Biomedical subjects
Publications and source records attributed to W Hart.
A family is described, in which the father and one daughter were found to suffer from primary hypothyroidism and chemodectoma. We could not find any previous description of this combination. The possibility of a new syndrome is considered.
Because gastrointestinal dysfunction is a major problem in children with human immunodeficiency virus (HIV) infection, we utilized breath hydrogen measurements to determine the relationship between disaccharide malabsorption and gastrointestinal dysfunction in HIV-infected children. We found a strong association between lactose intolerance and persistent diarrheal disease in this population (p less than 0.007, Mann-Whitney U test). We also found evidence of sucrose malabsorption and persistent diarrheal disease in three of the children. Extensive microbiologic evaluations failed to reveal an etiologic agent related to the occurrence of gastrointestinal symptoms. Our findings indicate that disaccharide intolerance is a common occurrence in HIV-infected children with persistent diarrheal disease. Careful attention to dietary intake may be required to ameliorate clinical symptoms and to maintain adequate nutrition.
The fixed combination of lisinopril 20 mg and hydrochlorothiazide 12.5 mg (L/HCTZ) was compared with each of the monocomponents in a multicentre, double-blind, randomized, parallel-group study involving elderly patients with mild to severe hypertension. At the end of the trial, a total of 278 patients had completed 8 weeks of treatment. SBP reduction from baseline in the L/HCTZ group was significantly greater, sitting and standing, compared with both the monotherapy groups. Sitting DBP reduction from baseline in the L/HCTZ group was significantly greater than in the hydrochlorothiazide group. Uric acid levels were raised significantly more in the L/HCTZ group compared with the lisinopril group, and the fall in potassium levels were significantly smaller in the L/HCTZ group compared with the hydrochlorothiazide group. Safety and tolerability were equivalent for the three groups.
The efficacy of and tolerance to felodipine given as extended-release (ER) tablets once daily (o.d.) and the plain tablets twice daily (b.i.d.) were compared in this study. After a 4-week period on placebo and a beta-blocker, 102 patients who had a diastolic blood pressure (DBP) in the supine position greater than 95 mm Hg were randomized to treatment with felodipine ER tablets 10 mg o.d. (n = 50) or plain tablets 5 mg b.i.d. (n = 52). If the DBP was greater than 90 mm Hg after 2 weeks, the dose was doubled. The total treatment time on felodipine was 6 weeks. Blood pressure (BP) was measured 2 h after the dose and at the end of the dosing interval, i.e., 24 h after ER and 12 h after plain tablets. Both formulations reduced BP significantly (15/12 mm Hg in the ER and 13/11 mm Hg in the plain tablet group, at the end of the dosing interval). No differences in BP reduction were seen between the groups. The proportion of responders was 71% on ER and 65% on plain tablets 24 and 12 h, respectively, after dose intake, and greater than 90% in both groups, when measured 2 h after dose. Ankle swelling and flushing were the most frequently reported adverse events. Eight patients (three on ER) were withdrawn, most of them due to vasodilatory side effects. Felodipine ER once daily was as effective and tolerable as plain tablets b.i.d.
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Angiotensin-converting enzyme (ACE) inhibition with captopril is accepted therapy for the treatment of symptomatic congestive heart failure. In this trial, we compared the new ACE inhibitor, lisinopril, to captopril during a 12-week randomized double-blind study. One hundred twenty-nine patients with New York Heart Association class II, III, or IV congestive heart failure were randomized to receive either lisinopril 5 mg/day (n = 64) or captopril 37.5 mg/day (n = 65) in 15 centers. Drug doses could be titrated upwards every 4 weeks. The primary measure of drug efficacy was improvement in treadmill exercise time using a modified Naughton protocol. Secondary measures of efficacy and the development of adverse effects were also examined. Lisinopril improved exercise time (following 12 weeks of therapy) more than captopril [from 500 +/- 30 to 682 +/- 34 sec (mean +/- SEM) with lisinopril versus 480 +/- 26 to 600 +/- 35 sec with captopril; difference between groups, p less than 0.05]. Adverse drug effects were unusual and similar in frequency in the two groups, although an increase in blood urea nitrogen was more common with lisinopril than with captopril (p less than 0.05). These results indicate that using the doses and treatment regimens studied, lisinopril is more effective than captopril for the treatment of symptomatic congestive heart failure. Adverse experiences with lisinopril were infrequent and similar in incidence to those observed with captopril.
