Contingent social reinforcement for fluid compliance in a hemodialysis patient.

Two approaches, (a) patient education and (b) compliance-contingent social reinforcement, were employed to improve compliance with fluid restrictions in a chronically noncompliant hemodialysis patient of borderline intellectual functioning. Results indicated that only social reinforcement led to improved compliance (i.e., decreased intersession weight gain). Treatment effects were well maintained at both 3- and 6-month follow-ups. Contingency management strategies are recommended as a potentially cost effective treatment for noncompliance in hemodialysis patients.

Hypoxia: a stimulus for tissue plasminogen activator release in humans?

Six healthy male volunteers between the ages of 22 and 33 years inspired normoxic (20.9% O2) and hypoxic (10% O2) gas mixtures continuously for 15 min on separate days while resting supine. The order of testing was counterbalanced. Heart rates (b.min-1), minute ventilation (L.min-1), transcutaneous PO2 (mm Hg) and euglobulin lysis times (min) were determined at the onset and at regular intervals. Heart rates and minute ventilation increased significantly with most of the change occurring by min 5. Transcutaneous PO2 declined exponentially but stabilized by min 10. Euglobulin lysis time response was highly variable with individual changes from 2-38% observed. Further, the group appeared to fall into two classes that could be described as responders versus non-responders. The variability of these data suggest that hypoxia may not be a direct cause of tissue plasminogen activator release into the circulation but that susceptible individuals may exhibit a substantial fibrinolytic response to hypoxia. Those factors that explain the variability require further elucidation.

Double-blind comparison of triamterene plus hydrochlorothiazide and spironolactone plus hydrochlorothiazide in the treatment of hypertension.

The results from this double-blind, multi-investigator study showed that a combination of 50 mg triamterene plus 25 mg hydrochlorothiazide and a combination of 25 mg spironolactone plus 25 mg hydrochlorothiazide were equally efficacious in lowering blood pressure in hypertensive outpatients, and that they produced the same type and incidence of adverse effects. Likewise, the two drug combinations produced similar effects on blood chemistry and hematology. There were no significant differences between the two combination drugs in efficacy laboratory studies, or adverse effects.