A comparison of the effect of enalapril and metoprolol on renal function, potassium balance, lipid profile, cardiac function, exercise tolerance and quality of life in hypertensive dialysis patients

26 patients with hypertension while on hemodialysis or continuous ambulatory peritoneal dialysis for end-stage renal diseases were treated first with enalapril and then changed to metoprolol. Both drugs were shown to be similarly effective in controlling blood pressure. There was no difference between the two drugs in their effects on renal function, potassium balance, lipid profile, cardiac function, exercise tolerance, and quality of life. Mild worsening of anemia was observed during treatment with enalapril. No serious side effects were reported. Use of enalapril is safe in the treatment of hypertension in dialysis patients.

Kt/V in CAPD by different estimations of V

This study compared the measurements of total body water (TBW) by 58% body weight (TBW58%), the Watson equation (TBWWV) and bioelectric impedance (TBWBIA) with the gold standard, Deuterium oxide (TBWD2O) dilution method in twenty continuous ambulatory peritoneal dialysis (CAPD) patients. TBW volumes were highest when calculated as TBW58% (42.6 +/- 9.4 liter) and lowest when calculated from TBWWV (34.6 +/- 6.8 liter). TBWBIA underestimated TBW when compared to TBWD2O, although the difference was not statistically significant (37.1 +/- 9.8 liter and 38.8 +/- 9.3 liter, respectively). In fact, TBWBIA correlated strongly with TBWD2O (r = 0.8, P < 0.0001). These discrepancies resulted in significant differences when Kt/V week-1 derived from the four methods were compared. To determine the effect of percent fat mass on the estimation of TBW by each method, we compared TBW and Kt/V week-1 derived from the four methods in nine CAPD patients who had normal percent fat mass (Non-Obese) and 11 CAPD patients who had greater than normal % fat mass (Obese). In the Non-Obese group, there was close correlation of TBWBIA, TBWWV and TBW58% when compared with TBWD2O (r = 0.93, P < 0.001, r = 0.89, P < 0.01 and R = 0.86, P < 0.01, respectively. Also, Kt/V week-1 derived from TBWBIA, TBWWV and TBW58% correlated strongly with Kt/V week-1 from TBWD2O (r = 0.93, P < 0.0005, r = 0.83, P < 0.01 and r = 0.8, P < 0.01, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Molecular genetics of major histocompatibility complex class II genes in hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the most common malignant tumor of the liver with a possible genetic predisposition. We have studied the HLA-DQ and -DR regions of 57 unrelated HCC patients of southern Chinese origin using molecular DNA techniques and compared them with 104 normal controls. Seventy-six hepatitis B carriers (HBsAg) were also studied. Restriction fragment length polymorphism (RFLP) was used to genotype the MHC class II DR beta, DQ alpha and DQ beta loci of the subjects. Polymerase chain reaction (PCR) using sequence primer for DQ beta genes was also performed. No significant difference was found in the HLA-DQ and -DR loci between HCC patients and normal controls, HCC patients and HBsAg carriers, or HBsAg carriers and normal controls respectively. Forty-one HCC patients were HBsAg positive, and no difference was found in the HLA-DQ and -DR genotype between this group of patients compared with the group of normal controls or HBsAg carriers. Thirty-six HCC patients had elevated alpha-fetoprotein levels, and 15 HCC patients had normal levels. No difference in the HLA-DQ and -DR loci was detected between these two groups and the controls. The results suggest that HLA-DQ and -DR genotypes are not associated with hepatocellular carcinoma in southern Chinese.

Cardiovascular responses to graded doses of three catecholamines during lactic and hydrochloric acidosis in dogs

We have studied the cardiovascular effects of incremental doses of three catecholamines in dogs subjected to lactic (LAC) and hydrochloric (HCl) acidosis. Fifty-four dogs were allocated randomly to one of three groups: control, LAC and HCl acidosis (n = 18 each group). In the acidotic models, 2 mol litre-1 of lactic acid (4 ml kg-1 h-1) or 2 mol litre-1 of HCl (1 ml kg-1 h-1) was infused i.v. until arterial pH was reduced to 7.00 +/- 0.1. Within each group, six dogs received one of three different drugs in logarithmically incremental doses: adrenaline 0.1, 0.2, 0.4, 0.8, 1.6, 3.2 micrograms kg-1 min-1, noradrenaline 0.1, 0.2, 0.4, 0.8, 1.6, 3.2 micrograms kg-1 min-1 and dobutamine 5, 10, 20, 40, 80, 160 micrograms kg-1 min-1. Cardiovascular variables were monitored, with periodic measurements of plasma electrolyte and lactate concentrations. The pH reduction induced by HCl or lactic acid was associated with a statistically significant increase in mean pulmonary arterial pressure (MPAP), prominent especially in the LAC group where MPAP increased from mean 18 (SD 5) to 27 (6) mm Hg. In the acidotic models, the reduction in myocardial responsiveness to adrenaline or noradrenaline was more prominent than that for the control for corresponding doses of drugs. In the LAC group mean cardiac index decreased significantly from 5.2 (1.8) to 2.2 (0.7) litre min-1 m-2 after infusion of adrenaline 3.2 micrograms kg-1 min-1 and decreased from 5.1 (1.1 to 2.4 (0.9) litre min-1 m-2 after infusion of noradrenaline 3.2 micrograms kg-1 min-1.(ABSTRACT TRUNCATED AT 250 WORDS)

