Behavior of blood pressure during pregnancy

In 948 women of the blood-pressure behaviour was registered weekly, from the 12. up to the 42. week of normal pregnancy. The normal range is stated with the single and double dissemination of the blood-pressure values; depending from the number of weeks being pregnant, and dessignation and meening to the pathological behaviour are represented. Desides, the frequency of various course-types of the blood-pressure during pregnancy is given, their possible meaning being discussed. For this purpose, 1337 single courses of the blood-pressure behaviour within pregnancy were explored.     

Ambulatory blood pressure monitoring during pregnancy. Comparison with mercury sphygmomanometry

There is little information concerning the relationship between blood pressures obtained by standard mercury sphygmomanometry and ambulatory blood pressure monitoring (ABPM) in pregnancy. We compared readings obtained with these two methods using an Hawksley random zero mercury sphygmomanometer and an Accutracker II ABPM device. Blood pressures were compared over 90 min with the pregnant woman seated and, in a separate study, over 30 min during standing and ambulation. When pregnant women were seated, the ABPM overestimated the systolic blood pressure (BP) by 5 (3,6) mm Hg (mean, 95% confidence limits) (P < .001) and underestimated diastolic phase IV readings by 7 (-9, -6) mm Hg (P < .001) and phase V readings by 3 (-5, -1) mm Hg (P < .01). Eighty-three percent of systolic readings agreed within 10 mm Hg. Seventy-six percent of diastolic phase V (but only 45% of phase IV) readings agreed within 6 mm Hg. When pregnant women were ambulatory, the ABPM overestimated systolic BP by 7 (4,10) mm Hg (P < .001) and underestimated diastolic phase IV readings by 6 (-8, -4) mm Hg (P < .001) and phase V readings by 4 (-6, -2) mm Hg (P < .01). Eighty percent of systolic readings agreed within 10 mm Hg. Fifty-five percent of diastolic phase V and 50% of diastolic phase IV readings agreed within 6 mm Hg. The Accutracker II blood pressure readings are reasonably comparable to those of mercury sphygmomanometry in pregnant women, particularly when assessing group data.(ABSTRACT TRUNCATED AT 250 WORDS)     

Postmarketing surveillance of lovastatin and simvastatin exposure during pregnancy

Pregnancy outcomes in women with inadvertent exposure to lovastatin and simvastatin during pregnancy have been examined based on reports submitted to the manufacturer as part of worldwide postmarketing surveillance. There were 134 reports of exposure during pregnancy in which pregnancy outcome was known. Among prospectively followed pregnancies with known outcome, the proportion of normal outcomes was 85%, congenital anomalies 4.0%, spontaneous abortions 8.0%, fetal deaths/stillbirths 1.0%, and miscellaneous adverse outcomes 2.0%. While the number of prospective reports available for evaluation were only sufficient to rule out a three- to fourfold increase in the overall frequency of congenital anomalies, these proportions do not exceed what would be expected in the general population. Based on findings from this interim evaluation, there is no relationship between exposure to therapeutic doses of these agents during pregnancy and the occurrence of adverse pregnancy outcomes.     

Evaluation of a new ambulatory blood pressure device

We assessed the OSCILL-IT ambulatory blood pressure (BP) recorder (FIGI sr1, Rome, Italy) according to the performance criteria set out by the British Hypertension Society (BHS) protocol. The OSCILL-IT is a portable, noninvasive recorder that uses a process that correlates systolic, mean, and diastolic areas, identified on the oscillations, to the cuff absolute pressure. According to the recommendations of BHS, a large heterogeneous population (100 subjects: 52 men aged from 19 to 79--median 44 and 48 women from 19 to 74--median 54) was recruited in order to assess accuracy and to analyze, in addition, the effects of observer agreement and BP level on the observer-device differences. With reference to BP level, we suggest also a new graphic approach. Four sets of sequential, same arm, comparative BP measurements were obtained, performed by the OSCILL-IT recorder and two skilled clinicians using a mercury column, for each subject. We used a linear combination for the statistical evaluations. We confirmed the observer agreement through the frequency distribution of BP as a function of the observer and through the differences between observers. We compared OSCILL-IT with sphygmomanometric readings: the differences were not significant. A visual inspection, with the addition of regression lines, showed that there were no variations in differences at the changing of BP level. The difference between observers and OSCILL-IT was 0.2 +/- 5.3 mm Hg and 0.2 +/- 5.8 mm Hg both for systolic BP (SBP) and diastolic BP (DBP). The level of agreement, according to BHS criteria, showed that 64% of all systolic and 70% of all diastolic readings obtained by the OSCILL-IT were within 5 mm Hg of the sphygmomanometric determinations. Therefore, the grade is C for SBP, even if 93% of SBP and 95% of DBP obtained by the OSCILL-IT were within 10 mm Hg of the sphygmomanometric determinations. These analyses demonstrate that the OSCILL-IT satisfies the accuracy parameters and the additional linear regression yields graphics more immediate.     

