Betaxolol: a pilot study of its pharmacological and therapeutic properties in pregnancy

Summary Twenty two pregnant women with mild to moderate hypertension were treated with betaxolol (10–40 mg/day), a cardioselective beta adrenoceptor blocking agent.The analysis of the changes from the baseline confirmed the antihypertensive effect of the drug with a mean decrease in SBP of 11.8 mm Hg and in DBP of 8.3 mm Hg. A diastolic BP < 90 mm Hg was obtained in 20 patients after the first day of therapy.Fetal safety, assessed by ultrasonography and cardiotocographic recording was excellent.The 22 mothers gave birth to 23 live born babies (one twin pregnancy). Mean Apgar scores were 8.3 and 9.1 at 1 and 5 min. Only 1 newborn had an Apgar score < 7. Three newborns suffered from fetal distress and 1 from threat for causes not related to therapy. At 9 months follow-up, all 23 babies were in good health.These data suggest that betaxolol is effective in reducing maternal blood pressure without any deleterious effect on the foetus and the newborn.     

Primary sarcoma of the pulmonary artery]

On the basis of one personal case of leiomyosarcoma, the various anatomicoclinical features of sarcomas of the pulmonary artery are summed up. They most often produce a picture of severe pulmonary embolism that is resistant to all treatments; the lesion most often is a hilar mass without any associated bronchoscopic abnormality. Angiograms are not always easily interpreted, and the modern imaging techniques (ultrasound, computed tomography, and above all MRI) can best lead to the preoperative diagnosis, although this lesion is unfrequent.     

Delusions and dementia: clinical and CT correlates

Introduction – Delusions occur frequently during the course of Alzheimer's disease (AD) and multi-infarct dementia (MID). Their clinical significance and their relationship with progression of disease and involvement of selected cerebral areas are still unclear. The aim of the study was to determine the clinical and CT correlates of delusions in patients with dementia. Material and methods – A series of 67 probable AD and 32 MID patients, underwent computed tomographic scans, psychometric tests, neurologic and psychiatric examination, and blood and serum tests. Results – Twenty-four patients were found to have delusions during the clinical evaluation. Delusional patients showed a significantly higher age when compared with non-delusional patients. The results of a multiple logistic regression (with stepwise deletion of the redundant variables) of the CT lesions on the presence of delusions, showed that only the presence of isolated white matter lesions in the frontal lobes were significantly related to the occurrence of delusions (Exp B = 3.42; Beta = 1.2; S.E. = 0.6; Sig T = 0.04). Frontal white matter changes were significantly related to delusions when a multiple regression analysis, entering age and total number of lesions at CT scans, was carried out. Conclusions – We found that focal lesions in the frontal areas were the only variable that appeared to be significantly and independently associated with delusional disorders.     

In vivo cell growth and pharmacologic determinants of clinical response in acute myelogenous leukemia

A predictable increase in the proliferative rate of malignant cells remaining after initial cytoreduction in vivo forms the rationale for timed sequential therapy (TST) with 1-B-D-arabinofuranosylcytosine (ara- C) for adult acute myelogenous leukemia (AML). The relationship between in vivo leukemic cell growth, intracellular ara-C metabolism, and clinical response to ara-C-containing TST was evaluated by comparing AML marrow cell growth kinetic and biochemical pharmacologic determinants obtained before therapy (day 0) and at the predicted peak of in vivo postdrug residual tumor proliferation (day 8). Serial measurements of DNA synthesis and net intracellular ara-C metabolism demonstrated marked increases in both determinants in day 8 residual tumor when compared with the pretreatment cells for newly diagnosed adults achieving complete remission but not for TST-refractory patients. The interrelationship of AML cell proliferation and biochemical pharmacology together quantitate cytotoxicity measured by both achievement and duration of remission and serve to predict eventual clinical outcome in response to TST with ara-C where both growth and favorable pharmacokinetics are intrinsic to the success of the drug schedule.     

A MULTICENTRE STUDY OF THE SAFETY AND EFFICACY OF AMLODIPINE IN MILD TO MODERATE HYPERTENSION

SUMMARY An open, non-comparative study of 10 weeks' duration was conducted in general practice to assess the safety of amlodipine in patients with mild to moderate hypertension. Of the 5352 patients entering the study, 5135 received amlodipine; 4621 patients (90%) with a mean age of 58.2 years completed the study. Normalisation of blood pressure was achieved in over 80% of patients with a mean reduction of 21/15 mmHg. The mean final dose of amlodipine was 6.8 mg/day. Adverse experiences possibly related to amlodipine were reported by 19.3% of patients, and overall adverse events led to withdrawal in 6.7% of patients. The most common reported side-effect was oedema. The frequency of headache was almost identical in older and younger patients and oedema, flushing and dizziness were seen only slightly more often in elderly patients. Ninety per cent of patients were considered by their GP to have shown excellent or good toleration of therapy. Over 85% of patients elected to continue on amlodipine therapy after completion of the study.     

Determinants of disability in alzheimer's disease

The aim of the study is to evaluate risk factors of disability in a population of 64 patients affected by Alzheimer's disease. The subjects were consecutively recruited at the day hospital service of an Alzheimer's dementia care unit. The associations between activities of daily living and age, cognitive status, affective status, cognitive symptoms duration and number of diseases were evaluated within a multidimensional assessment programme. Cognitive performance, as detected by the Mini-Mental Status Examination, was the main independent predictor of disability; other independent predictors of disability were age and cognitive disease duration. Number of diseases—physical and mental–and self-rated depression scores were not independently associated with disability. It is concluded that, in a population of Alzheimer's patients, cognitive impairment has a high impact on the aetiology of disability, but other variables such as age and disease duration should be taken into account. It is also suggested that cognitive performance is the most important indicator of performance in activities of daily living.