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Biomedical subjects

J V Felicetta

Publications and source records attributed to J V Felicetta.

At least 19 recordsLinked to original sources
PubMed1998

Prevention and Treatment of Hypertension Study (PATHS): effects of an alcohol treatment program on blood pressure.

OBJECTIVE: To determine whether blood pressure is reduced for at least 6 months with an intervention to lower alcohol intake in moderate to heavy drinkers with above optimal to slightly elevated diastolic blood pressure, and whether reduction of alcohol intake can be maintained for 2 years. DESIGN: A randomized controlled trial. METHODS: Six hundred forty-one outpatient veterans with an average intake of 3 or more alcoholic drinks per day in the 6 months before entry into the study and with diastolic blood pressure 80 to 99 mm Hg were randomly assigned to a cognitive-behavioral alcohol reduction intervention program or a control observation group for 15 to 24 months. The goal of the intervention was the lower of 2 or fewer drinks daily or a 50% reduction in intake. A subgroup with hypertension was defined as having a diastolic blood pressure of 90 to 99 mm Hg, or 80 to 99 mm Hg if recently taking medication for hypertension. RESULTS: Reduction in average weekly self-reported alcohol intake was significantly greater (P<.001) at every assessment from 3 to 24 months in the intervention group vs the control group: levels declined from 432 g/wk at baseline by 202 g/wk in the intervention group and from 445 g/wk by 78 g/wk in the control group in the first 6 months, with similar reductions after 24 months. The intervention group had a 1.2/0.7-mm Hg greater reduction in blood pressure than the control group (for each, P = .17 and P = .18) for the 6-month primary end point; for the hypertensive stratum the difference was 0.9/0.7 mm Hg (for each, P = .58 and P = .44). CONCLUSIONS: The 1.3 drinks per day average difference between changes in self-reported alcohol intake observed in this trial produced only small nonsignificant effects on blood pressure. The results from the Prevention and Treatment of Hypertension Study (PATHS) do not provide strong support for reducing alcohol consumption in nondependent moderate drinkers as a sole method for the prevention or treatment of hypertension.

Adult↗
PubMed1992

A dose-response trial of once-daily diltiazem.

This trial was performed to determine the safe and effective dosage range of once daily diltiazem (diltiazem CD) capsules for treatment of essential hypertension. Patients with essential hypertension having supine diastolic blood pressure values greater than or equal to 95 mm Hg and less than or equal to 110 mm Hg were randomly assigned to receive placebo or one of four doses of diltiazem CD: 90, 180, 360, or 540 mg. Blood pressure was measured at trough, 24 hours after the dose, and at the time of peak effect, 10 hours after the dose. Diltiazem CD lowered both supine diastolic and systolic blood pressure. A linear dose response was seen with changes in diastolic and systolic blood pressure and heart rate for trough and peak measurements. Trough/peak ratios for the 180, 360, and 540 mg doses were all greater than 0.50. Adverse effects were dose related; those most commonly reported were headache (8.6%), bradycardia (8.1%), and edema (7%), with bradycardia and edema possibly dose related. It is therefore concluded that diltiazem CD is a safe and effective antihypertensive agent.

Adolescent↗
PubMed1991

Evaluating arthritic complaints.

Adults with arthritic conditions are seen frequently in primary care clinics. However, more than 100 different entities can produce joint and muscle symptoms, which makes it challenging to correctly diagnose musculoskeletal complaints. There are several logical steps to follow in assessing joint disorders. The first is to differentiate between what is and what is not arthritis. Additional steps necessary for an appropriate diagnosis include analysis of a thorough history, physical examination, and laboratory and X-ray results. It is of critical importance to identify the most common forms of arthritis, as well as the specific conditions that require immediate referral. The onset, incidence, findings and pathophysiology of the following entities in the adult population are discussed: septic arthritis, osteoarthritis, rheumatoid arthritis, the crystal-induced diseases, human immunodeficiency virus (HIV) and arthritis, the seronegative spondyloarthropathies and systemic lupus erythematosus.

Adult↗
PubMed1990

Treating diabetes in the elderly. What are the special considerations?

Management of diabetes in elderly patients generally follows the same lines as in younger patients; that is, improvement of blood glucose status with diet, oral hypoglycemic, and insulin therapy as required. Older patients are more fragile, however, and more caution must be used with therapeutic interventions.

Aged↗
PubMed1990

When to worry about hypoglycemia.

The important causes of hypoglycemia unrelated to known diabetes are relatively few. Postprandial hypoglycemia is a relatively benign disorder. Fasting hypoglycemia is more serious and may be caused by metabolic disturbances or tumors. Several hereditary disorders cause hypoglycemia in infants and must be diagnosed and treated before serious damage occurs. A systematic clinical approach increases the likelihood of making the correct diagnosis in a timely fashion.

Fasting↗
PubMed1989

Age-related changes in calcium metabolism. Why they occur and what can be done.

Aging has myriad effects on calcium homeostasis and metabolism. Levels of parathyroid hormone rise, making the diagnosis of primary hyperparathyroidism more difficult. Vitamin D levels decline, affecting the rate of calcium absorption from the intestine. As more and more physicians attempt to combat osteoporosis with calcium supplements, an increasing number of cases of hyperparathyroidism will likely be diagnosed. The use of supplemental calcium is probably appropriate for most elderly patients, particularly white women, but experimental evidence supporting this recommendation is surprisingly scanty. The patient's age is a major consideration when assessing laboratory results, disease risk, and optimal therapeutic strategies.

Adult↗
PubMed1989

Effects of illness on thyroid function tests.

