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Biomedical subjects

D S Silverberg

Publications and source records attributed to D S Silverberg.

At least 19 recordsLinked to original sources
PubMed1990

Non-pharmacological treatment of hypertension.

Weight reduction, alcohol restriction, mild salt restriction, eating a vegetarian diet and increasing aerobic exercise will generally lower the blood pressure in patients with essential hypertension. Eating a diet rich in potassium and reducing caffeine intake may also be helpful in reducing the pressure, but increasing the fiber or calcium intake will generally be ineffective. Reducing fat intake from the usual 40% of total calories to 25-30% may reduce hypertension directly or by weight reduction. Smoking, when combined with excessive caffeine or alcohol intake may have an additive effect on blood pressure. Monotherapy with such behavioral techniques as self-monitoring of blood pressure, biofeedback, meditation, yoga, progressive muscular relaxation or cognitive therapy may reduce the blood pressure to a variable degree, and combinations of these treatments may be even more successful.

Behavior Therapy↗
PubMed1990

Comparison of hypertension treatment on and off the worksite.

A survey was carried out in two plants in Haifa, Israel on the prevalence of treated and controlled hypertension. In both plants hypertension treatment was being carried out by family physicians at regular family clinics. In factory A, after screening, a programme of follow-up and treatment by the plant doctor and nurse was introduced. In factory B all hypertensives continued to be referred to their family physician for treatment and follow-up. One year later all previously detected hypertensives were reassessed. The percentage of treated hypertensives had increased from 70.9% to 100% in factory A, and from 55.0% to 62.1% in factory B. The percentage of controlled hypertensives among those treated had increased from 52.7% to 83.7% in factory A, and from 28.0% to 38.9% in factory B. Thus, the percentage of all hypertensives who were controlled increased from 37.3% to 83.7% in Factory A and from 15.4% to 24.1% in Factory B. The introduction of on-site treatment and follow-up of hypertension by a doctor-nurse team was associated with marked improvement of all aspects of hypertensive care.

Family Practice↗
PubMed1990

Group discussions with the health care team--a method of improving care of hypertension in general practice.

A management-by-objective approach was used by the health care administration of the Kupat Holim Sick Fund to improve care of hypertension in 20 family practices in the city of Ashdod in central Israel. The doctor-nurse teams in these clinics met jointly on a regular basis with a physician-instructor, reviewed the results of their care of hypertension and discussed ways of improving it. Over a seven-year period, until 1988, the percentage of the population treated increased from 4.0% to 9.2% and percentage of treated patients who had diastolic pressure of 100 mmHg or more fell from 29.6% to 13.4%. Dropout rate ranged from 2.3% to 3.1% per year over the whole period. In 20 other practices in the Ashdod area in 1988 used for comparison, only 5.9% of the population was treated and the per cent treated was less than Ashdod for all age groups above 30. Dropout rate was higher, averaging 9.8% per year, and the percentage of patients with diastolic pressures of 100 mmHg or more was higher (18.1%). Thus the use of regular discussions with feedback to the health care team was associated with better detection, treatment and follow-up of hypertension.

Adult↗
PubMed1979

Evaluation of hypertension control in general practice.

A review of the medical charts of 17 general practitioners in six family clinics in Tel Aviv showed that a blood pressure reading was recorded for 69.3% of the adult patients. Elevated values--greater than or equal to 160 (systolic) and/or greater than or equal to 95 (diastolic) mm Hg--were seen in 26.1% of the patients with recorded blood pressure readings. Antihypertensive medications were presecribed for 74.5% of those with elevated blood pressure. In two thirds of the treated group, blood pressure had been measured only once or twice before the initiation of therapy. Of the treated patients, 30% seem to have stopped therapy on their own initiative. Treatment was discontinued by the physician in 18%. Of the 52% who remained on treatment, only one third had a normal systolic or diastolic pressure on the last reading. The failure to reduce blood pressure in the other two thirds may be due, at least in part, to the use of methyldopa and reserpine without a diuretic.

Adult↗
PubMed1979

Status of hypertension treatment in Israel.

