Plasma renin activity and angiotensin pressor dose in hypertension correlation and diagnostic implications

Data obtained from 65 hypertensive patients showed a clear-cut positive correlation between peripheral plasma renin activity and the pressor response to exogenous angiotensin II (r =+0.75). For the various causes of hypertension, the mean values of plasma renin concentration were found to correspond closely to the mean values of the angiotensin pressor dose. In individual cases, however, the pressor dose of angiotensin was not found to be a reliable gauge of peripheral venous renin activity.It was impossible to establish a causal diagnosis from the results of the angiotensin infusion test or the renin level in peripheral blood under normal conditions. If, however, determinations are carried out on the renal venous effluent with sodium restriction and with the patient in the upright position the renin level is very valuable both in the diagnosis of renovascular hypertension and in predicting the probable outcome of surgical treatment.

Fibroblast growth factor 23 (FGF-23) is an early predictor of mortality in patients with cardiac arrest

BACKGROUND

Post-cardiac arrest management has seen significant advances with profound improvements in survival and neurologic outcome. However, early prognostication after return of spontaneous circulation remains most challenging. Biomarkers have evolved as helpful tools in identifying patients who are at increased risk of adverse outcome. While fibroblast growth factor 23 (FGF-23) has recently emerged as a promising predictor of mortality in patients with cardiogenic shock, its role in risk stratification in post-resuscitation management remains unresolved.

METHODS

This study included 90 patients who had been resuscitated and transferred to the ICU of the University Hospital Heidelberg. Survivors and non-survivors were retrospectively analyzed for known prognostic biomarkers as well as FGF-23 serum levels 24h and 72 h post cardiac arrest (CA).

RESULTS

FGF-23 levels were significantly elevated in non-survivors compared to survivors. ROC analysis of FGF-23 levels at 24h and 72 h post CA yielded an AUC of 0.759 and 0.726, respectively, for prediction of overall survival after 6 months. FGF-23 levels remained as significant prognosticators after adjusting for age, renal function, and initial cardiac rhythm. FGF-23 levels did not show significant differences in patient outcome after stratification for cardiac origin of CA or left ventricular dysfunction. Furthermore, FGF-23 levels were moderately predictive of poor neurologic outcome in ROC analysis on day 1 and day 3 post CA with an AUC of 0.738 and 0.687, respectively.

CONCLUSION

This study demonstrates elevated FGF-23 serum levels to be potentially helpful in prediction of mortality and poor neurological outcome as early as 24h post cardiac arrest.

Lack of a diurnal plasma adenosine 3',5'-monophosphate rhythm

Plasma cAMP levels were measured using a protein-binding radioassay in nine healthy volunteer subjects over a period of 24 h under standardized conditions and also after an hour of orthostatism. No circadian variations of cAMP in plasma were observed. After orthostatism, however, there was a significant rise in cAMP concentrations.

[The effect of acute diuresis augmentation on urea and creatinine clearance in healthy people and in patients with chronic renal insufficiency (author's transl)]

According to earlier observations no further augmentation of urea clearance should be possible above a urine flow of 2 ml/min (so-called augmentation limit). In normal people and in patients with renal insufficiency no augmentation limit of urea and creatinine clearance could be ascertained: increasing urine flow was correlated with augmentation of urea and creatinine clearance. Calculating the protein equivalent the augmentation of urea excretion by increased diuresis seems to be of clinical importance only in the treatment of renal insufficiency with small basic diuresis.

Sources of human plasma cyclic AMP. Examinations before and after beta 2 adrenergic stimulation

Plasma cyclic AMP was measured in different vessels in seventeen volunteers before and after stimulation with terbutaline. Differences between arterial blood and blood from the hepatic vein, right ventricle, inferior vena cava and a cubital vein could not be demonstrated. Only in the renal vein was the concentration of cyclic AMP decreased. Our results indicate that cyclic AMP is not generated from any specific isolated organ and that changes in cyclic AMP after subcutaneous injection of terbutaline reflect a general influence of this drug.

Quality of Life and Screening on Body Dysmorphic Disorder, Depression, Anxiety in Septorhinoplasty

OBJECTIVES

Septorhinoplasty (SRPL) can improve quality of life (QoL) in functional and aesthetical aspects of the nose. A key factor compromising postoperative satisfaction is symptoms of body dysmorphic disorder (BDD), defined by excessive concerns and distress over slight or imagined physical defects. Although a high prevalence of BDD in SRPL patients is evident, the effect of positive screening on BDD and other psychiatric disorders is understudied. It was hypothesized that patients screening positive for BDD, depression or anxiety do not show increased postoperative QoL.

METHODS

A multicenter, prospective study including 259 patients. For psychiatric evaluation, the BDD concern questionnaire-aesthetic version and the Hospital Anxiety and Depression Scale were used; for disease-specific QoL the Rhinoplasty Outcomes Evaluation (ROE) and the Functional Rhinoplasty Outcome Inventory (FROI-17).

