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Biomedical subjects

J L Pool

Publications and source records attributed to J L Pool.

At least 55 records · Page 3Linked to original sources
PubMed1987

Plasma lipid lowering effects of doxazosin, a new selective alpha1 adrenergic inhibitor for systemic hypertension.

Hypertension and hypercholesterolemia are 2 major risk factors for atherosclerotic coronary artery disease (CAD). Elevations of both blood pressure and serum cholesterol levels should be reduced to control CAD risk. Doxazosin is a once-daily, long-acting, selective alpha 1-adrenergic inhibitor that is effective for the treatment of essential hypertension. During controlled studies of doxazosin's antihypertensive efficacy, 3 serum lipid parameters were measured; total cholesterol, total triglyceride and high density lipoprotein (HDL) cholesterol. In 10- to 12-week placebo-controlled studies, 142 doxazosin-treated patients were compared with 155 placebo-controlled subjects. Doxazosin patients had an increase of 8.9% in the HDL/total cholesterol ratio (p less than 0.05), whereas total cholesterol, HDL cholesterol and triglyceride levels were not significantly different between the 2 study groups. During a 52-week comparison of doxazosin versus atenolol, doxazosin treatment was associated with a significant decrease in total triglyceride levels (5%; p less than 0.001) and increases in HDL cholesterol levels (3.9%; p less than 0.01) and HDL/total cholesterol ratio (5.4%; p less than 0.0001). Doxazosin is an effective antihypertensive agent that has a favorable impact on serum lipid levels, thereby promoting a beneficial effect on 2 major CAD risk factors.

Adrenergic alpha-Antagonists↗
PubMed1987

Mitral valve prolapse with symptoms of beta-adrenergic hypersensitivity. Beta 2-adrenergic receptor supercoupling with desensitization on isoproterenol exposure.

Autonomic nervous system dysfunction has recently been identified in a subset of patients with mitral valve prolapse. These autonomic nervous system abnormalities may correspond, in part, to biochemical alterations in beta-adrenergic receptors. Nine women with mitral valve prolapse and symptoms and signs of beta-adrenergic hypersensitivity and seven normal volunteer women were studied. Quiet standing (five minutes) increased both heart rate and plasma norepinephrine (p less than 0.05) in symptomatic patients with mitral valve prolapse compared with normal subjects. The dose of isoproterenol required either to increase heart rate 25 beats/minute (0.5 +/- 0.3 microgram versus 1.0 +/- 0.3 microgram) or to decrease mean arterial pressure 20 mm Hg (11.1 +/- 4.8 versus 78.2 +/- 25.2 micrograms) was significantly less in the patients with mitral valve prolapse than in the volunteers. Symptomatic patients with mitral valve prolapse were desensitized by a four-hour isoproterenol infusion, whereas sensitivity in normal control subjects did not change. In the patients with mitral valve prolapse, baseline beta-adrenergic receptor coupling was elevated compared with that in control subjects (220 +/- 7 versus 81 +/- 2; p less than 0.001). Isoproterenol infusion induced uncoupling in these patients (KL/KH = 35 +/- 3, p less than 0.05) but did not alter coupling in normal volunteers. This study demonstrates physiologic and pharmacologic beta-adrenergic hypersensitivity in vivo directly corresponding to biochemical supercoupling in a subset of patients with mitral valve prolapse.

Adult↗
PubMed1987

Localization of ectopic pheochromocytomas by magnetic resonance imaging.

Magnetic resonance imaging (MRI) was utilized to localize ectopic pheochromocytomas in two patients. In both cases, MRI proved superior to computed tomography. Differentiation from surrounding tissue was excellent. MRI permits spatial localization and by assessment of signal contrast intensity provides a suggestion as to the characteristics of the tumor without the use of invasive procedures or intravenous injections. MRI should be considered as an alternative to computed tomography when evaluating patients with a suspected pheochromocytoma.

Adrenal Gland Neoplasms↗
PubMed1987

Controlled multicenter study of the antihypertensive effects of lisinopril, hydrochlorothiazide, and lisinopril plus hydrochlorothiazide in the treatment of 394 patients with mild to moderate essential hypertension.

Lisinopril (LIS) is a lysine analog of enalaprilat, the active metabolite of enalapril, an angiotensin-converting enzyme inhibitor (ACEI). Unlike enalapril, the precursor of enalaprilat, LIS is not a prodrug but has equal ACEI efficacy and potency and a slightly longer duration of action after oral administration. Short-term (12 weeks) and long-term (24 weeks) blood pressure control has been studied with LIS, hydrochlorothiazide (HCTZ), and LIS + HCTZ when given once a day. Drug treatment had three phases: (i) 2-4 weeks of single-blind placebo washout; (ii) 12 weeks of double-blind comparison therapy with LIS 20, 40, and 80 mg vs. HCTZ 12.5, 25, and 50 mg, vs. LIS + HCTZ 20 + 12.5, 40 + 25, and 80 + 50 mg; (iii) 13-24 weeks single-blind LIS vs. LIS + HCTZ. Starting double-blind therapy at the lowest dose, all three groups doubled the dose at weeks 4 and 8 if BP was not controlled with sitting diastolic BP (SDBP) less than 90 mm Hg. At the end of 12 weeks of double-blind therapy, uncontrolled HCTZ-only and LIS-only treatment groups were advanced to combination LIS + HCTZ therapy but uncontrolled LIS + HCTZ patients were dropped. Mean BP reductions (systolic/diastolic, mm Hg) for all three groups after 12 weeks of double-blind comparison therapy were: (i) LIS (n = 162), -16.6/-12.5; (ii) HCTZ (n = 155), -10.4/-6.8; (iii) LIS + HCTZ (n = 74), -23.9/-18.2 with p less than 0.01 for all groups compared to baseline.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Neurosurgical management of carotid sinus hypersensitivity. Report of three cases.

