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Biomedical subjects

B Martina

Publications and source records attributed to B Martina.

At least 55 records · Page 3Linked to original sources
PubMed1996

Effects of cilazapril on vascular structure and function in essential hypertension.

Hypertension is associated with an altered design of resistance vessels and decreased endothelium-dependent vasodilator response to acetylcholine. A role of angiotensin II in both defects is suggested by animal experiments in which angiotensin-converting enzyme inhibition reverted structural and functional changes. We investigated the effects of 20 weeks of therapy with the angiotensin-converting enzyme inhibitor cilazapril (5 mg twice daily) on the endothelium-dependent response to brachial artery infusions of acetylcholine and the endothelium-independent vascular relaxation after sodium nitroprusside in 22 subjects with mild to moderate essential hypertension. In addition, we measured minimal forearm vascular resistance (ratio of mean arterial pressure and forearm blood flow after heating, ischemia, and ischemic exercise) as an indirect estimate of vascular structure. Cilazapril decreased blood pressure (151 +/- 14/99 +/- 7 mm Hg during placebo to 138 +/- 17/89 +/- 8 mm Hg after cilazapril treatment, P<.01) and baseline (42.2 +/- 12.6 to 37.1 +/- 10.6 U, P<.05) and minimal (3.0 +/- 1.1 to 2.4 +/- 0.7 U, 15.9 +/- 20.2%; P<.05) forearm vascular resistances. The change in minimal forearm vascular resistance was unrelated to age, duration of hypertension, or changes in blood pressure. Sodium nitroprusside increased forearm blood flow from 2.6 +/- 1.0 to 11.4 +/- 5.9 mL/min per 100 mL and acetylcholine to 21.5 +/- 17.8. Both responses did not change after cilazapril. The data provide indirect evidence that cilazapril therapy may improve vascular structure in human hypertension. The lack of relationship between vascular and blood pressure changes would be compatible with experimental evidence supporting a role for angiotensin II in the development and regression of vascular changes, but this needs further study. Therapy with cilazapril for 20 weeks, like other antihypertensive therapy, does not seem to influence endothelial vasodilator function in humans to a significant degree.

Adult↗
PubMed1995

[Prospective therapy study in differentiated thyroid carcinoma].

Controversy still exists regarding the appropriate treatment for differentiated thyroid carcinoma, i.e. the extent of surgery and the usefulness of prophylactic 131I thyroid ablation. However, the debate is nowadays confined to those patients who may be categorized as having a favorable prognosis with respect to tumor-related death or serious recurrence, and the point of discussion is essentially the optimal treatment to prevent curable recurrences. From the literature it may be deduced that patients with a node negative papillary tumor of stage I and II in the age-related TNM classification system, and patients with a minimally invasive follicular carcinoma, have an excellent prognosis with respect to survival and recurrence. In a prospective study during a 20-year period from one surgical and one pathological institution 136 consecutive patients were treated. Patients with an incidental pT1 N0 tumor, or with a stage I or II node negative papillary carcinoma, or with a minimally invasive follicular carcinoma respectively, had a reduced extent of treatment. This consisted in resection for the concomitant benign goiter (7%), hemithyroidectomy (32%), or total thyroidectomy without 131I ablation (18%). All other patients, including those with a node positive tumor in stage I or II, had total thyroidectomy and 131I ablation (43%). Patients with a multifocal tumor had total thyroidectomy with or without 131I ablation. Hemi- or total thyroidectomy was technically carried out by capsular dissection with identification of the parathyroids, as introduced by Kocher and Halsted. Peritracheal and -laryngeal nodes were regularly searched for, and functional neck dissection was done in node positive tumors. Total thyroidectomy was carried out by completion thyroidectomy in 29 (35%) of the 83 patients. 5 patients (7%) with papillary carcinoma, all in stage III or IV, and 5 patients (8%) with follicular carcinoma, all with a high degree of capsular angio-invasion, died from the tumor 6 months to 16 years after diagnosis. A further patient with a high degree follicular carcinoma is alive with residual disease. All these patients with an unfavorable course underwent total thyroidectomy and 131I ablation as initial therapy. Two patients with papillary carcinoma had a presumptively curable recurrence, namely, a node recurrence in a pT1 N1 tumor (following total thyroidectomy and radio-iodine ablation), and a contralateral recurrence after hemithyroidectomy in a pT2 N0 tumor in a young patient. In sum, in no case with an unfavorable course was a radical therapy omitted initially, and less than total thyroidectomy with 131I ablation (n = 77 [57%]) led to a (curable) recurrence in only one instance (1.3%).(ABSTRACT TRUNCATED AT 400 WORDS)

