Freebase cocaine and memory

Despite the seriousness of acute medical and psychological consequences of cocaine abuse, little knowledge exists about the chronic effects of the drug. Investigation of a sample of abstinent freebase (crack) abusers in the Bahamas provides the first research evidence that prolonged cocaine abuse may result in persistent short-term memory disturbances.

Reninlike enzymes in human vasculature

The present study was designed to identify angiotensin I (Ang I)-forming angiotensinogenases in human extrarenal vasculature and to examine the theory of Jiménez Días on their stimulation in essential hypertension. Vascular sections obtained intraoperatively from 14 normotensive and 16 hypertensive patients undergoing corrective surgery, 68 umbilical cord blood vessels from parturient women, tissue samples from nine explanted hearts, and serum from anephric and healthy individuals were investigated. Ang I-forming angiotensinogenase activities were determined enzyme-kinetically by using Ang I radioimmunoassay and purified sheep or human angiotensinogens. Three nonrenin Ang I-forming angiotensinogenases (pH optima of 4.0, 5.1, and 6.1) were identified in extrarenal vasculature, in cardiac tissues, and in plasma. Highest specific activities of nonrenin Ang I-forming angiotensinogenase (in nanograms Ang I per gram times hour; mean +/- SD) were found in cardiac tissue (2,821 +/- 497, n = 9), followed by carotid artery intima (1,448 +/- 982, n = 10), arteries (1,307 +/- 736, n = 18), and umbilical cord arteries (135 +/- 55, n = 35). Extrarenal arterial Ang I-forming angiotensinogenases were linearly correlated with those of local angiotensin converting enzyme and plasma renin activity. In essential hypertension, extrarenal arterial Ang I-forming angiotensinogenases were scattered, but not generally stimulated. The data obtained indicate the existence of nonrenin Ang I-forming angiotensinogenases in human extrarenal vasculature, in kidney, and in plasma. The postulate of stimulation of extrarenal arterial Ang I-forming angiotensinogenases in essential hypertension cannot be supported. Similar to the classification of plasma renin activity, a classification of Ang I-forming angiotensinogenase activity is proposed, consisting of patients with essential hypertension divided into subgroups exhibiting high, normal, or low vascular Ang I-forming angiotensinogenase activities.

Treatment of advanced transitional cell carcinoma of the bladder with irradiation and concomitant 5-fluorouracil infusion

Twenty patients with advanced transitional cell carcinoma of the bladder were treated with radiation and concomitant continuous infusion of 5-fluorouracil with or without Mitomycin. Nineteen of 20 patients were assessed for response. Fourteen of 19 patients (74%) obtained a complete response within 3 to 6 months. An additional three patients (15%) acquired and maintained a complete response after local transurethral resection of the tumor and intravesical chemotherapy, raising the overall complete response (CR) rate to 17/19 (89%). Of the two patients with persistent disease, one is alive and well after salvage cystectomy. Eighteen of 20 patients were evaluated for survival with a median follow-up of 38 months. Seven patients remain alive and well 51 to 78 months, whereas three patients died from intercurrent disease. Eight patients died of either distant metastatic disease (7 patients) or regional disease (1 patient). An adjusted survival calculated by the Life Table Method was 53.6% at 5 years, whereas the overall survival was 39%. The combined modality therapy was well tolerated with no need for treatment interruption or reduction in dose. Late bladder complications include one patient with hemorrhagic cystitis, two patients with dysuria, and two with symptoms of irritable bladder. One patient required a colostomy for a chronic hemorrhagic proctitis. Bladder preservation was achieved in 19/20 patients.

[Effect of chronic renal failure and hemodialysis on the pancreas-specific enzyme pattern in the serum]

Amylase concentration in serum is frequently found increased in chronic renal insufficiency without being associated with pancreatic diseases. A prospective study was performed in 71 patients with chronic renal insufficiency undergoing hemodialysis for comparison of different pancreatic enzymes in serum. 7 patients were not considered in this comparative study because of chronic pancreatitis-like-changes in ultrasound. Increased serum concentrations were found for total amylase in 27 patients (42.2%), pancreatic amylase in 26 patients (25.0%), lipase in 50 patients (78.1%), immunoreactive trypsin in 61 patients (95.3%) and for elastase 1 in 7 patients (10.9%). Hemodialysis did not affect any of the investigated pancreatic serum-enzymes. Elastase 1 determination in serum appears superior to the other pancreatic serum-enzymes because of higher specificity, not limited by renal insufficiency. The different serum concentration of elastase 1 and trypsin, which have a similar molecular weight, points towards a completely different clearance mechanism for these enzymes.

