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Biomedical subjects

C Isles

Publications and source records attributed to C Isles.

At least 19 recordsLinked to original sources
PubMed1990

Survival associated with renovascular disease in Glasgow and Newcastle: a collaborative study.

Data from 121 consecutive patients with hypertension and renovascular disease, first diagnosed between 1975 and 1982 in Glasgow and Newcastle, were analysed retrospectively to determine the factors which influenced their outcome. Thirty-six patients died between the data of arteriography and 1st January 1987, giving five and ten year survival rates of 83% and 67%. Survival was greatly reduced in comparison with that of age-sex-matched controls in the general population of the West of Scotland, and was also less than that of essential hypertensives matched for age, sex, initial diastolic blood pressure and smoking habit who had attended the Glasgow Blood Pressure Clinic during the same period. Multivariate analysis showed that age, cigarette smoking and presence of atheromatous disease were significantly and independently related to outcome among the patients with renovascular disease, whereas male sex, centre of origin, severity of hypertension when first seen, initial renal function and presence of bilateral disease were not. Despite a trend towards benefit from surgical intervention (ten year survival in medical group 62%, in surgical group 71%; p = 0.19) our data do not prove that intervention is better than medical treatment, largely because the decision on intervention was not randomised. A prospective trial would be required to answer this important question.

Adult↗
PubMed1988

Angiotensin converting enzyme inhibition and renal insufficiency in patients with bilateral renovascular disease.

A 70 year old patient with malignant hypertension due to bilateral renal artery disease developed acute renal failure within 36 hrs of starting an angiotensin converting enzyme (ACE) inhibitor. Review of the consecutive series of 14 patients with bilateral renal artery disease who had also been given ACE inhibitors showed that functional renal sufficiency was common but not invariable under these circumstances. Although renal function returned towards pretreatment levels in most cases when ACE inhibitors were withdrawn, the speed with which acute renal failure may occasionally develop suggests that renal artery disease should be excluded before prescribing ACE inhibitors for hypertensive patients with undiagnosed renal impairment.

Acute Kidney Injury↗
PubMed1987

Fatal outcome following inhalation of Tipp-Ex.

Recent measures to combat glue sniffing have led to a decrease in the availability of toluene-based glues. As a result, abuse of other more accessible solvents appears to have increased. Of particular concern are the halogenated hydrocarbons which are more likely to cause fatal cardiac arrhythmias than toluene. We wish to report three cases presenting within a period of six months where death occurred following inhalation of Tipp-Ex, a seemingly innocuous preparation of 1,1,1-trichloroethane which is widely available in offices and schools.

Acute Disease↗
PubMed1984

Abnormal haemostasis and blood viscosity in malignant hypertension.

We have previously shown abnormalities of haemostasis suggestive of intravascular coagulation in patients with malignant hypertension, a condition associated with retinopathy and renal fibrin deposition. To determine whether such abnormalities are specific to malignant hypertension, we have measured several haemostatic and haemorheological variables in 18 patients with malignant hypertension (Group 1), 18 matched healthy controls (Group 2), and 18 patients with non-malignant hypertension (Group 3) matched for renal pathology, blood pressure and serum creatinine with Group 1. Both Groups 1 and 3 had increased mean levels of fibrinogen, factor VIIIc, beta-thromboglobulin, plasma viscosity and blood viscosity (corrected for haematocrit); and decreased mean levels of haematocrit, antithrombin III and platelet count. Mean levels of fast antiplasmin and alpha2-macroglobulin were elevated in Group 1 but not in Group 3. We conclude that most blood abnormalities are not specific to malignant hypertension; are also present in patients with non-malignant hypertension who have similar levels of blood pressure and renal damage; and might result from renal damage as well as promoting further renal damage by enhancing fibrin deposition. However increased levels of fibrinolytic inhibitors in malignant hypertension merit further investigation in relation to removal of renal fibrin.

Adult↗
PubMed1981

Polycythaemia vera presenting as an acute abdomen.

A patient who presented with severe abdominal pain was found to have an intrahepatic haematoma complicating previously undiagnosed polycythaemia vera (PV). Full recovery followed treatment with bed rest, control of hypertension, daily venesection and 32P. The hazards of surgery in uncontrolled PV are discussed and re-emphasized.

Abdomen, Acute↗
PubMed1981

Minoxidil in the management of intractable hypertension.

Eighty-seven patients with intractable hypertension received minoxidil for a mean duration of 27 months (range three months to five years). A significant reduction in mean outpatient blood pressure from 206/129 to 158/98 mmHg (p less than 0.001 for both systolic and diastolic values) was recorded after one month's treatment. In 26 patients who received minoxidil for four or more years a further reduction in mean blood pressure to 147/89 mmHg was achieved. The mean daily dose of minoxidil was 23 mg (range 2.5 to 60 mg). In all patients a beta adrenergic neurone blocker and a diuretic were prescribed with minoxidil to counteract tachycardia and fluid retention. Thirteen patients required the addition of a fourth hypotensive agent. The use of minoxidil led to simpler drug regimens with the majority of patients well controlled on twice daily or once daily schedules. Most patients commented spontaneously on a feeling of improved wellbeing while taking minoxidil which also appeared to be relatively free from side effects commonly encountered with other hypotensive drugs, particularly drowsiness, dizziness and impotence. Fluid retention of 7 kg or more occurred in 18 patients, more commonly in those with renal impairment, but could be controlled by increasing the dose or potency of diuretics. Four patients with end stage renal failure and one patient with normal renal function developed pericardial effusions. Hirsutism was universal and limited the usefulness of the drug in women. We currently recommend minoxidil for hypertensive men who diastolic blood pressure remains greater than or equal to 110 mmHg despite an adequate trial of a beta adrenergic neurone blocker, diuretic and an additional drug, or for patients who find the side effects of such therapy intolerable.

Adolescent↗
PubMed1980

Advantages of treatment of hypertension with Minoxidil.

A detailed study has been made of the five hypertensive patients who received Minoxidil in Dumfries; four have been observed for over a year. Minoxidil was found to be highly effective, free from commonly encountered side effects and capable of achieving excellent control of blood pressure when given once daily. Its use led to simpler drug regimens, improved compliance and significant reduction in the length, or even need, of admission to hospital. A prolonged and clinically useful delay in the recurrence of hypertension following withdrawal of the drug was also observed.

Adult↗
PubMed1979

Excess smoking in malignant-phase hypertension.

The smoking habits of 82 patients with malignant-phase hypertension were compared with those of subjects in three control groups matched for age and sex. Sixty-seven (82%) of the patients with malignant-phase hypertension were smokers compared with 41 (50%) and 71 (43%) of the patients in two control groups with non-malignant hypertension, and 43 people (52%) in a general population survey. The excess of smokers in the malignant-phase group was significant for men and women, together and separately, for cigarette smoking alone, and for all forms of smoking. There were no significant differences between the control groups. The chance of a hypertensive patient who smoked having the malignant phase was five times that of a hypertensive patient who did not. Twelve patients in the malignant-phase group had never smoked. All were alive three and a half years on average after presentation (range 11 months to seven years). Twenty-four (36%) of the smokers with malignant-phase hypertension died during the same period. The mortality rate was significantly higher among patients with renal failure, as was the prevalence of smoking. Eighteen patients with malignant-phase hypertension had a serum creatinine concentration higher than 250 mumol/l (2.8 mg/100 ml); 17 were smokers and one an ex-smoker. Eleven of these 18 patients died.It is concluded that hypertensive patients who smoke are much more likely to develop the malignant phase than those who do not, and that once the condition has developed it follows a particularly lethal course in smokers.

Age Factors↗