Changes in glomerular filtration rate during long term treatment with propranolol and peripheral vasodilators in patients with arterial hypertension.
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Biomedical subjects
Publications and source records attributed to K Rasmussen.
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As part of a cardiovascular survey phonocardiography and auscultation concentrating on the presence/absence of S4 were studied prospectively in 1714 presumably healthy men aged 40--59 yr. The following conclusions were reached: (1) routine phonocardiograms revealed an S4 in greater than 50%; (2) auscultation suggested the presence of S4 in greater than 30%; (3) interobserver variation was approximately 1/6 in the blind interprelation of the phonocardiograms by 2 observers; (4) approximately 3/4 of reported audible S4s were correctly identified; (5) a direct association between S4 and the length of the PQ (PR) interval was found, and (6) a positive association between higher blood pressure and S4, but (7) no association to age, latent coronary heart disease (CHD) nor various CHD risk factors. Thus an S4 is of little diagnostic value in screening of apparently healthy middle-aged subjects, but probably is not a completely innocent finding as suggested recently by some investigators.
A number of N-dicarboxylmonoglycines of biological interest have been synthesized. They were characterized by means of mass spectrometry. Gas chromatography of the methyl esters of methylmalonyl-, succinyl-, glutaryl-, adipyl-, suberyl- and sebacylglycines showed a single sharp peak for each compound on Dexsil 300 and OV-17 columns. Methylene unit values and mass spectra of the six methyl esters are reported.
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In fifteen patients with hypertension, inadequately controlled during treatment with propranolol alone (mean dosage 333 mg/day), plasma volume (PV) and extracellular fluid volume (ECV) were determined. After addition of prazosin for 3 months (mean dosage 9 mg/day) there was a significant increase in PV and ECV, on average 8 and 5%, respectively. The decrease in supine blood pressure, systolic as well as diastolic, was very modest, on average 11 mmHg (SD +/- 12) and 4 mmHg (SD +/- 7), respectively. The changes in standing blood pressure were more pronounced. It is assumed that the expansion of PV and ECV contributes to the inadequate blood pressure response found in the present study.
A comparative trial was carried out in 21 patients on the antihypertensive effect of pindolol given once or twice a day. A change-over design was employed, with two treatment schedules and four treamtnet periods of six weeks each. No statistically significant difference was found in BP lowering effect between one and two daily doses. It is unlikely that a switch from pindolol twice daily to the same amount once daily will crease the BP by more than at most 1.0 mmHg systolic and 2.2 mmHg diastolic, or decrease it by more than 2.7 and 1.0 mmHg, respectively. It is concluded that pindolol given once daily can be recommended.
In 16 patients with hypertension, BP could not be controlled satisfactorily by treatment with propranolol alone (mean dosage 325 mg/day). Plasma volume (PV) (T-1824) and extracellular fluid volume (ECV) (82Br-distribution space) were determined in these patients before and after the addition of hydralazine for three months (mean dosage 135 mg/day). After the addition of hydralazine, PV and ECV increased significantly, by 9% and 3%, respectively. Systolic and diastolic BPs decreased, by 15% and 13%. The mechanisms inducing fluid retention during treatment with hydralazine and the clinical significance of the problem are discussed. It is concluded that the addition of a diuretic to propranolol-hydralazine treatment is often well indicated.
The clinical symptoms in a 10-year-old girl with progressive dystonic cerebral palsy are described. The biochemical findings were dominated by large amounts of glutaric acid in the urine. The disorder is caused by impairment of the degradation of glutaryl-CoA. A survey is given of the clinical and biochemical symptoms, based on the five cases reported so far. It is concluded that patients with progressive dystonic palsy should be examined for disorders in the metabolism of organic acids.
A woman with deletion 14q as well as inversion 14 is presented, and physical signs are compared with those of patients with deletion long arm 13. No previous case of deletion long arm 14 has been published.
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Urine samples from 18 individuals with various types of dicarboxylic acidurias have been investigated by mass fragmentography for N-dicarboxyl-mono-glycines (dicarboxylglycines). One patient with methylmalonic acidemia excreted 14-20 microgram methylmalonylglycine/mg creatinine, three patients with glutaric aciduria excreted 20-60 microgram glutarylglycine/creatinine, and one patient with C6-C10-dicarboxylic aciduria excreted 120-365 microgram succinylglycine/mg creatinine. Excretion of C6-C10-dicarboxylic acids in patients with ketosis and glycogenosis and in neonates were not accompanied by excretion of C8-C10-dicarboxylglycines in measurable amounts (greater than 1 microgram/mg creatinine). Nor did patients with succinic aciduria excrete succinylglycine in amounts larger than 1 microgram/mg creatinine. On the basis of these data it is argued that production of short- and medium-chain dicarboxylglycines is not a metabolic pathway of biological significance for the elimination of short- and medium-chain dicarboxylic acids from individuals with dicarboxylic acidurias.
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Cytogenetic examination of a 14-year-old severely retarded girl revealed a karyotype of 47 chromosomes with an extra bisatellited chromosome, a translocation between No. 22 and a chromosome in the D group. The girl had presented an early autistic syndrome beginning about 6 months of age during plastering for a congenital luxation of the hips and receding from the age of 5. In addition, she was hyperkinetic with various aggressive and auto-aggressive traits and had atypical minor epileptic fits. Data from child psychiatric examinations at 5 and 14 years are presented. The importance of giving parents information as early as possible about biological causes of mental retardation and mental illness is stressed.