Previous studies have indicated the existance of haemodynamically important structural vascular changes in patients and animals with hypertension. Possible pathophysiological implications of these changes are discussed. Two studies dealing with the question of reversibility of the structural changes on long-term blood pressure lowering therapy are described. The results indicate that the changes are partially but not completely reversible.
The commonest organism in urinary tract infections (UTI) is Escherichia coli. Pyelonephritogenic E.coli strains possess P-fimbriae which firmly attach to uroepithelial cells by recognition of a carbohydrate structure, alpha-D-Galp-(1-4)-beta-D-Galp, which is confined within all glycosphingolipids related to the human P-blood group antigens. Several investigators have studied virulence properties of E.coli and host resistance in relation to UTI. Uroepithelial cells from children and women with recurrent UTI have an increased capacity to bind E.coli. In contrast to previous studies the present one deals with patients with renal scarring, who constitute the major risk group among patients with UTI. P-fimbriae mediated binding to uroepithelial cells was studied and the risk of recurrent UTI in patients with renal scarring was determined. Ninety per cent of the E.coli isolates from female patients with acute non-obstructive pyelonephritis in this study possess P-fimbriae (I). The fecal E.coli colonies obtained from these patients were P-fimbriated in 55% compared to 11% of the fecal E.coli colonies from healthy controls. The P-blood group distribution in 56 female patients with renal scarring and a history of febrile UTI was the same as in a control group of 39 healthy subjects (II). A history of recurrent and/or early infections did not increase the percentage of the P1 blood group phenotype. Forty-nine female patients with renal scarring were prospectively investigated for the incidence of symptomatic UTI in relation to fecal colonization with P-fimbriated E.coli (III). Fifty-three per cent of the patients had altogether 65 episodes of symptomatic UTI during the three-year follow-up (0.036 infections per month). Eight patients (16%) had nine attacks of acute pyelonephritis and 4/5 of the tested E.coli strains from these patients were P-fimbriated. No relationship was demonstrated between the presence of P-fimbriated E.coli in the fecal flora and the development of subsequent acute pyelonephritis. The binding of P-fimbriated E.coli to uroepithelial cells from 19 female patients with renal scarring was studied with the fluorescence-activated cell sorting (FACS) analysis (IV). The uroepithelial cells from the patients with renal scarring exhibited a significantly higher binding capacity (p less than 0.01) than uroepithelial cells from healthy controls. Furthermore, uroepithelial cells from the patients with renal scarring and kidney insufficiency had a higher availability of P-fimbriae receptors on their uroepithelial cells than cells obtained from patients with renal scarring and normal renal function (r = -0.75, p less than 0.001) (V).(ABSTRACT TRUNCATED AT 400 WORDS)
Two types of end-point measurement are presently available in clinical trials of the effect of treatment of hyperlipidaemia on cardiovascular disease; these are the incidence of clinical events and the arteriographic assessment of progression or regression of atherosclerosis. These approaches are briefly reviewed. In the present trial, 25 hyperlipidaemic men with symptomatic femoral atherosclerosis underwent biplanar femoral arteriography at baseline. They were then randomised into treatment and usual-care groups; treatment was individualized, comprising a lipid-lowering diet with cholestyramine, nicotinic acid or clofibrate as appropriate for the lipoprotein disorder. Mean cholesterol and triglyceride levels were 19% and 37% lower in the treatment group. Arteriography was repeated after a mean period of 19 months. With attention to blinding of observers, changes in arteriograms were quantitated using computerised image analysis and visual methods, and expressed both by patient and by arterial segment. All end-points were in conformity and showed a lower rate of progression of arterial disease in the treatment group, and a higher frequency of segmental regression in treated patients. In this small trial of patients with functionally-significant atherosclerosis, effective treatment of hyperlipidaemia favourably affected the course of the arterial disease.
