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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The cranial computerized axial tomography (CAT) findings in groups of patients with epilepsy, migraine, hypertension, and other general medical disorders have been reviewed to assess the frequency and patterns of focal and diffuse brain damage. In addition to demonstrating focal lesions in a proportion of patients with seizures and in patients presenting with a stroke, the CAT scan showed a premature degree of cerebral atrophy in an appreciable proportion of patients with long-standing epilepsy, hypertension and diabetes, and in some patients with migraine, valvular and ischaemic, heart disease, chronic obstructive airways disease, and chronic renal failure. The value of CAT as a means of screening for brain damage in groups of individuals at risk is discussed.
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PMID:Computerized axial tomography in the detection of brain damage. 2. Epilepsy, migraine, and general medical disorders. 746 20

The mechanism of hypertension induced by recombinant human erythropoietin (rHuEPO) is unclear but may include an increase in peripheral vascular resistance. We studied changes of arterial pressure and plasma endothelin in nine consecutive hemodialysis patients before, and 6 and 12 weeks after, starting rHuEPO. In six patients, changes in cardiac index (CI), stroke index (SI) and total peripheral resistance index (TPRI) were measured by bioimpedance, and forearm vascular responsiveness to intra-arterial norepinephrine (30 to 240 pmol/min) and endothelin-1 (5 pmol/min) were assessed. Six healthy age and sex matched subjects also underwent assessment of forearm vascular responsiveness to norepinephrine and endothelin-1. Treatment with rHuEPO significantly increased hemoglobin and mean arterial pressure (MAP). TPRI also increased by 35 +/- 11%. Plasma endothelin, although elevated basally, remained unchanged. Intra-arterial infusion of norepinephrine caused a maximal increase in forearm vascular resistance (FVR) of 17 +/- 9% before rHuEPO, significantly less than the 32 +/- 5% increase in healthy control subjects (P = 0.04). The response increased to 65 +/- 15% (P = 0.03) after 12 weeks rHuEPO treatment (P = 0.51 vs. controls). Endothelin-1 caused a maximal increase of FVR at 60 minutes of 45 +/- 24% before rHuEPO, which was not significantly different from controls, and tended to decrease with rHuEPO therapy. The response to endothelin-1, but not norepinephrine, correlated inversely with MAP (r = -0.52; P = 0.03) and TPRI (r = -0.51; P = 0.04). In conclusion, these studies show that anemia in chronic renal failure is associated with depressed vascular responsiveness to norepinephrine which is restored by rHuEPO therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Erythropoietin enhances vascular responsiveness to norepinephrine in renal failure. 747 68

The authors have performed 631 urgent suprapubic transvesical adenomectomies in patients with prostate adenoma complicated by acute urine retention or hemorrhage. Prearranged and urgent interventions had, by the authors' experience, virtually the same rate of postoperative complications and lethal outcomes. The risk in urgent adenomectomy performed in 294 patients was attributed to their concurrent affections: postinfarction cardiosclerosis, myocardial ischemia or hypertensive crisis, hemiparesis after brain apoplexy, bronchial asthma, diabetes mellitus, hepatic cirrhosis, chronic lymphoid leukemia, drug polyallergy, multiple tumors of the urinary bladder, stomach, etc., in stage T1-3NOMO. 80 patients had intermittent chronic renal failure. In compensation of severe concurrent diseases and satisfactory condition of the patients urgent adenomectomy was conducted within 24 hours since hospitalization. Longer interval (within 24-72 hours) was necessary in subcompensation of the concurrent diseases, intermittent chronic renal failure which were intensively treated. The authors achieved uneventful postoperative course for 272 (92.5%) high-risk patients. Postoperative lethality made up 3.06%. According to 1-11-year follow-up 7 patients died, for the most part of blood and respiratory diseases. Functional long-term outcomes were good in 83.5% of the patients. Basing on their experience, the authors specify indications to urgent adenomectomy and optimal time of its conduction. Contraindications to urgent adenomectomy were revised and narrowed.
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PMID:[The indications and contraindications for emergency adenomectomy in patients with severe concomitant diseases]. 753 45

