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

It has been considered unlikely that patients with insulin-dependent diabetes and diabetic nephropathy with nephrotic range proteinuria can substantially reduce proteinuria and continue for many years without further loss of renal function. We present a patient who had the diagnosis of insulin-dependent diabetes made at age 15, had his first of 6 laser treatments for proliferative and hemorrhagic retinopathy at age 27 and was found to have nephrotic range proteinuria and edema with hypertension at age 29, when results of a renal biopsy were typical of diabetic nephropathy. Ten years later, with the last 5.5 years on ACE inhibitors, proteinuria has been < 0.65 g/24 h for 2 years and recently 0.22 g, serum creatinine is unchanged at 90 to 102 mu mol/l, DTPA GFR is 104 ml/min and retinopathy has remained stable without laser therapy for 7 years. Blood pressure on clinic visits has averaged 126/74 for the last 8 years. This duration of stable renal function and the major decrease in proteinuria after being in the neprotic range is very rare in reports, if not unique.
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PMID:Stable renal function in insulin-dependent diabetes mellitus 10 years after nephrotic range proteinuria. 890 67

A case of acromegaly associated with variegated spinal disorders was reported. The spinal disorders were multiple cervical disc herniations, spinal epidural cavernous angioma, multiple ossification of the spinal ligament and lumbar canal stenosis. A 51-year-old woman with acromegaly, complaining of disturbances of delicate hand movement and gate, consulted our department. Her past history included diabetes mellitus, hypertension and progressing enlargement of her extremities. Serum growth hormone level was 65.7 ng/ml and somatomedin-c level was 746 ng/ml. Brain MRI showed a pituitary tumor extending to the right cavernous sinus. Cervical MRI revealed disc herniations at C5/6 and C6/7. Thoracic MRI revealed osteoporosis, ossification of the posterior longitudinal ligament and multiple ossification of yellow ligament. Lumbar MRI disclosed ossification of yellow ligament and canal stenosis. Anterior fusion of C5-C7 and an intracapsular removal of the pituitary tumor were performed. Its pathology was that of eosinophilic adenoma. After 3 months, she suffered from paraparesis. On repeating MRI examination with Gd-DTPA, a spinal epidural mass was found at T4. Under laminectomy of Th3-5 and Th8-11, the epidural mass and ossified yellow ligament were removed. The epidural mass was cavernous angioma. She was able to walk without any assistance. An association of spinal canal stenosis with acromegaly is well known. But the association of disc herniation and with the ossification of spinal ligaments is rather rare in the literature. Spinal epidural cavernous angioma is very rare. We discussed the etiological aspects and the management of spinal disorders with acromegaly.
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PMID:[A case of acromegaly associated with variegated spinal disorders]. 891 52

A 28-year-old male presented with a low grade fever, decreased activity, left hemiparesis and signs of intracranial hypertension. CT showed a moderate hydrocephalus and a large irregular mass in the right temporoparietal region with garland-like enhancement after injection of the contract medium. These findings suggested a malignant brain tumor. MR images demonstrated a mass with low-iso signal intensity on T1 weighted image and low-iso-high mixed intensity on T2, which is like a mosaic pattern. Multiple cerebrospinal fluid space seedings including the wall of the lateral ventricle, the surface of the cerebellum and pons, and the cervical spinal cord were clearly delineated on MR images after Gd-DTPA injection. The large mass was totally removed by craniotomy after ventricle drainage for hydrocephalus. Microscopic examinations showed dense fibrous connective tissue with infiltration of Langhans' giant cells, lymphocytes and fibroblasts around the necrotic centers. These hard components may have been responsible for the low signal intensity on T2-MR images. Many Candida elements were clearly shown with the periodic acid Schiff stain. The diagnosis was that the lesion was an intraparenchymal granuloma due to Candida infection. The patient died on the 8th postoperative day because of brain stem malfunction. Intracranial fungal infection rarely produces a granuloma in the central nervous system. Though it is difficult to diagnose a large irregular mass in the brain, MR images, especially T2 weighted images are useful for the diagnosis of fungal granuloma.
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PMID:[Intracranial fungal granuloma with CSF space dissemination: a case report]. 893 95

