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Biomedical subjects

L Sellars

Publications and source records attributed to L Sellars.

33 records · Page 2Linked to original sources
PubMed1985

Prognosis for pregnancy after correction of renovascular hypertension.

Renal artery stenosis was diagnosed in 3 women when hypertension of pregnancy persisted beyond the puerperium; all had poor obstetric histories and 2 had been hypertensive in the first trimester. A fourth case presented as hypertension associated with oral contraceptive use. After corrective procedures 6 further pregnancies were embarked upon, all of them successful and with only minor hypertensive complications in 2. Renal artery stenosis is an important cause of pregnancy hypertension persisting after the puerperium, since its correction greatly improves the prognosis for future pregnancies.

Adult↗
PubMed1985

The renin-angiotensin-aldosterone system in decompensated cirrhosis: its activity in relation to sodium balance.

Plasma renin activity (PRA), plasma renin concentration (PRC), plasma angiotensin II concentration (AII), plasma and urinary aldosterone (PA, UA) and urinary sodium excretion (UNaV) were measured in 51 normal controls, 16 patients with decompensated cirrhosis (i.e. ascites and/or oedema present) in sodium equilibrium (Group 1) and 13 patients with decompensated cirrhosis in a phase of active sodium retention (Group 2). In Group 1 the mean supine and erect values, although lower, were not significantly different from controls. In Group 2 the mean values were significantly elevated, but several individual values were within the normal range; there were significant direct relationships between plasma renin activity and plasma renin concentration (r = 0.85, p less than 0.001 erect), plasma renin concentration and plasma angiotensin II concentration (r = 0.86, p less than 0.001 erect), and plasma angiotensin II concentration and plasma aldosterone (r = 0.70, p less than 0.01 erect). In Group 2 there was an inverse correlation between urinary sodium excretion and both urinary aldosterone (r = -0.50) and erect plasma aldosterone (r = -0.36) but, perhaps because of the narrow range of sodium excretion rates, significance was not reached. The normal values in Group 1 indicate that hyperaldosteronism is not essential for the maintenance of established ascites, but do not exclude a role for aldosterone in the control of sodium excretion if it is accepted that renal tubular sensitivity to aldosterone is increased in these patients. In Group 2, the raised mean plasma and urinary aldosterone levels and the trend towards an inverse relationship with urinary sodium excretion suggests a role for aldosterone in the active retention of sodium. It appears that stimulation of the renin-angiotensin system is the major factor in the elevation of plasma aldosterone; there was no relationship between plasma aldosterone and either plasma sodium or potassium levels. The mechanism of renin hypersecretion is unclear but this may represent part of a sympathetically mediated response in order to maintain blood pressure. The close relationship between plasma renin activity and plasma renin concentration indicates that the former is a valid measure of circulating renin levels in cirrhosis, despite low renin-substrate levels.

Aldosterone↗
PubMed1985

Renovascular hypertension: ten years' experience in a regional centre.

In a unit serving a population of three million, 60 hypertensive patients with renovascular disease were identified over a 10-year period. The presence of renovascular disease was usually suggested by intravenous urography (IVU), although this was falsely negative in 21 per cent of cases; isotope renography (IR) was normal in a similar proportion of patients (25 per cent). Eight patients were treated medically and 52 underwent surgical procedures; nephrectomy in 32, autotransplantation in 10, by pass graft in six and percutaneous transluminal angioplasty in four. Twenty-three per cent of patients were cured, 37 per cent improved and 40 per cent unchanged one year after surgery, but the response could not be accurately predicted. Clinical features were of some value in that those patients most likely to benefit from surgery were younger, had less severe hypertension of shorter duration, smoked less, had less severe retinopathy and less cardiomegaly. There was also a trend for those with better renal function and less electrocardiographic evidence of left ventricular hypertrophy to benefit from surgery. The IVU and IR did not predict response to surgery but arteriographic appearances of fibromuscular dysplasia indicated there should be a favourable response. The renal vein renin ratio, basal or stimulated, was of no prognostic value since approximately two-thirds of patients with ratios above or below the threshold value had some benefit from surgery. We conclude that the surgical treatment of renovascular hypertension is worthwhile but the number of patients suitable for surgery is small. Clinical features and the results of simple investigations provided the best guide to surgical outcome in our patients.

