摘要:

Eighteen patients with mild hypertension (diastolic blood pressure ≥ 90 and <104 mm Hg) and 15 normotensive control subjects were studied. Insulin tolerance tests (ITT) and fasting plasma insulin (FPI) level measurements were performed to evaluate insulin sensitivity. Insulin sensitivity, as measured with the ITT, showed a strong correlation with body mass index (BMI) in the hypertensive and control groups (r = −0.68, p < 0.01 and r = −0.61, p < 0.01, respectively). The fasting insulin levels also correlated significantly with BMI in both groups (r = 0.55, p < 0.05 in the hypertensive and r = 0.76, p < 0.01 in the control group). Insulin sensitivity in the hypertensive subjects whose BMI was ≤27.0 kg/m2(nonobese), as measured with the ITT and FPI, was not different from the nonobese normal controls (Kitt, 5.36 ± 1.74% min−1versus 5.61 ± 1.66% min−1, respectively, p > 0.2; FPI, 5.8 ± 3.4 μU/ml versus 7.1 ± 2.5 μU/ml, respectively, p > 0.2). Also, insulin sensitivity, as measured with the ITT, was not statistically significantly different between hypertensive and normotensive obese subjects (Kitt, 2.82 ± 1.55% versus 3.90 ± 0.67% min−1, respectively, p ≥ 0.1). When fasting plasma insulin levels were compared, a higher level was observed in the obese normotensive subjects than in the obese hypertensive group (FPI, 19.8 ± 10.0 μU/ml and 11.5 ± 4.9 μU/ml, p < 0.05). The obese hypertensive individuals had higher FPI levels and significantly lower Kittvalues than nonobese hypertensives (Kitt, 2.82 ± 1.55% min−1versus 5.36 ± 1.66, respectively, p < 0.01; FPI, 11.5 ± 4.9 μU/ml versus 5.8 ± 3.4 μU/ml, respectively, p < 0.05). The slope of the regression line between Kittand BMI (as obtained from regression analysis) was smaller in the control groups (-0.19) than in the hypertensive groups (−0.55).The slope between FPI and BMI, however, was of greater magnitude in the control groups: 1.41 and 0.84 (control and hypertensive groups, respectively).We conclude that in mild hypertension, insulin sensitivity is a function of the degree of adiposity and that a significant degree of insulin resistance was not present in our group of mildly hypertensive subjects.

ISSN:0002-9629    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The polymerase chain reaction, employing degenerate primers specific for the intramembrane domains III and VI of G-coupled receptors, was used to generate partial clones encoding those receptors carried by cultured rataorta smooth muscle cells. One clone, spanning the intramembrane domains IV-VI of a receptor specific for endothelin-1 (ET-R[A]), was used as a probe to screen a human placental cDNA library. The clone pL4–3, encoding a selective type of human endothelin receptor (ET-R[A]), has an open reading frame encoding a protein 427 amino acids in length, with a relative molecular weight of 48,625 daltons. The sequence analysis suggests the presence of a signal peptide, two potential sites for glycosylation in the N terminal extracellular domain, the seven transmembrane domains typical of G-protein receptors, and several potential sites for phosphorylation in the C terminal cytoplasmic domain. At the amino acid level, the human ET-R(A) shows 91% and 94% identity with the rat and bovine ET-R(A)s, respectively, and 59% similarity with the human ET-R(B).Xenopus laevisoocytes injected with the cloned cDNA express binding sites specific for endothelin-1. Expression of the message in COS 7 cells gave a membrane-bound product to which binding of the [125I]-ET-1 was inhibited by peptide analogues specific for ET-R(A).

