[Typhoid fever]. / Typhus abdominalis.

The second part of this review accounts on a patient with classic symptoms of typhoid fever. The case history is commented in the light of todays knowledge. The case was taken from the clinical notes of Schönlein one of the most famous clinicians of the first part of the 19th century. It reveals the difficulties of the physician to cope with such a disease without our present diagnostic and therapeutic possibilities. It is surprising to realize that 150 years ago therapy of typhoid fever was not substantially different from that in use up to the recent introduction of specific antibacterial therapy. Since the typical course of typhoid fever is only rarely encountered nowadays the case seems suitable to recall this clinical picture to our generation of physicians.

[Acute rheumatic fever]. / Akutes Rheumatisches Fieber.

In view of the progress in modern medicine it might be of interest to revive how a century ago a physician diagnosed and treated without our current technology. The transition to science based medicine around 1840 invites to follow bedside medicine by reviewing old case histories in the light of current knowledge. The clinical lectures of Schoenlein one of the leading clinicians of this time appear particularly suited. This first part gives a short biography of Schoenlein and comments the history of a patient with the classic picture of rheumatic fever. This case demonstrates the priming of physicians by prevailing theory and philosophy which may be gracefully accepted by the patient. This brings to conscience that medicine and physicians have roles beyond modern technology.

[Therapy of urinary tract infection from the internal medicine viewpoint]. / Therapie des Harnwegsinfektes aus internistischer Sicht.

Effective treatment of urinary tract infection is dependent on a precise case history and a thorough physical examination. Before using antibacterial compounds it is mandatory that the physiological defense mechanisms be actively supported by nonspecific actions. Depending on the environment where patients are being cared for (general practitioner--hospital), the antibacterial therapy should take into account bacteriological information on the sensitivity of the bacteria to antibacterial agents.

Long-term effects of a complex behavioral treatment of essential hypertension.

A multidimensional behavioral program was developed for the treatment of essential hypertension. Over a course of 6 weeks, 108 patients of a rehabilitation center were treated with this program consisting of health education, self-monitoring of blood pressure, relaxation techniques, and a social skill training in addition to standard medical treatment alone. Blood pressure and other cardiovascular risk factors were monitored for a period of 12 months. Blood pressure levels became normotensive in both groups at the end of the 6-week training program. However, the blood pressure reduction in the behavioral treatment group was achieved with fewer patients taking antihypertensive medication than in the control group. The number of patients taking antihypertensive drugs in the treatment group was 60.2% prior to treatment and 44.4% after treatment; figures for the control group were 68% and 73.8%, respectively (p less than or equal to 0.01). Almost identical data were obtained at the 6- and 23-month follow-up examinations. No consistent changes were observed in weight, smoking, or blood lipids. These results demonstrate beneficial and long-lasting effects of a combined medical and psychologic treatment of essential hypertension as compared to medical treatment alone.

Intracellular calcium in secondary hypertension.

In 13 essential hypertensives, 15 renal hypertensives, 16 patients with phaeochromocytoma, 6 patients with renal artery stenosis and in 21 normotensive controls the Ca2+ and K+ content in the asked material from red blood cells was determined by flame photometry. Furthermore, intracellular K+ concentration was measured in the haemolysate. The ratio between Ca2+ and K+ concentration in ashed red blood cells (Cai2+/Ki+) was 2.07 +/- 0.9110-3 in normotensives, 4.58 +/- 1.68 10(-3) in essential hypertensives (p less than 0.01), 3.13 +/- 1.90 10(-3) in renal hypertensives (p less than 0.05), 2.15 +/- 1.62 in patients with phaeochromocytoma and in patients with renal artery stenosis 2.25 +/- 1.25. Intracellular K+ concentration was 94.3 +/- 3.1 mumol/l in normotensives, 94.7 +/- 3.8 mumol/l in essential hypertensives and 93.8 +/- 3.9 mumol/l in renal hypertensives, 198.2 +/- 149.1 mumol/l in patients with phaeochromocytoma and 201.1 +/- 139.1 mumol/l in patients with renal artery stenosis. Therefore, intracellular total Ca2+ concentrations is concluded to be increased in red blood cells from essential hypertensives and, to a lesser extent, in those from renal hypertensives. The method to determined Cai2+/Ki+ in the red blood cells may thus be suitable to assess cellular Ca2+ content in hypertension.

Effects of drugs on magnesium requirements.

