AIDS and needlestick.
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Acquired Immunodeficiency Syndrome↗
Biomedical subjects
B Bauer
Publications and source records attributed to B Bauer.
Efficacy and safety of ramipril in combination with hydrochlorothiazide: results of a long-term study.
Hypertensive patients from a double-blind study comparing 5 mg of ramipril, 10 mg of ramipril, and 5 mg of ramipril + 25 mg of hydrochlorothiazide (HCTZ) were enrolled in an open 1-year extension study with ramipril and concomitant HCTZ. The starting dose of ramipril was 5 mg/day. Patients were given 25 mg of HCTZ in addition only if their diastolic blood pressure (DBP) was higher than 90 mm Hg. During treatment, the investigator was permitted to adjust the dosage of ramipril and HCTZ according to BP response and tolerance. A total of 159 patients were included in the 1-year study (86 men, 73 women, mean age of 54 years). One hundred twenty-one of the 159 patients received the combination of ramipril + HCTZ at some point in the study, 83 of them for more than 50 weeks. Thirty-eight patients were treated with ramipril alone over the entire study. In patients treated with ramipril monotherapy throughout the study, the largest drop in blood pressure occurred before visit 1. In patients treated with ramipril + HCTZ for greater than or equal to 50 weeks, the mean blood pressure continued to fall up to around week 10, while the therapy was being adjusted. Subsequently, the mean blood pressures remained low and fairly stable in both treatment groups. Similar results were seen in patients treated with the combination for less than 50 weeks. Adverse events were reported in 11 of the 38 patients in the ramipril group, in 22 of 83 patients treated with the combination for more than 50 weeks, and in 9 of 38 patients treated with the combination for 50 weeks or less. The analysis of the laboratory values revealed no general deterioration. It can be concluded that ramipril alone and in combination with HCTZ is an effective and safe drug for the long-term treatment of essential hypertension.
Adult↗
[Possibilities of ACE inhibitor therapy in acute myocardial ischemia].
Acute myocardial ischemia results from an increased cardiac workload in presence of a critical coronary stenosis (demand ischemia), coronary occlusion (supply ischemia) or a combination of both. It is complicated by cardiac arrhythmias and deterioration of function of ischemic myocardium and results in an increased load and dilatation of non-ischemic myocardium. Cardiac protection in acute myocardial ischemia can be related to preservation of coronary blood flow, function of ischemic and non-ischemic myocardium or prevention of cardiac arrhythmias. In control animals and humans, ACE-inhibitors have no major effect on coronary blood flow. Myocardial ischemia raises plasma-renin-activity, angiotensin I-conversion by passage through coronary circulation, and plasma-angiotensin-II-concentrations. ACE-inhibitors and angiotensin-II-receptor blockers increase coronary blood flow during myocardial ischemia. Other mechanisms (bradykinin potentiation) may be involved. We found a potentiation of the coronary dilatory effect of the neuropeptide neurotensin (which is probably mediated by prostaglandins) by ACE-inhibitor. ACE-inhibitor may delay infarct development in animal experiments and improve function of ischemic myocardium. The importance of early dilatation of non-ischemic myocardium is unknown and it is unclear whether it may be prevented by an ACE-inhibitor as was shown for late dilatation. Studies on the effect of ACE-inhibitors in exercise-induced angina pectoris are controversial. An antiischemic and coronary dilatory effect has been shown by invasive studies in patients. A preliminary study in unstable angina pectoris was positive. Beneficial hemodynamic and antiarrhythmic effects (as well as excessive hypotension, however) have been shown in patients with acute myocardial infarction.
Angiotensin-Converting Enzyme Inhibitors↗
Preliminary vascular control for renal trauma.
Preliminary control of the renal vascular pedicle prior to opening Gerota's fascia is advocated as the standard approach for decreasing the rate of nephrectomy from trauma. This method, however, has not been studied widely. Previous reports failed to grade the severity of the renal injury and involved small patient series and historic control for comparison of nephrectomy rates. We studied 297 patients with renal trauma during a ten year period. Sixty-three of 75 patients with penetrating injuries and 12 of 222 patients with blunt injuries underwent renal exploration. We obtained vascular control prior to opening Gerota's fascia in 32 patients; it was obtained in 43 patients after opening Gerota's fascia. The nephrectomy rate depended on the degree of injury rather than on the type of renal vascular control obtained. Obtaining vascular control after opening Gerota's fascia did not increase the nephrectomy rate and shortened operative time by an average of 58 minutes. We recommend vascular control after opening Gerota's fascia when there is a large hematoma crossing the midline, a rapidly expanding renal hematoma, if the patient is unstable, or if Gerota's fascia has already been opened by the injury.
Accidents, Traffic↗
Coronary arteriolar vasoconstriction in myocardial ischaemia. Vasopressin, renin-angiotensin system and ANF.
