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Biomedical subjects

N Winer

Publications and source records attributed to N Winer.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Monitoring of labor by fetal pulse oximetry in a case of fetal atrial-ventricular block].

We present our experience with fetal pulse oximetry during labor monitoring in a case of fetal atrio-ventricular block. Fetal pulse oximetry is a recent technique of fetal monitoring. It is based on the photometric properties of hemoglobin and reduced hemoglobin. The continuous and noninvasive method measured fetal saturation in oxygen. It can detect fetal hypoxia, cause of acute suffering. Saturation was continuously greater than 40%. Spontaneous delivery raised no problem, either for the fetus or the mother.

Acid-Base Equilibrium↗
PubMed1996

[Pregnancy in primary antiphospholipid syndrome. Proposal for a common management protocol].

OBJECTIVE: Primary antiphospholipid syndrome (APS) is by definition associated with high obstetric risk. We performed a retrospective study of pregnancies in women with this syndrome in an attempt to define a common means of caring these patients. STUDY DESIGN: Women with APS followed in Internal Medicine Department and in Gynecology Department since 1989 were studied retrospectively. RESULTS: Fifteen women with primary APS had a total of 51 pregnancies, 39 (76%) of which ended in embryonic (n = 24) or fetal (n = 15) loss. Only 6/39 untreated pregnancies led to a live birth, including 2 cases of intrauterine growth retardation. Among the 12 pregnancies treated preventively for obstetric complications, 6 led to a live birth. The treatments used were dissimilar and included aspirin, corticosteroids and heparin, either alone or in association. Four of these 6 live births were obtained by aspirin alone. Gravidic toxemia was observed in one untreated patient. CONCLUSION: The obstetric prognosis for untreated APS is appalling. The benefit of heparin therapy in association with aspirin remains to be demonstrated, ideally in a protocol comparing aspirin alone with aspirin and heparin.

Adrenal Cortex Hormones↗
PubMed1995

Obstetrical prognosis for carbon dioxide laser conisation of the uterine cervix.

Carbon dioxide laser conisation is a very reliable surgical technique for cervical intraepithelial dysplasia. As cervical morphology and function are better preserved than with other techniques, obstetrical morbidity should be lower in the often young and pauciparous women who undergo this procedure. In our study comparing the course of 71 pregnancies (55 children) in 54 operated women with that of 82 pregnancies (59 children) in these same women before conisation, the rates for complications at the beginning of pregnancy were similar (respectively, 14.1% and 13.4%, early spontaneous abortions; 2.8% and 2.4%, extrauterine pregnancies; and no late spontaneous abortions). The increased risks of premature delivery (13.2% vs. 8.5%), chorioamnionitis (1.9% vs. 0%), premature rupture of membranes (1.9% vs. 0%) and prematurity (11.3% vs. 1.7%) were not statistically significant. Only the percentage of natural term births was significantly reduced (73.6% vs. 90%; P = 0.025), but this difference was no longer apparent after correction for the prevalence of associated obstetrical pathologies and prematurity and/or cesarean factors which was significantly greater for the 53 pregnancies that developed after carbon dioxide laser conisation.

Abortion, Spontaneous↗
PubMed1995

[Malignant non-Hodgkin's lymphoma of the cervix. A case report].

Isolated malignant non Hodgkin lymphomas (MNHL) of uterine cervix are rare, and the therapeutic strategy is not always clearly established. The authors report a case of a 78-years-old woman presenting a MNHL FIGO stage IIB and Ann Arbor stage IE. Extention evaluation was negative. The histologic and immunohistochemical examination revealed a centroblastic lymphoma type G in the Working Formulation (WF). The patient was successfully treated by surgery followed with combination chemotherapy and external radiation therapy. Intermediate grade primary MNHL of the uterine cervix are the most frequent. The opportunity of surgery is discussed because lymphoma is a general disease with blood dissemination. We propose a therapeutic strategy according to patient age and the wishes for pregnancy. The young woman could undergo polychemotherapy, perimenopausal woman a combination of chemotherapy and radiation therapy, and post-menopausal woman surgery followed by external radiation therapy.

Aged↗
PubMed1993

[The fundamental basis and obstetrical applications of mifepristone or RU-486 (voluntary interrupted pregnancies excluded)].

RU 486 is an anti-progesterone steroid used in obstetrics to achieve maturation of the cervix before an endouterine procedure in late abortions during the first 3 months, in therapeutic pregnancy termination during months 3-6 or 6-9 and in expelling fetuses which have died in utero. RU 486 has also been proposed for use in inducing or facilitating labor at term.

