Association between aortic stenosis and hypertension

BACKGROUND AND AIM OF THE STUDY: Hypertension causes increased shear stress across the aortic valve. Shear stress across endothelial cells in vitro induces inflammation, which has been demonstrated on stenosed valve leaflets in vivo. In theory, longstanding hypertension could result in aortic stenosis. The study aim was to identify a possible clinical association between these two conditions. METHODS: Data relating to patients with a primary or secondary discharge diagnosis of hypertension or aortic stenosis in the Republic of Ireland were obtained from the Hospital In-Patient Enquiry National File for 1995 to 1999 inclusive. Proportions were compared using chi-squared testing. RESULTS: A total of 3.39 million discharges occurred during this period. Hypertension was the primary or secondary diagnosis in 6.2%, and aortic stenosis in 0.33%. Both conditions were present in 0.07%. Hypertension was present in 21.0% of those with aortic stenosis, and aortic stenosis in 1.1% of those with hypertension. Hypertension was associated with aortic stenosis with an odds ratio of 4.0 (95% confidence interval 3.9 to 4.2, p = 0.0001). CONCLUSION: Aortic stenosis and hypertension were significantly associated in patients discharged from hospital. If hypertension is shown to be contributing to aortic valve disease then, potentially, better blood pressure control might prevent the progression of stenosis.     

Effects of ingesting 6% and 12% glucose/electrolyte beverages during prolonged intermittent cycling in the heat

Summary This study compared the effects of ingesting 6% (MC) and 12% (HC) glucose/electrolyte beverages, and a flavored water placebo (P) on markers of fluid absorption, palatability, and physiological function during prolonged intermittent cycling in the heat. On three occasions, 15 trained male cyclists performed two 60 min cycling bouts at 65% (E ₁ and E ₂). A brief exhaustive performance ride (3 min) was completed after E ₁ and E ₂, and after 20 min recovery (P ₁, P ₂, P ₃). Every 20 min, subjects consumed 275 mL of P, MC or HC. The first drink contained 20 mL of D₂O, a tracer of fluid entry into blood plasma. Plasma D₂O accumulation was slower for HC than for P and MC (P<0.001). HC caused more nausea (P<0.01) and fullness (P<0.05) than MC or P, and subjects said they would be less likely to consume HC during training or competition (P<0.10). Sweat rates, HR, T _re, T _sk, , and PV were similar for all drinks. Performance of P ₁, P ₂, P ₃ were not different among drinks. However, four cyclists failed to maintain the prescribed work rate during E ₂ for HC but only one failed for MC and P. These data suggest that the slow absorption of a 12% glucose/electrolyte beverage during prolonged intermittent exercise in the heat may increase the risk of gastrointestinal distress and thereby limit performance.     

Exstrophy of the bladder. I. Long-term results in a series of 37 cases treated by ureterosigmoidostomy.

Of the 37 patients with exstrophy of the bladder in whom ureterosigmoidostomy was selected as the mainstay of treatment 4 died of causes related to the procedure. Faulty judgment and poor followup accounted for these deaths, which might well be preventable today. In 18 survivors, or approximately half of the entire series, the operation has held up well for many years, with no further surgical procedure being required for complications. In 12 patients, or approximately a third of the group, remedial operations for complications attributable to the ureterosigmoidostomy have been required but it was elected to retain this form of diversion. The long-term end result in these patients also remains acceptable. Combining these 2 groups 30 of 37 patients with ureterosigmoidostomy may be considered to have been eventually successful. However, in 7 of 37 patients the method was a frank failure, in that 4 patients died and 3 required substitution of another form of diversion. While all forms of treatment of exstrophy of the bladder leave much to be desired, results obtainable in today's setting lead us to recommend ureterosigmoidostomy as first choice in the management of this disorder. This recommendation is accompanied by the admonition that systematic followup is imperative so that if things do go badly from the clinical, laboratory or urographic viewpoint corrective measures can be done before renal deterioration occurs. The measures required may range from simple correction of electrolytes to conversion to an ileal loop.     

Peripheral pulmonary embolization from central pulmonary aneurysm.

A 59-year-old man underwent successful repair of a pulmonary arterial aneurysm because of peripheral pulmonary embolization. These lesions are relatively rare; and, to out knowledge, peripheral embolization from such an aneurysm has not been previously reported.