Biomedical subjects

A Overlack

Publications and source records attributed to A Overlack.

At least 37 records · Page 2Linked to original sources

PubMed1992

Angiotensin-converting enzyme inhibition in mild hypertension with concomitant diseases and therapies: an efficacy, safety, and compatibility study of novel design, the Perindopril Therapeutic Safety Study.

Despite a marked reduction in cardiovascular morbidity and mortality, treated hypertensive patients remain at increased risk of coronary artery disease and its complications compared with untreated normotensive subjects. Mild hypertension is often associated with other, usually chronic, diseases. The failure of first-line antihypertensive therapy to deal adequately with concomitant disease and associated therapy might account for the poor improvement in the cardiovascular prognosis. This possibility has been addressed in an ongoing trial of novel design, the Perindopril Therapeutic Safety Study, a multicenter, double-blind, randomized and placebo-controlled trial to determine the safety, efficacy, and interaction of angiotensin-converting enzyme (ACE) inhibition with eight of the most common concomitant diseases and their therapies. A total of 480 male and female patients (60 per disease group) aged 30-70 years, with a diastolic pressure of 90-104 mm Hg, were included after a 3-week placebo run-in if they satisfied standard criteria for any of the following: hyperlipidemia, type II diabetes, ischemic heart disease, cardiac arrhythmia, peripheral arterial disease, nephropathy with proteinuria, chronic obstructive lung disease, or rheumatoid arthritis. Of these, 460 patients have completed the 6-week double-blind phase (comprising two assessments, at 3 and 6 weeks), and are currently undergoing assessments every 3 months over a 1-year follow-up period. The end points include the incidence of progression or improvement in concomitant disease, the incidence of positive or negative interaction between ACE inhibition and concomitant therapy, change in blood pressure, adverse biochemical and hemodynamic reactions, self-reported side effects, and quality of life indices. Interim results for the 6-week double blind phase will shortly be available. However, the desirability and feasibility of conducting a study according to this novel design have already been proved.

Adult↗

PubMed1992

Cough induced by ACE-inhibitors. A kinin related phenomenon?

Cough induced by ACE-inhibitors may be related to bronchial hyperreactivity and/or to an accumulation of kinins. In a placebo-controlled, double-blind randomized study in asthmatic and hypertensive patients lung function and bronchial reactivity to histamine and bradykinin remained unaltered although in hypertensive patients with cough, reactivity to histamine tended to be more pronounced and bronchial hyperreactivity to be more frequent than in those without cough. The findings do not support a major role of kinins in ACE inhibitor-induced cough.

Adult↗

PubMed1992

Airway responsiveness and cough induced by angiotensin converting enzyme inhibition.

Dry cough is one of the most common side-effects of angiotensin converting enzyme inhibitors. The mechanism of cough induced by ACE inhibitors is not completely understood and may be related to bronchial hyperreactivity and/or an accumulation of kinins. In a placebo-controlled, double-blind randomised study, the effect of captopril on lung function and bronchial reactivity to histamine and bradykinin was investigated in eight asthmatic and 12 hypertensive patients (six with and six without cough during previous ACE inhibition). Lung function did not change in any patient after a single (25 mg) or short-term (2 x 25 mg for two weeks) administration of captopril. Bronchial reactivity to histamine and bradykinin remained unaltered in all groups. In hypertensive patients with cough, reactivity to histamine tended to be more pronounced and bronchial hyperreactivity to be more frequent than in those without cough. In conclusion, the present results do not support a major role for kinins in cough induced by ACE inhibition. On the other hand, bronchial hyperreactivity may be important in some patients. Additionally, these results demonstrate that treatment with ACE inhibitors is safe in most patients with bronchial asthma.

Adult↗

PubMed1992

[Primary amyloid tumor of the lung].

Primary idiopathic amyloidosis may be a diagnostic problem because of its low incidence and its variable manifestations. The clinical and radiographic findings in a patient with accidentally discovered primary amyloidosis of the lung are presented. The extensive mediastinal and hilar lymph-node enlargement was striking. Peripheral bronchial carcinoma was initially suspected because of the radiographic and CT findings. Various patterns of pulmonary amyloidosis have to be considered in the differential diagnosis of nodules and interstitial changes of the lung.

Amyloidosis↗

PubMed1991

[Chronic hemorrhagic pleural effusion in mediastinal pancreatic pseudocyst].

A 48-year-old patient is presented with chronic hemorrhagic pleural effusion due to a pancreatitis-induced pseudocyst. High levels of pleural fluid amylase and demonstration of the pseudocyst by endoscopic retrograde cholangio-pancreatography (ERCP) provided the diagnosis. After chest tube draining for about two weeks curative surgery was undertaken.

