Reversibility of cerebral symptoms in severe hypertension in relation to acute antihypertensive therapy. Danish Multicenter Study

Cerebral symptoms were registered in a multicenter study including 64 patients with severe hypertension, diastolic blood pressure (DBP) greater than or equal to 135 mmHg, and more or less pronounced hypertensive encephalopathy. The symptoms were: headache (70%), dizziness (35%), consciousness disturbances (28%), nausea (27%), paresis (23%), blurred vision (22%), paraesthesia (21%) and vomiting (14%). None had convulsions or coma. Initial treatment was furosemide i.v., and if DBP was greater than or equal to 125 mmHg after one hour, patients were randomized to treatment with either i.v. diazoxide (bolus injections of 75-150 mg) or i.m. dihydralazine (bolus injections of 6-12.5 mg). A gradual fall in blood pressure (BP) was obtained in all three groups. Along with BP reduction a substantial regression of neurological symptoms was registered. After 5 hours only minor cerebral symptoms were present without significant difference between diazoxide and dihydralazine. None developed cerebral complications. The study failed to show a significant correlation between BP reduction and regression of neurological symptoms graded semiquantitatively. Reduction of BP by titration using small repeated bolus injections is recommended, but oral treatment should be considered in the patients who are able to ingest peroral medication in spite of neurological symptoms.     

Severe hepatitis treated with an artificial liver support system.

We designed an artificial liver support system (ALSS) including plasma exchange, charcoal hemoperfusion, plasma bilirubin absorption, charcoal plasma perfusion, hemofiltration and hemodialysis. We chose different methods or their combinations according to the patient's conditions. We investigated the effect of ALSS in 154 patients with severe hepatitis, 72 of whom survived. All data were analyzed by SPSS. The effectiveness of ALSS treatment was compared at different stages (i.e. early, middle and end stages). After each ALSS treatment, the liver function of these patients greatly improved, serum endotoxin and HBV-DNA concentrations were significantly decreased, and the serum concentration of aromatic amino acids (AAA) such as methionine decreased while BCAA/AAA ratio increased. Patients treated with ALSS in the early or middle stages of disease had much higher survival rates than patients in the end stage of disease. Thus, we concluded that ALSS is a reliable therapy for advanced liver diseases and treatment in early or middle stages is appropriate.     

Severe gastrointestinal bleeding in a uremic patient treated with estrogen-progesterone therapy.

Gastrointestinal bleeding is a frequent complication in hemodialysis patients; angiodysplasia is a potential cause, with a higher incidence in uremic patients. We describe a case of severe anemia (Hemoglobin up to 3.5 g/dl) secondary to diffuse angiodysplastic lesions in a hemodialysis patient with mixed connective tissue disease. The case is characterised both by the severity of the clinical picture (extension and entity of angiodysplastic lesions, frequency of bleeding episodes) and by the patient's religious faith which made her reject blood transfusions. We underline the efficacy of estrogen-progesterone therapy in view of the modest results obtained with other therapeutic strategies on bleeding.     

Obesity associated with hypertension or hyperlipidemia accelerates renal damage.

Obesity is known as a risk factor for nephropathy, especially nephrotic syndrome and focal segmental glomerulosclerosis, and can aggravate renal dysfunction. However, whether these changes are caused by obesity itself or by the associated hypertension (HT) and hyperlipidemia (HC) remains unclear at present. We investigated the influence of HT and HC in obesity on glomerular morphometry. The study included cases with obesity alone (O, body mass index more than 25 kg/m(2), n = 16), O+HC (n = 8), O+HT (n = 17), HC (n = 10) alone, HT (n = 7) alone, and normal subjects (N, n = 11). Renal biopsies were examined and the glomerular diameter, and length and diameter of the glomerular capillary loop were determined using image analysis software. Clinically related data were obtained from medical records at the time of biopsy. Obesity was associated with dilatation of glomerular diameter due to glomerular loop elongation. However, end-stage renal disease (ESRD) was not noted in patients with obesity only. In contrast, ESRD requiring hemodialysis was noted in group O+HT within a 7.7-year follow-up period. Furthermore, enlargement of loop diameter was noted in group O+HC, but not in HC alone. These results suggest that obesity alone may not result in glomerular hyperfiltration or renal dysfunction, but obesity associated with hypertension or hyperlipidemia may accelerate renal damage.     

