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Biomedical subjects

L Baer

Publications and source records attributed to L Baer.

At least 127 records · Page 7Linked to original sources
PubMed1985

Microcomputer-assisted relaxation.

The present pilot study was designed to test the effectiveness of a microcomputer program developed by the authors to induce relaxation and focused attention, which are common to most clinical stress-reduction and hypnotic procedures. A nonclinical sample of 20 adults used the program on an APPLE IIc computer in two 30-min. sessions in a within-subjects design. Repeated measures analyses of variance showed significant decreases in the Spielberger State Anxiety Scale and on a visual analog anxiety scale. Limitations and implications of the study are discussed.

Adolescent↗
PubMed1983

Cardiac failure in Addison's disease.

In an average 30 years of follow-up study, seven of 22 patients with primary adrenal insufficiency have had cardiac failure. Comparison of these seven with the 15 who remain free of this complication revealed that the former group were somewhat older and had higher incidences of unrelated cardiac disease and of nonsteroid-dependent hypertension, but that their replacement regimens, with respect to sodium supplementation and sodium-retaining steroids, were identical with the latter. Coincident with the appearance of cardiac failure, all seven patients had a decrease in sodium requirements. Adequate control of the adrenal disease was subsequently possible with elimination of mineralocorticoid support in one of the six who had initially required this therapy and a reduction in dosage in the other five. In all seven, dietary sodium supplements were no longer required. In three patients with severe failure, sodium restriction was imposed and diuretics were added, although the latter therapy has required close monitoring to avoid sodium depletion.

Addison Disease↗
PubMed1983

Panic attacks and the dexamethasone suppression test.

Of 51 patients with panic attacks, 11.8% (7.8% with a correction factor) had a positive dexamethasone suppression test. This is significantly lower than the rate for melancholia. This difference suggests that panic attacks and major depression may be associated with different biological mechanisms.

Adult↗
PubMed1982

Use of metyrosine in the anaesthetic management of patients with catecholamine-secreting tumours. A case report.

Metyrosine 1.5 g daily for days decreased 24-h urine metanephrine concentration by about 60% in a patient with multiple catecholamine-secreting paragangliomas. Despite the considerable inhibition of catecholamine synthesis, this patient exhibited stress-induced sympathetic overactivity, indicated by increases in arterial pressure and serum catecholamine and urine metanephrine concentrations. It is concluded that metyrosine should be introduced early to the preoperative regimen. In this way, optimal inhibitory effect on catecholamine synthesis can be obtained and maintained for a sufficient time to allow catecholamine stores to become as close to normal as possible. Attainment of the optimal therapeutic effect is not clearly defined, but would seem to be best gauged by a combination of clinical tests of sympathetic responses and of suppression of urinary excretion of metanephrines or VMA.

Anesthesia, Epidural↗
PubMed1981

Renal vasoactive hormones in scleroderma (progressive systemic sclerosis).

Plasma renin activity and the urinary excretions of kallikrein, kinin, immunoreactive PGE (iPGE) and aldosterone were determined in 23 patients with progressive systemic sclerosis (PSS) on a fixed sodium and potassium intake who had no clinically apparent renal disease. Urinary excretions of kallikrein and kinin in the PSS patients were not significantly different from those of a group of sex and race-matched normal controls. In the female PSS patients urinary excretion of iPGE was also found to be normal. Upright PRA was appropriate for the urinary sodium excretion in 18 PSS patients (13 normotensive and 5 hypertensives) but was significantly elevated in the remaining 5 (all normotensive). The data suggest that the renal kallikrein-kinin and prostaglandin systems are unaltered in PSS patients without clinical evidence of renal disease.

Adult↗
PubMed1981

Hypertension in health care providers: effectiveness of worksite treatment programs in a state mental health agency.

Twenty-seven per cent of 6,785 employees of the Office of Mental Health, New York State, had blood pressure greater than or equal to 140/90; 66 per cent were previously known hypertensives. Treatment of hypertension was initiated at three worksites by a nurse-physician team using a stepped-care drug protocol. Of 232 patients under treatment, 67 per cent (156) have diastolic blood pressure controlled to less than 95 mmHg. Mean length of follow-up at the first established worksite was 3.7 +/- 0.4 years and at all three worksites 13.5 months.

Follow-Up Studies↗
PubMed1981

Renal angioplasty for hypertension: predictive factors for long-term success.

