Stress management in a military health promotion program: effectiveness and cost efficiency.

An experimental study was conducted to determine the impact of a stress management course within a health promotion program. Assessments were made of stress related symptoms, perception of stress, and blood pressure. Costs of the program per benefit were calculated.

Radioimmunoassay of a new angiotensin-converting enzyme inhibitor (perindopril) in human plasma and urine: advantages of coupling anion-exchange column chromatography with radioimmunoassay.

Perindopril (P) is a prodrug whose active metabolite perindoprilat (PT) is an antihypertensive agent which acts by inhibition of angiotensin-converting enzyme (ACE). Anti-PT antiserum was produced in a rabbit immunized against PT that was covalently linked to bovine serum albumin. The radioligand is an iodinated (125I) derivative of PT-glycyltyrosinamide. Both the drug (PT) and the prodrug (P) are assayed in the same sample; PT is assayed as is and P is assayed after quantitative alkaline hydrolysis into PT. Certain data obtained from such assays suggest the occurrence in plasma and urine of a third immunoreactive component. A chromatographic fractionation of samples allowed us to isolate a new immunoreactive metabolite which was further identified as a glucuronide of PT (PT-G). Therefore, the whole assay was carried out as follows: biological samples were fractionated by stepwise chromatography on a anion-exchange resin (the first fraction contained P, the second contained PT, and the third contained PT-G); and RIA was performed on fractions 2 and 3 as is, and on fraction 1 after alkaline hydrolysis. Performances and assessments of this method are presented together with an example of a pharmacokinetic profile.

[Problems posed by the adjusting of a dosage form of a drug for children]. / Problèmes posés par l'adaptation d'une forme médicamenteuse à l'usage pédiatrique.

The safe use of drugs for pediatric patients is based upon good conditions of administration, in order to ensure accuracy and reproducibility of the dose received. But dosage adjustment often needs also a transformation of the galenic form, and that involves many risks or error. Some solutions are proposed in order to standardize the methods of drug adjustment for pediatric use.

What is the most appropriate stimulation mode in patients with sinus node dysfunction?

Sinus node disease (SND) has caused many controversies about the appropriate stimulation mode. We compared the advantages and disadvantages of VVI, AAI, DDD, and DDI mode. In an additional study, left ventricular function at rest (R) and during exercise (E) was investigated in dual chamber and ventricular stimulation mode with a stimulation rate of 70 ppm (R) and 110 ppm (E). A total of 223 patients (pts) was investigated (67 AAI, 87 VVI, 69 DDI). Hemodynamic disadvantages in VVI mode resulted in a 55% actuarial incidence of atrial fibrillation after five years. In AAI mode, we found another 25% complication rate due to impaired AV conduction (n = 9) or a bradyarrhythmia (n = 6) with slow ventricular response. DDI mode implies the possibility of sustaining a pacemaker mediated tachycardia. Single ventricular stimulation with a high stimulation rate (110 ppm) under E showed a worse left ventricular performance as compared to dual chamber stimulation. DDI mode shows none of the aforementioned disadvantages. To sum it up: Until a dual chamber rate responsive pacemaker becomes available, the DDI mode represents the best stimulation mode for patients with a SND.

[Heart surgery in the aged patient]. / Herzoperationen im fortgeschrittenen Lebensalter.

107 patients at the age of 80 years or more were operated for coronary or valvular heart disease between 1978 and 1984. The indication for surgery was instable angina in coronary patients and intractable heart failure in such with valvular lesions. 9 coronary and 5 valvular patients died postoperatively, 7 were early postoperative deaths, mainly due to myocardial failure. The majority of cases could be improved for 1 to 2 stages according to NYHA-classification. In this group pulmonary complications were predominant. According to this observation heart operations can also be indicated in the older age patient group without very much more risk than in younger ones.

Analysis of in situ inflammation of allogeneic canine kidney grafts under antilymphocyte globulin treatment.

15 mongrel dogs receiving allografts were treated with antilymphocyte globulin (ALG; 20 mg/kg b.w. daily). The kinetics and distribution of inflammatory cells invading the transplant were analyzed by transplant aspiration cytology. Only transplant aspiration cytology enables one to observe the direct influence of ALG within the grafts themselves. Although a low-potency ALG was used, ALG-treated animals showed a significant long-term suppression of the in situ inflammation of lymphocytes (p less than 0.05) and lymphoblasts (p less than 0.05) during the entire experimental period. Other leucocyte populations were influenced to a lesser degree. This in situ reduction combined with a significant prolongation of graft function (p less than 0.001) establishes the beneficial effect of ALG in suppressing cell-mediated immune responses in renal allografts.

Study of urinary excretion of butobarbitone in man in relation to the percentage of ideal body weight.

1 Thirty-three patients with no evidence of endocrine disease, hepatic or renal insufficiency or sleep disorders, were classified in groups 1 to 4 in order of increasing of percentage of ideal body weight (IBW) respectively: less than 90% of IBW, 90--120%, 120--180%, and greater than 180% of IBW. After oral administration of 200 mg butobarbitone, concentration of the intact drug was measured by gas liquid chromatographic assay in urine samples collected during 72 h and at three times in blood. 2 A highly significant negative relationship was found between the cumulative excretion of butobarbitone with urine and the logarithm of the percentage of IBW. In contrast for a given weight, excretion of the drug with urine was found to be weakly correlated with the diuresis. 3 The cumulative urinary elimination of butobarbitone was significantly different between the groups studied, except of the difference between the group 2 and 3 of the patients. No significant difference was found between the renal clearances of butobarbitone in the four groups of subjects. 4 We conclude that redistribution of butobarbitone into adipose tissues can explain the obtained results and that obesity modifies the pharmacokinetics of the drug.

[Merits of the assay of plasma catecholamines in a glucagon test to diagnosis of pheochromocytoma (author's transl)]. / Diagnostic d'un phéochromocytome par dosage des catécholamines plasmatiques au cours du test au glucagon.

In one female patient suffering from an extra-adrenal pheochromocytoma, a stimulation test with glucagon was performed. In spite of the absence of an increase in heart rate and blood pressure, a pronounced increase in plasma catecholamines showed this test to be positive. The authors discuss the reliability criteria of this test, and confirm its good tolerance.