Increases in atrial natriuretic peptide after delivery and in the puerperium.
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Adult↗
Biomedical subjects
D Clement
Publications and source records attributed to D Clement.
Relation between mortality and treated blood pressure in elderly patients with hypertension: report of the European Working Party on High Blood Pressure in the Elderly.
OBJECTIVE: To investigate the relation between mortality and treated systolic and diastolic blood pressures. DESIGN: Randomised double blind placebo controlled trial. Mortality in the two treatment groups was examined in thirds of treated systolic and diastolic blood pressures. PATIENTS: 339 And 352 patients allocated to placebo and active treatment, respectively. The groups were similar at randomisation in sex ratio (70% women), mean age (71.5 years), blood pressure (182/101 mm Hg), and proportion of patients with cardiovascular complications (35%). MEASUREMENTS AND MAIN RESULTS: In the placebo group total mortality rose with increasing systolic pressure whereas it had a U shaped relation with diastolic pressure, the total lowest mortality being in patients in the middle third of the distribution of diastolic pressure. In the group given active treatment total mortality showed a U shaped relation with systolic pressure and an inverse association with treated diastolic pressure. In both groups cardiovascular and non-cardiovascular mortality followed the same trends as total mortality. The increased mortality in the lowest thirds of pressure was not associated with an increased proportion of patients with cardiovascular complications at randomisation or with a fall in diastolic pressure exceeding the median fall in pressure in each group. In contrast, patients in the lowest thirds of pressure showed greater decreases in body weight and haemoglobin concentration than those in the middle and upper thirds of pressure. CONCLUSIONS: In patients taking active treatment total mortality was increased in the lowest thirds of treated systolic and diastolic blood pressures. This increased mortality is not necessarily explained by an exaggerated reduction in pressure induced by drugs as for diastolic pressure a U shaped relation also existed during treatment with placebo. In addition, patients in the lowest thirds of systolic and diastolic pressures were characterised by decreases in body weight and haemoglobin concentration, and the patients in the lowest thirds of diastolic pressure taking active treatment also by an increased non-cardiovascular mortality, suggesting some deterioration of general health.
Aged↗
Isradipine in essential hypertension: the Belgian General Practitioners' Study.
Over 200 hypertensive patients were recruited by 37 general practitioners into a single-blind 12-week study to assess the efficacy, tolerability, and safety of isradipine as an antihypertensive, alone and in combination with guanfacine. A total of 212 patients were given isradipine at doses of 1.25 and 2.5 mg twice daily. Twelve hours after the last dose, diastolic blood pressure was reduced to no more than 90 mm Hg in 52.6 percent of patients treated with isradipine alone. After eight weeks of treatment, 30 percent of patients were also given guanfacine 1 mg daily. By Week 12, 67.6 percent of the patients had attained normotension. Compared with placebo, side-effect frequency was higher for flushing and edema with isradipine, and dry mouth was more frequent with added guanfacine. Electrocardiographic examinations and routine laboratory determinations showed no clinically relevant changes. These data indicate that isradipine as monotherapy and in combination with guanfacine is an effective antihypertensive agent. Most patients will continue to participate in a two-year follow-up involving bimonthly clinical visits and half-yearly electrocardiographic examinations and laboratory determinations.
Adrenergic alpha-Agonists↗
Hepatitis B-associated polyarteritis nodosa in Alaskan Eskimos: clinical and epidemiologic features and long-term follow-up.
We analyzed the demographic, clinical, laboratory and histologic features of 13 patients who were diagnosed as having polyarteritis nodosa associated with hepatitis B virus infection over a 12-year period, 1974 to 1985. All 13 patients were Yupik Eskimos and resided in southwest Alaska, an area hyperendemic for hepatitis B virus infection. The annual incidence of hepatitis B virus-associated polyarteritis nodosa for this population is 7.7 cases per 100,000 population. All patients presented with multisystem disease, and all had biopsy or angiographic findings consistent with polyarteritis nodosa. All 13 were positive for hepatitis B surface antigen and hepatitis B e antigen at diagnosis. Two untreated patients and two of five patients who received corticosteroids died, vs. none of six who received corticosteroids plus cyclophosphamide. None of the patients who survived the initial bout of polyarteritis nodosa has relapsed after a mean follow-up of 55 months, but all have become chronic HBsAg carriers. In eight patients, clinical or serologic evidence indicated that polyarteritis nodosa followed recent hepatitis B virus infection. We concluded that hepatitis B virus-associated polyarteritis nodosa is a serious, life-threatening complication that occurs early in the course of hepatitis B virus infection, is ameliorated by immunosuppressive therapy and can be prevented by hepatitis B vaccine.
