Is there any desensitization of presynaptic alpha 2-adrenergic receptors in hypertension? Experimental and clinical studies]

Several authors have discussed an alteration of adrenergic receptivity in arterial hypertension. De Champlain (Hypertension 1990; 8: S77-S85) suggested that postsynaptic alpha 1-adrenergic functions became dominant while beta-adrenergic functions are attenuated in arterial hypertension. However, the status of presynaptic alpha 2-adrenoceptors remains unknown. The present study investigates presynaptic alpha 2-adrenoceptors in hypertension through the measurement of plasma levels of noradrenaline after administration of yohimbine, an alpha 2-adrenoceptor antagonist, in essential hypertension. Yohimbine (0.2 mg/kg per os) induced a 73% increase of plasma levels of noradrenaline in hypertensive patients (n = 12) and a 178% one in normotensive subjects (n = 6, p < 0.05). A similar significant difference was found in experimental neurogenic hypertension observed in awake dogs 3 weeks after sinoaortic denervation: the increase in plasma concentrations of noradrenaline after yohimbine (0.5 mg/kg i.v.) was +279% in hypertensive versus +642% in normotensive dogs (p < 0.05). The results show that the magnitude of the yohimbine-induced sympathetic activation is lower in hypertensives than in normotensives. They suggest the existence of a presynaptic alpha 2-adrenoceptor desensitization in arterial hypertension. The abnormality of this presynaptic inhibitory mechanism can increase the sympathetic tone and help to develop and maintain arterial hypertension.     

A fully 3D small PET scanner.

A fully 3D small PET scanner based on a novel detection principle for gamma rays is described. It uses BaF2 scintillator and photosensitive wire chambers. Extensive tests with technical prototypes have shown that such a system will have a detection efficiency for gamma rays comparable with what can be obtained with the more traditional approach, and a spatial resolution determined by the size of the crystals. The expected performances of the scanner, based on our measurements and on simulations, are given.     

Multiple myeloma: epidemiological features in a well-defined population in Burgundy, France

Epidemiological features of multiple myeloma were studied over a seven-year period (1980-86) in the department of C?te d'Or (population 478,000). The crude annual incidence rates were 3.7/100,000 for males and 4.0/100,000 for females. The corresponding age-standardized rates were 2.5 and 2.1. The sex ratio was 1.2. Cumulative rates were 0.3% for both sexes. Age and specific incidence were low before 50 and increased with advancing age up to 85 years in males and females. There was no significant variation in incidence over the seven-year period. The risk of multiple myeloma was slightly higher in urban than in rural areas (the variations were not significant). The period between the beginning of the symptoms and the diagnosis was often short, less than one month in 56% of the cases. When compared to other population based registries the incidence rates are similar to those reported all over the world (except for registries with a high proportion of blacks in the population). Cases have been staged according to Durie and Salmon classification: 32% of the cases were classified as Stage I. This result suggests that globally cases diagnosed in a well-defined population are less severe than those reported in hospital statistics. Survival showed significant differences: there were better rates for patients under 75 and for patients at stage I and II compared with stage III patients. Percentage and morphology of plasma cells also influenced prognosis.     

Nephroblastoma with egg-shell peripheral calcifications. Apropos of 3 cases

Three cases of nephroblastoma presented "egg-shell" peripheral calcifications of pseudocystic appearance of radiology. These peripheral lesions are compared with the more commonly reported central calcifications. Their pathology is unknown and they lack prognostic significance of any importance. As for all nephroblastomas the diagnosis is based on straight abdomen images, intravenous urography, ultrasound and computed tomography. Differential diagnosis is basically from renal adenocarcinoma in children, the latter often exhibiting similar calcifications, the distinction between the two types of tumor depending on age of onset. These calcified lesions are non-specific findings and various diagnoses are discussed.     

