Neurohumoral mechanisms and left ventricular hypertrophy: effects of hygienic therapy

To determine the effects of hygienic (non-drug) therapy on blood pressure (BP) control and its relationship to sympathetic tone and left ventricular mass (LVM) in primary hypertension, plasma norepinephrine (NE) and renin activity (PRA), LVM, and nutritional and behavioral status were assessed in 76 borderline to mild hypertensives. Pretherapy plasma NE was related to diastolic blood pressure (DBP) and PRA (r = 0.24, P less than .05 and r = 0.37, P less than .01, respectively). Plasma NE of high renin patients (221 +/- 52) (mean +/- SD) was greater than that of normal renin patients (159 +/- 61, ng/l, P less than .01). LVM was related to systolic blood pressure (SBP) (P less than .001), DBP (P less than .01) and urinary sodium (P less than .05), and inversely related to PRA (P less than .01). Septal wall thickness was related to hostility (r = 0.42, P less than .05). After seven weeks of hygienic therapy, DBP was reduced by 6 mmHg (P less than .01). The change in SBP was related to baseline plasma NE (P less than .05) and inversely related to LVM (P less than .05). These results suggest that raised sympathetic tone may be a pathogenic factor in primary hypertension and that hygienic therapy lowers BP more effectively in patients with raised sympathetic tone and low LVM.

Effects of clonidine on central and peripheral nerve tone in primary hypertension

To define the mechanisms whereby clonidine lowers blood pressure, we measured cerebrospinal fluid and plasma levels of norepinephrine, normetanephrine, epinephrine, dopamine, and the dopamine metabolite homovanillic acid in 10 primary hypertensive subjects before and after 3 months of clonidine treatment (mean dose, 0.68 mg/day). Catecholamines were measured by radioenzymatic methods. Cerebrospinal fluid and plasma sampling was performed after subjects had fasted and remained supine overnight, and plasma sampling was repeated 2 hours later, after subjects had ambulated. Supine and upright blood pressure fell, as might be expected. Cerebrospinal fluid levels of norepinephrine and normetanephrine fell significantly, but dopamine and homovanillic acid levels were unchanged. Plasma norepinephrine, normetanephrine, and epinephrine levels decreased 30 to 50%, and supine dopamine levels also fell. The percent fall in supine blood pressure was related to the fall of cerebrospinal fluid and plasma norepinephrine. There were also positive relationships between the decreases of plasma norepinephrine and of normetanephrine and dopamine. The cerebrospinal fluid/plasma norepinephrine ratio was unaffected by clonidine, suggesting that the drug lowered both pools equally. Our findings indicate that clonidine decreases both central and peripheral norepinephrine activity. The dopaminergic activity of cerebrospinal fluid was unaffected by clonidine, and though plasma dopamine levels tended to be lower after treatment, mean plasma prolactin level, an index of dopaminergic activity, was also unchanged. The fall in plasma epinephrine level is probably related to diminished sympathetic adrenomedullary stimulation and is unlikely to contribute to clonidine's antihypertensive action. These results also suggest that measurement of normetanephrine in cerebrospinal fluid and plasma provides a good index of norepinephrine activity.

Effects of exercise on blood pressure, plasma catecholamines, potassium and the electrocardiogram after diuretic and neural-blocking therapy for moderate hypertension

Blood pressure control in mild and moderate hypertension may reduce morbidity and mortality. On the other hand, antihypertensive drugs may cause adverse metabolic, electrolyte, neural and hemodynamic alterations that detract from their effectiveness. The effect of hydrochlorothiazide (HCTZ) on some of these factors was compared with that of HCTZ and a sympatholytic drug in 20 hypertensive patients with left ventricular hypertrophy and retinopathy. HCTZ controlled blood pressure at rest and during maximum treadmill exercise (-12 mm Hg systolic and diastolic pressure (p less than 0.05), reduced left ventricular mass by 7% (p less than 0.05) and lessened aerobic impairment at maximum treadmill exercise by 45% (p less than 0.05). These effects were further improved after "neural blockade." A potential adverse effect of HCTZ--hypokalemia (-0.6 mEq/liter, p less than 0.01)--and the associated incidence of ectopy during effort (50%) were lessened after neutralizing neural tone. Combination therapy with low-dose diuretic and sympatholytic drugs was effective and well tolerated in patients with cardiac and vascular sequelae of moderately severe hypertension.

Sympathoadrenal responses to stress: the linking of type A behavior pattern to ischemic heart disease

This report is an analysis of the findings of blood pressure, pulse rate, adrenergic and noradrenergic responses to laboratory and clinical stresses in subjects according to Type A and Type B behavior patterns. Thirty-three experiments of Type A - B cardiovascular and sympathoadrenal responses to a variety of laboratory stressors were identified. Twenty-nine of these were analyzed and the data of 20 were pooled to give mean values for the percentage increments of systolic and diastolic blood pressures, pulse rates, and plasma levels of NE and E for Type A vs B patients respectively; (15 +/- 2 vs 10 +/- 1, P less than .05; 13 +/- 1 vs 8 +/- 1, P less than .02; 19 +/- 2 vs 13 +/- 2, P less than .05, 60 +/- 11 vs 19 +/- 8, P less than .02; and 106 +/- 45 vs 23 +/- 12, P less than .1). Seventy-five percent of the analyzed experiments provided evidence for heightened cardiovascular and sympathoadrenal responsivity in Type A subjects. NE and E appear to be hormonal intermediates which play a lethal role in ischemic heart disease. Neutralization of neural tone may be an important goal in the therapy of hypertensives with Type A behavior pattern.

