Prevalence of gastroesophageal reflux in dogs undergoing MRI for a thoracolumbar vertebral column pathology.

OBJECTIVES: The aims of the study were to investigate the prevalence and extent of gastroesophageal reflux, and the prevalence of regurgitation in dogs undergoing thoracolumbar spine magnetic resonance imaging, and to explore possible associations of reflux and regurgitation with signalment (breed, age, sex, neuter status), bodyweight, body condition score and drugs used in the anaesthetic protocol. MATERIALS AND METHODS: The thoracic part of the oesophagus was retrospectively assessed for presence and quantification of fluid on two T2 weighted sequences. Patient breed, age, sex, neuter status, weight and body condition score were recorded. Anaesthetic records were reviewed for the presence of regurgitation and detailed anaesthetic protocols. RESULTS: Fifty percent (95% confidence interval: 45 to 57%) of included dogs had evidence of gastroesophageal reflux. Reflux was not associated with the individual breed, age, sex, neuter status or body weight. Brachycephalic dogs did not demonstrate significantly higher rates of reflux compared to non-brachycephalic dogs. A larger volume of reflux was associated with a higher chance of regurgitation. CLINICAL SIGNIFICANCE: Gastroesophageal reflux is a common finding in dogs undergoing thoracolumbar spine magnetic resonance imaging. Dogs which regurgitated had higher volumes of reflux. Early detection and quantification of the volume of reflux is helpful as it may allow the anaesthetist to take measures which may reduce the risk of associated complications.

Interim PET-CT-guided therapy in elderly patients with Hodgkin lymphoma-a retrospective national multi-center study.

Hodgkin lymphoma (HL), a disease of mostly young patients, also peaks in the elderly. Despite the profound improvement in the outcome of young patients, in the elderly, 5-year progression-free survival (PFS) rates are under 70%. Interim PET-CT (iPET) is known to be highly predictive for PFS in young HL patients, but it has not been sufficiently validated in the elderly patient population. In this multi-center collaboration, all consecutive elderly patients (age ≥ 60) diagnosed with HL between 1998 and 2016 were retrospectively reviewed. Baseline characteristics, outcome measures, and iPET results, classified according to the Deauville score, were recorded and analyzed. We identified 78 elderly HL patients (median age 69) who underwent iPET. ABVD was the treatment regimen in 52 (67%) patients. Eighty-three percent of patients had iPET scores of 1-3 while 17% had scores of 4-5. Patients with iPET scores of 1-3 had 5-year PFS and OS rates of 72% and 82% compared with 25% and 45%, respectively, in patients with scores of 4-5 (p < 0.001). Our findings show that iPET is highly predictive of outcome in elderly HL patients and provide evidence that iPET-guided therapy in this patient population may be key to achieving superior treatment outcome.

Creatinine level as a predictor of hypertensive disorders during pregnancy.

This study aims to examine the association between creatinine level during the first 20 weeks of pregnancy and the development of pre-eclampsia in the second half of the pregnancy. The study population included all registered births (n=9341) between 2001 and 2007 in a tertiary medical centre. Student's t-test and receiver operating characteristic (ROC) curves were used to determine any association. Significant association was documented between creatinine level in the first 20 weeks and the prevalence of hypertensive disorders. The mean plasma creatinine value in women with mild pre-eclampsia versus healthy women was 0.59 mg/dL +/- 0.14 versus 0.57 mg/dL +/- 0.15, respectively (P = 0.023). The mean plasma creatinine value in women with severe pre-eclampsia versus healthy women was 0.61 mg/dL +/- 0.17 versus 0.58 mg/dL +/- 0.15, respectively (P = 0.040). The mean plasma creatinine value in women with hypertensive disorders versus healthy women was 0.60 mg/dL +/- 0.15 versus 0.58 mg/dL +/- 0.15, respectively (P=0.003). The ROC curve demonstrated a significant association between creatinine level in the first 20 weeks of pregnancy and the development of mild and severe pre-eclampsia in the second half of pregnancy (area under the curve: 0.54, 95% confidence interval [CI]: 0.51-0.57, P = 0.02, and 0.56, 95% CI: 0.50-0.62, P = 0.033, respectively). Higher creatinine levels during the first 20 weeks of pregnancy are associated with a higher risk of developing mild and severe pre-eclampsia.

