Biomedical subjects
Publications and source records attributed to L Poggi.
Posttraumatic diaphragmatic rupture or eventration is still a challenging problem. Herein five cases of patients with such a diaphragmatic lesion treated successfully by laparoscopy are reported with a discussion of the advantages of this mini-invasive surgical approach.
XHNF1(&bgr;) is a homeobox-containing gene initially expressed at the blastula stage in the vegetal part of the Xenopus embryo. We investigated its early role by functional ablation, through mRNA injection of an XHNF1(beta)/engrailed repressor fusion construct (XHNF1(beta)/EngR). Dorsal injections of XHNF1(beta)/EngR mRNA abolish dorsal mesoderm formation, leading to axial deficiencies; ventral injections disrupt ventral mesoderm formation without affecting axial development. XHNF1(beta)/EngR phenotypic effects specifically depend on the DNA-binding activity of its homeodomain and are fully rescued by coinjection of XHNF1(beta) mRNA. Vegetal injection of XHNF1(beta)/EngR mRNA blocks the mesoderm-inducing ability of vegetal explants. Both B-Vg1 and VegT maternal determinants trigger XHNF1(beta) expression in animal caps. XHNF1(beta)/EngR mRNA blocks B-Vg1-mediated, but not by eFGF-mediated, mesoderm induction in animals caps. However, wild-type XHNF1(beta) mRNA does not trigger Xbra expression in animal caps. We conclude that XHNF1(beta) function is essential, though not sufficient, for mesoderm induction in the Xenopus embryo.
UNLABELLED: The ineluctable fade out of mercury sphingomanometer pressure device involve the necessity in using automatic blood pressure systems. In parallel the recent PHARE II study witness of a lack in the control of hypertension in general practice. In the basis of an automatic blood pressure device measure, we had try to know the efficiency of blood pressure contrôl (BPC) in a specialised consultation. METHOD: 100 patients with essential systolo-diastolic hypertension (HTA) were screened. An independent physician measured the blood pressure level with an OMRON 705 CP device 3 times. The acceptable BPC was considered less than 160/95 mmHg and the optimal BPC less than 140/90 mmHg. There was 70 man, 30 female (mean age = 67 year old). The initial mean blood pressure was 169/104 mmHg. RESULTS: The final blood pressure measured was 137/80 mmHg. The percentage of patients who have an acceptable contrôl (< 160/95) was 91% and an optimal contrôl (< 140/90) 66%. 12% of these 66 maintain a height cardio-vascular risk. The mean number of medication used was 2 and it's paradoxally not differ between the optimal blood pressure control group and the other patients who need probably an intensive medication. In conclusion these study shows us the importance in understanding our patients particularity in order to increase the treatment efficiency.
The latest results of studies and therapeutic trials have shown the following: Present therapeutic strategies for arterial hypertension have a certain efficacy, but appear to have reached a plateau. Arterial hypertension essentially affects older subjects who can benefit from the advantages of antihypertensive treatment as much as, if not more than, younger subjects. A better evaluation of the cardiovascular risk of the patient is essential: This should include all the components of arterial hypertension (diastolic and systolic blood pressures and pulse pressure), risk factors, associated pathologies, and target-organ damage. Such an evaluation will help fix therapeutic objectives tailored to individual patientsí needs. The limitations of monotherapy in achieving this objective: They are demonstrated in clinical practise, as well as in large-scale trials. In this context, new strategies based on the first-line use of fixed very-low-dose combination therapies appear to be both useful and promising, as well as being in line with the latest recommendations.
The objective of the present study was to determine the predictive factors of treatment compliance in hypertensive patients. This was an open large-scale multicenter study where mild to moderate essential hypertensive patients received trandolapril (2 mg) once daily for 30 to 60 days in addition to their usual treatment. Trandolapril was packed in electronic pill boxes that registered date and time of each opening. The main compliance parameters were the percentage of missed doses, the percentage of delayed doses, and the percentage of correct dosing periods. Predictive factors of poor compliance (correct dosing periods < 80%) were determined using a multivariate stepwise logistic regression analysis. Two thousand one hundred seventy-three patients aged 60 +/- 12 years were analyzed. Of the total patients 37% were poor compliers; 29% of patients forgot more than 10% of doses and 36% of patients delayed more than 10% of doses. Ranked predictive factors of poor compliance were: age < 60 years (odds ratio [OR], 1.80 [1.49 to 2.17], P = .0001), the Paris area (OR, 1.70 [1.32 to 2.19], P = .0001), smokers (OR, 1.65 [1.29 to 2.11], P = .0001), monotherapy (OR, 1.40 [1.14 to 1.72], P = .0012), and baseline diastolic blood pressure > or = 100 mm Hg (OR, 1.21 [1.01 to 1.46], P = .044). Therefore, we conclude that young hypertensives, large city dwellers, and smokers are more likely to be poor compliers. The presence of some of these characteristics might incite the physician either to encourage patient compliance or to prescribe antihypertensive drugs that have an effect that persists even beyond 24 h.
