Elevated blood pressure in men accompanying patients to the obstetrician's office.

Hypertension is common and leads to increased mortality among adults; yet, one-third of hypertensive adults in the United States are unaware of their condition. The purpose of this study was to determine the frequency of unrecognized elevated blood pressure (BP) in men accompanying pregnant women to the obstetrician's office. Blood pressure measurements were offered to men accompanying pregnant women to four obstetrics practices in St. Louis, Missouri. Age, race, history of hypertension, and relationship to the pregnant woman were also recorded. A total of 191 men participated in the study. Participants' ages ranged from 15 to 69 years, with a mean of 27 years. Elevated BP (> 140/90 mm Hg) was detected in 40 men (21%). Only 5% of men with an elevated BP were aware of a prior history of elevated BP. We conclude that the obstetrician's office provides a good opportunity for initial screening for hypertension in men. Follow-up is necessary to determine the accuracy of the diagnosis.

Clinical use of growth factors in chronic renal failure.

Erythropoietin has been demonstrated to improve the quality of life in patients with chronic renal failure, and growth hormone has been approved for use in children with chronic renal failure and short stature as a growth promoting agent. Growth factors also have great therapeutic potential to improve glomerular function in the setting of chronic renal failure. Further studies are required to delineate the role of insulin-like growth factor I in the setting of end-stage chronic renal failure.

Acute renal failure in the cardiac care unit: etiologies, outcomes, and prognostic factors.

BACKGROUND: Heart disease is a leading cause of hospitalizations, and its prevalence is expected to grow rapidly over the next few decades. The purpose of this study was to examine the incidence, etiologies, outcomes, and risk factors for mortality of acute renal failure (ARF) in cardiac care unit (CCU) patients. METHODS: A retrospective, cohort study examining all patients who developed ARF while in the CCU at Barnes-Jewish Hospital over a 17-month time period was performed. Charts were reviewed to determine etiologies, hospital mortality rates, and risk factors for mortality. RESULTS: Four percent of admissions to the CCU met criteria for ARF while in the unit. The etiologies of ARF were congestive heart failure (CHF; 35%), multifactorial (usually involving CHF; 26%), arrest/arrhythmia (13%), contrast (11%), volume depletion (6%), sepsis (6%) and obstruction (3%). The mortality rate was 50%. Oliguria, mechanical ventilation, and decreased cardiac function were statistically significant risk factors for mortality by univariate but not multivariate analysis. Thirty percent of patients with a cardiac index of less than 2.0 liter/min/m2 survived to discharge. CONCLUSIONS: ARF occurs commonly in CCU patients and is associated with a high mortality rate. However, there are a significant number of survivors even among patients with severely depressed cardiac function.

Insulin-like growth factor I improves renal function in patients with end-stage chronic renal failure.

There is no pharmacological treatment to increase the glomerular filtration rate in end-stage renal disease (ESRD). The administration of 100 microgram/kg of insulin-like growth factor (IGF) I twice a day to patients with ESRD increases inulin clearance. However, its effect is short-lived and IGF-I has major side effects when given this way. To assess whether the use of a lower intermittent dose of IGF-I would effect sustained improved function with tolerable side effects we performed 1) a prospective open-labeled 24-day trial in which we enrolled five patients and 2) a 31-day randomized, double-blinded, placebo-controlled trial in which we enrolled 10 patients. Patients with ESRD [creatinine clearance of <15 ml. min-1. (1.73 m2)-1] and scheduled to initiate renal replacement therapy received subcutaneous IGF-I, 50 microgram. kg-1. day-1, or vehicle. Treatment with IGF I resulted in significantly increased glomerular filtration rates (inulin clearances) during the 3rd and 4th wk of therapy in both prospective and double-blinded studies. Vehicle had no effect. No patient required discontinuation of drug secondary to side effects. We conclude that IGF-I effects sustained improvement of renal function (clearances comparable to those generally achieved by dialysis) in patients with ESRD and is well tolerated.

[Effectiveness and limits of D-penicillamine therapy]. / Wirksamkeit und Grenzen der D-Penicillamintherapie.

A total of 232 patients with rheumatoid arthritis were treated with DPA. Withdrawal from treatment was mainly due to adverse events in the first year of treatment, while in the subsequent years it was mainly due to loss of efficacy. Of the patients treated, 68 were included in the present study, as they fulfilled the criteria of continuous long-term observation regularly performed. The effects of therapy were graded after 1 year of treatment, at the last examination in the outpatient department or before withdrawal, respectively. It could be seen that a long duration of the disease did not exclude positive effects of therapy; however, early use of DPA led to more favourable results with respect to the number of successfully treated patients and to the extent of the grading of efficacy. In patients who did not respond to DPA therapy, not only was the duration of the disease longer, but also previous therapy with other slow acting antirheumatic agents had been stopped because of inefficacy. This group of patients seems to cover therapy-resistant cases. After 1 year of treatment, improvement was measured in 54 patients. During further treatment, a tendency to return to initial values of clinical and laboratory parameters was noted. In about half the patients with only moderate improvement after 1 year, subsequent treatment was terminated (because of inefficacy) quite soon in most cases, i.e. within 5 years. Optimal improvement after 1 year, however, seems to indicate a long-term positive response to DPA therapy. In cases with no obvious effect of DPA after 1 year a response is not to be expected with ongoing treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[Course of chronic polyarthritis]. / Verlaufsformen der chronischen Polyarthritis.

The great variety of rheumatoid arthritis is well known. By means of exemplary cases subgroups are described, which show more homogeneity in relation to onset and course than rheumatoid arthritis as defined by the ARA-criteria. As a result of treatment clinical signs of inflammation as joint pain and swelling and laboratory findings as ESR and Hb may improve, but there is no change in radiological progression. There are correlations between clinical and laboratory measurements but not to radiological findings. It is considered that inflammation and joint destruction may result from independent pathomechanisms. The conclusion is that the pathognomonic process of rheumatoid arthritis, i.e. destruction, shown by radiological progression, is not influenced by treatment and is reflecting the natural course of the disease.

The balneotherapy of rheumatoid arthritis.

Balneotherapy as a special form of physiotherapy has, with other measures, a definite place in the plan of treatment for rheumatoid arthritis. The range of indication for a specific application is extremely wide. It can be introduced with different therapeutic objectives and be adapted to the situation prevailing during the course of rheumatoid arthritis. Careful analysis of the individual case is necessary, in which duration, intensity of the disease, activity of the disease process, progression and stage are taken into account. An acute episode of rheumatoid arthritis with high activity of the disease process is an absolute contraindication for any stimulus therapy. It this phase of the disease the most important aim of treatment is to stop the inflammation and ankylosis. The intensely stimulating sulphur and mud baths are indicated mainly in non-progressive forms of rheumatoid arthritis and in post-arthritic arthroses without or with low activity.