Cervix Uteri↗
PubMed1993

Progesterone and mifepristone modify principally the responses of circular myometrium to oxytocin in preparturient rats: comparison with responses to acetylcholine and to calcium.

We have recently reported that in the pregnant rat myometrium the synthetic OT/AVP V1 antagonist d(CH2)5[Tyr(Me)2]OVT has similar pA2 values against oxytocin (OT) or arginine vasopressin in longitudinal myometrial strips and against arginine vasopressin in circular myometrial strips. However, the antagonist is inactive against OT in circular strips, suggesting that the receptor involved in the action of OT in circular muscle is distinct from the OT receptor in longitudinal muscle. In this study, models of progesterone-blocked and progesterone + mifepristone-induced rat parturition were designed to check whether progesterone modulated OT responsiveness differentially in the two myometrial layers. Responses to OT were measured in organ bath experiments and compared with responses to acetylcholine and to calcium ions (Ca2+) in depolarized myometrial strips. Compared with control animals at day 21 of pregnancy, maximal responses to OT in longitudinally cut strips from progesterone- or progesterone + mifepristone-treated rats were only marginally affected by steroid treatments. In contrast, progesterone almost totally abolished responses to OT in the circular myometrium, whereas mifepristone treatment restored responses to those seen at spontaneous parturition. In both muscle layers, responses to acetylcholine were unaffected by steroid treatments and those to Ca2+ were decreased by progesterone treatment (however, to a lesser extent than those of OT) and were restored by mifepristone. These results suggest the presence of two populations of OT receptors in the myometrium: a constitutive type of receptor predominent in longitudinal muscle and a progesterone-regulated receptor present in circular muscle.

Acetylcholine↗
PubMed1990

Placebo-controlled trial of once-a-day isradipine monotherapy in mild to moderately severe hypertension.

The efficacy and safety of once-daily dosing of isradipine, a new calcium antagonist vasodilator, was evaluated in a multicenter, placebo-controlled trial in hypertensive patients who had supine diastolic blood pressure (SDBP) 100-119 mm Hg. After a 3-week single-blind placebo washout patients randomly received either isradipine, 5 mg once daily, or a matching placebo; if SDBP remained greater than or equal to 95 mm Hg or less than or equal to 10 mm Hg below baseline at four weekly clinic visits, isradipine was increased at weekly intervals by 5 mg once daily up to 20 mg and maintained during weeks 5 and 6. At week 6 mean supine blood pressure 24 hours after dosing had declined from 163 +/- 20/105 +/- 5 (N = 78) to 146 +/- 17/92 +/- 7 mm Hg (N = 60) on isradipine, 14.5 mg once daily, and from 163 +/- 20/105 +/- 6 (N = 85) to 157 +/- 18/99 +/- 10 mm Hg (N = 64) on placebo (P less than .001 between groups). Standing blood pressure decreased from 159 +/- 20/104 +/- 8 to 144 +/- 18/93 +/- 11 mm Hg with isradipine and from 160 +/- 22/105 +/- 9 to 154 +/- 19/101 +/- 11 mm Hg with placebo (P less than .001 between groups) without signs or symptoms of postural hypotension. A SDBP less than or equal to 90 mm Hg or a greater than or equal to 10 mm Hg fall below baseline was achieved in 41 of 78 isradipine-treated (53%) and 18 of 85 placebo-treated subjects (21%).(ABSTRACT TRUNCATED AT 250 WORDS)

Antihypertensive Agents↗
PubMed1990

Pheochromocytoma.

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Adrenal Gland Neoplasms↗
PubMed1990

Hypertensive crisis.

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Antihypertensive Agents↗
PubMed1989

Comparison of intravenous dilevalol with placebo in moderate hypertension.

Dilevalol, an agent that combines nonselective beta-blocking and beta 2-mediated vasodilating properties, was compared with placebo in 16 subjects with moderate hypertension in a double-blind crossover study. Dilevalol or a placebo was administered intravenously in bolus injections of 25, 50, and 50 mg at 15-minute intervals. Fifteen minutes after a cumulative dose of 125 mg, the blood pressure was lowered by 11/9 mm Hg, compared with 2/1 mm Hg after placebo (p less than 0.01 between groups for systolic and diastolic blood pressure), an effect that persisted for at least 105 minutes. Standing systolic blood pressure was also lowered in dilevalol-treated patients without orthostatic symptoms. No significant effects on heart rate were noted. Fifteen minutes after the last dose of dilevalol, plasma norepinephrine levels increased from a baseline of 200 +/- 24 to 495 +/- 44 pg/ml (p less than 0.01), compared with a nonsignificant rise from 262 +/- 21 to 306 +/- 28 pg/ml with placebo vehicle. Dilevalol also increased alpha-human atrial natriuretic factor by 5.4 pg/ml, compared with 0.5 pg/ml after placebo (p less than 0.01 between groups). Plasma renin activity and plasma epinephrine, aldosterone, and cyclic guanosine monophosphate levels were unchanged by dilevalol. There were no significant adverse effects with dilevalol administration. Compared with placebo, dilevalol given intravenously appears to be safe and effective antihypertensive treatment.

