[Non-drug therapy of arterial hypertension].
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Biomedical subjects
Publications and source records attributed to P Singer.
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Serum triglycerides appeared significantly lower in spontaneously hypertensive as compared to normotensive rats except in 8-week-old animals. Tri-, di and monoglycerides decreased continuously with age in the former but revealed only a transient fall in the latter. The remarkably high portion of partial glycerides (about 30% of total glycerides) in serum should be considered in all studies on lipolysis in rats.
We report the results of a survey of the attitudes and practices of obstetricians and paediatricians in Victoria with respect to the treatment of infants born with severe handicaps. Eighty-seven obstetricians and 111 paediatricians either completed questionnaires or agreed to be interviewed during the period 1981-1982. The treatment of severely handicapped infants is a matter of increasing concern to members both of the public and of the medical profession. The principal question is whether every infant should have its life prolonged by all available means, or whether some infants born with severe handicaps should be allowed to die. We attempt to identify areas of consensus and disagreement. We do not propound any particular point of view--our intention is rather to stimulate debate.
Glucose use as demonstrated by 2-deoxyglucose autoradiography increases in the hypoglossal nucleus after axotomy of the hypoglossal nerve. There are several possible explanations for this increase, including increased energy metabolism to support increased protein, RNA, and lipid synthesis during regeneration or, alternatively, increased electrical activity associated with the site of nerve transection or alterations in the neurolemma. To evaluate the possible role of electrical activity, we recorded spike activity in the hypoglossal nucleus after axotomy and evaluated glucose uptake in the hypoglossal nucleus after xylocaine application to the proximal nerve stump. There was no evidence from these experiments that an increased number of action potentials is responsible for the increased glucose use after axotomy.
Fifteen healthy volunteers were put on a mackerel and herring diet, consisting of a prescribed daily isocaloric regimen in a cross-over design, for 2 weeks. Eicosapentaenoic acid (EPA - C20:5, n-3) was predominantly incorporated into cholesterol esters, whereas docosahexaenoic acid (C22:6, n-3) appeared more in serum triglycerides, indicating that the function of the latter may be different from that of EPA. After mackerel ingestion, serum triglycerides, total cholesterol and lecithin cholesterol acyl transferase (LCAT) activity were significantly decreased, returning to basal levels 3 months later. Low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol and postheparin lipolytic activity (PHLA) remained unchanged at the end of the mackerel diet. Generally, after the herring diet the differences were minor, only LCAT activity being significantly decreased. A markedly lower systolic and diastolic blood pressure at the end of the mackerel period could be observed. After herring diet a slight diminution of blood pressure was not significant. Accordingly, plasma noradrenaline was only significantly decreased at the end of the mackerel period. Dopamine-beta-hydroxylase (DBH) activity in serum had no differences before, during and after the study. From the data presented it can be said that a mackerel diet exerts a beneficial influence on cardiovascular risk.
The fatty acid pattern of serum triglycerides and cholesterol esters has been estimated in spontaneously hypertensive rats (SHR) and normotensive Wistar rats (WR) at 4, 5, 6, 7, and 8 weeks of age. The percentage of linoleic acid (LA) was lower in SHR when compared with WR, but increased with age in both strains. Arachidonic acid (AA) showed an abrupt fall in SHR and WR at 5 weeks of age in comparison to 4 week old rats. The fall was more pronounced in serum triglycerides of the former and in cholesterol esters of the latter. The changes in AA occurred prior to the onset of hypertension in SHR. From the data it can be concluded that the formation of AA from LA might be dependent on age being quantitatively different in SHR and WR. Furthermore, eicosapentaenoic acid (EPA) appeared lower in SHR than in age-related WR. Docosapentaenoic and docosahexaenoic acids also revealed a marked decrease in rats between 4 and 5 weeks of age indicating that individual polyunsaturated fatty acids (PUFA) change in a different manner which might be relevant to the development of high blood pressure in SHR.
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In vitro fertilisation is now an established technique for treating some forms of infertility, yet it remains ethically controversial. New developments, such as embryo donation and embryo freezing, have led to further discussion. We briefly discuss the ethical aspects of IVF, focusing on the issues of resource allocation, the 'unnaturalness' of the procedure, the moral status of the embryo, surrogate motherhood, and restrictions on access to IVF. We argue that, on the whole, IVF is an ethically justifiable method of assisting infertile couples.
