ISSN:0091-2700    

DOI:10.1177/009127009203200601

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

The hemopoietic growth factors are peptide hormones that are known to be responsible for the in vitro and in vivo proliferation of bone marrow progenitor cells into mature differentiated cells. These cytokines have had a major impact on the management of patients with cytopenias and have been extensively used as an adjunct to the management of patients with hematologic malignancies, with or without prior intensive chemotherapy. Other potential uses, being rigorously studied, include the potential mobilization of stem cells as well as recruitment phase‐specific cells into the cell cycle, thus providing a more sensitive environment for targeting specific chemotherapeutic agent

ISSN:0091-2700    

DOI:10.1177/009127009203200602

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

This article analyzes the development of the small group case conference format, historically, elsewhere, and at the authors' institution, as a way of introducing second‐year medical students enrolled in a basic pharmacology course to the practicalities, nuances, and challenges of contemporary drug therapy. A number of goals and purposes for these conferences have been identified and incorporated into the development and execution of a plan carried out over the past 14 years. Two examples of the conferences were presented, including an analysis of their teaching features. A listing of the general topics of 40 individual conferences used by the authors was provided. The authors reviewed evidence based on several methods of evaluation that the conferences are enthusiastically accepted by second‐year medical students as an adjunctive approach to teaching both basic and applied clinical pharmacology. In addition, the authors find that the conferences subserve a number of other teaching functions such as problem‐solving, information retrieval and presentation, and peer co‐instruction. The conferences provide a mechanism for faculty‐student interaction and an additional way to evaluate student knowledge and performance beyond the more conventional examination a

ISSN:0091-2700    

DOI:10.1177/009127009203200603

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

ISSN:0091-2700    

DOI:10.1177/009127009203200604

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Terazosin (Hytrin®; Abbott Laboratories, North Chicago, IL) is a new, selective alpha‐adrenoceptor blocking agent used on once‐a‐day basis for therapy of mild‐to‐moderate hypertension. Its pharmacologic properties are similar to those of prazosin. Terazosin however, differs from prazosin in that its water solubility is 25 times greater than that of prazosin and its elimination half‐life is about three times that of prazosin. Greater water solubility facilitates intravenous formulation, and longer half‐life allows once‐daily administration of terazosin. Terazosin is effective in lowering blood pressure and has a beneficial effect on plasma lipid profile. The major advantage of terazosin compared with prazosin, however, is its long duration of action. Terazosin is safe and effective when used in combination with diuretics and other antihypertensive agents, and in the long‐term treatment of patients with mild to moderate esse

ISSN:0091-2700    

DOI:10.1177/009127009203200605

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

For many decades, the casual blood pressure (BP) has been the standard for assessing BP response to antihypertensive agents in clinical trials. Noninvasive ambulatory BP technology has improved vastly in the last 15 years and has been increasingly used in dose‐response studies as well as efficacy trials. Through these studies we have learned that casual BP may not be representative of the average daily blood pressure, that it may be quite susceptible to observer bias, and that it may result in inaccurate calculation of the trough‐to‐peak ratio of an antihypertensive drug. Perhaps more importantly is that a large body of data now supports the superiority of average daily BP over that of the casual or clinic BP in predicting several indexes of hypertensive target organ damage. Thus, use of the ambulatory BP technique in antihypertensive trials yields BP data that are far less susceptible to improper diagnosis and are representative of the hypertensive burden that causes vascular di

ISSN:0091-2700    

DOI:10.1177/009127009203200606

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Hypertension is only one component of a multifaceted metabolic‐hemodynamic complex that also includes obesity, subtle and overt glucose intolerance, dyslipidemia, enhanced vascular resistance and accelerated atherosclerosis. Results of a number of studies in the past 5 years have shown that even nonobese, nondiabetic individuals with hypertension display insulin resistance, which is located in peripheral tissues (primarily skeletal muscle), is limited to nonoxidative pathways of glucose disposal, and appears to be directly correlated with the severity of hypertension. Insulin resistance and associated hyperinsulinemia in hypertensive individuals are also associated with increased plasma triglyceride levels and decreased high‐density lipoprotein concentrations, which likely contributes to enhanced atherosclerosis. Hyperinsuiinemia may directly promote atherosclerosis by enhancing LDL‐cholesterol accumulation in vessel walls, vascular smooth muscle migration, and proliferation, augmenting connective tissue synthesis in the vascular wall, and decreasing the regression of lipid plaques. The enhanced peripheral vascular resistance that characterizes insulin resistance/hyperinsu Jinemic states may be related to decreased vascular smooth muscle responses to insulin, which normally modulates (attenuates) vascular contractile responses to vasoactive a