Staphylococcus colonization in atopic dermatitis treated with fluticasone or tacrolimus with or without antibiotics.

BACKGROUND: The skin of patients with atopic dermatitis (AD) exhibits a striking susceptibility to colonization and infection by Staphylococcus aureus. Treatment with topical anti-inflammatory drugs alone can reduce S. aureus colonization. OBJECTIVES: To compare the clinical severity of AD and the S. aureus colonization rate between AD patients treated with topical glucocorticoids and those treated with tacrolimus and to evaluate the effects of complementary topical antistaphylococcal antibiotic therapy and the development of fusidic acid-resistant S. aureus. METHODS: Sixty AD patients were enrolled in a prospective, parallel, randomized study of an 8-week treatment with topical 0.05% fluticasone propionate or 0.03% tacrolimus, with or without complementary fusidic acid. Disease severity scoring of AD based on SCORing of Atopic Dermatitis (SCORAD), colonization rate and density of S. aureus on the skin, and antibiotic susceptibility of S. aureus isolates were evaluated. RESULTS: The reduction in SCORAD scores correlated with the reduction of S. aureus numbers. Treatment with topical tacrolimus resulted in a comparable reduction in SCORAD scores to fluticasone but a slower eradication of S. aureus. Complementary fusidic acid had no additional benefit compared with fluticasone or tacrolimus alone. Two patients developed fusidic acid-resistant S. aureus after 8 weeks of fusidic acid treatment. CONCLUSION: Tacrolimus is an appropriate alternative treatment for chronic AD. Topical anti-inflammatory therapy alone to improve the allergic skin inflammation of AD can reduce S. aureus colonization of the skin. Topical antibiotics should be reserved for short-term use in obvious secondary bacterial infection.     

Severe Phenotype of Non-alcoholic Fatty Liver Disease in Pediatric Patients with Subclinical Hypothyroidism: a Retrospective Multicenter Study from Korea

BackgroundIt is uncertain whether non-alcoholic fatty liver disease (NAFLD) is associated with subclinical hypothyroidism (SH) in pediatric patients. The purpose of this study was to investigated the prevalence and related factors of SH in pediatric patients with NAFLD. We also evaluate the association between liver fibrosis and SH.MethodsWe retrospectively reviewed medical records for patients aged 4 to 18 years who were diagnosed with NAFLD and tested for thyroid function from January 2015 to December 2019 at 10 hospitals in Korea.ResultsThe study included 428 patients with NAFLD. The prevalence of SH in pediatric NAFLD patients was 13.6%. In multivariate logistic regression, higher levels of steatosis on ultrasound and higher aspartate aminotransferase to platelet count ratio index (APRI) score were associated with increased risk of SH. Using receiver operating characteristic curves, the optimal cutoff value of the APRI score for predicting SH was 0.6012 (area under the curve, 0.67; P < 0.001; sensitivity 72.4%, specificity 61.9%, positive predictive value 23%, and negative predictive value 93.5%).ConclusionSH was often observed in patients with NAFLD, more frequently in patients with more severe liver damage. Thyroid function tests should be performed on pediatric NAFLD patients, especially those with higher grades of liver steatosis and fibrosis.     

