Biomedical subjects
Publications and source records attributed to M Lilja.
In a group of 12 hypertensive outpatients, randomized double-blind cross-over comparison of the antihypertensive effect of various doses of cyclothiazide and hydrochlorthiazide revealed that 2.5 mg of cyclothiazide daily or 25 mg of hydrochlorthiazide daily have an equal antihypertensive effect. Increasing the dose of either diuretic did not further reduce the blood pressure.
Haemodynamic effects of atenolol 50 mg, clonidine 0.15 mg, and prazosin 5 mg, given twice daily, and of the combinations atenolol + prazosin and clonidine + prazosin were studied in 8 hypertensive outpatients. Measurements were made at rest, during isometric sustained handgrip and submaximal ergometer work in mostly double-blind and cross-over fashion. Given individually atenolol and prazosin lowered resting supine blood pressure. The addition of prazosin increased the antihypertensive effects of atenolol but not of clonidine. At the end of the isometric exercise atenolol and prazosin given alone both lowered diastolic blood pressure as compared to respective pretreatment values. During handgrip prazosin contributed a little, but not much, to the antihypertensive effects of atenolol and clonidine. During dynamic exercise atenolol, clonidine, and prazosin given alone each lowered blood pressure, prazosin decreasing diastolic blood pressure in particular. Prazosin added to the antihypertensive effect of atenolol more than that of clonidine. Echocardiographic measurements revealed no significant differences between treatments at rest. During handgrip the mean velocity of left ventricular circumferential muscle fibre shortening was reduced by atenolol as compared to pretreatment values. We conclude that atenolol + prazosin may help the patients to maintain adequate haemodynamics during daily physical stresses whilst the combination prazosin + clonidine may not offer any particular advantages.
Two cases of food-borne botulism following consumption of commercially canned German-made liver sausage are presented. The more serious case involved respiratory paralysis for 15 days, the milder one only muscle weakness in the area of the cranial nerves. Both of the patients recovered well and returned to their jobs half a year after the onset of the illness.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A hypertensive reaction is described in a 28-year-old woman with renal failure who took 30-70 clonidine tablets (150 micrograms each) with suicidal intent. She became increasingly drowsy. Her blood pressure on admission was 210/150 mmHg and gradually fell to 140/100 mmHg during the next 16 hours, at which time her plasma clonidine concentration was 4.7 ng/ml. This interesting hypertensive reaction was probably due to excessive stimulation of peripheral postsynaptic alpha-adrenoceptors.
Concomitant administration of the alpha 2-adrenoceptor agonist, clonidine, and the alpha 1- and non-selective beta-adrenoceptor antagonist, labetalol, was studied in 12 hypertensive outpatients treated with thiazide diuretics. Clonidine, 0.15 mg b.i.d., effectively lowered supine, standing and isometric blood pressure values when administered to patients on cyclothiazide, 2.5 mg q.d. Addition of labetalol, 200 mg b.i.d., to the diuretic-clonidine treatment resulted in further reduction of blood pressure at rest both in the supine and standing position. In contrast, during isometric work, addition of labetalol to the diuretic-clonidine regimen did not exhibit the same additive antihypertensive effect. When clonidine was given in a dose of 0.3 mg once daily in the evening and the other two drugs as previously, the same antihypertensive effect was observed in the afternoon. Labetalol did not provoke new side-effects of its own.
The effects of two b.i.d. dosing schedules of clonidine on blood pressure, side-effects and plasma concentration of clonidine were studied in a randomized cross-over study. The blood pressures of 10 hypertensive inpatients on diuretic treatment were recorded every 3-4 hours throughout the study. A twice-daily regimen with 0.075 mg clonidine administered at 8 a.m. and 0.15 mg at 10 p.m. resulted in a wider fluctuation of blood pressure than the same doses given at 8 a.m. and 4 p.m. The most conspicuous finding was the significant rise (p less than 0.001) of diastolic blood pressure at 8 p.m., when clonidine was given at 8 a.m. and 10 p.m. The overall mean values of supine systolic and diastolic blood pressures were normotensive and did not differ from each other in the two dosing schedules. There were no obvious differences in subjective side-effects between the two regimens. Predose clonidine concentrations varied interindividually between 0.15 and 1.12 ng/ml, but the fluctuation in one and the same subject was small and related to dose and its timing. Thus, twice-daily dosing of clonidine seems to result in a satisfactory blood pressure reduction. Fluctuation of blood pressure is greater when the evening dose is given at 10 p.m.
