摘要:

The southeastern United States has the highest occurrence of heart disease and stroke and among the highest rates of congestive heart failure and renal failure in the country. The Consortium for Southeastern Hypertension Control (COSEHC) is cooperating with other organizations in implementing initiatives to reduce morbidity and mortality from hypertension-related conditions in the southeastern United States. This article outlines for clinicians special consideration for implementation of the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) in the southeastern United States. Clinicians are encouraged to adapt the recommendations of JNC VI to their own patient groups, paying attention to these specific areas: (1) Ensure screening for hypertension in your practice and community. (2) Evaluate all patients for accompanying risk factors and target organ damage. (3) Promote lifestyle management for individual patients and populations for prevention and treatment of hypertension. (4) Set a goal blood pressure for each patient, and monitor progress toward that goal. (5) Recognize that many patients will be candidates for blood pressure goals of <130/85 mm Hg. (6) Pay attention to compelling and special indications such as diabetes, congestive heart failure, and renal dysfunction. (7) Consider combination therapy. (8) Maximize staff contributions to enhance patient adherence. (9) Encourage patient, family, and community activities to promote healthy lifestyles and blood pressure control.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A high burden of hypertension-related cardiovascular disease remains an unfortunate hallmark in the southeastern United States (also known as the Stroke Belt). A convergence of factors related to aging, systolic blood pressure (BP), and hypertension control rates indicate that the Southeast burden will remain and probably increase well into the next century unless strategic initiatives are undertaken soon. More specifically, systolic BP, which is a major independent risk factor, increases as a function of age, whereas diastolic BP reaches a plateau. Given a selective immigration of elderly residents from other areas of the country, the Southeast is “aging” more rapidly. Thus, isolated systolic hypertension (ISH), which carries a very high relative risk, is likely to increase at a faster rate in the Southeast than in other areas of the U.S. Moreover, control rates for systolic BP are poorer than for diastolic BP. Hypertension control rates are also lower in elderly people than in younger patients with hypertension. In the absence of a paradigm shift in medical practice, control rates will decline as the prevalence of ISH rises in an aging population. The health and economic implications of an inadequate response to this challenge are imposing, particularly for the Southeast. On a positive note, the emerging recognition of systolic BP as a significant risk factor may lead to more appropriate recognition and higher rates of treatment and control. Randomized, controlled clinical trials have clearly established that treatment reduces BP in the elderly patient with ISH and combined systolic-diastolic hypertension. Moreover, treatment dramatically reduces hypertension-related cardiovascular complications among elderly patients with hypertension. In summary, the Southeast will lead the aging of the nation into the next century. The implications of this large demographic shift are likely to worsen rather than reduce the relative burden of cardiovascular disease in the Stroke Belt. Thus, a high priority should be given to the recognition, treatment, and control of systolic hypertension in the Southeast.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Hypertension and end-stage renal disease (ESRD) constitute a major health threat to Puerto Ricans in the United States and in the Commonwealth. In the Hispanic population of the United States, Puerto Ricans seem to have a worse health status than Mexican- and Cuban Americans. Poverty, language, and lack of education increase the risk of less-than-adequate diagnosis and treatment of hypertension. In the Commonwealth, hypertension is a common problem. Deaths caused by heart disease continue to increase on the island. Although the health care system in Puerto Rico continues to improve, changes in diet, increased social stress, and the high prevalence of diabetes mellitus and obesity may add to the increased death rate from cardiovascular causes. The incidence and prevalence of ESRD in Puerto Rico is as high as in the United States; however, diabetes mellitus seems to be the primary diagnosis in a larger number of patients with ESRD than in the U.S. Preventive and control measures must be urgently taken by public health officials to minimize the impact of these disorders in thehealth of Puerto Ricans.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

As with other G protein-coupled receptors, type I angiotensin II receptors (AT1R) are plasma membrane-associated receptors that bind an extracellular agonist and initiate signal transduction pathways that mediate the physiologic actions elicited by the peptide. After agonist binding, AT1R undergo endocytosis and, after intracellular ligand dissociation, the receptors recycle to the plasma membrane. There are data from a variety of cell types suggesting that internalization of AT1R may be involved in activating a subset of angiotensin II-mediated signaling pathways. The evidence for active cytoplasmic and nuclear angiotensin II receptors is also reviewed. These studies suggest that internalization of peptide and receptor may be a necessary step for the transmission of the full range of cellular responses produced by angiotensin II.