Is Helicobacter pylori really the cause of gastroduodenal disease?
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Duodenal Diseases↗
Biomedical subjects
A P Shapiro
Publications and source records attributed to A P Shapiro.
Cerebral blood flow in hypertensive patients: an initial report of reduced and compensatory blood flow responses during performance of two cognitive tasks.
We asked whether the altered cerebral vasculature associated with essential hypertension might dampen or redirect the regional cerebral blood flow (rCBF) response to cognitive work. Relative rCBF was assessed with [(15)O]water positron emission tomography during a working memory task, a memory span task, and two perceptual control tasks. Unmedicated hypertensive patients and control subjects differed in rCBF response during both memory tasks. Hypertensives showed relatively diminished rCBF responses in right hemisphere areas combined with compensatory activation of homologous areas in the left cerebral cortex. Essential hypertension appears to selectively influence the circulatory reserve of portions of cerebral cortex and secondarily induce recruitment of other cortical areas to process certain tasks.
Aged↗
The effect of litigation status on adjustment to whiplash injury.
STUDY DESIGN: This retrospective study examined the effect of civil litigation on reports of pain and disability in chronic pain patients who sustained whiplash injuries after a motor vehicle accident. OBJECTIVES: To examine the effect of litigation on adjustment to chronic pain. SUMMARY OF BACKGROUND DATA: A common methodologic weakness with many studies in this area is the composition of the nonlitigant group, which often includes individuals who have completed litigation as well as those who opted not to litigate. This introduces a confound in that litigant and nonlitigant groups differ not only with respect to litigation status but with respect to any factors that predispose one to litigate. METHODS: Questionnaire data were obtained from 41 patients (current litigants) in the process of litigation and 21 patients (postlitigants) who had completed litigation. Subjects completed self-report measures assessing demographic characteristics, psychological distress, sleep disturbance, employment status, and various pain indices. RESULTS: There were no significant group differences in demographic characteristics, employment status, or psychological distress. Litigants, however, reported more pain than did postlitigants. Group differences in pain reports remained statistically significant even after controlling for length of time since accident and initial severity of the injuries. CONCLUSIONS: That litigation status did not predict employment status suggests that secondary gain does not figure prominently in influencing the functionality of these patients. The rather robust effect of litigation status on pain reports is discussed with respect to the potential mediational role of the stress of litigation.
Adaptation, Psychological↗
Reply to Drs. Lemmer and Pickering.
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Animals↗
Hypertension and neuropsychological performance in men: interactive effects of age.
Potentially interactive effects of hypertension and age on the performance of neuropsychological and information processing tests were examined in 123 untreated hypertensive and 50 normotensive men. After covarying education, average alcohol consumption, trait anxiety, and depression scores, results indicated an interaction of age and hypertension. Young hypertensive men (23-40 years) scored significantly worse than young normotensive men on tests of attention/executive function and working memory; middle-aged hypertensive (41-56 years) and normotensive participants were not distinguished by any measures. Hypertensive men performed significantly more poorly than normotensive men on tests of manual dexterity. Results suggest that neuropsychological sequelae of hypertension are more pronounced in young than in middle-aged hypertensive individuals and are independent of various demographic, psychosocial, and alcohol-related factors.
Adult↗
Systolic hypertension in critical aortic stenosis and the effect of valve replacement.
All cases of aortic valve replacement (AVR) for critical aortic stenosis (AS) in a 3 year period were reviewed and 43 cases were included in the study. Twenty patients had systolic hypertension preoperatively by sphygmomanometry and/or by measurement of central aortic pressure during cardiac catheterization. These patients also had a significantly higher mean left ventricular (LV) peak pressure than their normotensive counterparts. Following AVR all 43 patients were normotensive. This study suggests that not only can an elevated blood pressure (BP) be found in the presence of AS, but that AS itself can cause hypertension, in which case AVR can result in normalization of BP. We suggest that the systolic hypertension is due to a partial transmission of the higher LV peak pressure across the aortic valve, despite the stenotic valve acting as a pressure barrier. This effect may be more pronounced the tighter the stenosis.
Adult↗
Clinical use of ambulatory blood pressure monitoring. A review of value in patient care.