An exploratory study of mother-child interaction during the second year of life

The aim of this study was to further understanding of development during the crucial second year of life. The study employed a naturalistic, semistructured situation for the observation of mother-child behavior. The experimental stimulus was the progressive diversion of the mother's attention away from her child. This diversion evoked separation anxiety in the child and the individual and interactive regulatory behaviors of the mother-child pair. Concurrently, the child's behavior was observed in a play group situation. One set of rating scales was devised for assessment of the mother-child interaction, and another set for assessment of the child's functioning in the play group. The major hypothesis was that maternal and child behaviors that foster the child's successful handling of phase-specific stresses and developmental tasks will be positively correlated with the child's functioning in the play group. This hypothesis is supported by the findings of the study.

Abnormal thyroid hormone and thyrotropin levels in homozygous sickle cell disease

Male patients with SS disease had significantly lower T3 and higher TSH levels than a comparison group. Stimulation with TRH in 10 male sibling pairs showed highly significant increases in T3 and TSH in both patients and sibling controls although the increase in TSH was significantly greater in SS disease. The interpretation of these findings is unclear although the thyroid indices indicate an abnormal pituitary-thyroid axis most consistent with a modest primary thyroid failure.

Blood pressure and lipid lowering effects of terazosin

Treatment of hypertension reduces the risk of developing stroke, renal failure and left ventricular failure but not that of coronary heart disease. The reasons for the less favourable results of antihypertensive regimens on coronary heart disease are manifold and unresolved. Antihypertensive treatments which in addition to their blood pressure lowering effects also favourably influence serum lipids offer greater promise to lower coronary heart disease. The long-acting postsynaptic alpha-blocker terazosin was assessed in terms of multifactorial aspects of patients with various risk profiles. The results of clinical trials underline that terazosin changes blood lipids in a beneficial direction and therefore has the potential to lower coronary heart disease more effectively than conventional antihypertensive medications.

Therapeutic assessment of urapidil or angiotensin-converting enzyme inhibition in systemic hypertension

The antihypertensive efficacy of urapidil, a postsynaptic alpha blocker with an additional central action, was compared with that of the angiotensin I converting enzyme inhibitor captopril under conditions of general practice (multicenter study). The study was performed in a double-blind, randomized, parallel-group fashion. After a 2-week washout and placebo phase, 295 essential hypertensive patients (World Health Organization grades I and II) were treated for 12 weeks with either urapidil or captopril, initially with urapidil, 60 mg twice daily or captopril, 25 mg twice daily, with the possibility of adjusting the dose according to blood pressure response after 2 weeks of treatment. Blood pressure values at the end of the 12-week treatment decreased significantly in the group receiving urapidil (n = 142, all dosages), from 175/103 to 154/89 mm Hg (p less than 0.001), and in the group receiving captopril (n = 153, all dosages) from 175/103 to 154/90 mm Hg (p less than 0.001); these values corresponded to 62% urapidil and 58% captopril responder rates (diastolic blood pressure less than or equal to 90 mm Hg), respectively. The computer-assisted frequency distribution of the patients with controlled diastolic blood pressure (less than or equal to 90 mm Hg) over the duration of the study demonstrated comparable efficacy for both drugs. Adverse effects were observed in 45 patients in the urapidil group and in 18 patients in the captopril group (vertigo, nausea, headache). The results revealed that the 2 antihypertensive agents with different modes of action controlled blood pressure with equal efficacy.(ABSTRACT TRUNCATED AT 250 WORDS)

[Methodologic evaluation of the relation of blood pressure and skinfold thickness: an epidemiologic approach]

The empirical evidence concerning the relationship between blood pressure and anthropometric characteristics (triceps skinfold, adiposity, and arm circumference) was assessed by means of meta-analysis. Different studies were evaluated critically for strength of design, methods and associations. It was found that the association between blood pressure and triceps skinfold holds for three different demographic categories. The question as to the independence of these associations remained unsolved. The effect of arm adiposity on the measurement of blood pressure was also discussed. Recommendations are give in order to standardize blood pressure measurements in clinical and research settings.

