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Biomedical subjects

G Y Lip

Publications and source records attributed to G Y Lip.

At least 91 records · Page 5Linked to original sources
PubMed2001

Management of hypertension in pregnancy.

Hypertension is an important cause of both maternal and fetal morbidity and mortality in pregnant women. There are still no definitive guidelines as to when and how patients should be treated, but it is important that appropriate treatment is initiated early in patients at highest risk and they are closely monitored. Hypertension in pregnancy can be a difficult condition to diagnose and treat because of the numerous and differing classification systems that have been used in the past. One classification system, which accounts for the multisystem involvement which can occur in pre-eclampsia and eclampsia, divides hypertension in pregnancy into 3 main groups: pre-eclampsia, gestational hypertension and chronic hypertension. Little benefit to the fetus has been shown from treating gestational and chronic hypertension, but studies in this area have been small and would not have had the power to show a difference in outcome between treated and untreated groups. However, the reduction in morbidity and mortality in the treatment of pre-eclampsia is significant. Therefore, all pregnancies complicated by hypertension require monitoring to detect the possible onset of superimposed pre-eclampsia/eclampsia. Institutions should have a management strategy for those mothers with severe hypertension including a multidisciplinary approach, where the patient is to be monitored and which antihypertensive agents are to be used. It should not be forgotten that the definitive treatment for severe hypertension is delivery of the fetus despite risks to fetal morbidity and mortality. This will reduce blood pressure, but hypertension per se may still persist post partum requiring short term therapy.

Antihypertensive Agents↗
PubMed2001

Measurement of free and complexed soluble vascular endothelial growth factor receptor, Flt-1, in fluid samples: development and application of two new immunoassays.

Vascular endothelial growth factor (VEGF) mediates endothelial cell mitogenesis and enhances vascular permeability. VEGF interacts with the endothelium via two membrane-spanning receptors, fms-like tyrosine kinase (Flt)-1 and kinase domain receptor. A soluble form of Flt-1 (sFlt-1) was isolated from endothelial cell media; however, its biological significance is still unknown, with limited data on plasma sFlt-1 levels in disease states. We have developed two new ELISAs for detecting free and VEGF-complexed sFlt-1, which were tested in accordance with standard validation and assessment methodologies employed in commercial settings. The intra-and inter-assay coefficients of variation are <5% and 10% respectively, and results are highly reproducible. Applying these ELISAs in a clinical setting, we measured levels of VEGF, free and complexed sFlt-1 in citrated plasma from 40 patients with cardiovascular disease and 40 healthy controls. Median (interquartile range) plasma levels of VEGF in patients were significantly greater than controls [403 pg/ml (158--925 pg/ml) versus 113 pg/ml (33--231 pg/ml), P< or =0.05]. Free sFlt-1 was significantly lower in patients compared with controls [8 ng/ml (2--22 ng/ml) versus 21 ng/ml (10--73 ng/ml), P< or =0.05]. There was no significant difference in the levels of complexed sFlt-1 between the two groups. Plasma levels of VEGF-complexed sFlt-1 are minimal, despite the presence of excess free sFlt-1. Thus unbound plasma VEGF detected by ELISA may represent the majority of circulating VEGF, and justifies the measurement of plasma VEGF as an indicator of circulating VEGF levels. Furthermore, these results suggest that circulating sFlt-1 may serve as a selective inhibitor of VEGF activity, and that this regulatory mechanism may be altered by pathological conditions.

Aged↗
PubMed2001

A prospective study of changes in patients' quality of life after aortic valve replacement.

