[Moderate systolic hypertension in elderly subjects. Results of a 10-year longitudinal study].
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Biomedical subjects
Publications and source records attributed to J F Henry.
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Basal plasma dopamine (DA), Norépinephrine (NE) and Epinephrine (E) were determined in controls (n = 15) essential hypertension (n = 19) and Pheochromocytoma (n = 9). Plasma NE was significantly higher in essential hypertension than in control and in 5 cases, plasma NE or E was 3 SD above mean control values. In 8/9 pheochromocytomas DA, E or NE were significantly elevated. In 1 case, catecholamine levels were within normal range during normotensive period. When a provocative glucagon test (1 mg I.V) was performed in controls, there was no change in blood pressure DA and NE levels, but a significant increase in plasma E 2.5 and 5 min. after injection. Similar results were obtained in 8/10 cases of labile hypertension. However in 2 cases plasma NE or E increased significantly without elevation in blood pressure. In 3/4 pheochromocytomas under normotensive phase, blood pressure and plasma catecholamines increased significantly; however in 1 case, no change was observed.
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The pharmacokinetics of amitryptyline (AMI) have been evaluated in six healthy elderly volunteers (72-83 years of age) after a single dose of 125 mg of AMI-HCl. AMI was absorbed rather slowly (mean peak time 10.4 +/- 1.6 hrs) but very efficiently (F: 0.59-0.75). The rate of formation of nortriptyline (NT) as well as the appearance clearance values (0.18-0.45 l/h/kg) of AMI were significantly lower than those previously described for younger subjects. Reversible alterating ECG were observed in 5 cases concomitantly with AMI peak plasma concentrations. The results indicate the desirability of reduced and/or divided daily doses of AMI in the elderly.
A case of acute renal failure associated with halothane-induced hepatitis is reported which responded to treatment. The possible mechanisms of rare disease association are discussed and precautions advised.
Authors have studied 9 parathyroid carcinomas under electron microscope (3% of their parathyroid lesions). Two types of the ultrastructural features were significant: 1) architectural: basal membrane abnormalities, sparse desmosomes, absence of nerve fiber; 2) cytological: nuclei atypism and abnormal mitochondria in tumors cells resembling dark chief cells. Also noticed were signs of cell hyperactivity and/or trouble in parathormon production or regulation.
The tolerance and anti-hypertensive activity of nicergoline, an alpha-adrenoceptor blocking agent, were studied in 28 hypertensive subjects older than 65 years (mean age: 84 years). The trial was conducted double-blind: 14 subjects were given nicergoline 30 mg/day divided into 6 doses ("lyocs"), and 14 subjects received a placebo identical in appearance with the drug. A mean decrease of 34 mm Hg in systolic arterial pressure (p < 0.001) and of 16 mm Hg in diastolic arterial pressure (p < 0.001) was observed in subjects under nicergoline. The corresponding changes in blood pressure (-12 and -7.9 mm Hg respectively) in subjects under placebo were not significant. No side-effect requiring discontinuation of treatment was encountered. The remarkable effectiveness and tolerance of nicergoline make it a highly suitable agent for the treatment of hypertension in elderly people.
In dogs with spontaneous mammary adenocarcinomas, a single nontoxic infusion of cytosine arabinoside after extracorporeal perfusion of plasms over immobilized protein A resulted in a necrotizing response rapid in onset and specific for tumorous tissue. Gross tumoricidal reactions 12 hours after this combined treatment exceeded the algebraic sum of responses to cytosine arabinoside and protein A perfusion treatments alone in the same dogs, implying a synergistic effect between the two. The magnitude, rapidity, and specificity of the tumoricidal response after the combined treatment suggests that it may be an effective chemimmunotherapeutic approach to breast adenocarcinoma.
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Pharmacokinetic profiles of imipramine and a newer tetracyclic antidepressant, maprotiline, were studied in elderly (75-83 years of age) subjects who were given a single oral dose of 125 and 175 mg, respectively, of these drugs. The apparent elimination half-life of imipramine was 20.8-34.9h (means 26.4h), its biovailability (F) was 40-64% (means 57%), and the apparent plasma clearance was from 0.27-0.57h/kg (mean 0.41h/kg). Maprotiline had a longer half-life (mean 31.5h range 20.6-51.8h, but its bioavailability (mean 50%) and plasma clearance (mean 0.49h/kg) values were in the range similar to those seen after imipramine. It appears that the elimination half-life of imipramine is longer and its plasma clearance is markedly reduced in elderly subjects when compared to values reported in young adults. Subjective clinical side effects were minimal with the two drugs. However, alterations in heart rate, blood pressure, or electrocardiogram occurred in all subjects. This suggests that caution should be exercised before initiating and during the treatment of elderly patients with these antidepressant drugs.
Human platelets have been shown to possess high-affinity binding sites for 3H-imipramine. These binding sites have a similar affinity and drug specificity to those already described in rat brain. The platelets from healthy volunteers show no difference in 3H-imipramine binding between the sexes but there is a decrease in maximal 3H-imipramine binding with increasing age of the donor.
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We recommand the following procedure: --positionment of the patient allowing the simultaneous approach of left pleural cavity and left femoral vessels. --aortic liberation far away of the isthm, in a diffuse hematoma. --medullar protection by femoro-femoral extra corporeal circulation. --recovery of aortic continuity either by direct suture or by interposition of an prosthetic tube, the sutures being largely supported by mediastinal cellular tissue. We have used this technique in 5 patients, with a good result in all cases.
The tolerance and antihypertensive action of acebutolol, as a sole drug and in combination with a diuretic, were studied in a population of 34 female subjects aged over 65 years, with a mean of 81 years, suffering from well tolerated essential hypertension. The study was carried out in the form of double blind permutations, each subject receiving successively in an order determined by random selection each of three therapeutic phases: acebutolol, acebutolol in combination with a diuretic and a placebo. The results showed that in the elderly acebutolol had a moderate diuretic action which was remarkably potentialised by diuretics. The tolerance of this beta-blocker was excellent: no cases of cardiac failure, and no disturbances in atrioventricular conduction developed during the phases with active treatment.
78 patients with one or more prosthetic heart valves were reoperated on between 1972 and 1978, and comprised 12% of the work load of valvular surgery. There were two postoperative periods in which the incidence of reoperation was high: the first year, 38%, and the period between the 5th and the 8th year, 41%. The main causes of reoperation could be divided into two groups: those common to all valves with paravalvular leaks (25%), endocarditis (12%) being the principal causes, and those associated with particular valves: deterioration of Beall prosthesis 33%, and thrombosis mainly affecting the Bjork and Beall prostheses (25%). The operative mortality was 12%. The fact that urgent operation is required in severe cases is underlined. In the light of these results, the surgical indications of reoperation should be discussed at an earlier stage. These indications are based essentially on the clinical condition of the patient and objective confirmation by further investigation should not delay the operation, which, in our experience, has never been unnecessary.
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