Hypertension: relationships between pathophysiology and therapy

Increased concentrations of milk antibodies in recurrent pulmonary aspiration in infants and young children

Concentrations of circulating antibodies against bovine serum albumin were significantly increased in six children with recurrent pulmonary aspiration (mean: 5.54 micrograms BSA-N/ml, range: 2.05-12.87 micrograms BSA-N/ml; mean value of 76 control infants: 0.38 microgram BSA-N/ml, 95% confidence interval: 0-0.98 microgram BSA-N/ml, p less than 0.001) as determined by radioimmuno-assay. IgG- and IgA-isotypes against bovine serum albumin, lactalbumin, lactoglobulin, casein and gammaglobulin were determined in four patients by enzyme-linked-immuno-sorbent-assay. Significant differences between patients and controls were found for IgG-antibodies against casein and bovine serum albumin and IgA-antibodies against alpha-lactalbumin and bovine serum albumin. Under certain conditions, stimulation of bronchus-associated lymphoid tissue may lead to a higher immune response than oral immunization. Determination of milk antibodies may be helpful in the diagnosis of recurrent pulmonary aspiration.

New concepts and drugs in the treatment of congestive heart failure

This article seeks to make clear the basic differences in the treatment of heart failure between therapeutic maneuvers that are aimed at improving the mechanical loading conditions of the heart and those that are aimed at augmenting the fundamental contractile or inotropic state of the myocardium. Emphasis is placed on recognizing that treatment expectations must be viewed within an age- or maturity-dependent framework, since a diminished margin of cardiocirculatory reserve exists in the smallest and youngest patients that limits the extent of benefit that may be derived from diverse treatment approaches.

Renal factors in juvenile hypertension

Essential hypertension in infancy, one believed to occur rarely if ever, is now increasingly recognized as a potential precursor of essential hypertension in adulthood. The mechanisms responsible for hypertension in childhood and adolescence are only beginning to be delineated. Renal factors assumed to be operative in juvenile hypertension are involving either volume control (by renal regulation of sodium-chloride and water balance) or vasoactive substances like the kallikrein-kinin, the renin-angiotensin and the prostaglandin system and other less well defined hormones. There is a close interrelationship of all these hormones with each other as well as a close linking of these vasoactive compounds to the renal regulation of sodium-chloride and water balance, thus interfering with a major environmental factor necessary for the development of essential hypertension. At present, data are insufficient to delineate a single hormone or a single hemodynamic abnormality as the only primary factor in juvenile hypertension. Further research into the pathomechanisms responsible for the elevation of blood pressure at its very beginning will improve our understanding of hypertension and possibly benefit its management by early intervention.