Potentiation of angiotensin II-stimulated vascular contraction by lithium

Previous studies have suggested that lithium prolongs or enhances vascular contractions stimulated by alpha-adrenergic agents. The present study was performed to determine whether a similar phenomenon occurs with angiotensin II (ANG II)-stimulated contractions and whether this phenomenon results from interactions with the phosphoinositide signaling system. Contractions of rat aortic rings with 100 nM ANG II were 38% greater in the presence of 20 mM LiCl than in its absence (0.47 +/- 0.07 vs. 0.34 +/- 0.05 g tension/mg dry tissue wt, P < 0.01). The effects of lithium on inositol phosphate responses, diacylglycerol responses, and intracellular calcium concentration on single or repeated stimulations with ANG II were then examined in vascular smooth muscle cells cultured from rat aorta. Cells exposed twice to 100 nM ANG II contained 50% lower inositol trisphosphate levels (InsP3) and 10% lower diacylglycerol levels than cells exposed to ANG II only once. LiCl or lithium acetate abolished these desensitizations in a concentration-dependent manner. Similarly, InsP3 and diacylglycerol responses to a single exposure of ANG II were heightened by lithium (by 75 and 25%, respectively), and the duration of the responses was prolonged by lithium (5- and 2-fold, respectively). In contrast, ANG II-stimulated calcium transients were not enhanced or prolonged by lithium, nor was desensitization of ANG II-stimulated cytosolic calcium mobilization upon serial exposures abolished by lithium. When ring contraction studies were repeated in the presence of the protein kinase C inhibitor staurosporine (150 nM), lithium no longer potentiated ANG II contractions [0.38 +/- 0.03 (control) vs. 0.35 +/- 0.06 g tension/mg dry tissue wt (lithium)].(ABSTRACT TRUNCATED AT 250 WORDS)

Ipratropium bromide and intraoperative bronchospasm

BACKGROUND

Ipratropium bromide (IB) is a synthetic anticholinergic bronchodilator which is effective when administered by inhalation. Therefore, IB may be effective for the management of intraoperative bronchospasm. This study was designed to evaluate the effects of inhaled IB in the management of intraoperative bronchospasm induced by endotracheal intubation.

METHODS

Nine asthmatics who were asymptomatic preoperatively were investigated. They developed bronchospasm after endotracheal intubation. IB 120 micrograms was aerosolized through the endotracheal tube. Heart rate, peak inspiratory pressure (PIP), airway resistance (Raw) and pulmonary resistance (Rpul) before and after IB administration were recorded and calculated.

RESULTS

IB 120 micrograms relieved wheezing in 11 +/- 4 min (mean +/- SD), and significantly decreased PIP in 5 min and reached peak effects at 120 minutes after administration. Raw and Rpul also decreased during similar time intervals. Heart rates had no significant change after IB administration.

CONCLUSIONS

The present study indicated that IB 120 micrograms could abate the intraoperative bronchospasm caused by airway hyperreactivity induced by endotracheal intubation in preoperatively asymptomatic asthmatic patients, and may have a role in the management of intraoperative bronchospasm.

Rethinking neurasthenia: the illness concepts of shenjing shuairuo among Chinese undergraduates in Hong Kong

Neurasthenia is both a Western disease construct and a popular Chinese illness concept (shenjing shuairuo, SJSR). Using a self-report questionnaire, we examined 148 Hong Kong Chinese undergraduates' concept of its epidemiology, symptomatology, etiology and treatment. Notwithstanding that fatigue is the sine qua non of neurasthenia in Western nosology, subjects believed that SJSR was compatible with a diversity of symptoms which fell, on factor analysis, into the "neurotic," "psychotic," "somatic" and "dysfunctional" subgroups. Contrary to the popular portrayal of SJSR as a physical or chronic fatigue disorder, the most common perceived symptoms were anxiety, insomnia, depression and fright. Logically, psychological etiology and remedy were highly emphasized. The perceived high prevalence, non-aggressive nature and symptomatic diversity of SJSR attested to the notion that it might camouflage and destigmatize psychiatric labels of insanity. The contextual study of neurasthenia illustrates how in its search for legitimacy an originally Western concept adapts, transforms, and acquires distinctive local meanings in a non-Western culture.