Cholangiopancreatography, Endoscopic Retrograde↗

PubMed1991

[Effectiveness of pravastatin and bezafibrate in primary hypercholesterolemia].

The efficacy and safety of pravastatin and bezafibrate (in retard form) were compared in a randomised double-blind trial comprising 96 patients (48 men, 48 women; mean age 52.5 [20-68] years) with primary hypercholesterolaemia types IIa and IIb. After four weeks' treatment 6 out of 38 patients (400 mg/d bezafibrate) and 27 out of 58 patients (20 mg/d pravastatin) reached a LDL cholesterol level of 190 mg/dl or less. In the other 31 patients of the pravastatin group the dose was raised to 40 mg/d. During the twelve-week course of pravastatin total cholesterol concentration fell from a mean of 364 +/- 75 mg/dl (initial value) to 281 +/- 61 mg/dl (P less than 0.01), while LDL-cholesterol fell from 288 +/- 81 mg/dl to 206 +/- 64 mg/dl (P less than 0.01) and triglyceride concentration from 168 +/- 83 mg/dl to 148 +/- 80 mg/dl (P less than 0.05). During the twelve-week course of treatment with 400 mg bezafibrate total cholesterol concentration fell from a mean of 363 +/- 91 mg/dl to 325 +/- 73 mg/dl (P less than 0.01), LDL-cholesterol level fell from 284 +/- 88 mg/dl to 242 +/- 70 mg/dl (P less than 0.01) and the triglyceride concentration from 173 +/- 91 mg/dl to 121 +/- 83 mg/dl (P less than 0.01). HDL cholesterol concentration rose by 9% in the bezafibrate group and by 8.4% in the pravastatin group (P less than 0.05). Except in the case of HDL-cholesterol, the falls were significantly different in the two treatment groups: pravastatin was superior to bezafibrate in terms of the reductions in both total and LDL-cholesterol (P less than 0.01 for each). However, bezafibrate produced a greater fall in serum triglycerides (P less than 0.05). No serious side effects were associated with either drug.

Adult↗

PubMed1991

Short-term dietary sodium restriction increases serum lipids and insulin in salt-sensitive and salt-resistant normotensive adults.

Evidence suggests that dietary salt reduction similar to diuretic therapy may adversely affect lipid and glucose metabolism. We studied 147 non-obese normotensive subjects (60 females and 87 males) aged 19-78 years who entered a single-blind crossover trial and were randomly assigned to a low salt diet of 20 mmol or a high salt diet of 300 mmol sodium per day, for 7 days each. Sodium restriction lowered mean arterial blood pressure (MAP) by a mean of 7.5 mmHg in 17% (salt-sensitive), had no hemodynamic effect in 67% (salt-resistant) and raised MAP by a mean of 6 mmHg in 16% of the subjects (reverse reactors). With dietary salt restriction serum total- and LDL-cholesterol as well as serum insulin and uric acid concentrations increased significantly in all three groups. The largest increases in total (10%) and LDL- (12%) cholesterol occurred in the reverse reactors. Salt-sensitives had significant higher lipoprotein(a) values than the other two groups. Salt-restriction had no significant effect on this parameter. Plasma renin activity, as well as plasma aldosterone and noradrenaline concentrations rose in all three groups during the low salt diet, the largest increases being observed in the reverse reactors. Short-term sodium restriction in normotensive adults has unfavourable effects on lipid and glucose metabolism, especially in subjects who do not derive hemodynamic benefit. Further studies are necessary to examine the effects of more moderate salt reduction for longer periods on the risk factor profile for cardiovascular disease before a low salt diet can be regarded as a safe public health measure for the general population.

Adult↗

PubMed1991

The influence of oral potassium citrate/bicarbonate on blood pressure in essential hypertension during unrestricted salt intake.

In several trials, a blood pressure lowering effect of potassium chloride could be demonstrated. However, it is not known if other potassium salts are also effective. In a randomized cross-over trial, 12 patients with essential hypertension were treated for 8 weeks with placebo and 120 mmol potassium per day. Potassium was given together with 50% citrate and 50% bicarbonate as anions. Urinary potassium excretion rose from 61.8 +/- 8.1 to 166.7 +/- 21.2 mmol/24 hours during potassium supplementation. However, blood pressure and heart rate remained unchanged when compared to placebo. Non-chloride potassium salts may not be effective in lowering blood pressure in essential hypertension. Since potassium rich foods like fruits and vegetables contain potassium mostly as non-chloride salts, it appears to be premature to recommend a high dietary potassium intake as a mean to treat elevated blood pressure.

Adult↗

PubMed1990

[Fever, productive cough, chest pain].