Vasopressin, the renin-angiotensin system and atrial natriuretic factor (ANF) interact in regulating blood pressure. While the vasoconstrictor effect of vasopressin and the renin-angiotensin system is well documented, the direct vascular effect of ANF is unclear. We studied in anaesthetized dogs the coronary vascular effects of agonists and antagonists of vasopressin and the renin-angiotensin system under control and ischaemic conditions, respectively. In addition, the action of ANF and its relationship to the renin-angiotensin system was analysed. A coronary artery was cannulated and perfused by a bypass system from the femoral arteries of the same animal. Coronary vasoconstriction by vasopressin was potentiated when myocardial ischaemia was induced by lowering coronary perfusion pressure while coronary constriction by angiotension I and II was mitigated. A vasopressin receptor blocker slightly reduced coronary blood flow at high doses (intrinsic activity) while the angiotensin II receptor blocker increased coronary flow in myocardial ischaemia. ANF effects were ambiguous at lower doses (1 ng (kg)-1 i.c.) with coronary constriction in 79% of dogs. At higher doses (1 microgram kg-1) ANF consistently induced coronary dilation. The angiotensin II receptor blocker saralasin significantly reduced this coronary dilator effect of ANF. Thus, in conclusion, a vasoconstrictor effect of endogenous vasopressin could not be shown by this study. In contrast, endogenous angiotensin II might participate in control of coronary blood flow during myocardial ischaemia. The coronary dilator effect of ANF at least in part appears to be due to interference with the renin-angiotensin system.
Angiotensin II↗
Any healthcare provider should...
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Critical Care↗
[Results of combined treatment of malignant brain tumors with various cytostatic protocols].
Nowadays best results in the treatment of malignant brain tumors can be obtained with an interdisciplinary combined treatment (operation, radiation, antineoplastic chemotherapy). We treated 83 patients with gliomas after operation with a combined radiation/chemotherapy. Chemotherapy was performed by two different schemas (Israel n = 49, COMP n = 34). Both groups had the same structure concerning the 10 most important prognostic factors. The median survival time was found to be 26.1 months in the Israel-group and 22.8 months respectively in the COMP-group. The number of the long-time survivors is increasing in the COMP-group.
Adolescent↗
[Psychosocial management of glioma patients treated with combined therapy].
Based on an empirical study it is pointed out that psychosocial care of patients with glioma differs in some points from that of other cancer patients. The first essential difference is that the emotional involvement of the care staff is not as intensive as those of other cancer patients. Other differences concern some illness- and therapy related effects such as family problems or monotony problems resulting from the longterm therapy. These specific problems are described in detail.
Brain Neoplasms↗
An open multicenter study to assess the long-term efficacy, tolerance, and safety of the oral angiotensin converting enzyme inhibitor ramipril in patients with mild to moderate essential hypertension.
Three hundred thirty-one patients with mild to moderate essential hypertension, 182 males and 149 females with a mean age of 54 (range, 17-87 years), were studied for 1 year in a clinical trial with ramipril, an angiotensin converting enzyme (ACE) inhibitor. The patients included had completed double-blind trials with ramipril vs. captopril, HCT, atenolol and ramipril plus piretanide. All cases were treated first with 5 mg ramipril and, where appropriate, also with 25 mg HCT. Adjustment of the dose in the range 1.25-20 mg ramipril was left to the investigator. Overall, a consistent reduction in blood pressure was achieved. Only small changes in mean blood pressure were noted during the 12 months (mean diastolic blood pressure 84.3-86.9 mm Hg, mean systolic blood pressure 145.6-148.2 mm Hg). Two hundred sixty-two (82%) of the 331 patients had diastolic values consistently equal to or lower than 95 mm Hg. There was a downward shift in the dosages upon which the investigators finally settled during the 12-month period in the patients receiving ramipril monotherapy. In patients also receiving HCT the initial dose was increased in most cases. Adverse events were observed in 6.7% of patients taking ramipril alone. The most frequent symptoms were dizziness, asthenia, pain in the upper abdomen and headache. Adverse effects occurred more frequently under continuous additional treatment with HCT, the same symptoms being reported. The clinical trial was prematurely terminated in six patients, in only two cases for medical reasons. The analysis of the laboratory findings revealed no general deterioration.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
A significant feature of Nager's syndrome: palatal agenesis.
Nager's syndrome, which has the facial features of Treacher Collins syndrome, preaxial upper limb defects, short stature, and frequently subnormal intelligence, is very rare. Five new cases have been collected. In four, there was virtually total absence of the soft palate. This has been described in two patients in the past. Differing methods of correcting this are presented.
Child, Preschool↗
Coronary effects of neuropeptides in dogs: role of cyclooxygenase products as mediators.
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Animals↗
Bioavailability of a new liquid formulation of penicillin V (Isocillin syrup) and the influence of ethanol on bioavailability of penicillin V.
