Increased occurrence of esophageal hypermotility disorders in patients with arterial hypertension

BACKGROUND AND OBJECTIVE: It has been noted in previous manometric examinations of the oesophagus in patients with chest pain that abnormal motility was often associated with arterial hypertension. A systematic study of this relationship was therefore undertaken. PATIENTS AND METHODS: In 40 patients with chest pain (18 women and 22 men, mean age 54.7 [24-70] years) and in 20 healthy volunteers (12 men, 8 women, mean age 50.8 [22-63] years) standardized oesophageal manometry and arterial blood pressure monitoring were performed over 24 hours. Coronary heart disease and gastrointestinal lesions had been excluded by angiography and endoscopy, respectively. RESULTS: 20 patients (group H) had hypertension (median 24-hour blood pressure > 135/85 mmHg), while 20 patients (group N) and the normal controls (group K) were normotensive. Oesophageal manometry data differed significantly between the three groups regarding distal pressure amplitude (in hPa [hectopascals]; group H: 62 hPa*,**, group N 44 hPa* and group K 36 hPa**; [*P < 0.0005]) and the proportion of simultaneous contractions (group H 23%, group N 22%**, group K 10%***; ***P < 0.001). The hypertensive patients had significantly more frequent motility abnormalities than normal controls (13/20 vs 4/20, P < 0.001); while normotensive patients had more frequent episodes of abnormal propulsion in the oesophagus (proportion of propulsive contractions in group H: 53%, in N: 44%, in K: 59%; P < 0.01). CONCLUSION: Oesophageal motility differed significantly in patients with chest pain from that in healthy controls. Patients with chest pain and hypertension more frequently had oesophageal hypermotility. This suggests a generalized abnormality of smooth muscle.     

The stress test in adolescents with and without a family history of arterial hypertension: the prognostic role of a systolic arterial pressure index

A family history of hypertension can influence the behaviour of blood pressure during ergometric stress test (EST) in normotensive subjects, so that it is also used in the assessment of risk of hypertension. To evaluate the relationship between parental history and blood pressure values during exercise, 57 consecutive adolescents (aged 10-16 years) were studied. Out of them, 25 patients have not been considered because of the presence of organic pathologies of various nature that could interfere with the pressure behaviour. All patients underwent EST with a load increase of 25 W every 3 min until the maximal age-related heart rate. The patients were divided in 2 groups based on the presence (PH+ 13 patients, mean age 13 +/- 2 years) or on the absence (PH- 19 patients, mean age 13 +/- 2 years) of parental history of hypertension. No difference in body surface and maximum workload was observed between the 2 groups. Exercise test induced an increase in systolic blood pressure (SBP) both in PH- and PH+ patients, but no significant differences were found in any stage of the exercise in the 2 groups. Maximum heart rate (HR) was not different in the 2 groups and diastolic blood pressure (DBP) was substantially unchanged during exercise. The variation of SBP (delta SBP) between maximum stress and first, third, fifth and tenth min of the recovery phase were considered. Besides, 4 SBP indexes were deduced from the ratio of SBP values at the first, third, fifth and tenth min of the recovery by the SBP value at the acme of stress.(ABSTRACT TRUNCATED AT 250 WORDS)     

Unilateral bronchography at a young age and ventilatory function

In 21 males, aged about 20, 18 out of them with chronic bronchopulmonary diseases (bronchiectases, focal fibrosis, deforming bronchitis) and three healthy--VC, FEFR1, FVC, MMV50, MEFR200-1200, MAEFR, MAEFR25-75 and MEFR50 and MEFR90 were spirographically investigated prior to, two hours afert and 24 hours after unilateral bronchography; the three of the investigations were combined with a subsequent inhalation bronchodilatation test with orziprenalin--aersol (alupent). A mixed (restrictive-obstructive) ventilation syndrome with bronchospasm was established to develop after the bronchography. The restrictive syndrome is prevailing and that is conditioned by the absence of a definite manifestation of the obstruction at the level of the flow rates with small pulmonary volmes. The restrictive syndrome is admitted to be conditioned by "fear of coughing and the obstructuve-by the opaque medium and bronchospasm after the injection of the opaque substance.     