Percutaneous transluminal angioplasty was performed in 31 hypertensive patients with primary success in 26 patients (83%). Twenty-three patients had a mean follow-up of 13 months. The cure rate was 30% with a further 26% being improved. However, in the group of patients with lateralizing renal vein renin values, the cure rate rose to 47% with a further 33% improved. Of the eight patients with fibromuscular disease, 83% were normotensive without medication at follow-up; in the 13 patients with atherosclerotic disease, 22% were cured and 44% were classified as improved. Patients with fibromuscular disease and lateralization of renin production are the best candidates for long-term success.

Adult↗
PubMed1980

Treatment of drug-resistant hypertension with minoxidil or angiotensin-converting enzyme inhibitor: blood pressure, renin, aldosterone, and electrolyte responses.

The effects of minoxidil and the angiotensin-converting enzyme inhibitor SQ 14,225 on blood pressure, sodium balance, plasma renin activity, plasma aldosterone concentration, aldosterone excretion rate, and renal function were studied in 11 drug-resistant hypertensive patients under controlled diets of sodium and potassium intake. Minoxidil treatment lowered blood pressure from 178/112 +/- 8/5 mm Hg (means +/- SEM) to 14/95 +/- 6/3 mm Hg. Plasma renin activity rose from 4.8 +/- 1.7 ng/ml/hr to 9.9 +/- 2.4; plasma aldosterone rose from 32.6 +/- 7.4 to 50.5 +/- 9.8 ng/dl; and aldosterone excretion rate rose from 7.6 +/- 1.3 to 15.2 +/- 3.5 micrograms/24 hr. Sodium retention could be controlled by increasing doses of diuretics, but a 10 mEq/day sodium intake in two patients resulted in significant increases of serum creatinine, and hyperkalemia was reversed by sodium loading. In five minoxidil-treated patients, substitution with the angiotensin-converting enzyme inhibitor SQ 14,225 lowered plasma and urinary aldosterone levels in two normal and high-renin patients but not significantly in three low-renin patients. Sodium excretion increased when aldosterone decreased, but blood pressure were more consistently controlled with minoxidil than with oral SQ 14,225.

Adult↗
PubMed1980

Adrenocorticotropin deficiency: correction of hyponatremia and hypoaldosteronism with chronic glucocorticoid therapy.

A 36-yr-old woman with a chronic wasting illness associated with hyponatremia and hypotension proved to have secondary adrenal insufficiency and low levels of GH and PRL. TSH, LH, and FSH responses remained normal. Aldosterone excretion was markedly reduced (0.74 microgram/day) before replacement therapy was started, but normal renin and aldosterone responses to sodium restriction were observed after 6 months of corticosteroid treatment. These responses were maintained after acute steroid withdrawal despite the continued absence of ACTH. Chronically adequate glucocorticoid levels were necessary to maintain a normal aldosterone response in this patient. If there is also a pituitary factor required for this response, it does not appear to be ACTH.

Adrenocorticotropic Hormone↗
PubMed1980

Effect of a time-slowing suggestion on performance accuracy on a perceptual motor task.

Three female subjects were hypnotized and played a video-tennis game under alternating control and experimental conditions in a within-subjects ABABAB withdrawal design. During control phases, subjects played the game under conditions of hypnotic relaxation. Prior to experimental phases a suggestion for subjective time-slowing, and ball-slowing, was presented. The initial presentation of the time-slowing suggestion did not result in improved performance accuracy. However, for all subjects, the second and third presentation of the suggestion resulted in significantly more longer volleys during experimental periods as compared to control periods. Possible explanation of the processes underlying improved performance accuracy are discussed in light of the subjective reports of the participants.

Adult↗
PubMed1978

Evaluation of surgical response in renovascular hypertension using angiotensin II blockade.

The mechanisms involved in residual or recurrent hypertension following operation to correct renal artery stenosis were studied in 10 patients by performing angiotensin II blockade with Saralasin (Sarcosine, alanine, angiotensin II) before and after operation. Peripheral renin and renal vein renin determinations, angiography, and renography were done as well. The limitations of renin determinations are cited and the application of angiotensin II blockade as a specific method of detecting renin-dependent hypertension before and after operation are presented. Saralasin infusion under the controlled conditions of our study proved to be a sensitive method for detection of renin-dependent hypertension. The results of Saralasin infusion correlated closely with peripheral and renal vein renin determinations. Thus angiotensin II blockade before and after operation may supercede more invasive and less specific diagnostic methods.

