Comparative effects of enarapril versus losartan on the prevention of diabetic nephropathy in type 2 diabetes patients with microalbuminuria

A prospective randomized open-labeled study was performed to compare the renoprotective effects of enarapril and losartan on the development of microalbuminuria in type 2 diabetic patients with hypertension. Diabetic patients who have hypertension and microalbuminuria at base line [n=19] were recruited. Enarapril [n=11] or losartan [n=8] was randomly chosen by envelope methods and was prescribed for one year. At the end of this study, the blood pressure of patients in these two groups decreased significantly. Urine albumin-creatinine ratio [U-ACR] also decreased in these two groups, however, U-ACR of enarapril group was not significantly different from that of losartan group at any time of this study. Body mass index, HbA1c, blood pressure, and serum lipid profiles were not significantly different between the two groups. From these results, we conclude that the effects of enarapril and losartan on the development of microalbuminuria in type 2 diabetic patients along with hypertension seem to be equivalent in terms of clinical renoprotection

Evaluation of Catheter-Directed Thrombolysis for Acute Deep Vein Thrombosis / 日本心臓血管外科学会雑誌

We report the efficacy of catheter-directed thrombolysis (CDT) for acute deep vein thrombosis. Between January 2003 and August 2004, 20 patients were treated with CDT for occlusive femoral, ilio-femoral and vena caval thrombosis, for less than 2 weeks from onset. Average age was 56.4 years (range 30-78 years), 11 patients were male, and the duration of leg symptoms was 4.4 days (range 1-12 days). Routine temporary inferior vena caval filters were used, and a multi-lumen catheter was inserted from the popliteal vein. Urokinase was used via the catheter by the combination drip infusion method and pulse-spray method. All patients received heparin and stasis of venous flow was prevented with intermittent pneumatic compression. If thrombus remained, mechanical thrombolysis was necessary. Metallic stents were implanted for iliac vein compression syndrome and organized thrombus. Venographic severity score (VS score) and extremity circumference were used to evaluate the effects of treatment. The duration of the treatment was 5.0±0.28 days (range 2-9 days) and the total dosage of urokinase was 1, 025, 000±57, 000 units (range 360, 000-1, 680, 000 unit). One (5%) iliac vein compression syndrome and two (10%) organized thrombi were treated by implanted metallic stents. Giant thrombi was captured by temporary inferior vena caval filters in two patients, but there was no pulmonary embolism. Two patients had thrombophilia, one was antiphospholipid syndrome and one was protein S deficiency. There was an early recurrence in one patient and re-CDT was needed. The VS score deteriorated to 6.2±2.5 (post CDT) significantly (<i>p</i><0.0001) from 26.2±6.3 (pre CDT). CDT for acute deep vein thrombosis was effective and its early outcome was acceptable.