Adult↗
PubMed1984

Haematuria in rheumatoid arthritis: an association with mesangial glomerulonephritis.

Twenty-four patients with rheumatoid arthritis and isolated haematuria were investigated for the cause of their haematuria. In 3 patients local urological disorders were identified, including a pelvicaliceal carcinoma. Renal biopsies were performed on the remaining 21 patients, and the most common abnormality found was a mild mesangial glomerulonephritis (71%). Immunofluorescence and electron microscopy in these patients usually gave normal results. The lesions occurred independently of gold or D-penicillamine therapy and were not associated with impairment of glomerular function.

Adult↗
PubMed1984

Extrarenal arteriovenous fistula. An unusual complication of percutaneous renal transplant biopsy.

A percutaneous allograft biopsy in a renal transplant recipient with declining function was followed by haemorrhage from the external iliac artery requiring repair of the puncture site. A common iliac arteriogram performed subsequently showed an external iliac arteriovenous fistula. In retrospect, an isotope scan performed at 48 h post-transplant, showed the upper pole of the graft overlying the iliac vessels. To avoid such complications we recommend a careful assessment of the anatomical relationships of the transplant kidney to major blood vessels prior to biopsy.

Adult↗
PubMed1983

Experience in the management of hypertension with unilateral chronic pyelonephritis: results of nephrectomy in selected patients.

We report the experience of a regional centre serving a population of 3 millions in the management of patients with hypertension and unilateral scarred kidneys between 1972 and 1981. Thirty one patients were studied, fifteen have been subjected to nephrectomy and sixteen managed conservatively. The medically and surgically treated patients differed only in that the diseased kidney was smaller, 7.7 +/- 1.9 vs 9.9 +/- 1.7 cm, (p less than 0.01), and systolic blood pressure higher, 224 +/- 34 vs 198 +/- 30 mmHg, (p = 0.05), in the surgically treated group. Following nephrectomy blood pressure was normal without drugs in four patients, control was made easier in 10 patients and only one patient, who had bilateral disease, failed to benefit. In the non-surgical group drugs could be withdrawn in only one patient and control became easier in only five. Serum creatinine did not increase following nephrectomy, but had increased significantly at the time of the most recent follow up in the medically treated patients (89 +/- 20 to 102 +/- 32 mumol 1(-1), p less than 0.05). We conclude that nephrectomy is of value in the management of some patients with unilateral chronic pyelonephritis and need not result in loss of renal function. Renal vein renin studies may be helpful in selecting patients for surgery but examination of the effect of nephrectomy in patients without differences in renal vein renin is necessary to establish this.

Adolescent↗
PubMed1983

Renal biopsy appearances in rheumatoid disease.

The renal biopsies of 30 patients with rheumatoid arthritis and clinical evidence of renal disease were reviewed; only patients in whom the intravenous pyelogram was normal were subjected to biopsy, thus excluding those with papillary necrosis and chronic pyelonephritis. Tissue was studied by light, electron and immunofluorescence microscopy. There were 13 cases of mesangial change, 9 of membranous glomerulonephritis, 4 of tubulointerstitial change, 2 cases of focal segmental glomerulosclerosis, 1 case of amyloid and 1 of diffuse proliferative glomerulonephritis with crescents. All 9 patients with membranous glomerulonephritis but only 6 of 13 with mesangial change had received gold or penicillamine. We found no evidence of "glomerulitis" or of a rheumatoid vasculitis.

Adult↗
PubMed1981

Sodium status and the renin-angiotensin-aldosterone system in compensated liver disease.

Exchangeable sodium, plasma renin activity, plasma angiotensin II and plasma aldosterone were measured in forty-six control subjects, nineteen patients with chronic non-cirrhotic liver disease and twenty patients with compensated cirrhosis (i.e. without ascites or oedema). In the three groups respectively, mean exchangeable sodium (mmol/kg lean body mass) was 53 (SD = 3), 50 (SD = 5) and 52 (SD = 8). Mean plasma renin activity (pmol l(-1) min(-1)) was 3.2, 3.1 and 3.0 supine and 6.2, 6.2 and 5.1 erect. Mean plasma angiotensin II (pmol l(-1) was 7.3, 5.8 and 6.6 supine and 10.6, 7.9 and 9.0 erect. Mean plasma aldosterone (pmol l(-1)) was 82, 64 and 77 supine and 188, 133 and 121 erect. There were no significant differences among the mean values of any of these variables. These findings indicate that, on the basis of exchangeable sodium measurements, sodium retention is not present in compensated liver disease and that the renin--angiotensin--aldosterone system is essentially normal.