Aldosterone↗
PubMed1989

Isradipine vs propranolol in hydrochlorothiazide-treated hypertensives. A multicenter evaluation.

A randomized, parallel, controlled study was conducted to evaluate the safety and efficacy of isradipine, 2.5 to 10 mg orally twice a day, compared with propranolol hydrochloride, 60 to 240 mg orally twice a day, in 78 hypertensives whose supine diastolic blood pressure was greater than 95 mm Hg while receiving 50 mg/d or more of hydrochlorothiazide. Isradipine or propranolol was titrated during a 10-week double-blind phase to achieve a supine diastolic blood pressure below 90 mm Hg while a fixed dose of hydrochlorothiazide was maintained. Supine diastolic blood pressure was reduced by 10 mm Hg in 88% of the isradipine/hydrochlorothiazide-treated and 83% of the propranolol/hydrochlorothiazide-treated groups and to less than 90 mm Hg in 55% of the isradipine/hydrochlorothiazide-treated and 69% of the propranolol/hydrochlorothiazide-treated patients. There was no significant difference in supine blood pressure reduction between either group, but there was a 3-to 4-beats per minute increase in supine heart rate in isradipine-treated patients and an expected 15- to 20-beats per minute decrease in heart rate in propranolol-treated patients. Five of 7 patients in the isradipine-treated group and 8 of 9 patients in the propranolol-treated group discontinued the therapy because of adverse reactions or treatment failure. Using Fisher's Exact Test, we found no significant difference in the relative frequency of individual adverse reactions between groups, although the absolute adverse reaction frequency was significantly higher with isradipine. This study demonstrates the effectiveness and safety of supplemental isradipine in the treatment of hypertension not controlled by hydrochlorothiazide alone.

Adult↗
PubMed1989

Dilevalol in severe hypertension. A multicenter trial of bolus intravenous dosing.

Dilevalol, the R-R optical isomer of labetalol, a nonselective beta-antagonist with vasodilation from selective beta 2 agonism, was administered in sequential multiple bolus intravenous injections of 10 to 100 mg in total doses ranging from 35 to 585 mg (mean dose, 414 mg) to 101 patients with supine diastolic blood pressures above 120 mm Hg. Mean blood pressure was reduced from 200 (+/- 3)/129 (+/- 1) mm Hg to 149 (+/- 2)/101 (+/- 1) mm Hg, a mean reduction of 51/28 mm Hg. The therapeutic goal was established as a reduction in supine diastolic blood pressure to less than 100 mm Hg or a reduction of at least 30 mm Hg. This was achieved in 62 (61%) of 101 patients, with an additional 7 patients having a final supine diastolic blood pressure of 100 mm Hg. Treatment with dilevalol was less successful in black male patients than in the group at large. There was a tendency for older patients to respond better than younger patients. Prior recent treatment of patients with beta-adrenergic antagonists decreased the effectiveness of the drug. Significant orthostatic hypotension was not noted. Sixty-four patients were transferred to oral dilevalol treatment in combination with a diuretic, and blood pressure in this group averaged 160/100 mm Hg after 1 month of therapy. Dilevalol appears to be a safe and effective drug that can be used intravenously successfully in the majority of patients with severe hypertension and provides an alternative to therapy with other agents. It also is a useful agent for oral treatment of these patients after successful intravenous therapy.

Administration, Oral↗
PubMed1987

Evaluation of isradipine (PN 200-110) in mild to moderate hypertension.

The efficacy and safety of isradipine (PN 200-110), a new dihydropyridine calcium antagonist, was evaluated in 87 hypertensive patients in a placebo-controlled, double-blind, randomized multicenter trial. After a 3-week single-blind washout phase, isradipine (or matching placebo) was administered for 4 weeks, beginning at 2.5 mg b.i.d. with increments of 2.5 mg b.i.d. at weekly intervals if supine diastolic blood pressure remained greater than or equal to 90 mm Hg. At the end of 1 week average supine blood pressure in the isradipine group (n = 45) fell from a baseline of 156 +/- 13/104 +/- 4 mm Hg to 146 +/- 14/97 +/- 7 mm Hg. By week 4 blood pressure was reduced by 19/14 mm Hg compared with 4/5 mm Hg in the placebo group (P less than 0.001 between groups). Supine and standing pulse rates were slightly increased initially with isradipine therapy but returned to baseline with increasing isradipine doses. Blood pressure responses at week 4 were good or excellent (supine diastolic less than or equal to 90 mm Hg or greater than or equal to 10 mm Hg decrease from baseline) in 87% of isradipine-treated patients and in 26% of placebo-treated patients. Headache, edema, abdominal discomfort, and constipation occurred slightly more frequently in isradipine-treated patients than in placebo-treated control subjects. The results indicate that isradipine, administered as monotherapy in doses of 2.5 to 10 mg b.i.d., is safe and effective in patients with mild to moderate essential hypertension.