A review of the records of 17 family practices in the Tel Aviv area showed that 31% of charts had no record of blood pressure readings. In other studies, only 45% of subjects with prescribed medication remained on treatment. Some of the patients who had started medication stopped going to the doctor of their own accord. Only 32% of those who remained on treatment had their blood pressure under control. Poor compliance, inadequate therapeutic regimen and high dropout rate explain the picture in Israel. A screening program for hypertension will fail if not accompanied by high-quality medical care and careful follow-up. When specially trained nurses joined doctors in the management of high blood pressure patients, a follow-up of 726 patients originally treated by a doctor alone and then by a doctor-nurse team for one year showed that the percentage of controlled hypertensives rose from 39.2 to 72.8% and the dropout rate fell from 30 to 0.65%. The adoption, on a national scale, of a doctor-nurse team approach for controlling hypertension is, therefore, strongly recommended.

Adult↗
PubMed1978

Effect of weight loss without salt restriction on the reduction of blood pressure in overweight hypertensive patients.

Overweight patients with uncomplicated essential hypertension were followed up biweekly for six months: 24 not receiving antihypertensive-drug therapy (Group I) and 83 on regular but inadequate (despite drug manipulation) antihypertensive-drug therapy (Group II). All patients in Group I and 57 randomly selected patients from group II (IIa) participated in a weight-reduction program. The remaining 26 from Group II (IIb) did not receive a dietary program. Salt intake was in the normal range in all three groups. All patients on the dietary program lost at least 3 kg (mean, 10.5 kg), and all but two showed a meaningful reduction in blood pressure; 75 per cent of Group I and 61 per cent of Group IIa returned to normal blood pressure. The weight and blood-pressure reductions were highly significant (P less than 0.001), were present in both sexes and all ages, and were directly associated. In Group IIb, no significant change in blood pressure or weight occurred (P greater than 0.30).

Adult↗
PubMed1978

Propranolol for the treatment of hypertension in pregnancy.

Twenty-five women were treated with propranolol during 26 pregnancies complicated by hypertension. The fetal wastage, which had been 48 per cent before treatment with propranolol was reduced to 15.4 per cent, with one missed abortion and three stillbirths. Of the 22 liveborn infants 2 were small-for-dates but all 22 had Apgar scores of 9 or 10 at five minutes. There were no congenital anomalies in 25 viable infants and none of the 22 liveborn infants had clinical or laboratory evidence of hypoglycaemia. The blood pressure was controlled in 17 of 19 patients taking propranolol alone (40 to 160 mg/day) and in 6 of 7 taking propranolol with diuretics.

Adult↗
PubMed1978

High renal plasma flow lability in the kidneys of hypertensive patients.

The spontaneous changes in renal plasma flow (RPF) were determined by sodium paraamino hippurate clearance (CPAH) in the individual kidneys of 71 patients with essential and secondary hypertension. These changes were expressed as changes in CPAH and as changes in CPAH per 100 ml Glomerular Filtration Rate (GFR = inulin clearance) for every individual kidney. Sixteen normal subjects were used as control. The RPF changes were measured between two consecutive 10 minute clearance periods during separated kidney function tests. In all the hypertensive groups studied, when RPF variability was expressed per 100 ml GFR, the variability was found to be two to five times greater than in normals. This findings suggests that in the hypertensive state the blood flow changes in the kidney are more labile than in normals. The high lability of renal blood flow could reflect and abnormality in renal vascular tone. This abnormality could be an important factor in the pathogenesis and maintenance of high blood pressure.

Adult↗
PubMed1977

Cholestyramine in uraemic pruritus.

In a patient with longstanding severe uraemic pruritus who was undergoing chronic haemodialysis cholestyramine caused the pruritus to disappear completely within a few days. A four-week randomised controlled double-blind study was therefore performed in 10 other patients with uraemic pruritus who were on chronic haemodialysis. The pruritus improved considerably in four of the five treated patients, whereas only one of those treated with placebo experienced relief. The patient who had no relief while on cholestyramine showed a considerable improvement when the dose subsequently doubled. One of the five patients receiving cholestyramine experienced mild and easily reversible constipation, and another suffered nausea. Neither of these complications prevented the patients from continuing treatment. Cholestyramine seems to be useful in treating uraemic pruritus, although it is not known how it acts.

