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

Autonomic dysteflexia is a pathologic reflex which occurs in patients with a spinal cord lesion above T7. The most dangerous manifestation of this reflex is marked increase in systolic and diastolic blood pressure. The trigger is the distension of the urinary bladder, urethra, rectum, or intestine. It can and does occur during radiological examinations such as cystourethrography, loopography, and probably during the barium enema. Because of possible deleterious consequences of marked hypertension, blood pressures in these patients should be continuously monitored during the examinations and appropriate measures immediately instituted should the reaction occur.
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PMID:Autonomic dysreflexia in patients with spinal cord lesions: complication of voiding cystourethrography and lleal loopography. 18 9

The authors report a 38 years old patient in whom an intravenous pyelogram was performed for moderate arterial hypertension. This showed a large filling defect in the right lower part of the bladder without renal function on that side. Endoscopic separation of the jet coming from the right half of the trigone showed a liquid containing numerous spermatozoa. A cystogram opacified by reflux a cavity in the genital system via this, the right ureter. With the diagnosis of ectopic ureter ending in the genital system, a nephro-ureterectomy demonstrated the attachment of the ureter into a pouch which communicated with the bladder and the seminal vesicle. A view of the normal embryology insists on the fact that contrary to the classic view, the pronephros disappears entirely and that the metanephros is at the origin of the Woffian canal which opens on the posterior wall of the urogenital sinus at the 28th day when the ureter springs from a ureteral bud. Since 1960 this would be the 34th case in the literature, seminal ectopia (24%) coming after ectopia in the prostatic urethra (54%). Epididymitis is a frequent presenting symptom (44%). The workup shows: absence of renal function (100%), raising of the ipsilateral trigone by a cystic swelling (76%), absence of the meatus on that side on endoscopy, presence of an ipsilateral mass above the prostate on rectal examination (30%). The diagnosis is confirmed by vasography where the ureter is opacified by the seminal vesicle or by systography after endoscopic incision of the mass. Excision of the seminal vesicle was done in conjunction with total nephroureterectomy in 17% of cases.
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PMID:[Ectopic ureter ending in the seminal vesicle in adults. Apropos of a case and review of the literature]. 48 Apr 13

A new method was developed for separate kidney function studies by catheterizing the ureters and exteriorizing the catheters through the urethra into the vagina. Renal artery plication was performed to reduce blood flow to one kidney by 66 +/- 5%. Arterial pressure increased from 107 +/- 2 to 131 +/- 3 mmHg and remained elevated for 28 days. Plasma renin activity was increased for the first 7-10 days only. Sodium and water excretion were markedly reduced in the kidney with the stenosed renal artery and after the first 2 days Na and water excretion were incresed in the contralateral kidney. These changes in Na and water excretion were frequently associated with similar directional changes in glomerular filtration rate (GFR) and renal plasma flow. An exception was noted in that renal sodium and water excretion remained low throughout the 28 days in the kidney with the constricted renal artery, whereas GRF returned to near the control level by the end of 2 wk. Altered filtration fraction did not appear to be a determining factor in control of the rate of Na excretion. It is suggested that GFR, the renin-angiotensin-aldosterone system, and other as yet undefined factors are involved in salt and water homeostasis during unilateral renal artery stenosis with hypertension.
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PMID:Separate renal function studies in conscious dogs with renovascular hypertension. 69 70

Steroid 11 beta-hydroxylase deficiency is relatively frequent in Israel among North African Jews. Over a 39-year period, 38 affected individuals from 25 families were diagnosed. Nineteen families came from Morocco, and in another 2, one parent came from Morocco (80% of all parents). Demographic studies showed that most of their grandparents were born in the region of the Atlas Mountains. In Israel, the overall incidence of the disorder is estimated between 1 in 30,000 to 1 in 40,000 births, but in offspring of Moroccan Jews the ratio is 1 in 5,000 to 1 in 7,000, with an allele frequency of 1 in 70 to 1 in 84 and a carrier frequency of 1 in 35 to 1 in 42. The clinical expression is characterized by a wide range of variability in the signs of androgen and mineralocorticoid excess. Virilization in the female ranged from enlarged clitoris in the mildest forms, to markedly hypertrophied clitoris with penile urethra and fused labial-scrotal folds in the most severe forms. Hypertension causing vascular accidents and death was observed in both severe and mildly virilized patients, whereas masculinized females were sometimes normotensive. Based on historical evidence, the origin of the ancestors, and the onomastic analysis of the families surnames, we propose that the mutation of 11 beta-hydroxylase deficiency in Jews from Morocco may have originated in either the ancient Jewish settlers or the native Berber tribes who lived in the region of the Atlas Mountains in the southern region of Morocco before the destruction of the Second Temple by the Romans, in the year 70 C.E.
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PMID:High frequency of congenital adrenal hyperplasia (classic 11 beta-hydroxylase deficiency) among Jews from Morocco. 155 23