Peculiarities of myocardial infarction at young age in Southern Croatia

The aim of this study was to assess whether acute myocardial infarction (AMI) in younger patients (< 45 years) differs from that in the older individuals (> 45 years). We have studied the records of all patients admitted to the Department of Medicine, Clinical Hospital of Split, Croatia, because of AMI from January 1st, 1987 to December 31st, 1991. The study group consisted of 1406 patients, 130 (9.2%) below, and 1276 (90.8%) above the age of 45. In the ?young? subgroup there were only 9 females (6.9%), significantly less than in the ?old? one (399 out of 1276 or 31.3%, p < 0.001). There were many more smokers among the younger (100 out of 130 or 76.9%) than among the older patients (524 out of 1276 or 41.1%, p < 0.001). The location of myocardial necrosis was also different: inferior infarction occurred in 65 out of 130 or 50% young patients and in 442 out of 1276 or 34.6% old patients; p < 0.001). Finally, the hospital mortality rate among the younger AMI patients was quite low (8 out of 130 or 6.2%) when compared to that of the older patients (282 out of 1276 or 22.1%, p < 0.001). In conclusion, AMI in younger individuals shows relevant peculiarities: the background of such patients almost invariably includes cigarette smoking; the female gender is about five times less affected, the diaphragmatic location is nearly two times more frequent, and the hospital mortality rate of these patients is almost four times lower than that of older patients.     

Microalbuminuria in arterial hypertension

Microalbuminuria is a considerable good indicator of atherogenic disease and cardiovascular risk. In the arterial hypertension, the main centre organ is the kidney. Structural and functional changes that happen in the hypertensive nephropathy are going to cause alterations m the albumin urinary excretion. The authors have done a revision of the main factors which can origin the existence of microalbuminuria in patients with arterial hypertension, and they conclude that this is an useful biochemist indicator in order to evaluate the degree of renal disease in these patients.     

Association between apolipoprotein(a) phenotypes and coronary heart disease at a young age

Fentanyl is a basic amine shown to have extensive first-pass pulmonary uptake. To evaluate the role of the pulmonary endothelium in this uptake process, the simultaneous pharmacokinetics of [3H]fentanyl and two marker drugs, blue dextran, and [14C]antipyrine, were evaluated in a flow-through system of pulmonary endothelial cells. Fentanyl equilibrium kinetics were determined in a static culture system. The flow-through system consisted of monolayers of bovine pulmonary artery endothelial cells cultured on solid microcarrier beads placed in a chromatography column and perfused at 1.0 ml/min (37 degreesC). Fentanyl and the markers were injected into the perfusate at the top of the column and samples were collected from the eluate at 9-s intervals for 10 min. The pharmacokinetic analyses were based on determinations of mean transit time and flow. Fentanyl was partitioned into the pulmonary endothelial cells 60 times more than the tissue water space marker antipyrine. In the static system, monolayers of bovine pulmonary artery endothelial cells were cultured in 3.8-cm2 wells to which were added 0 to 946 micromol (0-500 microgram/ml) of unlabeled fentanyl citrate and 0.14 micromol of [3H]fentanyl. After a 10-min incubation, solubilized cells were assayed for [3H]fentanyl. Pulmonary endothelial cells contained a higher relative fentanyl concentration at lower fentanyl supernatant concentrations than would be expected if uptake occurred by diffusion alone. These observations can be explained with a model of fentanyl uptake that includes both passive diffusion and saturable active uptake. This suggests that the extensive first-pass pulmonary uptake of fentanyl observed in vivo is due largely to vascular endothelial drug uptake by both a passive and a saturable active uptake process.     

The epidemiological and prevention problems of arterial hypertension at an oil and gas complex in western Siberia

In capable male population (age 20-59 years) developing oil and gas extraction in the Western Siberia the incidence of arterial hypertension reached 14.1%. Wide introduction of preventive programs in the extreme conditions of labour helped to normalize blood pressure in every second patient and to maintain health in migrants from other regions.     

Retinal arterial occlusions in young adults

Stereotactic posteroventral pallidotomy can improve motor performance in Parkinson's disease. Interruption of inhibitory pallidal projections to ventrolateral thalamus, components of a cortical-basal ganglia motor loop allows for this clinical benefit. We hypothesized that pallidotomy would lead to increased movement related activity in motor cortical areas receiving projections from ventrolateral thalamus. This was tested in 6 Parkinson's disease patients who underwent stereotactic posteroventral pallidotomy. Each patient was imaged with positron emission tomography (PET) measures of regional cerebral blood flow (rCBF) during performance of a simple prehension task and at rest. Scans were acquired before and 17 weeks after surgery. After pallidotomy, movement-related changes of rCBF increased significantly in both the supplementary motor area (SMA) and premotor cortex but not in primary motor cortex. The results demonstrate the importance of pallidothalamic circuitry for regulating volitional movements and confirm that disruption of inhibitory input to the ventrolateral thalamus can augment movement-related activity in motor association areas.