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Effects of phorbol 12,13-dibutyrate on the vascular tone and on norepinephrine- and potassium-induced contractions of cat cerebral arteries.

Phorbol 12,13-dibutyrate (PDB), an activator of protein kinase C (PKC), induced slow-developing sustained contractions in segments of cat middle cerebral arteries. PDB-induced responses were not affected by phentolamine (1 microM) and endothelium removal, and were reduced by 1-(5-isoquinoline sulfonyl)-2-methylpiperazine (25 microM) and staurosporine (10 nM), PKC inhibitors. Forskolin (25 microM) produced a rapid and marked vasodilation in segments contracted with PDB. The 4 alpha-phorbol 12,13-didecanoate, an inactive compound, induced slight vasodilation. Preincubation with nifedipine diminished the responses elicited by PDB at all concentrations used. Ca-free medium containing 3 mM ethylene glycol bis(beta-aminoethyl ether)-N,N'-tetraacetic acid (EGTA), but not 1 mM, markedly reduced the phorbol-induced responses at concentrations up to 10 nM. Nifedipine (0.1 microM) and forskolin (25 microM) produced a rapid and marked relaxation of PDB (10 nM)-evoked contractions in segments incubated in a Ca-free solution (1 mM EGTA), but PBD responses in 3 mM EGTA were not affected by nifedipine. PDB (10 and 100 nM) practically did not modify K-induced contractions, but reduced vasoconstrictions elicited by different norepinephrine concentrations; this effect was phorbol concentration and preincubation time-dependent. These results indicate that: 1) PDB induced PKC activation and contraction mainly produced by Ca entry (essentially at low PDB concentrations) through dihydropyridine-sensitive Ca channels; 2) the activated PKC has elevated sensitivity for Ca; 3) PKC may be involved in the alpha adrenoceptors desensitization, but did not play an important role in the norepinephrine-induced contraction in these arteries.

Animals↗

[Incidence of exertion hypertension in normotensive individuals].

Exercise hypertension is the blood pressure response to dynamic exercise stress which is considered excessive as compared to what is normally observed in a healthy population. It is a useful indicator to assist in detecting those persons who may develop sustained hypertension. Research has been conducted on a large number of patients, carefully selected using as criteria: arterial pressure, presence of other diseases and age. The examination has been conducted by observing the stressor test on the cycloergometer and annotating the Pa with the traditional method. The data was then analyzed using statistical methods. We conclude that at the moment of maximum effort the patients can be divided into two groups based upon PaD values superior or inferior to 20% of base values or to 95 mmHg. Those who exceed these values (43% of all patients studied) are considered as effort hypertensive subjects. The work's originality derives from the statistically proven consideration that the evaluation of PaD at the 8th minute of the test with cardiac rate between 70 and 90% of the maximum theoretical cardiac rate is predictive of effort hypertension. Hence continuation of the test can be avoided with advantages in terms of time and reduction of the generic risks inherent in carrying out a maximal test. Follow up on the patients is in progress.

Adolescent↗

Elevated intraocular pressure following penetrating keratoplasty.

IOP was retrospectively studied in 229 consecutive cases of PK, with a mean follow-up period of 84 weeks. Twenty-seven percent of the cases had preoperative glaucoma, three-fourths of which were medically controlled prior to keratoplasty. Following PK, 34% of the total sample developed sustained elevated IOP but only five (2%) patients required surgical treatment for glaucoma. The mean time from PK to first IOP rise was 24 weeks. Variables which were significantly associated with IOP rise included preoperative glaucoma (P less than .001), aphakia (P less than .01), and IOL removal (P less than .01). When eyes with preoperative diagnoses of glaucoma were excluded from the analysis, aphakia was no longer associated with postoperative IOP rise. Keratoconus patients were at significantly less risk than patients with other corneal diagnoses. Factors not associated with IOP rise included previous PKs, pseudophakia, intraoperative vitrectomy, PAS lysis, iridoplasty, secondary IOL placement, and concomitant cataract extraction with IOL (triple procedure).

Aphakia↗

Open assessment of the safety and efficacy of thioridazine in the treatment of patients with borderline personality disorder.

