Antihypertensive effects of captopril and saralasin in essential and renal hypertension

The antihypertensive effect of captopril and its mechanism of action were studied in patients with essential and renal hypertension. In mild essential hypertension (n = 12), during monotherapy with captopril (50 to 450 mg, 4 to 12 weeks) blood pressure was normalized in seven, improved in two and remained unchanged in three patients, plasma levels of active and acid-activatable inactive renin significantly increased and angiotensin II decreased, whereas no consistent changes in urinary kallikrein excretion occurred. In severe renal (n = 14) and essential (n = 9) hypertension, blood pressure was normalized in eight (seven with renal hypertension), improved in seven and unchanged in eight patients, when captopril (50 to 450 mg, 3 to 15 months) was added to the antihypertensive medication. In one patient with stenosis in a transplanted renal artery reversible renal failure occurred during captopril therapy possibly because of a steep initial decrease in blood pressure, although a toxic effect of the drug cannot be excluded. In another series of 12 renal and 8 essential hypertensive patients, a significant correlation between the acute effect of captopril (within 90 minutes) and saralasin on blood pressure was demonstrated (r = 0.71, p < 0.001). The change in blood pressure after either drug was significantly related to the initial plasma renin concentration.In conclusion, captopril sems to be an effective antihypertensive agent in essential and renal hypertension. Renal function should be monitored during captopril therapy. Our studies suggest that captopril decreases blood pressure by inhibiting the vasopressor action of the renin-angiotensin system.     

Gastritis staging: interobserver agreement by applying OLGA and OLGIM systems

Atrophic gastritis remains a difficult histopathological diagnosis with low interobserver agreement. The aim of our study was to compare gastritis staging and interobserver agreement between general and expert gastrointestinal (GI) pathologists using Operative Link for Gastritis Assessment (OLGA) and Operative Link on Gastric Intestinal Metaplasia (OLGIM). We enrolled 835 patients undergoing upper endoscopy in the study. Two general and two expert gastrointestinal pathologists graded biopsy specimens according to the Sydney classification, and the stage of gastritis was assessed by OLGA and OLGIM system. Using OLGA, 280 (33.4 %) patients had gastritis (stage I–IV), whereas with OLGIM this was 167 (19.9 %). OLGA stage III– IV gastritis was observed in 25 patients, whereas by OLGIM stage III–IV was found in 23 patients. Interobserver agreement between expert GI pathologists for atrophy in the antrum, incisura angularis, and corpus was moderate (kappa?=?0.53, 0.57 and 0.41, respectively, p?<?0.0001), but almost perfect for intestinal metaplasia (kappa?=?0.82, 0.80 and 0.81, respectively, p?<?0.0001). However, interobserver agreement between general pathologists was poor for atrophy, but moderate for intestinal metaplasia. OLGIM staging provided the highest interobserver agreement, but a substantial proportion of potentially high-risk individuals would be missed if only OLGIM staging is applied. Therefore, we recommend to use a combination of OLGA and OLGIM for staging of chronic gastritis.     

175. Spätergebnisse der Revascularisation bei Urämie und renovasculärem Hochdruck

Zusammenfassung Von 174 wegen renovasculären Hochdrucks operierten Patienten wiesen 10 eine Niereninsuffizienz auf, meist in Verbindung mit einem Parenchymschaden. Durch Revascularisation wurde bei 7 Patienten die Nierenfunktion gebessert, einer ver starb postoperativ. Nach durchschnittlich 3,5 Jahren war der Blutdruck bei 1 Patient normal, bei 6 gebessert. Es sollte revascularisiert werden, wenn ein Fortschreiten der Insuffizienz zu erwarten ist, eine renovasculäre Teilursache anzunehmen ist und die Insuffizienz noch keine höheren Ausmaße erreicht hat.     

The Validity of a Biomarker Method for Indirect Detection of Gastric Mucosal Atrophy Versus Standard Histopathology

Background  

Atrophy of the stomach mucosa is considered to be premalignant lesion for gastric cancer development; easy identification of this condition from a blood-sample would allow identifying the group of individuals at increased risk for cancer development.     

Value of gastrin-17 in detecting antral atrophy

PurposeDecreased plasma gastrin-17 (G-17), particularly after protein stimulation, is indicative of atrophy in the antral stomach mucosa. Available data on the value of this biomarker is inconclusive. Our study was aimed to evaluate the performance of the G-17 test in Caucasian and Asian patients for antral atrophy evaluation either in fasting state or after protein stimulation.Material/Methods241 dyspeptic patients aged 55 and above from Latvia (125), Lithuania (76) and Taiwan (40) were enrolled. G-17 levels were detected in plasma samples obtained either during fasting or after a protein-rich test meal. Levels <1pmol/L at fast and <5 pmol/L after stimulation were considered indicative of atrophy.ResultsThe sensitivity of the test was 15.8%, its specificity 88.7%, and the overall accuracy 83% in the fasting state, and 36.8, 86.5, and 82.6%, respectively, after stimulation. In the Caucasian subgroup, the corresponding figures were 15.4, 91.5, and 86.6% in the fasting state and 30.8, 92.6, 88.6% after stimulation; but for the Asian subgroup the corresponding figures were 16.7, 73.5, and 65% (fasting) and 50, 52.9, and 52.5% (stimulated).ConclusionsThe performance of G-17 was better after protein stimulation. G-17 was highly specific in the Caucasian, but not in the Asian subgroups. Still the low test sensitivity either at fast or following protein stimulation does not allow us to recommend it for wide screening purpose to diagnose antral atrophy.     

Kaposi's sarcoma and aplastic pancytopenia: simultaneous occurrence in a patient

A 49 year old patient developed simultaneously a histologically verified Kaposi's sarcoma and an idiopathic aplastic pancytopenia. An association of these perhaps virus-induced diseases has not been reported until now. Consequences concerning the diagnostic approach of changes in peripheral blood cells in patients with Kaposi's sarcoma are delineated. Changes in peripheral blood and bone marrow in patients with Kaposi's sarcoma are discussed.