Biomedical subjects
J Chodakowska
Publications and source records attributed to J Chodakowska.
[Case of isolated pulmonary amyloidosis].
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[Does hormonal activity of pheochromocytoma affect long-term prognosis in surgically treated patients?].
89 patients were operated upon for pheochromocytoma. 61 patients (37 women and 24 men) were available for follow-up. Mean age at operation was 39 +/- 12.3 yrs. Before operation paroxysmal and sustained hypertension were observed in 34 (55.7%) and 27 (44.3%) patients, respectively. Postoperatively permanent normalization of blood pressure was achieved in 38 cases (62.3%). All patients were divided into four groups. Group I with increased urine excretion of noradrenaline (NA) and adrenaline (A) consisted of 19 (31.1%) patients. Group II (increased NA excretion) included 27 (44.3%) patients. Group III comprised 3 (4.9%) cases with elevated A excretion. 12 (19.7%) patients with normal urinary excretion of catecholamines and increased excretion of methoxycatecholamines were alloted to group IV. Permanent normalization of blood pressure predominantly was observed in group IV--91.6%, whilst in group I, II and III this hypotensive effect was noted in 57.9%, 51.8% and 2/3, respectively. Permanent normalization of blood pressure can be mainly expected in patients with pheochromocytoma in whom catecholamines are rapidly inactivated within the tumor.
[Effect of long-term prazosin treatment on certain humoral and metabolic factors in patients with primary hypertension].
An effect of the long-term prazosin therapy on sympathetic activity, renin plasma activity and beta-endorphin and lipid blood levels was investigated in 23 patients with the primary arterial blood hypertension. Group A included 18 patients treated with prazosin, and group B - 5 patients treated with prazosin combined with propranolol. Mean daily dose of prazosin in group A was 3.0-10.0 +/- 1.3 mg in different phases of therapy whereas in group B mean daily dose of prazosin was 3.0-6.5 +/- 1.8 mg and propranolol 50-80 mg. Significant decrease in diastolic and systolic blood pressure (p < 0.01) was achieved in both groups. Additionally significant decrease in pulse rate (p < 0.01) was seen in group B. It was found that prazosin produced significant increase in plasma noradrenaline in group A and decrease in 4-hydroxy-3-methoxyglycol excretion with the urine (p < 0.05) in both groups. Moreover, negative correlation between a decrease in blood pressure (diastolic) and noradrenaline excretion with the urine (p < 0.05) was noted in group A. No effect of prazosin therapy on plasma renin activity, beta-endorphin and lipids blood levels was observed in both groups. These results suggest that prazosin therapy in patients with the primary blood hypertension exerts an effect on sympathetic activity and does not change plasma renin activity or blood beta-endorphin and lipids levels.
[Evaluation of the usefulness of certain localization methods in diagnosis of pheochromocytoma].
Localization tests including TC-scans, scintigraphy with 131I-radiolabelled metaiodobenzylguanidine and ultrasound have been performed in 68 patients with diagnosed pheochromocytoma. Diagnosis was based on clinical symptoms and increased catecholamines and/or their metabolites excretion with the urine. Proper diagnosis with CT-scans was 97%, scintigraphy--92%, and ultrasound--93%; false negative results in scintigraphy amounted to 8% (3 patients) and 5% (3 patients) in case of ultrasound. CT-scans were free of such errors. False positive diagnosis was made in 2 (3%) patients with CT-scans and in 1 (2%) patient tested with ultrasound. These results suggest that pheochromocytoma may be precisely localized with non-invasive techniques, especially CT-scans.
[Test with clonidine for diagnosing pheochromocytoma].
Noradrenaline, adrenaline and mean arterial pressure prior to and 3 hours after clonidine administration were evaluated in order to assess a value of single dose of 0.3 mg clonidine in the diagnosis of pheochromocytoma. The study involved 12 patients with pheochromocytoma, 17 patients with arterial hypertension, and 9 patients with borderline hypertension. Seven healthy volunteers served as a control group. It was found that clonidine decreased noradrenaline levels in all healthy subjects and patients with the primary blood hypertension and did not affect noradrenaline levels in patients with pheochromocytoma. Clonidine decreased noradrenaline levels in two patients with normal resting noradrenaline levels. Simultaneously, clonidine decreased noradrenaline levels in two patients with normal resting levels of this catecholamine. The obtained results indicate low specificity of the clonidine test and its value in the diagnosis of pheochromocytoma in patients with normal noradrenaline blood levels.
[Blood pressure in patients after unilateral adrenalectomy for aldosterone producing adrenal adenoma].
Forty five patients (35 women and 10 men) who underwent adrenalectomy for aldosterone-producing adrenal adenoma were followed up for 5.7 +/- 4.7 years (1-17 years). Stable normalization of blood pressure was noted in 27 (60%) patients. In 16 patients the primary hypertension and in 1 patient the second adrenal adenoma were diagnosed after surgery. Statistically significant decrease in daily excretion of adrenaline and noradrenaline with the urine, reduced adrenaline/noradrenaline ratio and reduced catecholamines and their metabolites ratio were noted in the operated patients in comparison to healthy volunteers indicating catecholamines metabolism disorders. Surgical treatment of adrenal adenoma besides normalization of blood pressure diminishes biochemical abnormalities. Development of the primary blood hypertension may be expected in some patients.
[Blood level of free serotonin, catecholamines and the renin-angiotensin-aldosterone system in patients with primary hypertension].