To determine the causes of death in autosomal dominant polycystic kidney disease (ADPKD) patients and to examine whether the extrarenal manifestations of ADPKD influence the causes of death, the medical records of 129 patients who died between 1956 and 1993 were reviewed; 58% of the 129 patients had an autopsy performed. Seventy-seven percent died after reaching ESRD. The mean age at death increased from 51 yr for those who died before 1975 to 59 yr for those who died after 1975, reflecting the introduction of renal replacement therapies. The most common cause of death before 1975 was infection (30%), followed by uremia (28%) and cardiac disease (21%); after 1975, these were cardiac disease (36%) and infection (24%). Infection was equally prevalent before and after 1975, presenting as sepsis in 94% and directly relating to ADPKD in 47% of these patients. Underlying factors for cardiac death were cardiac hypertrophy, seen in 89% of all autopsied patients, and coronary artery disease, seen in 81%. A neurologic event was the cause of death in 12% of patients; these were ruptured intracranial aneurysm in 6%, hypertensive intracranial hemorrhage in 5%, and ischemic stroke in 1%. The mean age of those who died of ruptured intracranial aneurysm was 37 yr. No patient died of renal cancer. Liver cysts were the most common extrarenal manifestation, seen in 70% of the autopsied cases; cysts in other organs were very rare. Colonic diverticula were found in 21%. Thus, the renal and extrarenal manifestations of ADPKD are important contributors to morbidity and mortality.
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PMID:Causes of death in autosomal dominant polycystic kidney disease. 757 53

Delapril is a carboxy-alkyl-dipeptide mainly converted in animals and humans to an active diacid derivative (M-I), which in turn is converted to an active 5-hydroxy-indane diacid (M-III). In humans these metabolites are excreted in the urine. The presence of the indanyl-glycine moiety gives delapril a high lipophilicity, greater than several other angiotensin-converting enzyme (ACE) inhibitors, such as captopril and enalapril. Due to its greater lipophilicity, delapril has been shown to exert a more effective inhibition of vascular ACE than captopril and enalapril, both in vitro and in vivo. The activity of delapril on tissue ACE also lasts longer than on the circulating enzyme. At doses ranging from 1-10 mg/kg orally, delapril exerts a marked and long-lasting antihypertensive action in various experimental models of hypertension. The blood pressure reduction has been shown to be accompanied by suppression of angiotensin II release from the vascular wall. In stroke-prone spontaneously hypertensive rats (SHR-SP) and in SHR with chronic renal failure, besides reducing hypertension, delapril significantly improves survival rate and prevents the development of stroke, cardiac hypertrophy, and renal sclerosis. The ability of delapril to reduce hypertrophy in vascular and cardiac tissue has been demonstrated in both in vitro and in vivo experiments.
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PMID:Pharmacokinetic and pharmacologic properties of delapril, a lipophilic nonsulfhydryl angiotensin-converting enzyme inhibitor. 777 36

Renovascular hypertension is one of the most common causes of secondary hypertension. Its early diagnosis is particularly important, firstly because it is one of the few potentially reversible causes of chronic renal failure. In many centers, including our own, renal angioplasty (PTA) or surgery is the treatment of choice for patients with renovascular hypertension. The aim of the study was the evaluation of the early and late results of PTA versus renovascular surgery. The diagnostic procedures and clinical course of renovascular hypertension were also analyzed. Among patients with renovascular hypertension treated in our Department during the 1981-1993 years, 89 patients (46 men, 43 women) were diagnosed and having renovascular hypertension (3% of all hypertensive patients). The average duration of hypertension in this group was 5 years. High incidence of accelerated hypertension (18%) and cardiovascular complications were observed: myocardial infarction in 20.2% of cases and stroke in 4.5%. The presence of renal failure was found in 22.5% of cases, hypokalemia in 11.2%, 38.3% of patients had changes in other arteries. Renal angioscintigraphy and captopril renal scintigraphy were performed in accordance with renal arteriography in 80% of patients. Arteriography showed unilateral renal artery stenosis in 78.7% of patients and bilateral - in 21.3%. The most common cause of renovascular hypertension in our material was atherosclerosis (65.2%). Fibromuscular dysplasia and Takayasu arteritis were diagnosed less frequently (25.8% and 9.0% respectively). Forty four patients were treated with PTA, 15 underwent surgical revascularization and 11 - unilateral nephrectomy. Early beneficial therapeutic effect (normalization or improvement of blood pressure control) was observed in 88.6% for PTA and 66.7% for surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Renovascular hypertension--clinical observations and long-term follow-up]. 787 Dec

The ability to record sympathetic nerve activity in conscious human subjects using intraneural microelectrodes (microneurography) has proven to be a powerful clinical research tool, which has shed new light on the pathophysiology of important blood pressure problems as exemplified in studies of patients with chronic renal failure. Hypertension is present in the majority of hemodialysis patients and is a major risk factor for their excessive mortality from heart attack and stroke. Microneurographic studies indicate that there is a neurogenic component to this hypertension. In addition, severe episodic hypotension is an important complication of maintenance hemodialysis. Microneurographic studies have advanced the concept that abrupt paradoxical withdrawal of sympathetic vasoconstrictor drive is an important cause of this episodic hypotension. These microneurographic data provide the conceptual framework for systematic assessment of new therapeutic strategies.
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PMID:Direct measurement of sympathetic activity: new insights into disordered blood pressure regulation in chronic renal failure. 788 90