The authors report two observations of monstrous ectasia of the prostatic urethra, in boys age 12, without any previous pathological history; discovered on at the time of major dysuria previous urinary troubles with chronic retention of 500 cl and 1.250 l respectively. In the absence of any organic obstacle, etiology relieves functional troubles. If functional explorations show a normal or hypertensive detrusor, then they discuss the possibility of vesico-sphincter dyssynergia or an obvious hypertension of the striated sphincter. From this moment onwards, purely intrinsic urethral functional trouble is plausible, all the more because the recovery was assured by treatments directed only at the urinary canal. In the first case, after surgical treatment owing to complex lesions (plastic reduction of the urethral ectasia preserving the posterior wall and respecting the striated sphincter) combined with diverticulectomies with urethral reimplantations), the patient recovered complete vesical waste removal at once, with normalisation of the flowmeter in six months. In the second case, a simpler treatment (sub-montanal urethrotomy of the principle) allowed a normalisation period of 10 months with complete vesical waste removal. The functional results are maintained after a period of nine and two years respectively. The integrity of the striated sphincter controlled post-operatively by the operatory gesture on the urinary canal and confronts the authors in the idea of intrinsic urethral pathology, although electronic microscopic examination may not have shown achalasia.
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PMID:[Junctional syndrome responsible for prostatic urethral dilatation: a new pathological entity?]. 237 31

Haemospermia is an uncommon disorder of diverse aetiology, which includes diseases of the urethra, prostate and hypertension. There is no report of haemospermia in this environment and this communication describes a case associated with severe hypertension.
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PMID:Severe hypertension and haemospermia--a case report. 248 79

75 cases of posterior urethra valves have been seen and treated from 1952 to 1984. The average follow-up is 11 years. The clinical symptomatology is described and the different treatments are analyzed from a critical point of view. A the present time the progress made by pediatric intensive care, minimization of endoscopes, better understanding of lesions, indicate that the only treatment has to be the valves. A urinary diversion is to be considered only if the life of the boy is in danger. It is rare to have to reimplant the ureters. 3 boys died. From the cases with long follow-up, 4 have high blood pressure, 16 have renal insufficiency, of these one had a successful renal transplant, 6 are dialyzed. The problems of urinary continence and fertility are discussed.
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PMID:[The valves of the posterior urethra]. 352 22

Urethral stricture in the tropics may be a serious public health problem; the majority of cases are caused by the gonococcus. The pathology is varied, and many advanced cases with complications are seen. Most strictures are seen in the posterior urethra, where fibrosis and narrowing may extend from a short length of under 5 mm to well over 10 cm. A wide variety of complications occurs. Diagnosis is easy when the patient presents in acute retention or with a history of difficult micturition, but more difficult when stricture is the underlying cause of perianal abscess, gangrene of the scrotum caused by extravasation, uremia or hypertension, hernia or rectal prolapse, urinary infection, or elephantiasis of scrotum with multiple fistulae. A careful history is helpful, paricularly if previous gonorrhea is involved. Physical examination varies according to mode of presentation and complications; a rectal examination and neurological examination should be included. Definitive investigation to prove the presence of a stricture includes urethrography and urethroscopy, if facilities are available. Indirect methods of diagnosis include tests for hemoglobin, blood urea, plain X-ray of the whole urinary tract, urinalysis, and others. It is preferable to leave instrumentation until last in diagnostic cases, to avoid infection, but a diagnostic bougie may be passed under strict aseptic conditions prior to treatment. The mainstay of treatment is regular bouginage for life, which is best done in a bougie clinic held at regular intervals. Equipment for bouginage, in order of desirability, includes soft plastic bougies, straight metal bougies, or curved metal bougies in larger sizes, a large stainless steel instrument tray, a basin for sterile water, and lubricant. Care should be taken during bouginage not to pass bougies into acutely inflamed strictures, and not to overstretch the urethra. Plastic bougies are preferable, until a stable situation has been reached. Surgery is indicated for a persistently impassable stricutre, for 1 requiring difficult bouginage at frequent intervals with many failures, for an established false passage, and for complications, especially bladder neck stenosis. Instructions for intravenous pyelograms and for urethrography from below and above, and diagrams of urethrograms indicating various pathological states and a diagnostic schema for urethral stricture are included.
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PMID:Urethral stricture. 469 33

Since 1968, we experienced 65 cases of urinary tract injury. These include a rare case of traumatic renal artery thrombosis which was later followed by renovascular hypertension, a rare case of complete ureteral disruption, and 2 cases of renal injury which were first treated conservatively but were nephrectomized later because of rebleeding. These cases are reported and discussion is made about the relationship between the clinical findings and the indication of nephrectomy. We used endoscopic management (Yasuda method) in the cases of complete disruption of posterior urethra accompanied by pelvic fracture and obtained good results.
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PMID:[A study of 65 cases of urinary tract injury]. 648 59

Studies in 18 Jewish families from Morocco, Tunis, Turkey and Iran revealed 26 patients with congenital adrenal hyperplasia due to 11 beta-hydroxylase deficiency. The clinical expression of androgen excess varied widely in affected females, and range from solely enlarged clitoris in the mildest forms to severely hypertrophied clitoris with penile urethra and fused labial-scrotal folds in the most extreme forms of masculinization. Intermediate degrees of severity were manifested by ambiguous genitalia. There was no correlation between the degree of virilization and the signs of mineralocorticoid excess. Severe volume-induced hypertension leading to vascular accidents and death were also observed in severe as well as in mildly virilized patients, while completely masculinized females were sometime normotensive. Overt hypokalemia was present in 6 patients but was not a constant feature of hypertensives. However, all affected individuals, except for 2 infants, had very low levels of plasma renin activity suggesting that a state of volume expansion was indeed present in the majority of cases, even though changes in blood pressure did not always occur. The clinical expression of this disorder is characterized by a wide range of variability in the signs of both androgen and mineralocorticoid excess, which do not necessarily correlate with the quantity of hormones secreted.
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PMID:Clinical variability of congenital adrenal hyperplasia due to 11 beta-hydroxylase deficiency. 704 83


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