Adult↗
PubMed1983

Treatment of severe hypertension with labetalol compared with methyldopa and furosemide. Results of a long-term, double-blind, multicenter trial.

Eighty-one severely hypertensive patients were enrolled in a multicenter, double-blind, parallel group study evaluating the efficacy and safety of labetalol alone or in combination with furosemide versus methyldopa in combination with furosemide. A one day to four week placebo lead-in phase was followed by a one- to six-week titration period and a one-year maintenance period. Treatment with labetalol alone or in combination with furosemide, as well as methyldopa plus furosemide, was associated with significant reductions in supine and standing blood pressure levels. Moreover, after six months and one year of treatment, respectively, labetalol caused a significantly (p less than 0.05) greater reduction in the systolic blood pressure than the methyldopa regimen. The antihypertensive effect of labetalol was associated with small, yet significant reductions in heart rate; in contrast, resting tachycardia was observed in methyldopa-treated patients. Side effect profiles of the two treatments were different, with nausea being the most commonly reported side effect during labetalol therapy, and asthenia, somnolence, and dry mouth during methyldopa therapy. Overall, 33 of 65 (53 percent) labetalol-treated and 28 of 60 (47 percent) methyldopa-treated patients had at least a good response (that is, standing diastolic blood pressure 90 to 94 mm Hg) to therapy, including 26 (40 percent) and 22 (37 percent) patients, respectively, who had standing diastolic blood pressure levels of less than 90 mm Hg. Thus, labetalol is a potentially safe and effective agent in the long-term management of the patient with severe hypertension.

Adult↗
PubMed1983

Influence of food on aspirin absorption from tablets and buffered solutions.

After a standard meal, 12 normal volunteers received three aspirin dosage forms in a single-dose, complete crossover study. The three dosage forms were an unbuffered tablet, an effervescent solution with 16 meq of buffer, and an effervescent solution with 34 meq of buffer. Plasma and urine aspirin, salicylic acid, and salicyluric acid were measured for 10 hr. Significant differences in the absorption kinetics of aspirin were observed, with aspirin from the two solutions being absorbed faster than from the tablet. Urine pH and renal clearance for all three acid compounds were influenced by the buffer during the first 2 hr only. Area under the curve (AUC) and urine accumulation comparisons suggest that 15-20% more aspirin reaches the general circulation after the tablet, but that the total salicylate absorbed is not different. Comparison with an earlier study indicates the solution with 34 meq of buffer is virtually unaffected by the presence of the meal while the solution with 16 meq buffer and the tablet are more slowly absorbed in the nonfasted state.

Adult↗
PubMed1982

Pindolol: effects on blood pressure and plasma renin activity.

The influence of pindolol, other antihypertensive agents, or placebo upon plasma renin activity (PRA) was examined in five separate studies involving 249 subjects (pindolol), n = 149; propranolol, n = 43; methyldopa, n = 13; chlorthalidone, n = 16; placebo, n = 28). In addition, the subjects were stratified in for studies into low (n = 104), medium (n = 96), or high (n = 15) PRA categories according to baseline PRA and sodium excretion measurements. The response to antihypertensive therapy was analyzed in each PRA category. Pindolol and propranolol lowered PRA comparably at equivalent dosages, although this effect was not consistently observed in all studies or at all dosage levels. Methyldopa therapy was not associated with a decline in PRA and chlorthalidone elevated PRA. Pindolol and propranolol lowered both supine and erect diastolic blood pressure (BP) comparably. This effect was similar in subjects categorized as having low or medium PRA. Too few patients were studied with high PRA to derive statistically meaningful data. Pindolol lowered standing systolic BP to a greater extent than did propranolol, especially in the medium PRA category. It was concluded that pindolol, like other beta-adrenergic blockers, lowers PRA, that the effect of pindolol on diastolic BP is independent of the baseline PRA category, and that pindolol is more effective than propranolol in lowering standing systolic BP, at least in the medium PRA category.

Adult↗