Prognostic factors in acute pulmonary edema.

Over a six-month period, 106 admissions of 94 patients for acute pulmonary edema were identified and their charts were reviewed. Precipitating factors for acute pulmonary edema included progressively worsening congestive heart failure in 25.5% of cases, coronary insufficiency in 20.8%, subendocardial myocardial infarction in 16.0%, acute transmural myocardial infarction in 10.4%, arrhythmia in 8.5%, medical noncompliance in 6.6%, and other causes in 12.6%. In-hospital mortality was 17.0% (16 patients). Of those patients discharged from the hospital, an additional 27 (39.7%) were dead at one year, giving an overall one-year mortality of 51.2%. We found that patients with progressively worsening congestive heart failure have a better prognosis than patients with other precipitants. Also, patients with an initial systolic blood pressure in the emergency room of 160 mm Hg or higher had an improved survival over patients with an initial systolic blood pressure under 160 mm Hg. No other in-hospital or long-term prognostic factors were identified.

Acute monoblastic leukemia (FAB-M5b) with t(8;14)(p11;q11.1).

A case of acute monocytic leukemia (FAB-M5b) expressing natural killer cell-associated antigens containing a t(8;14)(p11;q11.1) is presented. We interpret this translocation to represent a variant of the t(8;16) previously reported in FAB-M5b. These findings support the contention that the 8p11 breakpoint site is the critical junction in the oncogenesis of acute monoblastic leukemia with differentiation.

Isolated systolic hypertension in the elderly: pathophysiology and treatment.

Isolated systolic hypertension (ISH) is a common clinical finding in the elderly population and appears to be a risk factor for cardiovascular morbidity and mortality. It appears feasible and safe to treat patients with various antihypertensive drugs; however, the morbidity and mortality benefits still need to be determined.

Calcium channel blockers in systemic hypertension.

Alterations in transmembrane flux of calcium ions may be playing a role in the pathophysiology of systemic hypertension. Calcium channel blockers have been shown to be effective antihypertensive drugs with excellent safety profiles. They are efficacious in the long term treatment of systemic hypertension in all population subgroups, and have special applicability for treating patients with hypertensive urgencies and individuals with concomitant diseases such as angina pectoris and arrhythmias.

Experimental argon laser thermal angioplasty as an adjunct to balloon angioplasty in peripheral arteriosclerotic disease.

Laser thermal recanalization has been used clinically as an adjunct to balloon angioplasty in the treatment of peripheral arteriosclerotic disease, with improved initial success rates in total peripheral occlusions and greater 1 yr vessel patency suggested, as compared to balloon angioplasty alone. However, the morphological effects of laser-assisted balloon angioplasty are unknown. Therefore, the goals of the present study were to evaluate 1) the angiographic and histologic effects of laser thermal recanalization followed by balloon angioplasty and 2) the hypothesis that balloon-catheter-induced neointimal fracture could be sealed by subsequent laser thermal angioplasty in an experimental rabbit iliac artery atherosclerotic model. In Group 1 (7 vessels), a 1.5 mm metal capped argon laser fiberoptic was introduced via femoral arteriotomy and 10 W of thermal power was applied to the iliac artery stenosis for 5 sec while maintaining constant back-and-forth motion. Thereafter, balloon angioplasty was performed in the same vessel segment with a 2.5 mm balloon catheter inflated 3 times at 5 atm for 30 sec each. Mean angiographic luminal diameter increased from 1.1 mm to 2.0 mm after both procedures, and mean final post balloon dissection grade was 0.6 on a scale of 0, 1+, and 2+. Perforation occurred once with the laser probe and once with the balloon catheter. Histologic examination of these vessels was characterized by irregular thermal erosions with minimal reactive thrombosis. In Group 2 (10 vessels), the sequence was reversed, with laser thermal angioplasty following balloon dilation. Mean angiographic luminal diameter improved from 1.2 mm to 1.8 mm after both procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Percutaneous double-balloon valvuloplasty of porcine bioprosthetic valves in the tricuspid position.

This is a description of the first two reported cases of double-balloon valvuloplasty in the treatment of porcine bioprosthetic valve stenosis in the tricuspid position. In both cases, the double-balloon technique resulted in a better hemodynamic improvement than single-balloon valvuloplasty and was well tolerated. Double-balloon valvuloplasty is a reasonable alternative to surgical replacement of a stenotic bioprosthesis in the tricuspid position.

Rest and exercise hemodynamic and adrenergic responses to enalapril, hydrochlorothiazide, and combination treatment in patients with systemic hypertension.

The effects of enalapril (10-20 mg twice daily), hydrochlorothiazide (25-50 mg twice daily), and combination enalapril-hydrochlorothiazide therapy (10-20 mg enalapril/25-50 mg hydrochlorothiazide in combination tablet twice daily) were evaluated and compared to no therapy (control) in eight patients with mild to moderate hypertension at rest and during treadmill exercise. All active treatments reduced standing blood pressure in patients at rest compared to the control group (p less than 0.05); however, none produced significant reductions of standing blood pressure in patients at peak exercise. Standing heart rates of patients at rest and at peak exercise were not changed with active therapy. However, standing heart rate in patients at rest was lower with enalapril than with hydrochlorothiazide and combination therapy (p less than 0.05). Heart rate of patients on hydrochlorothiazide was higher than with control and other therapies at Stage I of exercise (p less than 0.01). Supine norepinephrine levels in patients at rest were elevated with both hydrochlorothiazide and combination therapy when compared to that in patients with enalapril and control (p less than 0.05). Treatment with enalapril alone produced no changes in plasma catecholamine levels compared to control. There were no differences between control and all treatment regimens in peak exercise levels of catecholamines. Thus, enalapril, hydrochlorothiazide, and combination therapy, although effective in lowering resting blood pressure, may not be effective in blunting the blood-pressure response to exercise. The drugs do not appear to have any significant effects on catecholamine levels in patients at peak exercise.