Severe illness of any type predictably leads to abnormal results on thyroid function tests. The first apparent changes are a decrease in total triiodothyronine (T3) and an increase in reverse T3. As disease progresses, a marked decline in thyroxine and an increase in T3 resin uptake are observed. Thyrotropin levels remain normal, confirming that the patient is euthyroid despite marked alterations in thyroid function tests. Supplemental thyroid hormone has never been shown to be of any value, and may indeed be harmful, in euthyroid patients with abnormal thyroid function. Recognition of the euthyroid sick syndrome is vital to avoid needless therapy.

Euthyroid Sick Syndromes↗
PubMed1989

Painful, painless, and postpartum thyroiditis. Distinct entities or merely variants?

Subacute thyroiditis is a common disease that often goes undetected. Indeed, both painful and painless thyroiditis are easily overlooked or misdiagnosed and perhaps mistreated unless careful attention is paid to the patient's history and physical examination. Treating the hyperthyroidism of subacute thyroiditis as if it were Graves' disease, for example, would be inappropriate, since therapy for the two entities is completely different. A form of painless thyroiditis, for reasons that remain unclear, can occur in the postpartum period and may be related to postpartum psychosis or depression.

Female↗
PubMed1989

Cushing's syndrome. How to pinpoint and treat the underlying cause.

In addition to prolonged glucocorticoid therapy (not discussed here), at least five other conditions cause Cushing's syndrome. They are excessive corticotropin secretion by the pituitary gland (which results in Cushing's disease), ectopic production of corticotropin by malignant nonpituitary tumors, benign adrenal adenoma, adrenal carcinoma, and primary adrenocortical nodular dysplasia. Each can be distinguished by a specific pathophysiologic process that triggers the adrenal glands to overproduce glucocorticoids. At present, diagnosis of Cushing's syndrome or disease relies heavily on the dexamethasone (Decadron, Hexadrol) suppression test. After diagnosis, other studies, including computed tomography, magnetic resonance imaging, and corticotropin radioimmunoassay, can be used to localize the site of the lesion. Treatment, of course, depends on the underlying cause.

Adrenal Cortex Neoplasms↗
PubMed1989

Atrial natriuretic peptide attenuates the reflex sympathetic responses to lower body negative pressure.

The authors studied the effect of intravenous infusion of atrial natriuretic peptide (ANP) on the plasma catecholamine and forearm vasoconstrictor responses to cardiopulmonary baroreflex deactivation in six normal, male volunteers in order to determine whether ANP influences reflex forearm vasoconstriction in humans. Unloading of low-pressure cardiopulmonary baroreceptors (CPBR) was accomplished by application of low levels (-10 and -20 mm Hg) of lower body negative pressure (LBNP). The authors measured the plasma norepinephrine (NE) and epinephrine, the mean arterial pressure (MAP), and the forearm vascular resistance (FVR) responses to reflex sympathetic activation by LBNP. ANP infusion (0.1 microgram.kg-1.min-1) decreased (p less than 0.01) basal MAP, as well as plasma renin activity and plasma aldosterone levels (p less than 0.05). ANP infusion also reduced (p less than 0.01) plasma NE responses to both levels of LBNP and tended to decrease both epinephrine and FVR during ANP infusion at -20 mm Hg LBNP (p = 0.8). These data suggest that exogenous ANP inhibits the reflex sympathetic responses that occur with CPBR unloading. The blunted plasma NE responses to CPBR unloading parallel the attenuation of FVR response to LBNP during ANP infusion, despite significant LBNP-induced hypotension.

Adult↗
PubMed1988

Systemic hypertension in diabetes mellitus.

Hypertension occurs more frequently in diabetics and markedly exacerbates the vascular morbidity and mortality resulting from this metabolic disorder. However, the etiology of hypertension in diabetics remains poorly understood. Like aging persons, diabetics have increased systemic resistance and a probable reduction in baroreceptor sensitivity. They also have an expanded total body sodium pool and a tendency to lower levels of plasma renin activity. Some of these factors suggest that a subtle calcium deficiency could also be of etiologic importance.

Aging↗
PubMed1988

Thyroid disease in the elderly. Special features, changes in management.

Many changes in thyroid physiology occur with aging. These changes correlate with major alterations in the normal physiologic functioning of the thyroid and with changes in thyroid hormone levels as measured by radioimmunoassay. Clinical manifestations of thyroid disease in elderly patients may be somewhat different than in younger patients. Both hyperthyroidism and hypothyroidism can be more difficult to diagnose in elderly patients because of subtle changes in disease presentation. The incidence of certain thyroid diseases, from benign single nodules to malignant anaplastic carcinoma, increases with age. A deliberate and cautious approach is needed when treating thyroid disease in the elderly, who are inherently more fragile than younger patients.

Aged↗
PubMed1987

Endocrine changes with critical illness.

Many alterations in hormonal economy occur predictably with critical illnesses, including changes in thyroid hormones, glucocorticoids, mineralocorticoids, and gonadotrophins. These effects are generally nonspecific and relate primarily to the severity of the illness, rather than to the exact nature of the illness. Thus a wide variety of critical illnesses, ranging from severe pneumonia to hepatic or renal failure, all tend to produce a similar pattern of "stress-induced" hormonal alterations.

Atrial Natriuretic Factor↗
PubMed1987

Thyroid changes with aging: significance and management.

A number of changes in thyroid physiology occur with normal aging, including a modest fall in T3 levels and a reduction in the rate of turnover of thyroid hormones. Additionally, the diagnosis of either hyperthyroidism or hypothyroidism can be more difficult in the elderly because the symptoms may be more subtle. Hyperthyroidism may be disguised by a very apathetic presentation, without many of the typical adrenergic symptoms such as tachycardia and nervousness. Some of the many ways in which hypothyroidism may present include occult congestive heart failure or a severe fecal impaction.

Aged↗