Little effect of ordinary antihypertensive therapy on nocturnal high blood pressure in patients with sleep disordered breathing.

The antihypertensive effects of four different antihypertensive medications (beta-blocking agent, atenolol 50 mg; calcium-antagonist, isradipine SRO [slow release] 2.5 mg; diuretic, hydrochlorothiazide [HCTZ] 25 mg; and angiotension converting enzyme-inhibitor, spirapril 6 mg) on obese patients with sleep disordered breathing and hypertension were compared by the ambulatory blood pressure measurement (ABPM). Eighteen patients were randomized in a double-blind, crossover fashion to receive each of the four different medications for 8 weeks. ABPM was performed at baseline and after an 8-week treatment with these medications. A 2- to 3-week washout period occurred both at baseline and between each of the four medications. Three patients were omitted from statistical analysis because of technical problems of ABPM. Atenolol, isradipine SRO, and spirapril decreased significantly (P < .01) the mean 24-h systolic blood pressure, whereas HCTZ did not. The mean 24-h diastolic blood pressure decreased significantly after all four medications: 12 (SD+/-14) mm Hg with atenolol, 7 (SD+/-10) mm Hg with isradipine SRO, 3 mm Hg (SD+/-14) with HCTZ, and 6 (SD+/-15) mm Hg with spirapril (P < .01). During nighttime none of the medications reduced the mean diastolic or systolic blood pressure significantly. According to the 24-h blood pressure curve the influence of these four medications during the whole measurement period was not similar. Atenolol and spirapril lost their antihypertensive effect during the early morning hours. The antihypertensive effect of HCTZ varied markedly from hour to hour. The trough-to-peak ratio of no medication was >0.50. Negative correlation was observed between the apnea time and the mean systolic 24-h (r = -0.604, P = NS) and the mean systolic nocturnal blood pressure change (r = -0.590, P = NS). Our study revealed that the daytime high blood pressure was quite easily controlled by the ordinary monotherapy in these patients with partial upper airway obstruction and hypertension. Instead none of the medications used decreased nocturnal high blood pressure markedly.

Conduction disturbances after different blood cardioplegia modes in coronary artery bypass grafting. Including comparison with an earlier patient series.

One-hundred and nine patients undergoing coronary artery bypass grafting were randomized to seven groups according to cardioplegia technique (5 types) and right coronary patho-anatomy (2 types). There were no major intergroup differences in postoperative outcome. Conduction disturbances developed in 26 patients, also without intergroup difference. Factors predictive of conduction disturbances were studied by univariate and multivariate analyses. Patients with such disturbances had lower myocardial temperatures than the others and more often postoperative atrial fibrillation (10/26 vs 15/83, p < 0.05). Comparison of this case series with a prospective study from our hospital in 1988-1989 showed that myocardial protection was superior in the present study. The incidence of right bundle branch block was similar in the two studies (24% vs 23%), but that of left-side conduction disturbances (bundle branch or fascicular block) was dramatically reduced (19% vs 1%, p < 0.0001) concomitantly with improved myocardial protection, indicating that development of a left-side conduction disturbance is associated with myocardial injury.

Atrial fibrillation after blood and crystalloid cardioplegia in CABG patients.

In an investigation of factors influencing the occurrence of supraventricular arrhythmias, ninety-eight patients were randomized to receive either cold blood (n = 49) or cold crystalloid (n = 49) cardioplegia during an elective coronary artery bypass grafting operation and were followed for seven days for the development of postoperative atrial fibrillation (AF). Twenty-one patients in the blood-cardioplegia group and nine in the crystalloid-cardioplegia group developed AF (p < 0.01). The patients who developed AF had smaller CK-MB enzyme leaks one hour after the operation (57 +/- 26 iu/L for AF vs 70 +/- 30 iu/L for normal rhythm, p < 0.05), and more often spontaneous beating after cross-clamp release (37% vs 15%, p < 0.05), which indicates that AF was not associated with poor ventricular myocardial protection or conduction system protection. The lesser amount of cardioprotective solution with AF patients (3551 +/- 1585 ml vs 4064 +/- 1562 ml, p < 0.05) and the time of onset of atrial fibrillation (4.0 +/- 1.8 postop. days) indicate that AF is probably caused at least partly by a reperfusion injury at the atrial level. The possibility of atrial fibrillation can be reduced by giving sufficient cardioplegia and giving beta-blocking medicine after the operation.

Rhythm disturbances after blood and crystalloid cardioplegia in coronary artery bypass grafting.

One hundred consecutive patients scheduled for coronary artery bypass grafting were randomized to receive either blood or crystalloid cardioplegia. Successful Holter monitoring for rhythm disturbances was done before and immediately after the operation in 83 cases. With both modes of cardioplegia there were increases in the occurrence of rhythm disturbances postoperatively. The increases were mostly statistically significant. There was no intergroup differences in the occurrence of arrhythmias. The association between these disturbances and cross-clamp times, myocardial temperatures during cross-clamping, myocardial fibrillation times during and after cross-clamping, CK-MB values and perioperative infarction all indicated ischaemia or incomplete myocardial protection as a major cause of the immediate postoperative rhythm disturbances.

Prevention of travellers' diarrhoea by oral B-subunit/whole-cell cholera vaccine.