ISSN:0091-2700    

DOI:10.1177/009127009203200607

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Cholestyramine is a nonabsorbable anion exchange resin that is used predominantly for the treatment of hypercholesterolemia in adults and the management of acute diarrhea in children. The authors report two cases of severe hyperchloremic nonanion gap metabolic acidosis associated with the use of cholestyramine therapy. The authors recommend that patients taking cholestyramine who have concomitant renal insufficiency or who are volume depleted or who are taking spironolactone be monitored carefully for the emergence of a hyperchloremic metabolic acidosis.

ISSN:0091-2700    

DOI:10.1177/009127009203200608

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

As part of a randomized, single‐blind, comparative study evaluating the efficacy of lovastatin and bezafibrate retard in the treatment of primary hypercholesterolemia, hemor‐heologic parameters (whole blood viscosity, hematocrit, plasma viscosity, red blood cell aggregation and de for mobility, and fibrinogen) were studied in 35 patients. Whole blood viscosity and plasma viscosity improved significantly after 3 months of treatment with lovastatin, whereas other hemorheologic variables remained unchanged. Stratifying 24 patients by their lipoprotein Lp(a) levels showed that in those with low Lp(a) (≤ 25 mg/dL) high‐density lipoprotein cholesterol increased and red blood cell aggregation as well as deformability decreased considerably, whereas in the group with high Lp (a) levels (>25 mg/dL), the opposite behavior was observed. Treatment of primary hypercholesterolemia with lovastatin may not only reduce the risk for atherosclerotic complications by its pronounced decrease of low‐density lipoprotein cholesterol, but also may favorably alter blood rheology, and may decrease insudation of plasmatic components into the arterial wall and improve tissue perfusion, in particular on the microcirculatory level. The possible relevance of Lp(a) levels for the hemorheologic effects of lovastatin remains to be e

ISSN:0091-2700    

DOI:10.1177/009127009203200609

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Dipyridamole stress thallium imaging has been widely employed to diagnose and assess the extent of coronary heart disease in patients who cannot exercise. When oral dipyridamole administration was used, a wide range of results for sensitivity, specificity, hemodynamic response and side effect profile has been reported. The authors hypothesized that the formulation used for oral administration of dipyridamole plays a major factor in this variability, and that the pulverized form of dipyridamole will achieve faster and more consistent response than the standard tablet form. The authors studied 13 consecutive patients who underwent thallium scintigraphy. Eight patients received dipyridamole pulverized and dissolved in a glycol/aqueous base diluent (group A), and jive patients received the standard form of dipyridamole (group B). In group A, mean peak systolic blood pressure decreased from 142 ± 31 (mean ± standard deviation) to 109 ± 30 (P = .05), and mean diastolic blood pressure decreased from 76 ± 14 to 51 ± 5. The mean heart rate changed from 78 ± 26 to 80 ± 10. In group B, baseline systolic blood pressure was 165 ± 12 and decreased to 156 ± 7 at 45 minutes and to 155 ± 14 at 90 minutes. Heart rate increased from baseline of 69 ±9 to 75 ±8 at 45 minutes and to 76 ± 11 at 90 minutes. At 45 minutes, the systolic blood pressure of the 8 group A patients dropped by 33 ± 19 mm Hg, whereas group B's changed by 9 ± 6 mm Hg (P<.005). The total dipyridamole dose used was significantly lower for group A as compared with group B (425 ± 66 mg and 800 mg, respectively; P<.0001). The time from start until thallium injection was shorter for group A (33 ± 7 minutes) as compared with 90 minutes for group B (P<.001). Sixty‐three percent of the patients who received the pulverized dipyridamole had a reversible perfusion defect on thallium imaging, but no patient had a positive study in group B. Side effects were observed in one patient receiving pulverized dipyridamole (13%), whereas 2 of 5 patients (40%) receiving tablets had side effects at 90 minutes and 4 of 5 patients (80%) had side effects between 90 and 180 minutes. The authors conclude that yield at thallium imaging with dipyridamole tablets is low, and late side effects appear high. Pulverized dipyridamole appears to be a sensitive provocative agent for thallium imaging with mild side effects ove

ISSN:0091-2700    

DOI:10.1177/009127009203200610

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY