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

Sodium nitroprusside (SNP) is rarely used in cardiology. It is reserved traditionally for severe episodes of arterial hypertension. Certain states of refractory heart failure represent new indications for use, which implies a double haemodynamic monitoring system: continuous control of systemic blood pressure by intra-arterial catheterization; control of pulmonary pressure and repeated measurements of cardiac output. Prolonged treatment requires continuous biological monitoring of toxicity and careful control of kidney function. As a moderator of blood pressure, SNP is remarkably effective. The hypotensive effect is immediate, readily reversible and generally tachyphylaxis is not observed. The effect of SNP on cardiac work is one of double load reduction: mainly a reduction in afterload or pressure and systemic resistance and a reduction in preload or pressure of ventricular filling. In this respect, SNP can be used effectively for severe cases of heart failure intractable to traditional cardio-stimulatory and diuretic treatments and stemming from diverse causes: acute stage of myocardial infarction, ventricular dilatation, mitral papillary syndrome, heart failure, either subacute or chronic, of various causes. As a rule, the immediate results are positive. Taking the patient off the drug can be difficult and may cause a return to the previous haemodynamic situation.
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PMID:[Use of sodium nitroprusside in cardiology]. 1 64

Definitive, if not curative surgery is available for the eight most common congenital cardiac defects-ductus arteriosus, ASD, coarctation, pulmonary valve stenosis, aortic valve stenosis, tetralogy of Fallot, and transposition. The results of surgery for uncomplicated cases of DA, ASD, VSD, and coarctation usually can be determined by clinical means (including chest radiogram and ECG). Postoperative heart catheterization is recommended for evaluation of the patient who has had surgery for pulmonary valve stenosis or artic stenosis and is necessary after tetralogy of Falot or transposition of the great arteries repair to identify the important postoperrative residua and sequelae. The term "curative" surgery probably shoud be reserved for operation for divion of ductus arteriosus unassociated with pulmonary hypertension and performed in childhood. After closure of ASD, patients should continue to be observed for late development of arrhythmias and persistent cardiac enlargement, although the incidence of these problems is low. After VSD closure the patient is still followed at intervals for possible ill effects of the ventriculotomy scar, manifest as arrhythmias, ventricular aneurysm or myocardial insufficiency. The patient with coarctation repair must be observed for a possible late complication from one of the several clinically silent cardiovascular or cerebrovascular anomalies as well as for the change of restenosis or unrelieved hypertension...
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PMID:Residuae, sequelae, and complications of surgery for congenital heart disease. 12 37

Hypertension in children is a rare disorder with reliable estimates of annual incidence that do not exceed 0.1%. At least one third of these cases have no definable etiology when all of the presently available diagnostic studies are used. Major invasive or expensive evaluations are indicated when hypertension is sustained or severe, and should be directed toward the renal and renovascular areas. Serum potassium and calcium estimates are essential in every case, but the more extensive evaluations of thyroid, parathyroid, adrenal cortical and adrenal medullary hormones should be reserved for patients with specific indications of malfunction in those systems.
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PMID:Hypertension in children: endocrine aspects. 44 May 7

From 1955 to 1977, 27 pediatric patients underwent surgical treatment for renovascular hypertension. Renal artery disease was most commonly caused by intimal or perimedial fibroplasia and occurred bilaterally in 7 patients. Overall results were 16 patients cured (59%), 5 patients improved (19%) and 6 failures (22%). The best results were obtained in children with unilateral renal artery stenosis. In recent years, ablative surgery has been largely supplanted by reconstructive vascular procedures in the treatment of this disease in children. Autogenous vascular bypass grafts have been most successful and aortorenal reimplantation may occasionally be employed. Renal autotransplantation should be reserved for children with the middle aortic syndrome or multiple lesions involving the branches of the renal artery. Splenorenal bypass and segmental resection with renastomosis have yielded poor results and are best avoided in this age group. Primary nephrectomy should only be performed in patients with renal atrophy or uncorrectable branch vessel disease. Renovascular hypertension in children is a potentially curable disease and revascularization with preservation of renal function should be the combined objectives of surgical therapy in the most cases.
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PMID:Stenosing renal artery disease in children: clinicopathologic correlation and results of surgical treatment. 74 36

The relative benefits and risks of reserpine and guanethidine were compared in patients with thiazide-treated mild to moderate hypertension (diastolic pressure 95-115 mm Hg). Forty-nine ambulant patients )30 men, 19 women) were treated throughout the study with hydrochlorothiazide, 50 mg/day. In this double blind crossover study each drug was added in graded increments until a predetermined therapeutic response was obtained, blood pressure measurements and side effect scores were evaluated biweekly. Major conclusions of the study were: 1) guanethidine, as well as reserpine, will reduce mild to moderate blood pressures to normal; 2) in most cases, side effects which did occur while taking guanethidine or reserpine were well tolerated and neither drug was clearly superior. Side effects associated with larger doses of guanethidine employed in severe hypertension were absent or only slightly bothersome. Thus, guanethidine apppears to have a good benefit-to-risk ratio in the therapy of mild to moderate hypertension and offers a number of advantages over drugs commonly used in this syndrome. This study refutes the common belief that guanethidine must be reserved only for the treatment of more severe degrees of hypertension.
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PMID:Patient acceptance of guanethidine as therapy for mild to moderate hypertension. A comparison with reserpine. 77 41

