Increased serum high-density lipoprotein cholesterol in hypertensive men treated with the potent vasodilator carprazidil

The effects of the potent arteriolar vasodilator carprazidil on serum lipoproteins and various clinical, biochemical and endocrine parameters were assessed in 15 men with mild to moderate essential hypertension. Following a carprazidil monotherapy (average dose 50 to 60 mg/d) of 8 weeks (N = 15) or 16 weeks (N = 12) duration, blood pressure was decreased significantly (P less than 0.01), while serum high-density lipoprotein cholesterol (+ 26% and + 24%, respectively; P less than 0.01) and the alpha-lipoprotein fraction (+ 26% and + 41%) were increased. Low- and very low-density lipoprotein cholesterol, triglycerides, as well as mean body weight, blood and plasma volume, heart rate, and plasma renin, aldosterone, norepinephrine, and epinephrine were not consistently altered. These results indicate that treatment of hypertensive men with carprazidil in modest dosage may have a favorable influence both on blood pressure and serum lipoproteins.     

Insulin-independent diabetes mellitus: Metabolic characteristics

Glucose intolerance in patients with insulin-independent diabetes mellitus can theoretically arise from a loss of normal tissue sensitivity to insulin (insulin resistance) and/or from a decrease in insulin secretory capacity. A review of available literature indicates that both of these defects can exist in these patients. Thus, patients with insulin-independent diabetes mellitus demonstrate a decrease in tissue sensitivity to insulin, and there is a significant relationship between the severity of the glucose intolerance and the magnitude of the insulin resistance in these patients. The relationship between glucose intolerance and insulin secretion in patients with insulin-independent diabetes is more complicated. Patients with mild glucose intolerance tend to have an insulin response to glucose equal to or greater than normal. As the severity of glucose intolerance increases, the insulin response becomes attenuated and patients with severe fasting hyperglycemia become hypoinsulinemic. On the basis of these changes in insulin resistance and insulin secretion, two formulations concerning the pathogenesis of insulin-independent diabetes seem possible. The first is based upon the premise that the basic defect in patients with insulin-independent diabetes is loss of normal tissue sensitivity to insulin. In an effort to maintain glucose homeostasis, increased amounts of insulin are secreted. However, as the need to augment insulin secretion continues, the beta cell may lose the ability to compensate, and frank hypoinsulinemia can supervene. Alternatively, patients with insulin-independent diabetes can be viewed as representing a metabolically heterogeneous group composed of individuals with various degrees of increased insulin resistance and decreased insulin secretory capacity. In this situation, the degree of glucose intolerance will vary as a function of the relative severity of the two metabolic defects. These relatively simple formulations are confounded by the fact that insulin deficiency can lead to insulin resistance, and vice versa, and that obesity will greatly affect insulin resistance and insulin secretion. Thus, the degree of glucose intolerance in any individual is the result of a complex series of relationships between both intrinsic and environmental factors controlling insulin resistance and insulin secretion. Our ability to understand the pathogenesis of insulin-independent diabetes mellitus will depend upon better understanding of these various relationships.     

Triiodothyronine turnover studies in euthyroid patients with autonomous thyroid nodules

Triiodothyronine (T₃) kinetic studies were carried out using ¹²⁵I-T₃ and the single injection technique in eight clinically euthyroid patients with autonomous thyroid nodules and the metabolic results were compared to those obtained in a group of 12 healthy control subjects. Plasma labeled T₃ concentration was measured by a chromatographic method based on the extraction of the hormone on Sephadex G-25 columns, followed by its elution with a specific anti-T₃ antiserum. The analysis of the experimental plasma disappearance curves of the labeled hormone was performed using the noncompartmental method. The results obtained showed a significantly increased metabolic clearance rate of T₃ in the patients with autonomous thyroid nodules, as compared to the control group. On the average, the T₃ production rates were increased more significantly than the corresponding circulating levels of the hormone, therefore, suggesting that the significant TSH inhibition observed in the euthyroid patients with autonomous thyroid nodules could be related with an increased peripheral utilization of triiodothyronine.     

