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Biomedical subjects

M Moser

Publications and source records attributed to M Moser.

At least 325 records · Page 18Linked to original sources
PubMed1986

The diuretic dilemma and the management of mild hypertension.

Diuretics are presently used as antihypertensive medications as first-step monotherapy or in combination with adrenergic-inhibiting agents in the majority of hypertensive patients in the United States. A 30-year experience has demonstrated that blood pressure is lowered to as great or greater degree with diuretics than with many of the antihypertensive drugs presently available, including converting enzyme inhibitors, calcium entry blockers, beta- or alpha-adrenergic inhibitors, or centrally acting sympatholytic agents. Diuretics appear to be especially effective in the elderly and in black patients. All of the major hypertension clinical trials on which we base our decisions for treatment have employed diuretics as first-step therapy, with a reduction in morbidity and mortality. The debate concerning the long-term safety of diuretic therapy has focused on the United States Multiple Risk Factor Intervention Trial results and several papers suggesting that the lipid-raising or potassium-lowering properties of diuretics may produce adverse effects. Suggestions have been made that the use of other drugs without metabolic side effects may result in greater benefit with less risk, especially in the management of mild hypertension where the risk of the disease is not immediate or great. A review of the MRFIT and lipid data from long-term studies have failed to establish the "toxicity" of diuretic agents. In addition, recent studies have not confirmed previous observations that diuretic-induced hypokalemia increases ventricular ectopy or contributes to sudden death.(ABSTRACT TRUNCATED AT 250 WORDS)

Arrhythmias, Cardiac↗
PubMed1986

[Follow-up of children after toxoplasmosis infection in pregnancy].

A vival toxoplasmosis infection was diagnosed in 188 cases (3,8%) out, of 49,582 pregnant women routinely screened. 4 children live with congenital toxoplasmosis. Follow-up studies showed that 33 children have specific antibodies, 5 are with suspect clinical findings. Therefore is the conclusion that more late signs of connatal toxoplasmosis are to be detected by follow-up investigations.

Antibodies↗
PubMed1986

Low-dose diuretic therapy for hypertension.

The efficacy of low dosages of diuretics was evaluated in two studies. In one, 62 (48%) of 130 patients became normotensive with 2.5 mg/day of metolazone. In the other, 28 (49%) of 57 patients became normotensive with 25 mg of chlorthalidone, compared with 12 (22%) of 55 patients given placebo. There was a marked variation in blood pressure response and the occurrence of hypokalemia (less than 3.5 mEq/L of potassium) from center to center and within patient groups in both studies. The mean decrease in serum potassium was between 0.5 and 0.6 mEq/L in the metolazone group and 0.44 mEq/L in the chlorthalidone-treated patients. This degree of hypokalemia is only slightly less than that noted when larger dosages of thiazide diuretics are used (0.6 to 0.7 mEq/L). It is concluded that 2.5 mg/day of metolazone or 25 mg/day of chlorthalidone are effective antihypertensive agents but that blood pressure lowering may be inconsistent at these dosage levels. It is reasonable, therefore, to begin diuretic therapy with low dosages, but larger dosages (5 mg of metolazone or 50 mg of chlorthalidone) should be tried before adding another drug or concluding that diuretic therapy is ineffective if an acceptable blood pressure response is not obtained. The degree of hypokalemia that occurs at lower-dose therapy is variable but may be of less clinical significance than that noted with higher dosages of diuretics in some patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Chlorthalidone↗
PubMed1985

Diuretics versus calcium-channel blockers in systemic hypertension: a preliminary multicenter experience with hydrochlorothiazide and sustained-release diltiazem.

The safety and efficacy of sustained-release diltiazem 120 to 180 mg, 2 times a day, were compared with hydrochlorothiazide 25 to 50 mg, 2 times a day, and the combination of diltiazem and hydrochlorothiazide in 56 patients with mild to moderate hypertension (supine diastolic blood pressure between 95 and 114 mm Hg) using a placebo-controlled, parallel-design protocol. Data from an additional 21 patients were evaluated for safety only. The data reported herein represent the preliminary experience from a larger 200-patient multicenter study. All patients received placebo for 4 weeks, followed by either hydrochlorothiazide or diltiazem titrated to achieve a diastolic blood pressure reduction of greater than or equal to 10 mm Hg to reach a goal supine diastolic blood pressure of less than 90 mm Hg. Patients not achieving the treatment goal received hydrochlorothiazide plus diltiazem. At week 14, on maintenance monotherapy, diltiazem and hydrochlorothiazide produced comparable reductions in blood pressure from placebo baseline (160.3 +/- 24.3/101.7 +/- 5.5 to 145.2 +/- 24.1/89.8 +/- 7.4 mm Hg with diltiazem, 156.0 +/- 15.6/103.7 +/- 4.7 to 134.1 +/- 12.5/89.2 +/- 9.5 mm Hg with hydrochlorothiazide, p less than 0.001 for both). Diltiazem and hydrochlorothiazide achieved goal blood pressure in 42% and 45% of patients, respectively. The effects in responders were sustained for 6 months. In patients who did not achieve the treatment goal, 63% responded to diltiazem plus hydrochlorothiazide.No clinically significant postural hypotension was observed on any regimen. Heart rate was slightly lower with diltiazem than with hydrochlorothiazide. Adverse effects were minimal with diltiazem, hydrochlorothiazide and diltiazem plus hydrochlorothiazide but more hypokalemia occurred with hydrochlorothiazide.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1985

