RESUMEN
This article starts with a concise synopsis of the history of edema. The role of underfilling, overflow, antidiuretic hormone, and acquaporins is subsequently discussed. Emphasis is given to the use of diuretics in edematous patients. The role and risks of albumin infusion are illustrated. The new hypothesis of pulse reverse osmosis is discussed. The final section deals with the measurement of colloid osmotic pressure in the clinical setting.
Asunto(s)
Edema/fisiopatología , Edema/terapia , Enfermedades Renales/fisiopatología , Enfermedades Renales/terapia , Humanos , Riñón/fisiopatología , Síndrome Nefrótico/fisiopatología , Síndrome Nefrótico/terapiaRESUMEN
The study examined whether indexing glomerular filtration rate (GFR) for body surface area is appropriate for people who are severely overweight. Twenty normotensive adult men who were severely overweight but without microalbuminuria were enrolled into this study. The control group consisted of 20 healthy subjects matched for age, sex, and height. GFR was determined by measuring insulin with the continuous-infusion method. The clearance of endogenous creatinine was also measured after two daily urine collections. Renal plasma flow (RPF) was measured by p-aminohippurate clearance using the continuous-infusion method. Lean body weight was measured by impedentiometry. Adjusting for body surface area (in 1.73 m(2)) caused a significant reduction in GFR (P < 0.0001) in overweight humans (84.1 +/- 2.32 versus 109.6 +/- 3.07 mL/min/1.73 m(2)). The difference disappeared when GFR/height criteria were adopted. No difference between obese and healthy controls occurred after adjusting for lean body weight. Data for creatinine clearance paralleled those with insulin clearance; a significant reduction (P < 0.001) occurred after indexing for basal surface area, which disappeared after correction for height, as well as for lean body weight.
Asunto(s)
Tasa de Filtración Glomerular/fisiología , Obesidad/fisiopatología , Tejido Adiposo/anatomía & histología , Adulto , Albuminuria/orina , Presión Sanguínea/fisiología , Constitución Corporal , Estatura , Índice de Masa Corporal , Superficie Corporal , Estudios de Casos y Controles , Creatinina/orina , Impedancia Eléctrica , Estudios de Seguimiento , Humanos , Inulina , Masculino , Músculo Esquelético/anatomía & histología , Flujo Plasmático Renal/fisiología , Ácido p-AminohipúricoRESUMEN
The leap in scientific discoveries made with new computer technologies can be compared to the invention of the printing press and expanding scientific thought in the 16th century. Nowadays, new communication technologies offering a multimedia contribution illustrate the fascinating reality of scientific exploration even for individuals who can otherwise not be reached. Since rare books are usually kept in libraries with limited access, the strict safekeeping, however, often overrides the need for academic consultation. Moreover, rare manuscripts are often illustrated with figures that are just as important as the written texts, but which are also unavailable. We combined our expertise in biology, medicine and multimedia to produce a CD-ROM with a hyperlinked text on the scientific revolution of the 16th century, focusing on the early conceptualization of life sciences in Europe. In this paper we show the first page of Malpighi's Epistle II (De pulmonibus - on the Lungs) as it appeared in Opera Omnia published in London (1686) by the Royal Society.
Asunto(s)
Disciplinas de las Ciencias Biológicas/historia , Manuscritos Médicos como Asunto/historia , CD-ROM , Europa (Continente) , Historia del Siglo XVI , Historia del Siglo XVII , Humanos , Hipermedia , ConocimientoRESUMEN
OBJECTIVES: A randomized controlled trial was set up to assess the effect of two different therapy regimens with lymphoblastoid interferon on the treatment and follow-up of patients with chronic C hepatitis. METHODS: Eighty-five patients with chronic hepatitis C were randomized into two treatment groups (n = 30 respectively) and one control group (no treatment: n = 25). In one treatment group patients received three million units of alpha-lymphoblastoid interferon. The other received six million units. RESULTS: A rapid decline in both alanine aminotransferase and aspartataminotransferase levels was seen in most treated patients (a complete response in 51% from group A and 55% from group B; partial response 29% from group A, 25% from group B). In five partial responders and six complete responders from group A and in seven partial responders and six complete responders in group B serum aminotransferase levels returned to baseline values in the follow-up. No change in serum bilirubin, albumin, IgG and prothrombin time during interferon treatment were seen. The histologic staging remained unchanged throughout the entire study. CONCLUSION: alpha-interferon treatment improves the clinical picture, biochemical parameters and histologic pattern in a large percentage of patients with hepatitis C. Long-term remission was seen in only 37% of treated patients. Using six million units of alpha-interferon has not proven to be significantly better than three million units. Protracted treatment for nine months seems to increase the percentage of patients in biochemical and histologic remission.
