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.     

Obesity, hypertension and atherosclerosis

OBJECTIVE: To determine the effect on oxygen saturation of instilling a saline bolus into artificial airways prior to suctioning, as measured by pulse oximeter. DESIGN: Quasi-experimental, single-case, counterbalanced design. SETTING: The surgical, medical and coronary intensive care units of a federal, teaching medical center. SUBJECTS: Subjects were 40 men, more than 40 years old, in need of intensive care nursing and mechanical ventilation. INTERVENTIONS: Subjects were suctioned as needed for 24 hours. A 5-mL saline bolus was instilled every other time the subject was suctioned. Outcome measurements were done immediately before and after suctioning and at 1-minute intervals for 5 minutes after suctioning. MAIN OUTCOME MEASURES: Noninvasive oxygen saturation values. RESULTS: The instillation of a saline bolus was found to have an adverse effect on oxygen saturation that worsened over time. Significant changes in oxygen saturation as a result of saline bolus instillation were found at 2,3,4 and 5 minutes after instillation. CONCLUSIONS: These results indicate that instilling saline prior to suctioning has an adverse effect on oxygen saturation. These results support the recommendation that the practice of instilling saline prior to suctioning should be abandoned as a routine procedure. More study is needed to investigate whether a specific group of patients may actually benefit from this procedure.     

Calcium antagonists and mortality risk in men and women with hypertension in the Framingham Heart Study

BACKGROUND: Several recent studies have suggested that calcium antagonist drugs, which are widely used for the treatment of hypertension, are associated with increased risk of cardiovascular disease. These studies have cast doubts on the long-term safety of calcium antagonists. OBJECTIVE: To examine the association of calcium antagonist use with mortality in subjects with hypertension followed up in the Framingham Heart Study. SUBJECTS AND METHODS: We stratified 3539 subjects (mean+/-SD age, 64+/-13 years) from the Framingham Heart Study who had hypertension at routine clinic examinations, according to the use of calcium antagonists and presence of coronary heart disease at the baseline examination. At each follow-up examination (every 2-4 years), subjects were reclassified with regard to the use of calcium antagonists. The end point of the study was all-cause mortality. Hazard ratios and 95% confidence intervals associated with the use of calcium antagonists were obtained using Cox proportional hazards regression models. RESULTS: There were 970 deaths during follow-up. Hazard ratios for mortality associated with the use of calcium antagonists were 0.93 (95% confidence interval, 0.72-1.21; P=.59) for subjects with hypertension without coronary heart disease, and 0.92 (95% confidence interval, 0.69-1.24; P=.58) for those with coronary heart disease at baseline. All models were adjusted for age, sex, current smoking, systolic and diastolic blood pressure, use of beta-blockers, and use of other antihypertensive medications. CONCLUSIONS: In this cohort of 3539 subjects with hypertension there were no differences in mortality among subjects with hypertension using a calcium antagonist compared with those who were not. Results were similar among subjects with hypertension with and without coronary heart disease. The results of ongoing long-term, randomized clinical trials will provide more definitive data on the safety of calcium antagonists.     

c-Fos expression in brain in response to hypotension and hypertension in conscious rats

Hypotension- and hypertension-evoked expression of the protein product, Fos, of the immediate early gene c-fos was assessed throughout the rat brain as an approach for describing the neuronal populations that respond to alterations in arterial blood pressure. Conscious, chronically catheterized rats were treated with the vasoconstricting drug phenylephrine or the vasodilatating drug hydralazine to increase or decrease, respectively, arterial pressure by approx. 40 mm Hg for 90 min. Rats were then anesthetized, fixed by vascular perfusion, and sections representing the entire brain were processed for the immunocytochemical localization of Fos. In control rats treated with isotonic saline, few Fos-positive neurons were observed. In contrast, phenylephrine and hydralazine treatments resulted in different, yet reproducible, patterns of Fos expression in the brain, with hydralazine evoking Fos expression in more brain regions than phenylephrine. Brain regions containing Fos-positive neurons in rats treated with hydralazine included nucleus tractus solitarius, area postrema, caudal ventrolateral medulla, rostral ventrolateral medulla, bed nucleus of the stria terminalis, amygdala, paraventricular nucleus, supraoptic nucleus, subfornical organ and the Islands of Calleja. The nucleus tractus solitarius, paraventricular nucleus and the amygdala also contained Fos-positive neurons in phenylephrine-treated rats, although the number of Fos-positive neurons was always less than that noted in the hydralazine-treated rats and the location of Fos-positive neurons within these regions tended to differ between treatments. These results generally fit within an emerging understanding of brain circuitry underlying cardiovascular regulation.     

