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L S Marks

Publications and source records attributed to L S Marks.

50 records · Page 3Linked to original sources

Saralasin bolus test. Rapid screening procedure for renin-mediated hypertension.

The angiotensin-blocking agent, saralasin, was given by rapid intravenous (bolus) injection to 21 hypertensive patients. A marked depressor response (average blood-pressure decrease of 30 mm Hg systolic and 20 mm Hg diastolic at 10 minutes after injection) was noted in 13 patients, of whom 11 had renovascular hypertension and 2 had high-renin essential hypertension. No change from prebolus blood-pressure was apparent at 10 minutes in 8 control patients with essential hypertension and normal or low peripheral plasma-renin activity. In all patients, blood-pressure response to saralasin bolus (10 mg) correlated with blood-pressure response to subsequent infusion of saralasin (10 microgram/kg/min). Blood-pressure response to rapid intravenous injection of saralasin--the "saralasin bolus test"--has many characteristics of an ideal screening procedure for renin-mediated hypertension.

Adult↗

Renal vein renin: value and limitations in the prediction of operative results.

Renal vein renin determinations, in contrast to isolated peripheral venous renin determinations, provide great help in the selection of patients who can benefit from an operation for renal hypertension. Patients with essential hypertension usually have renal vein renin ratios, larger/smaller, close to unity, but the available cumulative data show that, statistically, ratios as large as 2.0 may occur in this group (95 per cent confidence limits). In patients with unilateral stenosis of a main renal artery, large renal vein renin ratios (stenotic/normal) have been followed by operative success in more than 90 per cent of patients. However, many operative successes have also been achieved in patients without a large renal vein renin ratio. This may be explained by inaccurate renal vein catheterization, inactive renin secretion, nonsimultaneous sampling, assay variability, and problems related to bilateral or segmental lesions. Recent refinements in the interpretation of renal vein renin data (contralateral suppression, ipsilateral hypersecretion in absolute terms, and a combination analysis scoring system) appear to increase the accuracy of the test. Detailed anatomic information, provided by arteriography, is essential for proper interpretation of renal vein renin data.

Angiography↗

Renal vein renin in essential hypertension.

A frequency distribution curve and interval percentages of variations in right versus left renal vein renin (RVR) were calculated from 227 sets of renin data from patients with mild and moderate essential hypertension (EH). A renal vein renin ratio (RVRR), large/small, of approximately 2.0 or more falls beyond the 95 per cent confidence interval, and may therefore by considered to be abnormal. Although assay variability and sampling errors may contribute to artifactually large RVRR's in EH, they usually indicate true disparity, probably secondary to asymmetrical nephrosclerosis. Recent hypotheses regarding diagnostic value of RVR in hypertension are evaluated in light of data yielded by this investigation. Simultaneous and/or replicate sampling should reduced within-patient variability and improve clinical interpretation of test results.

Adult↗