Adenocarcinoma, Follicular↗
PubMed1994

Nail fold capillaroscopy and echocardiography in mild-to-moderate hypertension treated with cilazapril plus hydrochlorothiazide: first results.

Essential hypertension is characterized by parallel and potentially reversible vascular and cardiac adaptations. In our study, capillaroscopy, echocardiography, and 24-h ambulatory blood pressure profiles were performed in 17 patients (aged 33-63 years; mean, 52 years) with mild-to-moderate hypertension. We measured morphological and hemodynamic parameters of capillary microcirculation as well as morphological echocardiographic parameters at baseline and after 6 weeks' treatment with 5 mg of cilazapril plus 12.5 mg of hydrochlorothiazide. Digital capillary blood flow measurements were assessed by nail fold video capillaroscopy. After 6 weeks of treatment with cilazapril plus hydrochlorothiazide, mean diastolic 24-h ambulatory blood pressure decreased from 98 +/- 6 to 85 +/- 7 mm Hg. Capillary blood cell velocity was 0.6 +/- 0.4 mm/s at baseline and increased to 0.6 +/- 0.4 mm/s. There were no significant changes in morphological capillaroscopic and echocardiographic parameters. In conclusion, we observed a trend toward higher capillary blood cell velocity as early as after 6 weeks of treatment with cilazapril plus hydrochlorothiazide in mild-to-moderate hypertension.

Administration, Oral↗
PubMed1994

Efficacy and tolerability of 5 mg of cilazapril plus 12.5 mg of hydrochlorothiazide in mild-to-moderate hypertension: results of 24-hour ambulatory blood pressure monitoring.

The efficacy and tolerability of a fixed combination of 5 mg of cilazapril and 12.5 mg of hydrochlorothiazide against hypertension was evaluated in 36 patients (26 men and 10 women) between 33-68 years old. Twenty-two had newly diagnosed hypertension and 14 had previously treated hypertension. Twenty-four-hour noninvasive ambulatory blood pressure monitoring (ABPM) was performed after a 2-week washout period. Measurements were taken at 20-min intervals during the day (from 8 a.m. to 10 p.m.) and at 30-min intervals during the night (from 10 p.m. to 8 a.m.). Patients with a mean diastolic daytime pressure of > or = 90 < 115 mg Hg were then given 5 mg of cilazapril plus 12.5 mg of hydrochlorothiazide once daily between 6 a.m. and 8 a.m. for 6 weeks. After this period, a second 24-h ABPM was performed. Office blood pressure measurements were taken at weeks -2, 0, 2, and 6. Routine laboratory blood samples were taken at weeks 0 and 6. Single blood pressure readings did not change significantly during the washout period (between weeks -2 and 0). The ABPM 24-h mean systolic pressure changed between weeks 0-6 from 143 +/- 13 to 126 +/- 11 mm Hg (p < 0.0001), and the mean diastolic pressure from 100 +/- 9 to 90 +/- 9 mm Hg (p < 0.0001). Twenty-eight patients (80) responded to treatment (response criteria: mean diastolic daytime pressure at week 6 < 90 mm Hg and/or a difference between weeks 0-6 > or = 5 mm Hg).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Intra-individual variations in triglyceride and total cholesterol levels in serum in mixed hyperlipidemia].