A 12-week open study was conducted to assess the possible efficacy and safety of low-dose thioridazine in 11 outpatients (8 women, 3 men) with borderline personality disorder (BPD) diagnosed according to DSM-III-R (American Psychiatric Association 1987) and the Diagnostic Interview for Borderline Patients (DIB; Gunderson et al. 1981) criteria. Mean thioridazine dose averaged 92 mg per day across the duration of this study. At endpoint, there was a significant reduction in Brief Psychiatric Rating Scale (BPRS; Overall & Gorham 1988) scores, and patients appeared to be less symptomatic on the impulse action patterns, affects, and psychosis subscales of the DIB (modified to assess change). Subjects completing the entire study (n = 6) also showed improvement in interpersonal relations. On self-report measures, significant improvement was noted on most Hopkins Symptom Checklist-90 (SCL-90; Derogatis et al. 1973) subscales, particularly in hostility and additional depressive features. Subjects completing the entire study showed significant improvement in paranoid ideation, interpersonal sensitivity, and anxiety. Three patients, however, developed sustained melancholic depressions that necessitated their discontinuation from the study and the initiation of anti-depressant treatment. These three individuals were more schizotypal, schizoid, and paranoid at baseline according to Personality Disorder Examination (PDE; Loranger et al. 1987) structured interviews. Weight gain was not a significant problem, but sedation and erectile dysfunction were. Overall, these findings suggest that thioridazine may exert prominent effects on patients with BPD and that double-blind, placebo-controlled studies are warranted.

Adult↗

Management of blood pressure changes during recombinant human erythropoietin therapy.

Onset or exacerbation of hypertension has been observed as a possible complication of recombinant human erythropoietin (r-HuEPO; EPOGEN [epoetin alfa], AMGEN Inc, Thousand Oaks, CA) therapy for the anemia of end-stage renal disease. This effect is attributed to an overly rapid rise in the hematocrit level and the accompanying consequences, which include increased hemoglobin, blood viscosity, and red cell mass, as well as normalization of the cardiac index of anemia. The sluggish response to these changes by compensatory mechanisms, resulting in increased peripheral vascular resistance, may be the means by which BP becomes elevated during therapy. Although more than one third of patients receiving r-HuEPO therapy have developed sustained increases in diastolic pressure of 10 mmHg or more, this potential problem is controllable. Prevention or correction of hypertension is accomplished by initiating therapy with a low-dose regimen that is slowly increased, thereby preventing a rapid rise in the hematocrit level. Drug intervention, together with dialysis prescription modification and restriction of dietary salt and fluid to regulate weight, can effectively control BP. Discontinuation of therapy for severe and uncontrollable hypertension rarely becomes necessary.

Anemia↗

[Surface recording of abnormal post-QRS micropotentials. Description and frequency in ventricular tachycardias after myocardial infarction].

In order to study abnormal post-QRS micropotentials, so called late potentials, and to determine their frequency in post myocardial infarction ventricular tachycardia (VT), high amplification electrocardiogrammes were recorded in 180 patients classified in 3 different groups: Group A comprising 36 patients who developed sustained VT after myocardial infarction; Group B comprising 124 patients with myocardial infarction uncomplicated by VT. This group was subdivided into subgroup B1 (retrospective study of 35 patients with chronic myocardial infarction, dating on average 10 months--range 7 days to 8 years) and subgroup B2 (prospective study of 89 patients investigated on the 7th and 60th days after infarction); Group C comprising 20 young, normal control subjects. Using computer assisted high amplification electrocardiography, all patients underwent at least 3 successive recordings of the following parameters: averaging 100 cycles; sampling: 1 kHz; band pass 20-300 Hz and 80-300 Hz; gain setting 10,000 and 25,000. Late potentials usually appears, after the end of the S wave, as high frequency oscillations with an amplitude (10 to 20 microV) significantly greater than that of the background noise. Our recordings also showed: the frequent presence, especially in intraventricular blocks, of fragmentation of the end of the R wave and of the S wave or terminal potentials; the presence of an abnormal giant low frequency high amplitude wave (40 to 80 microV) in 5 patients with a large left ventricular aneurysm.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Management of ventricular arrhythmias occurring in patients after myocardial infarction.

