The long-term effects of low-dose 17beta-estradiol and dydrogesterone hormone replacement therapy on 24-h ambulatory blood pressure in hypertensive postmenopausal women: a 1-year randomized, prospective study.

OBJECTIVE: The aim of this study was to assess the long-term effects of low-dose oral hormone replacement therapy (HRT) on 24-h blood pressure in hypertensive postmenopausal women. STUDY DESIGN: In this 12-month, prospective study, 66 postmenopausal women with mild or moderate hypertension were randomly assigned to receive either HRT with 1 mg/day micronized 17beta-estradiol sequentially combined with 10 mg/day dydrogesterone for 14 days of each 28-day cycle, or no therapy. Ambulatory blood pressure measurements were recorded for a 24-h period at baseline and after 12 months of treatment or follow-up. RESULTS: Blood pressure did not differ significantly between the groups at baseline. After 12 months, there were falls in 24-h systolic, diastolic and mean arterial blood pressure in both the HRT and control groups; only the fall in mean arterial blood pressure in the HRT group achieved statistical significance (-2.0 +/- 0.8 mmHg, p < 0.01). While there was no significant decrease in daytime systolic or mean arterial blood pressure in either group, a significant decrease in diastolic blood pressure (-1.8 +/- 10 mmHg, p < 0.001) was observed in the HRT group. Night-time systolic and mean arterial blood pressure also decreased significantly (p < 0.001) in the HRT group (-3.0 +/- 1.5 mmHg and -2.2 +/- 0.6 mmHg, respectively), but no significant change was observed in the control group. Conclusion: Low-dose oral HRT caused significant falls in both daytime and night-time ambulatory blood pressure in postmenopausal women with mild or moderate hypertension.     

Effect of maternal postural change on maternal hemodynamics in late pregnancy--supine hypertension

The purpose of this investigation was to ascertain the effect of postural change in late pregnant women from the left lateral recumbent position to the supine position on their blood circulation. Patients in whom the blood pressure at the right upper limb in the supine position increased by at least 20mmHg or more (diastolic and/or systolic pressure) were classified as the supine hypertensive group. Patients in whom the blood pressure of the right upper limb decreased by at least 20mmHg or more were classified as the supine hypotensive group. And other patients were classified as the no blood pressure change group. The results were as follows. 1. The incidence of supine hypertension was 48% in primigravidas and 38% in multigravidas. Supine hypertension was especially common in PIH (pregnancy induced hypertension) complicated women (75%). 2. Maternal cardiac function: With postural change from the left lateral recumbent position to the supine position, CO (cardiac output) decreased and SVR (systemic vascular resistance) was increased in both the supine hypertensive and the no blood pressure change groups by the thermodilution method (n = 14). CVP (central venous pressure) and PCWP (pulmonary capillary wedge pressure) shows different pattern of change in the supine hypertensive group and the no blood pressure change group. In the former group, CVP was decreased by 45 +/- 16% and PCWP was increased by 21 +/- 9% in the supine position compared with in the left lateral recumbent position. However, in the latter group, CVP decreased by 87 +/- 69% and PCWP decreased by 53 +/- 46% as the result of the same postural change.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of fetal breathing movements on umbilical venous blood flow in fetal lambs

The effects of fetal breathing movements on the blood flow pattern in the common umbilical vein were studied in six chronically instrumented fetal lambs between 106 and 143 days gestation. Umbilical venous blood flow was measured with an electromagnetic flow transducer around the intra-abdominal common umbilical vein. Fetal breathing movements were recorded by means of an intratracheal catheter. During rapid irregular breathing movements instantaneous umbilical venous blood flow showed undulations with the frequency of the breathing movements. An inspiratory movement, characterized by a fall in tracheal pressure (mean +/- S.D. = 5.3 +/- 1.7 mmHg) was accompanied by a decrease in instantaneous umbilical venous blood flow (mean +/- S.D. = 10.5 +/- 2.8%). This decrease in umbilical blood flow during inspiration was accompanied by an increase in intra-abdominal pressure. A much greater decrease (mean +/- S.D. = 40.6 +/- 18.4%) in instantaneous umbilical venous blood flow occurred during deep inspiratory efforts (mean pressure drop +/- S.D. = 15.5 +/- 4.3 mmHg), accompanied by marked increases in intra-abdominal pressure. Isolated expiratory efforts resulted in an increase in both tracheal (mean +/- S.D. = 6.3 +/- 2.6 mmHg) and intra-abdominal pressure, while umbilical venous blood flow decreased (mean +/- S.D. = 33.5 +/- 21.3%). These observations show the great influence of fetal respiratory movements on the blood flow pattern in the common umbilical vein. The changes in instantaneous umbilical venous blood flow are possibly brought about by changes in intra-abdominal pressure.     