Various factors are involved in the pathogenesis of anemia in dialysis patients. Reduced erythropoiesis is mainly attributed to erythropoietin deficiency. Stimulation of erythropoiesis may be promoted by androgens. Substitution of iron is recommended in case of iron deficiency. As a rule, supplementation of vitamin B12 is not necessary, but administration of folic acid is recommended. Treatment of anemia in renal failure is rendered more effective by increased technical efficiency in hemodialysis permitting a relatively protein-rich diet. Blood transfusions are not necessary during routine treatment of dialysis. Since bilateral nephrectomy will always provoke severe anemia, it should be reserved to special cases of severe hypertension. Until now, no conservative therapy has been developed which would allow optimal treatment of anemia in dialysis patients. Successful renal transplantation still is, and will be, the best therapeutic intervention.
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PMID:[Anemia in terminal kidney failure. Pathogenesis and therapy]. 83 56

Cooperation between the family physician and the kidney-center begins with the recognition of a renal disease and pre-dialysis treatment. Our patients usually are sent for the preparation of an arterio-venous shunt operation (Cimino or modifications) when serum creatinin levels amount to 8 to 10 mg/100 ml. Peripheral veins on both forearms should be reserved for these procedures early in the course of renal disease and vascular punctures should be avoided. Dialysis treatment is performed either at the kidney-center, at one of our partner-centers, at the central self-care facility operating under the care and supervision of the kidney-center or as home-dialysis-treatment. Each patients continues to receive technical and medical services of the center. Central self-care dialysis as well as home-dialysis are organized by the Kuratorium for Heimdialyse e.V. in this area. This organization also provides an on-cell-service of technicians. Nurses and physicians take regular rotations to staff the dialysis- and the self-care-units. The family physician takes care of the hemodialysis patinet in cooperation with the hospital. In case of medical problems the patient is transferred to the kidney-center. The patient must be well instructued on problems and complications which might occur during hemodialysis, either due to the basic disease or in connexion with hemodialysis. In some cases of complications patients must be admitted to the center without delay. Emergency situations usually can be avoided as technical standard of dialysis equipment and standard of training of patients or their parners is high. Medications, such as phosphate binders (aluminium hydroxide), iron vitamins and allopurinol are provided if necessary. Patients are advised to limit intake of fluids and potassium containing foods. The sodium intake depends on blood pressure-values. In case of hypertension there will be salt restriction, in case of hypotension the salt intake is increased. Chronic intermittent hemodialysis treatment can result in successful rehabilitation. Further improvement concerning personal and medical problems can only be expected from kidney transplantation.
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PMID:[Care of the hemodialysis patients by the family physician]. 84 54

Obese people, more than 45 kg above their ideal weight, can be treated by an intestinal by-pass. This operation must be reserved for patients where conservative treatment failed, where there is no organic origin, and given the operative risk be not increased by underlying serious disease. Good pre- and postoperative collaboration of the patient together with clinical and biological controls are essential. The operation consists of an end-to-side jejuno-ileostomy with proximal suture of the blind loops; or an end-to-end jejuno-ileostomy with implantation of the blind loops in the colon. Loss of weight to near ideal plus improvement of diabetes, hypertension, gout and hyperlipaemia can be expected. Diarhea will occur for a few months or one year. Biochemical values usually remain stable: values for lipids decrease to lower normal if elevated before the operation. During fast weight loss, there are changes in the liver structure and hepatic tests; these are transient and reversible.
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PMID:[Intestinal by-pass for obesity (author's transl)]. 98 31

Treatment of idiopathic hypertrophic subaortic stenosis (IHSS) remains a controversial problem and depending upon many factors, medical or surgical treatment may be elected. When medical therapy fails and surgery is recommended, choice of an appropriate surgical technique may be difficult. An analysis is given of 27 patients who have undergone only mitral valve replacement as definitive treatment. Twenty-six patients were dismissed from the hospital with good or excellent results and one died (3.7 percent mortality). Pressure gradients across the left ventricular outflow tract after operation were eliminated in every instance. The mean preoperative gradient was 74 mm Hg and postoperatively was 6.9 mm Hg. Advantages and disadvantages of mitral valve replacement as definitive treatment of IHSS are presented. This method of treatment should be reserved for patients with incapacitating symptoms, congestive heart failure, severe left ventricular hypertension, unusual electrocardiographic findings or in patients who have failed to respond favorably to previous septectomy.
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PMID:Mitral valve replacement for idiopathic hypertrophic subaortic stenosis. Results in 27 patients. 98 41

This has been a review on the subject of papilledema from a clinical, pathologic and experimental point of view. Terminology has been clarified. The term papilledema should be reserved for those patients with optic disc edema caused by increased intracranial pressure. The forms of papilledema which are identifiable are: 1. Early (incipient) form which develops into an acute type and then into a fully developed form; 2. Fully developed form, characterized by obscured disc margins, hemorrhages and ischemic infarcts; 3. Chronic papilledema which may persist (the name "vintage" papilledema may be applied to those patients affected in varying degrees up to several years); and 4. Chronic atrophic papilledema which, as the name implies, illustrates a form we do not see as frequently as in years past. It is the type we are now trying to prevent and in this effort we are fortunately achieveing some success. The importance of the intracranial expanding lesions and the influence of the rapidity of elevation and duration of intracranial hypertension on the optic nerve has been considered, based on the clinical and experimental work to date. The pathogenesis of papilledema has been considered in some detail. A unified whole is difficult to arrive at in such a complex situation. Recent advances in our understanding of anatomic, mechanical (sheath space pressure), tissue and vascular pressure as related to increased intracranial pressure have been described. A hydrostatic mechanism brings these factors together in a reasonable, although admittedly not completely proven concept of a mechanism for the development of papilledema. Clarification of terminology and clinical appearance of the various forms of disc edema related to intracranial pressure are of practical value in the diagnosis and management of each patient we see with this clinical entity.
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PMID:Papilledema: its recognition and relation to increased intracranial pressure. 108 22


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