A survey was conducted in a cohort of 235 general practitioners (GP) selected by Sofres Medical who were representative of the French medical population, to measure the percentage of patients with hypertension, treated hypertensives and patients with controlled hypertension. Data were collected over 1 week of office consultation. Practitioners were initially instructed to use the same type of mercury sphygmomanometer, equipped with pneumatic cuffs of different sizes. Three consecutive blood pressure (BP) measurements were made and the last two were recorded. Practitioners had to carry out their own survey over a period of 1 week on all patients > 18 years of age who visited their offices. Patients were considered as hypertensive (HP) if the mean of the two recorded BP measurements was > or = 140/90 mm Hg or if they were taking antihypertensive drug treatment. Three cutoff points were used to define controlled hypertension: < 140/90 mm Hg (overall population of HP), < 160/95 mm Hg (HP < 65 years of age), and < 160/90 mm Hg (HP > or = 65 years of age). Among 12,351 patients (mean age, 48.6 years; women, 58%), 5020 were HP, (41%) of whom 2035 were without treatment (41%) and 2985 were receiving antihypertensive drug treatment (59%). Two hundred-thirty patients (4.6%) remained at high risk with moderate or severe hypertension (BP > or = 180 [systolic] or 105 [diastolic] mm Hg), ie, 1 patient/week/GP. The study confirms the high prevalence of hypertension in general practice and shows that 7 of 10 patients have an acceptable control of their BP (< 160/95 or < 160/90 mm Hg according to age) but only 24% of treated HP achieved the target of a BP level < 140/90 mm Hg, representing 28% of the 18 to 64 year old group and 21% of the elderly group. French GP did not choose an optimal control, and the medical community is waiting for answers to crucial questions, ie, does optimal BP control significantly improve the absolute cardiovascular risk? How far should blood pressure be lowered?
To assess the adequacy of antihypertensive treatment in the French population, a survey was conducted from October 1990 to April 1991 in five French cities during sales exhibitions. A total of 7107 individuals visited the stand of the French National Committee to have their blood pressure (BP) measured. Among them, 1289 were treated hypertensive subjects fully aware of their treatment. The efficacy of antihypertensive treatment was assessed in this population. Among those hypertensive treated subjects 35 to 65 years old, 60% had a BP < 160/95 mm Hg and 27% < 140/90 mm Hg. Among those > 64 years of age, 44% had a BP < 160/90 mm Hg. In 1992, these results were included in a publication by the World Hypertension League. Data obtained with this new and interesting approach were reviewed 4 years later. The approach is inexpensive (the equivalent of US $28,000) and made it possible to directly inform thousands of people, normotensive and hypertensive, about arterial hypertension and antihypertensive drug therapy, as well as risk factors for cardiovascular disease. This kind of approach may be worth a strict evaluation, to assess whether it is really useful in improving high blood pressure control in the population.
To improve blood pressure (BP) control in general practice, 3122 general practitioners agreed to participate in a result awareness program. A survey carried out 6 months after participating physicians had been informed of the outcome of treatments they had given showed that blood pressure control (cut-off point: BP < 140/90 mm Hg) had not improved. However, using less stringent criteria, a slight improvement in blood pressure control could be observed. Although this improvement was marginal, results are sufficiently encouraging to warrant another study after a new awareness campaign among the medical population.