Case-control study of colorectal cancer and fecal mutagenicity

Fecal mutagenicity was measured in 68 patients with colorectal cancer and in 114 controls, using Salmonella tester strains TA98 and TA100 with and without S9 activation. Samples were also tested for fecapentaenes by high-performance liquid chromatography, to permit the separation of fecapentaene and non-fecapentaene mutagenicity. Overall, no significant case-control differences in fecal mutagenicity were observed. However, when samples containing high concentrations of fecapentaenes were excluded, non-fecapentaene TA98 mutagenicity was observed in eight cases (12%) and only four controls (4%), resulting in an estimated relative risk of 4.4 (95% confidence interval = 1.0-21.1). The association of colorectal cancer risk with non-fecapentaene TA98 mutagenicity could not be explained as an artifact of diagnostic workup or gastrointestinal bleeding among the cases. Smoking could also be excluded as a source of the TA98 mutagenicity seen, but possible dietary origins are still being explored.

The epidemiology of blood pressure in young Mexican adults

The distribution of blood pressure and associated factors (height, weight, body mass index, age, social class) was assessed in young Mexican adults, with a cross-sectional study of 657 male and female students enrolled at the University of Mexico, aged from 19 to 25 years. Significantly higher blood pressure levels were observed in males than in females. Borderline hypertension was found in 20.7% of the study subjects. Of all anthropometric factors, age and social class, weight was determined by stepwise regression analysis as the best predictor for blood pressure when using a linear model. However, when a quadratic model was used, a 'U' relationship and a significant variation between blood pressure and social class was detected. This relationship was magnified when blood pressure was categorized into borderline hypertension and normotensives. These findings suggest the hypothesis that hypertension has a non-linear association with social class in environments that are undergoing an intermediate step of modernization and economic transition such as is occurring in Latin American countries today.

Bacterial meningitis with initial normal cerebrospinal fluid findings

Seven pediatric patients with bacterial meningitis but with initial normal cerebrospinal fluid (CSF) findings are presented. They represent 6.5% of all cases with bacterial meningitis seen at our medical center during a 5-year period. In all cases, the duration of symptoms before the initial lumbar puncture was short (6-24 h). The case-fatality rate was 3/7 (43%) compared with 10/100 (10%) among children with abnormal initial CSF, despite early initiation of antibiotics. Bacterial meningitis with an initial normal CSF finding is not rare and may be associated with poor outcome.

Case-control study of colorectal cancer and fecapentaene excretion

The fecapentaenes are potent mutagens found in high concentrations in the stools of some individuals. These compounds are produced in vivo by common species of the colonic microflora, from precursors of unknown origin. The fecapentaenes have been postulated to increase the risk of colorectal cancer. To test this hypothesis, we measured fecapentaene excretion in 69 patients with adenocarcinoma of the colon or rectum, newly diagnosed at three Washington, DC area hospitals. The cases were compared with 114 surgical controls, frequency matched to the cases on age, sex, and hospital. We attempted to measure fecapentaene excretion 4 times for each subject: before surgery; and at 1 mo; 3 mo; and 6 mo following surgery. Contrary to our study hypothesis, we found fecapentaene excretion during the four study periods to be similar or even lower in cases compared to controls. An indirect measurement of fecapentaene precursors also tended to be lower in cases. The case-control differences could not be explained as effects of bleeding or of the colorectal diagnostic workup, which was assessed in a separate group of 86 patients. We conclude from these data that the excretion of fecapentaenes does not increase the risk of colorectal cancer, at least when measured near the time of diagnosis.

Is increased plasma viscosity a risk factor for high blood pressure?