Intraocular pressure in pregnant and non-pregnant Nigerian women

A number of hormones are known to affect intraocular pressure. Of these, the female sex hormones are the predominant ones to cause variations in intraocular pressure. The aim of this study was to determine if variation in sex hormones in pregnancy affects intraocular pressure. This study was a longitudinal one. 117 pregnant women aged 20 to 35 years in their first trimester of pregnancy were followed longitudinally throughout the course of pregnancy, and six weeks post partum. One hundred non pregnant women with a regular menstrual cycle of 26-29 days were also recruited and examined for changes in intraocular pressure. Intraocular pressure was measured with the handheld Kowa applanation tonometer. Mean Intraocular Pressure (MIOP) was 14.7 +/- 2.2 mmHg, 13.2 +/- 2.0 mmHg and 11.0 +/- 1.3 mmHg in the three trimesters respectively. There was thus a fall in Intraocular Pressure during pregnancy and this was highly statistically significant (P<0.0001). At 6 weeks postpartum MIOP increased to 14.2 +/- 1.8 mmHg. The difference between the mean values of Intraocular Pressure in the third trimester and 6 weeks postpartum was also statistically significant P<0.0001. Intraocular pressure decreased as pregnancy advanced. Postpartum, there was increase in intraocular pressure to near pre pregnant level. The difference in mean IOP between the pregnant and non pregnant women was statistically significant (P<0.05).     

Pulse pressure and risk of preeclampsia: a prospective study

OBJECTIVE: To find whether pulse pressure, a measure of arterial compliance, is associated early in pregnancy with increased risk of developing preeclampsia. METHODS: In a prospective cohort of 576 nulliparas, we examined blood pressures throughout pregnancy and at 6-8 weeks postpartum. Measurements during weeks 7-15, 16-24, and 25-38 of gestation were pooled to find averages for each period. Outcomes assessed were gestational hypertension and preeclampsia. Logistic regression analysis was used to develop relative risks and 95% confidence intervals. RESULTS: We confirmed 34 (5.9%) cases of preeclampsia, 32 (5.6%) cases of gestational hypertension, and 510 normotensive women. Mean systolic and diastolic blood pressures and mean arterial pressures were elevated throughout pregnancy in women who developed hypertensive disorders of pregnancy compared with normotensive women. Pulse pressure at 7-15 weeks was significantly higher in women who developed preeclampsia (45 +/- 6 mmHg) than in those who developed gestational hypertension (41 +/- 7 mmHg, P =.03) and normotensive women (41 +/- 8 mmHg, P =.01). Examined in tertiles, increasing pulse pressure was associated with increasing risk of developing preeclampsia (P for trend =.01) but not gestational hypertension (P for trend =.95). After adjustment for potential confounders, a 1-mmHg rise in early pregnancy pulse pressure was associated with a 6% (95% confidence interval: 1, 10) increase in risk for developing preeclampsia but not gestational hypertension (relative risk: 1%; 95% confidence interval: -1, 6). Beyond 15 weeks' gestation, differences between groups diminished, but women with any hypertensive disorder had higher pulse pressures than women with uncomplicated pregnancies. CONCLUSION: Elevated pulse pressure, indicating poor arterial compliance, was evident early in pregnancies of women who subsequently developed preeclampsia.     

Cardiovascular and metabolic responses to intermittent umbilical cord occlusion in the preterm ovine fetus