AIMS: To gain information on serious adverse events in a large number of patients exposed to perindopril. METHODS: Four thousand seven hundred and eighty-eight general practitioners throughout France collaborated in the recruitment of 47,351 patients for a 12 month postmarketing study. Data collection was undertaken by company representatives under the supervision of nine regional medical officers. Computerised data entry was performed by six pharmaceutical officers. Serious adverse events were later individually reviewed medically. RESULTS: Withdrawals due to adverse events occurred in 6.1% of female and 3.2% of males patients. The ascertainment of adverse events in this study approved satisfactory, as shown by the reported incidence of cough, which was 11.3% in women and 7.8% in men, this being compatible with the best estimates of the true incidence of cough during ACE-inhibitor therapy. Serious adverse reactions-anaphylaxis and blood dyscrasias-were rare. CONCLUSIONS: This study successfully followed a large cohort of patients treated with perindopril and failed to demonstrate any unexpected hazards.
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Clinical measurement of the blood pressure associated with assessment of the other cardiovascular risk factors: cholesterol, smoking, age, sex, diabetes and cardiovascular heredity, allow appreciation of the cardiovascular risk of hypertensive patients after the results of the Framingham study. There is no consensus about the optimal clinical blood pressure with treatment and about the control of treated hypertensives which remains low in population studies (28% in France, 27% in the United States). New methods of blood pressure measurements such as ambulatory blood pressure monitoring and self-measurement of the blood pressure are better correlated to cardiovascular events and morbi-mortality than measurement of the blood pressure during consultation in hypertensive patients. Ambulatory blood pressure recording also seems to be more predictive of regression of left ventricular hypertrophy. Therefore, the latest recommendations, especially the American consensus, advise using these techniques when the physician is in doubt about the value of the clinical blood pressure measurement of hypertensive patients, especially in the case of apparent antihypertensive drug resistance. Finally, what does good blood pressure control imply in 1988: normal clinical blood pressure measurements compared with ambulatory blood pressure monitoring or self-measurement of the blood pressure? Does it mean control of the patient's absolute cardiovascular risk? The answers to these questions can only be obtained by future prospective studies.
The aim of this study was to evaluate the antihypertensive effect of drugs according to the initial ambulatory blood pressure (BP) level. After a 15-day placebo run-in period, 105 patients with moderate essential hypertension (mean age, 52 years) underwent 24-h BP monitoring (spacelabs: 1 measure/15 min). Patients were subdivided into two groups: the "High" group, with 24-h mean values of systolic BP (SBP) > 137 or diastolic BP (DBP) > 87 mm Hg, and the "Low" group, with SBP < or = 137 and DBP < or = 87 mm Hg. All patients received, in a random and double-blind design, either bisoprolol (10 mg q.d.) or lisinopril (20 mg q.d.) for 8 weeks. At the end of this active treatment period, office and ambulatory BP measurements were performed. Casual measurements revealed similar BP decreases in all subgroups receiving bisoprolol and lisinopril; BP monitoring showed that the antihypertensive effect depended on the baseline mean 24-h value; -15/-12 mm Hg for bisoprolol and -18/-13 mm Hg for lisinopril in the High group; -7/-6 mm Hg for bisoprolol and -6/-6 mm Hg for lisinopril in the Low group. This study shows that the antihypertensive effect depended on initial ambulatory BP values, with a lower BP decrease in the Low group. Assessment of the antihypertensive effect on ambulatory BP is useful in clinical trials.
The aim of this study was to measure the percentage of patients with hypertension, treated hypertension and controlled hypertension, using data collected over one week by 235 general practitioners well representative of the French medical population and selected by SOFRES Médical. Practitioners had to carry out their own survey over a period of one week on all patients above 18 years of age who visited their office. They were initially instructed to use the same type of mercury sphygmomanometer, equiped with the same pneumatic cuffs of different sizes. Three consecutive blood pressure measurements were effected, the last two were recorded. Patients were considered as hypertensive if the mean of the two recorded BP measurements was > or = 140-90 mmHg, or < 140-90 mmHg under pharmacological treatment. Hypertensive patients were considered as controlled when their blood pressure levels were overall < 140-90 mmHg under treatment. According to age, two other control levels were analysed: blood pressure < 160-95 mmHg before 65 years and blood pressure < 160-90 mmHg at 65 years or more. Among 12,351 patients, 5,020 are hypertensive (4%), 2,985 under pharmacological treatment (59%) and 2,035 without treatment (4%). Among untreated patients, 9% had an hypertension above the borderline values. Before 65 years, 28% had an under treatment blood pressure < 140-90 mmHg and 71% < 160-95 mmHg. Among 65 years or more hypertensive patients, 21% had an under treatment blood pressure < 140-90 mmHg and 60% < 160-90 mmHg. Before 65 years, 25% among patients with a monotherapy remained with a blood pressure > 160-95 mmHg and 34% with a blood pressure > 160-90 mmHg among those of 65 years or more; 230 patients (5%) remained in high risk with a blood pressure > 180-105 mmHg. 176 untreated and 54 despite their treatment. This study carried out in French medical practice yield two main conclusions regarding the management of hypertension: as the prevalence of hypertensive patients is 41%: one patient out of two, high blood pressure has to be a main aim for the medical teaching. Even if a reasonable control of the blood pressure is achieved in most cases, blood pressure got a normal level for 24% only of treated hypertensive patients and too many patients were keeping high risk because they have been not or not enough treated. This study, as a real audit, gives some useful informations to general practitioners in order to improve their scores.