Data from several epidemiologic studies have suggested that, among other variables, hematocrit and fibrinogen may constitute risk factors for high blood pressure. As part of a population survey for cardiovascular risk factors, plasma viscosity and hemoglobin were measured. Blood pressure was determined under standardized conditions according to the recommendations of the AHA. A two-stage age-sex-stratified cluster sample of 5,312 persons, aged twenty-five to sixty-four years, was selected from a mixed urban/rural target population of 282,279 (total population approximately 533,000). A net response of 79.3% was achieved. Multiple logistic regression analyses including plasma viscosity, hemoglobin, body mass index, alcohol consumption, smoking behavior, and total serum cholesterol as independent variables were run controlling for both age and sex. Plasma viscosity appeared as a significant main effect in all analyses and demonstrated the strongest association with high blood pressure next to body mass index. Whether this association implies a causal relationship cannot be answered from cross-sectional data. However, even if plasma hyperviscosity represents a secondary phenomenon in hypertension, it might be of prognostic relevance. There is evidence that increased plasma viscosity may contribute to myocardial hypertrophy. Therefore hypertensives with impaired blood fluidity might constitute a subgroup at particular risk for cardiovascular complications. When antihypertensive drugs are selected, their influence on blood viscosity should be taken into account.

Efficacy of urapidil in the management of essential hypertension: a comparison with captopril

In a randomized double-blind multicentre study the efficacy (lowering diastolic blood pressure less than or equal to 90 mmHg) of urapidil, a postsynaptic alpha-blocker with central action, was compared with that of the angiotensin converting enzyme inhibitor captopril. Two hundred and ninety-five essential hypertensives (World Health Organization stages I-II; 140 males, 155 females; mean age 51 years) were treated for 12 weeks with either 30-90 mg urapidil twice a day or 12.5-50mg captopril twice a day. Supine blood pressure values (mmHg, means +/- s.d.) at the end of the 12-week treatment period fell in the urapidil group (n = 142) from 175 +/- 19/103 +/- 6 to 154 +/- 17/89 +/- 9 (P less than 0.001), in the captopril group (n = 153) from 175 +/- 19/103 +/- 6 to 154 +/- 19/90 +/- 9 (P less than 0.001), representing responder rates of 62% for urapidil and 58% for captopril. The results demonstrate that two antihypertensive medications with different modes of action control blood pressure with equal efficacy. A dose decrease was possible in 20% of each group, but a dose increase was necessary in 39% of the urapidil and 44% of the captopril group.

Clinical experience with doxazosin in general medical practice

The antihypertensive efficacy, lipid effects, and safety of doxazosin, a selective alpha 1-inhibitor for the reduction of coronary heart disease (CHD) risk in hypertensive patients, was assessed in a general medical practice setting. Seven hundred seventy-one patients were entered into the study, which involved three phases: (1) a 2-week baseline period, (2) an 8-week period in which patients received doxazosin, 1 to 8 mg once daily, and (3) a 4-week maintenance period. From baseline to final visit there was a highly significant 27% reduction (p less than 0.001) in calculated CHD risk based on the Framingham equation as a consequence of doxazosin's favorable effects on both blood pressure and serum lipid levels. Efficacy and toleration of doxazosin therapy were good to excellent in most patients. The investigators' global assessment of efficacy of once-daily doxazosin therapy was excellent or good for 82% of patients and fair or poor for only 18% of patients. After 12 weeks, 83% of the patients were considered therapy successes (sitting diastolic blood pressure either less than or equal to 90 mm Hg or greater than or equal to 10 mm Hg reduction not reaching less than or equal to 90 mm Hg) at a mean daily dose of 3.5 mg. Seventy-one percent achieved "normalized" blood pressure control (sitting diastolic less than or equal to 90 mm Hg with a decrease of greater than or equal to 5 mm Hg) at a mean dose of 3.1 mg once daily. By the final treatment visit, systolic/diastolic blood pressures of efficacy evaluable patients were reduced by 20.6/15.3 and 21.0/15.4 mm Hg from a mean baseline of 166/104 and 165/104 mm Hg in the sitting and standing positions, respectively (p less than 0.05). Total cholesterol was significantly decreased (p less than 0.01). Most side effects were mild or moderate and disappeared with or were tolerated on continued therapy. The investigators' global assessment of patient toleration of doxazosin treatment was excellent or good for 89% of the 763 patients evaluated and fair or poor for only 11% of patients. The most commonly reported side effects were headache (8%) and dizziness (7%). No clinically significant laboratory changes were apparent, and no trends were observed with regard to organ systems or correlations with dose or duration of treatment.

