Vasoconstriction to endogenous endothelin-1 is increased in the peripheral circulation of patients with essential hypertension.

BACKGROUND: In humans, endothelin (ET)-1 could be implicated in the pathophysiology of several cardiovascular diseases, including essential hypertension. We therefore evaluated the role of ET-1 in control of vascular tone in essential hypertension. METHODS AND RESULTS: We used strain-gauge venous plethysmography to test changes in forearm blood flow induced by intrabrachial infusion of TAK-044 (10, 30, and 100 microgram. 100 mL(-1). min(-1)), an ET(A)/ET(B) receptor antagonist, or sodium nitroprusside (1 and 2 microgram. 100 mL(-1). min(-1)), a vasodilator that acts on smooth muscle cells, in hypertensive patients and healthy controls (n=10 in each group). The NO pathway was also evaluated by infusion of N(G)-monomethyl-L-arginine, (L-NMMA; 10, 30, and 100 microgram. 100 mL(-1). min(-1)), an NO synthase inhibitor, and norepinephrine (3, 9, and 30 ng. 100 mL(-1). min(-1)) as control. Immunoreactive plasma ET-1 was measured by radioimmunoassay. In hypertensive patients, TAK-044 caused a vasodilation that was significantly (P<0.01) increased compared with normotensive subjects. Moreover, vasoconstriction to L-NMMA was significantly (P<0.01) decreased in hypertensive patients compared with controls. In contrast, the vascular responses to sodium nitroprusside and norepinephrine, as well as levels of immunoreactive plasma ET-1, were similar in hypertensive patients and controls. In the study population, vasodilation to TAK-044 and vasoconstriction to L-NMMA showed an inverse correlation (r=-0.56, P<0.05). CONCLUSIONS: These results indicate that TAK-044 caused a greater degree of vasodilation in the forearm vessels of essential hypertensive patients compared with normotensive subjects, an alteration associated with decreased tonic NO release.

The use of an ankle joint distractor in ankle arthroscopy.

Joint distraction, whether manual or mechanical, is a common practice in orthopedic surgery for knee and shoulder arthroscopy and can be extrapolated to include ankle joint arthroscopy. Manual joint distraction involves manipulation of the ankle joint by gravity or manual traction applied by an assistant. Mechanical distraction can be achieved by joint infiltration with solution or a joint distractor. Although the use of a joint distractor in arthroscopy of the ankle is not a new technique, podiatric literature has rarely reported on its use to allow for easier access and implementation of arthroscopic instruments. The ankle joint distractor allows the surgeon to take advantage of pathologic ligamentous laxity, thus increasing the joint space from an average 3.4 to 7.8 mm.

[Ridogrel, a new platelet antiaggregant molecule with a double mechanism of action. A pharmacological and clinical profile]. / Ridogrel, una nuova molecula antiaggregante piastrinica a doppio meccanismo d'azione. Profilo farmacologico e clinico.

Ridogrel has a double mechanism of action: it is a combined thromboxane A2 synthetase inhibitor and thromboxane A2/prostaglandin endoperoxide receptor blocker, demonstrated in vitro, as well as in vivo in animals and in man. In man, ridogrel is quickly absorbed after oral administration (30-60 min). The half-life is about 6-9 hours. At the oral dose of 300 mg b.i.d., the steady state has been reached at the third day of administration. Pharmacodynamic studies in healthy volunteers as well as in patients demonstrate a marked decrease in TXB2 serum level and an increase in 6ketoPGF1 alpha level. Moreover ridogrel inhibits the human platelet aggregation induced by U46619, collagen and arachidonic acid (thromboxane A2/prostaglandin endoperoxide receptor blocker). During the ridogrel treatment there have been neither variations of coagulative parameters (PTT, APTT, plasmatic fibrinogen) nor variations of other metabolic parameters except for those concerning the antiaggregant activity. To conclude, the preliminary data on about 100 healthy volunteers and more than 100 patients show that pharmacologic combined actions on enzyme and on receptors could be more efficacious than one single activity in eliminating circulatory flux resistance, in potentiating thrombolysis and in preventing or postponing vessels reocclusions. According to the above-mentioned results, ridogrel could have a good application in correction of thrombotic disorders due to platelet activation.

Ciprofloxacin: a study of usage in pedal infections with case reports.

Ciprofloxacin, an antibiotic of the quinolone class, has exhibited properties that may lead to frequent use in the febrile patient. Particularly important to the podiatrist is the bactericidal action of the drug on penicillinase producing Staphylococcus aureus and Pseudomonas species. Ciprofloxacin also kills many Gram-negative bacteria, and some anaerobic bacteria. Infections of this nature have been classically treated with parenteral antibiotics in a hospital setting. Ciprofloxacin has demonstrated, in clinical studies, the ability to kill these organisms in skin, soft tissues, and bone while using an oral route of administration. When considering cost-containment strategies in the patient with osteomyelitis, ciprofloxacin can cost between 50% to 80% less than parenteral therapy.

Joint depression calcaneal fracture.

A case report of a joint depression type calcaneal fracture (Rowe type 5) is presented. The causes, history, and suggested treatments, as well as sequelae and complications are discussed.

An unusual mixed infection in a diabetic patient: Citrobacter freundii and Peptococcus magnus.

A case of an unusual mixed infection of the foot involving Citrobacter freundii and Peptococcus magnus is presented. Characteristics and treatment of infections caused by these organisms are reviewed. The possible effects of an infection of this type in a compromised patient are also presented.