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The efficacy and acceptability of perindopril were assessed over one year by 4800 French general practitioners in an open label study of 47,351 freely consenting adults with mild to moderate hypertension. Perindopril was administered as a single daily dose each morning. The starting dose of 4 mg (or 2 mg in patients over 70 years) was doubled after one month, to a maximum of 8 mg if diastolic blood pressure (DBP) was greater than 95 mmHg. Thereafter a non-potassium sparing diuretic was added to the 8 mg dose if necessary. At 12 months, effective blood pressure control, defined as recumbent DBP below 90 mmHg, was achieved in between 68 and 77% of patients. The majority of patients (80% [n = 37,348]) received perindopril alone throughout the 12-month study period. The final prescription (at six months) revealed that 65% of patients were treated with the once daily 4 mg dose. Throughout the 12 months of the study, 7.6% of patients (n = 3564) discontinued treatment, 5.1% (n = 2401) due to adverse events and 0.4% (n = 187) due to fatal events (principally cardiovascular reasons). Cough was the most frequent adverse symptom, leading to withdrawal of 3.28% of patients; this symptom was spontaneously reported in an additional 6.4% of patients throughout the one-year period but did not lead to discontinuation. All other adverse events leading to withdrawal were present in less than 0.4% of cases. The majority of fatal outcomes was due to cardiovascular events (n = 78), 37 were due to cancer, 19 due to road accidents and 53 due to miscellaneous causes.(ABSTRACT TRUNCATED AT 250 WORDS)
The majority of patients affected by primary hyperparathyroidism present now in surgical series are little or totally asymptomatic. This is due to widespread use of multiphasic screening for hypercalcemia as far as to more liberal indications for parathyroid exploration. The debate about the need for parathyroidectomy is open in these patients, having few or no signs at all of primary hyperparathyroidism, because conservative treatment has yielded confused results. The authors analyzed preoperative biochemical values and surgical outcome from 26 patients affected by primary hyperparathyroidism. Thirteen cases had overt primary hyperparathyroidism (group A) and 13 had asymptomatic disease (group B). Patients in group A had higher preoperative PTH values than patients in group (p < 0.05). After surgery, the patients in group A showed parathyroid glands which weighted significatively more than ones in group B (p +/- 0.01). Further, a significant correlation between preoperative PTH value and glandular weight was demonstrated in all cases. The authors conclude surgery for patients having mild primary hyperparathyroidism may give some problems related to the very small size of abnormal glands found during operation. We advise a close follow-up for these patients initially without treatment: surgery should be recommended for those showing PTH values higher than 150 pg/ml.
Clinical and 24-hour ambulatory measurements were made in 46 patients with mild to moderate essential hypertension in order to confirm that the efficacy and safety of sustained-release diltiazem LP 300 mg were the same regardless of the time of day at which it was taken. After two weeks of placebo, patients were randomly assigned double-blind to take diltiazem LP 300 mg either morning or evening for four weeks. Diltiazem LP 300 mg significantly lowered diastolic and systolic blood pressure in both groups by clinical or 24-hour ambulatory measurement, and without any difference according to whether diltiazem LP 300 mg was administered morning or evening. A lesser fall in blood pressure during the night in both groups led to study of the effect of diltiazem LP 300 mg according to initial ambulatory diastolic blood pressure level. Diltiazem brought about a greater fall in blood pressure when patients had an ambulatory diastolic pressure of 90 mmHg or more. Clinical, laboratory and electrocardiographic parameters were all satisfactory, regardless of the time at which the drug was taken.
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