Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The therapeutic efficacy of cyclosporine (CsA) as an immunosuppressive agent was complemented by a modest, long-term incidence of toxic complications in 402 renal allograft recipients engrafted one to five years prior to analysis. The overall patient and graft survivals at one year were 97% and 84% (actual), and at five years 92% and 67% (actuarial). The immunosuppressive therapeutic index was excellent: only 12% of allografts were lost from rejection, with 5% of patients succumbing to infection. While infections were common, tending to emanate in the urinary tract or to be viral in etiology, they were generally mild and readily controlled. Only four patients displayed malignancies; none succumbed to this cause. The most common toxic complication was hypertrichosis, which was accentuated in pediatric patients. While tremors occurred in 20% of patients, primarily during the first three months, other neuroectodermal complications of parethesias, depression, somnolence, and seizures were rare. Hepatotoxicity, which was noted in 50% of patients, particularly recipients of cadaveric grafts, generally was first seen as a transaminase elevation, at least partially reversible by dose-reduction and abating by the third year. Associated disturbances of cholelithiasis and pancreatitis were occasionally observed. Nephrotoxicity was the only persistent, long-term complication. Hypertension occurred in 72% of patients during the first month, 36% in the second year, and about 15% thereafter. Hyperuricemia, which occurred in about 30% of recipients during the first two years, was occasionally associated with symptomatic gout. The mean serum creatinine level remained elevated throughout the follow-up period at 1.8-1.9 mg/dl, suggesting persistent, but nonprogressive, drug-induced renal injury. The present analysis documents the relative safety of CsA for long-term therapy, and highlights the need for new approaches to ameliorate drug-induced nephrotoxicity.
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PMID:Complications of cyclosporine-prednisone immunosuppression in 402 renal allograft recipients exclusively followed at a single center for from one to five years. 354 76

Three patients are presented as illustrative examples of severe necrotizing pancreatitis associated with diuretic therapy. The presumed initiating factor was use of a benzothiadiazine (chlorothiazide, hydrochlorothiazide) or phthalimidine (chlorthalidone) diuretic to control hypertension, after the exclusion of other etiologies. We present these illustrative cases and a collective review, emphasizing that pancreatitis associated with these widely prescribed medications can be fatal and may be more common that previously thought.
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PMID:Diuretic-associated pancreatitis: a collective review and illustrative cases. 363 Oct 33

240 patients operated on for PHPT in the years 1956-79 were compared with 240 sex and age matched randomized controls to examine the present state of health of the patients. Diseases which occurred in both groups were registered to clarify their possible association with PHPT. Recurring urinary tract infections occurred as often in both groups, though renal stones had naturally been more frequent in the PHPT group. Serum creatinine was elevated in 33 PHPT patients and in 9 controls (p less than 0.001), and renal damage was also more severe in the PHPT patients. Malaise and fatigue occurred in 29 PHPT patients and in 14 controls (p less than 0.05). Medically treated hypertension was found in 95 PHPT patients and in 53 controls (p less than 0.001). Eight PHPT patients and one control had had pancreatitis (p less than 0.01). Peptic ulcer disease and gallstones were registered as frequently in both groups. 16 PHPT patients and three controls had received previous irradiation to the neck region (p less than 0.01). Six PHPT patients, but none of the controls, had had a differentiated non-medullary thyroid carcinoma. Two of the thyroid carcinoma patients had received irradiation. Other malignant diseases were as frequent in both groups. Three controls were hypercalcaemic and had PHPT verified at operation. The prevalence of PHPT in the control group was 1.25%. The state of health was normal in 52% of the PHPT patients and in 68% of the controls (p less than 0.001). The results indicate that PHPT permanently deteriorates the health of the patients and should therefore be diagnosed and treated as early as possible in the course of the disease.
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PMID:The state of health of patients previously operated on for primary hyperparathyroidism compared with randomized controls. 402 76

Two hundred and eighty-nine patients operated on for primary hyperparathyroidism (PHPT) in the years 1956-79 have been followed up for a mean period of 5 years. The aim of the study was to investigate the symptomatology of PHPT and the disappearance of the symptoms after operative treatment. Of the presenting symptoms hypercalcaemic crisis and cystic bone changes were cured, and none of the patients with pancreatitis as presenting symptom had a recurrence. In the renal stone group, 10% of the patients had recurring stones during the follow-up period. The presenting symptom disappeared in 84% of the patients. Thirty-five% of the patients had no presenting symptom and were classified as "asymptomatic", though, on questioning, most of them had various symptoms which disappeared postoperatively. Malaise, fatigue and muscular weakness disappeared in 79% of the patients, upper abdominal pains in 66%, constipation in 63%, pains in the extremities in 51% depression in 65%. Hypertension increased by 28% during the follow-up period; only three of the 90 patients with hypertension has discontinued antihypertensive treatment postoperatively. During the follow-up study, 6% of the patients were hypercalcaemic, though the serum calcium was only slightly elevated in almost all of these patients (mean +/- SD 2.75 +/- 0.09 mmol/l) and most of them had the multiglandular form of PHPT. The renal function did not deteriorate as much as was expected on the basis of earlier reports; only two patients had a serum creatinine over 500 mumol/l.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Long-term effect of surgical treatment on the symptoms of primary hyperparathyroidism. 407 2