Complex coronary angioplasty: Multiple coronary dilatations

Selected patients underwent PTCA of multiple stenoses in different vessels or in the same vessel. Three hundred nine patients underwent 685 PTCA procedures in various combinations of arterial and vein graft stenoses. A multiple dilatation procedure was defined as successful when all lesions attempted were successfully dilated, or when the considered-critical-stenosis was successfully dilated and this resulted in a patient clinical improvement. Angiographic success was achieved in 599 of 685 lesions attempted (87.4%) and in 285 of 309 patients (92.2%). Complications included a mortality rate of 1.0%, an MI rate of 4.2% per patient and 1.9% per lesion attempted, and a 3.6% incidence of emergency CABG. Follow-up data show that 58 patients (20.4%) had clinical evidence of a lesion recurrence, and that 92.5% (37 of 40 patients) who underwent repeat angioplasty had a successful procedure. A sustained clinical improvement was obtained in 264 of 309 patients (85.4%). The data indicate that multiple dilatations are feasible with good success rates and acceptable complication rates. Further evaluation of this extended application of PTCA is needed to clearly establish its role in the therapy of CAD.     

The use of calcium with verapamil in the management of supraventricular tachyarrhythmias

Verapamil, a calcium channel blocking drug, terminates supraventricular arrhythmias but may have a negative inotropic effect and produce peripheral vasodilatation and hypotension. We studied the efficacy of intravenous calcium gluconate in reversing or preventing the hypotensive effect of verapamil in 31 patients with atrial tachyarrhythmias. In 21 instances, verapamil was given first, and in 13 calcium was used as pretreatment before the administration of verapamil. Calcium gluconate, when given as pretreatment, prevented the fall in blood pressure induced by verapamil, and when given after verapamil restored blood pressure to control values. The administration of calcium did not alter the antiarrhythmic effect of verapamil.     

Reversal of diuretic-induced increases in serum low-density-lipoprotein cholesterol by the betablocker pindolol

Seventeen patients with mild to moderate essential hypertension received during three consecutive 4 wk periods a matched placebo, the thiazide-like diuretic, clopamide in a low dosage of 5 mg/day, or this diuretic combined with the betablocker, pindolol in a low dosage of 10 mg/day. Compared to placebo conditions, clopamide monotherapy significantly increased serum low-density lipoprotein cholesterol (LDL-C) by 13% (p < 0.025). Following addition of pindolol, serum LDL-C was restored to control values. These variations in serum LDL-C were unrelated to concomitant changes in blood pressure, plasma potassium, renin activity or aldosterone levels. Blood pressure in the supine position was reduced from $\text{152}\text{99}\text{±}\text{13}\text{9}\text{mm Hg (+SD)}$ to $\text{141}\text{93}\text{±}\text{15}\text{7}\text{mm Hg}$ following diuretic-monotherapy and to $\text{139}\text{90}\text{±}\text{12}\text{9}\text{mm Hg}$ following diuretic-betablocker combination treatment. These findings suggest that antihypertensive combination treatment with low doses of clopamide and pindolol is not only effective and well tolerated, but may also avoid the increase in serum LDL-C levels occurring when the thiazide-like diuretic is given alone.     

尤昭玲教授运用中医药对宫腔粘连致不孕症的诊疗特色

宫腔粘连(IUA)又称Asherman综合征,是宫腔内膜受损导致宫腔部分或全部粘连的现象,90％以上系刮宫损伤子宫内膜所致[1],其他原因致IUA的有子宫内膜结核、子宫肌瘤挖除术、诊断性刮宫术等.其主要表现为月经量减少甚至闭经,周期性下腹痛,流产和继发性不孕.宫腔粘连严重影响妇女生活质量,对有生育要求的患者影响更大.近年来,其发病率呈上升趋势.经阴道超声检查无创、便捷、费用低,其对中、重度宫腔粘连的检出率较高,分别为71.7％(33/46)和82.1％(23/28)[2],是宫腔粘连的重要辅助检查.     

导师孟安琪教授治疗湿热瘀结型慢性盆腔炎经验总结

慢性盆腔炎是生育期妇女多发病、常见病,多病程较长,且反复发作,缠绵难愈。近几年由于妇科小手术的不断增加,无菌操作观念不够重视等原因,其发病率呈上升趋势,严重地危害着广大妇女的身心健康。孟安琪教授详细研究其发病机制,通过中医辨证论治,中药多种途径给药,在慢性盆腔炎的治疗上,尤以临床上多见的湿热瘀阻型慢性盆腔炎取得了令人满意的疗效。