Swings in serum concentrations of total cholesterol and triglycerides were assessed retrospectively in 12 of 60 patients with mixed hyperlipidaemia (ten men, two women; mean age 44 [38-55] years). A second disease as a cause of the hyperlipidaemia had been excluded. Despite clinical stability and unchanged drug therapy the fasting values of triglycerides, measured enzymatically, in a minimum of four different samples (over several months) differed by more than 5 mmol/l, a mean of 16.6 (5-41.9) mmol/l. The lowest values were 2.7 (1.3-7.5) mmol/l, the highest 17.9 (6.4-44.6) mmol/l. Total cholesterol concentrations varied around 5.5 (1.6-31.7) mmol/l, minimal values 5.7 (4.2-8.9) mmol/l, maximal ones 12.0 (6.9-37.4) mmol/l. Six of the twelve patients consumed more than 60 g alcohol daily. The cause of the marked variations between individual samples is uncertain. Marked swings in triglyceride and total cholesterol concentrations are likely in mixed hyperlipidaemia. It is, therefore, essential to measure these concentrations repeatedly to assess correctly the diagnosis and treatment.

Adult↗
PubMed1993

Effects of angiotensin converting enzyme inhibition on endothelial vasodilator function in primary human hypertension.

Hypertension in animal models and in humans is associated with a decreased vasodilator response to acetylcholine which causes vascular relaxation by release of endothelium-derived relaxing factor from the endothelium. Since lowering of blood pressure, particularly with angiotensin converting enzyme inhibitors, improved the response to acetylcholine we investigated the effects of brachial artery infusions of ascending dosages of acetylcholine on forearm blood flow before and after 5 months of therapy with the angiotensin converting enzyme inhibitor, cilazapril, in 10 patients with mild to moderate primary hypertension. Cilazapril decreased blood pressure from 150.8 +/- 14.4/98.9 +/- 4.3 mmHg during placebo to 138.8 +/- 15.6/88.6 +/- 8.9 mmHg (P < 0.01). Brachial artery acetylcholine infusions increased forearm blood flow from 2.95 +/- 1.5 to a maximum of 22.8 +/- 11.5 ml.min-1.100 ml-1 forearm tissue and decreased forearm vascular resistance from 48.1 +/- 34.1 to 6.9 +/- 6.9 units before cilazapril. This response did not change after cilazapril therapy. Our findings in patients with primary hypertension, therefore, do not support the concept that angiotensin converting enzyme inhibition influences endothelium-dependent vascular relaxation to acetylcholine to a significant degree. Whether this lack of effect on endothelial vasodilator function is specific for the vascular bed chosen for study or whether it represents a fundamental difference between animal models and human hypertension remains an important issue to be clarified.

Acetylcholine↗
PubMed1992

[Stress-induced bundle-branch block].

We present two patients with exercise-induced bundle branch block (BBB), in which coronary heart disease could not be diagnosed by noninvasive techniques. Exercise-induced BBB (right BBB more than left BBB) is strongly associated with and requires intensive search for coronary heart disease.

Aged↗
PubMed1992

[Long-term follow-up after thyroidectomy: incidence of recurrent goiter and functional results].

We analyzed the postoperative longterm results after strumectomy for sporadic goiter in 26 patients. The follow-up time was 25.1 +/- 14.7 (7-58) years (x +/- SD, extremes). Actual goiter recurrence without need for surgery was observed and sonographically confirmed in 3 patients, and 1 patient without actual recurrence had had a second strumectomy for goiter recurrence in the past. Hence the overall frequency of goiter recurrence in this study is 15% (4/26 patients). The patients with a present recurrence (n = 3) were significantly younger at the time of operation (29 +/- 11, 14-41 years) than those without recurrence (n = 23; 45 +/- 11, 28-60 years; p < 0.001). No patient had clinical endocrine dysfunction. Only four patients had been treated with thyroxine and they all suppressed TSH in the presence of euthyroid FT4 and T3 levels without present recurrence of goiter. 22 patients had no thyroid hormone prophylaxis and in only four of them (18%) was observed a recurrence in the longterm follow-up without endemic iodine deficiency. Prophylaxis with thyroid hormones often is not required in low risk patients operated upon and carefully controlled after strumectomy from non-iodine-deficient regions. Patients at risk for recurrence (second strumectomy, family history, elevated TSH, clinical or sonographic evidence for thyroid growth) should be considered for thyroxine therapy with regular follow-up.