ISSN:0002-9629    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

A prospective evaluation of lower airway bacteriology from intubated, mechanically ventilated patients was performed by comparing the qualitative and quantitative recovery of bacteria using four different techniques. Twelve intubated, mechanically ventilated patients who satisfied accepted clinical criteria for the suspicion of ventilator-associated pneumonia were studied. Airway secretions were obtained from each patient by: (1) blind endotracheal aspiration (ET); (2) Accu-cath pulmonary culture catheter (Accu); (3) bronchoscopic protected specimen brush (BPSB); and (4) bronchoalveolar lavage (BAL). ET specimens were cultured semiquantitatively (1+ to 4+) aerobically, and all other specimens were cultured quantitatively both aerobically and anaerobically. The BPSB recovered 9 organisms in ≥103colony forming units/ml, a standard number often used to indicate significant growth. Of these 9 organisms, 7 were recovered at ≥103cfu/ml by Accu, and 6 were recovered at ≥104cfu/ml by BAL. All 8 aerobic isolates recovered in ≥103cfu/ml by BPSB also were recovered by ET aspirate. Five of these were recovered in ≥3+ semi-quantitative growth by ET aspirate. Of 30 organisms recovered in <3+ semi-quantitative growth by ET aspirate, 28 were recovered in <103cfu/ml by BPSB, indicating a negative predictive value of 93%. Thus, it appears that these four methods provide reasonably similar qualitative and quantitative recovery of bacteria from the lower airways of intubated, mechanically ventilated patients. In addition, routine Gram's stain and semi-quantitative aerobic culture of endotracheal aspirate may provide useful information in patients with suspected ventilator-associated pneumonia.

ISSN:0002-9629    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

In vitro experiments with granular pneumocytes suggest that surfactant protein-A (SP-A) inhibits secretion of pulmonary surfactant. We examined whether SP-A inhibits surfactant secretion induced by lung distention during lung lavage. Human SP-A was obtained by lung lavage in a patient with pulmonary alveolar proteinosis. After centrifugation of the lavagate, the pellet was repeatedly washed with saline and then extracted with chloroform:methanol. The methanol:saline phase was separated and lyophilized to yield the SP-A product. SDS-PAGE and immunoblot analysis indicated that our preparation of SP-A had only minor contamination with human plasma proteins. To examine secretion, we used freshly killed newborn rabbit pups of 29.5 days gestation and lavaged the lungs by 10 sequential, fresh saline washes. Littermate neighbor pairs were lavaged with SP-A or human plasma protein at concentrations of 1, 6, 10, and 50 μg/ml, and disaturated phosphatidylcholine (DSPC) was analyzed as a marker for surfactant. The inhibition of surfactant secretion was maximal at a concentration of 10 μg/ml; the average yield by the last two pairs of washes, an index of surfactant secretion, was 286 ± 41 μg/g dry lung weight for SP-A, compared to 405 ± 37 μg/g dry lung weight for controls, an inhibition of 30% (p < 0.005). There were no changes in the volumes of returned lavage or in the concentrations of lactate dehydrogenase or DNA. To test whether SP-A increased cellular uptake of DSPC in the lungs, we prepared radioactive exogenous surfactant, lavaged it into the lungs, and monitored recovery of radioactivity by continued lavage. Recovery was the same in treated and control lungs. We conclude that SP-A may inhibit surfactant secretion stimulated by lung distention.

ISSN:0002-9629    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Two patients who received granulocyte colony stimulating factor (G-CSF) before or during radiotherapy are reviewed. Both patients developed granulocytopenia after multi-agent chemotherapy. One patient had breast cancer with multiple distant metastasis and received palliative radiotherapy to the spine and hip joint. The other patient had locally advanced anal carcinoma and received concurrent 5-fluorouracil, mitomycin, and radiation therapy. Both patients completed the planned course of radiotherapy without interruption, after administration of G-CSF.

ISSN:0002-9629    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The authors report on a patient with an undescribed constellation of lymph nodal plasmacytosis, perinodal epithelioid cell granulomas and fibrosis as well as anti-Sm and antiphospholipid antibodies. The illness does not meet the criteria of well-known nosologic entities, but it is thought to represent an unrecognized nosological entity within the group of undifferentiated immune disorders.

ISSN:0002-9629    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Severe hypertension frequently requires hospitalization. Although hospital admission is undesirable for most patients, others are motivated to achieve hospitalization status for secondary gain. The authors present a case of a prison inmate who simulated severe hypertension with a combination of Valsalva's maneuver and arm flexion, on the background of preexisting essential hypertension and mitral valve prolapse. His secondary intent—to avoid his prison duties—classifies him as a malingerer. The differences between this malingering and the psychiatric diagnosis of Munchausen syndrome are discussed. The contributions of essential hypertension and mitral valve prolapse to the self-induced blood pressure elevations also are considered.

ISSN:0002-9629    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Loxoscelism, or envenomation by the brown recluse spider, may result in necrotic lesions and systemic reactions, including hemolytic anemia. Histologically, it resembles a cutaneous Arthus reaction. The reaction mechanism involves interactions between complement, neutrophils, and the clotting system. It is best treated with analgesics, avoidance of early surgical debridement, and oral dapsone.

ISSN:0002-9629    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1992

数据来源: OVID