Postoperative mortality a university Department of General Surgery: incidence of cardiac-related deaths

OBJECTIVES: To evaluate the incidence of cardiac deaths following noncardiac nonvascular surgery. STUDY DESIGN: Retrospective survey. PATIENTS: All patients undergoing mainly endocrinous and digestive surgery in a University department of general surgery between 1991 and 1996. METHODS: Analysis of all deaths occurring intra- and postoperatively, until discharge of the patients. Demographic and medical data, including patent myocardial ischaemia and risk factors for coronary artery disease, were recorded and compared with a control group including all patients undergoing surgery from January to September 1996. RESULTS: In the 8,700 patients who underwent mainly endocrine neck surgery (66%), or intra-abdominal surgery (31%), the mortality rate (n = 96) was 1.1% (95% confidence interval [95% CI] = 0.9-1.3%). Patent myocardial ischaemia or high risk factors for coronary artery disease were existing in 24% of patients with neck surgery, 31% of those with intra-abdominal surgery, and in 60% of the deceased patients (P < 0.01 vs control group). Those who died were older, were in a higher ASA physical class, and had undergone an emergency procedure more often than patients of the control group (P < 0.002 for each parameter). Two cardiac deaths, in patients with a patent cardiopathy, were recorded (cardiac mortality: 0.02%; 95% CI = 0.003-0.08%). The main cause of death was infection (n = 46), followed by haemorrhage (n = 12). Seven deaths remained unexplained. CONCLUSION: This study suggests that cardiac morbidity is a rare cause of death after noncardiac nonvascular surgery.     

Management of bone marrow biopsy related bleeding risks: a retrospective observational study

Journal of Thrombosis and Thrombolysis - Bone marrow biopsies are largely used for the diagnosis and prognostic of various hematological diseases. Complications are rare but can be as serious as...     

Rheumatoid flat foot and deformity of the first ray

OBJECTIVE: To study the relationship between flat foot and forefoot deformities in rheumatoid arthritis (RA) in order to improve understanding of the progression of deformity and thus provide more appropriate treatment. METHODS: Anteroposterior and lateral weight-bearing radiographs were obtained of 308 feet of patients with RA and 202 feet of patients with neck pain (control feet). RESULTS: In women with RA, we observed with disease duration an increased frequency of flat foot that was correlated with first ray deformity (chiefly metatarsus primus adductus) and severe stages of disability. Flat foot increased very markedly after 3-4 years of disease duration. In control women, flat feet were more frequent after the age of 50 years. CONCLUSION: In RA the inflammatory and mechanical factors leading to foot deformity must receive early medical treatment to avoid progressive hindfoot deformities that lead to disability.     

Intensive chemotherapy with mitoxantrone administered as a single injection in patients with high-risk acute myeloid leukemia: results of the EMA 2000 trial

Following a dose-escalation study performed to assess the maximally tolerated dose of high-dose mitoxantrone in a single injection combined with chemotherapy, a phase II trial (EMA 2000 regimen) was performed in patients with refractory or relapsed acute myelogenous leukemia (AML) between October 2000 and December 2003. Sixty-two patients entered the study and received mitoxantrone 45 mg/m² on day 1 in combination with cytarabine and etoposide. Overall, 39 patients (63%) achieved complete remission (CR). Four patients died during remission induction, and 19 patients had resistant disease. Median time to granulocyte and platelet recovery was 34 and 39 days, respectively. The predominant non-hematologic toxicity was infection, with 53% severe infections. Thirty-three of the 39 remitters received subsequent treatment consisting of maintenance chemotherapy courses in 17 patients, allogeneic stem cell transplantation (SCT) in 7 patients, and autologous SCT in 9 patients. The median overall survival of the entire cohort was 8.1 months, with 18% at 2.5 years. EMA chemotherapy using a single injection of mitoxantrone is effective in the treatment of high-risk AML. CR proportion was significantly higher in patients with a first CR duration 6 months when compared with those from a control trial using standard-dose mitoxantrone (90 vs 70%, p=0.03).