Some of the problems facing clinicians in the management of patients with ventricular ectopy occurring during the convalescent phase of myocardial infarction (MI) are discussed, and the pertinent literature is surveyed. The outstanding problem is identification of the patient at high risk for developing sustained ventricular tachycardia or fibrillation. Decisions on administration of antiarrhythmic agents to post-MI patients have long been based solely on detection of ventricular ectopy. By now, however, it has become apparent that this approach has not favorably altered the incidence of sudden cardiac death and has exposed many asymptomatic patients needlessly to potentially toxic antiarrhythmic agents. At present, assessment of the benefit/risk ratio favors treating asymptomatic complex ventricular ectopy only in patients with significant left ventricular dysfunction, provided that treatment results in the adequate suppression of complex forms of the ventricular ectopy and does not produce deleterious effects. The benefit/risk ratio does not favor treatment of asymptomatic ventricular ectopy in other groups of post-(MI) patients. Improved methods of identifying patients requiring treatment are needed. Programmed ventricular stimulation and noninvasive interrogation of signal-averaged electrocardiograms are designed to detect the presence of an arrhythmogenic substrate and offer promise for improved identification of patients at risk for sudden cardiac death.

Anti-Arrhythmia Agents↗

Exercise hypertension in healthy normotensive subjects. Implications, evaluation and interpretation.

Exercise hypertension, defined as a blood pressure response to a dynamic exercise stressor which is considered excessive to what is normally observed in a healthy population, is currently the subject of much discussion. This interest appears to be related to the recent concerns that are being expressed in the utilization of hypertensive drugs with respect to their long-term benefits and risks. I would seem that the proper selection of patients for drug therapy will become as important as the treatment itself, not only for clinical purposes but to insure the quality of life of a patient in the pursuit of his/her daily activities. Also, a number of retrospective studies have shown that an exaggerated blood pressure response to exercise in resting normotensive persons could be a useful indicator to assist in detecting those persons who may be on the way to developing sustained hypertension. The literature suggests that this is a tenable hypothesis but one that will require testing by prospective research. In this respect, it has been suggested that if the blood pressure response to a dynamic exercise in borderline or labile hypertensives is normal, it is possible to dismiss the diagnosis of hypertension, at least temporarily. However, if the blood pressure response is exaggerated, then the diagnosis of hypertension should be considered. In Canada, the Canadian Aerobic Fitness Test (CAFT) has been utilized to assist in detecting exercise hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

The psychopathology of feeling and thinking in a schizophrenic.

This paper describes the process and technique of brief analytic psychotherapy with a 22-year-old schizophrenic man who was treated twice weekly for ten months and then followed up for two years. During therapy, re-integration occurred in his affective and cognitive processes. Despite his subjective experience of loss of the capacity for thought and for verbal and non-verbal communication, he had an unusual ability for conveying the stages by which he moved from total confusion and thought disorder to normal intellectual functioning, and for understanding the connections between his various experiences. Four phases of therapy are defined: a phase of disintegration and undifferentiation lasting six weeks, a phase of depression lasting for five weeks, a phase of multiple feelings lasting for fourt thought disorder to normal intellectual functioning, and for understanding the connections between his various experiences. Four phases of therapy are defined: a phase of disintegration and undifferentiation lasting six weeks, a phase of depression lasting for five weeks, a phase of multiple feelings lasting for fourt thought disorder to normal intellectual functioning, and for understanding the connections between his various experiences. Four phases of therapy are defined: a phase of disintegration and undifferentiation lasting six weeks, a phase of depression lasting for five weeks, a phase of multiple feelings lasting for fourteen weeks, and a phase of self-sustained development, starting in the twenty-fifth week and continuing beyond the end of therapy. The patient identified two major types of divisions between thinking, feeling and acting parts of himself and between masculine and feminine parts. Insight into these divisions helped him to understand disorders in his perception of time, and in thinking, remembering and using words and other symbols. His descriptions are presented here in the hope that they may throw light on the difficulties of similar, but less articulate, patients.

Adult↗

Circulating thymic hormone levels in severe combined immunodeficiency.

Twenty-three patients with severe combined immunodeficiency disease were studied for circulating thymic hormone levels (facteur thymique serique, FTS), 21 prior to treatment by transplantation of bone marrow, thymus or fetal liver. Thirteen showed undetectable FTS activity. Only two had normal levels of this hormone. In serial determinations of FTS activity prior to and after transplantation, patients given bone marrow transplants developed sustained increments of serum FTS activity early in the course of their immunological reconstitution. However, patients given transplants of fetal liver alone or fetal liver plus thymus from fetuses of less than 12 weeks gestation generally did not show an increment of FTS activity during the period of observation. Transplantation of irradiated thymus derived from fetuses of more than 14 weeks gestation produced sustained increases of thymic hormone activity. These observations suggest that a cell of haematopoietic origin provides a stimulus necessary for differentiation or maturation of thymic secretory activity and that this cell(s) is present in post-natal marrow, but is either undeveloped or immature in the early fetal liver or fails to migrate to the thymus of an allogeneic host.

