Atrial natriuretic factor in pregnancy-induced hypertension and preeclampsia: increased plasma concentrations possibly explaining these hypovolemic states with paradoxical hyporeninism.

Plasma immunoreactive atrial natriuretic factor 99-126 (ir ANF), plasma volume, plasma renin activity, and plasma aldosterone were measured during pregnancy in 14 normotensive nonpregnant women, 15 normotensive pregnant women, 35 patients with pregnancy-induced hypertension (PIH), and in ten patients with preeclampsia (PE). Repeated measurements were carried out 2 months after delivery in a subgroup of the same patients. The plasma levels of ANF were found to be higher in pregnant normotensive women than in nonpregnant normotensive women, but the decrease of plasma ANF 2 months after delivery was not significant on the basis of seven paired data, so that it cannot presently be stated with certainty that pregnancy per se stimulates ANF secretion. Still higher levels of ANF were found in PIH and, especially, in PE. A positive correlation was found in the pooled population of normotensive and hypertensive pregnant women between plasma ANF and mean arterial pressure. A greater decrease of plasma ANF was found after delivery in the hypertensive patients than in the normotensive controls. This excludes an absolute deficiency of ANF secretion in the pathogenesis of hypertension. These findings suggest a compensatory role of ANF in the prevention of blood pressure increase. Plasma renin activity (PRA) and plasma aldosterone concentrations were higher in normotensive pregnant women than in normotensive nonpregnant women. Compared to normal pregnancy, plasma volume was decreased in PIH (-17%) and in PE (-25%), whereas PRA was less increased in both groups and plasma aldosterone concentration was less increased only in the PE group. The simultaneous high levels of plasma ANF may explain this inappropriate hypostimulation of renin secretion by hypovolemia in these hypertensive states.

The international prostate symptom score: physician versus self-administration in the quantification of symptomatology.

OBJECTIVES: The International Prostate Symptom Score (IPSS), originally known as the American Urological Association Score, is the most commonly used scoring system for the quantification of benign prostatic hyperplasia symptoms. One area that has remained unexplored is the stability of the questionnaire construct between different modes of administration. The objective of this study was to measure differences in IPSS when administered by the physician versus patient self-administration. The impact of order of administration was also examined. METHODS: Sixty-four patients completed two IPSS questionnaires during the same office visit, one self-administered and the other by physician interview. The influence of order of administration was examined by randomly allocating patients to either self-administration or physician-administration first. Total symptom scores (questions 1 to 7) and quality of life scores (question 8) were compared between the two modes of administration. Multivariate analysis of variance was performed to assess the effect of age, medical history (obtained from the IPSS form), order of administration, and physician (A and B) on the observed differences. RESULTS: The distribution of differences was similar between the two orders of administration. Overall, 26 patients had a higher total score with self-administration, 30 with physician-administration, and 8 had identical scores on both. Mean total symptom scores and quality of life assessments by physician- versus patient-administered questionnaires were similar (10.9 versus 10.4 and 1.8 versus 2.2, respectively). No statistically significant difference was observed. The order of administration did not show statistical significance (P > 0.05) by multivariate analysis. As well, no interaction was seen between the aforementioned variables. CONCLUSIONS: There is no difference in the information obtained if patients self-administer the questionnaire as opposed to physician administration.

[Digoxin-like natriuretic factor, raised during normal pregnancy, is increased in pregnancy-induced hypertension and pre-eclampsia]. / Le facteur natriurétique digoxin-like, augmenté dans la grossesse normale, est majoré dans l'hypertension induite par la grossesse et la prééclampsie.