Control of coronary heart disease risk factors with doxazosin as monotherapy and in combination therapy

Although the pathology of essential hypertension is still unclear, studies have shown that doxazosin, a selective alpha 1-inhibitor, is able to effectively control mild-to-moderate hypertension. The aim of these two, noncomparative studies was to evaluate the efficacy and toleration of doxazosin when used as monotherapy and in combination with other antihypertensive agents. In study I, 154 patients with standing and sitting diastolic blood pressures (DBPs) ranging from 95 to 115 mm Hg were treated with once-daily doxazosin (1 to 8 mg) as monotherapy for 12 weeks. Both sitting and standing blood pressures were significantly reduced by doxazosin monotherapy. Target DBP of less than or equal to 90 mm Hg was achieved in 86% of patients after 12 weeks of therapy with doxazosin, and there was no change in heart rate. Cholesterol and triglyceride levels were significantly decreased by doxazosin, but there was no change in glucose levels. Minor side effects were seen in 17.5% of patients, and 2.6% discontinued therapy. In study II, 65 patients with DBPs ranging from 95 to 115 mm Hg on existing antihypertensive therapies were concomitantly treated with doxazosin (1 to 8 mg) once daily for 12 weeks. Target DBPs of less than or equal to 90 mm Hg was achieved in 71% of patients after 12 weeks of therapy with doxazosin. There was no change in heart rate throughout the treatment period, and plasma cholesterol, triglyceride, and glucose levels remained essentially unchanged. Three patients, each receiving a beta-blocker, a diuretic, and doxazosin, were withdrawn because of side effects. Minor side effects, which were considered drug related were seen in 21% of patients. Doxazosin is a drug with good antihypertensive efficacy and is well tolerated as monotherapy and in combination with beta-blockers, thiazide diuretics, angiotensin converting enzyme inhibitors, and various combinations of these drugs.(ABSTRACT TRUNCATED AT 250 WORDS)

Differences in the epidemiology of childhood community-acquired bacterial meningitis between two ethnic populations cohabiting in one geographic area

A comparison of the epidemiology of community-acquired bacterial meningitis between Jewish and Bedouin populations cohabiting one geographical area is reported here. During the years 1981 to 1985, 100 children younger than 13 years old with community-acquired bacterial meningitis were hospitalized. Seventy-one patients were younger than 12 months. The principal bacteria isolated were Haemophilus influenzae 42%; Streptococcus pneumoniae 29% and Neisseria meningitidis 20%. The case fatality rate was 12%. The chance of acquiring meningitis during the first 5 years of life was twice as common among Bedouins than among Jews (328/100,000 vs. 173/100,000, respectively; P less than 0.0001). The most common cause of meningitis during the first year of life was S. pneumoniae among Bedouins and H. influenzae among Jews. Meningitis caused by H. influenzae and S. pneumoniae was usually associated with respiratory morbidity during fall and winter among Jews, but with diarrheal morbidity during summer and fall among Bedouins. Since the most prevalent type of morbidity among Jews results from respiratory infections and among Bedouins from diarrhea, our findings suggest that community-acquired bacterial meningitis is associated with the type of morbidity most prevalent in the community at any given season rather than with a specific type of infection.

Treatment of mild hypertension with urapidil or captopril

The aim of this study was to compare the efficacy (lowering diastolic blood pressure to 90 mm Hg or less) of urapidil, a postsynaptic alpha-blocker with central action with that of captopril in a randomized, double-blind, multicenter study. Two hundred ninety-five essential hypertensives (WHO I/II) (140 male, 155 female, age 56-60 years) were treated for 12 weeks with either 30 to 90 mg urapidil bid or 12.5 to 50 mg captopril bid. Supine blood pressure values (mmHg, mean +/- SD) at the end of the 12-week treatment dropped for the urapidil group (n = 142) from 175/103 +/- 19/6 to 154/89 +/- 17/9 (P less than 0.001), and in the captopril group (n = 153) from 175/103 +/- 19/6 to 154/90 +/- 19/9 (P less than 0.001), corresponding to 62% urapidil and 58% captopril responder rates. The results demonstrate that the two antihypertensive medications with different modes of action control blood pressure with equal efficacy at three dose levels. A dose decrease was possible in 20% of each group, but a dose increase was necessary in 39% of urapidil and 44% of captopril group.

