The significance of vascular hyperreaction as measured by the cold-pressor test

The majority of individuals with essential hypertension and some with usually normal blood pressure manifest unusual lability and marked reactions of blood pressure to various internal and external stimuli. This suggests that the mechanism for regulating blood pressure which is possessed by these individuals is hyperreactive. The cold-pressor test is a satisfactory method of determining the reactivity of the blood pressure. The test consists in measuring the reaction of the blood pressure to a standard cold stimulus.¹In this paper the expression, “person with usually normal blood pressure,” will appear frequently. It means a person who does not have persistent hypertension, one whose blood pressure remains within normal limits unless caused to rise by a stimulus. Later in this paper such persons will be divided into the classes called “normal hyporeactors” and “normal hyperreactor.”     

Blood pressure in the arm and thigh of man: I. A study of averages,variations, and differences between thigh and arm

Blood pressure, pulse pressure, the difference of blood pressure in thigh and arm, and the pulse rate in 112 subjects in the horizontal posture showed great variability from person to person.The tendency of the diastolic blood pressure to increase while the systolic blood pressure remained essentially the same on changing from the horizontal to the standing position is in agreement with the results reported by others.Fifty-nine and five-tenths per cent of all blood pressures fell within 10 per cent, and 86.5 per cent fell within 20 per cent, of the average for the group. These results are almost identical with those of Strang.¹⁶Differential blood pressures between thigh and arm revealed a wide range of values; the average was 35 mm., systolic, and 27 mm., diastolic, for the horizontal posture. Assumption of the standing posture resulted in a differential pressure of 78 mm., systolic, and 66 mm., diastolic.No apparent correlation was noted between differential pressures and factors such as age, sex, or occupation.No significant differences were found between blood pressures in the left and right thighs of normal subjects.Knowledge of the range of blood pressure in the normal, nonhyperreacting subject, as contrasted to that in the normal, hyperreacting, or hypertensive, hyperreacting subject, is particularly important for those who are trying to evaluate therapeutic attempts to lower or raise the blood pressure.     

Blood pressure in the arm and thigh of man: III. Effect of venous engorgement

The production of congestion of an extremity by means of a tight cuff usually results in little change in systolic blood pressure, but, in some cases, it may result in considerable increase in diastolic pressure and a decrease in the intensity of the diastolic auscultatory sounds in that extremity. It is not known why some persons exhibit these tendencies, whereas others do not. Possible mechanisms are discussed.Slow or intermittent deflation of a blood pressure cuff below the level of systolic pressure may tend to increase the value of the diastolic blood pressure in some cases. Suggestions are offered to obviate this tendency.     

Community Factors and Hospital Readmission Rates

Objective

To examine the relationship between community factors and hospital readmission rates.

Data Sources/Study Setting

We examined all hospitals with publicly reported 30-day readmission rates for patients discharged during July 1, 2007, to June 30, 2010, with acute myocardial infarction (AMI), heart failure (HF), or pneumonia (PN). We linked these to publicly available county data from the Area Resource File, the Census, Nursing Home Compare, and the Neilsen PopFacts datasets.

Study Design

We used hierarchical linear models to assess the effect of county demographic, access to care, and nursing home quality characteristics on the pooled 30-day risk-standardized readmission rate.

Data Collection/Extraction Methods

Not applicable.

Principal Findings

The study sample included 4,073 hospitals. Fifty-eight percent of national variation in hospital readmission rates was explained by the county in which the hospital was located. In multivariable analysis, a number of county characteristics were found to be independently associated with higher readmission rates, the strongest associations being for measures of access to care. These county characteristics explained almost half of the total variation across counties.

Conclusions

Community factors, as measured by county characteristics, explain a substantial amount of variation in hospital readmission rates.     

Over-the-Counter “Adrenal Support” Supplements Contain Thyroid and Steroid-Based Adrenal Hormones

Objective

To assess whether dietary supplements that are herbal and/or animal-derived products, marketed for enhancing metabolism or promoting energy, “adrenal fatigue,” or “adrenal support,” contain thyroid or steroid hormones.

Chemoradiotherapy as initial management in patients with squamous cell carcinoma of the head and neck

Thirty-nine previously untreated or minimally treated patients with squamous cell carcinoma of the head and neck were entered onto a chemoradiotherapy protocol employing multiple courses of simultaneous radiation therapy, cisplatin, and a 4-day 5-FU infusion. Thirty-eight patients were evaluable for response and toxicity. Twenty-three patients underwent surgical resection midway through this therapy and 11 (48%) were pathologically free of disease. Thirty-five of the 38 patients (92%) were ultimately rendered disease-free by this combined modality protocol. Thirty-one patients remain disease-free, with a projected 2-year disease-free survival of 74%. Although the treatment-associated mucositis and myelo-suppression were significant, this chemoradiotherapeutic approach is promising and merits further study.