By the use of various experimental procedures with rats, the significance of intraluminal hypertension, caused by ductal obstruction, reflux of bile and duodenal reflux were considered with regard to their capacity for producing pancreatitis. The extent of the histological changes in the pancreas after 48 hours as well as the period of survival in the individual experimental groups served as the parameters for the comparison. The results show that the rise in intraluminal pressure is alone enough to produce acute pancreatitis. It follows from this that rise of pressure in the duct system caused by ductal obstruction may be the triggering factor in the induction of pancreatitis. Reflux of bile, bacterial colonisation of the pancreas by duodenal reflux as well as activation of proteolytic enzymes were not necessary a prior factors but ones which have an aggravating effect in the development of the disease.
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PMID:[Intraluminal hypertension as a pathogenetic factor of acute pancreatitis in the rat (author's transl)]. 615 47

Three groups of eight dogs each were studied to evaluate the early evolution of the hyperamylasemia, hyperlipasemia, and acinar cell pathology at the light and electron microscopic levels during acute Diazinon-induced pancreatitis. Two more groups of five dogs each were evaluated for the effects of cholinergic receptor blockade with atropine and ductal decompression on the evolution of serum enzyme changes and acinar cell pathology. Group I dogs received a secretin infusion of 2 units/kg/hr, and a Diazinon infusion of 75 mg/kg, and demonstrated significant increases in serum amylase and lipase at one, two and three hours. Light microscopy revealed acinar cell vacuolization and progressive interstitial edema. Electron microscopy revealed the formation of large intracytoplasmic vacuoles filled with flocculent material, the fusion of these vacuoles with basolateral membrane, and the formation of interstitial edema. In both group II dogs (that received secretin alone) and Group III dogs (that received atropine, 200 micrograms/kg IV prior to secretin and Diazinon), the serum enzyme levels and histologic results were normal. In group IV dogs, pancreatic duct cannulation to prevent hypertension prevented the hyperamylasemia and hyperlipasemia, but not the acinar cell vacuolization and interstitial edema. This model for acute interstitial pancreatitis is apparently cholinergic-receptor mediated, the serum enzyme elevations are due primarily to ductal hypertension, and the acinar cell pathology is primarily due to cholinergic stimulation and occurs independent of ductal hypertension.
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PMID:The effect of atropine and duct decompression on the evolution of Diazinon-induced acute canine pancreatitis. 617 84

The chance finding of an unusual, eccentrically situated, ballooning, atheroma-like acellular deposit of lipid and calcium in the wall of a very small pancreatic interlobular artery prompted a detailed review of 75 autopsies to determine the distribution, prevalence, and possible clinical significance of such lesions. The lesion was present in 12 of the 75 cases (16 per cent), and in ten it was limited to the pancreas. It correlated best with severe coronary atherosclerosis. In a significantly greater percentage of the cases in which it was present, either hypertension or diabetes, or both, were present. The incidence of pancreatic parenchymal disease was similar in both the positive and the negative groups. The lesion, which has apparently not been previously described, may be a peripheral extension of severe atherosclerosis of the large and medium-sized arteries. The morphologic features suggest that the altered vessel walls may be rupture-prone. Future studies of better-preserved portions of pancreas in cases of acute hemorrhagic pancreatitis may reveal the lesion and lend support to this hypothesis.
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PMID:Microatheromas of very small arteries: unusual lesions involving primarily the pancreas. 664 93

The observation of 32 cases of primary (autonomous) pancreatitis with more or less pronounced mechanical jaundice resulting from a compression of the pancreatic portion of the common bile duct is analyzed. The authors believe that it is necessary to abolish both biliary and pancreatic hypertension and to create favourable conditions for the outflow of the bile and pancreatic juice. Variants of the operations are thought to depend on the degree and extension of changes in the both systems of ducts.
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PMID:[Surgical treatment of primary chronic pancreatitis complicated by mechanical jaundice]. 678 Nov 18

Involvement of the splenic venous outflow tract by pancreatic disease can cause localized splenic venous hypertension and esophageal varices. Resolution of this problem resides in splenectomy and distal pancreatectomy or perhaps splenectomy alone. Although this phenomenon most commonly arises from thrombosis of the splenic vein by adjacent pancreatitis, we report a case arising from nonocclusive obstruction of the splenic vein by an adjacent pancreatic pseudotumor.
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PMID:Left-sided portal hypertension from pancreatic pseudotumor. 698 47

The clinical and epidemiological literature is reviewed as to metabolic effects of oral contraceptives (OCs). Both the estrogens and the progestins in OCs cause biochemical alterations which have metabolic consequences. Changes in glucose, lipid, and protein metabolism suggest that the dosage of both estrogens and progestins should be minimized as much as possible. All studies with OCs show no changes in glucose tolerance, but all do consistently show elevated plasma insulin levels as a result of OC usage. This occurs because the pill causes a decrease in insulin sensitivity in healthy women. Increases in age and weight, regardless of OC usage, will also cause an increase in glucose tolerance. Oral glucose tolerance deteriorates in all OC user groups, the greatest deterioration being in the high-dose estrogen users. Women with a history of gestational diabetes or impaired glucose tolerance should be considered high-risk pill users. Lipid abnormalities as a result of pill usage are primarily due to estrogen content. Fasting triglyceride levels are increased in all estrogen users. High-risk factors to be considered in OC prescription are: moderate obesity; diabetes; history of gestational diabetes; hypertension; history of pancreatitis, gallbladder or liver disease; physical evidence of xanthomatosis; age over 30 and smoker; age over 35; family history of hyperlipidemia; and family history of early atherosclerotic vascular disease. Many of the pill-induced protein synthesis changes are similar to those which occur during pregnancy. These, too, are due to estrogen content.
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PMID:Metabolic effects of the birth control pill. 702 12


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