Prospective survey of availability of cadaveric kidneys for transplantation.

A prospective study in Nottingham hospitals, serving 3/4 million population, identified 25 potential kidney donors in one year. Seventeen later died in circumstances when kidney donation would have been possible. Twelve kidneys were actually removedfor transplantation out of the possible 34. The reasons for failure to donate kidneyswere either relatives' refusal or a failure of the doctors looking after those patientsto consider them as potential donors. If all possible donors had their kidneys removed there would be sufficient available to approximately equal the numbers of patients likely to require renal transplatation.

Chronic renal failure in Nottingham and requirements for dialysis and transplantfacilities.

A retrospective study of uraemic patients covering 12 months of 1970 and a prospective survey covering six months in 1973-4 is reported for a population of almost 3/4million. The number of patients requiring regular dialysis treatment or transplantation or both is considered to be 45 per million of population under 65, 39 per million under 60, and 29 per million under 50 years of age.

Post marketing surveillance of captopril (for hypertension): a preliminary report.

1 The methodology and interim results of a post marketing surveillance of captopril, the first orally active angiotensin converting enzyme inhibitor are presented. 2 Utilising viewdata technology, details of hypertensive patients were entered directly into a mainframe computer. This allowed day to day monitoring of events; a facility not available with paper-based methods. 3 The design of the study allowed analysis of results including some details of efficacy, concomitant therapy, any disease symptoms and reasons for withdrawal. These factors could be categorised according to sex and age. 4 This preliminary report is based on the first 13,295 patients entered from July 1983 with follow-up until January 1985. The results of the study confirm the safety of captopril in the patients studied.

A single dose comparison of piretanide and bumetanide in congestive cardiac failure.

1 This study has compared the diuresis produced by a single oral administration of 6 mg piretanide, 9 mg piretanide and 1 mg bumetanide in a group of nine patients with cardiac failure using a balanced randomized design. 2 The natriuresis and kaliuresis produced in the first 6 h after administration of piretanide 9 mg and bumetanide 1 mg were similar. Piretanide 6 mg produced a lesser response. 3 There was evidence of sodium and water conservation following the diuresis for up to 48 h with all three treatments. 4 The patterns of urate and calcium excretion were similar for the two diuretics.

Controlled comparison of the effects of furosemide and hydrochlorothiazide added to propranolol in the treatment of hypertension.

Forty patients completed a double-blind parallel group study comparing furosemide (FUR) and hydrochlorothiazide (HCT) when added to a stable dose of beta blocker in the treatment of mild to moderate hypertension. Both diuretics caused a significant additional fall in blood pressure (BP) when added to propranolol, and there were no differences in the mean BP achieved. However, a higher proportion of patients achieved satisfactory control (BP less than 160/95 mm Hg) on FUR than on HCT and, in addition, there was a more marked dose-response effect with FUR. This study showed that FUR is at least as effective as HCT in the treatment of hypertension when added to propranolol, and appears to possess certain advantages in comparison to the thiazide.

Oral piretanide in chronic renal failure.

1 The effects of high doses of piretanide, a new diuretic agent chemically related to frusemide and bumetanide were evaluated in twelve patients with severe chronic renal insufficiency (creatinine clearance below 25 ml/min). 2 Patients received either 30 mg or 60 mg piretanide orally after a water load of 11. Urine volume and the excretion of electrolytes, creatinine, urea and uric acid were measured over the subsequent 24 h. 3 Piretanide produced an effective diuresis and natriuresis in these patients, its action being broadly similar to those of bumetanide and frusemide observed in previous studies.

Safety of tacrine: clinical trials, treatment IND, and postmarketing experience.

The safety of tacrine (Cognex), a centrally active, reversible acetylcholinesterase inhibitor approved in 1993 for the treatment of mild to moderate dementia of the Alzheimer type, was evaluated in 2,706 patients with Alzheimer disease (AD) in clinical trials and in 9861 patients with AD in a treatment investigational new drug (TIND) program. More than 190,000 patients in the United States received tacrine during the first 2 years following marketing approval. The most common tacrine-associated adverse events were elevated liver transaminase levels [alanine aminotransferase (ALT) and, to a lesser degree, aspartate aminotransferase] and peripheral cholinergic events involving primarily the digestive system (nausea, vomiting, diarrhea, dyspepsia, anorexia, and weight loss). Based on clinical trial experience, potentially clinically significant (>3 x upper limit of normal) ALT elevations occurred in 25% of patients, requiring routine monitoring early in treatment. The elevations were almost always asymptomatic, rarely accompanied by significant increases in bilirubin, and related to time on drug rather than to dose (90% occurred within the first 12 weeks of treatment). Gastrointestinal events were related to dose and generally of mild to moderate intensity. Tacrine-associated events, including ALT elevations, were reversible. Cholinergic events were manageable with dosage adjustment. Tacrine was not associated with permanent liver injury in clinical trials or a TIND setting.