Comparative effects of diltiazem and hydrochlorothiazide in blacks with systemic hypertension.

The blood pressure-lowering effects of a calcium-entry blocker, diltiazem (240 or 360 mg/day), and a thiazide diuretic, hydrochlorothiazide (50 or 100 mg/day), were studied in 20 black hypertensive patients. Supine blood pressure decreases of -34/-18 mm Hg for diltiazem and -29/-21 mm Hg for hydrochlorothiazide were noted after 14 weeks of therapy. Differences between drugs were not significant. Blood pressures were normalized in all 4 of the monotherapy nonresponders when the 2 drugs were combined. Significant adverse effects were not noted. These data suggest that diltiazem is an effective antihypertensive agent in black patients. As monotherapy, its blood pressure-lowering effect is equivalent to hydrochlorothiazide.

Adult↗
PubMed1985

[Comparative study on the effect of diet, exercise and iodine balneotherapy on blood rheologic parameters in diabetics within the scope of a 4 week health resort stay in Bad Hall].

A total of 123 spa patients with inadequately controlled diabetes mellitus was divided into the following 3 therapeutic groups: 1. therapeutic exercise alone, 2. iodine therapy with iodine brine (including drinking cure with "iodine-brine concentrate"), 3. remedial exercise plus iodine brine therapy. All patients received a rigidly controlled diabetic diet. The following parameters were determined at the beginning and at the end of the cure: whole blood and plasma viscosity, fibrinogen, blood glucose, total and HDL-cholesterol, triglycerides, HbA1c, alpha 2-macroglobulin, total protein, microhaematocrit. A significant improvement was found in the values of whole blood viscosity, cholesterol, triglycerides and blood glucose, indicative of a beneficial effect on metabolism, primarily due to the administered diet. The largest decreases were shown by blood viscosity, relative viscosity, triglycerides, cholesterol and HbA1c in group III, and by plasma viscosity in group II. alpha 2-Macroglobulins did not change. Fibrinogen was raised in groups I and III. The importance of the improved blood rheological properties is discussed, particularly with respect to reduced erythrocyte flexibility in diabetics.

Arteriosclerosis↗
PubMed1985

Collagen metabolism during the healing process of the cauterized rat cornea. An experimental study.

Attempts were made (1) to develop an appropriate method for producing standardizable and reproducible experimental opacities of the cornea of rats and (2) to study quantitatively the course and intensity of the healing process of these corneal wounds. The right cornea of rats was cauterized by drops of 1.5 N HC1 over 30 s; the left one served as a control. The spontaneous course of wound healing, as well as the possible effect on this process of spray treatment with iodine brine or, for comparative purposes, with isotonic NaCl, was studied for 10 consecutive days by measuring the 24-h incorporation of 14C-labelled proline as a measure of de novo collagen synthesis. Spray treatment (1) abolishes the transient inhibition of proline incorporation observed in the unsprayed cornea on the first day after injury and (2) significantly advances the maximum collagen synthesis rate from day 3-4 to day 2 after the wound occurred. The position and magnitude of the 14C-proline incorporation peak are considered to be useful parameters for estimating corneal wound healing activity and its alteration by various agents. However, in this experimental design, it could not be proved that iodine has a specific effect.

Administration, Topical↗
PubMed1985

Controlled clinical trials in emergency medicine.

In this first article of a series on controlled clinical trials in emergency medicine, an overview of the structure of such studies and the relevant issues related to study design, data generation, statistical analysis, and reporting are presented. The importance of precise patient selection, randomization and stratification, blinding, and equivalent therapeutic intervention in study design has been discussed. In addition, precise outcome and measurement criteria, assessor qualifications, deficiencies in data, appropriate sample-size selection, and reporting are also presented. Although an idealized framework for the conduct and analysis of a controlled clinical trial is provided, it should be appreciated that design and analytical compromises may at times be difficult to avoid in clinical research. Future articles in this series will discuss randomization in clinical trials, alternatives to randomization, beta error and sample-size determination, the statistical and analytical issues related to imperfections in the execution of a trial, and issues related to the reporting of clinical trials.