Central and peripheral noradrenergic tone in primary hypertension

The contents of norepinephrine (NE), epinephrine (E), dopamine (DA), normetanephrine (NMN), and 4-hydroxy-3-methoxyphenylethylene glycol (MHPG) were measured in the plasma and cerebrospinal fluid (CSF) of 66 patients with primary hypertension and 24 patients with normal blood pressure and minor neurological disorders. Plasma and CSF NE and NMN concentrations were raised in the hypertensive patients. The plasma and CSF NE levels and arterial blood pressure of a small subset of hypertensive patients were normalized after clonidine therapy. In hypertensive patients the content of DA was lower and the ratio of NE/DA was greater; CSF and plasma NE contents were related to the level of arterial blood pressure; and the content of MHPG in CSF was linked strongly with NE content in plasma and CSF and to the level of arterial blood pressure. Thus both central sympathetic nerve tone and peripheral sympathetic nerve tone were enhanced in young patients with uncomplicated hypertension. The elevated levels of neurohormones and their metabolites in some patients with primary hypertension may be related to increased synthesis and release of neural NE and may be pathogenic in the blood pressure elevation.

The relationships of free to conjugated normetanephrine in plasma and spinal fluid of hypertensive patients

The concentrations of free and total normetanephrine (NMN) were determined in the plasma of normotensives and patients with primary hypertension and pheochromocytoma. NMN values were measured in the cerebrospinal fluid (CSF) of patients. Free and conjugated NMN, the latter after acid hydrolysis, were assayed using S-adenosylmethionine in the presence of phenylethanolamine-N-methyltransferase to form labeled metanephrine. The conjugates of NMN were present in plasma as sulfates principally, as they were also liberated with arylsulfatase. Free and conjugated NMN levels were 117 +/- 10 and 1417 +/- 109 ng/liter, respectively in plasma of normotensives. The mean ratio of the content of conjugated to free NMN was 14.9 +/- 1.8 (mean +/- SEM). The contents of free and conjugated NMN were 155 +/- 33 and 1670 +/- 320 ng/liter in primary hypertensives, respectively, and the ratio of conjugated to free NMN was 18.5 +/- 3.3. These values did not differ significantly from those in normotensives. The contents of free and total NMN in the plasma of patients with pheochromocytoma were 50- to 60-fold greater than values in normotensive and primary hypertensives. The mean ratio of conjugated to free NMN in the plasma of patients with pheochromocytoma was similar to those in normotensives and primary hypertensives. The contents of free and conjugated NMN in the CSF of patients with pheochromocytoma exceeded those in primary hypertensives (P less than 0.01 and P less than 0.001). Further, the ratio of conjugated to free NMN in CSF was increased in patients with pheochromocytoma (33.9 +/- 8.1) compared to that primary hypertensives (8.3 +/- 2.3; P less than 0.001). The measurement of NMN in plasma and CSF may help characterize sympathetic nerve tone in patients with primary hypertension to elucidate the pathophysiology of the elevated blood pressure.

[Anesthesiological problems in tracheal resection operations. Clinical contribution]

The anaesthesia technique adopted for tracheal resection in a woman patient with tracheal stenosis secondary to prolonged intubation is reported. The criteria underlying the choice of anaesthesia are outlined. Various anaesthesiological techniques are discussed and solutions illustrated in relation to the location of tracheal stenosis.

Changes in plasma and cerebrospinal fluid electrolytes in hypercapnia

A study on two groups of patients in acute respiratory failure with hypercapnia (18 subjects) and in hypercapnic coma (18 subjects) has been carried out to determine the related changes in sodium ion, potassium ion, chloride ion, urea and osmolality in blood and cerebrospinal fluid. There were significant differences between the two pathological states and particularly in coma, changes in transmembrane active transport of electrolytes are significantly related to high concentrations of CO2 in the brain.

[Experimental research on the effect of electro-acupuncture on reparative processes]

With a view to clarifying the mechanism whereby electroacupuncture aids teh repair of trophic ulcers, including inveterate forms resistant to ordinary treatments, reference is made to histochemical findings and histological findings in periulcerous tissues and experimental research into wound healing. Preliminary work showed that electroacupuncture improves the blood supply to ulcerous tissue and the local biochemistry, and accelerates the repair process. Experimental work also made it clear that the method, when use on alternate days with the modalities employed in clinical practice, accelerates the healing of wounds in the experimental animal.