伴精神分裂样或类躁狂抑郁症状的Turner综合征

为较全面地了解Ｔｕｒｎｅｒ综合征伴精神障碍的临床特征，对１７例患者进行临床分析。躯体表现主要为缺乏女性特征、原发性闭经、乳房发育不良、外阴幼稚型、多伴身材矮小和其它躯体外形异常。肛诊和Ｂ超显示子宫和卵巢发育不良；ＩＱ平均６８．５，其中操作ＩＱ明显为低（平均５７．８），多呈边缘性至中度智力障碍；皮纹学改变主要是猿线出现率增高，ａｔｄ角增大，总指纹嵴数和ａ－ｂ嵴纹明显增加；染色体核型：４５，Ｘ／４６，ＸＸ８例，４６，Ｘｉ（Ｘｑ）和４５，Ｘ／４６，Ｘｉ（Ｘｑ）各２例，４５，Ｘ／４６，ＸＹ１例；仅４例为纯合子４５，Ｘ。１４例呈精神分裂样改变，３例类似躁狂抑郁症状群。精神障碍发生的原因除有其生物学和心理社会学的因素外，智力水平低下可作为促发因素，并对精神障碍的类型和治疗略加讨论，指出注意躯体外型特征和进行遗传学检验有助于鉴别诊断。     

Essential hypertension: hostility, psychiatric symptoms and marital stress in patients and spouses.

Scores on self-report questionnaire measures of hostility, psychiatric symptoms, marital dissatisfaction, and assertion discomfort/behaviour were compared for male (n = 26) and female (n = 25) patients with essential hypertension and their spouses, and matched normotensive controls. Correlations and factor analysis revealed clinically meaningful associations between elevated psychiatric symptoms, hostility, and assertive behaviour. These differed for male and female patients, especially regarding assertive behaviour. The findings suggest that communication training might be helpful for a sizeable proportion of married patients with essential hypertension.     

High-dose terazosin therapy (5mg) in Korean patients with lower urinary tract symptoms with or without concomitant hypertension: a prospective, open-label study

PURPOSE: We determined the efficacy and safety of a relatively high dose of terazosin (5mg) in Korean patients with lower urinary tract symptoms (LUTS), with or without concomitant hypertension. MATERIALS AND METHODS: From July to December 2006, 200 men who consecutively presented with LUTS were prospectively studied. Eight weeks after treatment, blood pressure (BP), uroflowmetry, and International Prostate Symptom Score (I-PSS) were assessed. For analysis purposes, patients were stratified according to concomitant hypertension. Of the 200 patients, 173 completed the scheduled eight-week treatment period. RESULTS: At baseline, no differences were evident in the two groups in terms of I-PSS, Qmax, PVR and BP. After eight weeks of treatment-although I-PSS and uroflowmetry parameters were not significantly different in the two groups-systolic and diastolic BP in the non-hypertensive control group were higher than in the hypertensive group (p= 0.001 and p=0.0100, respectively). Changes in I-PSS, uroflowmetry parameters, and BPs measured at week eight post- treatment commencement did not significantly differ between the two groups. Moreover, the addition of 5mg of terazosin to antihypertensives did not cause a significant reduction in either systolic or diastolic BP in either group. CONCLUSION: Adding terazosin to existing antihypertensive regimens did not seem to increase the incidence of adverse events. Our findings suggest that 5mg terazosin is effective and that it has an acceptable safety profile as an add-on therapy for patients with LUTS and concomitant hypertension.     

Exacerbated symptoms in Blastocystis sp.-infected patients treated with metronidazole: two case studies

Parasitology Research - Blastocystis sp. is a gastrointestinal (GI) protozoan parasite reported to cause non-specific GI symptoms including diarrhea, flatulence, abdominal pain, and nausea....     