OBJECTIVE: To determine the cardiovascular and metabolic responses to umbilical cord occlusion in the preterm ovine fetus and the impact of repetitive intermittent insults over a 4-day period. METHODS: Repetitive umbilical cord occlusions (experimental group, n = 7; control group, n = 7) were performed daily (112-115 days' gestation, term = 147 days). Mean arterial pressure (MAP), fetal heart rate (FHR), and FHR variation were monitored, and arterial blood was sampled at predetermined intervals. RESULTS: During umbilical cord occlusions, arterial oxygen pressure (PaO2) (approximately 17 mmHg) and glucose (approximately 0.3) millimoles per liter (mmol/L) fell and arterial carbon dioxide pressure (approximately 8 mmHg) rose (P < .01) to a similar extent on days 1 and 4. Umbilical cord occlusion produced a rise in lactate over the course of successive umbilical cord occlusions each day, the magnitude of which tended to be reduced by day 4 (0.3 +/- 0.1 versus 0.6 +/- 0.1 mmol/L). Control hour FHR and MAP were unaltered over the 4 days, but the delta (delta) FHR to delta PaO2 ratio during umbilical cord occlusions was less on day 4 than on day 1 (6.0 +/- 0.4 versus 10.9 +/- 1.5 beats per minute/mmHg; P < .01). During occlusion hours, high FHR variation episodes, as a measure of fetal activity, were reduced (14.6 +/- 1.5 versus 4.2 +/- 1.3 min/h; P < .01), whereas the reduction in short-term (7.4 +/- 0.7 to 5.8 +/- 0.6 milliseconds; P < .05) and long-term (34.9 +/- 2.7 to 30.0 +/- 0.6 milliseconds; P < .05) FHR variation reached significance only on day 4. CONCLUSION: The increase in lactate and reduced high-FHR variation episodes over successive umbilical cord occlusions may affect fetal growth and development. Furthermore, repeated umbilical cord occlusions over several days alter the preterm FHR response to subsequent stresses, suggesting an altered chemoreflex response.     

Hemodynamic and clinical efficacies of catheter balloon percutaneous transvenous mitral commissurotomy: experience of 100 patients with rheumatic mitral stenosis

From January 1987 to December 1988, 100 patients with symptomatic severe rheumatic mitral stenosis underwent percutaneous transvenous mitral commissurotomy (PTMC). The patients included 32 males and 68 females, aged 19-71 years (mean of 41). Mild mitral regurgitation (grade 1 or 2) was present in 23 patients and a history of thromboembolism in 12. One patient had had mitral restenosis after surgical open mitral commissurotomy 9 years earlier. The mitral valve was successfully dilated in 97 patients. PTMC resulted in immediate improvements in hemodynamic measurements. The left atrial pressure decreased from 24.5 +/- 5.3 to 14.8 +/- 5.2 mmHg (p less than 0.001), the mean mitral transvalvular gradient from 13.8 +/- 4.8 to 5.0 +/- 2.8 mmHg (p less than 0.001), and the mean pulmonary artery pressure from 38.8 +/- 12.0 to 30.6 +/- 10.3 mmHg (p less than 0.001). The mitral valve area increased from 1.1 +/- 0.3 to 2.2 +/- 0.8 cm2 (p less than 0.001). The cardiac output increased from 4.5 +/- 1.2 to 4.84 +/- 1.2 L/min (p less than 0.05). The right atrial pressure did not change significantly after PTMC (6.5 +/- 3.8 vs 6.4 +/- 4.0 mmHg). The mitral valve area measured by 2-D echocardiograms increased from 1.04 +/- 0.48 to 1.88 +/- 0.66 cm2 after PTMC (p less than 0.001). All 97 patients were followed for 6-24 months (median of 13) after the PTMC. After an initial recovery period of 1-2 weeks, all patients reported improvements in symptoms and in New York Heart Association (NYHA) functional class by at least one class. A comparison between treadmill exercise test durations before, and 3 months after PTMC, showed an increase from 9.1 +/- 4.3 to 15.4 +/- 3.8 minutes (n = 60; p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Studies on the significance of 17 alpha,20 alpha-dihydroxy-4-pregnen-3-one (17 alpha,20 alpha-P) in pregnancy induced hypertension (PIH) and its site of production

We have measured 17 alpha,20 alpha-P, 17 alpha-OHP and aldosterone in maternal peripheral blood, umbilical arterial and venous blood in normal pregnancy and PIH. The PIH cases studies had a systolic blood pressure above 140 mmHg and a diastolic blood pressure above 90 mmHg for more than two weeks. The 800 G supernatant of the ovary and placenta from human was used as an enzyme source for in vitro studies. Incubation was carried out in a Dubnoff-type incubator at 37 degrees C for 2, 4, 8 and 12 hours. As substrates, [4-14C]-P5,[4-14C]-P and [4-14C]-17 alpha-OHP were used. Concentrations of aldosterone and 17 alpha-OHP of PIH cases were not significantly different from those of control. Concentrations of 17 alpha,20 alpha-P in normal pregnancy and PIH were as follows. Peripheral vein blood, 0.39 +/- 0.08 and 0.64 +/- 0.19 ng/ml, umbilical arterial blood, 0.33 +/- 0.09 and 0.65 +/- 0.19 ng/ml, umbilical vein blood 0.50 +/- 0.12 and 0.84 +/- 0.17 ng/ml, respectively. The 17 alpha,20 alpha-P levels in the maternal peripheral venous, umbilical arterial and venous blood of hypertensive cases were all higher than those of the normal pregnancy. The synthesis of 17 alpha,20 alpha-P in vitro occurred from all the substrates used in the ovary and only from [4-14C]17 alpha-OHP in the placenta. These results suggest that 17 alpha,20 alpha-P is somehow related to the increase in blood pressure and the amount of this steroid is significantly greater in PIH cases than controls.(ABSTRACT TRUNCATED AT 250 WORDS)     

