Plasma concentration of neuropeptide Y in patients with adrenal hypertension

The mechanisms of hypertension during primary hyperaldosteronism and Cushing's syndrome are not completely understood. An enhanced vascular sensitivity to noradrenaline has been described in both situations. Neuropeptide Y (NPY) induces direct vasoconstriction and potentiates the action of noradrenaline. Sodium retention and dexamethasone have been shown to increase circulating NPY levels in animals and the expression of NPY in neuroendocrine cells. In order to determine if NPY could be involved in the enhanced vascular sensitivity to noradrenaline associated with adrenocortical hyperactivity, we measured plasma NPY in patients with Cushing's syndrome (n = 26) and primary hyperaldosteronism (n = 15) and compared it with that of hypertensive patients with pheochromocytomas (n = 13) or essential hypertension (n = 51) and with normotensive controls (n = 47). The concentration of NPY-Like immunoreactivity (NPY-Li) (mean +/- S.E.) in controls was 39.6 +/- 3.0 pg/ml. Elevated concentrations were found in 77% of the samples collected from pheochromocytoma patients (1180.4 +/- 394.0 pg/ml). NPY-Li levels in patients with essential hypertension (35.0 +/- 2.6 pg/ml), primary hyperaldosteronism (31.3 +/- 3.9 pg/ml) and Cushing's syndrome (33.1 +/- 4.8 pg/ml) were not different from that of controls. NPY-Li levels in hypertensive and normotensive patients with Cushing's syndrome were similar (38.5 +/- 7.5 vs 24.2 +/- 3.7 pg/ml). No correlation was found between the NPY-Li level and the mean blood pressure at the time of sampling. Our results suggest that NPY is unlikely to be involved in the pathogenesis of hypertension associated with primary hyperaldosteronism and Cushing's syndrome.

[Mortality of dilated myocardiopathies as a function of continuation of alcohol drinking. Multivariate analysis concerning 236 patients]

A retrospective study was conducted in 236 consecutive patients with dilated cardiomyopathy to determine the characteristics of the disease in heavy alcohol drinkers (n = 110) and to study its outcome, using a Cox model, according to whether the patients were abstainers (n = 49) or continued to indulge drinking (n = 61). At the time of diagnosis, pulmonary pressures were higher in heavy drinkers than in abstainers. During a mean follow-up period of 39 +/- 27 months, 80 patients died of heart disease, viz.: 46 out of 127 non-alcoholic patients (36.2 per cent), 31 out of 61 heavy drinkers (50.8 per cent) and 3 out of 49 patients who had given up alcohol (6.12 per cent). Thus, independently of other parameters, abstinence is a highly significant (P less than 0.001) factor of favourable prognosis in dilated cardiomyopathy.

The contribution of bidimensional echocardiography in the diagnosis of cardiac tumours. Based on 25 observed cases

This paper reviews 25 intracardiac tumours (12 myxomas and 13 thrombi) studied by T.M. echography, bidimensional (2-D) echography and cineangiography during a two year period. In addition, five cardiac tumours (two myxomas, three thrombi) were studied by echography alone, and correctly diagnosed. T.M. echography gives false negative results, whereas both 2-D echo and cineangiography give reliable diagnosis. However, 2-D echo should be the procedure of choice as it is non-invasive, and may be used on patients with equivocal symptoms. Since bidimensional echography has become available during the past two years, 12 myxomas have been correctly diagnosed, compared to 14 found during the previous 13 years.

[Arterial hypertension and horseshoe kidney during Von Recklinghausen's disease. Angiographic study and review of the literature (author's transl)]

Angiographic studies in a young girl aged 16 years who developed arterial hypertension during the course of Von Recklinghausen's disease, demonstrated the presence of an obliterated renal artery in a horseshoe kidney. The distal arterial segment was revascularized by two homolateral ureteral arteries. A full review of the literature revealed 30 cases of renal artery lesions for which angiography had been carried out in young people with neurofibromatosis. This demonstrates the low incidence of obliterative lesions (4 cases throughout the world) which are always associated with collateral vascularization. It was not possible to apply the usual surgical treatment in our case because of the associated horseshoe kidney.