In an open, randomized four-way crossover study, four different formulations of penicillin V each containing 1.2 mega units were tested: A) new liquid formulation of Isocillin syrup, B) new liquid formulation of Isocillin syrup plus ethanol, C) commercially available penicillin V syrup containing ethanol as solubilizer and D) Isocillin film tablets. Six male and eight female healthy volunteers participated in the study. Serum concentration and urinary excretion of penicillin V were measured by HPLC or bioassay. The new liquid formulation of Isocillin syrup showed highest Cmax and AUC values. Correspondingly, urinary excretion of the new liquid formulation of Isocillin syrup was highest (38% of the given dose). Mean pharmacokinetic data of the new liquid formulation of Isocillin syrup were: tmax (h) = 0.81, Cmax (mg/l) = 9.92, AUC0-8h (mgh/l) = 13.67, lambda z (h) = 0.68, Cltot/f (ml/min) = 964. Ethanol (4.6%) had no absorption-enhancing effects. From a clinical point of view, all four formulations investigated in this trial showed serum concentrations well above bactericidal concentrations (greater than 1 mg/l) for more than 3 h. Although the interindividual variability of serum levels was high, the levels observed would guarantee therapeutic efficacy against penicillin sensitive bacterial strains.
Adult↗
Effects of flumethrin pour-on against Glossina palpalis gambiensis (Diptera, Glossinidae) during releases in a fly proof stable.
2000 males and females of Glossina palpalis gambiensis were released in the presence of a Zebu treated with flumethrin pour-on in a fly proof stable. From the first day after treatment until day 15, the flies were released at intervals of two days. The mortalities were highest during the first five days after treatment. With the exception of the first two releases the "knock down" effects were distinctly higher than the corresponding mortalities, ranging between 60% and 100% during the observation period.
Animals↗
Serum amino acids in experimentally induced endotoxic shock: the prognostic significance of hyperalaninemia.
Serum amino acid levels were determined in 40 male rabbits before and 2, 6, and 24 hr after shock induction with 50 micrograms kg-1 endotoxin from Escherichia coli 0 111 and compared with amino acid levels of 32 age-matched control animals. Whereas total amino acid concentration in the control group decreased continuously over the 24 hr period due to fasting of the animals, the corresponding concentration in the endotoxin-treated animals remained at the initial level for the first 6 hr after shock induction. During this period, the release of amino acids from peripheral tissues was apparently enhanced, as evidenced by elevated levels of serum phenylalanine and tyrosine. Endotoxin administration exerted a salient effect on serum alanine levels. In all endotoxin-treated rabbits, alanine concentration was increased significantly 2 hr (P less than 0.00001) and 6 hr (P less than 0.00001) after injection of the toxin, whereas alanine levels in the control group remained essentially unchanged. In most animals, peak alanine concentrations were observed at the 6 hr sampling time. Blood glucose measurements indicated that by this time the hyperglycemic period, which is typical of the initial phase of endotoxic shock, was already finished. A high level of alanine following shock induction alluded to the impending death of the animal. In all rabbits in which alanine concentration rose by more than 600 mumols l-1 during the first 2 hr after endotoxin administration, the increase correlated significantly with the rate of lethality (P less than 0.0001). In contrast, alanine levels of surviving animals increased only moderately. It was concluded from these results that monitoring serum alanine levels might be a valuable and practical tool to assess the severity and outcome of endotoxic shock.
Alanine↗
Plasma lipids and plasma lipoproteins in diabetics with and without proliferative retinopathy.
The single most important factor related to the development of diabetic retinopathy is the duration of diabetes. Little is known about the underlying mechanisms, but many factors have been suggested to be involved, among them derangements in plasma lipids and plasma lipoproteins. In the present study we examined the relation between plasma lipids, plasma lipoproteins, and the duration of diabetes in Type I diabetics with and without proliferative retinopathy. The duration of diabetes in the two groups was 12.2 +/- 2.8 and 21.5 +/- 9.0 years, respectively (mean +/- SD; p less than 0.01). Except for moderately low HDL levels, plasma lipid and lipoprotein concentrations were normal in both groups of patients. The levels of lipids and lipoproteins did not correlate with the duration of diabetes. Furthermore, no differences were seen between patients with and without proliferative retinopathy. Thus, the present study does not indicate that plasma lipids and plasma lipoproteins play any major role in the development of diabetic proliferative retinopathy.
Adult↗
Neuroradiology case of the day.
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Adolescent↗
Treatment planning for conformation therapy using a multi-leaf collimator.
In high energy photon therapy an optimum dose distribution is achieved with an irradiation from several directions, thus adapting the field shape to the target volume. Some methods of irradiation planning using these techniques are presented. The result of such a treatment planning is demonstrated.
Humans↗
Effects of Flumethrin Pour-on against Glossina palpalis gambiensis (Diptera, Glossinidae).
1920 males and females of Glossina palpalis gambiensis were fed 3 times on a Zebu treated with Flumethrin Pour-on. This resulted in a significant increase of the mortality and abortion rate of the flies. The fly-specific effects of Flumethrin Pour-on were time-dependent: Clear effects on the performance of the flies were observed during the first 20 days after treatment of the Zebu; an initial 90% "knock down" effect decreased to 40% during the first 15 days.
Animals↗