A number of drugs can influence Mg metabolism and produce changes in serum Mg concentrations. These alterations must always be considered in the differential diagnosis of cases with Mg disturbances. Hypermagnesemia is seen, particularly after administration of Mg-containing drugs in renal insufficiency. Marked hypomagnesemia can be observed in a great number of patients, particularly in those treated with loop diuretics, osmotic substances and with antineoplastics, such as cisplatin.

Weight reduction and salt restriction in hypertension: effects on blood pressure and intracellular electrolytes.

In 16 essential hypertensives on a program of energy restriction (800 kcal/day) with and without simultaneous salt restriction, the effects on blood pressure and intracellular Na+ and Ca2+ in red blood cells were studied. A decrease in blood pressure and intracellular free Na+ and Ca2+ was only observed in the cases of simultaneous energy and salt restriction. The beneficial effect of weight reduction in hypertension thus depends on a diminished salt intake and is probably mediated by changes in intracellular free Ca2+.

Elemental and trace element distribution in medical samples: analysis by proton-induced X-ray emission.

The analysis of trace elements is performed by proton-induced X-ray emission. The process is most effective if the velocity of the exciting particles--protons--is similar to the velocity of the electron on its orbit in the simple atomic model of Bohr. For K-shell electrons of the elements with 15 less than or equal to z less than or equal to 40 this requires proton energies of a few MeV, available from electrostatic van de Graaf accelerator machines. After knocking out the K-shell electron, the empty place is filled up by electrons jumping from higher orbits with simultaneous emission of characteristic X-rays, which are registered with a cooled Si (Li) detector. By a set of electrodes the beam can be swept across the specimen surface. Therefore this method yields an excellent correlation of trace element distribution within the morphological structure of organic tissue. In the present study the sweep went along a line perpendicular to the arterial wall layers (aortic, renal artery and heart muscle) of normotensive and spontaneously hypertensive rats. Along this line all elements and trace elements are recorded simultaneously. These are P, S, Cl, K, Ca, Fe, Cu, Zn, Br and Sr. The trace element content of the aortic wall and the renal artery, of 22 spontaneously hypertensive and 11 normotensive rats and of human heart muscle was investigated. The results demonstrate that Zn was only detected in the muscle-containing layers of the arteries. There was no different distribution between hypertensive and normotensive rats. However, Ca2+ was mainly detected in the smooth muscle-containing tunica media of hypertensive rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects on blood pressure of cross circulation between spontaneously hypertensive and normotensive rats.

In order to examine the role of humoral factors for the development of hypertension in the spontaneously hypertensive rat of the Münster strain (SHR) cross circulation experiments with normotensive Wistar Kyoto rats were performed. Cross circulation between SHR and normotensive rats for 30 min increased mean arterial pressure in the latter by 29.1 +/- 7.6 mm Hg (p less than 0.01). Transmission of hypertension by cross circulation was abolished by nephrectomy, adrenalectomy, volume depletion or chronic salt restriction in the SHR. It is concluded that hypertension in SHR is caused by a circulating hypertensive agent produced in kidneys and adrenals, the secretion of which can be suppressed by volume or salt depletion.

Zinc metabolism during captopril treatment.

In 14 hypertensives the effect of captopril (angiotensin-converting enzyme inhibitor) treatment on red blood cell Na+, K+, Mg2+ and Zn2+ concentrations and on plasma Zn2+ concentrations were studied. Intraerythrocytic Zn2+ concentrations increased slightly, whereas plasma zinc concentrations decreased. The concurrence of hypozincemia with side effects resembling the symptoms of zinc deficiency such as loss of smell and taste suggests a role of alterations in zinc metabolism for the pharmacodynamics of captopril.

Compliance with salt restriction as a limiting factor in the primary prevention of hypertension.

It is an important but still unresolved question whether reduction of salt intake in the offspring of hypertensives (a high risk group) prevents the development of the disease. Therefore, 178 offspring (14-26 years old) of hypertensives were enrolled in a 2-year pilot trial aimed mainly at a reduction in salt consumption. For the intervention group (n = 99) a behavioural approach was chosen with extensive counselling by experienced dietitians. The controls (n = 79) received no continuous dietary advice. Both groups showed a small decline in sodium intake over time, but the differences between the two groups were not significant. Division into subgroups with and without sodium reduction revealed no differences in blood pressure. We conclude that the inherent resistance to any change of lifestyle among healthy subjects may require new and more comprehensive motivational approaches.

Evidence for a hypertensive factor in the blood of essential hypertensives.