UNLABELLED: The increase of peripheral resistance in pregnancy induced hypertension (PIH) and in preeclampsia (PE) is not yet explained since previous studies have found that renin-angiotensin-aldosterone system is actually depressed, that adrenergic system is inconstantly stimulated and that vasodilating prostaglandins are inconstantly decreased. In order to get a better insight in the pathogenesis of PIH and PE, we have measured the 24 h urinary excretion of digoxin-like natriuretic factor (DLF) in 15 normotensive pregnant women (NP), in 29 women with PIH and in 6 women with PE under normal salt diet, without treatment. DLF have been measured by radio receptor binding assay. Normal values were established in 14 normotensive non pregnant (NNP). In NP, 24 h urinary excretion of DLF was significantly higher than in NNP (respectively 14.9 +/- 7.5 and 9.5 +/- 2.5 nmol/mmol of creatininuria, p less than 0.01). Comparatively to NP, 24 h urinary excretion of DLF was significantly higher in PIH (31.7 +/- 19 nmol/mmol of creatininuria) and in PE (40.7 +/- 16.3 nmol/mmol of creatininuria). In PIH and PE, there were simultaneously a decrease of plasma renin activity and plasma volume but no difference for plasma catecholamines. IN CONCLUSION: 1. the production of DLF is increased by normal pregnancy; 2. it is increased in PIH and PE in comparison with NP and may explain the increase of peripheral resistance.

[Sequential study of the plasmatic atrial natriuretic factor and the urinary excretion of an ouabain displacing factor and of dopamine in normotensive pregnant women before and after labor]. / Etude séquentielle du facteur atrial natriurétique plasmatique et de l'excrétion urinaire d'un facteur déplaçant l'ouabaïne et de la dopamine chez la femme enceinte normotendue avant et après l'accouchement.

Estimation of urinary excretion of a ouabain displacing factor (ODF) and dopamine was carried out immediately before delivery, 7 days and 70-90 days after delivery in 12 normotensive pregnant women. Simultaneous estimation of plasma 99-126 atrial natriuretic factor (ANF), plasma renin activity (PRA) and plasma aldosterone were also undertaken. The data were compared with those obtained in a non pregnant normotensive group of women (n = 14) and a group of pregnant normotensive women in the early third trimester (n = 14). Urinary ODF and dopamine were significantly higher in the early third trimester when compared with non pregnant women but immediately before delivery, ODF excretion had fallen below non pregnant values and dopamine excretion had dropped to control values. Both remained low after delivery. Plasma ANF was higher in pregnant women when compared with non pregnant controls and remained high just before delivery and 7 and 70-90 days after delivery. PRA and plasma aldosterone were higher during pregnancy and had fallen to non pregnant values 7 days post-partum. It is concluded that there is considerable discrepancy in the evolution of natriuretic and antinatriuretic factors before and after delivery and that the drop of PRA and aldosterone by 7 days post-partum, contrasting with the unchanged high values of ANF, may contribute to negative sodium balance after delivery.

[Pregnancy-induced hypertension and pre-eclampsia develop in spite of high circulating levels of cardionatrin]. / L'hypertension induite par la grossesse et la prééclampsie se développent malgré des taux circulants élevés de cardionatrine.

Plasma cardionatrine was measured during pregnancy in 14 normotensive non pregnant women, 15 normotensive pregnant women, 35 pregnancy induced hypertension (PIH) and 10 preeclampsia (PE) and again 2 months after delivery in respectively 7, 15 and 7 cases together with plasma volume, PRA and plasma aldosterone. The plasma levels of cardionatrine are higher in pregnant normotensive women than in non pregnant normotensive women suggesting that pregnancy per se stimulates cardionatrine secretion. The higher levels of cardionatrine in PIH and specially in PE during pregnancy and the greater decrease of plasma cardionatrine after delivery in the hypertensive patients than in the normotensive controls exclude a deficiency of cardionatrine secretion in the pathogenesis of hypertension. These data rather suggest a compensatory role of cardionatrine in the prevention of blood pressure increase. Plasma volume was decreased in PIH (-17 p. 100) and in preeclampsia (-25 p. 100). The simultaneous high levels of cardionatrin may explain the inappropriate stimulation of the renin and aldosterone secretion in these hypovolemic hypertensive states.

[Increase of the pressor response to angiotensin II in normal pregnancy. A sign of increasing blood volume more than decreasing vascular reactivity]. / L'augmentation de la dose pressive d'angiotensine II au cours de la grossesse normale. Un reflet de l'augmentation de la volémie plutôt que la diminution de la réactivité vasculaire.