Modification of neutrophil adhesion to human endothelial cell line in acute ischemic stroke by dipyridamole and candesartan.

Ischemic stroke is a leading cause of disability. Inflammation of the vessel wall following neutrophil adhesion to vascular endothelium may contribute to ischemic damage. We studied the effect of a platelet inhibitor and an angiotensin II receptor antagonist: alone or in combination, on the adhesion of neutrophils to endothelial cell line in stroke patients. Neutrophils were collected from 12 patients with ischemic stroke within 48 h. Six patients with previous stroke and six healthy volunteers served as control. Neutrophils were incubated with dipyridamole, candesartan or both and allowed to adhere to human endothelial cell line (ECV-304). Adhesion and expression of adhesion molecules (AM) were determined using fluorescence-activated cell-sorting (FACS). Dipyridamole and the combination of dipyridamole and candesartan inhibited significantly the adhesion of neutrophils from ischemic stroke patients as compared to controls with a prominent additive effect. No inhibition was seen in the control groups. These drugs also reduced significantly the expression of the AM Mac-1. Both candesartan and dipyridamole inhibited the adhesion of neutrophils to vascular endothelium in ischemic stroke patients but not in chronic stroke patients or healthy persons. This effect may be related to specific downregulation of Mac-1 by these drugs or other intracellular events.

The prescription pattern of oral nitrates in coronary artery disease. Appropriateness and cost considerations.

OBJECTIVES: To evaluate the prescription patterns of oral nitrates in terms of appropriateness and cost in a community setting. METHODS: A period prevalence, descriptive, applied study. Data including age, gender, type of medication, dosage and cost were extracted from the database of the largest health maintenance organisation (HMO) in Israel. The study population included enrollees over 35 years of age who received oral nitrates at least once during the 12-month study period. RESULTS: Oral nitrates were prescribed for 8007 patients (mean age 72.85+/-9.59 years, male:female ratio 1:1). A total of 52,694 prescriptions were issued for 56,553 medications, of these 88.1% for mononitrates, which constituted 95% of the annual cost for patients and the HMO. The mean prescribed daily dose for the various drugs ranged from 30% less than to 50% more than the recommended dose. Combination therapy with at least two nitrates, which is not the recommended treatment, was given to 5% of the patients. The recommended alternative treatment will alleviate the financial burden for providers and patients. CONCLUSIONS: Improved prescription habits can provide enhanced quality as well as cost savings for patients and providers.

Relations of diastolic left ventricular filling to systolic chamber and myocardial contractility in hypertensive patients with left ventricular hypertrophy (The PRESERVE Study).

Abnormalities of left ventricular (LV) diastolic filling and stress-corrected midwall shortening (MWS) have been described in hypertensive patients with normal ejection fraction (EF). However, whether stress-corrected MWS parallels LV diastolic filling better than EF does remains uncertain. Blood pressure, body mass index, echocardiographic LV mass and LV geometry, EF and stress-corrected MWS, LV diastolic filling (peak E- and A-wave velocities, E-wave deceleration time, and atrial filling fraction) were evaluated in 212 hypertensive patients with LV hypertrophy enrolled in the Prospective Randomized Enalapril Study Evaluating Regression of Ventricular Enlargement study. LV structure, geometry, as well as LV diastolic filling, were compared between patients with reduced EF (<55%, n = 39, 18%) and those with normal EF (>55%) as well as between patients with reduced stress-corrected MWS (<89.2%, n = 31, 15%) and those with normal stress-corrected MWS (>89.2%). Patients with reduced EF had higher LV mass, eccentric LV geometry, and higher heart rate than those with normal EF, although they did not differ in age, blood pressure, or body mass index. LV filling pattern was also similar in those 2 groups. Patients with reduced stress-corrected MWS had higher atrial filling fraction, body mass index, heart rate, LV mass, and concentric geometry than those with normal stress-corrected MWS. Atrial filling fraction was negatively associated with stress-corrected MWS, but not with EF in multivariate models, independently of age, gender, heart rate, and body mass index. Thus, in hypertensive patients with LV hypertrophy, abnormal LV diastolic filling is more closely related to impaired myocardial contractility than to LV chamber EF.

