Risk factors for atherosclerosis in an elderly outpatient population in the city of São Paulo.

OBJECTIVE: To analyze in out clinic elderly patients of both sexes for the prevalence of risk factors for atherosclerosis and study their association with the complications of atherosclerosis. METHODS: Five hundred and sixteen outpatients, 152 men and 364 women, 60 years or older, were studied. The prevalences of hypertension, dyslipidemia, diabetes mellitus, cigarette smoking and obesity were determined in both sexes and compared using the chi-square test. The association between these factors and the presence of atherosclerotic complications was analyzed by logistic regression. RESULTS: The comparative analysis of the factors in both sexes showed that hypertension, total cholesterol > or = 240 mg/dL, LDL-cholesterol > or = 160 mg/dL, and body mass index > 27.5 were more frequent among women, but HDL-cholesterol < 35 mg/dL and cigarette smoking were more frequent among men, and no difference occurred between sexes in relation to the frequency of triglycerides > or = 250 mg/dL and diabetes mellitus. After adjustment of the variables in the regression model, we observed that in the total of elderly patients, risk factors for complications of atherosclerosis were: triglycerides > or = 250 mg/dL, hypertension, and male sex. Among men, the risk factors were: LDL-cholesterol > or = 160 mg/dL, diabetes mellitus, HDL-cholesterol < 35 mg/dL and hypertension. Among women, the risk factors were: triglycerides > or = 250 mg/dL and hypertension. CONCLUSION: The results showed that, in the elderly, the risk factors for atherosclerosis persist, but with different behaviors between men and women. The study suggests that the relative importance of the risk factors can change with the aging process.

Determination of antipyrine and metabolites in plasma of a patient with mild renal failure.

A method has been developed for the simultaneous determination of antipyrine and its three major metabolites in plasma of patients with renal failure. Plasma samples (500 microl) were hydrolyzed with beta-glucuronidase/aryl sulphatase. The compounds, after addition of sodium chloride, were extracted with chloroform:ethanol (90:10, v/v) in acidic medium. Chromatographic conditions comprise a C18 column, a mobile phase with 30% methanol and 70% 0.25N sodium acetate buffer (pH 5.0), a total run time of 10 minutes, and ultraviolet absorbance detection at 254 nm. Confidence limits showed 0.5 to 40.0 microg/ml(-1) linearity (r2 = 0.999); 0.1 microg/ml(-1) HMA, 0.05 microg/ml(-1) antipyrine and NORA, and 0.5 microg/ml(-1) OHA sensitivity and absolute recovery >95%. Interprecision and intraprecision expressed as coefficient of variation were <10% for all compounds investigated. The assay shows to be suitable for pharmacokinetics and drug metabolism studies after administration of a single oral dose of 500 mg of antipyrine to a patient with hypertension and chronic renal failure (CL(CR) = 34.17 ml/min(-1); 1.73 m(-2)).

Influence of renal failure on cytochrome P450 activity in hypertensive patients using a "cocktail" of antipyrine and nifedipine.

OBJECTIVE: Two substrates were coadministered in a "cocktail" approach to evaluate the contribution of renal failure to drug oxidation. PATIENTS: Nineteen hypertensive patients, nine of them with chronic renal failure (CLCR 38.9 vs 102.3 ml.min-1 1.73 m-2), were investigated after peroral administration of a combination of antipyrine (500 mg, in capsules) and nifedipine (10 mg, in Oxcord capsules) in the morning after an overnight fast. RESULTS: This "cocktail" approach made it possible to characterize in vivo the activities of different forms of cytochrome P450 in a single-study protocol using the total clearance of nifedipine and clearance for production of 3-hydroxymethylantipyrine (HMA), 4-hydroxyantipyrine (OHA) and norantipyrine (NORA). With this "cocktail" approach (antipyrine plus nifedipine), we can suggest a selective effect on the activities of cytochrome P450 forms associated with the formation of dehydronifedipine (P450 III A4) and of NORA in patients with mild renal failure under long-term antihypertensive therapy.

Effect of peritubular hypertonicity on water and urea transport of inner medullary collecting duct.

The effect of bath fluid hypertonicity on hydraulic conductivity (Lp) and [14C]urea permeability (Pu) of the distal inner medullary collecting duct (IMCD) was studied in the absence and in the presence of vasopressin (VP) using the in vitro microperfusion technique of rat IMCD. In the first three groups of IMCD, we observed that in the absence of VP the Lp was not different from zero when the osmotic gradient was created by hypotonic perfusate and isotonic bath fluid, but it was significantly greater than 1.0 x 10(-6) cm.atm-1.s-1 when the osmotic gradient was created by hypertonic bath and isotonic perfusion fluid. The increase in Lp was observed when the hypertonicity of the bath fluid was produced by the addition of NaCl or raffinose, but no such effect was observed with urea. The stimulated effect of bath fluid hypertonicity on Lp was also observed in the IMCD obtained from Brattleboro homozygous rats in which VP is absent. The NaCl hypertonic bath increased the Pu in the absence of VP. In another series of experiments with VP (10(-10) M) we observed that the hypertonic bath fluid increased in a reversible manner the VP-stimulated Lp of distal IMCD. However, the NaCl hypertonicity of the bath fluid was not able to increase dibutyryladenosine 3',5'-cyclic monophosphate-stimulated Lp. The Pu stimulated by VP (10(-10) M) increased twofold when the bath fluid was hypertonic. Therefore hypertonicity of the peritubular fluid produced by the addition of NaCl or raffinose increases the Lp and Pu in the absence and in the presence of VP. No such effect was noted with the addition of urea.

