Comparison of the effects of amlodipine and verapamil on autonomic activity in hypertensive patients

Background: Many studies have shown that autonomic activation is one of the major factors in the etiology of hypertension. Furthermore, sympathovagal imbalance may be responsible for arrhythmias and sudden cardiac death. The aim of the present study was to compare and to evaluate the effects of short-term therapy with amlodipine and verapamil on heart rate variability (HRV) in patients with essential hypertension. Methods: Forty patients with essential hypertension (11 men and 29 women, mean age 50.5+/-10.4 years) were included in the study. Patients with cardiac, metabolic, or any other systemic disease were excluded. Patients were randomized to receive either amlodipine (10 mg; n=20) or verapamil (240 mg; n=20). Patients underwent 24-h Holter monitoring assessment before treatment and after the 4-week treatment period. Standard deviation of normal RR intervals (SDNN), standard deviation of all 5-min mean normal RR intervals (SDANN), square root of the mean of the sum of the squares of differences between adjacent RR intervals (r-MSSD), and pNN50 (time domain variables) and TF, high-frequency power (HF), low-frequency power (LF), and sympathovagal balance (LF/HF; frequency domain variables) were analyzed before and after treatment. Results: Blood pressure (BP) was reduced to a similar degree, from 182/104 to 128/85 mmHg with verapamil and from 174/100 to 124/86 mmHg with amlodipine (verapamil p<0.001; amlodipine p<0.001). This study revealed that amlodipine had no significant effect on any of the time or frequency domain parameters. In contrast, in patients on verapamil, there were significant increases in all time domain parameters, and the LF/HF ratio was significantly decreased (p<0.05). Conclusions: These results suggest that verapamil may have additional positive effects on sympathico-parasympathetic control beyond lowering blood pressure compared with amlodipine, even after short-term treatment in hypertensive patients.     

Validation of the Omron M6 (HEM-7001-E) upper arm blood pressure measuring device according to the International Protocol in elderly patients

OBJECTIVE: Despite the widespread use of automated self-measurement monitors, there is limited published evidence on their accuracy and reliability on different patient groups. The objective of this study was to evaluate the accuracy and reliability of the Omron M6 (HEM-7001-E) upper-arm blood pressure (BP) device against mercury sphygmomanometer on elderly patients according to the criteria of the International Protocol. DESIGNS AND METHODS: Thirty-three patients above 65 years of age, who were classified based on the BP categories of the International Protocol, were recruited for the study. BP measurements at the upper arm with the Omron M6 were compared with the results obtained by two trained observers using a mercury sphygmomanometer. Nine sequential BP measurements were taken. During the validation study, 99 measurements were obtained from 33 patients for comparison. The first phase was carried out on 15 patients and if the device passed this phase, 18 more patients were selected. RESULTS: Mean discrepancies and standard deviations of the device sphygmomanometer were 1.4+/-5.3 mmHg for systolic BP (SBP) and -1.4+/-4.5 mmHg for diastolic BP (DBP) in the study group. The device passed phase 1 in 15 patients. In phase 2.1, from the total 99 comparisons, 76, 92, and 97 for SBP and 77, 94, and 99 for DBP were less than 5, 10, and 15 mmHg, respectively. The Omron M6 passed phases 2.1 and 2.2 in the elderly group of patients. CONCLUSION: The Omron M6 (HEM-7001-E) upper-arm BP monitor passed according to the International Protocol criteria and can be recommended for use in elderly patients.     

Inhibition of bacterial growth by lignocaine in propofol emulsion

Contamination of propofol, in an emulsion formulation, has been associated with infective complications. Local anaesthetics,some of which are known to have antibacterial properties, are frequently added to the solution to reduce pain on injection. We examined the growth rates of E. coli, S. aureus, S. epidermidis and P. aeruginosa in propofol with and without lignocaine 0.1%-2% after incubation for 2, 5 and 24 hours at 37 degrees C. Growth of microorganisms in each solution was compared by counting the number of colony forming units (CFU). Propofol supported the growth of all microorganisms. An increase in the number of CFUs was observed in all drug combinations 2, 5 and 24 hours after inoculation except for S. aureus (P<0.05). No difference was found in CFU numbers between 2 and 5 hours for this microorganism. With E. coli, a significant decline in colony counts was observed in mixtures of 1% and 2% lignocaine (P<0.05). With the other microorganisms only 2% lignocaine showed a significant reduction in the number of CFUs (P<0.05). We conclude that lignocaine in recommended clinical doses (0.05%-0.1%) did not exhibit adequate antibacterial activity to prevent infective complications.     