Hostility, social support, and coronary heart disease in the National Heart, Lung, and Blood Institute Family Heart Study

This cross-sectional study investigated the association of hostility and social support to coronary heart disease (CHD) in 2 groups of men and women: those with a familial predisposition for CHD (high-risk sample) and a randomly selected group. The hypothesis was that hostility and low social support would be associated with CHD, and would have a greater effect in the high-risk group. The random sample contained 2,447 individuals (47.1% male) from 576 families, and the high-risk sample consisted of 2,300 people (45.5% male) from 542 families. Odds ratios (OR) and their 95% confidence intervals were calculated using generalized estimating equations (GEE) for logistic regression. Family was specified as the clustering variable, and robust SEEs were obtained to account for dependence of the data within families. After controlling for age, education, body mass index, exercise, smoking history, drinking history, and drinking >5 drinks a day, hostility was associated with a history of coronary bypass surgery or coronary angioplasty in high-risk men (OR 1.21) and a history of myocardial infarction in high-risk women (OR 1.39). High-risk women with high social support had reduced odds of a previous myocardial infarction (OR 0.76), whereas women with high network adequacy in the random sample had reduced risk of myocardial infarction (OR 0.41) and angina (OR 0.49). A ratio of high hostility to low social support was associated with past myocardial infarction in high-risk women (OR 2.47) and a history of angina (OR 2.02) in the random sample men. These results suggest that high hostility and low social support are associated with some manifestations of CHD after controlling for adverse health behaviors.     

Headaches, idiopathic intracranial hypertension, and pseudopapilledema

A young woman with frontal headaches of several months' evolution and monocular transient "tunnel" obscurations that developed after a generalized seizure is described. She had elevation of the optic discs (pseudopapilledema), greater on the side of her visual symptoms. No intracranial lesions were identified. Cerebrospinal fluid pressure was increased, diagnostic of idiopathic intracranial hypertension (IIH). Because both IIH and pseudopapilledema may cause transient visual obscurations (TVO), fortuitous discovery of pseudopapilledema in a patient with TVO does not preclude the necessity of performing a diagnostic lumbar puncture. Establishing the correct diagnosis has obvious therapeutic and prognostic implications.     

Heart pathology of extracardiac origin. IV. Pulmonary hypertension in chronic respiratory diseases

Until the 1950's, psychological adaptation to the polar regions was expressed by survivors more in terms of their endurance and heroism after the event than by any studied preparation beforehand, a careful monitoring of performance in situ, the follow-up of subjects afterwards, and a scholarly comparison of data-based research finding. This paper covers some of the omissions, and presents the results of a few studies that should be of value to the variety of people who for quite different periods and purposes visit polar regions. Because of the author's own background in Antarctic research it draws upon material collected in Antarctica, but it also includes empirical studies made by behavioural scientists in the Arctic. Its aim is to encourage potential venturers to the polar areas to prepare themselves mentally as well as physically and logistically for the task ahead of them, whether it be for the long winter night at base or for the long summer day in the field. It concludes with a plea for all the venturers to accept an obligation to provide research data on themselves. The outcome, if done systematically, could be of value both for future participants and for behavioural scientists, because in the past human factors in exploration have been given little attention.     

Angiotensinogen genotype, sodium reduction, weight loss, and prevention of hypertension: trials of hypertension prevention, phase II

Hox genes are segmentally expressed in the developing vertebrate hindbrain, neural crest cells and pharyngeal arches suggesting an important role in patterning these structures. Here we discuss the cellular and molecular mechanisms controlling segmentation and specification in the branchial region of the head. In addition, based on the recent phenotypical and molecular analysis of loss-of-function mutants in the mouse, we speculate that Hox genes may act like Drosophila selector genes in this system.     