The blood-ocular barrier (BOB) shares similar neuroepithelial origin, microanatomy and functions with the blood-brain barrier. There are many natural (e. g. diabetes, hypertension) or iatrogenic (chemotherapy, retinal photocoagulation) conditions which can cause a BOB breakdown, resulting in visual acuity impairment or loss. The authors examined 42 patients affected by BOB damage in different pathological conditions. All patients previously underwent a conventional fluoroangiographic (FA) study. Nine patients with normal FA exam were evaluated also. Despite normal MRI findings immediately after Gd-DTPA injection, contrast leakage into the vitreous body or into the aqueous fluid was demonstrated in delayed scans (40-50 min after contrast administration), proving the existence of a BOB damage (sensitively 94 %). Although FA exam remains the choice modality in BOB breakdown demonstration, we propose MRI as a useful diagnostic tool when optic media opacity (cataract, haemovitreous, intraocular silicon oil) occurs, preventing direct retinal fundus imaging and/or an early screening tool.
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PMID:Blood-ocular barrier damage: use of contrast-enhanced MRI. 900 Apr 10

Midaortic syndrome (MAS) is a well-recognized but rare cause of renovascular hypertension (RVH). Several techniques have been described to treat RVH caused by MAS. The authors recently treated two children with MAS and RVH. In both patients the right kidney had two renal arteries. A 13-year-old boy presented with severe headaches, pain in his lower extremities with exertion, and marked hypertension (blood pressure, 170/110). An aortogram demonstrated 70% narrowing of his abdominal aorta from the suprarenal region to 5 cm above the iliac bifurcation. There was significant stenosis of the celiac axis, superior mesenteric artery, and left renal artery. The right kidney had two renal arteries, and the upper pole artery was stenotic at its origin. A 10-year-old girl, known to have hypertension for several years had an aortogram that demonstrated 70% narrowing of the abdominal aorta from the suprarenal region to 3 cm above the iliac bifurcation. There was involvement of the left renal artery at its orifice. She also had two renal arteries to the right kidney with the right upper pole artery being stenotic at its origin and in the mid-portion of the vessel. Aortic reconstruction was accomplished with a polytetrafluoroehtylene (PTFE) bypass graft in each case. The first case also involved patch angioplasty of the celiac axis. In both cases, the right kidney was autotransplanted. It was removed intraoperatively, cold perfused, and the two renal arteries reconstructed followed by transplantation to the right iliac vessels. In both cases the left renal artery was reimplanted into the PTFE graft. Both patients had uncomplicated postoperative courses. The 13-year-old boy had evidence of renal ischemia in a portion of the lower pole of the autotransplanted kidney by DTPA scan. He has mild hypertension controlled with antihypertensive medication. The 10-year-old girl has a normal DTPA scan and is normotensive. MAS is a rare and challenging congenital vascular anomaly that causes RVH. In the presence of double renal arteries the technique of autotransplantation with cold perfusion and "bench" vascular reconstruction reduces the warm ischemia time and should produce satisfactory results.
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PMID:Renal autotransplantation for renovascular hypertension caused by midaortic syndrome. 904 31

Renal scintigrams with 99Tc-DTPA were analysed retrospectively in 19 patients with essential hypertension. Glomerular filtration rate (GFR) was measured by Gates technique. Ratio GFR to plasma volume (PV) was quantified by A. M. Peters' technique (1994). PV was calculated as the relation of these two indices. Total GFR in hypertensive patients widely ranged (from 76.8 ml/min to 165.7 ml/min). Three groups were selected taking into account hypertension duration: patients with decreased, normal and increased values of basal GFR. The severity of hypertension did not affect the GFR, but showed positive and strong correlation with PV (r = 0.91; p < 0.05). GFR/PV was decreased in hypertensive patients. Factors affecting the GFR in hypertensive subjects are discussed.
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PMID:[The use of a new method for determining the ratio of the glomerular filtration rate to circulating plasma volume in patients with arterial hypertension]. 904 82

1. Hypertension and renal failure are the two most common and severe complications due to cyclosporine A (CsA) therapy after transplantation. To determine whether an in vivo treatment with pentoxifylline (PTX) can prevent the toxic effects of CsA, three groups of rats were studied. 2. The first group of rats (n = 11) received daily injections of CsA (15 mg/kg, i.m.) and PTX (45 mg/kg, i.p., b.i.d.), the second group of rats (n = 11) was treated with CsA only and the third group of rats (n = 11) served as the control group (vehicle treatment). 3. Whole blood CsA levels were similar in CsA + PTX and CsA alone groups. Although CsA treatment significantly increased mean arterial blood pressure (110.00 +/- 2.48 mmHg; P < 0.01), there was no significant increase in the PTX co-treated group (104.09 +/- 2.96 mmHg) compared with initial values. In both the CsA alone and CsA + PTX groups the heart rate (365.45 +/- 6.65 and 357.27 +/- 7.23 b.p.m., respectively; P < 0.05) were found to be significantly higher than initial values. Serum creatinine levels increased significantly in the CsA alone group (1.40 +/- 0.11 mg/dL; P < 0.01) compared with control values (0.81 +/- 0.04 mg/dL). This increase was prevented by co-treatment with PTX (serum creatinine 1.11 +/- 0.01 mg/dL; P < 0.05). Total [99mTc]-DTPA percentage renal uptake, as an index of glomerular filtration rate (GFR), was markedly and significantly lower in the CsA alone group (10.01 +/- 0.79%; P < 0.01) than in the control group (18.19 +/- 1.32%). Pentoxifylline co-treatment attenuated this decrease compared with GFR in the CsA alone group (13.00 +/- 0.75%; P < 0.01). 4. These results suggest that the co-administration of PTX with CsA may prevent the dose-limiting toxic effects of CsA therapy.
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PMID:Beneficial effects of pentoxifylline on cyclosporine-induced nephrotoxicity. 914 89

