National High Blood Pressure Education Program (NHBPEP) review paper on complications of shock wave lithotripsy for urinary calculi
Article Abstract:
Advances have been rapid in developing new techniques for removing urinary calculi (stones in the urinary tract); most stones can now be removed in a noninvasive or less invasive manner than open surgery. Many of these approaches use extracorporeal shock wave lithotripsy (ESWL), a method in which shock waves are focused on the stone while the patient is immersed in water. This article reviews results from studies of the effects from ESWL, including those that report adverse effects. ESWL, like open surgery, should only be used for stones that are causing symptoms, blocking or threatening to block the flow of urine, or that are a source of infection. The best results are obtained for stones two centimeters in size or smaller, located in the upper or middle segment of the ureter. Treating both kidneys at once may cause permanent impairment of kidney function; more studies of this issue are needed. Stones will form again in most patients unless the conditions that cause them are treated, and some problems, such as infection, elevated blood calcium or uric acid levels, or poor renal function, should be investigated at the time of ESWL. Patients with recurrent stones should undergo metabolic evaluation. Some kinds of stone (calcium oxalate monohydrate) are more resistant to ESWL than others (calcium oxalate dihydrate, uric acid). Acute complications of the procedure are mainly the result of the passage of stone fragments or of a large piece that will not pass. Although early evidence indicated no negative effects of shock waves, it now appears that cellular destruction can be caused by the high-energy waves. Results from animal studies are described. Acute (pooling of blood or fluid, enlargement of the kidney) and chronic (slightly impaired renal function, pancreatic inflammation) effects have been noted after ESWL, including an increased incidence of hypertension. Mortality for ESWL is approximately the same as that associated with the anesthetic used for the procedure. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Digitalis-like activity in human plasma: relation to blood pressure and sodium balance
Article Abstract:
Many drugs are thought to be therapeutically active because they mimic the action of compounds already present in the body. This notion is illustrated by the discovery, in human tissues, of opioid proteins, which have effects similar to morphine. Digitalis is an important agent in the treatment of heart failure because it improves heart contraction and fluid excretion. Identification of a native digitalis-like factor would be very significant. Such a factor, which could alter kidney cell function, has been identified in human urine and mammalian blood. Eighty-seven blood specimens, assumed to contain a digitalis-like factor, were studied using cultured (laboratory-grown) kidney cells to determine if levels of the factor might differ in subjects with and without high blood pressure. The effect of dietary sodium on the factor was also explored. Digitalis-like factor activity was significantly higher in patients with high blood pressure, and activity tended to be correlated with blood pressure levels. Activity was higher in individuals with a high salt intake, and it correlated significantly with urinary sodium excretion. Although the results provide evidence for greater amounts of a digitalis-like factor in hypertensive patients, they can not rule out the possibility that increased digitalis-like factor might be caused by high blood pressure, rather than being a regulatory response to it. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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