Felodipine or Hydrochlorothiazide/Triamterene for Treatment of Hypertension in the Elderly: Effects on Blood Pressure, Hypertensive Heart Disease, Metabolic and Hormonal Parameters

Trenkwalder P, Plaschke M, Aulehner R, Lydtin H. Felodipine or Hydrochlorothiazide/Triamterene for Treatment of' Hypertension in the Elderly: Effects on Blood Pressure, Hypertensive Heart Disease, Metabolic and Hormonal Parameters.

The aim of the study was to compare the antihypertensive efficacy of either felodipine or the diuretic combination hydrochlorothiazide/triamterene in a group (n = 65) of elderly (≥70 years) hypertensives (office blood pressure ≥ 60/95 mmHg) with special regard to ambulatory blood pressure monitoring, hypertensive heart disease and metabolic parameters. This was a randomized, double-blind study with a treatment period of 6 months. Reduction of office and 24-hr ambulatory blood pressure was comparable with both treatment regimens; after 6 months, 18 of 29 patients in the felodipine group (62%) and 20 of 27 patients in the diuretic group (74%; p = 0.4) were controlled. While episodes of ischemic type ST-segment depression were significantly reduced in the felodipine group (from 49 to 9 episodes), there was no significant change in the diuretic group (from 24 to 21 episodes). Both regimens decreased left ventricular wall thickness, but the decline in left ventricular muscle mass index was significant only for felodipine. Felodipine did not induce any change in metabolic or hormonal parameters; the diuretic combination significantly increased serum creatinine, uric acid, plasma renin activity, and plasma prorenin. Thus, the antihypertensive efficacy of felodipine and the diuretic combination was comparable in elderly hypertensives; only felodipine, however, improved parameters of hypertensive heart diesease and showed a neutral metabolic and hormonal profile.     

尼群地平、依那普利与牛磺酸合并应用对肾性高血压大鼠降压的协同研究

尼群地平１０ｍｇ·ｋｇ－１、依那普利１０ｍｇ·ｋｇ－１和牛磺酸５０ｍｇ·ｋｇ－１一次口服对肾性高血压大鼠均有降压作用，三者降压作用强度相当，最大降压百分率（给药后６ｈ）分别为３３、３６．６和２５．１，降压持续时间相似，给药后２４ｈ的降压百分率分别为１４．２、４．８和１３．７。尼群地平，依那普利分别与牛磺酸以及尼群地平与依那普利合用均有协同降压作用，Ｑ值分别为２．２１、２．６７和１．６４，且降压作用持久，给药后２４ｈ的降压百分率分别为３９．６、２６．８和３８．８，显著高于各药单用。     

预防肝硬化上消化道出血的临床研究

目的　探讨普萘洛尔和低剂量兰索拉唑长期维持治疗对预防肝硬化门脉高压消化道出血的疗效。方法　1 1 9例肝硬化门脉高压患者随机分为 3组 :Ⅰ组 :给予口服普萘洛尔加上护肝治疗。Ⅱ组 :联合给予低剂量兰索拉唑和普萘洛尔。Ⅲ组 :仅给予护肝治疗。兰索拉唑维持服药 6个月 ,普萘洛尔及一般对症治疗维持 1年。观察治疗前后各组患者所伴发溃疡、门脉高压性胃病 (PHG)、急性胃黏膜病变 (AGML)情况 (发生率 ) ,各组消化道出血的复发率、门静脉直径 (PVD)、脾静脉直径 (SVD)的变化。结果　经 1年观察 ,结果显示 ,普萘洛尔组、联合治疗组、对照组出血的复发率分别为 1 5 0 %、2 2 %、48 5 % ,组Ⅰ、组Ⅱ复发率显著低于组Ⅲ ,同时 ,组Ⅰ与组Ⅱ间的差异有显著性意义。治疗可见组Ⅰ、组Ⅱ患者所伴发的溃疡、PHG、AGML明显改善 ,PVD、SVD缩小。结论　普萘洛尔组联合抑制酸维持治疗 ,可预防引起消化道出血多种病因 ,较单用普萘洛尔的疗效好     

Intraparenchymal blood-fluid levels in traumatic intracerebral haematomas

Summary Blood-fluid levels within the cerebral parenchyma are observed more frequently on CT and MRI in traumatic intracerebral haematomas than in those of other aetiologies. The intraparenchymal blood-fluid interface can be formed without a fluid cavity. It is suggested that the blood-fluid levels represent layering of red blood cells within areas of contusion necrosis as well as extensive contusion oedema. The more extensive the damage to brain tissue, the more often blood-fluid levels formed. A poorer outcome can be therefore predicted when an intraparenchymal blood-fluid interface is seen.     