Renovascular disease is an important cause of hypertension in children because it is potentially treatable by surgical or angioplasty techniques. The aim of this study was to assess the accuracy of radio-isotopes (DMSA, DTPA and MAG3) combined with the angiotensin converting enzyme inhibitor, captopril, in detecting children with renovascular hypertension. We retrospectively reviewed the ultrasound and pre- and post-captopril radionuclide studies (either DMSA and/or DPTA and/or MAG3) of children with sustained hypertension investigated at our institution. Renal angiography was used as the 'reference technique'. Thirty-nine children, over a period of 10 years, were evaluated: 17 (44%) children had renovascular disease that involved the proximal three divisions of the renal arteries, some of which were amenable to treatment. The overall sensitivity, specificity, positive predictive value and negative predictive value for detecting such renovascular disease, as assessed by changes between pre- and post-captopril radio-isotope studies, were disappointing at 59%, 68%, 59% and 68%, respectively. When considering only abnormalities in post-captopril studies, these indices were 82%, 41%, 52% and 75%, respectively. Three children with potentially treatable renovascular disease were not identified on the captopril studies. We conclude that renal angiography should remain the 'reference technique' in identifying children suspected of renovascular hypertension.
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PMID:The investigation of renovascular hypertension in children: the accuracy of radio-isotopes in detecting renovascular disease. 942 1

The aim of the study was to evaluate the effect of angiotensin converting enzyme inhibition on renoscintigraphic curves using DTPA as a tracer in patients with essential (EH) and renovascular (RVH) hypertension. Twenty four patients with EH and sixteen with RVH were studied. Protocol consisted of control renoscintigraphy with DTPA and the second one after captopril administration in dose 25 mg performed after three days. Relative DTPA uptake of the single kidney was calculated from the curve time-activity between 120 and 180 second after tracer administration. Results were expressed as a quotient of the relative DTPA uptake of ischemic or "weaker" kidney to the DTPA uptake of both kidneys (coefficient A) or contralateral one (coefficient B). Coefficient A in basic renoscintigraphy did not differ in patients with EH and RVH and was 45.81 +/- 3.02% and 44.66 +/- 6.17% respectively. In renoscintigraphy with captopril coefficient A decreased significantly (P < 0.001) in patients with RVH and was significantly lower (p < 0.05) than in patients with EH. Change (delta) of coefficient B after captopril was significantly higher in patients with RVH (p < 0.001). Significant correlations were found between delta coefficient A and delta diastolic (DAP) and mean (MAP) arterial pressure as well as delta plasma renin activity (PRA) after captopril in patients with RVH. Similarly, relationships were shown between percentage change (% delta) of coefficient B and % delta of systolic (SAP), DAP and MAP as well as delta PRA after captopril in patients with RVH.
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PMID:[Usefulness of angiotensin converting enzyme inhibitors in the diagnosis of renovascular hypertension. II. Comparison of the effect of angiotensin converting enzyme inhibition on reno-scintigraphic curves with DTPA in patients with essential and renovascular hypertension]. 948 Apr 62

We measured blood ammonia in pre-angioplasty samples from the renal veins, aorta and inferior vena cava of 15 patients with hypertension due to unilateral renal artery stenosis confirmed by arteriography. Patients with renal insufficiency or small kidneys were excluded. Mean ammonia values were microgram/dl: vein of affected kidney, 106.00 +/- 12.75; vein of unaffected kidney, 75.65 +/- 23.10; aorta 61.04 +/- 15.00; vena cava, 62.44 +/- 19.65. The value for the affected kidney was significantly higher than the other three values (p < 0.001). Mean +/- SD DTPA uptake (%) was 42.8 +/- 2.21 in the affected kidney and 56.53 +/- 3.64 in the unaffected kidney. This difference did not correlate significantly with that of the ammonia concentrations tau = -0.292).
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PMID:Ammonia concentration in the renal veins in unilateral renal artery stenosis with hypertension. 970 71


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