摘要:

The effects of enalapril alone and in combination with the cyclooxygenase inhibitors sulindac and indomethacin on blood pressure (BP), plasma aldosterone, renin activity and converting enzyme activity were evaluated in 29 patients with mild to moderate essential hypertension, 26 of whom had low plasma renin activity. Patients were randomly assigned to one of three treatment groups. All patients underwent a 4-week placebo phase (phase I), then received enalapril (20 mg BID) for 4 weeks (phase II). In phase III, group I (n = 10) continued on enalapril alone; group II (n = 9) received sulindac 200 mg BID plus enalapril, and group III (n = 10) received indomethacin 50 mg BID plus enalapril, all for 4 weeks. Enalapril lowered BP significantly (mean supine BP 149/100 in phase I vs. 134/90 in phase II,p< 0.05) without inhibiting aldosterone production. The BP effect was not blunted by concomitant administration of sulindac or indomethacin. Enalapril lowered converting enzyme activity to 25% to 30% of baseline and tended to increase renin activity. In the 10 patients who received indomethacin (group III), the effects of enalapril alone and enalapril plus indomethacin on urinary excretion of 6-keto prostaglandin F1α(PGF1α, a stable metabolite of prostacyclin (PGI2), were examined. Enalapril increased urinary 6-keto PGF1αin group III from 118 ± 23 to 194 ± 38 ng/g creatinine (p< 0.05), while addition of indomethacin reduced 6-keto PGF1αto basal levels (138 ± 26 ng/g creatinine). There was no significant correlation between the fall in blood pressure and the increase in 6-keto PGF1αexcretion in enalapril-treated patients. These data indicate that the antihypertensive effect of enalapril in essential hypertension occurs in the absence of an active renin-angiotension system and is associated with increased excretion of 6-keto PGF1αbut is not blunted by cyclooxygenase inhibitors. These findings indicate (1) enalapril administration is associated with enhanced prostacyclin production in this patient group but (2) the antihypertensive action of enalapril is not critically dependent on prostacyclin, since blockade of prostacyclin production with a cyclooxygenase inhibitor does not blunt the antihypertensive effect of the drug.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Children have frequent staphylococcal infections, and many lack antibody to TSST-1, a toxin associated with the toxic shock syndrome (TSS). To determine why there have been no nonmenstrual cases of TSS reported in children in Utah, the authors testedS. aureusisolated from children for TSST-1 by radial immunodiffusion and sera from other hospitalized children by radioimmunoassay for antibody to TSST-1. TSST-1 was produced by 25% ofS. aureus. Fifty-two children had infections with toxin producing strains. None had TSS. The prevalence of presumably protective levels of antibody (⩾1: 100) was high in newborns (80%), declined until age 2 years and then gradually increased with age. Therefore, there may have been about 20 children with toxigenic infection who lacked protective antibody but did not show the usual features of TSS. We conclude that the rarity of TSS in children is not caused by misdiagnosis, underreporting, or the absence of toxigenic strains or susceptible patients. Additional factors, such as local conditions or duration of carriage, may influence the clinical presentation of infection with TSST-1 producing staphylococci.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Blood, pH and bicarbonate were examined in 40 normal subjects and in 53 patients with anemia. Included were 28 patients with thalassemia, 18 with aplastic anemia and seven with iron deficiency anemia. Mean increases in pH of 0–0.04 and decreases in HCO3of 2.3–3.5 mEq/L were observed. Changes were not significantly affected by the degree of erythropoiesis or by the severity of the anemia and were essentially the same in the three groups of patients studied. Typical changes of a mild, uncompensated alkalosis were also produced on four occasions in one transfused thalassemic patient.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The muscular makeup of the sprint-trained athlete may make him especially susceptible to severe lactic acidosis from cocaine-induced seizures. Because of a high percentage of glycolytic muscle fibers (compared to the muscle fiber type of the endurancetrained athlete), the lactic acidosis and heat generated from muscular activity is much greater in the sprint-trained athlete than in the endurance-trained athlete. The role of cocaine in producing seizures and increasing glycolysis, both of which produce lactic acidosis, is discussed. The hypothesis is presented that the elite athlete may be at greater risk of death than the general population from lactic acidosis produced as a result of cocaine-induced seizures.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Aliquots of the same serum sample from 10 proven and 10 probable cases of primary hyperparathyroidism (1†HPT) and 25 of hypercalcemia of malignancy (HCM) were sent to two different laboratories for C-terminal or midmolecule and N-terminal immunoreactive parathyroid hormone (iPTH) assays and total serum calcium measurements. Elevations in iPTH were observed in 70% to 95% of 1†HPT and 13% to 46% of HCM cases. There was a good correlation among the assays in the 1†HPT group. A significant correlation was found only between the C-terminal and N-terminal assays from the same laboratory in the HCM group. Only one (5%) of 20 1†HPT patients had normal iPTH in all assays while only one (4%) of 25 HCM patients had elevated iPTH in all assays. This study shows that currently available assays for iPTH can detect elevations in most patients with 1†HPT and can discriminate them from HCM. When renal function is impaired an N-terminal assay can still discriminate.