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Biomedical subjects

G Pouliadis

Publications and source records attributed to G Pouliadis.

12 recordsLinked to original sources
PubMed1979

[Hypertension in unilateral (non-vascular) nephrosclerosis: renin activity in the venous kidney blood and effect of nephrectomy].

13 patients (9 females, 4 males) with hypertension and unilateral (non-vascular) small kidney underwent nephrectomy. Before surgery, renin activity (PRA) was measured in renal vein blood before and/or 15 and 30 minutes after intravenous stimulation with 40 mg furosemide. From these PRA values renin rations (PRA affected side/PRA unaffected side) were calculated. A ratio of greater than or equal to 1.5 was considered to be significant. After a mean postoperative observation period of 3.9 +/- 1.3 years 6 patients (46%) were cured and 6 were improved. In only 1 patient (8%) did hypertension remain unchanged. No differences could be observed between the renin ratios of cured and improved cases. Furthermore, in no patient was a correlation found between preoperative renin ratios and the degree of postoperative blood pressure reduction. Finally, both patients with renin ratios less than or equal to 1.4 were cured by surgery. Marked differences between cured and improved patients were seen in preoperative blood pressure values, age, duration of hypertension and renal function. Cured patients were younger and had much lower mean systolic and diastolic blood pressure values, shorter duration of hypertension and better renal function than improved patients. These results show that the diagnostic and prognostic validity of renal venous renin ratios is very limited in patients with a unilateral (non-vascular) small kidney. In these patients the effect of nephrectomy can already be predicted by analyzing simple anamnestic, clinical and chemical data.

Adolescent↗
PubMed1979

[Renovascular hypertension. Prognostic value of renal venous renin determinations (author's transl)].

In the present study the effect of surgery on blood pressure was investigated in 35 patients with renovascular hypertension: 17 patients with fibromuscular hyperplasia (FMD) and 18 with atherosclerosis (ASS) of the renal artery. Patients with FMD were younger (31,8 years), showed a shorter duration of hypertension (1.8 years) and were prevalently female (82%), whereas patients with ASS were markedly older (48.2 years), showed a longer duration of hypertension (2.6 years) and were most often male (78%). In both groups of patients the intravenous urogram was positive in a comparable high percentage (FMD=64%, ASS=61%). Following surgical intervention 47%(n=8) of the 17 patients with FMD were cured, 47% (n=8) were improved and only 6% (n=1) showed insufficient reduction of blood pressure values. In ASS the respective values were 28, 55 and 17%. Consequently a good effect of surgery (cured and improved) was observed in 88.5% of all patients. Patients with ASS who failed to respond to surgery (n=3) showed a remarkable long duration of hypertension (7.0 plus or minus 1.4 years). Plasma renin activity (PRA) was determined preoperatively in both renal veins in all 35 patients. From these values the PRA-ratio (PRA affected/unaffected side) was calculated. In 27 patients PRA determinations were repeated following (15 and 30 min) intravenous injection of 40 mg furosemide. PRA-ratios of larger than or equal to 1.5 were considered to be significant. In 31 patients with unilateral renovascular hypertension PRA-ratios were correlated to the postoperative blood pressure reduction. No significant differences in mean PRA-ratios were observed between cured and improved patients. Furthermore, for the total group of 31 patients no significant correlations were obtained between PRA-ratios and postoperative blood pressure reduction. Our results do not support the widespread opinion that PRA determinations in both renal veins are useful to predict the effect of surgery in patients with unilateral renovascular disease. Therefore, from our experience this method should not be recommended as obligatory in the diagnostic work-up of renovascular hypertension.

Adult↗
PubMed1979

[Complications of nephrotic syndrome with special reference to thromboembolic accidents].

The nephrotic syndrome may be associated with several complications caused by severe proteinuria. The consequences of severe renal protein loss are disturbances of water and electrolyte metabolism, thromboses and thromboembolic complications, hyperlipidemia with accelerated atherosclerosis and, finally, some other complications due to the decreased oncotic pressure and the renal loss of transport globulins and immunoglobulins. Diagnosis and treatment of these complications are important in the management of patients with nephrotic syndrome. In the present study, the frequency and localization of thromboses and thromboembolic complications in 11 patients with nephrotic syndrome are described. In addition, factors which are known to be responsible for the hypercoagulable state in nephrotic syndrome were evaluated and correlated to the thromboembolic complications in these patients. An important finding was that in all patients with thromboses and thromboembolic complications, the serum albumin concentrations were below 2 g/100 ml, whereas, with one exception, serum albumin levels were above 2 g/100 ml in cases without thromboembolic complications. Our results indicate that serum albumin levels may be used as an indirect parameter to assess the risk of thromboembolic complications in patients with nephrotic syndrome.