OBJECTIVE: To examine the value of ambulatory blood pressure monitoring in routine clinical use. DESIGN: We retrospectively reviewed 350 determinations made over a 4-year period. SETTING AND PATIENTS: A practice-based sample of patients attending the Hypertension Outpatient Clinic. RESULTS: Successful records were obtained in 346 of these procedures and night/sleep recordings were accomplished in 320. Monitor readings compared satisfactorily with auscultatory determinations. Declines in systolic and diastolic blood pressure during night/sleep of 8.2% and 13.2%, respectively, and a fall in the heart rate of 12.0% were noted; these declines were significantly lesser in patients with diabetes. Age, gender, therapy, and 24-hour average blood pressures, however, had minimal relationship to the night/sleep declines in blood pressure and heart rate. CONCLUSIONS: Twenty-four-hour blood pressure monitoring is acceptable to patients. Night/sleep declines in blood pressure are blunted in diabetics.
Ambulatory Care Facilities↗
Reversible nephrotic syndrome due to high renin state in renovascular hypertension.
Unilateral renal artery stenosis can lead to a non-functional kidney which secretes large amounts of renin. Four cases are presented in which the high renin state resulted in hypertension, proteinuria from the intact contralateral kidney, and secondary aldosteronism. The proteinuria was in the nephrotic range, which is unusual in renovascular hypertension, but gradually disappeared after correction of the high renin state by removal of the renin-secreting kidney or administration of an ACE inhibitor. Accordingly, when there is marked proteinuria in the presence of new-onset or rapidly progressive hypertension, hypokalaemic alkalosis, and a high peripheral PRA, renal artery stenosis should be considered since the proteinuria may be reversible after nephrectomy, repair of the ischaemic kidney or medical therapy.
Aged↗
Essence, investigation, and management of "neuropathic" pains: hopes from acknowledgment of chaos.
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Fibromyalgia↗
Strategic-behavioral intervention in the treatment of chronic nonorganic motor disorders.
Chronic nonorganic motor disorders pose particular difficulties because of a combination of diagnostic confusion and intractability to psychotherapeutic or behavioral interventions. Three cases are presented, all of whom failed a rehabilitation approach that emphasized basic behavioral principles of shaping and reinforcement. Despite this initial failure, all three patients showed dramatic and rapid improvement after implementation of an intervention combing elements of strategic and behavior therapy. The strategic element consisted of placing patients in a double bind by telling them full recovery constituted proof of an organic etiology and failure to recovery constituted conclusive evidence of a nonorganic or psychiatric etiology. These cases also illustrate the difficulty in distinguishing between conversion and factitious disorders.
Adolescent↗
Neurobehavioral effects of antihypertensive medications.
Although millions of hypertensive individuals receive chronic treatment with antihypertensive medication, the effect on the central nervous system by these drugs is poorly understood. Such treatment, while generally well tolerated, frequently produces symptoms of drowsiness, weakness, altered memory and impaired concentration. In addition to subjective evidence derived from patient reports, a large number of investigations have now been published which attempt to objectively assess the influence of antihypertensive medication on behavioral or cognitive performance. This paper summarizes and critically evaluates experimental studies of the effect of antihypertensive medication on subjects' performance of neuropsychological tasks and reviews the pharmacologic mechanisms by which these drugs may affect behavior. The literature is incomplete in its assessment of all domains of neuropsychological performance and all drug classes, and methodologic deficiencies are common. Nonetheless, the consensus of all studies and the findings of well-designed studies in particular do not identify any notable areas of performance impairment in patients receiving antihypertensive medication. Moreover, results suggest that, in certain instances, drug treatment may even enhance performance. In light of the limitations of the literature, however, an adequate understanding of the effects of antihypertensive therapy on behavioral functioning awaits completion of large, well-designed investigations including all major drug classes and thorough neurobehavioral assessments.
Adrenergic beta-Antagonists↗
Outcome of renal crisis in systemic sclerosis: relation to availability of angiotensin converting enzyme (ACE) inhibitors.
