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

Chronic intermittent hemodialysis may relieve some medical problems of terminal uremia (for example, azotemia, acidosis, hypertension, neuro-muscular disorders, bleeding, pericarditis) to such a degree that many patients are able to resume their normal activity. There remain, however, problems which are not readily changed by hemodialysis (anemia, peripheral neuropathy, pruritus, sexual impotence, renal osteodystrophy). These, together with medical problems possibly caused by hemodialysis (for example, osmotic disequilibrium, errors in dialysate composition, hepatitis, hemosiderosis, isoimmunization from blood transfusions, shunt problems and psychological problems of dependency upon the artificial kidney) represent a limitation of the present type of hemodialysis therapy.
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PMID:Some medical problems of chronic hemodialysis. 486 55

Seven patients with chronic renal failure underwent intermittent hemodialysis for five to 37 months (111 patient-months on a twice-weekly basis) employing arteriovenous Teflon-Silastic cannulas and the modified two-layer Kiil hemodialyzer. A single-pass 37 degrees C. dialysate system has been used. One patient died of an indirectly related cause. All other patients have been successfully rehabilitated and now carry on normal activity of moderate sedentary type. Complications included recurring infection and clotting of arteriovenous cannulas. Hypertension and anemia were common complications requiring careful control. Peripheral neuropathy was noted in five of the seven patients but was of clinical significance in only one patient. Metastatic calcification, osteoporosis and urolithiasis also occurred in this patient. Peptic ulcers with hemorrhage developed in two patients. The degree of rehabilitation and psychological adjustment achieved by this group of patients strongly indicates the need for expansion of dialysis facilities and further research into the medical and economic aspects of dialysis.
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PMID:Intermittent hemodialysis in terminal chronic renal failure. 590 69

Fifty-three patients with polyarteritis who were followed up for at least 2 years were defined clinically and studied retrospectively to determine the influence of clinical factors and treatment on the prognosis. There was a spectrum of severity of disease, and the 5-year survival in the group was 55%. A small number of patients had evidence of ongoing immune-complex disease, as indicated by the presence of cryoglobulins or hepatitis Bs antigen or by diminished serum complement. These markers were not associated with distinct clinical features and did not influence prognosis. Organ involvement that most adversely affected prognosis was that of the gut and the kidneys. Six of 8 patients with bowel infarction or serious gastrointestinal bleeding died, and 6 of 10 patients with renal insufficiency died. Hypertension and peripheral neuropathy did not influence the prognosis. Thirty-six patients were treated with corticosteroids alone and 14 with a combination of corticosteroids and cytotoxic agents (3 received no treatment); the outcome was the same in both groups. Twenty-two in the steroid-alone group and six in the combination group were alive when last seen. Early deaths were usually due to complications directly related to the vasculitis, and late deaths were often due to cerebrovascular or cardiovascular complications. At the last follow-up, 18 patients were in remission, and 13 had inactive vasculitic disease and were on maintenance treatment.
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PMID:Clinical features, prognosis, and response to treatment in polyarteritis. 610 26

Clinical symptoms, biochemical analyses, immunologic status and angiographic findings corresponding to seven HBsAg positive patients with panarteritis nodosa and to 16 HBsAg negative patients with panarteritis nodosa have been compared. HBsAg positive cases showed a statistical significant higher incidences of Raynaud's phenomenon (p less than 0.05) and cardiopathies (p les than 0.05), as well as high occurrence of blood hypertension, artropathy, liver involvement and peripheral neuropathy. Significant differences in relation to cell immunity were not found. Humoral immune disturbances were more common among HBsAg positive patients, being hypergammaglobulinemia (p less than 0.01), IgM increase and decrease of complement factors (C3, C4 and C3PA) the most frequent abnormalities recorded. Angiographic studies revealed a high incidence of microaneurisms for the HBsAg positive group.
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PMID:[Comparative study between HBsAg positive and HBsAg negative panarteritis nodosa in a series of 25 cases (author's transl)]. 610 34

Polyarteritis nodosa developed in one of 34 patients undergoing long-term maintenance hemodialysis with persistent hepatitis B surface antigenemia. Exacerbation of the baseline hypertension and progressive peripheral neuropathy during the recovery phase of hepatitis B surface antigen hepatitis were the initial features. Poor response to aggressive corticosteroid and immunosuppressive therapy in this patient was in contrast to recent experience in patients undergoing long-term hemodialysis and the general population.
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PMID:Polyarteritis nodosa after HBsAg hepatitis in a patient undergoing hemodialysis: manifestation and response to therapy. 612 36