Lead and the kidney: nephropathy, hypertension, and gout

Lead intoxication in human beings has been documented since the second century B.C. Renal disease, hypertension, and gout have all been linked to lead by strong circumstantial evidence. Both acute and chronic nephropathy can occur as a result of lead poisoning. Acute renal failure develops following acute lead intoxication and is often associated with gastrointestinal, neurologic, and hematologic disorders. Both blood and urinary laboratory abnormalities are associated with acute intoxication and are often diagnostic. Chronic lead nephropathy, a chronic tubulointerstitial nephritis on biopsy, occurs in the setting of long-term lead exposure and is often associated with hypertension and gout. Diagnosis of chronic lead nephropathy is more difficult since the laboratory abnormalities seen with acute lead intoxication are not present with chronic lead exposure. The typical clinical picture and the exclusion of other causes of renal disease allow the diagnosis of chronic lead nephropathy to be made. Evaluation of lead stores by either the calcium disodium edetate (EDTA) mobilization test or K-x-ray fluorescence are helpful in clinching the diagnosis. Treatment with EDTA lead mobilization is effective for acute lead poisoning while avoidance of further lead exposure prevents recurrence of lead intoxication. Treatment of chronic lead nephropathy with EDTA lead mobilization is useful if renal failure is modest; however, EDTA mobilization is of no benefit in patients with more severe renal insufficiency.     

Ethanol, stroke, brain damage, and excitotoxicity

The N-methyl-d-aspartate (NMDA)-glutamate receptor could contribute to stroke, trauma, and alcohol-induced brain damage through activation of nitric oxide formation and excitotoxicity. In rat primary cortical cultures NMDA was more potent at activating nitric oxide formation than triggering excitotoxicity. Ethanol dose dependently inhibited both responses. In contrast, treatment of neuronal cultures with ethanol (100 mM) for 4 days significantly increased NMDA stimulated nitric oxide formation and excitotoxicity. These findings suggest that ethanol acutely inhibits but chronically causes supersensitivity to NMDA-induced excitotoxicity in neuronal cultures. To investigate ethanol's interaction with stroke induced damage models of global cerebral ischemia were studied. Transient global ischemia resulted in a loss of hippocampal CA1 pyramidal neurons over a 3- to 5-day period. Determinations of the NMDA receptor ligand binding stoichiometry or postischemic receptor binding changes did not show differences between neurons that undergo delayed neuronal death following ischemia and those that show no toxicity, for example, CA1 and dentate gyrus, respectively. Acute ethanol (3 g/kg) was found to protect against ischemia-induced CA1 hippocampal damage by lowering body temperature, but not under temperature controled conditions. These studies indicate that the factors contributing to stroke-induced brain damage are complex, although they are consistent with chronic ethanol increasing stroke-induced brain damage by increasing NMDA excitotoxicity.     

Experience, memory, and the brain.

Discusses 3 research approaches—behavioral intervention, somatic intervention, and the correlational approach—that focus on relations between the nervous system and learning and memory. Experiments involving behavioral intervention have shown that giving rodents either enriched experience in a complex environment or formal training leads to measurable changes in their brains. Such research is being applied not only to aid laboratory and farm animals but also to help human patients and aging normal people. Complementary laboratory research involving somatic intervention with pharmaceutical agents has shown that treatments that prevent ocurrence of neural changes induced by experience also block formation of long-term memory. Further research is investigating direct processes and modulatory influences in the earlier stages of memory formation. This work may lead to help for many individuals who suffer from deficiencies of memory formation and may eventually aid the performance of people with normal memory. It is argued that such research must be conducted with extensive advance consideration and planning lest applications exacerbate existing disparities among social groups within nations and between the more- and less-developed nations. (99 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Imagery, memory, and the brain.

Reviews literature on brain mechanisms underlying episodic and semantic memory functions of nonverbal imagery. Brain functions are inferred from effects of lateralized presentation of different materials or tasks to one or the other cerebral hemisphere of normal Ss and cerebral commissurotomy patients as well as from performance deficits resulting from focal brain lesions. Inferences about imagery are based primarily on the effects of relevant stimulus attributes and task variables. The present authors conclude that the 2 hemispheres and different cortical areas within each hemisphere are differentially involved in episodic and semantic memory functions of imagery. Implications for neuropsychological models of imagery, dual coding theory, and the episodic–semantic memory distinction are noted. (French abstract) (110 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hormones, the brain, and me.

My research program in psychoneuroendocrinology, a subdiscipline of psychology, has focused on the investigation of three areas of women's health. First, the authors have studied the role of androgen in female sexuality; second, the authors have investigated the effects of estrogen on mood in women, and more recently, the authors have demonstrated the conditions under which estrogen treatment would be neuroprotective with regard to cognitive functioning in aging women. The results of our own and of other researchers' studies in all three areas of psychoneuroendocrinology are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)