OBJECTIVE: To determine the outcome of scleroderma renal crisis before and after the availability of angiotensin converting enzyme (ACE) inhibitors. DESIGN: Evaluation of a large cohort of patients with systemic sclerosis and renal crisis who were followed prospectively. SETTING: University scleroderma center. PATIENTS: One hundred and eight patients who had scleroderma renal crisis between 1972 and 1987. INTERVENTION: ACE inhibitors. MEASUREMENTS AND MAIN RESULTS: Therapy with ACE inhibitors has dramatically improved the survival of patients with scleroderma renal crisis (1-year survival, 15% without and 76% with ACE inhibitors; P less than 0.001). However, 24 (44%) of 55 patients with scleroderma renal crisis who were treated with ACE inhibitors died early or required permanent dialysis. Older age, male sex, an initial serum creatinine level of more than 270 mumol/L, inadequately controlled blood pressure, and congestive heart failure were associated with these poor outcomes, but only older age and congestive heart failure were significant in a multivariate logistic regression analysis. Eleven of twenty patients (55%) who survived dialysis more than 3 months and continued to receive therapy with ACE inhibitors were able to discontinue dialysis after 3 to 15 months compared with 0 of 15 dialysis patients who did not receive ACE-inhibitor therapy (P = 0.002). CONCLUSIONS: Patients with systemic sclerosis who develop hypertension should be treated with an ACE inhibitor. Improved survival and successful discontinuation of dialysis are possible when ACE inhibitors are used to treat scleroderma renal crisis.
Acute Kidney Injury↗
Absence of behavioral differences in young normotensive adults as a function of parental history of hypertension.
It has been previously demonstrated that mildly hypertensive subjects show deficits in their performance on various sensory-perceptual, cognitive, and psychomotor tests relative to matched normotensive control subjects, and that these behavioral deficits are reversible following treatment with antihypertensive medication. To examine whether these deficits are an outcome of elevated blood pressure, rather than preceding the hypertensive state, normotensive offspring of hypertensives and normotensives were administered a test battery. Results showed that with minor exceptions, offspring of hypertensives and offspring of normotensives performed similarly on the tests. These results suggest that the behavioral deficits seen in hypertensives arise subsequent to the onset of elevated blood pressure.
Adolescent↗
Hypertension, creatinine, and plasma renin activity in heart transplant recipients.
Development of de novo hypertension in a large proportion of orthotopic heart transplant recipients receiving cyclosporine has previously been reported. This hypertension is characterized by a persistence of increased peripheral resistance, sodium retention, and loss of nocturnal decline in BP. Vascular nephropathy with plasma renin activity (PRA) elevation from cyclosporine (CsA) may also be major factor in the progress of hypertension. To investigate this hypothesis, observations of BP, creatinine (Cr), and PRA were made in 144 heart transplant recipients followed for up to four and a half years. Median Cr was 133 mumol/l. Average diastolic BP and mean PRA values were significantly higher in patients with Cr greater than or equal to the median. Cr and PRA were significantly correlated (r = 0.4; P less than 0.001) in recipients with Cr greater than or equal to 133 mumols/l but not in those with Cr less than 133 mumols/l. In a selected subsample of heart transplant recipients with repeated Cr and PRA values, Cr and PRA appeared to increase longitudinally after transplant. These data are derived from a case series of patients managed on a variety of antihypertensive agents (excluding ACE inhibitors) needed to control the persistent hypertension.
Antihypertensive Agents↗
Hypertension following orthotopic cardiac transplantation.