[Family with predominance of cardiac involvement in Steinert's disease]. / Família com predominância do comprometimento cardíaco na doença de Steinert.

We report an affected family (mother and two children) with prominent cardiac form as reflected by the mother, 49, with neuromuscular signs (muscular atrophy os face, neck and distally in the extremities) who received an implantable pacemaker after 2 consecutive episodes of syncope and baseline EKG with P-R of 250 ms, QRS of 130 ms (LBBB) and conduction system intervals displaying overt widening (AH of 140 ms with a ERP of junction tissue of 590 ms, and Wenckebach point of 115 bpm; and HV of 80 ms before and 95 ms after pharmacological stress with procainamide). As long as its mode of inheritance is autosomal dominant, the cardiovascular examination of her two affected siblings (F1 and F2) revealed: F1 (male, 31), with P-R of 180 ms and QRS of 100 ms; F2 (female, 27), with P-R of 200 ms and QRS of 100 ms, both with left axis deviation. Echocardiographic studies were normal in both, but Holter studies showed remarkable bradycardia in both and intermittent rate-related (phase 3) LBBB in F2. Also for F1 and F2 conduction system intervals, except for AH (normal in both), displayed severe widening (HV of 70 ms in F1 and of 80 ms in F2, but only in this later with a procainamide stress extra widening to 130 ms). All three patients showed normal NS function, as usual for the disease. F2 is kept under close surveillance for the appearance of any symptom. In conclusion, although rarely symptomatic, the intensity of IV conduction system damage should not be disregarded in this condition.

Effect of chlorpropamide on water and urea transport in the inner medullary collecting duct.

The present in vitro microperfusion study examined whether chlorpropamide (CPM) has a direct effect on hydraulic conductivity (Lp x 10(-6) cm/atm.sec) and 14C-urea permeability (Pu x 10(-5) cm/sec) in the middle and distal inner medullary collecting duct (IMCD) obtained from acutely water-loaded Wistar rats and rats homozygous for diabetes insipidus (DI). CPM (10(-4) M) added to the bath fluid increased the Lp in the water-loaded Wistar rats from -0.05 +/- 0.13 to 6.25 +/- 0.74 (p less than 0.01) and in the DI rats from 0.05 +/- 0.01 to 5.95 +/- 0.84 (p less than 0.01), but had no effect when it was added to the perfusate. CPM stimulated Lp in a dose-dependent manner with the threshold effect at 10(-6) M. However, the addition of CPM (10(-4) M) to submaximal concentration of VP in the bath fluid did not increase the Lp. Furthermore, CPM was unable to block the inhibitory action of PGE2 on the vasopressin (VP)-stimulated Lp. On the contrary, PGE2 blocked the CPM-stimulated Lp. CPM (10(-4) M) in the peritubular fluid was able to cause a significant rise of the Pu from 13.5 +/- 0.8 to 17.3 +/- 1.0 reversibly, which represented 16% of maximum stimulated effect produced by 50 microU/ml of VP. Thus, pharmacological doses of CPM added to the peritubular side have a direct effect on terminal IMCD increasing water and urea permeability in the absence of VP, but this drug does not potentiate the VP-stimulated water transport in the IMCD. Our results were unable to confirm the hypothesis that CPM potentiates the VP-antidiuresis by the inhibition of PGE2 action in the rat IMCD.

Amiodarona injetável no tratamento das arritmias supraventriculares: resultados imediatos / Intravenous amiodarone in the treatment of supraventricular arrhythmias: immediate results

Sessenta e cinco pacientes de taquiarritmias supraventriculares,que nao apresentavam insuficiencia cardiaca funcional III e IV (NHA), foram medicados com amiodarona intravenosa na dose de 5 mg/kg, injectada durante 30 s. Repetia-se uma dose de 2,5 mg/kg caso nao houvesse, apos 15 min reversao para ritmo sinusal (RS).Apos 30 min conforme a resposta classificava-se o paciente nos seguintes grupos: 1 - reversao para RS; 2 - diminuicao da frequencia ventricular de pelo menos 20% da inicial; 3 inalterado. Os grupos 1 e 2 eram considerados como de sucesso terapeutico. Dos 65 casos, 24 apresentavam taquicardia paroxistica supraventricular, neles ocorrendo 18 sucessos(75%); 10 tinham flutter atrial e neles foram obtidos 3 sucessos (30%); 31 apresentavam fibrilacao atrial, com 24 sucessos (77%). Nenhum caso de fibrilacao atrial reverteu para ritmo sinusal. Efeitos indesejaveis ocorreram em 5 (7,6%) pacientes: 3 tiveram sensacao de mal estar geral um, bradicardia sinusal sintomatica e um, edema agudo de pulmao. Conclui-se que a amiodarona intravenosa e uma opao terapeutica para o tratamento das taquiarritmias supreventriculares em pacientes que nao apresentem insuficiencia cardiaca importante

Corrected transposition of the great vessels: a vectorcardiographic study.

The vectorcardiograms (VCGs) of two groups of patients with corrected transposition of the great vessels (CTGV) were studied; the first, group A, included 17 patients with CTGV in "situs solitus,", characterized by leftward orientation of the cardiac apex; the second group, group B, with three patients, presented CTGV in "situs solitus" and apex to the right. All cases had one or more associated defects: ventricular septal defect, atrial septal defect, pulmonic stenosis or tricuspid insufficiency.