Cholestyramine Resin↗
PubMed1977

Anemia in hemodialysis patients.

The association between anemia and chronic renal failure has been recognized since the early 19th century. With the introduction of regular dialysis treatment, an understanding of all aspects of this uremic complication has become of great importance, including an appreciation of the hazards of multiple blood transfusions. This analysis of hemoglobin levels and transfusion requirements in 84 dialysis patients focuses specific attention on hemolytic mechanisms, blood loss, and the effect of bilateral nephrectomy on erythropoiesis. Because no replacement for renal erythropoietin is available, particular attention must be paid to less important, but partially correctable factors that contribute to anemia. Blood transfusion requirements can then be reduced to a minimum, together with the risks of hypersplenism, hepatitis, and sensitization of the patient to alloantigens.

Adolescent↗
PubMed1976

Antibody-coated bacteria in the urine of preschool and school-aged girls with asymptomatic bacteriuria.

Urine samples from 3564 girls aged 2 to 13 years were screened for evidence of infection. Cultures were positive (bacteria count, more than 10(5)/ml) in 61 (1.7%) by the dipslide method and in 55 (1.5%) by standard culture techniques. In 13 (23.6%) of the 55, antibody-coated bacteria (ACB) were detected in the urine. The clinical, bacteriologic, radiologic and urinalysis findings in children with ACB were no different from those in children in whom the bacteria were not coated. Direct examination of uncentrifuged urine under high power revealed one or more bacteria per two high-power fields in 96% of infected urine samples and in only 7% of noninfected samples. Five or more leukocytes per high-power field in centrifuged urine were detected in 36.7% of infected urine samples but not in noninfected samples. The ACB test did not differentiate between asymptomatic bacteriuria with parenchymal scarring or vesicoureteral reflux or both and asymptomatic bacteriuria without these abnormalities.

Adolescent↗
PubMed1976

Long-term follow-up of a hypertension screening program.

Of 185 people found to be hypertensive in a shopping centre screening program who went to their physician and had medication prescribed, then were contacted 18 months later, 33 had discontinued the medication at their physician's request. But of 152 who were to continue taking medication 139 (91.4%) had complied. Blood pressure had decreased to less than 160 mm Hg systolic or less than 95 mm Hg diastolic, or both, in 65.1% of the 152; was 160 to 169 mm Hg systolic or 95 to 99 mm Hg diastolic, or both, in 13.8%; was mildly or moderately decreased but still above 169 mm Hg systolic or 99 mmHg diastolic, or both, in 8.6%; and was higher than before the onset of treatment in 3.9%. Adequacy of blood pressure control was not related to age, sex, initial blood pressure values, awareness before the screening of having hypertension, or treatment for hypertension before the screening. Diuretics had been prescribed for 93.5% of the 139 patients, most often as single-pill combinations with other antihypertensive agents.

Alberta↗
PubMed1976

Bone demineralization in renal failure: a longitudinal study of the distal femur using photon absorptiometry.

The bone mineral content (BMC) of the lower end of the femur was measured by photon absorptiometry in 87 patients with chronic renal failure. The gamma-ray photon source was Am241. Serial measurements were obtained for up to two years. The mean BMC of the adult patients, comprising: 18 pre-dialysis (CRF), 41 chronic haemodialysis (CHD) and 19 renal transplant (RT) patients were all significantly lower than controls with the exception of the male CRF group. Two adults and one child on chronic haemodialysis showed a significant rate of bone loss (less than 2% per year). In one of these adults the addition of daily oral 1 alpha hydroxycholecalciferol was associated with no further reduction in BMC. Two children and one adult on chronic haemodialysis showed a significant rate of increase in BMC (less than 2% per year). This adult had had a tendency to loss of BMC on standard CHD treatment but after receiving parenteral 1,25 dihydroxycholecalciferol three times weekly showed a significant rate of loss of BMC on serial measurement. Two adults and one child with CRF had a significant rate of increase in BMC on standard treatment.

Adolescent↗