Clinical Trials as Topic↗
PubMed1985

Methodology reporting in three acute care journals: replication and reliability.

As the sciences of emergency medicine and acute care medicine develop, it becomes imperative for researchers in these fields to accurately and completely report the methodology of their investigations. It is only through complete reporting that other investigators can critically examine, replicate, or expand on the results of an investigation. The purpose of our study was to compare the completeness of methodology reporting in three acute care journals, Annals of Emergency Medicine, Critical Care Medicine, and Journal of Trauma. Thirty-eight criteria characteristics necessary for the replication of a clinical trial were identified and grouped into ten categories. The categories were experimental design, recruitment and exclusion of subjects, selection of study sample, subject allocation, therapeutic regimen, blindness, outcome criteria, analysis of confounders, withdrawal of subjects, and statistical analysis. All prospective, interventional, controlled trials appearing in these journals from January 1980 to June 1983 were identified. A total of 45 trials were found. Each trial was read independently by two reviewers to determine whether each of the 38 criteria was clearly reported, not clearly reported, or not applicable. Disagreements were resolved by a third reader (adjudicator). The results are reported as the mean proportion of items clearly reported +/- standard deviation: Annals of Emergency Medicine (n = 16), 0.39 +/- 0.10; Journal of Trauma (n = 18), 0.33 +/- 0.14; and Critical Care Medicine (n = 11), 0.32 +/- 0.09. A one-way analysis of variance found no statistically significant difference between journals with respect to these proportions (P = .25).(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Trials as Topic↗
PubMed1985

Reporting methodology protocols in three acute care journals.

Our study compared the reporting of methodology protocol details in three acute care journals, Annals of Emergency Medicine, Critical Care Medicine, and Journal of Trauma. Eleven criteria previously reported for evaluation of clinical trials in the medical literature were used. These were eligibility criteria, admission before allocation, random allocation, method of randomization, patients' blindness to treatment, blind assessment of outcome, treatment complications, loss to follow-up, statistical methods, statistical analysis, and power. All prospective, interventional, controlled trials appearing in the journals from January 1980 to June 1983 were identified. A total of 45 trials was found. Each study was read independently by two reviewers to determine whether each of the 11 criteria was reported clearly, reported unclearly, or not applicable. Disagreements were resolved by a third reader (adjudicator). The results are reported as the mean proportion of items clearly reported plus or minus the standard deviation: Annals of Emergency Medicine (n = 16), 0.40 +/- 0.18; Journal of Trauma (n = 18), 0.41 +/- 0.24; Critical Care Medicine (n = 11), 0.35 +/- 0.18. A one-way analysis of variance found no statistically significant difference between journals with respect to these proportions (P = .75). The study reveals that these journals, as judged by these criteria, do not report enough methodologic information to allow assessment of bias-reducing techniques and statistical methodology.

Analysis of Variance↗
PubMed1985

Effects of pressure-controlled intermittent coronary sinus occlusion on regional ischemic myocardial function.

Pressure-controlled intermittent coronary sinus occlusion has been reported to reduce infarct size in dogs with coronary artery occlusion, possibly because of increased ischemic zone perfusion and washout of toxic metabolites. The influence of this intervention on regional myocardial function was investigated in open and closed chest dogs. In six open chest dogs with severe stenosis of the left anterior descending coronary artery and subsequent total occlusion, a 10 minute application of intermittent coronary sinus occlusion increased ischemic myocardial segment shortening from 5.5 +/- 1.2 to 8.2 +/- 2.6% (NS) and from -0.1 +/- 2.1 to 2.3 +/- 1.2% (NS), respectively. In eight closed chest anesthetized dogs, intermittent coronary sinus occlusion was applied for 2.5 hours between 30 minutes and 3 hours of intravascular balloon occlusion of the proximal left anterior descending coronary artery. Standardized two-dimensional echocardiographic measurements of left ventricular function were performed to derive systolic sectional and segmental fractional area changes in five short-axis cross sections of the left ventricle. Fractional area change in all the severely ischemic segments (less than 5% systolic wall thickening) was -4.0 +/- 4.7% at 30 minutes after occlusion, and increased with subsequent 60 and 150 minutes of treatment to 13.1 +/- 3.3 and 7.0 +/- 3.3%, respectively (p less than 0.05). At the most extensively involved low papillary muscle level of the ventricle, regional ischemic fractional area change was increased by intermittent coronary sinus occlusion between 30 and 180 minutes of coronary occlusion from -0.4 +/- 0.1 to 14.4 +/- 4% (p less than 0.05), whereas a further deterioration was noted in untreated dogs with coronary occlusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1985

Blood pressure lowering and potassium conservation by triamterene-hydrochlorothiazide and amiloride-hydrochlorothiazide in hypertension.