Asunto(s)
Antivirales/administración & dosificación , Hepatitis C/tratamiento farmacológico , Interferón-alfa/administración & dosificación , Adulto , Alanina Transaminasa/sangre , Enfermedad Crónica , Método Doble Ciego , Femenino , Estudios de Seguimiento , Hepatitis C/sangre , Hepatitis C/patología , Humanos , Hígado/patología , Masculino , Persona de Mediana Edad , Factores de TiempoRESUMEN
OBJECTIVE: To explore the possible link between diabetic nephropathy and the enhanced activity of the polyol pathway, known to occur in IDDM subjects. RESEARCH DESIGN AND METHODS: We studied the effects of the aldose reductase inhibitor tolrestat (200 mg/day) on urinary albumin excretion rate and glomerular filtration rate in 20 IDDM patients with diabetic nephropathy. RESULTS: Six months of placebo treatment produced no significant changes in glomerular filtration rate, urinary albumin excretion rate, and renal plasma flow. Consequently, filtration fraction remained unchanged. During tolrestat treatment, glomerular filtration rate decreased from the basal value of 156 +/- 14 ml.min-1.1.73 m2 to 142 +/- 13.7 ml.min-1.1.73 m2 (P < 0.001) at 2 mo; 128 +/- 12.4 ml.min-1.1.73 m2 (P < 0.001) at 4 mo; and 123.7 +/- 13.0 ml.min-1.1.73 m2 at 6 mo. A significant decrease of urinary albumin excretion rate was observed during the trial (basal values 219 +/- 32.5 vs. 196.9 +/- 28.5 micrograms/min at 2 mo [P < 0.05]; 171.6 +/- 25.5 micrograms/min at 4 mo [P < 0.001]; and 58.6 +/- 19.3 micrograms/min at 6 mo [P < 0.001]). No significant change in renal plasma flow was seen during tolrestat treatment. Filtration fraction significantly decreased in the tolrestat group from the basal value of 0.23 +/- 0.02 to 0.21 +/- 0.01 at 2 mo (P < 0.005); 0.18 +/- 0.02 at 4 mo (P < 0.001); and 0.17 +/- 0.02 at 6 mo (P < 0.001). CONCLUSIONS: The polyol pathway is implicated in hemodynamic changes associated with early diabetic nephropathy, and aldose reductase treatment can positively influence these parameters.
Asunto(s)
Albuminuria , Aldehído Reductasa/antagonistas & inhibidores , Diabetes Mellitus Tipo 1/fisiopatología , Nefropatías Diabéticas/tratamiento farmacológico , Nefropatías Diabéticas/fisiopatología , Tasa de Filtración Glomerular , Naftalenos/uso terapéutico , Adulto , Glucemia/análisis , Presión Sanguínea , Diabetes Mellitus Tipo 1/sangre , Nefropatías Diabéticas/sangre , Método Doble Ciego , Femenino , Humanos , Riñón/irrigación sanguínea , Masculino , Flujo Sanguíneo Regional , Factores de TiempoRESUMEN
OBJECTIVES: To confirm recent reports on the incidence of human lymphocyte antigens (HLA) in familial hypertrophic cardiomyopathy and to better define the genetic patterns found in these patients. METHODS: A large family (31 members, 18M, 13F, age range 6-80 years) with a high incidence of hypertrophic cardiomyopathy was screened for HLA, dermatoglyphic patterns and blood subtyping. RESULTS: Our finding show variable expression of the disease and reduced penetrance. No linkage between the disease-causing gene and HLA loci could be demonstrated in the family. There was no specific haplotype which present in all affected individuals and missing in all controls. Haplotype A2 B18 was the most commonly encountered in affected individuals but was absent in IV 3 and present in a few controls. No linkage was found between the disease-responsible gene and the blood groups. Finally, no typical pattern emerged from the dermatoglyphic studies. CONCLUSION: The genetic assessment of this family, in agreement with other European studies, showed no clear correlation between hypertrophic cardiomyopathy and blood groups ABO, Rh, Lewis, Duffy and was unable to show atypical or unusual dermatoglyphic patterns.
Asunto(s)
Cardiomiopatía Hipertrófica/genética , Cardiomiopatía Hipertrófica/fisiopatología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Ecocardiografía , Femenino , Ligamiento Genético , Antígenos HLA/análisis , Humanos , Masculino , Persona de Mediana EdadRESUMEN
To define the availability of Doppler echocardiography in evaluating left ventricular hemodynamic changes induced by some clinical findings of acute coronary insufficiency, we selected 12 patients with angina and 32 affected by acute myocardial infarction. Doppler echocardiography was performed at hospital admittance and during recovery time. Left ventricular contractility was defined on the systolic aortic flow spectrum by measuring the aortic velocity maximum, the time to peak/left ventricular ejection time ratio, and the cardiac output. During the first examination, left ventricular contractility significantly decreased in patients with angina and in those with acute myocardial infarction. After the acute phase, these parameters slightly improved. Left ventricular diastolic filling was evaluated in the transmitral flow. A decreased E-wave velocity and an increased late component (A wave) with inversion of the E/A wave ratio were found in patients with acute myocardial infarction during the first examination. This morphology inverts when the patients stabilize. On the contrary, this ratio stayed above one during and after angina. In this study, we also defined the usefulness of the color Doppler method in setting up criteria to identify some early morphological complications of acute myocardial infarction in 12 patients with acute infarction and a new systolic murmur. This technique showed an ischemic rupture of the ventricular septum in five cases and mitral regurgitation in seven. The color Doppler method has allowed us to obtain a semi-quantitative assessment of the mitral regurgitation and the location of the ventricular septal defect.
Asunto(s)
Angina de Pecho/diagnóstico por imagen , Ecocardiografía Doppler/métodos , Hemodinámica , Infarto del Miocardio/diagnóstico por imagen , Función Ventricular Izquierda/fisiología , Adulto , Anciano , Angina de Pecho/fisiopatología , Estudios de Evaluación como Asunto , Rotura Cardíaca Posinfarto/complicaciones , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/fisiopatología , Tabiques Cardíacos , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/etiología , Insuficiencia de la Válvula Mitral/fisiopatología , Infarto del Miocardio/fisiopatología , Sensibilidad y EspecificidadRESUMEN
In a double-blind, crossover study, nebulized ketanserin, a 5-HT2 receptor antagonist, and a placebo were given to eight patients with moderate to severe nonasthmatic COPD. Intravenous ketanserin had rapid onset of action and induced a longer lasting bronchial response than inhaled ketanserin. These results confirm that ketanserin acts as a mild bronchodilator in patients with COPD and demonstrate that the inhaled route has no advantage over the intravenous route in terms of effectiveness. Thus, 5-HT may play a role in bronchomotor tone, at least in patients with chronic airway obstruction.
Asunto(s)
Ketanserina/administración & dosificación , Enfermedades Pulmonares Obstructivas/fisiopatología , Administración por Inhalación , Adulto , Anciano , Presión Sanguínea/efectos de los fármacos , Método Doble Ciego , Femenino , Flujo Espiratorio Forzado/efectos de los fármacos , Volumen Espiratorio Forzado/efectos de los fármacos , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Inyecciones Intravenosas , Ketanserina/uso terapéutico , Enfermedades Pulmonares Obstructivas/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Nebulizadores y Vaporizadores , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
The aim of this study was to evaluate the usefulness of the angiotensin converting enzyme (ACE) inhibitor enalapril in a group of 30 patients (mean age 73.3 years) with moderate hypertension and normal haematological and chemical parameters (170 +/- 8.1 mmHg systolic and 104 +/- 5.8 mmHg diastolic blood pressure), who were receiving diuretic therapy with chlorthalidone (12.5 mg/day). This therapy caused a significant decrease in systolic and diastolic blood pressure (to 165 +/- 6.7 and 98 +/- 4.7 mmHg, respectively; P less than 0.001) but it also induced hypokalaemia (3.04 +/- 0.7 mmol/l; P less than 0.001) and multiple (greater than 10/h) and complex premature ventricular depolarizations (2nd, 3rd and 4th Lown grade). Enalapril treatment (5 mg/day for 5 days and 10 mg thereafter) was added to the diuretic therapy and after 2 months a further decrease in blood pressure was observed (to 158 +/- 5.6 mmHg systolic, P less than 0.001; 87.2 +/- 5.0 mmHg diastolic, P less than 0.001). Moreover, there was a significant reduction in the mean heart rate (from 79 to 72 beats/min, P less than 0.005) and an increase in serum potassium (to 4.19 +/- 0.2 mmol/l; P less than 0.001). In 80% of patients a 24-h dynamic electrocardiogram showed a significant reduction in both the number and complexity of premature ventricular depolarizations. Our findings suggest that ACE inhibitors can be useful in patients developing hypokalaemia during therapy. However, we are not yet able to explain the beneficial effects of enalapril in decreasing the frequency of premature ventricular depolarizations.
Asunto(s)
Clortalidona/uso terapéutico , Enalapril/uso terapéutico , Hipertensión/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Presión Sanguínea/efectos de los fármacos , Clortalidona/administración & dosificación , Clortalidona/efectos adversos , Ensayos Clínicos como Asunto , Esquema de Medicación , Quimioterapia Combinada , Enalapril/administración & dosificación , Femenino , Humanos , Hipertensión/sangre , Hipertensión/fisiopatología , Masculino , Potasio/sangreRESUMEN
The role played by serotonin (5-HT) in the regulation of bronchomotor tone has up to now been a much debated question, although there is good evidence that it induces intense bronchoconstriction after inhalation in asthmatic patients. Serotonin has been found to contract the tracheobronchial smooth muscle of different animals. Some data suggest that tracheobronchial contraction due to serotonin is mediated by its interaction with the S2-receptor. The blockade of this receptor by ketanserin, a serotoninergic antagonist which primarily binds to S2-serotoninergic receptors, produces bronchodilation. The respiratory effects of intravenously administered ketanserin (10 mg) or placebo were compared in a double-blind crossover study in 14 patients with chronic obstruction of the airways. The forced expiratory volume in one second (FEV1) and the instantaneous forced expiratory flow after 50 percent of the forced vital capacity has been exhaled (FEF50%) did not change after placebo, but they increased significantly after administration of ketanserin. The results suggest that in patients with chronic obstructive pulmonary disease, serotonin may play a role in the development of obstruction of the airways, even if the mechanism remains undefined.