RESULTS

In preoperative evaluation, 32.5% had a positive screening for BDD, 42.2% for increased anxiety, and 32.9% for depression. Mean QoL improved in the whole cohort (FROI total score: 54.4 ± 21.8 to 32.8 ± 23.7 and ROE: 32.3 ± 15.6 to 69.8 ± 23.1, both p < 0.001). Patients screening positive for BDD, depression or anxiety did show an increased postoperative QoL, but to a significantly lower degree and with lower pre- and postoperative QoL levels.

CONCLUSIONS

SRPL patients show a high prevalence of BDD symptoms, elevated anxiety, and depression. These subgroups show lower QoL levels and an impaired QoL increase after surgery. Rhinoplasty surgeons must be aware of the disorders and their symptoms, discuss potential concerns with the patients, and potentially refer them to a specialist.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:2187-2193, 2024.

Brachial plexus tumors extending into the cervicothoracic spine: a review with operative nuances and outcomes

BACKGROUND

The rarity and anatomical complexity of brachial plexus tumors (BPTs) impose many challenges onto surgeons performing surgical resections, especially when these tumors invade the cervicothoracic spine. Treatment choices and surgery outcomes heavily depend on anatomical location and tumor type.

METHODS

The authors performed an extensive review of the published literature (PubMed) focusing on "brachial plexus tumors" that identified invasion of the cervicothoracic spine.

RESULTS

The search yielded 2774 articles pertaining to "brachial plexus tumors". Articles not in the English language or involving cervicothoracic spinal invasion were excluded.

CONCLUSIONS

Recent research has shown that the most common method used to resect tumors of the proximal roots is the dorsal subscapular approach. Despite its association with high morbidity rate, this technique offers excellent exposure to the spinal roots and intraforaminal portion of the spinal nerve. The dorsal approach is used to resect recurrent lower trunk tumors and dumbbell-shaped neurofibromas, yet it is also the least common overall approach used in brachial plexus tumor resections. The ventral or anterior technique is commonly used to resect tumors at the cord to division level, and root to trunk level. Motor complications, transient nerve palsy, and bleeding are among the most common complications of the anterior supraclavicular approach. Further controlled studies are needed to fully determine the optimal surgical approach used to obtain the best outcomes and least complications for each type of brachial plexus tumor.

[Plasma-cAMP in primary and secondary hyperparathyroidism (author's transl)]

3 patients with operatively proven primary hyperparathyroidism showed normal plasma cAMP concentrations. 5 patients in chronic dialysis treatment independent of the level of parathyroid hormone had increased plasma cAMP concentrations. These observations suggest that there is under these circumstances no regulation of plasma cAMP by the parathyroid hormone.

[T4/T8 ratio in bronchoalveolar lavage in sarcoidosis--a marker of activity and/or prognosis?]

In 158 patients with histologically confirmed intrathoracic sarcoidosis the T4/T8 quotient was checked in broncho-alveolar lavage (BAL) for its informative value with regard to activity and prognosis of the disease. In asymptomatic patients with x-ray type I and normal lung function, in radiological remissions of x-ray types I and improvement in the course of disease in patients whose disease had initially been classified acute, we found statistically significantly higher T4/T8 quotients than in the other patient groups; we did not observe any deterioration in the course of the disease. High T4/T8 quotients will thus not generally point to an active or progressing disease; the information conveyed by these data is of limited clinical usefulness in individual cases only.

[Polychemotherapy of inoperable bronchogenic carcinoma: preliminary results (author's transl)]

Preliminary results indicate that BACO and SAKK are capable of inducing remission in 80-90% of cases of small-cell bronchogenic carcinoma; these remissions last for about 6 months and not only prolong, but improve the quality of, life. In view of the small number of cases so far observed no assessment can as yet be made of the superiority of one or the other method concerning the incidence and duration of remissions and survival time. In cases of squamous cell cancer the two therapeutic methods succeeded in only 30-40% of the patients in inducing partical remissions and they did not appear to improve the quality of life. The question whether the treatment actually prolongs life as compared with the natural course of the disease remains open.

[Tracheobronchopathia osteochondroplastica and coexistent mucoepidermoid carcinoma of the lung: Case report]

Pneumonia of the middle lobe that had been diagnosed by x-ray in a male patient of 51 years of age did not recede completely despite antibiotic treatment. CT showed a space-occupying growth in the middle lobe of about 1.5 cm size, with consecutive atelectasis. Bronchoscopy revealed a pronounced pattern of tracheobronchopathia osteochondroplastica, but it was not possible to confirm the middle lobe syndrome (Brock's syndrome) by histological examination. A mucoepidermoid carcinoma of the middle lobe was histologically established by thoracotomy besides the tracheobronchopathia osteochondroplastica. 9 months post-operatively there is no pointer to any recurrence or metastasising.