Central and regional normetadrenaline in evaluation of neurogenic aspects of hypertension: aid to diagnosis of phaeochromocytoma

1. Free normetadrenaline concentrations in plasma of patients with phaeochromocytoma were elevated 20-1000-fold as compared with values in primary hypertensive subjects. 2. Spinal fluid normetadrenaline was 1.8-16% of the simultaneous plasma values in patients with phaeochromocytoma, whereas levels in spinal fluid exceeded those of plasma in primary hypertension. 3. Spinal fluid noradrenaline was 7.9-58% of simultaneous values of plasma noradrenaline in patients with phaeochromocytoma, whereas values in plasma and cerebrospinal fluid were similar in primary hypertension. 4. Plasma noradrenaline and normetadrenaline levels were both elevated in veins from regions subsequently found to harbour chromaffin tumours. 5. The excessive amounts of normetadrenaline produced in phaeochromocytoma enters plasma but not spinal fluid and can be used for diagnosis and localization of phaeochromocytoma.

A radioenzymatic assay for free and conjugated normetanephrine and octopamine excretion in man

A radioenzymatic method for the measurement of free and conjugated normetanephrine (NMN) and octopamine (OCT) is described for human urine. The assay is based on the conversion of NMN or OCT to radiolabeled metanephrine (MN) or synephrine (SYN) by phenylethanolamine-N-methyl transferase (PNMT), using tritium-labeled S-adenosyl-methionine [3H]SAM as methyl donor. Thin-layer chromatographic separation yields an assay of high specificity. The sensitivity of the assay is 5 and 2.5 pg of NMN or OCT, respectively. The normal value of free and conjugated NMN was found to be 23 +/- 13 and 102 +/- 49 ng/mg creatinine. Four patients with pheochromocytoma had highly increased levels of free and conjugated NMN. The urinary excretions of free and total octopamine were 5.7 +/- 2.8 and 34.8 +/- 16.6 ng/mg of creatinine, respectively, in normal patients.

[Control of arterial pressure in aortic coarctation surgery]

After reporting personal experience in the pharmacological control of intraoperative hypertension in 14 patients with aortic coarctation, 7 of them treated with trimetaphan (TMF) and 2 with nitroprussiate of sodium (NPS), stress is laid on the advantages of NPS in comparison with TMF, namely as regards speed of induction, prompt reversibility of action and lesser interference with the haemodynamics of the renal and coronary circulations. Attention is also called to the collateral effects, such as reflex cardiostimulation, which may require the use of beta-blocking drugs, and cyanide-induced toxicity which demands dose limitation (0.5 mg/kg/h). NPS is considered the drug of choice in those situations which require emergency pressure control and in controlled hypotension, for which TMF was used in the past.

Combined serum and bone marrow radioimmunoassays for prostatic acid phosphatase

Combined serum and bone marrow radioimmunoassays for prostatic acid phosphatase provide a unique means for the early diagnosis and more accurate clinical staging of prostatic cancer. The combined screening technique appears to be helpful, particularly in providing a clinical assessment of the presence or absence of early, subclinical lymphatic and bone marrow metastases. Low titer elevations of bone marrow prostatic acid phosphatase by radioimmunoassay have been observed commonly in clinically understaged C prostatic cancer with normal technetium bone scans, indicating the presence of unrecognized stage D disease with bone metastases. The combined screening method also is of distinct clinical value in the early diagnosis of prostatic cancer and in monitoring the effects of specific therapy. In therapeutically responsive patients marked suppression of serum and bone marrow prostatic acid phosphatase is observed regularly with the radioimmunochemical method under study.

A solid phase radioimmunoassay for prostatic acid phosphatase

The sensitivity of a recently developed solid phase radioimmunoassay for human prostatic acid phosphatase was compared to that of an enzymatic method using p-nitrophenylphosphate as substrate. In 109 histologically verified untreated stages I to IV prostatic cancers and 200 men without such cancer the solid phase radioimmunoassay method demonstrated substantially greater sensitivity and specificity than the enzymatic technique. In the 109 prostatic malignancies the immunochemical method correctly classified 80 (73 per cent) versus 34 (31 per cent) for the p-nitrophenylphosphate enzymatic technique (p less than 10(-6). In 44 stages I and II cancers confined to the prostate the radioimmunoassay was abnormally elevated in 19 (43 per cent) with only 4 (9.1 per cent) enzymatic elevations (p less than 10(-3). In 65 stages III and IV extraprostatic cancers correct classifications were noted in 61 (94 per cent) of the radioimmunoassays and 30 (46 per cent) enzymatic tests (p less than 10(-6). The radioimmunoassay in 200 male controls yielded 11 (5.6 per cent) and the p-nitrophenylphosphate enzymatic test yielded 7 (3.5 per cent) falsely positive results. In 90 non-prostatic human cancer sera 85 (94.5 per cent) were correctly classified as negative by the radioimmunoassay for prostatic acid phosphatase versus 66 (73 per cent) as negative by the enzymatic method. These data are discussed in terms of the merits of a radioimmunochemical approach for the measurement of human serum prostatic acid phosphatase.