Implantation of encapsulated glial cell line-derived neurotrophic factor-secreting cells prevents long-lasting learning impairment following neonatal hypoxic-ischemic brain insult in rats

OBJECTIVE: Implantation of encapsulated glial cell line-derived neurotrophic factor-secreting cells into brain parenchyma reduces histological brain damage following hypoxic-ischemic stress in neonatal rats. We examined the effect of glial cell line-derived neurotrophic factors on long-term learning and memory impairment and morphological changes up to 18 weeks after hypoxic-ischemic stress in neonatal rats. STUDY DESIGN: Baby hamster kidney cells were transfected with expression vector either including (glial cell line-derived neurotrophic factor-hypoxic-ischemic group; n = 10) or not including (control-hypoxic-ischemic group; n = 8) human glial cell line-derived neurotrophic factor cDNA, encapsulated in semipermeable hollow fibers, and implanted into the left brain parenchyma of 7-day-old Wistar rats. Two days after implantation the rats received hypoxic-ischemic stress, and their behavior was then examined in several learning tasks: the 8-arm radial maze, choice reaction time, and water maze tasks, which examine short-term working memory, attention process, and long-term reference memory, respectively. The rats were killed 18 weeks after the hypoxic-ischemic insult for evaluation of brain damage. Two additional control groups were used: the control group (n = 15), which underwent no treatment, and the glial cell line-derived neurotrophic factor group (n = 6), which underwent implantation of the glial cell line-derived neurotrophic factor capsule but did not undergo hypoxic-ischemic stress. RESULTS: The decrease in the size of the cerebral hemisphere was significantly less in the glial cell line-derived neurotrophic factor-hypoxic-ischemic group, compared with the control-hypoxic-ischemic group, and improved performance was observed in all three tasks for the glial cell line-derived neurotrophic factor-hypoxic-ischemic group: for the control-hypoxic-ischemic group versus the glial cell line-derived neurotrophic factor-hypoxic-ischemic group, respectively, in the 8-arm radial maze test, average number of correct choices was 6.2 +/- 0.1 versus 6.9 +/- 0.1 ( P < .01); in the choice reaction time test, average reaction time for a correct response was 2.35 +/- 0.1 seconds versus 1.97 +/- 0.09 seconds ( P < .01); in the water maze test, average swimming length was 1120.0 +/- 95.2 cm versus 841.6 +/- 92.1 cm ( P < .01). All results for the glial cell line-derived neurotrophic factor group were similar to those for the control group. CONCLUSION: Glial cell line-derived neurotrophic factor treatment is effective in not only reducing brain damage but also inhibiting learning and memory impairment, following hypoxic-ischemic insult in neonatal rats. No adverse effects in learning and memory tests were observed in the glial cell line-derived neurotrophic factor group.     

Urinary PGE2 levels in toxemia of pregnancy

Urinary PGE2 levels in urine collected over 24 hours were measured by radioimmunoassay after chloroform extraction. In normal pregnancy, urinary PGE2 levels did not change during pregnancy. After 36 gestational weeks, urinary PGE2 levels in severe hypertensive pregnancy (616 +/- 91 ng/day (mean +/- S.E., n = 18)) were significantly decreased compared to those of normal pregnancy (1,039 +/- 85 ng/day, n = 13, p less than 0.005) and mild hypertensive pregnancy (1,025 +/- 140 ng/day, n = 8, p less than 0.03). We then analyzed the urinary PGE2 levels by noting clinical symptoms and their severity. Urinary PGE2 levels in the severe blood pressure group were significantly decreased compared to those of the mild group. There was a significant negative correlation between urinary PGE2 and mean blood pressure, systolic pressure and diastolic pressure. Diastolic pressure in particular had the most significant negative correlation with the urinary PGE2 level (n = 33, r = -0.593, p less than 0.001). Urinary PGE2 levels in the severe proteinuria and edema groups were significantly decreased compared to those in the mild group. These results suggested that renal synthesis of PGE2 may be decreased in severe hypertensive pregnancy and closely related to blood pressure, especially to diastolic pressure, and also related to the occurrence of edema.     