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We describe a 3 1/2 year trial in which we used immunofluorescence to detect and titrate antibody to six common viruses in normal healthy blood donors drawn at random from West and South East Scotland. The trial was designed to allow selection of blood donations rich in specific antiviral antibody for inclusion in the plasma pool which would, in turn, be used for the preparation of specific antiviral immunoglobulin. The results show the natural frequency of occurrence of antibody to different viruses in healthy adult blood donors.
Methane was oxidized to carbon dioxide in the absence of oxygen by water samples from Lake Mendota, Madison, Wis. The anaerobic oxidation of methane did not result in the assimilation of carbon from methane into material precipitable by cold 10% trichloracetic acid. Only samples taken at the suface of the sediment of Lake Mendota were capable of catalyzine the anaerobic oxidation of methane. The rate of methane oxidation in the presence of oxygen was highest in samples taken from near the thermocline. Of the radioactive methane oxidized, 30 to 60% was assimilated into material precipitable by cold 10% trichloroacetic acid during aerobic incubation of the samples. These data support the conclusion that two distinct groups of methane-oxidizing organisms occur in stratifield lakes. Enrichments with acetate and methane as the sole sources of carbon and energy and sulfate as the electron acceptor resulted in the growth of bacteria that oxidize methane. Sulfate, acetate, and methane were all required for growth of enrichments. Acetate was not oxidized to carbon dioxide but was assimilated by cells. Methane was not assimilated but was oxidized to carbon dioxide in the absence of air.
Corneal thicknesses and endothelial cell densities were studied in nine patients with ocular hypertension receiving long-term unilateral topical epinephrine hydrochloride therapy. No difference was noted in corneal thickness in the treated eyes. There was a significant (P less than .02) reduction in endothelial cell count in the treated eyes compared to their untreated fellow controls. Those patients who had the most marked intraocular pressure response to epinephrine also had the greatest endothelial cell loss.
Since in utero exposure to diethylstilbestrol (DES) is known to cause abnormalities of the female genital tract later in life, exposed male offspring were located, surveyed by mail, and compared with unexposed male offspring from the same period and medical practices. The exposed and unexposed respondents appeared comparable and did not differ in their response to most medical questions. However, a larger proportion of exposed than of unexposed boys had experienced problems in passing urine (12.9% vs. 1.8%, P = .0003) and abnormalities of the penile urethra (4.4% vs. 0%; P = .017).
The metabolism of hydroxyproline was investigated in six healthy subjects and four patients with chronic renal insufficiency (creatinine clearances respectively 40, 10, 7, 2 1/2 ml/min). For this purpose hydroxy-DL-proline-2-(14)C was administered intravenously and the excretion patterns of radio-activity in plasma, urine and expired air (14CO2) were determined. A separation procedure (using thin layer chromatography followed by oxidation with D-amino acid oxidase) made it possible to determine the concentration of hydroxy-L-proline-2-(14)C in the presence of the D-isomer and the degradation products of both. Although the use of a racemic mixture as tracer made conclusions more difficult, it could be shown that in uremic patients the concentration of hydroxy-DL-proline -2-(14)C remained high in the blood for a longer period, the metabolites appeared in the urine later, and the peak respiratory 14CO2 excretion was reached later and was lower than in the healthy subjects. On this basis it was concluded that the metabolism of hydroxyproline is diminished in patients with renal insufficiency.
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The plasma concentration of hydroxyproline fractions were determined in 52 patients with diminished renal function. High levels were found in each case and a correlation was found between the serum creatinine concentration and the plasma concentrations of peptide-bound hydroxyproline. Bone biopsies was taken from 16 patients from renal insufficiency and the results of morphometric studies of the biopsies were correlated with the blood determinations. Free hydroxyproline levels correlated significantly both with bone formation and with bone resorption. However peptide-bound and protein-bound hydroxyproline levels did not correlate with bone histology. Hence the plasma concentration of free hydroxyproline in patients with renal insufficiency can be used as an index of bone collagen turn-over.
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