Hypertension: pathophysiology and treatment

Arterial hypertension is a major cause of morbidity and mortalitybecause of its association with coronary heart disease, cerebrovasculardisease and renal disease. The extent of target organ involvement(i.e. heart, brain and kidneys) determines outcome. North Americanstudies have shown that hypertension is a major contributorto 500 000 strokes (250 000 deaths) and 1 000 000 myocardialinfarctions (500 000 deaths) per annum.     

The surgical hypertensive patient

We reviewed the pathophysiology and treatment of hypertensionin a recent edition of this journal (see key references). Inthis article, we discuss the management of the hypertensivepatient presenting for surgery and anaesthesia.     

Effect of antagonists of adrenergic and cholinergic receptors on ion transport in the isolated rabbit caecum wall

A hypothesis was tested in this study that antagonists of adrenergic and cholinergic receptors affect sodium and chloride ion transport in the rabbit caecum. A modified Ussing chamber was used in the experiment. It was demonstrated that isolated caecum responded to a mechanical stimulus, which consisted in gentle rinsing of the mucous surface, with changes in transepithelial electrical potential difference. An application of ion transport inhibitors, amiloride for sodium and bumetanide for chloride ions, demonstrated that both sodium and chloride ion transport in part determined the response. Pharmaceuticals that are antagonistic at neural receptors (alpha- and beta-adrenergic, nicotinic, and muscarinic), applied both for incubation and stimulation, reduced electrical potential and inhibited responses to mechanical stimuli. Basing on the results of this experiment and literature data, one can presume that analogical responses occur in vivo, and the physiological role of the autonomic system includes regulation of the thickness and consistence of mucus that separates fecal masses from the caecum walls.     

Nimesulide (Aulin)--the selective COX-2 inhibitor in the treatment of ENT diseases

Nonsteroidal antiinflammatory drugs (NSAIDs) are widely used in the treatment of controlling inflammatory process and relief of pain in upper airways disorders, due to their inhibition of the cyclooxygenase (COX). After classical NSAIDs different adverse effects are observed, which limit their usage in many patients. The beginning of the nineties gave the evidences, that two cyclooxygenase isoforms existed: COX-1 and COX-2. The blockage of COX-1 in consequence cause the adverse effects of NSAIDs. And COX-2 is responsible for the most inflammatory symptoms, such as pain, oedema, fever, increase of vessel permeability. So the selective inhibitors of COX-2 would be much more safe drugs, comparing with the classical NSAIDs in the treatment of inflammatory diseases. Nimesulide belongs to the new generation of NSAIDs. It not only inhibits more selectively the activity of COX-2, but has also some other properties, that increase its antiinflammatory and analgesic function. Effectiveness of nimesulide has been demonstrated by numerous clinical studies in various inflammatory diseases of upper airways. Its anti-inflammatory, analgesic and antipyretic efficacy has been at least comparable with classical NSAIDs, but the adverse effects of nimesulide have been milder and less frequent. So all those facts suggest, that nimesulide should be taken into account in the treatment of the inflammatory diseases of the ear, nose and throat.     

Acute colonic pseudo-obstruction (Ogilvie's syndrome) in pneumococcal meningo-encephalitis treated with neostigmine

We report the case of a 71-year-old man with acute colonic pseudo-obstruction that complicates a pneumococcal meningo-encephalitis. After 48 h of conservative management with nothing by mouth, nasogastric suction, fluid and electrolyte correction, withdrawal of any anticholinergic agents, a pharmacological approach with 2 mg of neostigmine was successful in intensive care unit. This treatment was effective in over 80% of patients of recent reports. Neostigmine might be considered as first-line therapy in patients who do not have major contraindications to its use, because of less frequent iatrogenic risk than colonoscopic decompression or surgery.     

Correlation of body temperature with protection against staphylococcal enterotoxin B exposure and use in determining vaccine dose-schedule

The immunoprotective potential of a recombinant vaccine against the incapacitating effect of aerosolized staphylococcal enterotoxin B (SEB) in nonhuman primates is reported. SEB belongs to a family of structurally related superantigens responsible for serious, life threatening pathologies. Injecting the recombinant SEB vaccine did not induce temperature elevation in rhesus monkeys, a classical symptom of toxic-shock syndrome. No temperature elevation was noted following injection with control tetanus toxoid. In addition to 100% survival, we observed a clear correlation between vaccine dose and mitigation of temperature elevation after a lethal SEB aerosol challenge. We conclude that the recombinant SEB vaccine is non-pyrogenic and that monitoring changes in body temperature is an important biomarker of toxic shock in a primate animal model.     

The D-Net diabetes self-management program: long-term implementation, outcomes, and generalization results

BACKGROUND: A prerequisite to translating research findings into practice is information on consistency of implementation, maintenance of results, and generalization of effects. This follow-up report is one of the few experimental studies to provide such information on Internet-based health education. METHODS: We present follow-up data 10 months following randomization on the "Diabetes Network (D-Net)" Internet-based self-management project, a randomized trial evaluating the incremental effects of adding (1) tailored self-management training or (2) peer support components to a basic Internet-based, information-focused comparison intervention. Participants were 320 adult type 2 diabetes patients from participating primary care offices, mean age 59 (SD = 9.2), who were relatively novice Internet users. RESULTS: All intervention components were consistently implemented by staff, but participant website usage decreased over time. All conditions were significantly improved from baseline on behavioral, psychosocial, and some biological outcomes; and there were few differences between conditions. Results were robust across on-line coaches, patient characteristics, and participating clinics. CONCLUSIONS: The basic D-Net intervention was implemented well and improvements were observed across a variety of patients, interventionists, and clinics. There were, however, difficulties in maintaining usage over time and additions of tailored self-management and peer support components generally did not significantly improve results.