Plasma volume and the pressor dose of angiotensin II were estimated in 15 normotensive pregnant women during the second and third trimester and 2-3 months post-partum together. Plasma volume estimated by the Evans Blue technique increased during pregnancy significantly more than the body weight: its increase was 37 and 54% of the post-partum values whereas the body weight increase was only 6 and 12%. The pressor dose of angiotensin II was significantly increased during pregnancy only when it was related to body weight (14.2 +/- 4.3 and 14.9 +/- 5.2 at the 2nd and 3rd trimester versus 11.2 +/- 2.9 ng min-1 kg-1 BW post-partum) but not when it was related to plasma volume (0.25 +/- 07 and 0.26 +/- 0.09 versus 0.25 +/- 0.07 ng min-1 ml-1 PV). It is concluded that the increased pressor dose of angiotensin II (related to body weight) observed in normal pregnancy cannot be interpreted as an evidence for decreased vascular reactivity but that it could be a mere reflection of plasma volume increase.

[Perinatal influence of sex hormones on the differential activation of corticotrope function during stress in the male and female]. / Influence périnatale des hormones sexuelles sur l'activation différentielle de la fonction corticotrope au cours d'un stress chez le mâle et la femelle.

The stress-induced activation of the corticostimulating function of the pituitary gland was noted to vary according to sex in both the adult and the newborn. The pituitary response in testosterone or estradiol-injected females at the time of birth was similar to that of intact males, in contrast, the castration of the males performed just before the postnatal surge of plasma testosterone was unable to modify at the 8th day, the male characteristic evolution in response to ether inhalation. Present data suggest--in the male, prenatal differentiation of the neuroendocrine pathways involved in the pattern of ACTH release in response to ether inhalation, probably in correlation with the peak of plasma testosterone on day 19 of gestation--in the female, the existence of androgen--sensitive structures in early postnatal life. An alpha stimulatory effect of norepinephrine on these neuroendocrine pathways was suggested. Present report also discuss--the catecholaminergic control of CRF X producing neurons--the sex dependent AVP and/or oxytocin (OT) release induced by a stress--the AVP and OT potentiation of CRF-induced ACTH release.

[Primary hyperparathyroidism. Lack of effect of cimetidine on plasma levels of parathyroid hormone and calcium]. / Hyperparathyroïdie primitive. Absence d'effet de la cimétidine sur les taux plasmatiques de parathormone et de calcium.

Because of the contradictory results formerly published as regards the effect of cimetidine in primary hyperparathyroidism, we have studied the effect of cimetidine at the daily dose of 1200 mg in 14 cases of primary hyperparathyroidism. The diagnosis was ascertained in all cases by the coexistence of an otherwise unexplained hypercalcemia and of a concomitantly elevated plasma concentration of immunoreactive parathyroid hormone (PiPTH) measured by 2 different antibodies and confirmed in 10 cases by surgical neck exploration. In 5 cases with severe hypercalcemia (greater than 12.0 mg/l) cimetidine was discontinued after 5 days because of its lack of effect on both plasma concentrations of calcium and PiPTH, and the patients were successfully operated. In 8 cases with milder hypercalcemia, cimetidine was given for 1.5-6 months. There was no significant change in both plasma concentrations of calcium (PCa) and PiPTH but a regression analysis showed that PCa was negatively correlated to time with a correlation coefficient which would have become significant if the follow-up had been 9 months. In the last patient severe hypercalcemia was controlled by simultaneous administration of phosphate, indomethacin and cimetidine without concomitant decrease of PiPTH; and 6 weeks after cimetidine discontinuation no significant increase of PCa and PiPTH occurred. These data show that cimetidine has no clinically therapeutic value in primary hyperparathyroidism.

The effectiveness of a professionally led support group for men with prostate cancer.

PURPOSE: This study investigated the effectiveness of support groups in: (a) helping patients and significant others voice their concerns about the physical and psychosocial implications of their disease in an emotionally supportive context, (b) enhancing patients' understanding of their disease and its treatments and side effects, and (c) facilitating more active involvement in their treatment. A total of 54 men and some family members participated in seven separate groups. Patients were invited to participate with a letter describing the goals of the support groups or were referred by nurses and doctors. METHOD: The participants met for a series of 10 weekly sessions each of 90 minutes duration. The meetings were led by a nurse and a psychologist, who together provided information on the medical aspects of the disease and its treatment, focused on the psychologic reactions to a diagnosis of cancer, and encouraged participants to adopt more active, health-promoting coping strategies. RESULTS: The participants were surveyed anonymously by questionnaire at the end of the tenth session on their views and attitudes about the support groups and their overall satisfaction. The results showed that participants in the support group felt they had a better understanding of their illness and perceived themselves as more involved in their treatment. They expressed that sharing their experiences with others gave them reassurance, helped alleviate their anxiety, and provided them with a more positive outlook. CONCLUSION: It was concluded that these findings furnished evidence of the effectiveness of support groups in facilitating perceptions of enhanced coping in men with prostate cancer.

Renin-angiotension-aldosterone system, urinary prostaglandins and kallikrein in pregnancy-induced hypertension: evidence for a dysregulation of the renin-angiotensin-prostacyclin loop.

Plasma renin activity (PRA) and aldosterone concentrations were measured simultaneously with urinary excretion of kallikrein and of four prostaglandins (PGE2, PGF2 alpha, 6-keto-PGF1 alpha and TXB2) in 23 patients with pregnancy-induced hypertension (PIH; 17 with permanent PIH (PH) and six with labile PIH (LH), i.e. patients whose hypertension was controlled only by home bed-rest) and in 16 normotensive pregnant women. Plasma renin activity was lower in PH than in controls or in LH. No difference between the three groups was observed for plasma aldosterone and urinary excretion of kallikrein and prostaglandins except that TXB2 was higher in LH than in PH. Thus patients with LH have a different biological profile from that of PH, since they have higher PRA and higher TXB2 excretion, an association that suggests a more pronounced ureteral compression by the gravid uterus in this group. Although no decreased synthesis of vasodilating prostaglandins was found in PH, a dysregulation of the renin-angiotensin-prostacyclin loop is suggested by a negative correlation between PRA and 6-keto-PGF1 alpha. An independent vasopressive substance which would stimulate PGI2 and suppress renin secretion is therefore postulated.

Prevalencia de factores de riesgo para enfermedades crónicas no transmisibles en alumnos de medicina y sociología, Universidad de Valparaíso, 2009 / Risk factors prevalence for chronic non-transmissible diseases in medical and sociology students, Universidad de Valparaíso, 2009

INTRODUCCIÓN: Las enfermedades crónicas no transmisibles corresponden a una de las principales causas de morbimortalidad en Chile y el mundo. Si bien su etiología es multifactorial, los factores de riesgo para estas enfermedades son susceptibles de ser modificados. Estos actúan por larga data previa a la manifestación de una enfermedad crónica no transmisible, por lo que resulta interesante conocer la prevalencia de estos factores en la población universitaria de distintas áreas de conocimiento, quienes experimentan un cambio en el ritmo de vida que podría afectar sus hábitos. OBJETIVO: Estimar y comparar la prevalencia de factores de riesgo para enfermedades crónicas no transmisibles en estudiantes de Medicina y Sociología de la Universidad de Valparaíso, en general y estratificado por sexo. MATERIAL Y MÉTODO: Estudio de corte transversal realizado entre julio y octubre de 2009. Se seleccionaron 67 alumnos de cada carrera mediante muestreo estratificado y se aplicó encuesta considerando sexo, edad y hábitos, más la medición de peso, talla, circunferencia de cintura, presión arterial y glicemia capilar. Análisis realizado con STATA 10.0, usando pruebas de χ2 y t de Student, considerando p<0,05 e intervalos de confianza de 95 por ciento. RESULTADOS: Se encontró mayor prevalencia de consumo nocivo de alcohol (40,3 por ciento), tabaquismo (44,78 por ciento) y mala alimentación (64,18 por ciento) en Sociología(p=0,004, p<0,0001 y p=0,011, respectivamente); mientras que en Medicina se encontró mayor prevalencia de sedentarismo (73,13 por ciento, p=0,045), existiendo ciertas diferencias por sexo entre ambas carreras. DISCUSIÓN: Los alumnos de Sociología y Medicina presentan diferente prevalencia de factores de riesgo para enfermedades crónicas no transmisibles. Se recomienda realizar promoción de estilos de vida saludable en ambos grupos.

INTRODUCTION: Non-transmissible chronic diseases are a main cause of morbimortality in Chile and worldwide. Although its etiology is multifactorial, risk factors for these diseases are likely to be modified. These ones act by long terms of time before the appearance of a non-transmissible chronic disease, so it is interesting to know the prevalence of these factors among students of different areas of knowledge, who changes their lifestyle that could affect their habits. OBJECTIVE: Estimate and compare the prevalence of risk factors for non-transmissible chronic diseases on Universidad de Valparaíso’s Medicine and Sociology students, overall and stratified by sex. MATERIAL AND METHOD: A cross sectional study was carried out between July and October 2009. A number of 67 students of each career were chosen by stratified sampling. A questionnaire was applied considering sex, age and habits, also anthropometric measures, arterial pressure and capillary blood glucose, were determined. Analysis with STATA 10.0, using χ2 and Student’s t-test, considering p<0.05 and 95 percent confidence interval. RESULTS: We found higher prevalence of harmful consumption of alcohol (40.3 percent),smoking habit (44.78 percent) and bad nutrition (64.18 percent) in Sociology(p=0.004, p<0.0001 y p=0.011, respectively); whereas in Medicine was found a higher prevalence of sedentary lifestyle (73.13 percent, p =0.045), with some differences by sex between both careers. DISCUSSION: Sociology and Medicine students have different prevalence of risk factors for non-transmissible chronic disease. We recommend promoting healthy lifestyles in both groups.

Effects of castration and testosterone on the pituitary and adrenal responses of the newborn rat to ether inhalation.

In 8-day-old rat newborns, the pituitary response to 2 min of ether inhalation was noted to vary according to sex. Plasma ACTH levels were similarly increased in males and females at the end of ether exposure; however, during the following 30 min, ACTH levels were always higher in females than in males. In order to verify that the putative masculinization of some neuroendocrine pathways involved in the pituitary response to ether stress was the result of the transitory surge of testosterone at birth, fetuses at term were delivered by cesarean section and thereafter immediately castrated or sham-castrated under cold anesthesia (males), injected with testosterone heptylate (1 mg s.c.) or olive oil used as solvent (females) before being put in the care of a nurse. The rise in plasma testosterone levels during the 1st h after birth was prevented or stopped in males put at 2 degrees C. At the 8th postnatal day, the newborns were subjected to 2 min of ether inhalation; they were sacrificed either just, before or after the end (0 and 30 min) of the stress procedure. Plasma immunoreactive ACTH level and adrenal corticosterone content were measured. The pituitary response, shown by the ACTH increase, in castrated or sham-castrated males and testosterone-injected females was similar to that of intact males but very different from that observed in olive-oil-injected or intact females. The rise in adrenal corticosterone content 30 min after ether inhalation was greater in intact and olive-oil-injected females than in testosterone-injected ones or in males; adrenal response was well correlated with the maintenance of ACTH release in the former and the decrease following transitory surge in the latter.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of pregnancy on plasma renin activity and glomerular synthesis of prostaglandins and thromboxane in rats.

Normal pregnancy in women and rats is characterized by an increased glomerular filtration rate. Because prostaglandin glomerular synthesis has been reported to be increased in 2 other circumstances with glomerular hyperfiltration (streptozotocin-induced diabetes and high protein dietary intake in Heymann nephrilis), we studied prostaglandin biosynthesis in glomeruli obtained from pregnant Wistar rats in comparison with non pregnant rats during the estrus cycle. Comparatively to the 3 first phases of the cycle, and wether or not arachidonic acid was present, PGE2 and PGF2 alpha production rates were found significantly higher in diestrus 2 (2-3 fold increase for both) at 15 days of pregnancy (2 fold increase for PGE2, 5-6 fold increase for PGF2 alpha) and at 21 days of pregnancy (5-6 fold increase for both). On the other hand synthesis of TXB2 was not increased during pregnancy nor during diestrus 2. Plasma renin activity (PRA) was increased during pregnancy. It is concluded that in presence of increased PRA, the increased synthesis of PGE2 may be the hormonal factor explaining, at least in part, the hemodynamic mechanism of glomerular hyperfiltration which has been previously described by micropuncture techniques and characterized by increased renal plasma flow, increased glomerular filtration pressure and decreased ultrafiltration coefficient.

Prostanoid synthesis by isolated rat glomeruli: effect of oestrous cycle and pregnancy.

1. An increase in glomerular prostaglandin (PG) synthesis has been reported in two experimental models of increased glomerular filtration rate (GFR). 2. Because pregnancy, in women and rats, is also associated with an increased GFR, we studied PG biosynthesis by glomeruli isolated from pregnant rats in comparison with virgin rats at the different phases of the oestrous cycle. 3. PGE2 and PGF2 alpha synthesis markedly increased during pregnancy (at day 21 of gestation a five- to sevenfold increase of PGE2 and PGF2 alpha was seen; at day 15 of gestation a threefold increase of PGE2 and a sixfold increase of PGF2 alpha was noted). However, thromboxane A2 (TXA2) synthesis was similar in all the groups studied. 4. Among the four phases of the oestrous cycle, dioestrus was characterized by a significant increase in glomerular synthesis of PGE2. 5. The fact that during pregnancy the increase in the vasodilator PGE2 is not counteracted by an increase in the constrictor TXA2 must be taken into account when explaining the glomerular hyperfiltration which characterizes the pregnant state. 6. The increase of PGE2 synthesis during dioestrus should be considered in studies of PG synthesis using virgin rats as controls.

Reduction in testicular function in rats. I. Reduction by a specific gonadotropin-releasing hormone antagonist in fetal rats.

A gonadotropin-releasing hormone (GnRH) antagonist, when injected 24 h before sacrifice to rat fetuses, did not modify plasma testosterone concentrations in males on day 18 of gestation but it did on days 19, 20 and 21. This GnRH antagonist reduced plasma luteinizing hormone (LH) levels and increased pituitary LH content in both male and female 19-day-old fetuses from mothers adrenalectomized on day 14 of gestation. An inverse relationship between plasma testosterone and LH levels was noted in males and females, on days 19 and 21. These data suggest that the hypothalamic control of gonadotropic function is operating by day 19 of fetal life and that a negative feedback of testosterone on LH and probably GnRH release is also operating in rat fetuses on days 19 and 21 of gestation.

Reduction in testicular function in rats. II. Reduction by dexamethasone in fetal and neonatal rats.

Chronic administration of dexamethasone in drinking water to maternal rats from days 15 to 21 of gestation (1) reduced plasma testosterone concentrations in male fetuses between days 19 and 21 but not earlier on day 18 and abolished the prenatal peak of plasma testosterone which normally occurs on day 19 of gestation, and (2) suppressed the postnatal surge of plasma testosterone in male newborns 1.5 and 2 h after delivery at term by cesarean section. The administration of dexamethasone to male fetuses at birth induced 1 h later a slight but not significant increase in hypothalamic gonadotropin-releasing hormone (GnRH) and pituitary luteinizing hormone (LH) contents, reduced drastically plasma LH levels and completely prevented the postnatal surge of plasma testosterone which occurred normally in littermate controls. A rise in pituitary LH content, and a sharp reduction in plasma LH and testosterone concentrations were noted in 19-day-old male fetuses whose mothers were acutely treated with dexamethasone on day 18 of gestation. Similar evolutions for LH were observed in littermate females. These results suggest that the inhibitory effects of exogenous glucocorticoids on testosterone secretion could be mediated in both fetuses and newborns at least partially through suppression of the hypothalamic and pituitary secretion of GnRH and LH, respectively, and provide insight how stress or hormone imbalance may affect the development of this neuroendocrine system.

A ouabain-displacing factor in normal pregnancy, pregnancy-induced hypertension and pre-eclampsia.

1. A ouabain-displacing factor (ODF) was measured in the urine of non-pregnant, normotensive pregnant and hypertensive pregnant women by a receptor-binding assay with sodium, potassium-dependent adenosine triphosphatase. 2. Urinary ODF was significantly increased in normal pregnancy. 3. Greater increases were seen in pregnancy-induced hypertension and pre-eclampsia.