Efficacy of urapidil in the management of essential hypertension. A comparison with captopril

In a multicentre study by general practitioners, the antihypertensive efficacy of urapidil, a postsynaptic alpha-blocker with central action, was compared with that of the angiotensin-converting enzyme inhibitor captopril. The study was of a double-blind, randomised parallel-group design. Following a 2-week washout and placebo phase, 295 essential hypertensives (WHO I/II) were treated for 12 weeks with either urapidil or captopril, initially with urapidil 60 mg twice daily or captopril 25mg twice daily, with the possibility of adjusting the dose according to blood pressure response after 2 weeks of treatment [diastolic blood pressure (DBP) 90 mm Hg or less: reduction of urapidil to 30 mg twice daily or captopril to 12.5mg twice daily; DBP 91 to 99 mm Hg: dose unchanged; DBP 100 mm Hg or more: dose increased to urapidil 90 mg twice daily or captopril 50 mg twice daily]. Blood pressure values at the end of the 12-week treatment period dropped significantly in the urapidil group (n = 142; all dosages) from 175/103 mm Hg to 154/89 mm Hg (p less than 0.001) and in the captopril group (n = 153; all dosages) blood pressure decreased from 175/103 mm Hg to 154/90 mm Hg (p less than 0.001), corresponding to 62% and 58% urapidil and captopril responder rates (DBP less than or equal to 90 mm Hg), respectively. The responder rate at 12 weeks under urapidil therapy was 30% for the initial, 17% for the lower and 15% for the higher dose; the respective values for captopril were 28, 16 and 14%.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of intrastriatal and intranigral administration of synthetic neuromelanin on the dopaminergic neurotoxicity of MPTP in rodents

Previous studies showed that the neurotoxin MPTP and its toxic metabolites bind with high affinity to neuromelanin (NM). Therefore, the presence of NM in human and primate but not in rodent substantia nigra, theoretically may be responsible for the species-selective dopaminergic (DA) toxicity of MPTP. We measured DA levels in rodent striatum 7 days after an acute single challenge with MPTP (40 mg/kg, s.c.) given alone or 24 h following unilateral intrastriatal injections of synthetic DA-NM in mice and intrastriatal or intranigral pigment administration in rats. Ipsilateral striatal DA levels were unaffected in control rodents treated with unilateral intrastriatal or intranigral DA-NM. In mice, systemic MPTP produced marked striatal DA depletions which were mildly increased in the striata given prior DA-NM injections. In rats, a species resistant to MPTP, administration of toxin did not affect striatal DA levels. However, after pretreatment with unilateral intrastriatal DA-NM, MPTP induced mild DA falls in ipsilateral striata. By contrast, intranigral administration of DA-NM followed by MPTP, did not alter ipsilateral striatal DA in rats. The findings suggest that intrastriatal DA-NM in mice and rats may augment or initiate, respectively. MPTP-induced damage to sensitive DA-nerve-terminals perhaps by its action as a depot for binding and protracted release and action of the toxin. Lack of effect of intranigral DA-NM which is retained extraneuronally suggests that role of NM in the toxicity of MPTP may depend on its location within DA cell bodies in the nigra.

The neurotoxin MPTP does not affect striatal superoxide dismutase activity in mice

Intraneuronal superoxide generation may be a possible mechanism of the dopaminergic (DA) neurotoxicity of MPTP. In such case, MPTP might theoretically affect superoxide dismutase (SOD) activity. We determined SOD activity and DA levels in striata of mice at 0.5, 1, 4, 16, 24 h or 7 days after an acute single injection of MPTP (40 mg/kg, s.c.). MPTP produced marked striatal DA depletions from 4 h post-treatment but SOD activity remained unaltered and similar to controls at all time points. Intrastriatal injections of purified SOD 15 min prior to systemic administration of MPTP did not attenuate the MPTP-induced striatal DA depletions in mice at 7 days post-treatment. Combined administration of MPTP with the SOD inhibitor diethyldithiocarbamate markedly enhanced striatal DA decreases produced by MPTP alone. Findings suggest that MPTP does not act via inhibition of SOD. Therefore, potentiation of MPTP toxicity by diethyldithiocarbamate may be due to interference with other enzymatic systems.