Alaska↗
Endocarditis from a dental focus. Importance of oral hygiene in valvar heart disease.
Fastidiously growing bacteria more and more are recognised as a source of infectious endocarditis. Over recent years, three new cases of endocarditis caused by Actinobacillus actinomycetemcomitans were diagnosed in our institution. The rise in frequency is possibly secondary to better laboratory skills. Two patients with Actinobacillus (Haemophilus) actinomycetemcomitans endocarditis presented the classical history of preexisting valvar disease together with poor dental hygiene. The third patient had no congenital or rheumatic preexisting lesion to the valves. The distal part of a ventriculo-atrial drainage device had caused microtrauma to the tricuspid valve. The right-sided endocarditis in this patient was complicated by pulmonary septic emboli. Dental origin of the infection was very likely in this patient too. No dental procedure had been performed in the months preceding the endocarditis of our three patients. They presented endocarditis with an oral microorganism in the absence of any dental manipulation. All three had very poor dental hygiene. Better dental care could possibly have prevented this serious complication.
Actinobacillus Infections↗
Interplay and interference of the carotid baroreceptors, central command, ergoreceptors on the peripheral vascular responses during static exercise.
1. The aim of the present study was to examine the influence of the carotid baroreceptors on the peripheral vascular responses during static exercise and its interference with the 'central command' and the ergoreceptors. 2. Ten healthy subjects performed an isometric handgrip with 30% of maximal voluntary contraction for 1.5 min. Five seconds prior to the end of the exercise the arterial circulation to the exercising forearm muscles was occluded for 1.5 min. The carotid baroreceptors were stimulated by neck suction at -40 mmHg for 0.5 min in each period, and also during control and recovery phase. Contralateral forearm and calf blood flow were measured simultaneously with ECG-triggered venous occlusion plethysmography. 3. The present findings suggest that there are 'central command' and ergoreceptors which modulate carotid baroreflex function to the afferent output to the heart and the peripheral circulation.
Adult↗
Ablation of ventricular tachycardia of right ventricular origin with low energy shocks.
Three shocks of 2 joules (2,000 volts within 0.3 msec) were given to a patient with ventricular tachycardia of right ventricular origin at the site of the earliest activation. A standard 6 Fr USCI mapping catheter was used. After the first shock the cycle length prolonged from 385 to 531 msec. After the second shock, the tachycardia was no longer inducible and it remained so after 1 week. No recurrences were seen during a follow-up period of 8 months. This is the first report demonstrating efficacy of modified low energy shocks for ventricular tachycardia.
Electric Countershock↗
Plasma tissue plasminogen activator levels in patients with coronary heart disease.
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Coronary Angiography↗
Diuretics--a risk in the long-term treatment of hypertensive patients?
The trial of the European Working Party on High blood pressure in the Elderly (EWPHE) revealed an overall decrease in cardiovascular mortality and morbidity in the actively treated patients. They received as first-line drugs a combination of hydrochlorothiazide and triamterene; methyldopa was added as necessary. The present post hoc analysis examined the effect of the diuretic treatment on cardiovascular events, both when given alone and in conjunction with methyldopa, by calculating the relative hazard rates (RHR) for cardiovascular mortality and morbidity. Using the Cox proportional hazard model, compared with placebo, a 34% reduction in cardiovascular mortality in the intention-to-treat analysis was demonstrated in the diuretic (hydrochlorothiazide and triamterene) group with an RHR of 0.66 and a 95% confidence interval (CI) of 0.44-0.97; the 16% decrease in the group treated with diuretics and methyldopa was not significant (RHR, 0.84; 95% CI, 0.56-1.25). The effect of treatment in the latter combined group became significant (RHR, 0.62; 95% CI, 0.40-0.95) when all cardiovascular study terminating events were considered; they were reduced by 38%. No effect of treatment on mortality from all causes was detected.
Aged↗
[Infections caused by Campylobacter fetus].
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Aged↗
The influence of transdermal glyceryl trinitrate on peripheral circulation in healthy subjects and in patients with congestive cardiac failure.
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Administration, Cutaneous↗
Chyle: a masquerading etiology of pericardial effusion.
A 25-year-old man with massive pericardial effusion is presented. The high lymphocyte amount and cytological analysis of the aspirated fluid suggested tuberculous or malignant pericarditis. The chylous nature of the effusion was only recognized after hemipericardiectomy, when reaccumulation of fluid into the pleural space appeared. This was successfully managed by medium chain triglyceride diet.
Adult↗
Acute oligohydramnios in postdate pregnancy.