Antibody Formation↗

Anaphylactic actions of platelet-activating factor.

Platelet-activating factor (1-O-alkyl-2-acetyl-sn-glycero-3-phosphorylcholine) is a potent inducer of systemic anaphylactoid reactions in animals. It was found to be similarly potent in contracting smooth muscle of guinea pig ileum and lung and in enhancing vascular permeability when injected subcutaneously into these animals. This factor, therefore, possesses in vitro and in vivo bioactions that resemble those of C3a and C5a anaphylatoxins. However, platelet-activating factor induces a slowly developing, sustained contractile wave in ileum that is not inhibited by an antihistaminic compound, pyrilamine, whereas C3a and C5a stimulate rapid transient contraction that is abrogated by the antihistamine. Furthermore, platelet-activating factor desensitized the ileum to restimulation by itself but not by C3a or C5a; conversely, C3a and C5a desensitized the ileum to themselves but not to platelet-activating factor. Thus, platelet-activating factor possesses a distinctive set of anaphylactic actions. It stimulates a slow wave of muscle contraction and can act independently of histamine release and receptors for the C3a and C5a anaphylatoxins.

Anaphylatoxins↗

Effects of apparently nontoxic doses of digoxin on ventricular ectopy after direct-current electrical shocks in dogs.

To determine whether nontoxic doses of digoxin increase the risk of serious ventricular arrhythmias after d.c. cardioversion, studies were made of the effects of different doses of digoxin on the incidence and severity of ventricular arrhythmias after graded, external d.c. shocks in 14 closed-chest dogs. Electrocardiograms were recorded continuously for 20 min before and 10 min immediately after sequential QRS-synchronized shocks of 10, 100 and 150 joules. Ventricular premature beats were counted and their severity was graded. Digoxin (0.01--0.05 mg/kg) was then given i.v. to 12 dogs. Despite a wide range of serum digoxin concentrations (1.3--12.5 ng/ml), electrocardiographic signs of digitalis toxicity did not develop in any of these animals. The same sequence of d.c. shocks was repeated after 2 hr in nine dogs and after more than 24 hr in three dogs. Neither the total number of ventricular ectopic beats nor the arrhythmia grade postshock differed significantly before and after digoxin. Furthermore, more dogs developed ventricular ectopy at each energy level after control shocks than following shocks after digoxin administration. Two additional dogs were given repeated digoxin doses until electrocardiographic evidence of digitalis toxicity was apparent. Both developed sustained ventricular tachycardia after electrical shocks at all energy levels. Whereas overt digitalis toxicity predisposes to serious ventricular arrhythmias after d.c. shocks, we conclude that the risk of postshock ventricular ectopy is not increased by pretreatment with apparently nontoxic digoxin doses.

Animals↗

Practical management of borderline hypertension.

Patients with borderline hypertension are at a higher risk to develop sustained hypertension and its sequelae, higher cardiovascular morbidity and mortality. However, this excess risk is not overwhelming. Aggressive antihypertensive medication for all patients with borderline hypertension is not warranted. Only patients who are at highest risk for hypertension and its complications should be given small doses of antihypertensive monotherapy. The objective of the treatment is to lower blood pressure without side effects. Patients who are not chosen for treatment must be continuously managed. The management includes following the blood pressure trends, dietary sodium restriction, and control of overweight.

Adolescent↗

The management of health and safety hazards in tourist resorts. World Tourism Organization.

The enjoyment of a holiday has to do with landscape, buildings, people, and their activities. For truly sustainable development, these components need to become better integrated. Ways of achieving this were discussed at the IVth World Health Organization International Conference on Tourist Health, Rimini, Italy, in May 1994. It was agreed that attention to the health enhancing aspects of each component in the built environment is essential. Risks to health from man-made hazards in tourist resorts therefore need to be eliminated where possible, or otherwise minimised, contained or controlled. A systematic approach is outlined here in which owners, managers, operators, workers and users all have responsibilities and in which occupational physicians can contribute.

