Hormone replacement therapy can augment vascular relaxation in post-menopausal women with type 2 diabetes.

BACKGROUND: Diabetes is a major risk factor for coronary heart disease in women and event rates increase substantially after the menopause. Observational studies have suggested that estrogens may provide cardioprotection by regulating endothelial nitric oxide synthase. METHODS: In order to examine the effect of hormone replacement therapy (HRT) on endothelium-dependent and -independent vascular relaxation in post-menopausal women with type 2 diabetes, an open study was conducted in which gluteal biopsies were collected from 17 women before and after 6 months of transdermal 17 beta-estradiol (80 microg twice weekly) in combination with oral norethisterone (1 mg daily). Small arteries (<550 microm) were dissected from fat and mounted on a wire myograph for assessment of relaxation in response to acetylcholine (ACh), bradykinin (BK) and sodium nitroprusside (SNP). RESULTS: Maximal relaxation responses to ACh, BK and SNP in women with diabetes and non-diabetic control subjects were 52 +/- 8 versus 96 +/- 2% (P < 0.05), 76 +/- 7 versus 97 +/- 1%, (P < 0.05) and 91 +/- 2 versus 98 +/- 1% (P < 0.05) respectively. After 6 months of HRT, maximal relaxation responses to ACh, BK and SNP in women with diabetes (compared with pre-HRT) were: 88 +/- 4 (P < 0.05), 93 +/- 3 (P < 0.05) and 98 +/- 1% (P < 0.05) respectively. At baseline and after HRT, EC50 (concentration required to obtain 50% of maximum response) data exhibited similar changes. CONCLUSIONS: HRT had potentially beneficial effects on vascular relaxation. Data were consistent with improvements in endothelial function, vascular smooth muscle function, or both. Controlled studies are required to confirm and extend these findings.

Pressor and subpressor doses of angiotensin II increase insulin sensitivity in NIDDM. Dissociation of metabolic and blood pressure effects.

There is evidence that the renin-angiotensin system may be involved in the metabolic as well as the cardiovascular features of diabetes and that pressor doses of angiotensin II (ANG II) increase insulin sensitivity in parallel with blood pressure (BP) in healthy subjects, but the effects of ANG II on insulin sensitivity have not been previously reported in patients with non-insulin-dependent diabetes mellitus (NIDDM). In a randomized, double-blind, placebo-controlled, crossover study, 11 patients with NIDDM attended 3 study days to evaluate the effects of a 3-h infusion of subpressor and pressor doses of ANG II on whole body insulin sensitivity using the euglycemic hyperinsulinemic clamp. BP and heart rate were recorded, and blood samples were collected for serum insulin, C-peptide, potassium, catecholamines, plasma renin activity, and plasma ANG II concentrations. Plasma levels of ANG II (means +/- SD) were 9 +/- 4, 29 +/- 9, and 168 +/- 47 pmol/ml after placebo, low dose infusion, and high dose infusion, respectively. The higher dose of ANG II was associated with significant increases in BP (e.g., 18 mmHg systolic BP at 150 min) and plasma aldosterone. Whole body insulin sensitivity was 23.8 +/- 12.7 mumol glucose.kg-1.min-1 after placebo and 30.6 +/- 12.7 and 27.2 +/- 13.3 following low and high dose ANG II infusions, respectively (P < 0.05, analysis of variance). In summary, acute infusion of ANG II, with or without an increase in BP, increases insulin sensitivity in normotensive patients with NIDDM.(ABSTRACT TRUNCATED AT 250 WORDS)

Oral pefloxacin mesylate in the treatment of continuous ambulatory peritoneal dialysis associated peritonitis: an open non-comparative study.

Twenty-two (15 female and 7 male) patients with continuous ambulatory peritoneal dialysis (CAPD) associated peritonitis were entered into an open non-comparative evaluation of oral pefloxacin mesylate. An initial loading dose of 800 mg was followed by 400 mg twice daily. Five patients were subsequently excluded or withdrawn. The mean age of the patients was 44 +/- 12.6 years. All three Gram-negative infections (Escherichia coli, Acinetobacter calcoaceticus, Serratia liquefaciens) and all three culture negative infections were cured after 21 days treatment. In contrast one of four (25%) Staphylococcus aureus infections was cured, two persisted during treatment and one relapsed, after treatments of between 10 and 25 days. One of seven (14%) Staph. epidermidis infections was cured, three persisted and three relapsed after treatments of between nine and 25 days. Two of the five persistent isolates became resistant: all four relapsed isolates remained sensitive. Twelve of the 22 (55%) patients had 16 side effects, most commonly skin or musculo-skeletal. Three stopped pefloxacin because of them, though one had taken an excessive dose in error. Pefloxacin mesylate is not optimal treatment for Gram-positive coccal peritonitis in patients on CAPD, but its role in Gram-negative disease needs further evaluation.

Semirigid and malleable penile implants.

Unless complications such as infection, erosion, or excessive bleeding develop and unless an inordinate number of malpractice suits ensue, I believe that the outpatient setting for implantation of a penile prosthesis will become increasingly utilized. As emphasized at the beginning of this article, the essential basis for success is thorough evaluation of the candidates for implantation, detailed and documented informed consent, and the elimination as outpatient candidates of poor-risk patients such as certain insulin-dependent diabetics. Patients who are good surgical and postsurgical risks are totally acceptable for outpatient operation. The cost to the patient and insurance carriers is drastically reduced. There is every reason to believe that, in the hands of the highly qualified surgeon, this type of intervention is safe, reliable, and cost-effective.