The comparison of the efficacy of scoring systems in organophosphate poisoning

The purpose of this study was to evaluate the impact of the Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation (APACHE) II and Simplified Acute Physiology Score (SAPS) II scoring systems for organophosphate poisoning (OPP) in an intensive care unit (ICU). The following data were collected on all consecutive patients who were admitted to the ICU between June 1999 and December 2004. Demographic data, GCS, APACHE II and SAPS II scoring systems were recorded. Predicted mortality was calculated using original regression formulas. Standardized mortality ratio (SMR) was computed with 95% confidence intervals (CI). The sensitivity and specificity for each scoring system were evaluated by calculating the Area Under the Receiver Operating Characteristic Curves. The actual mortality in OPP was 21.9%. Predicted mortality by all systems was not significantly different from actual mortality [SMR and 95% CI for GCS: 1.00 (0.65 1.35), APACHE II: 0.87 (0.54-1.03), SAPS II: 1.40 (0.98-1.82)]. The area under the ROC curve for APACHE II is largest, but there is no statistically significant difference when compared with SAPS II and GCS (GCS 0.900 +/- 0.059, APACHE II 0.929 +/- 0.045 and SAPS II 0.891 +/- 0.057). In our ICU group of patients, in predicting the mortality rates in OPP, the three scoring systems, which are GCS, APACHE II and SAPS II, had similar impacts; however, GCS system has superiority over the other systems in being easy to perform, and not requiring complex physiologic parameters and laboratory methods.     

Efficacy of tramadol versus meperidine for pain relief and safe recovery after adenotonsillectomy

BACKGROUND AND OBJECTIVE: Adequate relief of pain after tonsillectomy is a common problem. We compared meperidine and tramadol when given at induction of anaesthesia with respect to their effects on postoperative pain relief and emergence characteristics after adenotonsillectomy in children. METHODS: Fifty children aged 4-7 yr undergoing tonsillectomy were randomly assigned to receive either tramadol 1 mg kg(-1) (n = 25) or meperidine 1 mg kg(-1) (n = 25) before commencement of the surgical procedure. Anaesthesia was induced with propofol (with cis-atracurium for muscle relaxation) and maintained with sevoflurane in oxygen and nitrous oxide. Postoperative pain was scored by a blinded observer using a facial pain scale in the recovery room at 0 (at arrival of the patient in the postoperative care unit) and at 10, 20 and 45 min thereafter. Agitation scores were also assessed by the same observer at 0 min. Heart rate and mean arterial pressure were recorded at regular intervals. The time to recovery to spontaneous respiration and the incidence of postoperative nausea and vomiting were noted. RESULTS: Facial pain scale scores were increased in the tramadol group at 0, 10 and 20 min (P < 0.05). No difference was observed in scores at the 45th min postoperation. Agitation scores were higher in the tramadol group than in the meperidine group. No statistical difference was found between the two groups. Heart rates and mean arterial pressures were similar in both groups. The time to recovery to spontaneous respiration was delayed with meperidine compared with tramadol (P < 0.05). The incidence of nausea and vomiting was not statistically different between groups. CONCLUSIONS: Meperidine was more effective for pain relief and provides better emergence characteristics than tramadol after tonsillectomy in children.     

新的高强度高选择性阿片μ受体激动剂［~11C］－羟甲芬太尼的合成

羟甲芬太尼（Ｉ）是一个新的高强度高选择性阿片μ受体激动剂。本文用ｃｉｓ－Ａ－Ｎ－［１－（２－羟基－２－苯乙基）－３－甲基－４－哌啶基］－苯胺（ＩＩ）或ｃｉｓ－Ｎ－［１－（苯甲酰甲基）－３－甲基－４－哌啶基］－苯胺（ＩＩＩ）作为前体合成了［１１Ｃ］－羟甲芬太尼，以便用正电子发射断层扫描（ＰＥＴ）来观察μ受体。通过水解ｃｉｓ－Ａ－羟甲芬太尼（Ｉ）和ｃｉｓ－Ｎ－［１－（苯甲酰甲基）－３－甲基－４－哌啶］－Ｎ－苯基丙酰胺（ｃｉｓ－ＩＶ）的４－Ｎ－丙酰基分别获得ＩＩ和ＩＩＩ。溴乙烷的格氏试剂与回旋加速器产生的［１１Ｃ］－二氧化碳反应后继而直接加入邻苯二甲酸二酰氯和２，６－二叔丁基吡啶生成同位素标记中间体［１１Ｃ］－丙酰氯。［１１Ｃ］－丙酰氯与ＯＨ－前体（ＩＩ）反应后再经ＨＰＬＣ分离纯化直接得［１１Ｃ］－羟甲芬太尼；［１１Ｃ］－丙酰氯与酮－前体（ＩＩＩ）反应后，再用硼氢化钠甲醇溶液处理，然后进行ＨＰＬＣ分离纯化得［１１Ｃ］－羟甲芬太尼。两种方法均可获得ｌｌ．１～１４．８ＧＢｑ／μｍｏｌ的特异性放射化学纯［１１Ｃ］－羟甲芬太尼。总共耗时为４０～５０ｍｉｎ（ＥＯＢ）。     

Anti-apoptotic effect of succinyl gelatine in a liver ischaemia–reperfusion injury model (Bcl-2, Bax, Caspase 3)?

