Annals of clinical research最新文献

Dihydropyridine and verapamil-like calcium channel blockers reduce blood pressure (BP) in essential hypertension (EH) but have different effects on heart rate (HR) at rest. This study compares the HR and hemodynamic responses to exercise of long-term treatment with nifedipine, nisoldipine, verapamil, tiapamil and diltiazem in five groups of patients with mild and moderate EH (diastolic BP ranging 100-120 mmHg). In a total of 76 patients (mean age 43 years) BP was measured intraarterially, cardiac output by dye dilution (Cardiogreen) and HR by electrocardiogram. Acutely HR and cardiac index (CI) rose (9 and 12%) while BP and total peripheral resistance index (TPRI) were reduced (9 and 19%). After one year calcium channel blockade intraarterial pressure at rest sitting fell from 172/105 to 150/91 mmHg (13%) and at 100 W exercise from 205/109 to 188/97 mmHg (10%). HR remained unchanged in the dihydropyridine groups (range +/- 3%) in all situations while it invariably fell (range 3 to 15%) in the groups treated with verapamil-like calcium blockers. The fall in HR was greater during exercise than at rest (mean 10% vs 6%). With these drugs stroke volume (SV) tended to increase (range 1 to 10%) while it remained unchanged in the dihydropyridine groups. Only minor changes were seen in CO. In all groups the TPRI fell, averaging 15% at rest and during exercise. Thus, the verapamil-like calcium blockers induce a negative chronotropic effect that is enhanced during work, but the cardiac pump function is preserved by a compensatory increase in SI. Independent on the cardiac responses both groups of calcium blockers lower BP by peripheral vasodilatation both at rest and during exercise.

Previous studies on the prevalence of sleep disturbances have shown that insomnia occurs in 3.2-42% of different populations. The wide reported variation in prevalence prompted a rigorous definition of insomnia to be introduced in this study. Randomly selected members of the population aged 30 to 65 years from two geographically different rural parts of central Sweden answered a sleep questionnaire. The response rates were 69.2% and 70.2%, respectively. Females significantly more often reported difficulty in falling asleep (7.1% of the women and 5.1% of the men). Among women 8.9 and among men 7.7% of individuals reported trouble with nocturnal awakenings. Using a stringently defined concept of insomnia as a disorder of initiating sleep (DIS), the prevalence rate of insomnia among women was 1.1% and among men 0.5%. Defining insomnia as a disorder of maintaining sleep (DMS), the prevalence among both women and men was 1.1%. Defining insomnia as a disorder of initiating and maintaining sleep (DIMS), the prevalence rate was 1.7% among women and 1.4% among men. This prevalence, which is lower than previously reported, demonstrate the importance of an operational definition of insomnia.

The plasma concentrations of vasoactive intestinal polypeptide and prolactin were measured before and after an exhaustive and a submaximal exercise test in 7 male marathon runners. A significant increase of vasoactive intestinal polypeptide was recorded after both tests, whereas the prolactin increase was observed only after the exhaustive exercise test. No significant correlation was found between the plasma vasoactive intestinal polypeptide and the plasma prolactin values recorded during the two exercise tests. Data suggest that the exercise-induced prolactin release occurs independently from variations of the vasoactive intestinal polypeptide levels in peripheral circulation.

Clinically significant differences between various beta-adrenoceptor blocking drugs exist. Patients with ischaemic heart disease and exertional angina pectoris benefit from all types of beta-blockers. Drugs with intrinsic sympathomimetic action (ISA) given intravenously may be safer in some patients with acute myocardial infarction than those drugs without ISA. In cardiac patients at rest they may have a vasodilator action and cause less myocardial depression than beta-blockers without ISA. When, however, the cardiac sympathetic tone is high pindolol and other beta-blockers with ISA act as any other beta-blockers, producing haemodynamic impairment. Studies have shown that beta-blockers with ISA confer less benefit in secondary prevention after myocardial infarction and they are not suitable for the treatment of obstructive cardiomyopathy. Non-selective beta-blockers may be advantageous in hypokalaemic arrhythmias. Beta 1-blockers may be preferred for patients with bronchoconstriction, diabetes, peripheral vascular disease and, theoretically to some extent in theory also in patients with hypertension. The extent and nature of side effects may also influence the selection of the most suitable beta-blocker in cardiovascular therapy.

The goal of exercise prescription is to advise and motivate an individual to attain the maximum health benefits of exercise for a given indication with minimum risk and other "costs". Numerous data indicate both perceived demand and medically determined need of such service for healthy as well as for sick people. The knowledge of the effects of exercise and its behavioral basis is sufficient for individual prescription for fitness maintenance and improvement. Safe and effective exercise as self-conducted activity or as formal rehabilitation can be prescribed also for large numbers of high risk and sick persons for fitness and to counteract the harmful effects of disease. The most problematic area is exercise prescription for disease prevention. Where ischaemic heart disease is concerned, the analysis of the published information suggests that regular exercise of moderate intensity and amount is an effective and feasible preventive measure, and its prescription is an appropriate medical service.

The study of the normal human individual provides an important baseline for the study of disease. Exercise physiology is particularly important because an exercise situation provides a unique opportunity to study how different functions are coordinated and integrated. In fact, most functions and structures are in one way or another affected by acute and chronic (i.e. training) exercise. There is unanimous agreement that regular exercise is essential for optimal function of the human body. It is evident that extrinsic factors, such as diet and exercise habits, are reflected in the morbidity and mortality statistics, especially in aging. Both healthy individuals and those with chronic illnesses and functional handicaps can improve their performances and, therefore, their quality of life by increased physical activity. In my opinion, epidemiological research has established that physical inactivity from a medical viewpoint is a risk factor threatening health and an optimal life style. Adverse effects of non-competitive exercises are very small in comparison with health benefits.

Membrane ion transports were investigated in lymphocytes from young normotensive and borderline hypertensive offspring with and without heredity for hypertension. Borderline hypertension per se was associated with an enhancement of sodium-potassium pump activity. Heredity per se was associated with increased sodium influx and ouabain-resistant sodium efflux.

An elderly man with small cell lung cancer developed a largely reversible, dementia-like syndrome after cranial irradiation and prolonged treatment with interferon (IFN). The development of the symptoms started 2 months after cranial irradiation following more than 2 years of IFN treatment. The behavioral impairment did not suggest any specific brain localization. The dementia-like behaviour may be due to a combined effect of irradiation and IFN.

To determine the factors associated with deaths from asthma we surveyed retrospectively all the death certificates issued in two regions of Finland (the province of Oulu and the province of Turku and Pori) over a ten-year period in which asthma had been given as the main cause of death. We then examined patients' records to check whether asthma was the main cause of death. A total of 156 deaths could be ascribed to asthma, 87 in patients under 65 at death and 69 over 65. More deaths tended to occur during the weekends, and in the younger age group more occurred during the night than by day. Previous drug treatment was considered inadequate in 45% of the cases. The management and drug treatment of the final exacerbation phase were also often inadequate, at least among the younger victims, and the terminal attack was usually short, death often occurring in three hours or less. Despite the shortcomings in treatment, the number of deaths from asthma in the younger age group has fallen in the province of Oulu over the last 20 years.