Nasal patency and sleep-related breathing disorders.

This article reviews the current insights in the contribution of nasal physiology, resistance and pathophysiology in relation to sleep-related breathing disorders. Different possible pathways have been followed to prove a clear role for the nose in this matter; they are reviewed and discussed. From all this it should be concluded that today there is only evidence for abnormal nasal resistance to be a possible cofactor in the disease. A short reminder about the currently available diagnostic tools for assessing nasal patency and resistance is given next. Finally the relation between the nose and treatment of sleep-related breathing disorders with nocturnal continuous positive airway pressure is discussed.

Paroxysmal appearing palsy of epileptic origin.

Higier first reported on "Paroxysmal appearing palsy of epileptic origin". This syndrome has only rarely been described under a variety of names such as: "focal inhibitory seizures, unilateral atonic seizures, hemiparetic seizures, ictal hemiparesis". The case report we present regards a 34-year-old woman who complained of sudden loss of tone accompanied by a left-sided hemiplegia lasting for several minutes. Treatment with carbamazepine was successful in reducing the attacks as might be expected in partial seizures. An inhibitory discharge may be causative of this syndrome in agreement with Higier's original theory.

Spinal osteomyelitis: an unusual complication in aortic graft surgery.

The case history of a patient with vertebral osteomyelitis due to a contiguous paraprosthetic aortic abscess is reported. This unusual complication may be associated with the indolent nature of paraprosthetic aortic infections. The diagnostic as well as therapeutic value of computerised tomography in this condition is emphasized.

Treatment of malignant pericardial tamponade with sclerosis induced by instillation of bleomycin.

Five patients with pericardial tamponade of neoplastic origin were treated by pericardiocentesis, drainage and local instillation of bleomycin. The pericardial effusion was adequately controlled in all patients. Survival was influenced not by the pericardial involvement, but by the natural evolution of the tumour. Side effects were minimal. The technique of drainage and bleomycin sclerosis is simple, safe, effective and inexpensive for the management of a malignant pericardial tamponade, providing all precautions necessary for diagnosis and pericardiocentesis are adequately taken.

Endobronchial tuberculosis: report of three cases.

Three patients are presented who had had a chronic cough for several months, a normal physical examination and a negative chest X-ray. Fiberoptic bronchoscopic examination revealed ulcerohaemorrhagic and/or stenotic lesions which proved to be of tuberculous origin. In one case there was a life-threatening haemoptysis, and a pneumonectomy was performed.

Improved renal function during chronic lisinopril treatment in moderate to severe primary hypertension.

The effect of the converting enzyme inhibitor lisinopril on renal and cardiac hemodynamics was studied in patients with moderate to severe primary hypertension, in a multicenter, double-blind, randomized clinical trial comparing the antihypertensive effect of lisinopril (LIS) and nifedipine (NIF). After a 2 week placebo run-in period, 15 patients were randomized in a 2:1 ratio to receive either LIS (20-80 mg q.d., n = 10) or NIF (20-40 mg b.i.d., n = 5). LIS significantly reduced blood pressure (BP) without changing heart rate or cardiac output. LIS significantly increased renal blood flow; glomerular filtration rate (GFR) was not changed. It can be concluded that LIS is an effective antihypertensive agent with a favorable renal hemodynamic profile.

Noninvasive ambulatory monitoring of blood pressure in essential hypertension. Effect of age on variability and disparity.

Noninvasive daytime ambulatory blood pressure monitoring using the Remler M 2000 Portometer was performed on 84 hypertensive patients to study the effects of age on blood pressure variability and on disparity between office and ambulatory blood pressure. Disparity was higher in younger (less than 30 years) and in older (greater than 60 years) subgroups, as compared with middle-aged (30-60 years) patients. Disparity correlated with age in those greater than 30 years and increased with increasing office blood pressure. Systolic blood pressure, but not diastolic blood pressure, correlated with its variability. In patients greater than 30 years old, diastolic, but not systolic, variability correlated with age. Both, the younger and the older patients showed a higher blood pressure variability as compared with middle-aged patients. Variability and disparity were unrelated to sex.

Effect of fenoldopam on the aldosterone response to metoclopramide in man.

The effect of fenoldopam, a selective DA1-agonist, on the plasma aldosterone response to metoclopramide was studied in six hypertensive patients included in a multicentre double-blind placebo controlled cross-over study of the antihypertensive effects of fenoldopam. Fenoldopam significantly increased baseline plasma renin activity (PRA); baseline plasma aldosterone levels rose slightly. Baseline PRL and the PRL response to metoclopramide were not altered by fenoldopam. After metoclopramide, a significant increase of plasma aldosterone was observed during treatment with fenoldopam, as well as in the placebo-period. The peak values were not significantly different and occurred at 15 min during both treatment periods. These results indicate that fenoldopam does not reduce metoclopramide-induced aldosterone secretion and therefore suggest that the adrenal dopamine receptor is not identical to the vascular DA1 receptor.