利培酮、氯氮平对精神分裂症患者生活质量的影响

目的 :探讨利培酮、氯氮平对精神分裂症患者生活质量的影响。方法 :对符合CCMD -Ⅱ -R诊断标准的精神分裂症患者 ,在使用利培酮 ( 2 4例 )、氯氮平 ( 2 6例 )治疗期间进行 6个月的随访 ,观察利醅酮、氯氮平对精神分裂症患者的精神症状、生活质量的影响。结果 :发现 :1、利培酮组对精神分裂症阳性、阴性症状的改善和氯氮平组相似 ,对PANSS总分的改善明显优于氯氮平组。 2、 6个月的治疗前后相比 ,利培酮对患者的生活质量的影响 ,除精神支柱外均非常明显地提高 ;氯氮平可以部分提高患者的生活质量 ,但对患者的生理领域、心理领域、独立性领域没有明显改善。 3、 6个月后 ,利培酮组比氯氮平组相比 ,利培酮组与氯氮平更能改善精神分裂症患者的生活质量 ,有利于患者重返社会。     

Quality of life of patients with metastatic breast or intestinal cancer, treated with anthroposophic medicine or with mainstream medicine, the latter with or without psycho-oncologic or supplementary anthroposophic therapy

This project dealt with two subjects. On the one hand, the measurement of the quality of life of cancer patients which needed to be further refined in order to assess the usefulness and efficacy of a treatment by complementary medicine. On the other hand, it was important to know whether severely ill cancer patients treated in an anthroposophical clinic would differ from equally ill patients in a university hospital in terms of attitude towards their illness and in terms of clinical diagnosis. Finally, an attempt was made to demonstrate an improvement of quality of life in conventionally treated patients of the university hospital, who were offered an additional treatment either with a supportive-expressive group therapy or with an anthroposophical therapy. More than 500 patients participated in the study. There were marked sociodemographic and medical differences between the patients of the anthroposophical clinic and those of the university hospital. In addition, it seems that spiritually oriented and active, problem-oriented coping contribute a lot to the quality of life. It was not possible to truly compare the value of the two additional therapies offered to the patients at the university hospital because patient accrual was much slower than anticipated and many patients left the study too early for health reasons or death.     

Modulation of B and T cell subsets in mice treated with fractionated total lymphoid irradiation. I. Blockage of differentiating B cell pathways

The effect of fractionated total lymphoid irradiation (TLI) on the maturation of B cells was examined in mice. At various times after irradiation of the mice, their spleen cells were tested for the mitogenic responses to dextran sulfate and lipopolysaccharide. In parallel the cells were stained with fluorescent anti-Thy-1 and various anti-Ig antisera, and were analyzed on a fluorescence-activated cell sorter (FACS). By comparison with normal spleen cells the cells of TLI-treated mice gave a high response to dextran sulfate and a low response to lipopolysaccharide. FACS analysis revealed that TLI-treated spleen contains elevated numbers of B cells bearing high IgM and low IgD on the surface. The B cells of TLI-treated mice retained these immature characteristics even two to four months after the last irradiation. These findings indicate that TLI causes a longlasting blockage in B cell maturation processes.     

Modulation of B and T cell subsets in mice treated with fractionated total lymphoid irradiation. II. Tolerance susceptibility of B cell subsets

Total lymphoid irradiation (TLI) results in long-lasting changes in the characteristics of both T and B cells suggestive of arrested maturation. A characteristic feature of immature B cells is their high susceptibility to tolerance induction. This study examines the susceptibility to tolerance to bovine serum albumin (BSA) of TLI-treated mice. Two experimental protocols were designed. In the first, tolerance to BSA was induced in TLI-treated adult (BALB/c × C57BL/6)F₁ mice, and the ability of B cells of those mice to respond to BSA was assessed in an adoptive transfer system. In the second experimental protocol, tolerance was induced in adoptive hosts reconstituted with purified B cells originating from TLI-treated mice and with splenic T cells of normal, untreated mice. Results obtained in these two systems clearly demonstrated that splenic B cells of TLI-treated mice are highly susceptible to tolerance induction. This high susceptibility of B cells is linked neither with the elevation of immature T cells nor with induced T suppressor cells which arise due to the long-term malfunction of the thymus. Tolerance could be induced in TLI cells even 4 months after termination of the treatment. Thus, maturation processes of B cells in TLI-treated mice are arrested for long periods of time.