Blood pressure changes at the Dead Sea (a low altitude area).

The Dead Sea (barometric pressure: 800 mm Hg) is an important balneotherapeutic centre for chronic dermatologic and arthritic diseases. In the past, hypertensive patients have complained sporadically of weakness and dizziness during a stay in the Dead Sea. It was therefore recommended that hypertensives do not stay at these health centres. The aim of our study was to investigate the changes in blood pressure (BP) parameters of 72 hypertensive and normotensive osteoarthritic and rheumatoid arthritic elderly patients during a 2-week stay in the Dead Sea, and to further evaluate the effect of different balneotherapeutic means on these BP changes. Following a primary BP assessment at the out-patient clinic (Beer Sheva barometric pressure: 745 mm Hg), the patients were divided into four groups: (1)thermomineral pool; (2)Dead Sea water baths; (3) combination of the aforementioned treatments; and (4) controls (no balneotherapy). We demonstrated that the systolic BP (SBP) of hypertensives and normotensives decreased by an average of 17 mm Hg and that diastolic BP (DBP) decreased by an average of 8 mm Hg from their basic clinic-measured values. These favourable results were sustained during the first 10 days duration, and by the end of their stay they had diminished slightly. Thermomineral water had an additional lowering effect on the BP of the normotensives, but the SBP of hypertensives increased. Immediately following Dead Sea bath immersion, we noted a temporary increase of SBP in normotensives only. No patient, hypertensive or normotensive, complained of dizziness, malaise, or any other complaint. In our experience, patients feel well at low altitudes, and there is no justification in upholding hypertension as a contraindication to balneotherapy in the Dead Sea.

The effects of replacing beta-blockers with an angiotensin converting enzyme inhibitor on the quality of life of hypertensive patients.

The aim was to evaluate the effects of a change of treatment from beta-blocker to captopril on the quality of life of hypertensive patients. One hundred forty-nine mild to moderate hypertensive patients who were being treated with beta-blockers were randomly assigned to receive captopril (12.5 to 50 mg twice daily), or to continue on beta-blocker treatment (atenolol: 25 to 100 mg once daily [n = 121], or propranolol, 10 to 80 mg twice daily [n = 12]). When required, 25 mg hydrochlorothiazide was added in each group. The patients were followed over periods ranging from 6 to 12 months. Blood pressure, treatment side effects, and quality of life were monitored. Blood pressure was equally well managed in both groups, though a lower level of treatment was required in the captopril group. The captopril treated patients exhibited favorable changes in several aspects of quality of life: sleep-related, gastrointestinal, and physical activity-related symptoms improved from baseline to end of follow-up. Drowsiness and the ability to concentrate significantly improved in the captopril group only (P <.01). Change in treatment from beta-blocker to captopril resulted in equally well controlled blood pressure on a lower drug dose. Moreover, the change to captopril had a positive impact on the quality of life.

The effects of diuretics on quality of life of hypertensive patients.

OBJECTIVES: To study the effect of diuretics and diuretics discontinuation on the quality of life (QOL) of hypertensive patients. METHODS: 149 beta blocker treated mild to moderate hypertensive patients were included in the study. Seventy-three were treated by beta blockers (BB's) only and 60 by BB's and diuretics, for 40 patients diuretics was discontinued. Physical symptoms and QOL were assessed before and 9-15 months after the change in treatment. RESULTS: At baseline, subjects on diuretics experienced more gastrointestinal symptoms, weakness, and sex related problems; and their QOL was poorer. At the end of the follow-up, patients on diuretics scored poorest on physical strength items and on health perceptions; those who were never treated by diuretics scored best; and those who stopped were in between. CONCLUSIONS: Diuretics treatment adversely affect patients' QOL. Cessation of diuretics treatment for at least 9 months improved some aspects of patients' QOL, though those who never received diuretics were better of than others.

Evaluating the response of mild hypertensives to biofeedback-assisted relaxation using a mental stress test.

