Diurnal blood pressure profile in older patients with isolated systolic hypertension. The SYST-EUR Investigators.

This study describes the diurnal blood pressure (BP) profile and identifies its correlates in older patients with isolated systolic hypertension (ISH). The ambulatory BP readings of 408 patients, aged > or = 60 years, with ISH on clinic measurement, enrolled in the placebo run-in phase of the Syst-Eur Trial were examined. The time-weighted 24 h BP, daytime and night-time BP and the cusum-derived crest and trough BP were computed to express the BP level. The daily alteration between the high and low BP span was estimated from the day-night BP difference, the cusum derived circadian alteration magnitude and plot height, as well as the amplitude of the Fourier curve. The 24 h SBP and DBP tended to be higher in men (150 +/- 15/82 +/- 9 mm Hg) than in women (147 +/- 17/79 +/- 10 mm Hg), but the sex difference was only significant for DBP. In multiple regression analysis, the 24 h SBP increased (P < 0.05) by 3 mm Hg for each 10 year increment in age and was also 10 mm Hg higher (P < 0.001) in smokers than in non-smokers; the 24 h DBP was 2 mm Hg higher (P < 0.05) in men than in women and decreased (P < 0.05) by 1.5 mm Hg for each 10 year increment in age. The day-night difference in SBP increased with 2 mm Hg for each 10 mm Hg increase in the conventional pressure, decreased with 5 mm Hg for each 10 year increment in age and was 6 mm Hg higher in smokers than in non-smokers; the day-night difference in diastolic pressure was 2 mm Hg greater in women than in men. We conclude that the main determinants of the diurnal BP variation in older patients with isolated systolic hypertension were sex, age, smoking habits and the level of pressure on conventional measurement.

Submicron emulsions as drug carriers. Studies on destabilization potential of various drugs.

Few drugs have been successfully formulated as submicron emulsions. The physicochemical stability of submicron emulsions on admixture of drugs is the main factor limiting a wider use of this type of vehicle for parenteral or other routes of administration. In a short-term stability studies we have investigated 35 drugs with regard to their compatibility with 20 or 5% parenteral fat emulsions. The study has shown that interaction of drugs with submicron emulsions is complex in nature. Taking into consideration the physicochemical properties of a drug e.g. lipophilicity or ionization, it is difficult to predict changes in the physical stability of the system. If destabilization occurs it is maximal at saturated concentrations and the presence of even significant amounts of the solid phase formed by undissolved drug does not influence the short-term stability of the system. Due to the increased ratio of emulgator to oil, emulsions containing 5% of oily phase are less susceptible to destabilization than 20% emulsions.

Increased partitioning of pilocarpine to the oily phase of submicron emulsion does not result in improved ocular bioavailability.

Submicron emulsions containing pilocarpine as ion-pair with mono-dodecylphosphoric acid were prepared. Physical stability of these preparations was confirmed during 4 months of storage at 4 degrees C. Approximately 50% of the drug was found in the aqueous phase of emulsion separated using an ultrafiltration technique, while the rest was present in the oily phase and interphase. The miotic effect observed in rabbits after application of the ion-pair in aqueous solution or in submicron emulsion was the same; indicating that the drug distribution into the oily phase of the colloidal vehicle does not improve ocular bioavailability.

Images of health technology in national and local strategies.

OBJECTIVES: This paper examines the potential of various models relating technology to society and institutional structures to inform health policy. Among the models discussed are various versions of technological determinism, social constructivism, actor network theory and critical theory. METHODS: The paper considers recent developments in policy and strategy that aim to shape the way the UK's National Health Service (NHS) integrates Information and Communication Technologies (ICTs) into health care and considers what these alternative models highlight or emphasise, and how they might influence the activities of setting local implementation strategies. RESULTS AND CONCLUSIONS: Contemporary ICTs are often presented as having a particular relevance and power in reforming or transforming the delivery of health care. Understanding how such technologies might be conceived of, implemented and become an integral part of some future health care system is an important and challenging task that requires innovative theoretical treatments.

Telehealth technology: consequences for structure through use.