The antihypertensive effect of labetalol (L) was compared with that of clonidine (C) in a randomized cross-over study in 17 hypertensive outpatients on bendrofluazide (B). After treatment for two weeks with B(5 mg qd), either L (100 mg tid) or C (0.1 mg tid) was given and their doses were titrated at 2-weekly visits until normotension was achieve, or intolerable side-effects occurred. The treatment with B and L or C was than continued in a cross-over fashion for two 6-week periods, with 3 week diuretic washouts and subsequent dose-titration periods between the treatment periods. At the end of B, the supine blood pressure (BP) was 156/101, and at the end of B + L and B + C it was 136/91 (p less than 0.001) and 137/91 (p less than 0.0001), respectively, pooling the data from both periods. At the end of B the standing BP was 155/115, and at the end of B + L and B + C 134/100 (p less than 0.001) and 139/106 (p less than 0.0001), respectively. The mean daily doses required were L 476 mg and C 0.335 mg. On a weight basis, labetalol had about 1/1400 of the potency of clonidine. 12 patients complained of tiredness and dry mouth on clonidine and 2 patients of unsteadiness on labetalol. Labetalol caused a psoriasiform rash on the hands in one patient and limb weakness in one patient.
Elective change of antihypertensive therapy from clonidine to beta-blockers was studied in 18 hypertensive inpatients on diuretic treatment. An abrupt cessation of clonidine (0.3 mg t.i.d.) and start of treatment 12 hours later with atenolol (50 mg b.i.d.) resulted, within 24-36 hours, in severe rise of blood pressure and intolerable symptoms of clonidine withdrawal in all 4 patients studied. Plasma noradrenaline levels were elevated 18-24 hours after the last dose of clonidine. Halving the previous daily clonidine dose (0.15 mg t.i.d.) and discontinuing it after three days on concomitant treatment with atenolol or timolol in increasing doses proved successful and caused only few side-effects in 14 hypertensive inpatients.
Explore the source record for details and available documents.
On the hypothesis that non-selective beta-blockers can antagonize or reverse the antihypertensive effect of clonidine (C), 12 hypertensive outpatients were treated with C alone and in combination with propranolol (P), atenolol (A) and prazosin (Pz). C alone (0.11 or 0.22 mg b.i.d.) or in combination with P (80 mg b.i.d.) did not provide normotension. Changing P to A (50 mg b.i.d.) reduced supine systolic and diastolic pressures, which now were significantly lower (p less than 0.01) than during C alone. Changing A to P again resulted in elevated pressures. Pz (1 mg t.i.d.) added to the C+P regimen lowered supine blood pressures to the levels otherwise recorded during C+A. C dose-dependently contracted rabbit aortic spiral in vitro, reaching about 50% of maximum responses to noradrenaline. Pz abolished this response. P (0.1--10 micrograms/ml) but not A somewhat enhanced responses to high doses of C. Sotalol rather antagonized C contractions. We conclude that A but not P enhances the antihypertensive action of C. No hypertensive interaction was observed.
The antihypertensive effect of clonidine given either two or three times a day with a diuretic was compared in a double-blind crossover study in 18 hypertensive patients. In 11 patients given clonidine three times a day there was better control of blood pressure, although the differences in most instances were of the order of only a few millimeters Hg. There were no differences in the frequency or severity of side effects. Clonidine twice daily with a diuretic appears to be adequate for most patients.
In order to evaluate the left ventricular (LV) response to isometric exercise in diabetics, 15 young insulin-dependent diabetic subjects and 12 control subjects of similar age and sex distribution performed a handgrip test during echocardiography. No base-line differences in hemodynamic or echocardiographic parameters were found between diabetic and control subjects. The heart rate and blood pressure responses to handgrip exercise were similar in the two groups, and LV dimensions, shortening fraction and velocity of circumferential fiber shortening remained unchanged in both groups. Three diabetic subjects had an impaired LV functional response to handgrip (a decrease of more than 5 percentage units in the shortening fraction). These 3 patients had high HbA1 values (17.6-18.2%) and modest correlations existed between decrease in the shortening fraction during handgrip and concentrations of HbA1 (r = 0.70, p less than 0.01) and fasting blood glucose (r = 0.62, p less than 0.01). Thus, most young insulin-dependent diabetic subjects appear to have a normal LV response to isometric exercise, but poor blood glucose control seems to be accompanied by a slight impairment of LV functional reserve.
OBJECTIVE: The purpose of this explorative study was to uncover and interpret the experiences, values, and meaning of being in daily occupations of older adults with functional impairments. METHOD: Interviews were conducted with 21 older adults with disabilities who were between 70 and 92 years of age. The interviews occurred in their home environments; 18 of the 21 participants lived alone. The interviews were analyzed using a constant comparative approach. FINDINGS: Occupational themes related to participation against the odds, retreat from occupation, the need for an invitation from others, and personal meanings related to capacities for occupation were uncovered. CONCLUSIONS: The findings suggest that the loss of positive belief in enjoyable occupations can be a sign of reduced hope in late life. For occupational therapists, whether an older adult has made a conscious choice to withdraw from occupational life or has too few occupational choices is important to distinguish.