Randomized double-blind study evaluating the efficacy on uterine fibroids shrinkage and on intra-operative blood loss of different length of leuprolide acetate depot treatment before myomectomy

OBJECT: To determine whether length of pre-operative treatment with gonadotrophin-releasing hormone agonists (GnRHa) may have different effects on uterine shrinkage and intra-operative blood loss, 36 patients with symptomatic uterine fibroids awaiting myomectomy were randomly divided into two groups. METHOD: Twenty patients received long-term GnRHa administration, six monthly depot injections of leuprolide acetate (LA), while 16 patients were treated with two monthly LA injections before surgery. The hemoglobin concentration and estradiol, follicle-stimulating hormone and luteinizing hormone concentrations were measured before and after treatment in both groups. RESULTS: Uterine volume decreased in the long-term treated group from 680+/-276 cm3 to 486+/-195 cm3 (36%) after two and to 388+/-172 cm3 (51%) after six LA injections. In the short-term treated group the basal uterine volume decreased from 745+/-320 cm3 to 456+/-177 cm3 (39%) after two LA injections. The uterine volume decrease was statistically significant (p<0.05) after two LA injections in both groups while the decrease observed between two and six LA injections was not significant (p>0.05). The intra-operative blood-loss was not significantly different between the two groups studied, 315+/-93 cm3 and 336+/-88 cm3. CONCLUSION: Two pre-operative GnRHa depot injections offer similar results, in terms of uterine shrinkage and intra-operative blood loss, and a longer treatment seems to be justified in cases of anemia.     

Protective effect of pentoxifylline on phorbol myristate acetate-induced acute lung injury in rats

The pathogenesis of adult respiratory distress syndrome (ARDS) is not clear, and its therapy is still a problem. Pentoxifylline, a methylxanthine derivative, can inhibit phosphodiesterase activity and thus increase the intracellular cAMP. There are also some hypotheses that pentoxifylline can attenuate pulmonary edema. In order to evaluate the protective effect of pentoxifylline in acute lung injury, we set up an isolated lung perfusion model in rats and induced experimental acute lung injury similar to ARDS by intravenously infused phorbol myristate acetate (PMA) 7.5 micrograms/300 g body weight. Four groups of experimental rats were studied: group 1, normal control group, neither PMA nor pentoxifylline was used in 6 rats; group 2 (acute lung injury group), only PMA was infused in 8 rats; group 3 (protective group), pentoxifylline 100 mg/300 g body weight was given intravenously before PMA infusion in 6 rats; group 4, only pentoxifylline was given in 6 rats. Pulmonary arterial pressure (PAP) as well as lung weight changes were recorded before and 5, 10, 15, 20 and 25 minutes after drug injection. Bronchial lavage fluids were then measured for albumin concentration. We found that PAP was strikingly increased in group 2 (54.0 +/- 8.8 mmHg), but the increase was significantly reduced in group 3 (29.8 +/- 5.8 mmHg, p less than 0.001). Similarly, the lung weight gain was markedly increased in group 2 (4.69 +/- 1.28 g), but was significantly attenuated in group 3 (1.25 +/- 1.60 g, p less than 0.001). There was no apparent change in PAP and lung weight gain throughout the entire procedure in groups 1 and 4.(ABSTRACT TRUNCATED AT 250 WORDS)     

Maternal blood pressure response to the intravenous administration of pethidine-promethazine during labor

A double blind study on the effect of an intravenous injection of a combination of 75 mg pethidine and 25 mg promethazine was conducted on 200 women during normal deliveries. Four groups of 50 women each received injections of pethidine and promethazine, promethazine alone, pethidine alone and normal saline. In the pethidine-promethazine group there was a significant elevation in blood pressure in the first 10 min following the injection as compared with the other groups. The mean (+/- S.D.) systolic blood pressure after the injection was 143.2 +/- 14.3 mmHg as compared with 118.9 +/- 8.4 mmHg before the injection, and the mean diastolic blood pressure as 96.9 +/- 8.4 mmHg after the injection as compared with 77.7 +/- 9.3 mmHg before the injection. 25 mg promethazine alone caused slight elevation in blood pressure which was further increased by combination with pethidine. The clinical significance of these observations is discussed.     