Aged↗
PubMed1978

[Periosteal bone formation in Crohn's disease].

Crohn's disease not only affects the gastrointestinal tract but also causes skeletal complications. Arthritis and ankylosing spondylitis are among the best known of these, while periostal new bone formation in patients with Crohn's disease is rare. A report is presented on a patient who developed this complication after Crohn's disease of many year's standing.

Adult↗
PubMed1977

[Studies on the differential determination of renin activity in renal venous blood in renal artery stenosis].

Plasma renin activity (PRA) was determined in both renal veins of 37 patients with angiographically proven renal artery stenosis. Renal venous PRA was determined in 17 patients without furosemide stimulation and in 20 patients before and 15 and 30 min after intravenous injection of 40 mg furosemide. 21 of 37 patients showed abnormally high peripheral PRA. In the 17 patients in whom renal venous PRA was measured without stimulation, 11 showed a PRA ratio (PRA stenotic side/PRA unaffected side) greater than or equal to 1.5. The 20 patients in whom stimulation with furosemide was performed were divided into 2 groups each containing 10 patients: The first group was characterized by an increase in PRA ratio after furosemide stimulation, while in the second group this PRA ratio decreased. In the first group mean duration of hypertension was 4.5 years compared to 7.5 years in the second group. In 17 of 37 patients renal artery stenosis was corrected by surgery. After operation 12 patients became normotensive and in 2 patients hypertension improved. There was no effect of renovascular surgery on blood pressure in only 3 patients. None of these patients showed an increasing ratio in response to furosemide. Our results suggest that the validity of renal venous PRA measurements is enhanced when the procedure is performed before and after administration of furosemide.

Furosemide↗
PubMed1976

[Arterial stenoses after kidney transplantation].

After 268 kidney allotransplants, 7 cases of renal artery stenosis were observed. An additional 3 patients were referred to use from another center. The outstanding symptom of all 10 patients was hypertension refractory to medical treatment, beginning not later then 10 months after transplantation. In 9 cases there was a murmur over the transplant. In 6 patients hypertension was accompanied by a deterioration of renal function which was resistant to antirejection therapy. The tentative diagnosis was confirmed by selective renal arteriography of the transplant. Two main types of stenoses could be diagnosed: Segmental stenoses, 0.5-2 cm distal to the anastomosis, which were due to intimal lesions caused during removal of the kidney or by the perfusion canula; and kinking stenoses due to a technically inadequate implantation. Hypertension was controlled in all but 1 patient with reconstruction of the artery. Therefore, hypertension after kidney transplantation refractory to medical treatment should be further investigated with selective renal arteriography of the transplant. Stenoses with clinical symptoms which are confirmed by arteriography should be surgically corrected.

Adult↗
PubMed1976

[Primary aldosteronism].

The syndrome of primary aldosteronism is caused either by an aldosterone-producing adenoma or by idiopathic bilateral adrenal hyperplasia. Hypokalemic hypertension is the leading symptome of the disease. Diagnosis is by the combination of abnormally high and non-suppressible aldosterone values with undetectable or low renin values unresponsive to postural changes or salt restriction. Patients with aldosterone-producing adenoma normally show a fall in plasma aldosterone in response to posture and ACTH-dependent circadian rhythm of aldosterone, whereas bilateral hyperplasia is characterized by postural increases in plasma aldosterone and an ACTH-independent diurnal aldosterone rhythm. These creteria serve to differentiate between adenoma and hyperplasia. An aldosterone-producing adenoma can be localized by veinography, determination of aldosterone concentration in both adrenal veins and by 131I-cholesterol scintigraphy. In our hands the determination of aldosterone in blood from both adrenal veins is the most efficient procedure. In interpreting the results, however, rhythmic and sudden changes in adrenal hormone secretion should be considered. In cases where no adrenal venous blood is obtained, 131I-cholesterol scintigraphy may be used to localize adenoma. In patients with aldosterone-producing adenomas unilateral adrenalectomy should be performed, whereas patients with idiopathic bilateral hyperplasia should receive antihypertensive therapy. As rare instances of primary aldosteronism, a case of aldosterone-producing carcinoma of the adrenal cortex and a case of presumably unilateral adrenal hyperplasia are reported.

Adenoma↗