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background:Taste and smell dysfunction has been reported to occur in patients with a variety of clinical problems. We wanted to investigate a specific group of patients in whom taste and smell dysfunction occurred putatively related to a specific biochemical abnormality in a salivary growth factor [gustin/carbonic anhydrase (CA) VI] considered responsible for maintenance of taste bud function.Methods:Eighteen patients developed loss and/or distortion of taste and smell after an acute influenza-type illness. They were evaluated clinically, by psychophysical tests of taste and smell function, by measurement of parotid salivary gustin/CAVI by a radioimmunoassay and by measurement of serum, urine, and salivary zinc. Biopsies of circumvallate papillae were obtained in 6 patients and examined by transmission electron microscopy. Similar studies were performed in 55 asymptomatic volunteers with biopsies of circumvallate papillae performed in 4.Results:Taste and smell acuity were impaired in patients compared with healthy volunteers and parotid gustin/CAVI, salivary, and serum zinc concentrations were lower in patients than in healthy volunteers. Taste buds in circumvallate papillae of patients exhibited severe vacuolization, cellular degeneration, and absence of dense extracellular material.Conclusions:These results describe a clinical disorder formulated as a syndrome of hyposmia (decreased smell acuity), hypogeusia (decreased taste acuity), dysosmia (distorted smell function), dysgeusia (distorted taste function), and decreased secretion of parotid saliva gustin/CAVI with associated pathological changes in taste bud anatomy. Because gustin/CAVI is found in humans only in parotid saliva and has been associated with taste bud growth and development these results suggest that inhibition of synthesis of gustin/CAVI is associated with development of taste bud abnormalities and thereby loss of taste function.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background:We previously described a disorder in 18 patients with decreased parotid saliva gustin/carbonic anhydrase (CA) VI secretion associated with loss of taste (hypogeusia) and smell (hyposmia) and distorted taste (dysgeusia) and smell (dysosmia). Because gustin/CAVI is a zinc-dependent enzyme we instituted a study of treatment with exogenous zinc to attempt to stimulate synthesis/secretion of gustin/CAVI and thereby attempt to correct the symptoms of this disorder.Methods:Fourteen of the 18 patients with this disorder completed the study. They were treated with 100 mg of exogenous zinc daily for 4 to 6 months, in an open clinical trial. Both before and after treatment, measurements were obtained of parotid saliva gustin/CAVI, parotid saliva, serum and urine zinc, taste and smell function, and, in some patients, examination of circumvallate taste buds by electron microscopy.Results:Treatment success was predicated upon significant increases in parotid saliva gustin/CAVI. This occurred in 10 of the 14 patients who were labeled responders; they also exhibited improvement in taste and smell acuity, a diminution in dysgeusia and dysosmia and increased zinc concentrations in parotid saliva, serum, and urine. Taste bud morphology returned to normal in each responder in whom it was measured. No increase in gustin/CAVI occurred in 4 patients who were labeled nonresponders; they exhibited no improvement in taste or smell acuity and no increases in parotid saliva zinc. However, serum and urine zinc increased to levels similar to those measured in the 10 responders. Two of 4 nonresponders reported diminution in dysgeusia and dysosmia. Taste bud morphology did not change from the abnormal state in the 1 nonresponder in whom it was measured.Conclusions:Zinc treatment is effective in patients in whom this trace metal increases synthesis/secretion of gustin/CAVI and ineffective in those in whom it does not. Increased gustin/CAVI in this disorder is probably associated with zinc stimulation of the gene responsible for the synthesis/secretion of gustin/CAVI. Among nonresponders, zinc was ineffective for several possible reasons, including resistance to zinc and possible sialylation of gustin/CAVI, which may render it functionally ineffective. Results suggest the hypothesis that gustin/CAVI is a trophic factor that promotes growth and development of taste buds through its action on taste bud stem cells.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A 55-year-old man was admitted to our hospital because of bilateral leg lymphedema. He also showed subcutaneous nodules and CT scan disclosed multiple enlarged lymph nodes at thoracic, abdominal, and inguinal areas. Biopsy of the inguinal lymph node and the subcutaneous nodule revealed noncaseating epithelioid cell granuloma, a finding consistent with sarcoidosis. Lymphedema was attributed to the blockade of lymph flow by the systemic lymph node involvement of the disease. Within 1 week after the initiation of steroid therapy, his leg edema disappeared. Lymphedema could be the initial symptom of systemic sarcoidosis.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Topical anesthetic drugs are widely used by clinicians during hospital and outpatient procedures and are also available to the public in a variety of over-the-counter preparations. Although generally safe, they may cause potentially life-threatening methemoglobinemia. We describe a patient who developed repeated episodes of severe methemoglobinemia after administration of topical Cetacaine spray (a proprietary mixture of benzocaine, tetracaine, and butamben) employed for pharyngeal anesthesia before endotracheal intubation, and briefly review the etiology and pathophysiology of this disorder. Cautious interpretation of oxyhemoglobin saturation values obtained by pulse oximetry or estimated from arterial blood gas analysis is crucial lest the diagnosis of severe methemoglobinemia and the resulting hypoxemia are overlooked. If necessary, the condition is usually readily corrected by intravenous administration of methylene blue.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background:Of the 13 reported cases of hypercalcemia associated with fungal infection, 1 was caused byCryptococcus neoformansand probably mediated by increased levels of 1,25-dihydroxyvitamin D [1,25(OH)2D]. Eight others were associated withCoccidioides immitis, of which only 2 had measured 1,25(OH)2D levels; in both, they were diminished. We report a patient with human immunodeficiency virus infection and simultaneousC immitisandC neoformanspneumonia andC immitisfungemia associated with hypercalcemia.Methods:Consecutive measurements of serum total and ionized calcium, phosphorous, blood urea nitrogen, creatinine, 25(OH)D, 1,25(OH)2D, parathyroid hormone (PTH), parathyroid hormone-related protein (PTHrp) and albumin were performed over a period of 46 months.Results:While the patient was hypercalcemic, intact serum PTH and PTHrp were undetectable, serum 25(OH)D levels were normal, and serum 1,25(OH)2D levels were in the high normal range. Successful treatment of theC immitisandC neoformansinfections resulted in resolution of the hypercalcemia and increase of PTH and PTHrp to the normal range.Conclusion:In some patients with HIV infection, coincident hypercalcemia, and severe fungal infection, the responsible factor may be 1,25(OH)2D. Although total serum levels of this compound may not be frankly elevated, they are inappropriately high for the circumstances. Free 1,25(OH)2D levels should be determined in this situation.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID