[Leiomyosarcoma of the inferior vena cava]. / Le cas clinique du mois. Leiomyosarcome de la veine cave inférieure.

Leiomyosarcoma of vena cava are rare tumors. They occur preferentially in the inferior vena cava. They affect preferentially women and the median age of incidence is on fifth decade. Their prognosis depends on the severity of venal occlusion, local invasion and presence of metastases. We report the case of a woman who died from occlusion of the inferior vena cava. We review the literature.

[Advances concerning aliskiren, direct renin inhibitor and aliskiren-hydrochlorothiazide]. / Avancées concernant l'aliskiren (Rasilez), inhibiteur direct de la rénine, et l'aliskiren- hydrochlorothiazide (Rasilez HCT).

Aliskiren (Rasilez), a direct renin inhibitor, is currently indicated for the treatment of essential hypertension, as monotherapy or in combination, especially with hydrochlorothiazide (Rasilez HCT). It may also be use to obtain a more complete blockade of the renin-angiotensin-aldosterone system (RAAS) when it is associated with an angiotensin converting enzyme inhibitor (ACEI) (or an AT1 angiotensin receptor antagonist) (ARA). There is some room for agents that may be more efficacious in reducing the progression of diabetic nephropathy than ACEI or ARA. In this context, the dual blockade of RAAS most probably offers a better efficacy than the simple blockade, but also exposes to a higher risk. Should ongoing trials confirm the preliminary favourable results, aliskiren might reach a forefront position among the armamentarium now available to optimize the RAAS blockade. The present article will summarize advances concerning the biochemical effects of the specific mode of action of aliskiren, especially the potential interferences related to increased renin/pro-renin levels, as well as results of recent clinical trials, not only in hypertension, but also in the fields of diabetes, renal insufficiency and cardiology. The objectives and design of the landmark study ALTITUDE will also be briefly presented.

Acute and chronic effect of molsidomine extended release on exercise capacity in patients with stable angina, a double-blind cross-over clinical trial versus placebo.

A double-blind, placebo-controlled, cross-over study was performed in 50 patients with ischemic heart disease and stable angina to determine the duration of efficacy of 8 mg molsidomine in extended-release form. Exercise testing was performed at baseline and 2, 4, 6, 8, and 10 h after intake of either the medication or the placebo. Total duration of exercise (in minutes) and total work performance (workload x min) was significantly improved in the molsidomine retard group, not only compared with baseline but also with placebo for all time-points. ST segment depression at 60 W and at maximal exercise improved similarly until 10 h after molsidomine retard treatment. The rate-pressure product (heart rate x systolic blood pressure) showed significant improvement only at 60 W. No attenuation of the obtained effects was observed after 14 days of treatment. The number of anginal attacks and the consumption of sublingual nitroderivates were significantly reduced with molsidomine retard 8 mg as compared with placebo. Molsidomine retard 8 mg is effective until at least 10 h after oral (p.o.) intake. A dose schedule of molsidomine retard 8 mg twice daily definitely reduces anginal symptoms.

Placebo-controlled comparison of spirapril at 6, 12 and 24 mg/day in mild to severe essential hypertension.

In a double-blind, parallel-group study, 260 patients with mild to severe essential hypertension were randomized to treatment with placebo or spirapril at 6, 12 or 24 mg once daily for 6 weeks. When blood pressures were measured at the end of the dosing interval (trough), all spirapril regimens had produced similar reductions in sitting systolic and diastolic blood pressures (siSBP/siDBP) which were significantly greater than those observed in placebo-treated patients. There were no relevant changes in resting heart rate in any of the study groups. At the study endpoint, the mean reductions in siSBP/siDBP were 14.9/11.5 mmHg with spirapril at 6 mg, 15.4/12.0 mmHg with spirapril at 12 mg and 17.8/12.4 mmHg with spirapril at 24 mg/day vs. 3.1/3.6 mmHg with placebo. In a subgroup of 122 patients, blood pressure was recorded at the end of the dosing interval and during the 8 hours immediately postdose to monitor the peak effects on blood pressure. All spirapril dosages produced similar reductions at peak with a mean decrease of siDBP of approximately 20 mmHg in comparison to baseline values vs 6-7 mmHg with placebo. The trough:peak ratios for 6, 12 and 24 mg all lay between 60% and 90% for siSBP and siDBP, indicating that most of the peak effect was maintained at trough. Spirapril was well tolerated; the adverse event profile was not different from that with placebo, and no dose-related adverse events were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of bopindolol on the circadian blood pressure profile in essential hypertension.

The effect of bopindolol on circadian blood pressure and heart rate profile was evaluated by means of an automatic recording technique (Pressurometer II). Blood pressure and heart rate was measured every 15 min for 24 h in 11 ambulant hypertensive patients. Recordings were made after 2 weeks on placebo then after treatment for 4 and 8 weeks with single daily doses of 0.5 or 1 mg bopindolol, according to a double-blind crossover plan. The results show a significant fall in the mean 24-h values for systolic and diastolic blood pressure and heart rate on both dosages of bopindolol. The low-dose level had a more marked effect on the day phase of the blood pressure profile, whereas the high-dose level affected day and night phases equally. Over all, the circadian rhythms of blood pressure and heart rate were not influenced. In conclusion, bopindolol has a well-defined antihypertensive effect on the various phases of the 24-h blood pressure and heart rate profiles.