Mediation by B1 and B2 receptors of vasodepressor responses to intravenously administered kinins in anaesthetized dogs.

1. Vasodepressor responses to intravenous (i.v.) injection of bradykinin (BK) and des-Arg9-BK, a selective B1 kinin receptor agonist, were characterized following i.v. pretreatment with selective B1 ([Leu8]-des-Arg9-BK) and B2 (Hoe 140) kinin receptor antagonists in anaesthetized dogs. 2. Des-Arg9-BK (0.05-3.3 nmol kg-1) produced dose-dependent decreases in mean arterial blood pressure with a ED50 0.4 nmol kg-1. The vasodepressor effects evoked by des-Arg9-BK (0.6 nmol kg-1) and BK (0.2 nmol kg-1) were greater after i.v. and i.a. injections, respectively. 3. The vasodepressor response to BK (0.6 nmol kg-1) but not to des-Arg9-BK (0.6 nmol kg-1) was significantly (P < 0.001) blocked by pretreatment with the B2 receptor antagonist, Hoe 140. 4. The vasodepressor response to des-Arg9-BK (0.6 nmol kg-1) but not to BK (0.6 nmol kg-1) was significantly (P < 0.001) reduced by pretreatment with the selective B1 receptor antagonist, [Leu8]-des-Arg9-BK. Although both B1 and B2 receptor antagonists caused a transient fall in blood pressure, their inhibitory action was unlikely to be related to a desensitization mechanism. 5. Inhibition of prostaglandin synthesis with indomethacin prevented the vasodepressor response induced by arachidonic acid (1 mg kg-1, i.v.) but not that to BK or des-Arg9-BK (0.6 nmol kg-1). 6. These results suggest, firstly, that the vasodepressor responses to i.v. BK and des-Arg9-BK are mediated by the activation of B2 and B1 receptors, respectively; secondly, that prostaglandins are not involved in the vasodepressor responses to kinins.(ABSTRACT TRUNCATED AT 250 WORDS)     

Intraoperative angiography in reconstructive surgery of aorto- iliac occlusions

In a group of 182 patients who underwent surgical treatment for aortoiliac occlusions 172 had to be subjected to intraoperative distal angiography. The operative tactics in this case was determined by the degree of affection of the peripheral vessels and the character of collateral circulation, which were appraised from the findings of the operative angiograms. According to this, all patients were divided into 4 groups. Two patients developed complications linked with faulty appraisal of the drainage paths.     

Use of immozymase in the treatment of suppurative wounds

The authors discuss the results of application of proteinase preparations immobilized on a water soluble carrier (Immozymase) and a water insoluble carrier (Profezyme) in the management of ++pyo-necrotic processes of various etiology and localization in 1,059 patients. The wounds were cleansed 1.5-2 times quicker than with the traditional methods of treatment. Immobilized proteinases possessing a prolonged therapeutic effect were found to stimulate the regeneration process. The authors believe the use of Immozymase to be promising in the treatment of purulent foci which are drained with difficulty and in intracavitary administration for treating purulent processes in the thoracic or abdominal cavity.     

Changes in plasma atrial natriuretic factor during sequential fluid removal and biochemical correction in end-stage chronic renal failure patients

Plasma immunoreactive atrial natriuretic factor (ANF) levels, their chromatographic profiles (high-performance liquid chromatography; HPLC) and changes during sequential ultrafiltration (UF; 1 litre/h) and biochemical correction without fluid removal (BC; 3 h) were studied in 8 end-stage chronic renal failure patients on intermittent haemodialysis (greater than 1 year). Patients entered randomly the UF-BC or BC-UF protocols that were reversed after 1 week. HPLC showed a single peak of ANF immunoreactivity in plasma of end-stage chronic renal failure patients before dialysis sessions. ANF at the end of fluid removal fell by 31 +/- 2% (p less than 0.01) during UF-BC and by 30 +/- 2% (p less than 0.01) at the end of BC during BC-UF. In both sequences a further slight reduction in plasma ANF was observed during the second phase: it was 8.5 +/- 5% (n.s.) during BC of the BC-UF and 12.5 +/- 2% (p less than 0.05) during fluid removal of BC-UF. Plasma ANF was not significantly removed by the machinery. BC did not modify the microhaematocrit in the BC-UF sequence while the microhaematocrit was significantly increased by UF (13 +/- 1 and 14 +/- 1%, p less than 0.005 vs. basal, respectively), and decreased by BC in the UF-BC sequence (-5 +/- 2% vs. end UF, p less than 0.05). Serum creatinine and urea decreased significantly during BC in both protocols while they were unmodified during UF. No significant changes were seen in PRC during either protocol.(ABSTRACT TRUNCATED AT 250 WORDS)     

Management of fractures in patients with osteoporosis

The treatment of the most common osteoporotic fractures has been reviewed. In general, early functional treatment is used to allow early restoration of function and weight bearing. Fracture treatment should always be accompanied by an investigation of the bone mass in these patients. Nutritional support and calcium and vitamin supplementation should be provided during the healing phase.     

New aspects in the diagnosis of intervertebral disk displacement of the upper lumbar spine with special reference to magnetic resonance tomography

A report is presented on two patients who received surgery on a disc prolapse between the lumbar vertebrae 4 and 5 as treatment for compression of the fifth lumbar root, but in whom the clinically relevant disc prolapse was located higher (lumbar vertebrae 1/2 or thoracic vertebra 12/lumbar vertebra 1). Magnetic resonance tomography made a major contribution to the later diagnosis of the high disc prolapses. Besides precise localization of the lesion, MRT made it easier to understand why such a high disc prolapse can cause a compression syndrome of the fifth lumbar root.     

Pneumatic sequential-compression boots compared with aspirin prophylaxis of deep-vein thrombosis after total knee arthroplasty

This prospective, randomized study was undertaken to compare the effectiveness of pneumatic sequential-compression boots with that of aspirin in preventing deep-vein thrombosis after total knee arthroplasty. Patients were randomly assigned to one of two prophylactic regimens: compression boots or aspirin. One hundred and nineteen patients completed the study. Seventy-two patients had unilateral arthroplasty and forty-seven, one-stage bilateral arthroplasty. In the unilateral group, the incidence of deep-vein thrombosis was 22 per cent for the patients who used compression boots compared with 47 per cent for those who received aspirin (p less than 0.03). In the bilateral group, the incidence of deep-vein thrombosis was 48 per cent for the patients who used compression boots compared with 68 per cent for those who received aspirin (p less than 0.20). The results confirm the effectiveness of compression boots in the treatment of patients who have had unilateral total knee arthroplasty. Despite the use of compression boots, however, patients who had bilateral arthroplasty were at greater risk for the development of deep-vein thrombosis.