Apoptosis of tissues may contribute to ischaemia–reperfusion injury. The aim of the present study was to determine whether administration of a colloid solution would prevent apoptosis after liver ischaemia–reperfusion. New Zealand rabbits, weighing 1.5–2 kg, were randomized to receive either 4% SG (20 ml kg ⁻¹h⁻¹ ) by 30 min of intravenous (i.v.) infusion (Group I, n= 7) or equivalent volumes of 0.9% sodium chloride (Group II, n= 6) i.v. before a 45 min interruption of the portal vein blood flow and then 45 min of reperfusion. The animals were killed following the reperfusion period. Their livers were processed for histopathological examination and paraffin sections of these tissues were examined. The expression of Bcl-2, Bax and caspase 3 were analysed by immunohistochemistry. ANOVA and the Wilcoxon W -test were used for statistical analysis, and mean values were expressed ±sd. Histologically, the foci of ischaemic necrosis were observed in liver specimens of the periportal area in one of the animals in Group I and in two in Group II. Immunhistochemical analysis demonstrated an increase in Bcl-2 protein levels in Group I compared to Group II ( P< 0.05). Bax expression was lower in Group I than in Group II. Immunoreactivity for caspase 3 did not differ significantly between the two groups (47.0 ± 35.93 in Group I, 32.83 ± 23.63 in Group II). Our results indicate that gelofusine did not protect the liver tissue against ischaemia–reperfusion-induced apoptosis.     

ABO-incompatible kidney transplantation with donor-specific skin graft

From November 3, 1975, to May 31, 1989, 711 (548 living-related and 163 cadavers) kidney transplantations were performed in our centers. In the final 2 years, 15 ABO-incompatible living related kidney transplantations were performed. In 4 cases, the recipient's blood groups was O and the donor's A1. In 3 cases the blood group of the recipient was A1 and the donor's AB, two patients were B with the donors A1 and the other 2 were O with donors B. The other 3 recipients group was B and the donors' were AB. The donors' and recipients' HLA-AB typing showed one haplotype matching in 12 and two haplotypes matching in 3 patients. The donors were mothers in 7 cases, sibling in 5, and father in 3 cases. At least 3 weeks before the renal transplantation, donor-specific skin grafts and subsequently splenectomy were performed on 9 recipients, but on 6 recipients without splenectomy. Following the skin graft, cross-match was done starting from the 15th day and then continued every week. The immunosuppression, which consisted of triple drugs (0.5 mg/kg prednisolone, 2 mg/kg cyclosporin-A and 2 mg/kg azathioprine) was followed by skin graft. Renal transplantation was performed according to cross-match and skin graft results, and all recipients prior to surgery received at least two sessions of plasmapheresis. Regular dose of immunosuppression that included triple drugs were used after the kidney transplantation and then Orthoclone OKT-3 and plasmapheresis were applied during the rejection episodes without bolus therapy. All patients were followed for 5 to 24 months (ave. 14,13 months).(ABSTRACT TRUNCATED AT 250 WORDS)     

Anti-apoptotic effect of succinyl gelatine in a liver ischaemia-reperfusion injury model (Bcl-2, Bax, Caspase 3)?

Apoptosis of tissues may contribute to ischaemia-reperfusion injury. The aim of the present study was to determine whether administration of a colloid solution would prevent apoptosis after liver ischaemia-reperfusion. New Zealand rabbits, weighing 1.5-2 kg, were randomized to receive either 4% SG (20 ml kg (-1)h(-1) ) by 30 min of intravenous (i.v.) infusion (Group I, n= 7) or equivalent volumes of 0.9% sodium chloride (Group II, n= 6) i.v. before a 45 min interruption of the portal vein blood flow and then 45 min of reperfusion. The animals were killed following the reperfusion period. Their livers were processed for histopathological examination and paraffin sections of these tissues were examined. The expression of Bcl-2, Bax and caspase 3 were analysed by immunohistochemistry. ANOVA and the Wilcoxon W -test were used for statistical analysis, and mean values were expressed +/-sd. Histologically, the foci of ischaemic necrosis were observed in liver specimens of the periportal area in one of the animals in Group I and in two in Group II. Immunhistochemical analysis demonstrated an increase in Bcl-2 protein levels in Group I compared to Group II ( P< 0.05). Bax expression was lower in Group I than in Group II. Immunoreactivity for caspase 3 did not differ significantly between the two groups (47.0 +/- 35.93 in Group I, 32.83 +/- 23.63 in Group II). Our results indicate that gelofusine did not protect the liver tissue against ischaemia-reperfusion-induced apoptosis.