Hipertensión por hiperaldosteronismo: más lesión cardiaca,mayor riesgo cardiovascular

Introduction and objectives

Primary hyperaldosteronism is the most common cause of secondary hypertension. Elevated aldosterone levels cause heart damage and increase cardiovascular morbidity and mortality. Early diagnosis could change the course of this entity. The objective of this report was to study the clinical characteristics, cardiac damage and cardiovascular risk associated with primary hyperaldosteronism.

Methods

We studied 157 patients with this diagnosis. We analyzed the reason for etiological investigation, and the routinely performed tests, including echocardiography. We used a cohort of 720 essential hypertensive patients followed in our unit for comparison.

Results

Compared with essential hypertensive patients, those with hyperaldosteronism were younger (56.9 [11.7] years vs 60 [14.4] years; P<.001), had higher blood pressure prior to the etiological diagnosis (136 [20.6] mmHg vs 156 [23.2] mmHg), more frequently had a family history of early cardiovascular disease (25.5% vs 2.2%; P<.001), and had a higher prevalence of concentric left ventricular hypertrophy (69% vs 25.7%) and higher cardiovascular risk. Specific treatment resulted in optimal control of systolic and diastolic blood pressures (from 150.7 [23.0] mmHg and 86.15 [14.07] mmHg to 12.69 [15.3] mmHg and 76.34 [9.7] mmHg, respectively). We suspected the presence of hyperaldosteronism because of resistant hypertension (33.1%), hypokalemia (38.2%), and hypertensive crises (12.7%). Only 4.6% of these patients had been referred from primary care with a suspected diagnosis of hyperaldosteronism.

Conclusions

Hyperaldosteronism should be suspected in cases of resistant hypertension, hypokalemia and hypertensive crises. The diagnosis of hyperaldosteronism allows better blood pressure control. The most prevalent target organ damage is left ventricular hypertrophy.Full English text available from:www.revespcardiol.org/en.     

Basic and clinical aspects of gastrointestinal pain

The gastrointestinal (GI) tract is a system of organs within multicellular animals which facilitates the ingestion, digestion, and absorption of food with subsequent defecation of waste. A complex arrangement of nerves and ancillary cells contributes to the sensorimotor apparatus required to subserve such essential functions that are with the exception of the extreme upper and lower ends of the GI tract normally subconscious. However, it also has the potential to provide conscious awareness of injury. Although this function can be protective, when dysregulated, particularly on a chronic basis, the same system can lead to considerable morbidity. The anatomical and molecular basis of gastrointestinal nociception, conditions associated with chronic unexplained visceral pain, and developments in treatment are presented in this review.     

脑卒中患者医院获得性肺炎106例临床分析

目的：探讨脑卒中患者发生医院获得性肺炎（HAP）的临床特点。方法：总结106例脑卒中患者发生HAP的临床资料,并进行分析。结果：106例发生HAP的患者中,G-感染占大多数,且部分产生耐药性,G＋感染患者中金黄色葡萄球菌均耐甲氧西林,仅对万古霉素敏感。病死率占11.3%。结论：HAP是住院脑卒中患者中最重要的并发症,重视引起HAP的危险因素,通过预防减少HAP的发病率和死亡率。     

Icariin/HAP纳米凝胶剂的处方优化及体外释放研究

[目的]对Icariin/HAP纳米凝胶剂处方进行优化并考察其体外释放特性。[方法]物理吸附法制备Icariin/HAP纳米混悬液,研和法制备Icariin/HAP纳米凝胶,采用正交设计对处方进行优化,透析法测定Icariin/HAP纳米凝胶中药物的释放。[结果]Icariin/HAP纳米凝胶优选处方为卡波姆浓度为1%,三乙醇胺用量为1.5%,丙二醇用量为5%。Icariin/HAP纳米凝胶剂、Icariin凝胶剂和Icariin溶液体外释放均符合一级模型和Weibull模型。[结论]以卡波姆为基质制备Icariin/HAP纳米凝胶,处方简单,质量稳定,可提高Icariin/HAP纳米混悬液的稳定性。     

Bacteriological testing and recurrence prevention efforts in the diagnosis and treatment of nursing- and healthcare-associated pneumonia and aspiration pneumonia: A questionnaire survey of hospitals across Japan

Background

Clinical practice guidelines for nursing- and healthcare-associated pneumonia (NHCAP) were developed for pneumonia caused by drug-resistant bacteria and pneumonia in elderly patients, particularly aspiration pneumonia. The identification of pathogenic bacteria and implementation of efforts to prevent the recurrence of aspiration pneumonia are very important in clinical practice. This study examined the extent to which clinicians have established bacteriological testing and recurrence prevention efforts for NHCAP and aspiration pneumonia.

