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

Our study was done to determine whether patients with schizophrenia and a coexisting physical disorder could adequately discuss the physical illness with a physician. We defined the minimal standard of adequate communication as the ability to acknowledge and name a physical problem during an index hospitalization. Of the 110 patients studied, 38 had a total of 54 medical illnesses (diabetes mellitus, hyponatremia, thyroid disorder, urinary tract infection, bladder dysfunction, hypertension, anemia, liver disorder, and seizure disorder). After two years of follow-up, 28 of these 38 patients agreed to participate in the second part of the study. Upon interview, 24 patients were unable to name at least one of their physical problems. This study reproduces the previous findings of psychiatric patients' difficulty in communicating about physical illness. It suggests that the communication difficulty is constant and not lessened in the nonacute situation.
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PMID:Communication difficulty of patients with schizophrenia and physical illness. 335 75

In these times of rapid advances in radiographic imaging, intravenous urography should be performed in an optimal way. The urographic examination should involve consultation between the referring physician and the radiologist. Necessary patient information should be accessible. McClennan said "patient selection for urographic studies should be efficacious with the radiologist exerting appropriate control so that the urogram is truly a consultative imaging service integrated into the total patient management." We share this view, and it is an extension of the philosophy of practice emphasized by other leaders in uroradiology. Cost containment, new imaging technologies, risk/benefit considerations, and evolving patterns of patient care have had a significant influence on genitourinary tract imaging. In addition, current debate about contrast media, digital radiography, efficacy, and utilization will undoubtedly have an influence on imaging during the next decade. Utilization of intravenous urography has decreased significantly in the past 15 years. Our volume of examinations has declined approximately 50% since 1970. This decline in our practice is attributed to several complex factors such as previous overutilization of screening urography for hypertension; the impact of US and CT for evaluation of obstruction, retroperitoneal disease (adenopathy and fibrosis), renal failure, and renal masses; concern about contrast medium-induced renal failure; and fewer repeat studies because of improved quality of intravenous urography in general radiology practice. In addition, overutilization of urography in patients with hematuria, prostatism, history of urinary tract infection, etc, continues to be debated in the medical community. In our integrated group practice, we have also observed overutilization of "high-tech" procedures in lieu of urography for evaluation of suspected urinary tract disease. Swings of the pendulum are inevitable in diagnostic imaging because of evolving technology and the art of medical practice. Although some differences of opinion about the details of urographic technique and indications for urography may exist, most would agree on the philosophy of producing a high-quality urographic examination. That philosophy focuses on producing the highest quality examination in each patient so that a diagnosis of normal or abnormal can be made accurately and confidently. Failure to demonstrate the entire urinary tract is a common cause of diagnostic error and one that can largely be eliminated by careful attention to the technical details of the examination.
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PMID:Intravenous urographic technique. 336 17

Pyelonephritic renal scarring is a common cause of renal failure and hypertension. We studied glomerular filtration rate (GFR), renal plasma flow (RPF), filtration fraction (FF), total renal area (TRA), systolic (SBP) and diastolic (DBP) blood pressure in 22 female patients with verified renal scarring and a history of febrile urinary tract infection (UTI) and in 9 healthy age-matched women with normal urograms and no history of symptomatic UTI. The patients with renal scarring had significantly lower GFR, smaller TRA and higher SBP than the healthy controls, but not significantly different RPF or FF. A decrease in GFR and RPF was associated with higher SBP and DBP in the patients with renal scarring. RPF/TRA, representing an approximation of the perfusion of renal tissue and GFR/TRA, were similar in patients with renal scarring and healthy controls. A reduction of renal parenchyma was accompanied by a proportional decrease in GFR and RPF, resulting in unchanged FF. These findings do not support the concept of hyperfiltration as a main cause of renal insufficiency in patients with pyelonephritis renal scarring. An increase in FF and a decrease in GFR/TRA and RPF/TRA was associated with higher DBP and a decrease in GFR/TRA and RPF/TRA with an increase in the urinary albumin excretion. We conclude that renal hemodynamics play an important part in the blood pressure control of patients with renal scarring and that in these patients with various degrees of renal failure there was no evidence of hyperfiltration or hyperperfusion by remnant glomeruli.
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PMID:Renal hemodynamics and blood pressure control in patients with pyelonephritic renal scarring. 341 7