Plasma concentrations of antidiuretic hormone (ADH) were measured in 8 patients with congestive heart failure (CHF) of NYHA functional class III-IV, before and during treatment with captopril, 6.25-25.0 mg t.i.d., added to their drug regimen. Before captopril treatment, plasma ADH was high, 2.5 times the upper limit of normal reference values. During treatment with captopril, plasma ADH levels were normalized, and remained so throughout the study, for at least 6 months. Plasma levels of angiotensin II were also reduced to a normal level. Reduction of plasma ADH during captopril treatment in CHF may partly depend on reduced angiotensin II formation, and may be beneficial by improving water balance. Atrial natriuretic peptide (ANP), was measured by radioimmunoassay in 17 patients with CHF. The highest levels were measured in the most severe CHF cases, and intermediate high values on NYHA functional class I-II patients. Plasma ANP concentrations in control patients (n = 18) without cardiac diseases ranged between 0 and 30 pg/ml. In two patients with paroxysmal supraventricular tachycardia, associated with transient polyuria, high plasma ANP concentrations were noticed during tachycardic episodes. Thus, ANP appears to be a circulating hormone in humans, and is released into the blood in clinical conditions associated with raised preload and atrial wall stretch.
: The distribution of antinuclear factors in sera of 615 relatives, and their 313 spouses, of 72 SLE probands is presented. A statistically significant, but irregular, aggregation of ANFs occurred in relatives. When the different patterns of nuclear fluorescence were analysed, the homogeneous type, but not the speckled type of ANF separated the relatives and the spouses. The correlation between ANFs and rheumatic disease was more manifest for relatives than for spouses. Non-rheumatic relatives and spouses did not differ with regard to any type of ANF.
Using a high efficiency membrane support pattern, described in the previous paper, a prototype of a new parallel plate dialyser has been developed. The new dialyser is designed in such a way that the number of components is reduced to one item per blood layer and the membrane is folded as a continuum. This permits a semiautomatic assembly of the unit, which reduces production costs. Furthermore this technique facilitates aseptic handling of the item. The in vitro performance has been tested and it compares favorably with commercially available disposable parallel plate dialysers.
In recent years, the importance of hormones from the hypophysis and adrenal cortex for various diseases has come more and more to the forefront, Two Swedish workers, EDSTROM and WESTMAN (l), showed that the implantation of calf hypophysis in a case of malignant chronic polyarthritis acted favourably on the rheumatic disease. The remarkable Americm investigations into the effect of these hormones on (among other things) the symptoms of rheumatoid arthritis have been a great stimulus to research in this field. SZENT-GYOR~YI had already established the presence of a very high proportion of ascorbic acid in the suprarenal glands. Consequently, it was possible to assume that this condition might be connected with the functioning of the suprarenal glands. The American Sayers et a1 '(2) have been able to show in experiments on rats and guinea-pigs that the proportion of ascorbic acid in the suprarenal glands changes in a typical way after the administration of adrenotrophic hormone. GIROUD e t al. (3) have reported that cortical hormone syntheses depended on the presence of ascorbic acid in the suprarenals. THORN et al. (4.6) and HENUH et al. (6.7) have shown that certain hormones of the hypophysis and suprmnal glands of the A. C. T. H. and Compound E type could exert an influence on the organism in such a way, that the circulating eosinofils decreas and the output of uric acid increases and that among other things rheumatio symptoms are f avourabl y affected . With these observations as a starting-point, we injected large doses of vitamins including ascorbic acid 1 g per day (10% solution), intravenously
The implantation of a permanent pacemaker has been carried out on 159 patients suffering from Adams-Stokes seizures. Elema 588 B electrodes were implanted in 119 patients and Chardack 5818 electrodes in 40 patients. The two types of electrodes differ with regard to both the implantation technique and weight and thickness. No difference was found in the incidence of electrode displacement or survival between the two groups, similarly the experience of the physician with regard to implantation had no influence on the frequency of displacement. Displacement on the other hand occurred significantly more frequently in those patients suffering from heart disease demonstrable by x-ray examination.
