Long-term experience with tertatolol in hypertension.

The long-term antihypertensive activity and acceptability of a new beta-blocking agent tertatolol (T) (5 mg once daily) was assessed in a 12-month (M0-M12) open study, in 110 out-patients (64 men, 46 women, mean age 53.5 +/- 1.0 years), presenting with stable placebo-resistant hypertension (HT) (95 less than or equal to diastolic blood pressure less than 130 mm Hg on 3 occasions during a 1-month placebo run-in period). To obtain normalization of blood pressure (BP), treatment was adapted as from M3, adding a combined thiazide- and potassium sparing-diuretic (D) and, if necessary, the vasodilator dihydralazine (V). At M12, 93.6% of patients were controlled (supine diastolic BP less than 95 mm Hg) among whom 72.7% under T monotherapy, 16.4% under double therapy (T + D) and 4.5% under triple therapy (T + D + V). Overall variations of BP were 26.4 mm Hg for SBP (from 171.7 +/- 1.6 to 145.3 +/- 1.3 mm Hg; p less than 0.01) and 19.9 mm Hg for DBP (from 105.6 +/- 0.7 to 85.7 +/- 0.6 mm Hg; p less than 0.01). Under T monotherapy, reduction in diastolic BP occurred early (15.0 mm Hg at M1) and was sustained thereafter (19.5 mm Hg at M12); HT control was comparable in the 40- to 60- and greater than 60-year-old age groups (respectively 67.6% and 74.1%) and higher in the less than 40-year-old group (100%). It also rose from 61.2% when initial diastolic BP was greater than 105 mm Hg to 82.0% when it was less than or equal to 105 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)

Dobutamine: a hemodynamic evaluation in pulmonary embolism shock.

Intravenous dobutamine was used in ten patients requiring aggressive therapy for massive pulmonary embolism with circulatory failure. Except in one patient who rapidly died, a 30-min dobutamine infusion (8.3 +/- 2.7 micrograms/kg . min) increased both cardiac index (from 1.7 +/- 0.4 to 2.3 +/- 0.6 L/min . m2, p less than .001) and stroke index (from 16.6 +/- 6.7 to 21 +/- 5 ml/m2, p less than .01), and also reduced pulmonary vascular resistance. Additional hemodynamic improvement was observed until weaning from dobutamine, which was successfully completed 3.3 +/- 0.9 days after the start of infusion.

Influence of lung and chest wall compliances on transmission of airway pressure to the pleural space in critically ill patients.

Nineteen patients with acute respiratory failure were divided into three groups according to their total compliance (CT). Transmission of airway pressure to the pleural space was then evaluated by measurement of esophageal pressure at both end-expiration and end-inspiration, and at three levels of PEEP. Chest wall (CW) and lung complicance (CL) were also calculated from simultaneous measurements of lung volume changes induced by tidal delivery. In group 1 (CT greater than 45 ml/cmH2O), 37 percent of airway pressure was transmitted to pleural space. In group 2 (CT between 45 and 30 ml/cmH2O), 32 percent of airway pressure was transmitted to the pleural space. In group 3 (CT less than 30 ml/cmH2O), only 24 percent of airway pressure was transmitted to the pleural space. These differences are statistically significant (p less than 0.001) and illustrate the influence of a progressive increase in lung stiffness (CL = 100.3 +/- 17.2 ml/cmH2O in group 1, CL = 45.0 +/- 6.3 ml/cmH2O in group 2, and CL = 28.6 +/- 8.9 ml/cmH2O in group 3) on transmission of airway pressure to the pleural space. Despite lesser transmission of airway pressure to the pleural space in the most damaged lungs, no significant difference was found between groups with regard to transmural venous pressure changes throughout the study.

[Evaluation of the severity of pulmonary embolism. Value of the measurement of stable carbon monoxide transfer capacity]. / Evaluation de la gravité des embolies pulmonaires. Intérêt de la mesure de la capacité de transfert du monoxyde de carbone à l'état stable.

A non-invasive and easily repeatable method of pulmonary gas exchange evaluation, using measurements of stable carbon monoxide transfer capacity (DLCO) and alveolar-capillary ductance ( DuaCo ), was compared to a complex, invasive method of pulmonary vascular bed evaluation (pulmonary angiography) in 17 patients during the first 24 hours of pulmonary embolism. DLCO and DuaCo measurements were subsequently repeated in several of the patients during the course of the disease. The study showed that DLCO was lowered in both massive (Walsh's angiographic index 12.9 +/- 1.9) and submassive (Walsh's index 4.1 +/- 1.3) pulmonary embolism, with values of 7.0 +/- 2.5 and 7.0 +/- 1.8 ml/min/mm Hg respectively. It also showed a highly significant correlation between the degree of vascular obstruction, as determined by Walsh's angiographic index, and the reduction of alveolar-capillary gas exchange, as evaluated by DuaCo (r = 0.80; p less than 0.001). A progressive improvement in the pulmonary capillary bed perfused could be suspected from the results of DuaCo monitoring during the course of embolism.