In recent years the focus of ICTs in healthcare has changed from the â back office' to the front end of patient care. These changes have been brought about by a number of factors including the potential of technologies, pressures for modernisation and administrative reforms, including blurring of the boundaries between different organisations (within and beyond the health sector), and which break down traditional barriers between administration of health services and the practice of medicine In this paper we explore in particular how technology is implicated in such changes, focussing on the consequences of the use of the new telehealth technologies, as seen in a set of linked case studies from an inner city borough in London. The paper addresses the way these technologies, through routine use, become (or not) resources and rules that embody new structures for health care.

[Remarks on conservative treatment of cerebral hematoma]. / Uwagi do zachowawczego leczenia krwiaków sródmózgowych.

Authors present 38 patients treated non-operatively because of intracerebral haematomas since 1988 till 1990 in ++Neuro-traumatological Ward Medical Academy of Lódz. The aforementioned data revealed that patients could be treated non-invasively if: 1. On admittance to the ward they were in good general condition they were conscious or their awareness was uptuned a bit. 2. Compression of ventricular system and even slight replacement of media line structures was not an indication to operative treatment if the consciousness of the patients had been good, had not deteriorated during the treatment and on CT scan control haematomas and mass effect vanished. 3. It seemed that if general and neurological condition of patients was good or improved the control could be performed in week or even longer periods of time.

[A case of Recklinghausen's disease with bilateral tumors of the cerebellopontile angle]. / Przypadek choroby Recklinghausena z obustronnym guzem kata.

A case of bilateral cerebellopontine angle neuroma in a patient with von Recklinghausen's disease was treated successfully surgically.

[Post-traumatic cerebellar hematomas]. / Pourazowe krwiaki sródmózgowe.

The authors present 16 cases of post-traumatic intracerebellar haematomas treated in the Department of Neurosurgery and the Division of Neurotraumatology, Chair of Neurosurgery, Medical Academy in Lódz in the years 1948-1987. The analysis included the type of trauma, the clinical course, the laboratory investigations and treatment methods. The following conclusions have been reached: Intracerebellar haematomas are post-traumatic complications of adult age following most frequency falls. On the basis of the clinical pattern it has not been possible to isolate a clinical syndrome characteristic for intracerebellar haematoma. A similar clinical course is observed in cases of other haematomas situated in other parts of the posterior cranial fossa. In the diagnosis of decisive importance is CT or operation. Mortality in intracerebellar haematomas is similar to that in epidural haematomas. Deaths occurred in cases operated on in acute stage. Owing to increasing availability of CT conservative treatment of intracerebellar haematomas has become possible. Follow-up shows that worse results of surgical treatment were obtained in cases of acute haematomas. In cases of chronic haematoma late results of treatment were good.

[Cases of malignant neoplasms of soft tissues of the scalp]. / Z kazuistyki nowotworów zlosliwych tkanek miekkich owlosionej czesci glowy.

Two cases of sarcomas of the scalp are reported. Attention is called to the importance of early diagnosis and radical surgical treatment despite the high malignancy and tendency for recurrences.

[Conservative treatment of post-traumatic intracerebellar hematoma]. / Zachowawcze leczenie pourazowych krwiaków sródmózdzkowych.

In previous years many authors stressed the very rare occurrence and difficulties in establishing of early diagnosis in cases of posttraumatic haematomas in the posterior cranial caeity, among them also the intracerebellar ones. The detection rate of this condition has increased greatly after introduction of computed tomography in the diagnosis of complications following craniocerebral trauma, changing also the view on the method of its treatment. Although before the introduction of CT the prevailin view was that all intracerebellar haematomas should be treated sugically the present opinion is that some of them meeting certain criteria (small size, peripheral situation in the cerebellar hemispheres laterally to the midline, absence of symptoms of intracranial hypertension, and the possibility of frequent CT control) may be treated successively without surgical intervention with adwantage to the patient. Two cases are presented in which intracerebellar haematomas were treated conserwatively. The authors review the pertinent literature stressing the criteria which should be considered in the qualification of patients for this management.