From plasma of essential hypertensives and normotensives several fractions were obtained after: (1) removing proteins with a relative molecular mass greater than 6,000-8,000, and (2) chromatography on a Biogel P4 or Biogel P2 column. The eluate was separated into 3-4 fractions. These fractions were concentrated to a small volume of 0.5 ml and were injected intravenously in normotensive rats, the mean arterial pressure of which was monitored. One of the fractions from normotensive plasma increased blood pressure in the rat in some but not in all cases. Using the fractions from hypertensive plasma there was an increase in blood pressure in the fraction corresponding to that of normotensive plasma increasing blood pressure and in another fraction of lower molecular weight. Angiotensin II is unlikely to be responsible, since it could be identified in another fraction than that containing the hypertensive factor. It can be concluded that in the blood of essential hypertensives a hypertensive factor is present, which increases blood pressure even in normotensive animals. Its secretion may represent the critical step in the pathogenesis of essential hypertension.

Essential hypertension versus secondary hypertension: discrimination by intracellular electrolytes.

Intracellular activities of sodium and calcium were determined in red blood cells in a group of 106 patients, consisting of essential and renal hypertensives and of normotensives with and without renal insufficiency. Calcium and sodium activities were elevated in essential hypertensives as compared to hypertensives suffering from renal insufficiency. Compared to normotensives without renal insufficiency higher sodium and calcium activities were measured in normotensives without renal impairment. Thus the results suggest that the determination of intracellular electrolytes might be a useful tool for the distinction of secondary hypertension. Furthermore, as yet unidentified humoral factors produced in the kidney might be involved in the regulation of the blood pressure, as a decrease in production of these hypothetic humoral factors (following the destruction of renal tissue) could be the cause for the changes in electrolyte composition.

Influence of low and high cadmium diet in normotensive and hypertensive SH-rats.

Normotensive and SH-rats (Münster strain) were fed a cadmium-rich, normal or cadmium-poor diet. The blood pressure was slightly increased in normotensive rats after feeding a cadmium-rich diet and decreased after a cadmium-poor diet. In contrast, in SH-rats blood pressure was decreased after a cadmium-rich and increased after a cadmium-poor diet. This behavior of the blood pressure corresponded with the intra-erythrocytic Ca2+ activities. Whereas the calcium activities increased in the normotensive group after a cadmium-rich diet, the calcium activities decreased in the SH-group after cadmium feeding. It should be pointed out that normally the calcium activities were found to be elevated in SH-rats. Thus, cadmium feeding here had the same effect as a calcium antagonist.

The evaluation of tissue Ca2+ by proton-induced x-ray emission in the arteries of spontaneously hypertensive and normotensive rats.

Numerous investigations have shown that Ca2+ plays a critical role in the pathogenesis of hypertension. The intracellular Ca2+ measurements were mainly carried out with Ca2+ selective electrodes. In the present study the particle-induced x-ray emission (PIXE) was used for investigating the Ca2+ distribution of arterial smooth muscle of spontaneously hypertensive and normotensive rats. PIXE yields a correlation of the Ca2+ distribution with the morphological structure of the arterial muscle. The Ca2+ content of the aortic wall of six spontaneously hypertensive and four normotensive rats was investigated. The results demonstrate that the tissue Ca2+ measurements found mainly in the smooth muscle containing tunica media of hypertensive rats are much higher (3105 micrograms Ca2+/g tissue +/- 569 micrograms Ca2+/g tissue) than of normotensive rats (2031 micrograms Ca2+/g tissue +/- 478 micrograms Ca2+/g tissue).

Intracellular sodium and calcium during antihypertensive treatment.

In 49 untreated essential hypertensives the effects of the loop diuretic, piretanide, in a dose of 12 mg daily (n = 14) and of 6 mg daily (n = 18) as well as of beta blockers (pindolol, metipranolol, atenolol, n = 17) on blood pressure, intracellular Ca++ and Na+ activity in red blood cells were examined. Intracellular ion activities were measured by ion-selective electrodes. The higher dose of piretanide caused a decrease of intracellular Ca++ activity and an increase of intracellular Na+ activity. Under the lower dose of piretanide there was a comparable decrease of intracellular Ca++ activity but no significant change of intracellular Na+ activity. Beta blockers decreased intracellular Ca++ activity but left intracellular Na+ activity unchanged. It is concluded that intracellular free Ca++ plays an important role in the regulation of vascular tone in essential hypertension. There seems to be no direct relation between intracellular free Na+ and blood pressure under antihypertensive therapy.