A new device for measuring and recording the forces applied during laryngoscopy

In characterising the forces exerted during laryngoscopy it is accepted that the significant force component is that which is parallel to the axis of the laryngoscope handle. This paper describes a new method of evaluating the forces exerted at laryngoscopy. A laryngoscope handle has been redesigned, incorporating a force-displacement transducer on the handle at the end opposite to where the blade is attached. The device is designed specifically to sense the axial component of force. The blade attachment block has been detached from the sleeve and connected to a steel shaft which forms the new battery compartment. This allows the axial force exerted at the blade during laryngoscopy to be transmitted along this shaft to the sensing transducer. Linear ball bearings have been introduced between the new shaft and the handle sleeve (outer casing). The rolling friction has been reduced to less than 0.1% by diamond-lapping the precision ground surface-hardened rod to produce a mirror finish. Thus, the force transmitted to the transducer is essentially constant regardless of where the load is applied along the blade. The output from the system is directly downloaded to a laptop computer and the data analysed almost instantaneously to determine the duration of laryngoscopy, the peak forces applied, the mean force with its standard deviation and graphic display of the data. Provision has been made for data entry checks, recording patient details and study data, and creating a data base for the storage and retrieval of the study details.

Duplex PCR system for simultaneous detection of Neisseria gonorrhoeae and Chlamydia trachomatis in clinical specimens

AIMS

To evaluate the use of a duplex polymerase chain reaction (PCR) assay for the simultaneous detection of Neisseria gonorrhoeae and Chlamydia trachomatis in clinical samples.

METHODS

Genital swab specimens were obtained from both China (203 swabs) and Hong Kong (202 swabs). N gonorrhoeae and C trachomatis were detected in each specimen with a number of tests including enzyme immunoassays (IDEIA) and PCR assays using both single and double primer pairs. The primer pair for N gonorrhoeae was derived from the cppB gene on its cryptic plasmid and the PCR product was 390 base pairs long. For C trachomatis, the PCR product was 473 base pairs long, resulting from amplification of a sequence in the common 7.4 kilobase plasmid present in all serovars. For N gonorrhoeae, PCR results were also compared with those obtained by culture and Gram's smear of the discharges.

RESULTS

For the 203 specimens collected in China, similar numbers of positive results (177) were obtained by both Gonozyme and duplex PCR for the detection of N gonorrhoeae. No discrepant results were found among the cultured specimens when Gonozyme and duplex PCR were compared. C trachomatis was detected in 47 specimens by duplex PCR, but was detected in only 28 by IDEIA. Of the 202 Hong Kong specimens, 46 were positive for N gonorrhoeae, detected by both Gonozyme and duplex PCR; 34 were positive for C trachomatis, 25 of which were detected by IDEIA and the remainder by duplex PCR.

CONCLUSIONS

The duplex PCR assay is a satisfactory diagnostic tool for the simultaneous detection of N gonorrhoeae and C trachomatis in clinical swab samples. Further evaluation is suggested.

Diagnosis of urogenital gonorrhoea: evaluation of an enzyme immunoassay and use of urine as a non-invasive specimen

Urethral swabs and urine samples were collected from 42 male patients attending a social hygiene clinic in Hong Kong and used for gonococcal culture and detection of antigens by enzyme immunoassay. Of the patients, 21 were suffering from gonorrhoea as indicated by positive gonococcal culture from both urethral swabs and urine. Twenty of the positive cases were detected by both swab and urine specimens using Gonozyme, an enzyme immunoassay kit. One culture-positive case failed detection by both swab and urine specimens. Gonozyme showed sensitivity and specificity of 95.2% and 100% respectively. With male patients, the use of urine as an alternative specimen to urethral swabs appears to have potential value for both culture and Gonozyme testing. Genital swabs and urine samples were subsequently collected from 108 patients (89 male, 19 female) attending the sexually transmitted disease monitoring centre in Guangzhou, China. Gonozyme tests were performed on both types of specimen, while only swabs were cultivated. When compared with swab culture, Gonozyme had sensitivity and specificity of 100% and 89.2% for males, and 100% and 90.9% for females, respectively. When urine was compared with swabs in the Gonozyme test, urine had sensitivity and specificity of 83.6% and 89.2% for males, and 62.5% and 81.8% for females, respectively. Hence, Gonozyme merits further investigation as an acceptable rapid diagnostic method for detection of Neisseria gonorrhoeae, especially when using urine as an alternative non-invasive specimen from male patients.

Control of post-transplant erythrocytosis by enalapril

OBJECTIVE

To assess the erythropoietin response in patients with erythrocytosis after renal transplantation who were treated with enalapril.

PATIENTS

Fourteen patients with stable renal transplants (creatinine clearance, 74.4 +/- 24.6 mL/min) and a packed cell volume of 51% or more over six months and who had no other cause for their erythrocytosis.

METHODS

Patients were treated with enalapril for six months. Serum erythropoietin levels, creatinine clearance and packed cell volume were measured before and during the study; patients were reviewed each month.

RESULTS

All patients had erythropoietin levels inappropriate for their packed cell volume. After six months' therapy with enalapril their mean erythropoietin concentration of 21.3 +/- 5.0 U/L fell to 7.4 +/- 1.3 U/L (P < 0.02) although the concentration increased in two patients. The mean packed cell volume fell from 52.7% +/- 0.5% to 44.4% +/- 1.0% (P < 0.0001). There was no change in renal function.

CONCLUSION

Low-dose enalapril controls post-transplant erythrocytosis, at least in part, by lowering serum erythropoietin levels.