It seems established that hypertension, to some degree, is a frequent consequence of cardiac transplantation. The hypertension occurs de novo and is not related to whether hypertension was present in association with the heart disease that led to the need for transplantation. The etiology of this hypertension is multifactorial and varies depending on the time that has ensued after transplantation. Acutely, it is primarily a problem related to intravascular volume expansion and persistently increased systemic vascular resistance. Although it may be modest in severity, it seems to be particularly resistant to therapy with most antihypertensive drugs. Moreover, the total "hyperbaric impact" of the hypertension is rendered greater because the blood pressure and heart rate in these patients with denervated hearts fails to show the usual 10 to 15 percent fall when recumbent/asleep at night, which occurs in normotensive individuals and in most with hypertension of other etiologies. The major factor in the persistence of the hypertension through the later stages post-transplantation appears to be the cyclosporine that is used as an immunosuppressive. Although cyclosporine has been the major contributor to reduced rejection in these individuals, and to their increasingly prolonged survival, it inevitably produces slowly progressive impairment of renal function. The damage to the kidney is reflected both in tubular as well as glomerular and vascular damage, with a steady fall in glomerular filtration and a rise in creatinine. From our studies it appears that the renal alterations are associated with a gradual rise in plasma renin activity and angiotensin II, which perhaps further damages the kidney and causes persistence of the increased systemic vascular resistance. The use of lower doses of cyclosporine during the ischemic phase in the kidney that immediately follows surgery and of reduced doses over time, often with azathioprine added, seems to minimize the renal damage, or at least to stabilize it and to slow progression of the renal dysfunction and hypertension. Treatment of the hypertension with conventional drugs has definite but limited value. Diuretics and vasodilators have been the mainstay of our approach during the early phases of the hypertension but our recent data indicate that ACE inhibitors may become relatively specific in management during the later phases of the post-transplantation period as PRA levels rise in response to vascular damage by cyclosporine. ACE inhibitors have inherent dangers that require careful monitoring.(ABSTRACT TRUNCATED AT 400 WORDS)
Cyclosporins↗
Drug-induced illness as a cause for admission to a community hospital.
To assess the rate of occurrence of drug-induced illness as a cause for admission to the general medicine service of a community hospital, charts were reviewed retrospectively of all patients admitted to the service over two randomly selected one-month periods. Statistical analysis was performed on patients over and under the age of 65, and on iatrogenic and noniatrogenic admissions. Twenty-three of 244 patients (9.4%) were admitted with drug-induced illness. Patients with drug-induced illness had 5.7 medications as compared to 3.2 medications per patient admitted for other reasons (P less than .05). A single drug was responsible for 61% of all drug-induced illness admissions. Aspirin and other nonsteroidal anti-inflammatory agents were most often implicated. Eighteen of 155 elderly patients (11.7%) were admitted with drug-induced illness. These patients were on an average of 6.3 medications as compared with 3.8 medications per elderly patient admitted for other causes (P less than .005). Polypharmacy and a preponderantly elderly population may explain the substantial number of admissions caused by adverse drug reactions. Further research to assess the role of patient age and the number and type of medications involved in the event of drug-induced illness requires standardization of definition and diagnostic criteria.
Adult↗
Behavioural consequences of hypertension: effects of age and type of antihypertensive agent.
In order to investigate the effects on behaviour of hypertension, age, and the types of antihypertensive agents, we have conducted a retrospective analysis in 100 hypertensive patients receiving chronic treatment in our Hypertension Clinic. A group of 80 normotensive subjects, matched for age, were included in the study. Half of the hypertensive patients were under the age of 50 (young group) and half were over the age of 50 yrs (old group). The antihypertensive agents had not been administered according to any specific protocol, but represented the choice of the individual clinicians treating the patients in the clinic. All patients had received treatment for at least one year, and usually for two years. The behavioural tests performed were designed to measure sensory-perceptive ability, cognitive ability and psychomotor function and were those employed and described in our previous studies. The results achieved were varied, but indicated that older age was associated with an impairment in performance as was blood pressure. Test performances in the young hypertensives were similar to those achieved by older normotensives. These results were more prominent in cognitive and psychomotor functions than in the sensory-perceptive tests. The antihypertensive drugs used also affected these results; the worst behavioural performances tended to be in patients receiving the central nervous system agonists (methyl-dopa and clonidine) and better performances in patients receiving beta-blockers alone when compared with the other groups. Surprisingly, patients receiving diuretics showed poorer performance levels, but these were better in patients who received a beta-blocker in combination with their diuretic.(ABSTRACT TRUNCATED AT 250 WORDS)
Aging↗
The statistical analysis of treatment effects in 24-hour ambulatory blood pressure recordings.
This paper presents a statistical analysis of treatment effects in 24-hour ambulatory blood pressure recordings. The statistical models account for circadian rhythms, subject effects, and the effects of treatment with drugs or relaxation therapy. In view of the heterogeneity of the subjects, we fit a separate linear model to the data of each subject, use robust statistical procedures to estimate the parameters of the linear models, and trim the data on a subject by subject basis. We use a meta-analytical method to combine the results of all subjects in the study.
Activity Cycles↗