The objective of this study was to evaluate the long term effect of a program of biofeedback-assisted relaxation on hypertensive patients by mental stress test reactivity. Twenty mild hypertensive patients were subjected to a mental arithmetic stress test before and six months after completing biofeedback-assisted relaxation therapy. The therapy consisted of 10 sessions of biofeedback-assisted relaxation instruction and continuous home practise. The study group was compared to a control group. The biofeedback-assisted relaxation treatment produced a mild improvement in blood pressure control and decreased the dose of drugs used as well as a decrease in state-anxiety (p < 0.05). The stress-induced increases in systolic blood pressure, diastolic blood pressure, heart rate, galvanic skin response and skin temperature were all significantly attenuated six months after completion of biofeedback-assisted relaxation treatment.

Efficacy and tolerability of slow release urapidil (ebrantil) in hypertensive patients with non-insulin dependent diabetes mellitus (NIDDM).

Urapidil, a new alpha-blocker that peripherally antagonizes postsynaptic alpha 1 receptors and centrally causes a reduction in sympathetic tone as agonist of the serotoninergic receptors, was assessed for its antihypertensive effect and its role on glucose and lipid metabolism and insulin sensitivity in diabetic hypertensive patients. Thirty-three non-insulin dependent diabetes mellitus (NIDDM) patients with diastolic blood pressure (BP) of 95-115 mm Hg were treated with either 30 or 60 mg urapidil twice a day, with a gradual increment up to a maximum of 90 mg b.i.d., in order to reduce diastolic pressure to < 90 mm Hg or by at least 10% in the sitting position. A significant reduction in systolic and diastolic arterial pressure, not accompanied by an increased heart rate, was achieved after 12 weeks of treatment. Lipid and carbohydrate homeostasis and glycemic control, as assessed by HbA1C levels, were not affected. The fasting insulin concentration before the glucose load remained similar, but there was a trend toward reduction in peak insulin concentration, and the ratio of insulin change to glucose change between fasting levels and peak levels was significantly lowered by treatment, suggesting improved insulin sensitivity. In conclusion, urapidil is an effective antihypertensive agent in NIDDM patients with essential hypertension, with a neutral effect on lipids and carbohydrates and a possible beneficial effect on insulin resistance.

Beta-adrenergic blocking agents in the treatment of pregnancy-induced hypertension.

Fifty-one women with pregnancy-induced hypertension (PIH) were randomly allocated to one of three treatment groups: A: hydralazine (13); B: hydralazine and propranolol (17); and C: hydralazine and pindolol (19). All women fulfilled the pretreatment criteria and were of similar age, numbers of previous pregnancies and had systolic blood pressure (SBP) of between 140 and 160 mmHg and diastolic blood pressure (DBP) of between 95 and 110 mmHg. Hypertension was treated equally well by all three regimens (mean SBP was 133.6, 130 and 134 mmHg, respectively). Heart rate was significantly higher than baseline in group A and lower in groups B and C, as is to be expected with beta-blocker treatment. Side-effects were more frequent in group A than in groups B and C, 62% of the patients on hydralazine monotherapy complained of palpitations compared to 35% on combination treatment. Fetal outcome differed in the various groups. Birth weight was significantly lower in group B, where regimen included propranolol, compared to that of group C, for whom the regimen included pindolol (3,044.7 +/- 443.8 and 2,709.6 +/- 485.5 gm, p < 0.05). Mean blood glucose of the newborns were similar in groups A and C (76.5 +/- 16.5 and 78.6 +/- 15 gm%) and significantly lower in group B (62.6 +/- 14 gm%, p < 0.02). In conclusion, blood pressure was equally well treated in all three treatment groups. However, more maternal side-effects occurred in group A, the group treated with hydralazine monotherapy, while propranolol in combination with hydrazaline (group B) had some negative effects on fetal development which did not occur in pindolol/hydrazaline combination.

Effect of placebo on office and on 24 hour noninvasive ambulatory blood pressure measurements.