This 27 year old woman had thoracic pain associated with breathing and movements for 10 months. Later on she complained about productive cough and fever. A pleural effusion developed. This effusion and the other symptoms did not resolve after therapy with erythromycin. Microbiology, serology and a bronchoscopy were unrevealing. A thoracoscopy was performed yielding epithelioid granulomas in the biopsy specimen from the pleura. Mycobacterium tuberculosis was grown from the pleural fluid. Symptoms subsided rapidly and the patient became well shortly after institution of anti-tuberculous therapy with a combination of three drugs.

Adult↗

PubMed1990

[Therapy of moderate hypertension with the calcium antagonist nitrendipine in combination with beta receptor blocker or diuretic].

The efficacy of the calcium channel blocker nitrendipine alone and in combination with the beta blocking agent acebutolol or hydrochlorothiazide was tested in 34 patients with moderate essential hypertension. After a wash out period of three to four weeks, all patients received placebo for two weeks, thereafter 20 mg of nitrendipine per day for four weeks. When diastolic blood pressure remained above 95 mmHg with nitrendipine, acebutolol (200 mg/d) or the thiazide (25 mg/d) was added in a randomised double-blind fashion. With nitrendipine alone, blood pressure could be normalized in nine patients with a drop in pressure from 168/108 to 152/89 mmHg. The other patients showed a fall in blood pressure from 164/110 to 152/102 mmHg. In these patients, the addition of acebutolol or thiazide was followed by a further fall in blood pressure which was similar with both drugs. With acebutolol blood pressure decreased from 154/102 to 146/94 mmHg and with the thiazide from 152/102 to 147/95 mmHg, respectively. Minor and mostly transient side effects were predominantly seen during therapy with nitrendipine alone. The fall in diastolic but not systolic blood pressure with nitrendipine was correlated with age. The blood pressure lowering effect of nitrendipine was independent of plasma renin activity and intracellular electrolyte concentrations. In the therapy of moderate hypertension, nitrendipine given in combination with a betablocker or a thiazide diuretic is effective and well tolerated.

Acebutolol↗

PubMed1990

[Weight loss, fever, dyspnea].

A 41-year-old homosexual man complained about weight loss of 14 kg over a period of 6 months. He developed exertional dyspnea and fever up to 39.6 degrees C. The ESR was elevated and the fraction of immature neutrophils increased. Penicillin was administered with no effect, chest X-ray showed basal pulmonary infiltrates, P. carinii was found in bronchioalveolar fluid. HIV-serology was positive. Sulfamethoxazole/trimethoprim (1600/320 mg daily) and 100 mg of prednisolone/die led to reduction of fever. Prevention of P. carinii pneumonia relapse is currently underway with bi-weekly inhalation of pentamidine-isethionate aerosol.

Acquired Immunodeficiency Syndrome↗

PubMed1990

A placebo-controlled blinded comparison of nedocromil sodium and beclomethasone dipropionate in bronchial asthma.

Two hundred and two patients aged 12-78 with chiefly moderate to severe asthma took part in a multicenter randomized blinded group comparison of nedocromil sodium (NS) 4 mg four times daily, beclomethasone dipropionate (BD) 0.1 mg four times daily, and placebo. Patients were assessed at the start and end of a two week baseline and after three and six weeks of treatment. Compared with placebo, both NS and BD significantly improved daytime dyspnoea and day and nighttime cough, as assessed by diary card scores. Lung function (FEV1) was significantly improved in the BD group. In the NS group there was also a significant reduction in concomitant use of inhaled beta 2-agonists. Overall opinions of efficacy by clinicians and patients were significantly in favor of both active treatments over placebo. There were no significant differences between the three treatments for peak expiratory flow rates, morning tightness or nighttime dyspnoea. Comparison between the two active treatments showed no significant differences in any of the variables.

Adolescent↗

PubMed1990

Peripheral neuropathies in patients with chronic obstructive pulmonary disease: a multicenter prevalence study.

To investigate the prevalence and type of peripheral neuropathies (PNP) in patients with chronic obstructive pulmonary disease (COPD), we studied lung function and blood gases, clinical signs of PNP, and neurophysiological function in 151 patients with COPD without known risk factors for PNP. Mean (SD) age was 65 (10) years, mean arterial PO2 was 59 (9) mmHg, mean ratio of forced expiratory volume in the first second to vital capacity (FEV1.0/VC) was 42 (12%). Thirty patients (20%) had clinically detectable and 6 (4%) had subclinical PNP of mild degree. Fourteen (9%) of the patients with clinically detectable PNP had symptoms due to PNP. Prevalence of PNP increased with severity of hypoxemia (p less than 0.05) and was more pronounced in the lower than in the upper limbs. Age and the degree of hypoxemia were predictors to differentiate between COPD patients with and without PNP. Although the cause of PNP in COPD patients remains unknown, our observations suggest that chronic hypoxemia may contribute to PNP.