Hypertensive diseases of pregnancy and parity

Chesley's classic long-term follow up study of eclamptic women clearly demonstrated the prognostic significance of parity in the differential diagnosis of various hypertensive diseases of pregnancy. Multiparous patients with eclampsia were different on long-term follow-up from primiparous eclamptic women. A logical conclusion from this observation is that multiparous and primiparous patient groups should be analyzed separately whenever hypertensive diseases of pregnancy are evaluated. This study is therefore an attempt to define the clinical profile of hypertension during pregnancy on the basis of parity alone. The prenatal and hospital records of 99 successive pregnant patients identified as hypertensive during a 1-year period at Mount Sinai Hospital Medical Center served as the study population. A group of 25 primiparous and 25 multiparous patients, all with uncomplicated pregnancies and normal deliveries in sequence during a 1-month period, served as normal nonhypertensive control groups. Various pregnancy parameters were statistically evaluated for study and control groups. Significant differences were found between hypertensive primiparous and multiparous patients in mean weight increase (p less than 0.05), gestational age at first increase in blood pressure (p less than 0.007), and time from first increase in blood pressure until delivery (p less than 0.008). The difference in birth weight was not significant between hypertensive groups. In contrast, among the control groups, multiparous patients had significantly larger offspring than primiparous patients (p less than 0.01). Weights of normal primiparous control women were almost identical to those of primiparous hypertensive women (3252.8 +/- 511.8 versus 3203.26 +/- 679.5 gm). Birth weights of offspring from multiparous hypertensive women, while not significantly different from those of primiparous hypertensive women, were significantly lower than those of multiparous control subjects (3093.94 +/- 898.7 versus 3593 +/- 305.6; p less than 0.01). No significant differences in a variety of laboratory findings, reflexes, edema, or mode of delivery were observed between the various groups. The clinical and laboratory presentation of hypertension in pregnancy may be similar between primiparous and multiparous patients. Nevertheless, clear differences do exist in both maternal presentation and impact of maternal disease on fetal growth and development. These differences strongly suggest a different pathophysiology as the underlying cause of hypertensive disease in primiparous and multiparous pregnant women.(ABSTRACT TRUNCATED AT 400 WORDS)     

Experimental model of respiratory distress syndrome by lung lavage with fluorocarbon

The purpose of this study was to determine how much alveolar surfactant is washed out by lung lavage with fluorocarbon and also to find out whether or not instillation of artificial surfactant can restore pulmonary function after lung lavage in rats. The lung lavage was performed manually, administering a tidal volume 5 mg (2 mg/100g body weight) of fluorocarbon for about eight seconds. This process was repeated more than 40 times. In the study group, 4 ml/kg (120 mg/kg) of artificial surfactant was instilled into the trachea, and the same amount of normal saline was instilled in the control group. The amount of phospholipids extracted in lung lavage was 16.6 +/- 3.6 mg/kg body weight in the control group and 18.9 +/- 3.7 mg/kg body weight in the experimental group. Immediately after instillation of the surfactant, arterial oxygen pressure increased from 84 +/- 17 mmHg to 195.1 +/- 26.7 mmHg, and remained high, at about 170-260 mmHg. In contrast the physiological saline treated group did not show any change. We conclude that lung lavage with fluorocarbon is an adequate ideal experimental model of respiratory distress syndrome and suggests that combination of artificial surfactant treatment after lung lavage with fluorocarbon might be a new pulmonary washing method for severe lung disease.     

High blood pressure six weeks postpartum after hypertensive pregnancy disorders at term is associated with chronic hypertension