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Mild hyperuricemia in patients with essential hypertension reflects early renal vascular involvement. This report describes a retrospective analysis of 28 patients with unilateral renal arterial disease and hypertension who underwent surgical treatment. Following surgical repair of the arterial lesion: systolic pressure decreased from 188 ± 25 to 146 ± 21 mm Hg (p<0.001); diastolic pressure decreased from 108 ± 4 to 87 ± 6 mm Hg (p<0.001), and serum uric acid and creatinine concentrations decreased from 7.0 ± 1.1 to 6.1 ± 1.4 mg/dL and from 1.3 ± 0.3 to 1.0 ± 0.3 (p<0.02 andp<0.03, respectively). The reduced serum potassium levels, reflecting hyperaldosteronism, increased after surgical treatment (p<0.003). The 28 patients were classified in three groups according to previous therapy: group I (14 patients) had been treated with a centrally active adrenergic agonist or a beta adrenergic receptor blocking agent; group II (7 patients) had been treated with a diuretic, and group III (7 patients) had never received antihypertensive therapy. Serum uric acid concentrations were similar in each of the three groups and decreased significantly in each group after correction of the renal artery stenosis. These data strengthen our previous observations and further suggest that serum uric acid concentration may be useful as an index of renal vascular involvement in hypertension.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A retrospective study of the clinical course and outcome of patients with serum digoxin concentrations (SDCs) greater than 3 ng/mL was conducted to determine the probability of a patient without initial signs or symptoms of digoxin toxicity subsequently developing signs or symptoms. Of 123 patients with SDCs greater than 3 ng/mL, 54 had no apparent signs or symptoms of toxicity at the time the index SDC was determined (group 1). Of these 54, two patients developed definite digoxin toxicity, although neither suffered significant morbidity. Digoxin administration was reduced or discontinued in all patients but one in group 1. There were no significant differences between the patients who had no signs or symptoms of digoxin toxicity (group 1) and those who did have signs or symptoms (group 2) in the mean SDC (3.9 ± 0.1 vs. 4.2 ± 0.2 ng/mL, respectively), the serum creatinine (2.9 ± 0.2 vs. 3.4 ± 0.4 mg/dL), or the incidence of atrial fibrillation (29/54 vs. 35/69) and coronary artery disease (21/54 vs. 18/69). The authors conclude that clinically stable patients receiving digoxin who have elevated SDCs but are without signs or symptoms of digoxin toxicity are at low risk of developing serious digoxin toxicity and do not generally require treatment beyond the discontinuation of digoxin therapy.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Cardiovascular risk factors in childhood are related to arterial wall changes that lead to atherosclerotic coronary artery disease in later life. Atherosclerosis begins early in life. The observations of early arterial wall connective tissue changes and accompanying early lipid deposition show the importance of understanding cardiovascular risk factors in children. Since risk factors found in childhood are potentially predictive of adult coronary heart disease, methods for prevention of atherosclerosis should begin in children. Rational strategies should be directed to removing atherogenic forces that work in a child at high risk. Primary prevention of atherosclerosis has its maximal potential when begun before advanced irreversible lesions can occur. Consideration needs to be directed to how cardiovascular connective tissue changes and lipid and calcium deposition can be modulated in the injury and healing processes. It is important to recognize that adult coronary artery disease is really a major pediatric problem.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A female patient had sarcoidosis of the thyroid and Hashimoto's thyroiditis. This seems to be the first report in which these two histological conditions were concomitantly present.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A 14-year-old girl with chronic idiopathic thrombocytopenic purpura (ITP) presented in relapse with a platelet count of 1,000/μUL and a high-level serum antiplatelet IgG antibody. She previously had been unresponsive to courses of therapy with steroids, vincristine, and splenectomy. When treatment with danazol and purified immunoglobulins was unsuccessful in controlling her rapidly progressive course, an 8-day plasma exchange procedure was initiated in combination with platelet transfusion therapy and immuno-suppression with cyclophosphamide and vincristine. Within 2 days, her clinical state improved markedly, correlating with a drop in her serum antiplatelet antibody level. She continued to improve and was discharged on a regimen of cyclophosphamide and danazol. Her antiplatelet antibody level had fallen to within the normal range, despite a typical platelet count of 5,000/μL during the 8-day period. Two weeks later her platelet count rose to 65,000/μL. This case suggests that a course of therapeutic plasma exchange may have a temporizing role in the acute management of life-threatening chronic ITP relapse, generating time for the more definitive therapy of immunosuppression to take effect.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID