Failure of platelet angiotensin II binding to predict pregnancy-induced hypertension

OBJECT: Nimodipine therapy has become a standard component of the treatment regimen used in patients with aneurysmal subarachnoid hemorrhage (SAH). Its prescribed use at 60 mg every 4 hours for 21 days is based on reputable, randomized prospective studies. However, because only 20 to 30% of patients with SAH suffer clinical cerebral vasospasm, it is clear that most patients do not actually need the drug. Of course, this fact is not evident until several treatment days have passed. It is common practice, without well-documented consequences, to terminate nimodipine therapy before 21 days in certain clinical circumstances. The aim of this study was to evaluate the effectiveness of abbreviating the duration of nimodipine treatment in the setting of a good-grade aneurysmal SAH. METHODS: A retrospective clinical review was made of 90 consecutive patients who experienced a Hunt and Hess Grade I through III aneurysmal SAH and were treated with nimodipine for 15 days or less. CONCLUSIONS: None of the patients studied suffered a delayed neurological deficit as a result of the abbreviated course of nimodipine.     

Epidemiology of pregnancy-induced hypertension

Although research on the link between drugs and crime is not a major concern for many Quebec researchers, the last five years have been the scene of an increasing number of studies on the subject. These studies can be divided in four groups: 1) criminal policies; 2) studies on prevalence; 3) relation between drugs and crime; 4) intervention and its impact. Results of these studies put additional pressure for adequate treatment of addicts having problems with the law. Social workers in rehabilitation centres have thus noticed an increasing number of addicts who had or were going through problems with the law. Yet a great proportion of addicts having problems with the justice system are not reached by rehabilitation services: it is those people who present the most deteriorated bio-social profile. Is it really worthwhile to intervene with this type of clientele? The answer is yes as long they can be kept in treatment sufficiently long. In any case, the simple judiciarization of a person says nothing of his character (e.g. violent, liar or fraudulent) or of his pathology (e.g. psychopath, sociopath ...). In fact, given the illicit nature of certain drugs, the simple fact of using can lead to criminalization. The challenge in research in this field will consist in better defining factors related to perseverance in treatment and therapeutic ingredients associated to the desired impact.     

Cell-mediated immunity imbalance in pregnancy-induced hypertension

Pregnancy is associated with modifications in the maternal immune system that may be involved in the absence of rejection of the fetoplacental graft characterized by the presence of paternal antigens. This active and specific tolerance towards the fetoplacental unit seems to be compromised in pregnancy-induced hypertension (PIH). To evaluate whether the immunological state in patients with PIH is altered with respect to normal pregnant women we studied 15 patients with PIH, 15 uncomplicated pregnant and 10 healthy nonpregnant women using monoclonal antibodies directed to specific lymphocyte antigen determinants, cytokines (TNF) and soluble molecules (sIL-2R, sCD8). The percentage of CD4 lymphocytes and of natural killer (NK) cells was significantly higher in PIH patients compared to controls (CD4: 42.9 +/- 10.5 vs. 32.7 +/- 12.5%; p < 0.05; NK: 14.7 +/- 6.3 vs. 8.3 +/- 3.4%; p < 0.01). However, these values did not differ when compared to normotensive nonpregnant controls (CD4: 53.1 +/- 5.9%; NK: 17.2 +/- 7.1%). In addition, the soluble IL-2 receptor (sIL-2R) was higher in PIH patients when compared to control patients (725.5 +/- 194.2 vs. 482.5 +/- 187.2 U/ml; p < 0.01). The immune response observed in normal pregnancies responsible for the tolerance towards the fetoplacental unit seems to be altered in PIH patients as suggested by higher levels of CD4 and NK cells, and sIL-2R. This may lead to a chronic rejection syndrome and be involved in the pathophysiology of PIH.     

Chronic hypertension, pregnancy-induced hypertension, and low birthweight

Menstrual and hormone patterns were investigated in 10 fertile women (median age 37, range 25-43 years) with locally advanced cervical cancer treated with neoadjuvant chemotherapy (CT). CT consisted of two cycles of high-dose cisplatin (CDDP, 40 mg/m2, Days 1 to 4) and bleomycin (B, 15 mg/m2, Days 1 and 8) separated by an interval of 21 days. Menstrual patterns before and during CT were recorded. FSH, LH, estradiol, and progesterone were assayed on the day that treatment was begun, after 2 and 4 days of CDDP administration, and weekly between and after the two cycles. Hormone assays during the first week of CT showed no significant change in hormone levels. After the first course of CT, five patients showed hypergonadotrophic amenorrhea and five patients maintained menses, two showing ovulatory and three showing follicular phase hormone patterns. After the second course of CT, one more patient become amenorrheic, and endocrine follow-up showed that two patients maintained hypergonadotrophic amenorrhea, four with hypergonadotrophic amenorrhea had a return of hormone levels to the follicular range of 7-9 weeks after, three maintained follicular phase hormone patterns until operation, and one ovulated. Gonadal dysfunction should be included among the side effects of high-dose CDDP and B regimens.     

A two-stage screening test for pregnancy-induced hypertension and preeclampsia

PURPOSE: To define the inductive pathways leading to rat tear IgA antibody responses. METHODS: Fluoresceinated dinitrophenylated bovine serum albumin was encapsulated in poly(lactide-co-glycolide) microparticles and was administered by intranasal, ocular topical, or gastrointestinal routes. Histologic methods were used to determine the microparticles' ability to access tissues associated with mucosal inductive pathways. Rats were immunized with microencapsulated antigen by intranasal or ocular topical routes. Tear IgA and serum IgG antibody concentrations were assessed by radioimmunoassay. The frequency of antibody-secreting cells in tissues, postulated to function in tear IgA induction, was measured by enzyme-linked immunospot assay. RESULTS: Although uptake of microencapsulated antigen was greatest at the site of delivery, ocular topical administration resulted in antigen uptake in the conjunctiva and in nasal-associated lymphoid tissue. Intranasal immunization resulted in earlier and significantly higher tear IgA and serum IgG antibody responses and in higher frequencies of antibody-secreting cells in corresponding draining cervical lymph nodes and lacrimal glands than did ocular topical immunization. CONCLUSIONS: Nasal-associated lymphoid tissue functions as a primary inductive site for tear IgA antibody responses by contributing triggered IgA-committed B cells to the lacrimal gland.     

Urinary N-acetyl-beta-D-glucosaminidase in the prediction of preeclampsia and pregnancy-induced hypertension

Urinary N-acetyl-beta-D-glucosaminidase was estimated in 109 primigravidas and the level correlated with the subsequent development of preeclampsia and pregnancy-induced hypertension in these women. The enzyme value was significantly higher in those who developed preeclampsia. Its sensitivity and specificity for the prediction of the disorder were 80% and 78% respectively. The positive predictive value was 21% while the negative predictive value was 98%.     

Selective modifications of the phospholipid fatty acid composition in human platelet membranes using nonspecific and specific lipid transfer proteins

In the framework of an earlier constructed model [N.S. Ananikyan et al. (1990) Biopolymers, Vol. 30, pp. 357-367], some analytical estimates for the correlation length and degree of helicity near the transition point were obtained in the case of an arbitrary topology of hydrogen bond closing (delta). It was shown that the Zimm-Bragg cooperativity parameter sigma is determined by the set of (delta-1) amino acid residues and so is nonlocal. An analytic expression for cooperativity parameters in a heteropolypeptide chain was obtained and numerical calculations showed that in case of heteropolypeptide with random primary structure the nonlocality of cooperativity parameter influenced the temperature dependence of helicity degree.     

Evidence of platelet activation in hypertension

To test the hypothesis that platelet activation is present in hypertension, we measured plasma markers beta thromboglobulin and soluble P-selectin in hypertensive patients and normotensive controls. Both markers were raised in the patients (P < 0.05), and in a subgroup of patients, beta thromboglobulin was reduced with successful treatment of hypertension with the ACE inhibitor quinapril. We suggest that reversible platelet activation is present in hypertension. This may be a contributing factor to the link between this risk factor and the development of thrombotic disease such as stroke.     

Arachidonic acid release from diacyl phosphatidylethanolamine by human platelet membranes

Sixty-one full-term, appropriate-weight black newborns had higher heart rates, replicating a racial heart rate difference, but did not differ significantly in systolic blood pressure from 71 white newborns. Systolic blood pressure in the newborn is related both to the total number of feedings from birth and to the total fluid intake.     

Lifestyle modifications for hypertension. The many benefits are worth the effort

Any approach to antihypertensive therapy should include lifestyle modifications. In the beginning, emphasis should be on weight loss and exercise, along with moderation of alcohol use and cessation of smoking. Patients should be encouraged to consume fresh rather than processed (and thus high-salt) foods and to limit use of salt in cooking and at the table. Even if patients eventually require antihypertensive medications, lifestyle modifications should continue, since there is evidence that such measures minimize the number and dose of medications required.     

Rebound hypertension during anaesthesia

A case of rebound hypertension under anaesthesia, following withdrawal of clonidine, is described and methods of treatment outlined.     

Decreased activity of oxidoreductases in erythrocytes and blood platelets from venous and umbilical blood of women with pregnancy-induced hypertension

Thirty two pregnancies with pregnancy-induced hypertension (PIH) and twenty seven control normal pregnancies were analysed with regard to maternal and fetal blood enzymatic antioxidants. In PIH maternal erythrocyte, platelet and serum blood and in umbilical cord blood levels of lipid peroxides were higher than in normal pregnancy. Also the activities of platelet and erythrocyte superoxide dismutase and glutathione peroxidase were lower in PIH women. The concentration of lipid peroxides was higher, and the activity of glutathione peroxidase were lower in umbilical cord elements of women with PIH, than corresponding values of women with normal pregnancy. We suggest that disturbances in antioxidant enzymatic system are involved in the pathogenesis of maternal PIH, and it may also have effects on the function of antioxidant status of the fetus.     

Nitric oxide prevents human platelet adhesion to fiber membranes in whole blood

During cardiopulmonary bypass or long-term extracorporeal life support, foreign surface induced platelet deposition in the oxygenator causes deterioration of gas exchange. In this study, the authors evaluated the effectiveness of nitric oxide (NO) in reducing the adhesion of platelets in whole blood to the surface of hollow fiber membranes. For this purpose, a test chamber was designed consisting of a gas exchanger with ten mitsubishi multi-layered composite hollow fibers (MHF: 257 mm OD; 203 mm ID; 70 mm length) and a polypropylene tube (16 mm OD; 100 mm length). Pure N2 (control) or nitric oxide (NO) (100 ppm, 200 ppm in N2) were delivered into the test chamber previously filled with 13 ml human whole blood. Platelet counts and platelet factor 4 (PF4), as a measure of platelet activation, were measured before and after either 1 or 2 hr of testing, and fibers were observed under scanning electron microscopic study (SEM) after each experiment. In the control and 100 ppm NO groups, platelet counts decreased and the level of PF4 increased during the 1 hr period. In the 200 ppm NO group, almost no platelet deposition could be observed on the surface of fibers under SEM. In conclusion, NO flow through hollow fiber membranes can markedly reduce platelet adhesion. Additional quantitative studies should define the optimal concentration for this effect and determine if this finding could improve oxygenator function, especially under conditions of long-term support.     

Isoxsuprine in hypertension during pregnancy

AIM: Direct cytokine modulation may benefit patients with inflammatory bowel disease. PATIENTS: Subcutaneous interferon gamma (1.5 microgram/kg) was given three times a week in an open pilot study to four patients with active Crohn's disease unresponsive to standard immunosuppressive drug treatment. RESULTS: In one patient, the C-reactive protein and Crohn's disease activity index returned to normal and the patient became asymptomatic. The other three patients did not complete the 12-week treatment course, one because of drug failure, one because of drug side effects, and one because of incidental disease. However, the Crohn's disease activity index fell substantially and the C-reactive protein returned to normal in three out of four patients. CONCLUSIONS: Interferon gamma may have a role in the treatment of resistant patients, but only if the dose can be optimised and drug side effects overcome.