ObjectivesHypertension in pregnancy is associated with cardiovascular disease (CVD) later in life. Blood pressure monitoring in women who experienced hypertension in pregnancy after puerperium has been suggested to be important for early detection and prevention of CVD. The aim of this study is to evaluate if hypertension six weeks postpartum is associated with chronic hypertension in women with a history of term hypertensive pregnancy disorders.Study designWomen with a history of term gestational hypertension or preeclampsia were included in a follow up study of the HYPITAT trial. Blood pressures were measured six weeks and 2.5 years postpartum according to the study protocol.Main outcome measuresHypertension was defined as a diastolic blood pressure ?90 mmHg and/or a systolic blood pressure ?140 mmHg or use of antihypertensive medication. Differences in categorical variables between groups were analyzed by Chi-Square tests. Blood pressure was analyzed using unpaired t-tests and Wilcox ranked tests.ResultsAmong 187 women who had term hypertensive pregnancy disorders, 75 (40%) had hypertension at six weeks postpartum. Of these 46 (61%) had hypertension 2.5 years postpartum. In contrast, of 112 women without hypertension at six weeks postpartum, 36 (32%) had hypertension 2.5 years (OR 3.3, 95% CI 1.8–6.2).ConclusionAmong 61% of women who had hypertensive pregnancy disorders at term, high blood pressure at six weeks postpartum indicated chronic hypertension. This warrants the importance of identification of hypertension 6 weeks postpartum for women’s future health.     

新疆不同民族妊娠期高血压疾病患者1162例临床分析

目的了解新疆不同民族间妊娠期高血压疾病的临床特点。 方法收集2018年1月至12月新疆维吾尔自治区8家医院诊断为妊娠期高血压疾病且终止妊娠的1162例患者临床资料,采用回顾性研究方法,根据患者民族分为汉族妊娠期高血压疾病组637例,哈萨克族201例,其他少数民族324例。分析不同民族间妊娠期高血压疾病发病率及临床特点。 结果汉族妊娠期高血压疾病发病率为5.38%,哈萨克族16.89%,其他少数民族9.91%;哈萨克族妊娠期高血压疾病患者与汉族及其他少数民族在转诊比例(33.3%、17.1%、17.9%, χ²＝26.397)、妊娠34周之前发病比例(47.3%、34.7%、37.0%, χ²＝10.343)、随机尿蛋白(+++)的比例(31.8%、20.3%、21.9%, χ²＝31.634)、子痫前期及子痫患者比例(74.6%、55.3%、60.5%, χ²＝24.064)、剖宫产分娩比例(86.1%、78.0%、77.5%, χ²＝6.896)、最高收缩压[(158.78±17.33)mmHg、(152.18±16.20)mmHg、(153.13±18.87)mmHg,t＝11.434)]、最高舒张压[(101.11±12.37)mmHg、(97.91±12.18)mmHg、(98.62±12.74)mmHg,t＝5.142]、终止妊娠孕周[(34.82±4.07)周、(36.44±3.26)周、(35.86±4.12)周,t＝15.335]等方面比较,差异均有统计学意义(P<0.05)。 结论妊娠期高血压疾病在新疆不同民族间发病率及临床表现存在差异。     

Effect of a traditional herbal medicine, tokishakuyakusan, on the fetal development of the spontaneously hypertensive rat

Forty-three pregnant spontaneously hypertensive rats were administered 1.5% saline and divided into 2 groups: The experimental group of 21 rats and the control group of 22 rats. The animals in the experimental group were administered daily 500 mg/kg of Tokishakuyakusan. No drug was administered to the animals in the control group. Systolic blood pressure measured from 4 to 18 days of pregnancy was similar in both the experimental and control groups. Mean (+/- S.E.) levels of blood viscosity in the experimental group measured on the 19th day of pregnancy were 13.6 +/- 1.6 centipoise (cp) at a shear rate of 0.5/sec and 3.5 +/- 0.1 cp at a shear rate of 230/sec and were significantly lower than those of the control group (19.1 +/- 1.6 cp at 0.5/sec, p less than 0.02; 4.4 +/- 0.2 cp at 230/sec, p less than 0.001). There were observed no significant differences in hematocrit, erythrocyte deformability and fibrinogen levels between two groups. There was observed no significant difference between the mean number in the litter in the 2 groups. The mean weight of the fetuses in the experimental group delivered on the 19th day of pregnancy was 2.4 +/- 0.1 g, being significantly heavier than that of the control group (2.0 +/- 0.0 g) (p less than 0.01). These results indicated that Tokishakuyakusan accelerated development of fetuses of hypertensive rats by utero-placental circulatory improvement which was caused by decreased maternal blood viscosity.     

