Pulmonary function in hypertensive patients treated with pindolol: a report of two studies

Pulmonary function was measured serially in two separate randomized trials of pindolol in the treatment of essential hypertension. Patients with overt obstructive airways disease were excluded. In study 1, 131 hypertensive patients were randomized to placebo (31) and 15 mg (33), 30 mg (33), and 60 mg (34) of pindolol. Pulmonary function was measured before and at weeks 8 and 15 of active medication. Bronchospasm--a 20% increase in forced expiratory volume in 1 second (FEV1) after isoprenaline--developed in three patients on active treatment and one on placebo. In eight patients on pindolol and one on placebo, bronchospasm ceased. Compared to placebo, no deterioration in pulmonary function occurred with pindolol and in three tests--maximum voluntary ventilation (MVV) (L/min), MVV%, midexpiratory flow rate (MEFR) (L/min)--significant improvement occurred. In study 2, 14 hypertensive patients were randomized to pindolol (mean dose 50 mg/day), 15 to propranolol (mean 360 mg/day), and 14 to chlorthalidone (mean 107 mg/day). Pulmonary function was measured after 3 weeks of placebo and again after 6 weeks of active treatment. While propranolol produced slight deterioration in pulmonary function, pindolol and chlorthalidone produced slight but significant improvement (p less than 0.05) with maximum MEFR (L/sec). Pulmonary function tests measured after isoprenaline were significantly worse in patients on propranolol compared to those on placebo, but were unchanged in patients on pindolol or chlorthalidone. The conclusions are: (1) Pindolol in antihypertensive doses does not produce airways obstruction and some improvement in pulmonary function may occur. (2) In comparable doses, pindolol has a positive effect on pulmonary function and propranolol a negative effect which, when summated, is statistically significant. (3) Propranolol, but not pindolol, appears to block the bronchodilator effects of isoprenaline. The lack of pulmonary function impairment may be due to intrinsic sympathomimetic activity properties of pindolol.

Beyond permanency planning

With permanency planning taking the spotlight increasingly in the field of foster care, it becomes urgent to examine the definition of permanency, the effect on practice, and the implications for service delivery.

Adrenergic- and cyclic nucleotide-induced glycerol release from brown adipocytes

Previous work has shown that although both alpha- and beta-agonists stimulate brown fat heat production, the beta agonist is quantitatively more effective. The finding in the present study that isoproterenol, a beta-agonist, significantly stimulates net glycerol release from isolated hamster brown adipocytes while the alpha-agonist, phenylephrine does not, may account (at least in part) for the differential thermogenic response to the two types of agents. The present study also compared lipolytic responses to AMP, cAMP, cGMP and theophylline, with the results indicating a greater rate of net glycerol release being induced by AMP and by cAMP than by theophylline or cGMP plus theophylline.

The use of the diving reflex to terminate supraventricular tachycardia in a 2-week-old infant

The use of the diving reflex to terminate a case of paroxysmal supraventricular tachycardia (PST) is described in a 2-week-old infant who presented in severe congestive heart failure with supraventricular tachycardia at a rate of 300. The infant's face was placed in a basin of ice water at 5 degrees C. for 5 seconds with manual occlusion of the infant's nostrils to prevent aspiration. The PST converted to a sinus rhythm of 120 within 3 seconds of facial immersion. The physiology of the diving reflex is reviewed and the uses and hazards of this reflex in terminating attacks of PST in infants is discussed.

Successful coping styles in professional women

This paper describes the experiences of seven women mental health professionals who met in a leaderless group over a period of a year and a half. There is a discussion of the conflicts for women in four major areas--competition, dependency needs, economic success and the search for role models, and the suggestion of possible successful resolutions in these conflict areas. The resolutions are a result of individual experiences and discussions in the group.

Type B hepatitis after needle-stick exposure: prevention with hepatitis B immune globulin. Final report of the Veterans Administration Cooperative Study

Hepatitis B immune globulin (HBIG) and immune serum globulin (ISG) were examined in a randomized, double-blind trial to assess their relative efficacies in preventing type B hepatitis after needle-stick exposure to hepatitis B surface antigen (HBsAG)-positive donors. Clinical hepatitis developed in 1.4% of HBIG and in 5.9% of ISG recipients (P = 0.016), and seroconversion (anti-HBs) occurred in 5.6% and 20.7% of them respectively (P less than 0.001). Mild and transient side-effects were noted in 3.0% of ISG and in 3.2% of HBIG recipients. Available donor sera were examined for DNA polymerase (DNAP) and e antigen and antibody (HBeAg; anti-HBE). Both DNAP and HBeAg showed a highly statistically significant correlation with the infectivity of HBsAg-positive donors. Hepatitis B immune globulin remained significantly superior to ISG in preventing type B hepatitis even when the analysis was confined to these two high-risk subgroups. The efficacy of ISG in preventing type B hepatitis cannot be ascertained because a true placebo group was not included.

Antigen-Initiated B Lymphocyte Differentiation

The effects of injection of unrelated antigens on the sedimentation velocity and buoyant density characteristics of specific “virgin” or “memory” adoptive transfer AFC-progenitors in unprimed or long-term hapten-primed adult mouse spleen were examined to determine if the physical properties of these B cells could be altered by nonspecific stimulation. Spleen cells from normal unprimed adult CBA mice (as a source of virgin B cells) or from long-term hapten-primed CBA (as a source of memory B cells) were separated and the fractions were tested for NIP-specific AFC-progenitor activity with an adoptive immune assay system that gave a direct linear measure of B cell activity. If the donor mice were injected 1 day previously with POL or HRC, the NIP-specific virgin IgM AFC-progenitor activity shifted from medium sized, medium-light density lymphocytes to larger, much lighter cells. The same 1-day nonspecific stimulation had little effect on the physical properties of either IgM or IgG memory AFC-progenitors, although a small increase in the size of such cells was observed 2 days post immunization with unrelated antigens. Nonspecific stimulation caused identical physical changes in the virgin AFC-progenitors of athymic nude mice, but only partially altered the physical properties of virgin AFC-progenitors in neonatal mice. In the latter case, a normal transformation occurred if adult, radioresistant macrophages were injected with the stimulating antigens.

These results indicate that a particular subset of virgin B cells responds nonspecifically to antigenic injections, becoming larger cells of lighter density. The mechanism of this effect appears to involve mature macrophages, but not functional T lymphocytes. Memory B cells do not readily respond in this way.