B-subunit/whole-cell cholera vaccine (BS-WC) has been shown to give Bangladeshi mothers and children only 3 months' protection against severe diarrhoea due to enterotoxigenic Escherichia coli (ETEC). Since a long-lasting effect is not necessary for protection against travellers' diarrhoea, a prospective double-blind study was conducted among tourists who went to Morocco from Finland. 307 tourists received two oral doses of BS-WC, whereas 308 controls received a placebo before departure. A research team went out with tourists and a laboratory for enteric pathogens was set up on location. A faecal specimen was taken from 100 randomly selected subjects before departure, from all travellers with diarrhoea, and routinely after return. Enteropathogenic bacteria were not isolated from any of the pre-departure specimens but were present during or after the holiday in 47% of tourists with travellers' diarrhoea, and in 14% of those without diarrhoea. BS-WC induced a 52% protection (p = 0.013) against diarrhoea caused by ETEC. The protection was better for mixed infections (65%, p = 0.016). The protective efficacy against a combination of ETEC and any other pathogen was 71% (p = 0.02), and that against ETEC plus Salmonella enterica even better at 82% (p = 0.01). Partial protection against travellers' diarrhoea is thus obtainable by active immunisation with BS-WC.

Mequitazine and dexchlorpheniramine in perennial rhinitis. A double-blind cross-over placebo-controlled study.

The therapeutic effect and adverse reactions of two antihistamines, mequitazine and dexchlorpheniramine were double-blindly compared both to placebo, to each other and to the pre-treatment status in 29 adult patients suffering from perennial rhinitis. Dexchlorpheniramine relieved the rhinitis symptoms significantly (p less than 0.01) better compared to placebo while mequitazine did not differ from placebo. 20 out of 29 patients chose dexchlorpheniramine as their favourite drug. Dexchlorpheniramine reduced all the separate symptoms studied (obstruction, rhinorrhoea, sneezing) significantly, mequitazine relieving merely rhinorrhoea. In anterior rhinoscopy mucosal congestion was reduced both by dexhlorpheniramine (p less than 0.01) and by mequitazine (p less than 0.05) but secretion or lividity showed no difference between the active drugs and placebo. The occurrence of side-effects was not significantly different between the drugs. In controlling perennial rhinitis symptoms mequitazine was markedly inferior to dexchlorpheniramine and only slightly better than placebo.

Otoscopic diagnosis of middle ear effusion in acute and non-acute otitis media. I. The value of different otoscopic findings.

To determine the value of different pneumotoscopic findings in diagnosing the middle ear effusion (MEE) of acute (AOM) and non-acute otitis media, 11,804 ear-related visits of 2,911 unselected children at ages 0.5-2.5 years were analysed. About half of these were examined by an otolaryngologist in one, and half by a pediatrician in another, urban area. Myringotomy was always performed when MEE was suspected, and it confirmed the presence of MEE in 85% (otolaryngologist) and 82% (pediatrician) of altogether 5,462 acute and in 69% (both doctors) of 1,092 non-acute cases suspected. Redness of the tympanic membrane (TM) was found in only 18% and 27% of the visits with AOM, and it predicted MEE with only 60% and 51% probability, if seen in acute visits. Cloudiness of the TM was noticed in 81% and 67% of the visits with AOM; its specificity and the other calculated variables were good in regard to the diagnosing of MEE, especially in acute cases in both groups. Distinctly impaired mobility of the TM was of about the same diagnostic value, but its position reliably indicated MEE only when bulging. In AOM the colour or mobility of the TM was normal very rarely, but the position was normal in a third of the cases. Thus, although there were differences in the incidences of different otoscopic findings in the two study groups, the diagnostic value of certain pneumatic otoscopic findings, especially cloudiness and distinct hypomobility of the TM, seemed to be good in both groups.

High-frequency hearing of dental personnel.

234 dentists and dental nurses were examined with a normal and a high-frequency audiometer in high standard clinical conditions. Their ordinary and high-frequency hearing as compared with the controls showed no significant differences. Thus, exposure to high-frequency noise from high-speed drills and other modern dental instrumentation does not appear to be harmful to one's hearing and does not necessitate audiologic screening procedures for dental personnel.

Urogenital involvements and rheumatic disorders in females. An interview study.

To study dependence between urogenital involvements and musculoskeletal complaints in females, 311 randomly selected women aged 15 to 54 were interviewed. In the analysis of these dependences musculoskeletal complaints were considered as a whole per person. A history of salpingitis, gonorrhoea, urinary tract infection (UTI) and Trichomonas vaginalis was revealed as constituting a relative risk factor of 4.4, 3.9, 3.1 and 4.5 respectively in connection with inflammatory rheumatic disease or suspicion of it, with or without dorsal pains of unknown cause. Anamnestic cervicitis was disclosed as constituting a relative risk factor of 1.9 in connection with joint pains in the extremities and 1.8 in connection with dorsalgia of unknown cause, but not a statistically significant relative risk of inflammatory rheumatic diseases or suspicion of them. Salpingitis is proposed as a diagnostic criterion for female Reiter's syndrome. In epidemiologic work the importance of considering the medical history of musculoskeletal complaints as a whole per person is emphasized.