Adult↗
PubMed1981

The relative roles of sodium and renin in the hypertension of renal disease. An assessment based on the response to frusemide and propranolol.

Twenty-seven patients with hypertension and varying degrees of renal failure were studied before and during the administration of frusemide. In 15 patients studies were repeated following the addition of propranolol. Mean exchangeable sodium was increased before the introduction of frusemide or propranolol in patients with azotemia, possibly due in part to the administration of other antihypertensive drugs, and was reduced to normal during frusemide treatment increasing slightly but significantly following the addition of propranolol. Blood pressure fell significantly with frusemide but there was no further significant fall with propranolol. The relationship of change in blood pressure to change in exchangeable sodium with frusemide did not reach significance. There was no relationship between changes in blood pressure and changes in plasma renin activity with frusemide, suggesting that the blood pressure response to frusemide is not limited by the rise in renin. The fall in blood pressure following the addition of propranolol was proportional to the dose of the drug but inversely proportional to the change in renin suggesting that renin levels are to some extent determined by the blood pressure response to propranolol rather than themselves determining that response. Serum creatinine was significantly increased during treatment with frusemide probably due to a combination of the effects of sodium depletion and the natural progression of the underlying renal disease rather than to nephrotoxicity. The further slight increase in serum creatinine following the addition of propranolol is in keeping with the reported effect of this drug on renal blood flow and glomerular filtration rate in patients without renal disease.

Adolescent↗
PubMed1979

Sodium retention and hypertension with short dialysis.

Exchangeable sodium was measured in 26 patients undergoing dialysis with a modestly shortened schedule of 14.8 hours weekly and related to blood-pressure control. The group was compared with 27 patients studied in 1969 during twice-weekly dialysis totalling 22 hours, and with 18 patients studied in 1973 during dialysis of 18--21 hours weekly in three sessions. Exchangeable sodium was significantly increased with short dialysis compared with the other schedules and, although mean blood pressure was not significantly increased, significantly more patients required antihypertensive treatment than in either 1969 or 1973. A trend towards more frequent resort to bilateral nephrectomy than in 1973 did not reach significance. Problems of hypertension and the side effects of its treatment, both medical and surgical, should be weighed against the social and economic advantages of short dialysis in deciding on the ideal schedule.

Adult↗
PubMedDate not supplied

Randomized prospective comparison of laparoscopic and open peritoneal dialysis catheter insertion.

OBJECTIVE: To compare laparoscopic and conventional peritoneal dialysis catheter insertion with respect to post operative discomfort, complication rates, and catheter survival. DESIGN: Randomized prospective study. SETTING: Tertiary referral renal unit. PATIENTS: Fifty patients commencing peritoneal dialysis. INTERVENTION: Catheters were implanted laparoscopically or by a conventional surgical technique. MAIN OUTCOME MEASURES: The duration of surgery, hospital stay, pain scores, and analgesic requirements were recorded. Complications (early/late) and catheter survival were compared. RESULTS: The conventional procedure was faster than the laparoscopic (14.3 vs 21.9 minutes, p < 0.0001). There was no difference in any other parameter assessed. CONCLUSIONS: The data suggest that the insertion techniques are equivalent, and that laparoscopic insertion does not reduce early complication rates.

Catheterization↗
PubMedDate not supplied

Locally applied transdermal nitrate patches for the treatment of ischaemic rest pain.

Patients with severe peripheral vascular disease may suffer considerable pain which can be difficult to control with conventional analgesics. We sought to assess the analgesic effect of transdermal nitrate patches in such patients. A prospective trial was performed in 15 patients with ischaemic rest pain due to atherosclerotic peripheral vascular disease. Pain control and oral analgesic requirement were assessed. Fourteen of the 15 had a good or moderate response to the nitrate patches with a subsequent reduction in oral analgesic requirement. The patients with primarily small vessel disease had the greatest improvement in pain control. We conclude that topical nitrates may be used to provide rapid and safe analgesia for patients with ischaemic rest pain.

Administration, Cutaneous↗