As a result of decreases in maternal mortality and infectious diseases, women's life expectancy has increased rapidly in this century and is expected to reach 83 years by the year 2000. However, there are a large number of chronic conditions that negatively affect the quality of life of women today: urinary tract infection, menstrual cycle disorders, hypertension, diabetes, osteoporosis, arthritis, eating disorders, substance abuse, and mental depression. Although women's life expectancy is 7.5 years greater than that of men, the morbidity rates are significantly higher for women. As women continue to enter the labor force in large numbers, questions are being raised regarding the physical and psychological hazards of jobs traditionally considered to be women's work, the risks associated with jobs that are physically demanding or involve exposure to toxic substances, and the association between pregnancy outcome and employment. Further research is needed on the effects of multiple role stress on women's health. Another recent trend has been the feminization of poverty: 2/3 of all US adults classified as poor are women. The lack of financial resources has a detrimental effect on nutrition, access to health care, and other preventive behaviors. Yet another social change related to women's health is the increasing number of elderly in the population. Women comprise 72% of the elderly poor, and over 80% of all retiring female workers do not have pension benefits. Access to, availability of, and payment for health care are problems for elderly women. It is important that research address the physiologic, psychosocial, and economic factors that together affect women's health status.
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PMID:Changing factors and changing needs in women's health care. 351 29

During antibiotic treatment for E. coli urinary tract infection and meningitis, a male new born developed a Candida albicans urinary tract infection with a mycotic kidney abscess and pelvicalyceal fungus balls diagnosed by US investigations and confirmed by radiology. Three weeks later a perirenal urinoma with arterial hypertension developed. After surgical treatment of the urinoma the arterial pressure returned to normal.
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PMID:Urinoma and arterial hypertension complicating neonatal renal candidiasis. 355 Jun 69

In the present study, the frequency and the mechanism of hypertension associated with unilateral hydronephrosis (UHY) were investigated in 115 patients. Hypertension (blood pressure greater than 140/90 mm Hg) was found in 20% of 101 consecutive patients with UHY. Twenty-six patients with UHY and hypertension were followed for 35 months and the effect of surgery on blood pressure was analyzed. Blood pressure fell from 178 +/- 4/108 +/- 4 to 135 +/- 2/84 +/- 2 mm Hg after surgery. Hypertension was cured in 62%, improved in 19% and unchanged in 19%. In 73% of the cured patients the PRA-ratio was greater than or equal to 1.5, while all unchanged patients had a value of less than 1.5. Hypertensive patients were significantly older than normotensive patients, but did not differ in kidney function, underlying cause of hydronephrosis, incidence of urinary tract infection or frequency of interstitial nephritis. We conclude that in UHY the incidence of hypertension is not particularly high. However, in a substantial number of patients, high blood pressure is reversible by surgery. In most of these patients the renin-angiotensin-aldosterone system seems to play an important role in sustaining high blood pressure, although in some patients other mechanisms might be operative as well. Since the overall incidence of hypertension is not particularly high in UHY, this secondary form of hypertension appears to be rare.
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PMID:Unilateral hydronephrosis and hypertension: cause or coincidence? 355 76

Fetal outcome was retrospectively studied in 217 pregnancies observed during the past two decades in 93 patients, 34 suffering from IgA nephropathy (IgAGN, 69 pregnancies), 53 from reflux nephropathy (RN, 137 pregnancies), and six from focal glomerular sclerosis (FGS, 10 pregnancies). Overall incidence of live births was 175 in 217 (81%). Fetal loss, corrected for induced abortions, was 10 in 66 (15%) in IgAGN, 18 in 129 (14%) in RN, and 2 in 10 in FGS. Renal failure and hypertension preexisting prior to conception or developing early in pregnancy were the most important factors associated with unsuccessful fetal outcome whereas urinary tract infection had limited effects in RN patients. Influence of pregnancy on the course of maternal renal disease was evaluated in the same groups of patients. An abnormally rapid deterioration of renal function was observed in three of the women with IgAGN and in one of the RN patients (with an additional case among 46 further female RN patients) but in none in the FGS group. All five women experiencing functional deterioration had a serum creatinine (SCr) level of greater than or equal to 200 mumol/L (2.3 mg/dL) and hypertension at conception. Hypertension in pregnancy was highly predictive of recurrence of hypertension in subsequent pregnancy and of the remote development of permanent hypertension in IgAGN patients. We conclude that when renal function is preserved, pregnancy is usually successful and no deleterious effects on maternal renal disease are to be expected in patients with IgAN, RN, and probably FGS.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pregnancy in IgA nephropathy, reflux nephropathy, and focal glomerular sclerosis. 355 6