[Porphyria cutanea tarda--new views on its pathogenesis and therapy]. / Porfiria skórna pózna--nowe spojrzenie na patogeneze i terapie.

Literature data and the results of our studies on the prevalence of the HCV infection markers in patients with porphyria cutanea tarda (PCT) are presented. We also present new views on the PCT pathogenesis in some cases, therapy of the cutaneous changes, and the use of interferon in the patients as a prevention of the hepatocellular carcinoma.

[Liver transplantation in a patient with hemolytic syndrome in the course of fulminant Wilson's disease]. / Transplantacja watroby u chorej z zespolem hemolitycznym w przebiegu piorunujacej postaci choroby Wilsona.

The case report of a 20 year old woman with fulminant liver failure and hemolytic syndrome was described. Huge amounts of copper excreted in the urine (3555 mg/12 h without, and 5180 mg/12 h after d-penicillamine provocation, respectively) confirmed the diagnosis of fulminant Wilson's disease. Because the patient's general condition worsened rapidly (hemolysis, diathesis hemorrhagic, ascites, encephalopathy increased during 3 days of clinical observation) orthotopic liver transplantation was performed. After the transplantation, ischemic type biliary lesion (ITBL) II stage was diagnosed. The woman is still being treated with Prograf and Urso-Falk. The patient returned to her normal life, continues to work and was married. Two years after OLT she gave birth to a healthy boy. The liver function tests are normal with the exception of GGTP and FALK activities elevation. Copper and ceruloplasmin level, as well as copper excretion in the urine are within the normal values.

[Low zinc levels in metabolic X syndrome (mzX) patients measured by hair zinc composition analysis]. / Niski poziom cynku u chorych z metabolicznym zespolem X (mzX) stwierdzany w oparciu o analize zawartosci tego pierwiastka we wlosach.

The hair zinc content in 16 patients with metabolic X syndrome (mzX) was measured by means of atomic absorption spectrometry method. The mean concentration (125.13 mg/kg) was lower than in the majority of other published studies. The differences among groups of patients with different sex or diseases (e.g. coronary heart disease, hypertension, type II diabetes mellitus) were not significant. It seems to be probably that deficiency of zinc plays a role in pathogenesis of mzX or that it is a consequence of mzX.

Ultrastructural study of the submandibular gland of the rat after 6-month exposure to cadmium and zinc in drinking water.

PURPOSE: Cadmium toxicity in the exposure of the general, professional and cigarette smoking populations has been well known. From the dental point of view, it is important to find out whether and how separate and joint exposures to cadmium and zinc affect the structure and function of the submandibular gland, which is the major saliva-releasing gland. Cadmium, a particularly active xenobiotic, damages cellular metabolism at the level of various enzymatic systems of the cell, which may disturb functioning of the salivary glands. Mutual interactions of cadmium and zinc suggest a protective role of zinc through the induction of metallothionein which inactivates cadmium effect. MATERIAL AND METHODS: The aim of the study was to assess the ultrastructural picture of chosen cell organelles of the submandibular salivary gland of the rat exposed to cadmium and zinc. The study used 90 male Wistar rats, of the initial b.w. 150-180 g. The animals were exposed to cadmium and/or zinc for 6 months. Cadmium was received in aqueous solutions of cadmium chloride with drinking water at a concentration of 5 mg Cd/dm3 or 50 mg Cd/dm3. Zinc was also given in aqueous solutions of zinc chloride ad libitum at concentrations of 30 mg Zn/dm3 and 60 mg Zn/dm3. RESULTS: The ultrastructural changes in the mucous and serous cells of the submandibular salivary gland were most pronounced at cadmium concentration of 50 mg Cd/dm3 and were mainly observed in the cell nucleus, Golgi Apparatus and secretory granules of the salivary gland cells. CONCLUSIONS: 1. Exposure to cadmium induces ultrastructural changes in the submandibular gland, which are dose and time of exposure. 2. Exposure to zinc did not affect significantly the ultrastructural picture of cells of the submandibular gland. 3. Zinc administered together with cadmium reduces the intensity of ultrastructural changes in the submandibular gland.