Two subgroups of patients were selected out of those dialysed for chronic renal failure. Group A included patients without arterial hypertension before dialysis, and group B patients with arterial hypertension before dialysis. Blood endogenous digoxin-like substance (DLS) has been assayed. Its blood levels were not increased in hypertensive patients either before or after dialysis. No correlation was found between DLS and mean arterial pressure in the whole group of patients with chronic renal failure. The obtained results do not suggest that arterial blood pressure in patients with chronic renal failure is related to the presence of DLS in the blood.
[Effect of isradipine on urinary excretion of catecholamines and their metabolites in patients with pheochromocytoma].
An effect of calcium antagonist-isradipine-on catecholamines and their metabolites excretion with the urine in 4 patients with pheochromocytoma has been analysed. It was found that the excretion of OFFnoradrenaline and vanilaminomandelic acid is reduced. It may indicate inhibitory effect of calcium antagonists on catecholamines secretion in patients with pheochromocytoma.
[Pseudo-pheochromocytoma].
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[Malignant pheochromocytoma].
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[Effect of long-term treatment with guanfacine on selected humoral metabolic indices in patients with primary hypertension].
An effect of the treatment with guanfacine on the activity of the adreno-sympathetic system, beta-thromboglobulin, beta-endorphin, and blood lipids was studied in 30 patients with the primary arterial blood hypertension. It was found that guanfacine significantly decreases plasma noradrenaline, adrenaline, and dopamine. Moreover, it decreases the excretion of noradrenaline, adrenaline and 4-hydroxy-3-methoxy-phenylglycol. These effects correlate with the drop in both systolic and diastolic blood pressure. A decrease in plasma renin activity was also observed. It correlated with the blood pressure drops. Guanfacine increased beta-endorphin levels while beta-thromboglobulin, total cholesterol and triglycerides levels remained unaffected. The authors suggest that the hypotensive effect of guanfacine is related to the decrease in adreno-sympathetic system activity and plasma renin activity and no effect on the erythrocyte activity and lipids metabolism.
[Effect of treatment with enalapril maleate on the levels of circulating catecholamines, beta endorphins, prostaglandins, and concentration of sodium in erythrocytes in patients with essential hypertension].
An effect of enalapril maleate on the activity of renin-angiotensin-aldosterone system and sympathetic reactivity, erythrocyte prostaglandin and sodium levels as well as blood beta-endorphin was investigated in 28 patients with the essential arterial blood hypertension. It was found that enalapril maleate significantly increased plasma renin activity, decreased plasma norepinephrine and its 24-hour excretion, and decreased erythrocyte beta-endorphin and sodium levels. Blood epinephrine and aldosterone levels and their daily excretion remained unchanged similarly to prostaglandins. The above results suggest that a decrease in sympathetic system activity and intracellular sodium concentration may play a role in the hypotensive action of enalapril maleate related to the inhibition of angiotensin II formation.
[Value of localizing examinations used in the diagnosis of primary hyperaldosteronism].
Localizing examinations were performed in 115 patients with the clinical and biochemical signs of the primary hyperaldosteronism between 1975 and 1978. Adenoma of the adrenal cortex was diagnosed in 52 examined patients out of whom 42 underwent surgery, and 12 were classified for the operation. The remaining patients, in whom a cause of hyperaldosteronism was not found, are treated conservatively and followed-up. It was shown that CT-scanning and scintigraphy of the suprarenal cortex are the most convenient techniques in the localization of tumours in patients with the primary hyperaldosteronism. Ultrasound is less valuable diagnostically but may help in tumour localization in about 50% of patients.
[Prazosin in the preoperative management of patients with phaeochromocytoma].
The use of prazosin--a drug selectively blocking alpha-adrenergic receptors--was considered for the preoperative management of patients with phaeochromocytoma. Prazosin was administered to 8 patients in whom the diagnosis was established basing on the clinical symptoms and daily excretion of catecholamines and their metabolites with the urine. Preliminary diagnosis was subsequently confirmed operationally. Prazosin could be considered effective only in the part of treated patients. This was manifested by the drop in blood pressure to nearly normal values and diminished attacks. However, prazosin did not prevent blood pressure increase during anaesthesia and surgery. The use of prazosin in patients with phaeochromocytoma for preoperative management may be an alternative pharmacological therapy producing appropriate drop in blood pressure in some patients.
[Advances in the pharmacological treatment of arterial hypertension].
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[Effect of cigarette smoking on arterial blood pressure and selected humoral indicators in healthy persons and in patients with primary arterial hypertension].
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Tissue catecholamine concentrations in spontaneously hypertensive rats.
Tissue concentrations of noradrenaline (NA), dopamine (DA) and adrenaline (A) were compared in spontaneously hypertensive (SHR) and normotensive (NCR) rats, aged 1, 3, 8, 14 and 24 weeks The organs analyzed included the brain, subdivided into prosencephalon and rhombencephalon, heart, adrenal glands and kidney. Brain catecholamines were significantly lower in SHR than in NCR, and the difference appeared already at the age of 3 weeks. Concomitant increase was found in the adrenal NA and A concentrations of the SHR. Concentration of NA in the heart decreased in the SHR following onset of hypertension. It is concluded that the diminished NA, DA and A concentrations in the brain as well as the augmented adrenal NA and A levels in the SHR may be causally related to the development of hypertension, while the heart NA level reflects the secondary, hypertension -- related changes.