Carotid sinus hypersensitivity (CSH) can cause severe bradycardia, hypotension, asystole, and cardiac arrest. Three patients with the combined (mixed) cardioinhibitory and vasodepressor form of CSH were studied with intensive cardiovascular monitoring. After medical management failed, the patients were successfully treated by transection of the glossopharyngeal nerve and upper rootlets of the vagus nerve at their exit from the brain stem. Methods of diagnosis of CSH, and the benefits and limitations of medical and surgical therapies are discussed.

Autonomic Nervous System Diseases↗
PubMed1986

Pharmacology of angiotensin converting enzyme inhibitors. A review.

Two angiotensin converting enzyme inhibitors are currently available for clinical use. Captopril, a sulfhydryl-containing compound, is a direct acting enzyme inhibitor. Enalapril is a non-sulfhydryl pro-drug that requires enzymatic conversion to enalaprilic acid, a potent angiotensin converting enzyme inhibitor. Both drugs lower blood pressure, suppress blood pressure response to angiotensin I infusion, and elevate plasma renin activity. Enalapril bioavailability is unaffected by food, whereas captopril availability is suppressed by food. Dose adjustments are necessary for patients with congestive heart failure and renal failure.

Angiotensin I↗
PubMed1986

Antihypertensive activity of isradipine in humans: a new dihydropyridine calcium channel antagonist.

Isradipine (Sandoz PN 200-110), a new dihydropyridine calcium channel antagonist, was evaluated in a randomized, double-blind, placebo-controlled trial for antihypertensive efficacy in 24 patients with essential hypertension. Two groups were studied: one received placebo throughout the entire study (n = 12) and the other received isradipine (n = 12), 2.5 mg b.i.d., for the first week, 5 mg b.i.d. the second week, and 10 mg b.i.d. the third week after an initial 3-week baseline placebo period. Blood pressure was measured approximately 3 hours after dosing. Isradipine, at a total daily dose of 10 mg, lowered average supine diastolic blood pressure 11.8 mm Hg, with only a 3.5 mm Hg decrease in systolic blood pressure compared with baseline. At a total daily dose of 20 mg, average supine diastolic blood pressure decreased 14.8 mm Hg and supine systolic blood pressure declined 13.9 mm Hg; both were significantly decreased compared with placebo or baseline. Heart rate was increased only minimally by isradipine. Renin level activity was increased slightly by isradipine. No serious adverse clinical or laboratory experiences were noted. Isradipine appears to be effective in lowering blood pressure without reflex tachycardia.

Adult↗
PubMed1984

The reach to recovery program. An evaluation of the attitudes of Connecticut surgeons.

Because the Reach to Recovery Program is under-utilized in Connecticut, the authors sent a 19-part questionnaire to all board-certified general surgeons in the state to evaluate their attitudes toward the Program. Most of the surgeons who responded were pleased with the Program and believed that it saved them time, and was of help to their patients. Twenty percent of the surgeons were unaware of various aspects of the Reach to Recovery Program. Historical and current aspects of the Program are presented. Suggestions are made regarding increasing the scope of the Program to address the needs of women who are to be treated with radiation therapy or who have had a mastectomy and are about to receive adjuvant chemotherapy.

Attitude of Health Personnel↗
PubMed1981

Tricyclic antidepressant overdose: clinical and pharmacologic observations.

Forty-seven patients with confirmed TCA overdoses were thoroughly evaluated with regard to clinical and electrocardiographic findings. In 22 patients plasma levels of the primary TCA and the desmethyl metabolite were determined. We found that both neurologic and cardiovascular complications were common, but independent of each other. While plasma levels of the parent of TCA compound correlated best with the neurologic disturbances, cardiac abnormalities were more related to the desmethyl metabolite level. Although plasma levels correlate with the clinical findings, sufficient overlap between normal and abnormal levels and findings exist that we do not feel that routine measurement of plasma levels is clinically useful at this time.

Adult↗
PubMed1977

Renin-aldosterone profiling in hypertension.

Renin-aldosterone profiling was used to classify patients with hypertension: 243 patients with essential hypertension were classified by renin-urinary sodium indexing; 107 were reclassified by response to administration of furosemide and intravenous saline; 45 were further classified by response to a low-sodium diet. Arbitrary "normal ranges" were determined in 89, 32, and 38 volunteers, respectively. Patients with low-renin apparently do not have "high-volume" hypertension. Rather, they show a primary renal abnormality in renin secretion and become relatively deficient in angiotensin II and aldosterone when they are subjected to diuresis. They can maintain aldosterone secretion under normal conditions because their adrenal aldosterone receptor is supersensitive to angiotensin II. No evidence of abnormal sympathetic neural activity was found among the renin subgroups. Renin-aldosterone profiling in current clinical practice seems useful mainly in the detection of patients with curable forms of secondary hypertension. Aldosterone/renin ratios may be particularly helpful in diagnosis when obtained after a patient has undergone expansion or contraction of his extracellular fluid volume.

Aldosterone↗