematosus was undertaken. Necrotizing arteritis was found in seven patients, mucinous intimal thickening in nine, onion-skin intimal thickening in two, and renal vein thrombosis in two. Active necrotizing arteritis was present most frequently in the arterioles and interlobular arteries, with healing necrotizing arteritis predominating in the arcuate and interlobar arteries. These events were closely related to the activity of glomerular lesions, and immunologic vascular injury seemed to be the causative factor. Rapidly progressive renal failure and severe hypertension had characterized the clinical courses of the patients. Mucinous intimal thickening, present in the arterioles and interlobular arteries, had been accompanied by accelerated hypertension. Although dialysis or accelerated hypertension may have been causes, other factors, including glucocorticoid therapy, must be considered. In one patient with class II lupus nephritis, renal vein thrombosis was considered the cause of the nephrotic syndrome. These vasculopathies, often detected in patients with lupus at autopsy, seem to alter the clinical course.
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PMID:Incidence and significance of intrarenal vasculopathies in patients with systemic lupus erythematosus. 397 86

Medical records of patients having unilateral nephrectomies done between 1953 and 1978 at a university hospital were reviewed after 5 to 30 years of follow-up to determine if this procedure causes insidious renal insufficiency. Forty patients (selected from 571) ranging in age from 20 to 72 years met the following criteria for inclusion in the study: subject over 20 years of age at nephrectomy; initial serum creatinine concentration less than 1.6 mg/dL; normal arterial blood pressure (less than 150/90 mm Hg); absence of risk factors for chronic renal disease, eg, systemic lupus erythematosis, diabetes mellitus, chronic glomerulonephritis; an initial and a follow-up serum creatinine level; at least 5 years of follow-up. After a mean follow-up of 11.8 years, paired analysis of changes in serum creatinine concentrations showed insignificant differences between pre- and post-nephrectomy levels (0.19 +/- 0.11 mg/dL +/- SEM). Only one patient had a post-nephrectomy serum creatinine level above 2.0 mg/dL. Six patients (four women, two men) developed hypertension (15%) after uninephrectomy, an incidence of hypertension not greater than that found in the population at large. We conclude that uninephrectomy at ages older than 20 years does not lead to renal insufficiency or hypertension in adult patients with normal prenephrectomy serum creatinine and blood pressure levels.
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PMID:Long-term effect of uninephrectomy on serum creatinine concentration and arterial blood pressure. 403 59

In a randomized cross-over trial in 23 patients with essential hypertension, a new peripheral vasodilator, endralazine, in a dose of 10-20 mg t.i.d. was compared with dihydralazine in a dose of 25-50 mg t.i.d. All patients also received pindolol (a beta-blocker) in a dose of 5-15 mg t.i.d. The lowest dose of both drugs was given to all patients for 2 weeks and was increased only if indicated. Endralazine was more effective than dihydralazine, but the side effects were about the same in frequency and severity, apart from flushing, which was more common with endralazine. Patients receiving endralazine in the second phase of the cross-over design continued to be treated with endralazine for a period of 10-12 months. Blood pressure control remained good during this time, and the dosage was slightly reduced. No side effects suggestive of drug-induced lupus were seen, and only borderline changes in immunological tests [antinuclear antibodies (ANA)] in one patient were seen. One patient was reported to have lupus erythematosus (LE) cells in the peripheral blood but the ANA test was negative. Endralazine appears to be a useful new drug for the treatment of hypertension.
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PMID:Endralazine, a new peripheral vasodilator--a randomized cross-over trial against dihydralazine. 618 29

Renal involvement is uncommon in the hydralazine induced systemic lupus erythematosus syndrome. Six women with hypertension are described who developed an immune complex glomerulonephritis after taking 50-300 mg hydralazine daily for 6 months to 7 years. Associated features were anemia (100%), hypocomplementemia (50%), a positive antinuclear antibody test (100%) and antibodies to double-stranded DNA (66%). All patients were slow acetylators and four had HLA-DR 4 genotype. Renal function deteriorated in all cases. Cessation of hydralazine combined with immunosuppressive therapy resulted in amelioration of the disease. It is likely that the patients had a hydralazine induced lupus glomerulonephritis, or alternatively had an unmasking of an inherent tendency to idiopathic lupus nephritis by hydralazine.
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PMID:Hydralazine and lupus nephritis. 624 Mar 59

The true incidence of the lupus syndrome induced by hydralazine was determined in a longitudinal study of 281 patients consecutively starting hydralazine for hypertension over a 51 month period. Data on the duration of treatment and the maximum dose achieved were examined using life table analysis. After three years' treatment with hydralazine the incidence of the lupus syndrome was 6.7% (95% confidence limits 3.2-10.2%). The incidence was dose dependent, with no cases recorded in patients taking 50 mg daily and incidences of 5.4% with 100 mg daily and of 10.4% with 200 mg daily. The incidence was higher in women (11.6%) than in men (2.8%). In women taking 200 mg daily the three year incidence was 19.4%. Hydralazine is an effective antihypertensive drug that has come to be used in restricted dosage (not more than 200 mg daily) because of its risk of inducing the lupus syndrome. This study shows that the true incidence of the syndrome is still unacceptably high even when the drug is prescribed according to current recommendations.
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PMID:The lupus syndrome induced by hydralazine: a common complication with low dose treatment. 643 20


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