Adult↗

PubMed1990

[Prevalence of polyneuropathies in patients with chronic obstructive lung disease].

A multicentric study of 151 COLD patients confirmed the increased prevalence of peripheral polyneuropathies (PNP) in hypoxaemic patients with chronic obstructive lung disease (COLD). 43 (28%) of these 151 COLD patients showed a clinically manifest PNP, whereas in a comparative group of 32 asthmatics there were only 2 clinical PNP cases. Patients with known risk factors for PNP were not included in the study. The polyneuropathy observed in such patients is usually mild, mainly sensorial, distal and leg-accentuated. Of 52 COLD patients with a PaO2 up to 55 Torr, polyneuropathy was seen in 21 (40%), and of 59 COLD patients with a PaO2 above 60 Torr, 10 (17%) had polyneuropathy. In multifactorial genesis (as would be expected), the degree of severity of hypoxaemia (calculated as reduction of the actual PaO2 value below the age-adjusted nominal value), as well as the age of the patient, are statistically significant predictors of clinically manifest PNP.

Aged↗

PubMed1989

[Dyspnea, fever].

A 28-year-old female with known allergic bronchial asthma complained about increasing dyspnea, white sputum and fever. Pulmonary infiltrates progressed in spite of tetracycline administration. An increased leucocyte count, eosinophilia and an elevated sedimentation rate were found. Bronchoscopy was unrevealing except for signs of mild bronchitis. Eosinophils were abundant in the bronchial lavage. Eosinophilic pneumonia was diagnosed in a biopsy specimen. Prednisolone (100 mg/die initially, decreasing doses thereafter) led to significant reduction of infiltrates and eosinophilia. After 8 weeks of treatment the patient had completely recovered.

Adult↗

PubMed1989

[Dyspnea at rest].

A 54 year old woman complained about progressive dyspnea. She was markedly obese and presented with right-sided pleural effusion of undetermined origin. Treatment for congestive heart failure did not reduce the pleural effusion. Pleural or pulmonic tumor was not found, a large intraabdominal mass contained ovarian tumor-cells. The exudative pleural fluid was interpreted as Meigs'-syndrome in view of the coexisting ascites.

Diagnosis, Differential↗

PubMed1989

[Fever, productive cough, night sweats].

A 43 year old male complained about fever, productive cough and nocturnal sweating. He was treated for pneumonia with antibiotics because of pulmonary infiltrate. Tomography revealed a large cavity with infiltrated border in the right inferior lobe. By means of bronchoscopy the diagnosis of bronchial tuberculosis was established. Mycobacterium tuberculosis was cultured. A comparison with previous radiographs suggested a duration of the disease of approximately 3 years. A combined chemotherapy with isoniazide, rifampicin and pyrazinamide resulted in rapid disappearance of symptoms and to regression of radiologic changes. The cavity persisted after 9 month of treatment.

Adult↗

PubMed1989

A placebo-controlled, blind comparison of nedocromil sodium and beclomethasone dipropionate in bronchial asthma.

A multi-centre, randomized, blind comparative group study was carried out in 202 adult patients, who had suffered from asthma for at least 2 years, to assess the effectiveness and tolerability of maintenance treatment with either 4 mg nedocromil sodium 4-times daily, 0.1 mg beclomethasone dipropionate 4-times daily or 2 puffs of placebo 4-times daily, given by inhalation. Lung function (FEV1 and sRaw) measurements were made at the beginning and end of a 2-week baseline period and then after 3 and 6 weeks of treatment: assessment were also made of asthma severity. Patients recorded daily on diary cards details of morning and evening PEFR, usage of inhaled bronchodilators, severity of dyspnoea, cough and morning tightness. The results showed that, compared with placebo, both nedocromil sodium and beclomethasone dipropionate-treated patients showed an improvement in FEV1 and a reduction in sRaw values: PEFR increased slightly in all three groups. There was an improvement in asthma severity, diminished rate of dyspnoea and cough, and reduced usage of inhaled bronchodilators in patients receiving active treatment but not in those on placebo. Overall assessment of treatment efficacy by both investigators and patients showed that opinions were significantly in favour of active treatment over placebo. Treatment was well tolerated and no serious side-effects were reported. It was concluded that at the dosages used nedocromil sodium was comparable with and equivalent to inhaled beclomethasone dipropionate in nearly all of the parameters assessed, and both drugs were superior to placebo in the maintenance treatment of asthma in adult patients.

Adolescent↗