ICU患者院内获得性肺部感染38例分析

目的探讨ICU患者院内获得性肺部感染发生的特征及防治办法。方法回顾性分析ICU患者226例临床资料。结果本组发生院内肺部感染38例(16.8%)。感染与昏迷程度、年龄、住院时间、基础疾病及医疗操作有一定关系。结论加强重症监护室消毒、加强无菌观念、减少医源性操作造成的感染及抗生素的合理应用等是控制院内肺部感染的重要措施。     

神经内科老年患者医院获得性肺炎危险因素分析

目的探讨神经内科老年患者获得性肺炎的临床特点及相关危险因素和防止措施。方法对本院2004年1月～2009年12月381例神经内科老年患者获得性肺炎的患者进行回顾性分析。结果脑血管病、痴呆、帕金森病在神经科老年患者发生医院获得性肺炎的比例高,临床特点不典型。381例患者并发HAP 78例,感染率20.5%;感染组死亡37例,死亡率47.43%,非感染组死亡64例,占非感染组21.10%;痰培养分离出的致病菌以革兰阴性杆菌为主,前5种主要病原菌分别是铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌、金黄色葡萄球菌,且对多种抗菌素存在耐药。结论神经内科老年患者获得性肺炎的临床表现不典型,感染率和死亡率高,要控制感染危险因素,监测病原菌,重视药物的选择和治疗策略。     

锶磷灰石烧结体修复颌骨缺损的实验研究

目的　用不同比例的元素锶 (Sr)替代羟磷灰石 (HA)中的部分钙元素 ,通过动物实验研究该种复合人工骨在颌骨缺损修复中的应用。方法　将 32只新西兰大白兔 (简称新白 )分为 4组 ,在兔的下颌角造成约 2 m m×12 mm× 4mm的缺损 ,用不同浓度 (10 % ,5 % ,0 % )的含锶 HA块分别予以修复 ,于 2周 ,1月 ,3月 ,6月时随机处死一组进行尸解、组织学、扫描电镜观察以评价其骨修复能力。结果　掺锶羟基磷灰石复合人工骨几乎不引起排斥反应 ,术后早期即随材料的降解 ,新生骨引导进入降解间隙 ,并逐渐诱导未分化细胞转化为成骨细胞 ,随时间延长其成骨量明显较纯羟基磷灰石组为多 ,同时发现 5 %的锶磷灰石烧结体其成骨能力较 10 %者好。结论　掺锶羟基磷灰石较纯羟基磷灰石有更好的组织相容性、骨引导能力及生物降解率 ,并可能具备一定程度的骨诱导能力 ;掺锶羟基磷灰石的骨形成能力与其浓度并不成正相关。     

Selective inhibition of Hepatocarcinoma cells by apatite nanoparticles

In 1 994,Hideki Aoki and his colleagues happened to find that apatite (HAP)nanoparticlesinhibited growth of cancer cells when they tried to determine the possi-bility for HAP nanoparticles to act as tumor suppressing drugs carrier〔1〕.LaterShipu Li etal.…     

羟基磷灰石制剂用于活髓切断术的动物实验研究

用５只１．５～２岁的杂种狗，共１６０个实验牙２４０牙根。采用氢氧化钙碘仿制剂、羟基磷灰石（ＨＡＰ）磷霉素钙制剂、磷霉素钙、ＨＡＰ４种盖髓剂进行了活髓切断术。术后分别观察１、４、８周和６月．结果表明：ＨＡＰ磷霉素钙制剂具有较好的生物相容性和促进牙髓形成牙本质桥的能力，且抗菌性能优越，无变态反应。