Angiotensin II↗
PubMed1977

Detection of renovascular hypertension with angiotensin II blockade.

Angiotensin II blockade with sarcosine 1-alanine 8-angiotensin II (saralasin, P-113) was done in 40 studies of 20 hypertensive patients. Eleven of 12 patients with a depressor response to angiotensin II blockade had significant renovascular or renal disease, and nine of 10 had renal vein renin measurements that lateralized to the abnormal kidney. In contrast, none of the patients without a depressor response had renovascular abnormalities. Plasma renin activity was usually high in responders to saralasin (18 ng/ml-h) when compared with nonresponders (0.5 ng/ml-h). In these studies a correlation between the fall in blood pressure and the rise in plasma renin activity during angiotensin II blockade was observed while renin was unchanged in the absence of depressor responses. In two renovascular renin-dependent hypertensive patients, treatment with diuretics induced severe hyperreninemia and a rise in blood pressure that was reversed by sodium loading.

Angiotensin II↗
PubMed1976

Renin and aldosterone suppression in the antihypertensive action of clonidine.

In 18 hypertensive patients receiving a constant (100 mEq/day) sodium diet, treatment with clonidine (0.3 mg/day for 5 days) decreased blood pressure in 11 patients with high and normal renin levels and 7 with low renin levels. The high and normal renin group had early and rapid reductions in blood pressure and plasma renin activity. In contrast, the low renin group had a more gradual hypotensive response and only a small absolute decrease in plasma renin. For all patients, pretreatment renin levels were related to the initial decrease in blood pressure but not to the reductions measured after 5 days. Thus, two mechanisms of action of clonidine are possible, one related to acute inhibition of the renin-angiotensin system in patients with high and normal renin levels and another that is independent of renin mechanisms and occurs in all hypertensive patients. In six additional patients with high renin levels induced by prior sodium depletion (10 mEq/day sodium diet), clonidine did not reduce blood pressure or renin, thus indicating that the suppressive action of this agent on renin pressor mechanisms occurs only in patients whose elevated renin levels are intrinsic to hypertension and unrelated to sodium depletion. Of the 18 patients receiving a normal sodium diet, 13 were classified as responding to treatment (decrease in both systolic and diastolic pressures of at least 10%). The five nonresponders had greater weight gain and higher values for aldosterone excretion. For all patients, there was a significant correlation between decrements in blood pressure and in aldosterone, suggesting that the countervailing effects of fluid accumulation on blood pressure in nonresponding patients resulted from a failure of aldosterone to be suppressed. Changes in aldosterone, in turn, correlated significantly with changes in renin. Thus, the antirenin effect of clonidine enhances its antihypertensive action not only by acutely ablating renin-angiotensin pressor mechanisms, but also by inhibiting aldosterone production and thereby minimizing longer-term reactive volume retention during treatment.

Adult↗
PubMed1976

Predictability of surgical response in renovascular hypertension.

One hundred sixteen patients underwent operation for renovascular hypertension from 1962 through 1975; 64% had aortorenal reconstruction and 36% had nephrectomy. Sixty-six percent were cured and 19% were improved. Rapid sequence intravenous pyelography, radioisotope renography, and renal arteriography were equal in ability to detect renovascular hypertension. Bilateral renal biopsy specimens had excellent prognostic value when performed in a graded semiquantitative manner. Plasma renin activity was the most consistently useful criterion for prediction of surgical cure if the following requirements were used: (1) elevated peripheral plasma renin activity, (2) elevated renin from the affected kidney, and (3) suppressed renin secretion from the contralateral kidney. An angiotensin II antagonist, saralasin acetate, used in six patients before operation in an attempt to identify those whose hypertension depended on angiotensin II activity, produced a depressor response correlating well with the surgical result.

Adolescent↗
PubMed1976

Primary aldosteronism with uncommon complications.

In a patient who had primary aldosteronism and severe total-body potassium depletion muscular tonic contractures developed during induction of anesthesia. After correction of the potassium deficit, the patient underwent uneventful anesthesia and transabdominal right adrenalectomy. Neither serum potassium level nor EKG seems to provide a reliable index of correction of potassium deficit. Measurement of potassium balance provided a method of quantitating the potassium depletion and of determining when the potassium deficit had been corrected. Balance studies should be utilized preoperatively when long-term potassium loss is suspected to reduced complication secondary to hypokalemia.

Adult↗