The incidence, timing, and predisposing factors of germinal matrix and intraventricular hemorrhage (GMH/IVH) in preterm neonates

Background Germinal matrix and intraventricular hemorrhage (GMH/IVH) is a known complication occurring in the first week of life in preterm neonates. However, the precise time of its occurrence and the ideal time to perform diagnostic imaging studies remain controversial. The purpose of this paper is to address these two issues in our patient population to allocate our resources to those at highest risk.Materials and methods This study included 282 premature newborns (under 37 weeks of gestation) that were admitted to our neonate ICU in a year’s time and screened for GMH/IVH. They were grouped in four categories according to their weight at birth, and according to their gestational age. All patients had a daily cranial ultrasound during the first week. It was then repeated once in the second week and once in the third.Results We found that the incidence of GMH/IVH among preterm neonates was 44.68%. It was inversely related to the weight and the age of the newborn. The onset of bleeding coordinated with the occurrence of hypoxia and respiratory distress requiring mechanical ventilation. The majorities occurred in the first 7 days of life; they were mostly grade I and II according to the Papule classification and silent for the most part. Complications were present in 41% of the survivors.     

Benign coital headache

We studied the natural history of patients with a diagnosis of benign coital headache who presented to a private neurological clinic between the years 1978 and 1991. Thirty-two patients (24M, 8F) were invited to participate and 26 patients (83%) responded. The period of follow-up ranged from six months to 14 years (median 6 years). Thirteen patients (50%) had recurrent attacks of coital headache epochs separated by intervals of up to 10 years. Eleven of these patients suffered a concomitant primary headache whereas this was present in only one of those patients without recurrent attacks of coital headache (p < 0.001). In all but one patient, who had a transient blurred vision, the headache was not accompanied by nausea, vomiting, visual disturbances, sensory/motor disturbances, or unconsciousness. We concluded that benign coital headache can be clearly distinguished from headaches due to cerebral aneurysm or arteriovenous malformation rupture. The presence of a concomitant primary headache syndrome is a risk-factor for recurrence of coital headache.     

妇科腹腔内出血的临床鉴别诊断

目的　明确妇科腹腔内出血的临床特征 ,以减少误诊。方法　对我院 1999年 1月至 2 0 0 1年 12月以妇科腹腔内出血收治的 186例患者的临床资料进行回顾性分析。结果　 186例病人包括 5种疾病 ,其中异位妊娠、卵巢破裂、出血性输卵管炎及腹部卒中易相互误诊。本资料 15 0例经手术止血 ,36例经保守治疗成功 ,无 1例死亡。结论　详细询问病史 ,血HCG检测和阴道B超检查 ,后穹窿或腹腔穿刺是简便而重要的诊断手段。     

显微手术治疗自发性基底节出血的临床研究

目的：探讨治疗自发性基底节出血的有效措施。方法：将1997年9月－2001年10月采用显微手术治疗的96例自发性脑出血患者，与1994年9月－1997年8月采用常规开颅清除血肿的88例同类患者，在术后血肿清除率，手术死亡率和致残率等方面作对比研究。结果：显微手术能显著提高血肿清除率（P＜0．05）、降低术后脑水肿反应发生率（P＜0．01），从而显著降低了手术死亡率（P＜0．05）和致残率（P＜0．05）。结论：显微手术是治疗自发性脑出血患者一种有效的手术方式。     

微创颅内血肿清除术治疗脑出血65例

我科于1999年10月以来,对各种原因引起的脑出血(出血量≥30 ml)的患者采用贾保祥[1]教授研制的微创颅内血肿清除术进行治疗,取得了良好效果。现报告如下。1临床资料1.1一般资料本组65例,男38例,女27例,发病年龄32岁-83岁,平均年龄56.2岁。其中高血压引起的脑出血63例,急性硬膜下血肿2例,超早期(发病7 h内)就诊28例,早期(发病7 h~3 d)就诊35例,延期(发病3 d以上)2例。1.2临床表现大部分患者发病早期均有头痛或头晕,其中呕吐52例,有高血压史者59例,有头部外伤史2例。神志清醒者17例,昏迷48例,其中深昏迷18例,中度昏迷21例,浅昏迷9例。61例偏瘫…     

The management of arteriovenous malformations in children

Between January 1941 and June 1989, 46 children below the age of 18 with an arteriovenous malformation (AVM) were managed. There were 7 patients with AVM diagnosed before the age of 2; 10 patients were diagnosed between the ages of 3 and 10; and 29 patients were diagnosed between 11 and 18. There were equal numbers of male and female patients. Twenty-five of the AVMs were large (>5 cm longest diameter). All 7 AVMs diagnosed before the age of 2 were large. The usual clinical presentation was congestive heart failure, bruit and an enlarging head. Three patients underwent excision with 2 deaths and 1 excellent result. In 11 patients (aged 3–18) with AVM without history of hemorrhage, 3 had excision with 2 excellent and 1 fair result. Four remained stable. Four developed progressive deficits or hemorrhage. In 10 patients (aged 3–18) with AVM and hemorrhage who were treated medically, 7 (70%) had an episode of re-hemorrhage. Three patients had excision of AVM after re-hemorrhage, but before the age of 18 with an excellent result. Eighteen patients (aged 3–18) with AVM and a single episode of hemorrhage underwent excision with 17 excellent or good results and 1 fair result. The overall mortality was 7%. Eighty-five percent of the children with excision of AVM had an excellent or good result. The best treatment for AVM in children is surgical excision.Presented at the XVII Annual Meeting of the International Society for Pediatric Neurosurgery, Bombay 1989