Benazepril versus felodipine as supplement to bendroflumethiazide: evaluation by office and ambulatory blood pressure.

OBJECTIVE: To compare a combination of a thiazide diuretic and an angiotensin converting enzyme inhibitor with a thiazide diuretic and a calcium antagonist. DESIGN: A double-blind randomized trial with subjects in two parallel groups administered either 10-20 mg benazepril once daily or 5-10 mg extended-release felodipine once daily, both titrated according to diastolic office blood pressure. During run-in and all 12 weeks of the study members of both groups were administered 2.5 mg bendroflumethiazide once daily. We measured 24 h ambulatory blood pressure with thiazide alone and after 12 weeks of combination therapy. SETTING: General practices. PATIENTS: We studied 96 hypertensive patients (50 women and 46 men), aged 25-75 years, whose blood pressures were insufficiently regulated (i.e. office diastolic blood pressure >/= 95 mmHg) despite treatment with a thiazide diuretic for at least 3 months. RESULTS: The responses of office blood pressure after 12 weeks of treatment did not differ between the groups and neither did the proportions of responders. The ambulatory recordings revealed, after 12 weeks of treatment, a fall in daytime blood pressure of 16.3/10.3 mmHg in members of the benazepril group compared with a fall of 8.5/5.2 mmHg in members of the felodipine group (P < 0.001/<0.001). Analysis of variance showed that the systolic but not the diastolic office blood pressure in members of the benazepril group was significantly lower during the 12-week study period. When evaluating rising single quote, left (low)white-coat-positive' patients separately, there was a tendency for there to be a more pronounced reduction of their (normal) blood pressure with benazepril therapy. There was a significant reduction in weight of patients in the benazepril group (by 0.9 kg), but not of patients in the felodipine group. We observed no difference in side effects between the two treatment groups.CONCLUSION: Add-on therapies both with benazepril and with felodipine are effective and both drug regimens are well tolerated, but ambulatory blood pressure monitoring yielded differing results.

[Development and treatment of renal insufficiency in multiple myeloma]. / Udvikling og behandling af nyreinsufficiens ved myelomatose.

Renal insufficiency occurs in 55% of patients with multiple myeloma and is second only to infection as the most common cause of death in these patients. In acute renal failure, improvement can be achieved by correcting fluid balance or hypercalcaemia. Since 1968 chronic dialysis has been recommended as a worthwhile treatment. Haemodialysis and CAPD appear to be equally effective. One year survival in myeloma patients maintained on chronic haemodialysis was 53% while it is reported as 66-76% for myeloma patients not on dialysis. Transplantation may be a treatment option, but only in carefully selected patients. It has been suggested that chronic dialysis should be offered only if there has been a good response to chemotherapy. However, response to chemotherapy and duration of remission are unrelated to renal function and many patients require dialysis before any response to chemotherapy is known. Therefore almost all uraemic myeloma patients should start dialysis initially.

[Relationship between distal systolic blood pressure and wound healing. A retrospective study of patients with crural ulcers]. / Relationen mellem distale systoliske blodtryk og sårheling. En retrospektiv undersøgelse af patienter med krurale ulcera.

To anticipate the need for ensuring quality in treatment of patients with ulceration of the lower leg and complicating arterial occlusive disease, three authors examined the files of 56 patients with systolic digital blood pressure (SDBP) below 60 mmHg, all admitted to the geriatric in-patient department over a 11-year period in a retrospective study. In 40 patients (71%) the ulcer healed. Eight patients (14%) required amputation, six patients (11%) died and two patients (4%) were unsolved. We found a significant correlation between SDBP and ulcer healing (p = 0.006). In patients with SDBP < or = 35 mmHg, healing on conservative pharmacotherapy was demonstrated even with critical ischaemia.

[Determination of vitamin b12 deficiency]. / Påvisning af vitamin B12 mangel.

Development of cobalamin deficiency in the tissues is considered to be a process which lasts for years. Macrocytic anaemia and/or neurological symptoms do not occur until late in this process. Serum cobalamins as the only parameter have proved less suitable for differentiation between healthy individuals with low serum cobalamin values and patients who require cobalamin for the remainder of their lives. The need for a better indicator for cobalamin deficiency has been emphasized. Recently developed methods of measurement have rendered determinations of serum methylmalonic acid possible. This value is raised in cases of cobalamin deficiency in the tissues. The serum methylmalonic values have proved both sensitive and specific to determine the extent to which genuine cobalamin deficiency is present or not and may also be employed for monitoring the effect of treatment as the raised values becomes normalized following substitution therapy with vitamin B12.

[Laboratory diagnosis of cobalamin deficiency. A comparative study of 2 serum cobalamin methods and serum methylmalonic acid]. / Laboratoriediagnostik af cobalaminmange. En sammenlignende undersøgelse af to serum-cobalaminmetoder og serum-metylmalonat.

The diagnosis of cobalamin deficiency is established traditionally by demonstration of lowered serum cobalamin, but, for many reasons it cannot be anticipated that the concentrations of cobalamins in the serum reflect the relationship between blood cobalamin and tissue cobalamin accurately. The blood methylmalonic acid which cannot be metabolized in cases of cellular cobalamin deficiency should, on the other hand, indicate the cobalamin available for the tissues. A blind, prospective, controlled investigation was undertaken to compare the clinical employability of a recently developed method for measurement of the concentration of methylmalonic acid in the serum with older and more recent methods of measuring serum cobalamins. The three methods classified 94, 72 and 74% of the patients correctly, respectively (n = 50). The results reveal that serum methylmalonic acid is a more sensitive and specific analysis for demonstrating whether cobalamin deficiency was present or not. Serum cobalamins measured by both methods are relatively insensitive and unspecific markers for cobalamin deficiency in the tissue. Low cobalamin concentrations do not indicate that the patient in question has cobalamin deficiency, and values in the lower half of the reference interval do not exclude cobalamin deficiency. Measurement of methylmalonic acid in the serum is recommended in patients with low-normal or low serum cobalamin.

[Malignant T-cell neoplasia during treatment with azathioprine and prednisone after kidney transplantation]. / Malign T-celle neoplasi under azatioprin- og prednisonbehandling efter nyretransplantation.

Patients receiving immunosuppressive treatment show an increased incidence of malignant lymphoproliferative disease, mainly in the form of B-lymphomata, on account of constant antigen stimulation from an implanted organ and/or impaired immunological defense which permit cells which have undergone mutation or have been transformed by viruses to proliferate. Malignant T-proliferative disease is rare in this patient category. The authors present a case in which a man treated with azathioprin and prednisone who had been well and without symptoms of rejection during a total of seven years after renal transplantation, which suggests that the T-cell neoplasia was due to the immunosuppressive treatment.

[Hemoperfusion in theophylline poisoning]. / Haemoperfusion ved teofyllinforgiftning.

On account of increased employment of theophylline depot preparations, theophylline intoxication occurs relatively frequently. A case report is briefly reviewed to describe the symptoms of poisoning and the principles of treatment. Particular emphasis is placed on discussion of the indications for carbon column haemoperfusion.