The evaluation of amniotic fluid volume plays a major role in antepartum fetal surveillance. Although the definition of diminished amniotic fluid volume varies, this sign is considered by itself an indication for intervention in the near-term fetus. The interval of testing is predicated on the concept that amniotic fluid volume diminishes slowly (unquantified) as a result of developing hypoxia. We present six postterm pregnancies in which amniotic fluid volume diminished abruptly over 24 hours. Although one fetus died, the three babies delivered by cesarean section and the two babies delivered after a 2-day labor did well, despite obvious postmaturity syndrome, meconium staining, and variable decelerations. Apgar scores in the survivors were above 8, and pH results failed to confirm hypoxia. These data suggest the need to better understand the mechanisms regulating amniotic fluid volume.
Acute Disease↗
Restrictive cardiomyopathy caused by adipositas cordis.
Adipositas cordis is a very rare disorder, characterized by fatty infiltration of myofibers. It has been related to dilated or hypertrophic cardiomyopathy and obesity. In this report, however, we present a non-obese patient, presenting with a restrictive syndrome and showing massive infiltration of adipocytes in the interventricular septum, proving adipositas cordis.
Cardiomyopathies↗
Comparative trial of lisinopril and nifedipine in mild to severe essential hypertension.
A total of 136 patients with mild to severe uncomplicated essential hypertension were evaluated in a multicenter, randomized, double-blind, double-placebo, parallel study to compare the effect of lisinopril, a new angiotensin-converting enzyme inhibitor, with that of nifedipine. Following a 2-week placebo control period the patients were treated with either 20-80 mg/day of lisinopril (n = 89) or with 40-80 mg/day of nifedipine (n = 47). Blood pressure was significantly reduced in both groups after 4, 8, and 12 weeks of treatment. There was no difference in the effect of lisinopril compared to nifedipine. No serious clinical or laboratory adverse experiences were observed during the study. The incidence of clinical side effects was significantly lower in the lisinopril group than in the nifedipine group (21.3 vs. 48.9%, p less than or equal to 0.01). There were no significant changes in laboratory data in either group. The results indicate that lisinopril is as effective as nifedipine in the treatment of uncomplicated essential hypertension and that lisinopril is well tolerated and has an acceptable safety profile.
Angiotensin-Converting Enzyme Inhibitors↗
Bromocriptine in an injectable retard form for puerperal lactation suppression: comparison with Estandron prolongatum.
Intramuscular injection of a single 50-mg dose of long-acting bromocriptine microspheres was compared with a single intramuscular dose of an estradiol/testosterone ester combination in a single-blind, randomized study of 54 subjects. Bromocriptine was significantly more effective than the steroid drug in preventing milk flow, and rebound lactation was not observed in any bromocriptine-treated patients. Neither group showed deleterious side effects or significant biologic changes in coagulation parameters. There were no blood pressure or electrocardiographic alterations. Postpartum prolactin suppression was more intense after bromocriptine administration than after steroid therapy.
Adult↗
Efficacy of antihypertensive drug treatment according to age, sex, blood pressure, and previous cardiovascular disease in patients over the age of 60.
Results of the European Working Party on High Blood Pressure in the Elderly (EWPHE) trial have been analysed in relation to age, sex, blood pressure, and previous cardiovascular disease. Cardiovascular mortality and the cardiovascular study-terminating events were significantly and independently related to treatment, age, cardiovascular complications at randomisation, and systolic but not diastolic blood pressure. The benefits of treatment observed in the trial seemed to be independent of entry blood pressure and the presence or absence of cardiovascular complications at entry. There was some evidence that treatment effect decreases with advancing age. Little or no benefit from treatment could be demonstrated in patients over the age of 80 years, the great majority of whom were women.
Age Factors↗
Ventricular tachycardia during exercise treated by verapamil.
The case history of two patients with symptomatic ventricular tachycardia is described. The first patient with systolic narrowing of a segment of the left anterior descending artery did not show any improvement on class I and III antiarrhythmic drugs. Oral verapamil suppressed the arrhythmia which showed some features of triggered activity. Cessation of the drug resulted in symptomatic recurrence. The second patient presented with a sustained ventricular tachycardia showing the morphology of right bundle branch block and left axis deviation. During electrophysiologic study the tachycardia was not inducible after oral verapamil. No definite conclusion on the mechanism of the arrhythmia could be drawn, nor on the mechanism of the antiarrhythmic action of verapamil in the first patient. Appropriate techniques to prove the efficacy of verapamil are needed in patients when it is given for chronic treatment of ventricular tachycardia.
Adult↗