Elevated BP in the clinical but not during daily activities (white coat hypertension) is a well recognised problem encountered in the diagnosis of mild hypertension. The aim of this study is to evaluate this phenomenon with a study population of 90 mild hypertensive patients subjected to 24h BP measurement, and to assess the effect of placebo on both the office and the daytime continual BP monitored values. For this purpose, 90 patients were evaluated after four weeks of single-blind placebo (Phase I) and, of these, 27 patients were evaluated after a further four weeks of double-blind placebo administration (Phase II). During Phase I treatment the mean office SBP (163.9 mmHg) and the mean office DBP (104.5 mmHg) were significantly higher than the average of the six readings obtained during the first two hours of automatic continual BP monitoring (158.6 and 98 mmHg respectively, P < 0.001) (white coat effect). These differences were much more pronounced when the comparison was made between office measurements and the average daytime values (SBP 152.8 mmHg, DBP 93.1 mmHg). At the end of Phase II, the average values of BP measurements obtained both in the office and from continual monitoring were significantly lower (placebo effect). However, the difference between the office and the daytime values persisted. Thus, notwithstanding the reduction in the BP measurements following placebo administration, the white coat effect persists.

Gender differences in health perceptions and their predictors.

This study explored the degree to which risks embedded in the social construction of gender roles and personality traits explained gender differences in health perceptions and reporting among mild hypertensive patients (134 women and 104 men) under the same treatment regime. Compared with men, women were less educated, less likely to be employed, less happy, more distressed, less satisfied with family functioning, and had a weaker sense of coherence. Twice as many women as men evaluated their health as 'poor', and on average reported 2.6 more symptoms than men. These gender differences largely disappeared when unhappiness, distress, and sense of coherence were controlled. While education attainment, employment, and satisfaction with family functioning decreased gender differences in some half of the symptoms, multivariate analysis suggested that unhappiness, distress, and the sense of coherence are far better predictors of gender differential health perceptions. It is suggested that beyond biological predispositions, women's health is in double jeopardy by gender role related risks, which affect morbidity both directly through immunology system and indirectly through health perceptions.

The use of transdermal clonidine in the hypertensive patient with chronic renal failure.

The efficacy of transdermally administered clonidine was evaluated in twenty-four patients with mild-to-moderate hypertension (seated diastolic blood pressure 95-115 mmHg) and renal impairment. Patients were initially treated with oral clonidine; the dose was titrated until the seated diastolic pressure fell below 90 mmHg or a minimum 10% reduction in baseline was achieved. Oral clonidine produced a significant decrease in both systolic and diastolic blood pressure; mean seated diastolic blood pressure decreased 16.9 mmHg from baseline. When transdermal clonidine was substituted for twice daily dosage of oral clonidine, blood pressure decreases were fully maintained. Sixteen patients completed three months of stable-dose transdermal therapy. The results suggest that, in mild-to-moderate hypertensive patients with chronic renal impairment, blood pressure can be controlled with a once-weekly application of transdermal clonidine as effectively as with oral clonidine. Mean diastolic blood pressure was decreased approximately 17% during clonidine therapy independent of the severity of renal dysfunction or route of clonidine administration.

Environmental and genetic factors of hypertension in a biracial Beduin population.

This study attempts to understand the various factors involved in the pathophysiology of hypertension in black Beduins. Parameters known to differentiate US black from white hypertensives were examined. Sixty Beduin families (thirty families each of black and white, total of 205 subjects) were evaluated for environmental risk factors: a traditional nomad shepherd life-style compared with working in a city, living in tents or in western style housing and dietary habits related to cardiovascular risk factors. Blood pressure, body mass index (BMI), sodium-lithium counter transport rate and 24 hour urinary sodium excretion (UNa) were measured and the data obtained were compared between normotensives and hypertensives, within each racial group. The mean value of the BMI of the white population was greater than that of the black population while the BMI of hypertensives was greater than that of the normotensives in each of the racial groups. The mean systolic BP of black hypertensives was greater than that of the corresponding whites. There were no significant differences in UNa between the four groups. Sodium-lithium countertransport was significantly higher in the hypertensive whites compared with the normotensive population (0.46 versus 0.22 mmol Li efflux/IRBC/hr). The countertransport rate for black hypertensives was lower than that of white hypertensives (0.20 versus 0.46). Black families had lower socio-economic scores than did white families and families with a hypertensive member scored lower than did families with a normotensive history. These results demonstrate some similarities between the American and Beduin black hypertensive populations, in spite of entirely different life-styles, indicating that in these populations genetic factors, rather than environmental influences, appear to be dominant in the pathophysiology of hypertension.