Hydrochlorothiazide-induced acute pulmonary edema.

OBJECTIVE: To describe a patient with noncardiogenic acute pulmonary edema induced by hydrochlorothiazide. CASE SUMMARY: A 70-year-old woman in generally good health, except for mild pedal edema, developed acute pulmonary edema after ingesting hydrochlorothiazide 12.5 mg for the first time. DISCUSSION: This is the fifteenth reported case of noncardiogenic pulmonary edema induced by hydrochlorothiazide. The investigations by previous authors seemed to rule out an immunologic mechanism; thus, the pathogenesis of the reaction is unknown. Most of the reactions have occurred in women. CONCLUSIONS: Noncardiogenic pulmonary edema appears to be an idiosyncratic reaction that occurs with some specificity with the thiazide diuretics. Clinicians should be aware of this potential, serious adverse reaction that occurs without warning.

Reassessment of circadian profile of blood pressure and heart rate in diabetic patients with autonomic neuropathy.

Previous studies have shown that the normal circadian blood pressure fall is absent in patients with diabetic autonomic neuropathy, while the reported rise in blood pressure during the night in the same patients is controversial. This study analyzed the circadian profile in 19 diabetic patients with established autonomic neuropathy. Twenty-four hour ambulatory systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate were recorded every 20 minutes during the day and every 60 minutes at night in 29 patients, 19 with diabetic autonomic neuropathy and 10 nondiabetic hypertensive patients as controls. Twelve diabetic patients with autonomic neuropathy with unknown hypertension were found to have hypertension based on 24 hour ambulatory blood pressure monitoring. Repeated measured analysis of variance (ANOVA) and trend analysis indicated that the linear systolic blood pressure increased from night to morning to afternoon while mean arterial pressure and diastolic blood pressure increased from night to morning but decreased from morning to afternoon. In practice, the early morning rise in systolic blood pressure in diabetic neuropathy is not different from that in normal or hypertensive patients and requires appropriate treatment. The absence of the nocturnal rise in the blood pressure revealed a subgroup of patients with diabetic neuropathy which demonstrated no fatal cardiovascular or renal events over 18 to 24 months of follow-up.

The long-term antihypertensive effects of prazosin and atenolol.

The efficacy and tolerability of the alpha-blocker prazosin was compared with that of atenolol, a beta-blocker, in the long-term treatment of uncomplicated, essential hypertension. Twelve patients were randomly assigned to prazosin treatment and 15 to treatment with atenolol. Drug therapy was titrated to reduce diastolic blood pressure by 10 mm Hg or to below 89 mm Hg, whichever was lower. If monotherapy with either study drug failed to do this, hydrochlorothiazide was added to the regimen. Once blood pressure control was established, patients received maintenance therapy at that dosage and were followed for up to 12 months. Blood pressure, side effects, and plasma lipid levels were monitored during this period. Seventy-five percent of patients receiving prazosin monotherapy attained blood pressure goals, compared with 60 percent of patients given atenolol monotherapy. With the addition of low-dose hydrochlorothiazide, those patients not having an adequate response to monotherapy attained blood pressure control. Blood pressure reductions were maintained without dosage adjustment throughout the maintenance period; patient acceptance was good, and there was no evidence of tolerance. Treatment with atenolol produced slight increases in plasma triglyceride levels and little change in total or low-density lipoprotein cholesterol. In contrast, patients treated with prazosin demonstrated no adverse effects with regard to lipid levels. Although a higher percentage of patients reached goal blood pressure with prazosin monotherapy than with atenolol, the response rates were comparable when hydrochlorothiazide was added to the regimens.

Two cases of complicated intestinal lipoma. Review of small intestinal lipomas.

Two cases of solitary small intestinal lipoma are presented. One occured in the duodenum as a submucosal pedunculated polyp with a bleeding ulcerated surface. This was diagnosed by means of the fiberoptic duodenoscope (Olympus D1G2). The second involved a large massive submucosal lipoma which formed the leading edge of an intussusception resulting in small bowel obstruction. A brief review of the pathology, complications, symptoms, radiographic diagnosis and treatment of small intestinal lipomas is given.