BACKGROUND AND AIM OF THE STUDY: After aortic valve replacement (AVR), 90% of survivors are in NYHA class I or II, and most return to work after three months. It is unclear, however, whether at that time patients have an improved quality of life (QOL), are able to perform physical and social activities, and live independently. METHODS: To assess this situation, 62 patients (39 males, 23 females; mean age 68.5 +/- 10 years) who underwent primary AVR completed the validated Short Form 36 (SF-36) questionnaire. QOL parameters were determined before and three months after surgery prospectively, and analyzed using the Wilcoxon matched pairs rank test. RESULTS: All patients showed significant improvement in all eight QOL parameters (score 0-100): (i) physical function (67 +/- 26 versus 37 +/- 28; p <0.00001); (ii) role limitation due to physical function (52 +/- 43 versus 20 +/- 37; p <0.0001); (iii) social function (80 +/- 25 versus 59 +/- 30; p <0.0001); (iv) role limitation due to emotional problems (64 +/- 41 versus 41 +/- 46; p = 0.01); (v) energy (62 +/- 22 versus 42 +/- 23; p <0.00001); (vi) mental health (78 +/- 19 versus 63 +/- 22; p <0.00001); (vii) pain (78 +/- 27 versus 67 +/- 32; p = 0.02); and (viii) general health perception (72 +/- 20 versus 58 +/- 21; p <0.00001). Significant improvements in QOL parameters were: (i) after mechanical and bioprosthetic AVR, seven of eight QOL parameters were improved; (ii) patients aged < 70 years had pronounced improvement in six of seven parameters, while those aged > or = 70 years had limited improvement in five of eight parameters; (iii) patients with valve sizes 19 and 21 mm improved in five of eight parameters, while those with > or = 23 mm implants improved in all eight parameters, regardless of post-AVR peak gradient of < 20 or > or = 20 mmHg; and (iv) patients with left ventricular end-diastolic dimension (LVEDD) < 55 mm improved in all eight parameters while those with LVEDD > or = 55 mm improved in only five parameters. CONCLUSION: There was significant improvement in patients' QOL at three months after AVR, regardless of the type of aortic implant used; improvement was greatest in those aged < 70 years. The results also suggest that patients with smaller implants (who were older) and those with LVEDD > or = 55 mm were less likely to show significant improvement in all QOL parameters at three months after AVR.

Adult↗
PubMed2001

Unstable angina following acute MI in a patient with bilateral coronary artery fistulae: an unusual presentation of coronary steal?

We report a 57-year-old woman with acute myocardial infarction and cardiac arrest who subsequently developed unstable angina. The possibility of a coronary steal syndrome contributing to her unstable angina arises in view of the presence of bilateral coronary artery fistulae between two atherosclerotic coronary arteries and the main pulmonary artery.

Acute Disease↗
PubMed2001

Increased platelet glycoprotein V levels in patients with coronary and peripheral atherosclerosis--the influence of aspirin and cigarette smoking.

As platelet hyperactivity is important in atherosclerosis and smoking, we hypothesized higher levels of soluble platelet membrane glycoprotein V (gpV) in 95 patients with peripheral artery disease (PAD) and 92 with coronary artery disease (CAD) compared to 99 healthy controls, and examined the effects of aspirin and of smoking two cigarettes on soluble gpV and platelet function. Soluble gpV (ELISA) was significantly raised in, but not between, both PAD and CAD patients, compared to controls (p < 0.05). In multivariate analysis, systolic blood pressure, smoking and atherosclerosis (all p < 0.01) were significant influences on soluble gpV in the whole study cohort. There was a weak correlation between soluble gpV and another platelet marker, soluble P selectin (p = 0.048). Acute smoking in 14 subjects increased platelet aggregability and beta-thromboglobulin, but not soluble gpV: there were no changes in 11 non-smokers. Five days consumption of aspirin (325 mg daily) by 14 subjects did not influence levels of soluble gpV. Our data indicate that soluble gpV may be a useful new marker of platelet activation in atherosclerosis, but may be influenced by smoking status and blood pressure.

Adenosine Diphosphate↗
PubMed2001

The impact of coronary heart disease in determining use of hormone replacement therapy in a general practice population.