Over the past two decades the incidence of stroke and myocardial infarction in hypertensive populations has decreased, yet the incidence of end-stage renal disease attributed to hypertension has increased. This apparent paradox has raised questions about the adequacy of blood pressure control in hypertensive patients with renal disease. Chronic renal failure is commonly associated with hypertension, and is often severe and difficult to control, particularly in patients with hypertensive nephrosclerosis. The optimal level of blood pressure control in these patients has not been established. Long-term diastolic blood pressure control to a level lower than 90 mm Hg is associated with stable or improving renal function in hypertensive nephrosclerosis and with slowing of the deterioration in renal function from other causes of renal failure. Moreover, recent studies indicate that when blood pressure control is achieved and maintained at a level of about 130/86 mm Hg (systolic/diastolic), deterioration in renal function can be halted even in black patients with hypertensive nephrosclerosis. Therefore, in hypertensive nephrosclerosis we attempt to control diastolic blood pressure at 80 to 85 mm Hg. Newer antihypertensive agents such as calcium channel blockers and angiotensin-converting enzyme inhibitors contribute to lowering blood pressure and preserving renal function. However, they have yet to be proven superior to conventional agents in double-blind randomized clinical trials in humans with hypertensive nephrosclerosis. Importantly, minoxidil is still relied on for aggressive control of blood pressure in many patients with hypertensive nephrosclerosis.
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PMID:Treatment of hypertension in nondiabetic renal disease. 792 53

Cerebrovascular accident (CVA) is an important predictor of survival in patients with chronic renal failure (CRF). Although serum lipoprotein (a) [Lp(a)] is an independent risk factor for atherosclerosis in the general population and Lp(a) levels are increased in patients with CRF, the relationship between increased Lp(a) and CVA has not been clarified in patients with CRF. We therefore determined the association between serum Lp(a) levels and the risk of CVA in a retrospective study of 105 patients with CRF. Lp(a) was measured by ELISA in 31 patients with CVA and 74 patients without CVA. The median Lp(a) concentration of the patients with CVA was significantly higher than that of patients without CVA (38 vs 23 mg/dl: p < 0.001). Logistic regression analysis determined that elevated serum Lp(a) concentration (relative risk ratio: 1.041, p < 0.005), hypertension (relative risk ratio: 9.747, p < 0.05) and smoking (relative risk ratio: 4.554, p < 0.05) were risk factors for CVA. In contrast, serum total cholesterol, triglycerides, high density lipoprotein cholesterol, low density lipoprotein cholesterol, gender underlying condition of renal disease and duration of hemodialysis were not associated with an increased risk of CVA. These results suggest that Lp(a) is a risk factor for clinical events attributable to CVA in patients with CRF.
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PMID:[Lipoprotein (a) is a risk factor for cerebrovascular accident in patients with chronic renal failure]. 807 23

Factors that contribute to the outcome of carotid endarterectomy include appropriate patient selection, preoperative medical optimization, meticulous operative technique and postoperative management. This study was designed to evaluate associated medical and operative risk factors with surgical outcomes for 9795 consecutive carotid endarterectomies performed by members of a voluntary regional vascular society. All data were reviewed and subject to a variety of statistical analyses in a blinded retrospective fashion. Factors including sex, increased age (> 70 years), cigarette smoking, chronic pulmonary disease and diabetes did not contribute independently to either increased operative neurologic morbidity or mortality rates. Cardiac disease (P < 0.0001) and chronic renal failure (P < 0.001) correlated independently with increased operative mortality, while hypertension (P < 0.05), cardiac disease (P < 0.01), renal failure (P < 0.0001), emergency surgery (P < 0.0001) and advanced neurologic symptoms at the time of operation (P < 0.0001) were associated with an increased operative stroke rate. In a group of 9021 patients who underwent 9795 carotid endarterectomies with a combined 3.1% incidence of operative neurologic morbidity or mortality (neurologic morbidity, 2.0%; mortality, 1.5%), specific preoperative medical risk factors could be identified. Only cardiac disease and chronic renal failure were associated with both significantly increased operative neurologic morbidity and operative mortality rates.
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PMID:Risk assessment in patients undergoing carotid endarterectomy. 807 92


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