The determinants of long-term blood pressure stability: control of trough blood pressure during sleep

Little is known regarding the prevalence and course of fatigue in cancer patients after treatment has ended and no recurrence found. The present study examines fatigue in disease-free cancer patients after being treated with radiotherapy (n = 154). The following questions are addressed. First, how do patients describe their fatigue 9 months after radiotherapy and is this different from fatigue in a nonselective sample from the general population (n = 139)? Secondly, to what degree is fatigue in patients associated with sociodemographic, medical, physical and psychological factors? Finally, is it possible to predict which patients will suffer from fatigue 9 months after radiotherapy? Results indicated that fatigue in disease-free cancer patients did not differ significantly from fatigue in the general population. However, for 34% of the patients, fatigue following treatment was worse than anticipated, 39% listed fatigue as one of the three symptoms causing them most distress, 26% of patients worried about their fatigue and patients' overall quality of life was negatively related to fatigue (r = -0.46). Fatigue in disease-free patients was significantly associated with: gender, physical distress, pain rating, sleep quality, functional disability, psychological distress and depression, but not with medical (diagnosis, prognosis, co-morbidity) or treatment-related (target area, total radiation dose, fractionation) variables. The degree of fatigue, functional disability and pain before radiotherapy were the best predictors of fatigue at 9-month follow-up, explaining 30%, 3% and 4% of the variance respectively. These findings are in line with the associations found with fatigue during treatment as reported in the preceding paper in this issue. The significant associations between fatigue and both psychological and physical variables demonstrate the complex aetiology of this symptom in patients and point out the necessity of a multidisciplinary approach for its treatment.     

Continuous blood pressure monitoring during stress ECG

This paper describes the process of narrative analysis as undertaken within a nursing study on scholars and scholarship. If follows an earlier paper titled: Theoretical perspectives on narrative inquiry that described the influencing ideas of Bruner (1987) and Roof (1994) upon the same study. Analysis procedures are described here in sufficient detail for other researchers wishing to implement a similar approach to do so. The process as described has two main components: (A) strategies of 'core story creation' and 'employment'; and (B) issues and dilemmas of narrative analysis, especially relating to rigour. The ideas of Polkinghorne (1988), Mishler (1986), and Labov (in Mishler 1986a) are introduced in so far as they impinge upon the analysis process. These relate especially to the development of key terms, and to the analysis strategies of core story creation and employment. Outcomes of the study in question are termed 'Signposting the lived-world of scholarship'.     

Sensitivity of blood pressure and renin activation during sodium restriction

The objective of the present study was to explore the interrelationships among cumulative sodium loss, renin activation, and blood pressure changes during sodium restriction in essential hypertensive patients. Specifically, we wanted to know whether the degree of sodium sensitivity of blood pressure depends on renin activation during steady state or on initial renin activation during the first days of sodium restriction. Sixty-seven untreated essential hypertensive patients were admitted to a metabolic ward for 8 days and put on a sodium restricted diet of 55 mmol/d from the second to the last day. Urinary excretions of sodium, potassium, and creatinine were determined along with mean arterial pressure and weight during 7 days. Besides measurements in steady state condition (after 7 days), active plasma renin concentration, aldosterone, and catecholamines were also assessed during the first 3 days of sodium restriction. Analyzable data are available for 55 patients. Baseline sodium excretion and the activation of renin during the first 3 days both appeared to be predictors of total sodium loss after 7 days. Changes in blood pressure were not related to changes in sodium balance, but they were to baseline blood pressure, baseline norepinephrine, and renin activation during the early phase of sodium restriction. In addition, blood pressure appeared to fall more when the normal relationship between sodium loss and early (but not late) activation of renin was disturbed. We conclude that sodium sensitivity of blood pressure during sodium restriction is associated with a relative unresponsiveness of the renin system during the early phase of sodium loss rather than to absolute renin levels during steady state.     

Cardiac output and blood pressure during active and passive standing

The present study was conducted to demonstrate immunohistochemically, the sites of c-fos protein expression in the brains of mice subjected to acute and chronic social defeat stress. To induce social stress, mice were placed in situations of species-specific intermale aggression either only once or five times at 24 h intervals. Two hours after the single or fifth defeat stress, many c-fos immunoreactive neurons were observed in a variety of brain regions including the limbic system and sensory relay nuclei. The c-fos immunoreactive neurons in the brains of acute defeat mice decreased in number with time and the c-fos staining pattern of acute defeat mice became indistinguishable from that of normal control mice by 24 h after the single defeat stress. In contrast, chronic defeat stress induced persistent c-fos expression in the forebrain and brainstem even 24 h after the fifth defeat stress. In the forebrain of chronic defeat mice, the olfactory bulb, cingulate cortex, hippocampus, entire hypothalamus, septal nuclei and the amygdaloid complex, except for the central nucleus, were labeled intensely with c-fos antiserum. In the lower brainstem, nerve cells with c-fos immunoreactivity were seen mainly in ascending and descending sensory relay nuclei relevant to auditory and vestibular transmission, epicritic sensation (gracile and external cuneate nuclei), pain inhibition (central gray and raphe nuclei), and viscerosensory transmission (solitary tract nucleus). The differences in c-fos expression among the normal control, acute and chronic defeat mice were evaluated by an enumeration of the immunopositive neurons within each brain nucleus examined, and they were confirmed subsequently by statistical analysis. There was little c-fos expression in the nucleus putamen, lateral, ventral and posterior thalamic nuclei, pretectal nuclei, medial geniculate nucleus, red nucleus, substantia nigra, cerebellum, spinal cord, or cranial nerve nuclei. These findings suggest that chronic but not acute defeat stress causes persistent c-fos expression in more widespread brain regions than do any other stresses so far investigated. The present study may shed light on the central mechanisms by which behavioral abnormalities and/or chronic sociopsychological stress leads to the occurrence of abnormal behavior and/or psychosomatic disorders in experimental animals and humans.     

Ambulatory blood pressure monitoring in pregnancy: what is normal?

This paper aims to explore the meaning of spirituality in relation to nursing care using concept synthesis. Walker and Avant give three ways in which concept synthesis can occur: discovering new dimensions to old concepts, searching for similarities and discrepancies among sets of related concepts, and observing previously undescribed phenomena. It is the first two of these methods which have been used here. The phenomena that emerged from a reading of the literature around spirituality were meaning, presencing, empathy/compassion, giving hope, love, religion/transcendence, touch and healing. These phenomena were studied in order to sort them into fewer categories. They all appeared to be products of a relationship, some physical (presencing, touch and healing), and others emotional (meaning, empathy/compassion, hope, love, and religion/transcendence). Some of the phenomena appeared to fit in both categories, especially healing, which could be of a physical or emotional/spiritual nature. Once the two main categories had been arranged, it was obvious that a split between psyche and soma was not appropriate for labelling the spiritual dimensions of nursing care, as the original definition of spirit was something which motivated the body. Spiritual care is inseparable from physical, social and psychological care because together they form the whole (Bradshaw 1994 p. 282). The two categories were then collapsed into one and given the label 'connection'.     

Evaluation of serum inhibin A as a surveillance marker after conservative management of tubal pregnancy

Tubal pregnancy is now commonly managed by laparoscopic salpingostomy or systemic methotrexate. A disadvantage of such conservative management is the need for appropriate follow-up, with serial measurement of serum concentrations of human chorionic gonadotrophin (HCG), to exclude persistent ectopic pregnancy (PEP). Concentrations of inhibin A, also a placental product, are significantly increased during pregnancy and the half-life of inhibin A is significantly shorter than that of HCG. To assess the suitability of inhibin A as a marker of PEP, we studied 16 women who had undergone surgery for a tubal pregnancy, measuring HCG and inhibin during follow-up. The mean +/- SEM time taken to achieve non-pregnant concentrations of inhibin A was significantly shorter than for HCG (4.2 +/- 0.8 days versus 21.6 +/- 4.4 days respectively; P < 0.001 Wilcoxon signed rank test). However, in all women the inhibin A concentration increased rapidly after reaching a nadir, reflecting the return of ovarian function, complicating the interpretation of results. In four women inhibin A was almost undetectable preoperatively, while the corresponding HCG concentration was high. These data suggest that inhibin A will not be a useful marker for PEP but that it may provide a more accurate preoperative assessment of trophoblast viability than HCG, thereby improving management.     

Bile acids from blood serum of women during normal pregnancy

Bile acid concentrations were measured enzymatically in study of women through normal pregnancy. Mean serum bile acid levels increased significantly, from 5.3 (SD 0.9) mumol/l at 16 weeks to 7.2 (SD 1.0) mumol/l at term. Serum bile acid concentrations were greater of older women, than of younger women.     

High blood pressure in pregnancy: effects of Ca2+ and Mg2+

Mucoepidermoid carcinoma of trachea and bronchi is a rare tumor, especially in children. The authors report a case of 9-year-old boy with mucoepidermoid carcinoma at the carina. His presenting symptoms were hemoptysis of recent onset and intermittent cough of 2 years' duration. Preoperative assessment of the tumor was an intraluminal polypoid mass arising from the carina extending into the trachea and right main stem bronchus. A complete resection with reconstruction of carina was successful. The tumor was 12 mm in size, polypoid with a broad base. It had characteristic features of a low-grade mucoepidermoid tumor, namely, admixture of islands of intermediate cells and glandular components with invasion of submucosa. The patient is now 15 months postsurgery free of disease.     

Charge flow separation: quantification of nucleated red blood cells in maternal blood during pregnancy

We set out to ascertain the numbers of fetal cells that enter the maternal blood stream during pregnancy. Samples of 15-16 ml of whole blood were collected from 225 women--mostly 10-18 weeks pregnant--and then processed by charge flow separation, a novel method based on free flow electrophoresis in a buffer counterflow gradient. After their recovery in four different separation instruments, nucleated red blood cells (NRBC) were enumerated histologically. In some cases fetal NRBC were identified and enumerated by fluorescence in situ hybridization with probes for the X and Y chromosomes and fetal haemoglobin mRNA. Recoveries were consistent among the four separation instruments: the median numbers of NRBC obtained were 4190, 1590, 2805 and 3860. Our data show that approximately 30 per cent of those cells were fetal. Thus, recent reports on the separation of fetal NRBC by other methods, give underestimates of their frequency in maternal blood.     

Age-related differences in ambulatory blood pressure during daily stress: Evidence for greater blood pressure reactivity with age.

Prior research on age and emotions has found that older adults may show better physiological regulation to stressful stimuli than do younger adults. However, the stress reactivity literature has shown that age is associated with higher cardiovascular reactivity to laboratory stress (J. R. Jennings et al., 1997). The authors investigated these conflicting findings further by examining daily ambulatory blood pressure in 428 middle-aged to older adults. Consistent with the age and reactivity literature, relatively old individuals showed significantly greater increases in ambulatory diastolic blood pressure compared with younger individuals when dealing with daily stressors. However, results also revealed that relatively old individuals reported less of an increase in negative affect during daily stress compared with their younger counterparts. The results of this study are consistent with the age-related increase in cardiovascular risk but highlight the complex links between stress and different facets of the aging process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ambient noise interferes with auscultatory blood pressure measurement during exercise

In the past decade, there has been a surge of renewed interest in the study of developmental evolution. One approach that has been taken is to examine the expression patterns of a candidate gene in divergent taxa and to use these results to infer which aspects of a particular genetic pathway are either conserved or altered. Here we consider this approach from the perspective of the neo-Darwinian paradigm for evolutionary change. If adaptations are typically composed of large numbers of gene substitutions that are of small effect individually, then the candidate gene approach is unlikely to bridge the gap between developmental pattern and evolutionary process: changes in gene expression patterns may identify the steps in developmental pathways that have been altered during evolution but fail to identify the actual genetic changes that have occurred. On the other hand, there is growing support for the view that adaptations often involve large-effect genes; fortunately, the candidate gene approach is well suited to this type of genetic architecture.     

Disappearance of antibodies to Cromer blood group system antigens during mid pregnancy

We are reporting the case of a 94-year-old male patient with a 10-year history of Parkinson's disease, who was admitted to our hospital with acute obstruction of esophageal passage. Esophageal obstruction was refractory to endoscopic intervention. However, discontinuation of the pre-existing levodopa medication led to its resolution within hours. While dysphagia is commonly encountered in patients with Parkinson's disease, the observed succession of drug discontinuation and resolution of obstruction in this case suggests an as yet rarely described side effect of levodopa. This potential side effect should be included in the differential diagnosis of dysphagia in Parkinson's disease, especially in the case of older patients, who may exhibit an increased rate of intestinal absorption of levodopa.