A systematic ophthalmological, medical, and biochemical screening of a rural population of diabetics in Western Australia is being carried out. A team of ophthalmologists, physicians, and paramedical personnel establish regional screening centres on a voluntary basis at weekends. Every attempt is made to locate and examine all known diabetics. All patients are given a thorough ophthalmic examination including standard multiple field colour fundus photography. Thorough physical examination includes assessment of cardiovascular and neurological status. Biochemical parameters include random blood sugar, urine analysis, serum creatinine, glycosylated haemoglobin, cholesterol, and high density lipoprotein. A detailed questionnaire and interview is carried out to assess the historical degree of control and the patient's knowledge of the control and management of diabetes. The sample now comprises an unselected population of 400 diabetics living in rural areas and allows comparison of areas which have scarce medical services with centres that are well supplied with medical practitioners. Incidence of retinopathy varies from 25 to 36 per cent of the diabetic population. Positive correlations of retinopathy have been found with duration, age, hypertension, level of control assessed biochemically at the time of examination, presence of ischaemic heart disease, peripheral neuropathy, and renal disease. Smoking also correlates positively. The data provide a baseline by which attempts to alter diabetic knowledge, management, and control may be measured in follow-up studies.
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PMID:Medical correlates and diabetic retinopathy screening. 626 42

Captopril, an inhibitor of the angiotensin-converting enzyme, was administered for 9 to 13 months to 11 patients with severe arterial hypertension and/or hypertension resistant to conventional treatments. The drug had to be discontinued in 2 patients on account of skin rash or peripheral neuropathy. In the remaining 9 patients, return of blood pressure to normal levels was obtained with combined captopril and diuretic treatment, except in one case where captopril alone proved sufficient. The anti-hypertensive effect developed over several weeks. No rebound phenomenon was observed after temporary arrest of captopril. Positive correlation was noted between the fall in blood pressure induced by the first dose of captopril and the patients' initial plasma renin activity. Captopril appears to be of considerable interest for the treatment of severe hypertension, even when it is associated with renal insufficiency.
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PMID:[Treatment of severe arterial hypertension with captopril (SQ 14.225) (author's transl)]. 626 57

The authors retrospectively investigated 62 diabetics who had received dialytic therapy at our department and our associated hospital over the past 10 years. We studied the complications and causes of death among the 62 subjects. Of the 62 patients (male 42, female 20), 27 (male 21, female 6), had died. The causes of death in the 27 cases included 7 from general weakness, 4 from gastrointestinal bleeding, 4 from cerebrovascular hemorrhage or thrombosis, 3 suicide, 3 congestive heart failure, 2 myocardial infarction, 2 hyperkalemia, 1 infection and 1 from hepatoma. With regard to diabetic retinopathy, 19 of the 62 patients suffered from bilateral blindness and 12 from unilateral blindness. In 8 patients, visual complications developed after hemodialysis, but 16 patients were already blind at the introduction of hemodialysis. There was no evidence that retinopathy was accelerated by dialysis and the authors suggest that the treatment of retinopathy is very important at the nondialyzed stage. With regard to other complications in dialyzed diabetics, unstable hypertension, diabetic gastroenteropathy, peripheral neuropathy, ischemic heart disease and gangrene were discovered in our population. Some rehabilitation was possible in all but 3 of the subjects (1 peripheral neuropathy, 2 leg amputation).
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PMID:Clinical study of complications in dialyzed diabetics. 668 May 16

Bilateral optic atrophy developed in a 15-year-old patient receiving concomitant neuraxis radiation therapy and weekly vincristine sulfate for medulloblastoma. Other neurologic manifestations that have been associated with vincristine therapy, including inappropriate secretion of antidiuretic hormone, hypertension, confusion, and a severe peripheral neuropathy, were also observed. Neither increased intracranial pressure nor active tumor was identified. Recovery of visual function followed discontinuation of vincristine. Other neurotoxicities also reversed with drug withdrawal. Visual loss occurring in a patient receiving vincristine should alert the physician to the possibility that the process is drug related. This complication may be more likely in patients receiving concomitant or previous cranial radiation therapy. Other central neurotoxicities of vincristine may also be accentuated by neuraxis radiation. It is recommended that vincristine be discontinued in this situation if an aggressive search for a structural anatomic lesion in the optic mechanism is unrevealing, as the prognosis for recovery of visual function appears excellent.
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PMID:Optic atrophy induced by vincristine. 709 98

The total plasma clearance of norepinephrine (NE) was assessed during steady state NE infusion at two different dose rates in 27 patients with non-azotemic diabetes mellitus as compared with 27 normal subjects. Lower NE dose rates were required in diabetics than in normal subjects (P less than 0.001) to induce similar increases in blood pressure. However, plasma NE levels during NE infusion correlated closely (r = 0.79 and 0.78; P less than 0.001) with concomitant dose rates, and this relationship was similar in both study groups. Moreover, the plasma NE clearance did not differ between low and high dose rates of NE infusion, and was similar in diabetics and normal subjects (6.0 +/- 3.1 and 5.1 +/- 2.6 liter/min, respectively). It correlated inversely with the pre-infusion plasma NE (r = -0.38 and -0.53; P less than 0.05);this relationship was also similar in the two groups. The correlation relating plasma NE to NE infusion rates as well as the plasma NE clearance did not differ between the 13 diabetics without and the 14 with signs of peripheral neuropathy or between the 17 patients with normal and the 10 patients with high blood pressure. These findings suggest that the kinetics of circulating NE are usually unaltered in non-azotemic diabetes mellitus. An increased pressor responsiveness to NE, in the presence of normal plasma NE concentrations and clearance rates, may be a setting predisposing for the development of hypertension in diabetic patients.
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PMID:Total plasma clearance of infused norepinephrine in non-azotemic diabetes mellitus. 710 95


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