Blood pressure is elevated in normotensive pregnant women with intrauterine growth restriction

OBJECTIVE: To assess the relationship between blood pressure pattern and intrauterine growth restriction in normotensive pregnant women. STUDY DESIGN: Twenty-four-hour ambulatory blood pressure was consecutively performed between 32 and 34 weeks in 139 normotensive, non-proteinuric, primigravidae with intrauterine growth restriction (IUGR) and in 140 primigravidae, matched for age and gestation, who were and remained normotensive throughout pregnancy and whose fetuses had regular fetal growth, who served as controls. RESULTS: Although all measures were within the normotensive range, blood pressure of mothers with IUGR were significantly higher than controls. Twenty-four-hour mean, daytime, and nighttime systolic were 119.9+/-11.9, 122.6+/-11.7, 114.4+/-13.3 mmHg, in women with IUGR and 108.0+/-7.4, 109.2+/-7.3, 102.1+/-8.5 mmHg, in controls. Twenty-four-hour diastolic average, daytime, and nighttime diastolic (mean+/-S.D.) 78.1+/-9.3, 69.2+/-10.6, 67.2+/-9.0 mmHg, in women with IUGR and 64.1+/-5.7, 66.0+/-5.7, 58.2+/-6.3 mmHg, in normal pregnant women. All differences p<0.0001. CONCLUSIONS: Pregnant women with idiopathic IUGR have blood pressure higher than normal. Although within clinic normotensive range, slightly higher levels of blood pressure can alter uterine and placental perfusion and determine fetal growth restriction.     

Calcium-phosphorus-magnesium homeostasis in pregnant women after renal transplantation.

OBJECTIVE: The aim of the study was the assessment of calcium-phosphorus-magnesium homeostasis in pregnant women after renal transplantation. METHODS: The study covered 64 pregnant women in the third trimester of gestation including: 33 women after renal transplantation (the study group) and 31 healthy pregnant women (the control group). Women from both groups were at the similar age: 30.8+/-4.7 vs. 31.3+/-5.0 years (NS) and at the same gestational age 34.8+/-2.4 vs. 35.3+/-2.6 weeks (NS). The mean body mass index (BMI) in the women from the study group before pregnancy was 21.49+/-2.81 vs. 22.1+/-3.02 in the control group (NS), BMI before delivery was 25.43+/-3.05 vs. 26.0+/-3.35 (NS), the percentage of the BMI increase during pregnancy was 18.7+/-7.68 vs. 17.65+/-7.13 (NS) and BMI increase during gestation was 3.93+/-1.56 vs. 3.90+/-1.54, respectively (NS). Arterial blood pressure at the time of blood samples collection for biochemical tests was 151.4+/-26.8/92.5+/-16.9 in women from the study group comparing to 115.0+/-6.0/68.0+/-7.0 mmHg (P<0.001) in the patients from the control group. The maximal blood pressure during pregnancy was 169.2+/-20.7/102.7+/-14.0 vs. 118.0+/-7.0/70.0+/-8.0 mmHg (P<0.001), respectively. We estimated serum levels of: total Ca, ionized Ca(2+), inorganic phosphorus (P(i)), Mg, total protein, albumin and blood morphology. Moreover, urine levels of Ca, P(i), Mg and protein were assessed. RESULTS: The pregnant women after renal transplantation presented increases in serum concentrations of total Ca (2.54+/-0.20 vs. 2.16+/-0.10 mmol/l; P<0.001) and ionized Ca(2+) (1.322+/-0.104 vs. 1.12+/-0.07 mmol/l; P<0.001) and the decrease in P(i) level (1.013+/-0.211 vs. 1.10+/-0.16 mmol/l; P<0.05), total protein (59.3+/-7.0 vs. 65+/-5 g/l; P<0.001) and albumin (461.6+/-65.65 vs. 493.2+/-59 micromol/l; P<0.05). Moreover, in the study group drop in red blood cells count to 3.71+/-0.56 vs. 4.01+/-0.35 x 10(12)/l (P<0.02) in the control group was detected. Despite increased volume of 24-h urine collection in the kidney recipients we observed significantly decreased urine 24-h calcium excretion 2.47+/-0.92 vs. 6.72+/-3.49 mmol (P<0.001) and simultaneous increase in urine Mg excretion 3.422+/-1.025 vs. 2.18+/-0.52 mmol/24 h (P<0.001). There was no difference in urine 24-h P(i) excretion between the study and the control group. The pregnant renal transplant recipients presented proteinuria of 1.19+/-1.9 g/24 h. CONCLUSIONS: Women after kidney grafting present vital aberrations in calcium-phosphorus-magnesium homeostasis during pregnancy. The most significant changes are associated with calcium metabolism (high increase in serum Ca levels and impairment of renal elimination of calcium). The observed changes may be influenced by the doses of immunosuppressive agents and disturbed renal function.