Which monotherapy for hypertension

The comparative blood pressure lowering and hemodynamic effects of four types of antihypertensive drugs, i.e.indapamide (diuretic), atenalol (betablocker), verapamil (calcium antagonist), and captopril (converting enzyme inhibitor), were evaluated among 30 middle aged men with mild to moderate essential hypertension in a double-blind randomized multiple crossover study. Blood pressure reduction were comparable regardless of hypotensives used. However atenolol 100 mg once daily also produced significant reduction in exercise-induced rate-pressure product and improved LV compliance echocardiogram indices within 2 weeks. Antihypertensive therapy is lifelong. Thus a daily single dose drug is advantageous for better patient acceptability and compliance during longterm antihypertensive therapy.(Auth)

Reproducible demonstration of blood flow at duodenal ulcer margins by endoscopic reflectance spectrophotometry.

Changes in gastrointestinal mucosal blood flow were evaluated by index of oxygen saturation (ISO2) and index of hemoglobin concentration (IHB) measured with a reflectance spectrophotometer. This report examined the reproducibility of endoscopic measurements of ISO2 and IHB. Study 1: The everted stomachs of three anesthetized rats provided hands-on instruction (one teacher and three learners). Six sets of readings were obtained endoscopically (the mean calculated to give the measurement) at each level of gastric mucosal perfusion when gastric blood flow was varied by withdrawing blood from the carotid artery. Study 2: Fourteen duodenal ulcer patients with ulcer bleeding were transfused and stabilized. Two endoscopists (one teacher and one learner) took turns to obtain endoscopic ISO2 and IHB measurements at the margin of the ulcer and at the adjacent normal appearing mucosa. delta ISO2 was calculated as the ulcer margin value minus adjacent mucosa value. In study 1, the correlation coefficients between the ISO2 measurements of the experienced and those of the other three observers were 0.99, 0.97, and 0.97, respectively. In study 2, the correlation coefficients between the ISO2 measurements obtained at the ulcer margin and at the adjacent normal mucosa, and delta ISO2 obtained by the experienced observer and one of the three learners were 0.94, 0.97, and 0.94, respectively. Relative to the adjacent area, 79% of the duodenal ulcers studied had increased (+delta ISO2), and 21% had decreased blood flow (-delta ISO2) at the ulcer margins. IHB measurements were less reproducible, particularly at the ulcer margin. The measurements of ISO2 and delta ISO2 were reproducible in the everted rat stomach and in duodenal ulcer patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Precut (needle knife) papillotomy for impacted common bile duct stone at the ampulla.

Twenty of 510 patients with common bile duct (CBD) stone underwent needle knife precut papillotomy after conventional papillotomy failed because of impacted ampullary stone. This facilitated deep cannulation and subsequent standard papillotomy in 12 patients. In four patients, the precut papillotomy was extended, resulting in spontaneous expulsion of stone. Bleeding precluded stone extraction in three patients, and these stones were removed at a second ERCP session. Ductal clearance was achieved in all except one patient who underwent surgical removal of the impacted stone. Mild bleeding occurred in four patients and was successfully controlled by endoscopic adrenalin injection. There was no perforation, pancreatitis, or exacerbation of cholangitis following the procedure.

Endoscopic cholangiopancreatography in hepatic clonorchiasis--a follow-up study.

Cholangiographic changes of the biliary system in 16 patients with proven hepatic clonorchiasis, diagnosed by positive stool or bile ova isolates, were studied. All patients presented with epigastric pain. Other symptoms included jaundice in 31% (5 of 16) and fever in 12.5% (2 of 16). Praziquantel given at 25 mg/kg for three doses in 1 day were administered. Three consecutive stool tests were performed 3 months after treatment and were negative in 87.5% (14 of 16). ERCP studies were repeated at a mean interval of 31.6 months (range, 8 to 69 months). Measurements of the bile ducts on retrograde cholangiograms before and after treatment were compared using the paired Student's t test. Filling defects and blunting of the terminal bile ducts seen on the initial cholangiogram, interpreted as the presence of adult worms, disappeared after treatment. However, there was no significant change between pre- and post-treatment measurement of bile duct caliber. Bile duct dilation, irregularities, and ductal proliferation persisted despite eradication of the parasite.

Urgent endoscopic drainage for acute suppurative cholangitis.

105 patients with acute calculous cholangitis who did not respond to conservative management underwent urgent endoscopic drainage of the biliary system at a mean of 1.5 days after admission. Treatment was successful in 102 (97%) patients. 3 of the patients in whom drainage was not successful underwent emergency surgery, with 1 death. 3 patients died of uncontrolled sepsis despite successful endoscopic drainage. 1 patient died of a stroke. The overall mortality was 4.7%. Among those in shock 2 out of 4 drained after 72 h died, compared with 3 out of 38 drained before 72 h. There were no deaths in the group without shock irrespective of the timing of drainage.