Accident Prevention↗

Microbial degradation of poly-beta-hydroxyalkanoates.

The search for new materials that are not hazardous to the environment has become a major issue in our society, engaged as it is in the attainment of sustainable development. Poly-beta-hydroxyalkanoates (PHA), produced exclusively by prokaryotes, can be used as thermoplastics and are fully biodegradable and innocuous to the environment. Biodegradability testing has quantified the capacity of microorganisms to degrade such new chemical compounds, particularly polyhydroxyalkanoates. Standardized tests may also discover new microorganisms and environmental conditions that accelerate biodegradation. We evaluate various techniques used to assess the biodegradability of PHA, and which may also be applied to test other kinds of polymers.

Biodegradation, Environmental↗

[White coat hypertension and blood pressure measurement at home].

"White-coat" hypertension, i.e. high readings in the clinic but normal readings at home, has been demonstrated in 21-58% of hypertensive subjects without end-organ injury. The condition can be diagnosed by means of home blood pressure monitoring, which should therefore be used as a supplement to monitoring by the physician. Owing to the low blood pressure readings at home, these patients should not be treated with drugs. In the event of anti-hypertensive treatment, home blood pressure monitoring is useful in helping to decide the minimum required dose, thus reducing risk of side effects, and in monitoring the response to therapy. White coat hypertension is associated with overweight, lipid abnormalities and high fasting insulin. Owing to the high risk of developing sustained hypertension, the patients' blood pressure must be measured regularly both at the clinic and at home.

Adult↗

Follow up of young people with high casual blood pressure.

High blood pressure (BP), often borderline hypertension, can be also found in adolescents. In these subjects the haemodynamic pattern, high cardiac output and normal vascular resistance, differs from that of older hypertensives. Although the risk for hypertension is higher in this group than in the general population, only a minority of them will develop sustained hypertension later in life. They can therefore be viewed as an enriched pool of future hypertensives but not as true prehypertensives. The aim of this longitudinal study was to analyse the relation between casual BP measured in high school students and in the same subjects 3 years later. In 1990, an extensive study on BP was carried out in 1062 high school students aged 18 years. Sitting BP, heart rate, weight, and body mass index (BMI) were measured in each subject. After 3 years, the 50 subjects with the highest BP level recorded in 1990 were recalled. Forty-five subjects (90%, 30 males and 15 females) agreed to undergo a second examination. They were seen as outpatients in the Hypertension Centre of our institute. BP was measured with a mercury sphygmomanometer after a 10 min rest three times in 5 min. Systolic and diastolic BP were significantly reduced after 3 years (137 +/- 13 vs 132 +/- 10 P = 0.002; 92 +/- 4 vs 85 +/- 6 P = 0.0001, mm Hg). By means of a multiple regression test, including parameters recorded in 1990, systolic blood pressure (SBP) (R = 0.53 Slg F = 0.0002) and diastolic blood pressure (DBP) (R = 0.60 Slg F = 0.0001) were shown as the main determinants of SBP, while DBP was related only to previous BMI (R = 0.37 Slg F = 0.01). The reduction of both SBP and DBP after 3 years could be explained either by a true, spontaneous decrease of BP or as a consequence of different environmental conditions during the second examination (more prolonged resting time, repeated measurements). However, data of this study demonstrate that casual SBP and DBP are the main determinants of future SBP, thus confirming the prognostic value of casual BP measurement in young people. Moreover, our data emphasises the role of BMI as the main determinant of future high DBP.

Adolescent↗

Conceptual frameworks for setting environmental standards.

Following the Second European Conference on Environment and Health, held from 20 to 22 June 1994 in Helsinki, the World Health Organization (WHO) established a National Environmental Health Action Plan pilot project. During 1995, and as part of its work for this project with the WHO European Environmental Health Committee, the UK Royal Commission on Environmental Pollution began to seek evidence for the basis of setting environmental standards and to ask if a more consistent and robust basis can be found for establishing them. This paper explores the conceptual frameworks needed to help establish policy and address practical questions associated with different pollutants, exposures and environmental settings. It addresses sustainable development, inter-generational equity and environmental quality, the European Charter on Environment and Health, the Treaty of Maastricht, economic, educational and training issues, risk assessment, the role of environmental epidemiology, and definitions of environmental quality objectives, environmental health indicators, environmental epidemiology and environmental impact assessment.

Environmental Health↗