The use of hormone replacement therapy (HRT) for cardiovascular risk reduction remains uncertain. Although previous epidemiological surveys have suggested a clear benefit and nearly 50% mortality risk reduction with HRT in postmenopausal women, recent randomised trials have largely failed to support this. The epidemiological surveys may have been biased in a number of ways including the possibility that HRT users in these studies may have been healthier and taken a greater interest in modifying cardiovascular risks. The aim of the present study was to determine to what extent the revelations from all these trials have influenced HRT prescribing in general practice, in relation to cardiovascular disease. We reviewed 140 women on HRT and 140 age-matched controls from one city centre general practice in the west of Birmingham who were randomly selected by computer. The main indication for HRT use was presence of symptoms associated with oestrogen deficiency. The prevention of osteoporosis accounted for 7.1% of HRT indications, while the primary prevention of CHD was not an issue discussed by either the patient or the GP. Among non-users, 86.4% did not have a known contraindication and many did not have serum lipid measurements or estimations of cardiovascular risk. There was no difference between HRT users and non-users for smoking habits and presence of cardiovascular risk factors including diabetes, hypertension and coronary heart disease. HRT users were also less likely to undergo investigations, such as cervical smear tests and mammograms. In conclusion, this survey reflects the current uncertainty surrounding the use of HRT for cardiovascular risk prevention. Importantly, women on HRT may not be any healthier than non-users, nor do they seek more preventive care than non-users. This is contrary to previous presumptions that selection and prevention bias were the explanation for the apparent cardioprotective effects of HRT.

Adult↗
PubMed2001

New pharmacological strategies for the treatment of heart failure.

Heart failure still carries a high morbidity and mortality, necessitating new approaches for its management. Greater understanding of the pathophysiology of heart failure has opened the way for novel therapeutic approaches, including analogs of natriuretic peptides and drugs that modulate endothelin, cytokine release and endothelial vasoconstriction. Other drugs are undergoing laboratory and clinical trials that will eventually supersede or complement less optimal heart failure treatments. Clinical trials will ascertain if these new strategies in the treatment of heart failure will ultimately be successful in the management of these patients.

Adrenergic beta-Antagonists↗
PubMed2001

YM-337. Yamanouchi.

Yamanouchi in collaboration with Protein Design Labs (PDL), is developing YM-337, a humanized antibody (C4G1) for the potential treatment of coronary artery disease, including myocardial infarction, arterial thrombosis and ischemic stroke. The antibody is based on a Yamanouchi murine antibody specific for the glycoprotein (GP) IIb/IIIa receptor found on human platelets 11942421. By June 1999, Yamanouchi was carrying out phase II trials on YM-337 in high-risk percutaneous transluminal coronary angioplasty (PTCA) patients in Europe and the US [326891]. These were ongoing in May 2001 [409092], [411763]. Phase II trials for the potential treatment of ischemic stroke were also underway by this time in Europe and the US [411763]. By 1998, Yamanouchi and PDL had an agreement for the development of a SMART C4G1. Yamanouchi holds exclusize worldwide rights to YM-337 and is responsible for all clinical trials and obtaining regulatory approval. As part of the collaboration, PDL has received milestone payments for humanization of the antibody and is entitled to receive royalties on product sales [274540].

Animals↗
PubMed2001

Darusentan (Abbott Laboratories).

Abbott (formerly Knoll) is developing darusentan, an endothelin A antagonist, as a potential treatment for congestive heart failure (CHF) [398274]. The compound entered phase II trials in December 1998 [310187]. In a model of monocrotaline-induced pulmonary hypertension, darusentan (50 mg/kg/day), significantly reduced right ventricular systolic pressure, and in a canine model of CHF chronic treatment for 2 weeks significantly reduced left ventricular end diastolic pressure, mean pulmonary artery pressure, and right atrial pressure. Darusentan is a selective antagonist in vitro (ET(A): K(i) = 1.4 nM; ET(B): K(i) = 184 nM) [339872].

Journal Article↗
PubMed2000

Effect of degree of blood pressure on the hypercoagulable state in chronic atrial fibrillation.

To investigate the hypothesis that higher levels of blood pressure would further promote the hypercoagulable state in atrial fibrillation (AF) by increasing the degree of hemostatic abnormalities, we studied 82 consecutive patients with chronic nonvalvular AF who were not taking antithrombotic therapy. Patients with AF had higher levels of plasma fibrin D-dimer, von Willebrand factor, and fibrinogen than controls in sinus rhythm, and no differences between tertiles of either systolic, diastolic, or mean blood pressure were found, suggesting other mechanisms may be contributing to the hypercoagulable state in AF.

Aged↗