Effects of once-daily doses of 50 mg triamterene with 25 mg hydrochlorothiazide and 5 mg amiloride with 50 mg hydrochlorothiazide were compared in a randomized, multicenter study of 84 adult subjects with mild to moderate hypertension (diastolic blood pressure 90 to 114 mm Hg). After a 3-wk placebo lead-in period, the subjects entered a 6-wk treatment period. The two drug regimens were compared with respect to antihypertensive effects and effects on serum potassium and magnesium levels during the final week of drug therapy, with the use of the last week of placebo therapy as a covariate. Both drug regimens substantially reduced mean supine systolic and diastolic blood pressures to well within normal limits; there was no significant difference the two groups. Twenty-four of the 41 subjects receiving triamterene-hydrochlorothiazide (59%) and 29 of the 43 patients receiving amiloride-hydrochlorothiazide (67%) had diastolic blood pressure less than 90 mm Hg at week 9. Five subjects receiving amiloride-hydrochlorothiazide (12%) and two subjects receiving triamterene-hydrochlorothiazide (5%) had hypokalemia (serum potassium level less than 3.5 mEq/l) at week 9. The average decrease in serum potassium levels during amiloride-hydrochlorothiazide therapy (-0.33 +/- 0.08 mEq/l) was greater than that after triamterene-hydrochlorothiazide (- 0.08 +/- 0.07 mEq/l). Serum magnesium levels were not changed by either regimen. Weight loss was greater in the amiloride-hydrochlorothiazide group than in the triamterene-hydrochlorothiazide group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

The case for treating mild hypertension.

Data are presented that define the risks of elevated blood pressure, both systolic and diastolic, and support the recent recommendations of the Third Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure in the United States that a consistently elevated pressure level above 140/90 mm Hg in adults should be lowered if possible. A summary of the major clinical trials, as well as a review of extensive data reported over the past 15-20 years, supports conclusions that mortality and morbidity are reduced, even in the mild hypertensive (diastolic BPs of 90-104 mm Hg), following blood pressure lowering to normotensive levels (less than 140-90 mm Hg). Numerous observations in the 1960s and 70s had established the benefits of treatment in patients with severe hypertension (diastolic BPs more than 115 mm Hg). The Veterans Administration studies also demonstrated that blood pressure lowering in patients with diastolic BPs above 105 mm Hg reduced mortality. More recently the 7-10-year U.S. Public Health Service Study and the Hypertension Detection and Follow-Up Program Study (HDFP) in the United States, and the Australian Study in Mild Hypertension, have demonstrated a decrease in cerebrovascular and a trend of a statistically significant decrease in overall cardiovascular mortality with effective blood pressure lowering.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Cellular interactions in graft-versus-host-induced T cell immune deficiency.

The present review summarizes some of this laboratory's recent findings and interpretations concerning the cellular interaction involved in graft-versus-host-induced immune deficiency. Our results indicate that GvHID induced by parental T cell recognition of allogeneic F1 class I plus class II MHC determinants abrogates CTL responses involving both self + X and H-2 alloantigen recognition. In contrast, GvHID induced by parental T cell recognition of only allogeneic F1 class II antigens reduces self + X CTL responses, but does not reduce allogeneic CTL activity. Parental T cell recognition of only class I H-2 antigens does not affect CTL responses. The GvHID is associated with a loss of ability of spleen cells from GvH mice to produce IL 2 and to express IL 2 receptors after stimulation with T cell mitogens. This reduction in IL 2 potential is associated with a reduction in T cells that survive mitogenic stimulation in culture. Freshly explanted spleen cells from GvHID mice exhibit normal numbers of T cells. Our findings are discussed in terms of there being distinct helper T cell pathways for the generation of CTL to self + X and alloantigens (Singer et al. 1984). The model proposed for selective loss of self + X T cell immunity in class II-induced GvHID is discussed with respect to the parallel selective loss of self + X CTL activity in the developmental stages of acquired immune deficiency syndrome (AIDS).

Animals↗
PubMed1985

Arteriovenous difference of the blood density in the coronary circulation.

The mechanical oscillator technique permits determining blood density continuously with high accuracy. Using this technique arteriovenous density gradients were recorded in the coronary vascular bed of anesthetized dogs. It was found that the coronary sinus blood has a higher density than arterial blood due to the loss of filtered fluid in the microcirculation. The amount of fluid loss corresponds to the lymph flow in the myocardium. Increase of venous pressure leads to an increase of the density gradient. Intermittent coronary sinus occlusion (ICSO) surprisingly leads to a reduction of the density gradient. Injection of osmotically hypertensive fluids influences the arteriovenous gradient by shifting extravascular fluid into the blood. The method permits the determination of filtration coefficients and to estimate the tissue volume available for fluid exchange.

Animals↗