Håkanson's method of treatment of trigeminal neuralgia by injecting glycerol into the trigeminal cistern is being used in a few clinical centers with encouraging results. We undertook this experimental study utilizing a rat sciatic nerve model to elucidate the mode of action of glycerol. Fifty-six rats were divided into three groups. The topical application of pure glycerol on the sciatic nerve was used in Group I. The intraneural injection of glycerol was used in Group II. The effect of graded concentrations of glycerol was studied in Group III. Physiological saline was the control in Groups I and II. The animals were killed at the end of either 1 or 3 1/2 weeks after the application of glycerol, and the sciatic nerves were examined with light and electron microscopy. Our results show that myelin disintegration and axonolysis occur with glycerol application. Myelinated and unmyelinated fibers are affected at random, although the most striking histological changes were seen in the myelinated fibers.
This paper describes a case of deliberate massive ingestion of Paraquat (over 300 mg/Kg). Evolution is toward a circulatory insufficiency with metabolic acidosis, hyperglycemia, and early death (18 hours). Severe pulmonary failure would have been expected, but not appeared. Autopsy revealed patchy necrosis of the liver but no severe damage of the other organs, including lung and adrenal.
A feeding survey was conducted amongst 100 infants during the first three months of life, from December 1980 to August 1981. If breast milk was not available, infants were fed with adapted nutrition. Recommended nutrition was changed in 62 infants, 30% within the first four weeks and 70% between six and ten weeks. Partially adapted nutrition was used by mothers most frequently, while breast milk and mixed milk feeding decreased to 42%. The different findings and causes of changes in the nutrition are discussed.
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Taking into consideration regulative aspects and perceptible interrelations with pressor and depressor systems some typical alterations of the carbohydrate and lipid metabolism in patients with essential arterial hypertension are summarized. An increased hormone-induced lipolysis is associated with impaired carbohydrate tolerance. Glucose-stimulated insulin response is enhanced in hypertensives, even if glucose tolerance is normal. In subjects with essential hypertension the percentage of linoleic acid in serum triglycerides is augmented, but decreased in subcutaneous adipose tissue. The fat cell volume is not different from that in normotensive probands. The mostly mild disturbances of carbohydrate and lipid metabolism are already evident in early stages of essential hypertension and indicate syndrome-like interrelations which should be analysed systematically and which are of fundamental significance for the causal proof of primarily preventive strategies for the reduction of the cardiovascular risk.
Psychiatrists working in hospital and in private practice took part in co-operative trial aimed at evaluating the effectiveness and safety of bromazepam. The study was of the open type and involved 10 hospital patients and 20 ambulatory patients. The same protocole was followed for each patient. Twenty-five patients (including 5 in hospital) had anxiety neurosis; the remaining 5 had anxiety following weaning from alcohol. The anxiolytic effects of the drug, determined by means of Hamilton's anxiety scale and overall clinical judgement, were generally found to be satisfactory. The effective doses ranged from 1 to 3 tablets per day in ambulatory patients and from 3 to 5 tablets per day in hospital patients. The main side-effects were related to unwanted sedation; they only occurred with the higher doses and rarely interfered with the beneficial effects of bromazepam.
In patients with labile essential hypertension without and with overweight as well as in normotensive controls the fatty acid pattern of serum triglycerides and subcutaneous adipose tissue was estimated by gas liquid chromatography. In serum triglycerides of hypertensives linoleic acid was increased but appeared decreased in depot fat. This inverse relationship could not be found for arachidonic acid. Correspondingly, the C 18:2/C 20:4-ratio was higher in serum triglycerides than in adipose tissue. Only in depot fat of overweight hypertensives the percentage of arachidonic acid was decreased when compared to subjects with normal body weight. Linolenic acid remained unchanged in serum triglycerides but decreased significantly in adipose tissue of hypertensive patients. Eicosapentaenoic acid was increased in serum triglycerides and depot fat of patients with essential hypertension of normal body weight. The results are discussed with respect to the possible pathogenesis of essential hypertension and the hypotensive potency of dietary linoleic acid which has been described in patients with high blood pressure.
The fat cell volume from subcutaneous adipose tissue of the anterior abdominal wall has been evaluated in 10 male patients with essential hypertension and in 10 male normotensive control subjects of normal body weight as well as in 9 male obese hypertensives. In both groups with normal weight no significant differences could be confirmed whereas in hypertensives with overweight the adipose cell volume was significantly increased. Thus, no evidence of enlarged adipocytes as a primary defect in patients with high blood pressure could be obtained. The results are discussed in view of obesity, hyperlipoproteinaemia (HLP), increased lipolysis, impaired glucose tolerance, and high insulin response which frequently are associated with essential hypertension and usually favour the accumulation of triglycerides in hepatocytes and adipocytes.
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