Adolescent↗
PubMed1992

[Anti-arrhythmia treatment using L-carnitine in acute myocardial infarct].

Carnitine, a quaternary amine (3-hydroxy-4-N-trimethylaminobutyric acid), plays an important physiologic role in fatty acid transport and metabolism as well as in energy production of the myocardial cell. L-carnitine in high doses has been postulated to have an antiarrhythmic effect and this has also been clinically proven. We studied 20 patients with acute myocardial infarction (AMI), 4-12 hours after onset of pain. The patients were randomized and treated double-blind with 5 g L-carnitine (n = 12) or placebo (n = 8) at hours 0, 12, 24, 36, and with 2 x 3 g on days 3 to 7 by intravenous infusion over 2 hours. The two groups were similar for age, sex, infarct site, maximum CPK and conventional antiarrhythmic therapy. 24-hour Holter-ECG was performed on days 1, 2 and 7 and showed no significant difference between the two groups with respect to incidence of ventricular premature beats (VPB) per hour. On the second day following AMI, however, only 4 of 12 carnitine-treated patients showed high-grade VPB (Lown IVa and IVb), in comparison with 7 of 8 patients in the placebo group. The difference is significant: p = 0.028 (Fisher's Exact Test). Carnitine was well tolerated and the efficacy demonstrated on the second day following AMI must be interpreted with caution.

Aged↗
PubMed1992

[Extrasystole following heart transplantation].

A 43 year old man developed extensive supraventricular and ventricular extrasystoles (over 500 supraventricular extrasystoles per hour, VES class II) within 3 months after orthotopic heart transplantation because of dilatative cardiomyopathy. At the same time severe graft rejection (class III according to Billingham) was documented. After treatment of the rejection the following three controls by 24 hours Holter EKG showed only slight supraventricular extrasystoles of less than 10 per hour and in three consecutive myocardial biopsies no rejection process requiring additional treatment was found. In individual cases severe ventricular arrhythmia registered by the family doctor may be a first hint for early rejection. Since intervals for inpatient controls have been extended observation of extrasystoles may be helpful for initiation of a next inpatient control. Incidence of extrasystoles after heart transplantation in the cyclosporine-era is discussed.

Adult↗
PubMed1989

[Prospective therapy study of differentiated thyroid cancer].

During a 15-year period (1973-1988) a consecutive series of papillary (n = 52) and follicular (n = 48) thyroid carcinomas was prospectively selected, on the basis of a clinico-pathologic and prognostic classification, for 1. non-total thyroidectomy, mostly hemithyroidectomy (n = 37), 2. total thyroidectomy (n = 19), or 3. total thyroidectomy and radioiodine (n = 44), together with exogenous suppressive thyroxine therapy in most patients. Patients with an occult or with an intrathyroidal, single papillary carcinoma without nodes, and microangioinvasive follicular carcinoma were often treated by non-total thyroidectomy or without radioiodine. During the follow-up period of 1-15 (7 +/- 4) years 5 recurrences (nodes n = 4, pulmonary n = 2) and 3 deaths occurred. Seven out of the 8 patients (age 58-76 years) had total thyroidectomy and radioiodine as initial treatment of an intrathyroidal papillary (n = 1), an extrathyroidal papillary (n = 3), and of an angioinvasive follicular (n = 4) carcinoma, respectively (no radioiodine in 1 patient). The study confirms that the outcome may be favourable in selected patients following hemithyroidectomy or without radioiodine treatment. Recurrences or death occurred in some biologically unfavourable tumors despite total thyroidectomy and radioiodine; the relatively frequent total thyroidectomy (73% of the patients) and radioiodine (51%) may have contributed to the disease-free course in the remaining patients.

Adenocarcinoma↗