We examined 42 patients 19 to 20 months after ureteral calculi had been removed with the ureterorenoscope. All 42 patients were asymptomatic and showed no evidence of an increased rate of urinary tract infection or hypertension. An excretory urogram in 38 patients demonstrated no abnormality related to the procedure, in particular no ureteral stenosis and renal scarring. Renal sonography in the remaining 4 patients likewise was normal. Reflux cystography revealed low grade (sterile) vesicoureteral reflux in 2 patients. In view of a 92 per cent success rate in 236 renoureteral units, with serious complications in only 2 per cent, the technique can be considered safe and effective.
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PMID:Late sequelae of the management of ureteral calculi with the ureterorenoscope. 373 1

The long-term results after antireflux operation in 47 adults are presented. Reflux was eliminated in all but 3 cases. Preoperatively most patients complained of urinary tract infection with or without fever, but sometimes investigation for hypertension or urolithiasis also led to the diagnosis. Postoperatively 70% of the patients are free of symptoms and infection. Renal scarring in pyelonephritic patients seems to stop after intervention. In all patients with a normal preoperative creatinine level, this level stays normal after the intervention. However, in 6 of 7 patients with a creatinine level of greater than 1.5 mg% before operation, the intervention could not stop the evolution toward terminal renal failure.
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PMID:Antireflux in adults: a long-term follow-up. 381 93

Traditionally 3 mechanisms are responsible for the development of renal damage when primary vesico-renal reflux is present: reflux is a manifestation of abnormal embryological development of the ureteral bud, with subsequent dysplasia; sterile reflux damages the kidney, perhaps trough a mechanical or/and an immunological mechanism; renal damage occurs as a result of the reflux of infected urine into susceptible renal papilla (intrarenal reflux). Whatever the mechanism, it is apparent that reflux and renal damage are intimately related. It does appear that for the most part damage is done at an early age. Operative repair of vesico-renal reflux has been advocated as a reliable method to stop reflux, with attendant cessation of renal damage and improvement in renal function. However some recent prospective study found that the rate of continued renal scarring is independent of medical or surgical therapy. The aim of the present paper is to study the functional and radiological long-term results after successful antireflux surgery (mean follow-up 6 years 4/12). 90 patients for a total of 140 refluxing ureters were studied for assessment of urinary infection, blood pressure and renal function. 40 patients for a total of 62 refluxing ureters were evaluated for determination of renal parameters evolution. At follow-up from 3 to 14 years (mean 6 4/12 years), less than 10% of the patients showed pathological bacteriuria generally without episodes of acute pyelonephritis. Hypertension was present in 4 (4.4%) out of 90 patients, aged from 14 to 18 years. There was a significant improvement in renal function after operation, especially in infants operated on in the first two years of life. The postoperative radiological study showed a growing of affected kidneys in about 89%. In almost 47%, the affected kidneys showed an increased growth. Only about the 5% of the kidneys showed a decreased development with a final evolution toward a small pyelonephritic kidney. The best results were obtained in patients operated on very early in the life. Our greatest challenge is to prevent the early destruction of nephrons. This means an early diagnosis of urinary tract infection and detection of vesico-renal reflux with an early treatment. The administration of prophylactic antibiotics and, when indicated, an early surgical treatment can minimize, in our opinion, the magnitude of renal damage for the most part of patients.
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PMID:[Long=term evaluation of renal damage in primary vesico-renal reflux after corrective surgery]. 383 30


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