Huge renal arteriovenous malformation mimicking a simple para-pelvic cyst.

The presenting symptoms of renal arteriovenous malformation are usually gross hematuria and hypertension. Herein we present an unusual case of a huge renal arteriovenous malformation without these signs, but with an ultrasound picture mimicking a simple para-pelvic cyst. Other imaging tests, including duplex ultrasound, computerized tomography and aortography, demonstrated the vascular lesion. We suggest that duplex ultrasound should accompany routine renal ultrasound in order not to miss such cases, especially when the physical examination suggests an intra-abdominal vascular lesion or bleeding.

Huge renal arteriovenous malformation mimicking simple parapelvic cyst.

The presenting symptoms of renal arteriovenous malformations are usually gross hematuria and hypertension. Herein we present an unusual case of huge renal arteriovenous malformation without these signs, but with ultrasound picture mimicking simple parapelvic cyst. Other imaging test, including Duplex ultrasound, computerized tomography and aortography, demonstrated that vascular lesion. We suggest that Duplex ultrasound should accompany the routine renal ultrasound in order not to miss such cases, especially when the physical examination suggests intra-abdominal vascular lesion or bleeding.

Partial cost-benefit analysis of two different modes of nonpharmacological control of hypertension in the community.

In the Dan and Ashkelon areas of Israel, 28 male and 24 female mild to moderate hypertensives without target organ damage aged 35-65 years were randomly assigned to treatment programmes (based on nutritional management, exercise and stress management techniques) either on an individual basis administered by physician-nurse teams (PN) or on a group basis from a team of paramedical professionals (PP) consisting of a psychologist, nutritionist and physical activity instructor. At 11 and 24 months follow-up, there were similar significant improvements in both treatment modes for such risk factors as body mass index, caloric intake and physical activity levels. There was a significant decrease in drug use from $36.28 a month at baseline to $18.94 a month at 11 month follow-up (P = 0.01) and to an estimated $20.48 at 24 months. Mean BP remained unchanged, despite the reduction in drug use, indicating a reduction in the underlying BP. The net present value (NPV) of the reduction in drug utilisation totalled $740 per person over a five year time horizon and a 7.5% discount rate. The total extra costs of treatment, training, case-note writing, travelling and follow-up booster sessions, amounted to $95 per patient for the PN mode and $234 per patient for the PP mode, yielding benefit to cost ratios of 7.79/1 and 3.16/l, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Resource savings from non-pharmacological control of hypertension.

Treatment of acute cardiovascular illness is expensive, and a preventative approach may be cheaper. Since pharmacological costs account for a large proportion of costs in prevention programmes, a non-pharmacological approach such as that used by us in Ashkelon on mild hypertensives, relying on stress management, weight management and exercise aimed at reducing risk factors, might prove to be more cost-effective. After six months on a 1,000 calorie/day diet, 69 obese subjects (initial body mass index greater than 28 kg/m2) had reduced their weight by an average of 7.3 kg (P less than 0.005). This weight reduction contributed to a significant decrease in systolic blood pressure (SBP) from 157.3 to 137.6 mmHg (P less than 0.005) and diastolic blood pressure (DBP) from 101.1 to 85.2 mmHg (P less than 0.005), which was sustained at two-year follow-up. Pharmacological treatment could be stopped in about one-quarter of these cases. In non-obese mild-hypertensives, deep muscle relaxation and biofeedback techniques were prescribed. Significant decreases in SBP (153.1 to 138.3 mmHg, P less than 0.005) and DBP (101.2 to 90.1 mmHg, P less than 0.005) were achieved at six months. In nine out of 19 cases pharmacological treatment was stopped after six to eight months. Smoking cessation was achieved by individual instruction together with stress management techniques, physical exercise and a nicotine-based chewing gum. After six months 18 out of 30 heavy smokers had stopped smoking, and the remaining 12 had reduced their cigarette consumption.(ABSTRACT TRUNCATED AT 250 WORDS)

[The "Ashkelon" hypertension detection and follow-up program].

The program described aims at enhancing awareness of high blood pressure and other risk factors for cardiovascular disease (CVD) and promoting a healthy lifestyle. The study population consisted of 11,000 workers at worksites and visitors to community centers, aged 25-65 years. The program was carried out in cooperation with primary care clinics and non-pharmacological control of high blood pressure was by a community center for prevention of CVD. In 1980, 56.0% of hypertensives were unaware of their condition, while by 1988 this was reduced to 6.1%. Body weight reduction resulted in lowering of blood pressure which enabled cessation of all antihypertensive treatment in 25%. Deep muscle relaxation enabled cessation in 47%. The savings effected in terms of antihypertensive treatment outweight the total cost of the program 3-fold.

The antihypertensive effect of atenolol and bopindolol in the elderly.

The antihypertensive efficacy and tolerability of two betablockers: atenolol and bopindolol, was compared in a group of 30 elderly subjects aged 64.8 +/- 4.6 years. The daily dose of the two agents was relatively low. Atenolol 50-100 mg and bopindolol 0.5-1.0 mg sufficed to cause reduction of DBP to the target of less than or equal to 95 mm Hg, when applied as monotherapy. This was achieved in 75% of cases with bopindolol and in 93% of cases with atenolol. Atenolol, 50-100 mg/dd, lowered blood pressure from 173.7 +/- 13.2/103.7 +/- 3.0 (weekly) to 155.5 +/- 16.5/86.5 +/- 8.2 mm Hg (week 12) (P less than 0.005) while bopindolol, 0.5-1.0 mg, lowered blood pressure from 171.6 +/- 11.3/104.1 +/- 3.6 to 158.7 +/- 20.9/86.1 +/- 6.0 mm Hg (P less than 0.005). Heart rate was reduced from 80.5 (week 4) to 66.7 +/- 7.3 (week 12) by atenolol (P less than 0.0001), and from 83.7 +/- 11.8 (week 4) to 71.1 +/- 7.5 (week 12) by bopindolol (P less than 0.0001). Between treatment differences: comparisons yielded P values which were not sufficiently low to reject the null hypothesis of no difference between the two treatments. Well-being and short-term memory were not affected by either agent and tolerability of both drugs was good. These findings demonstrate that both bopindolol and atenolol are useful agents for control of hypertension in the elderly.

Dying: A universal human experience?

This paper explores the question, "Is there a universal psychological experience suffered by all dying persons?" a question to which the popular theory of Kübler-Ross presupposes an affirmative answer. Our answer takes three steps: first, a comparison between the Kübler-Ross model of dying and that of the late medievalBook of the Craft of Dying centered upon the five Kübler-Ross "stages"; second, a philosophical critique of the terms of this comparison; and third, a revised look at the alleged similarities between the two models, providing a deeper look at the moral and spiritual assumptions behind each.

Anton Boisen revisited.

Anton Boisen was both a psychologist of religion and a schizophrenic. His autobiography presents his "case history" but leaves many of his psychotic communications and experiences uninterpreted. This essay attempts to account for Boisen's most idiosyncratic psychotic products, drawing on theories of Jung and Bateson. Boisen and Jung both used experiences deriving from psychotic episodes to shape their subsequent life work. Boisen remained within liberal Protestantism, relinquishing his own "crazy" critique of Christianity developed during his mental illness. This critique is expressed through Boisen's notion of the "Family of Four", a plan for world renewal that he himself never adequately interpreted.