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1.
J Craniofac Surg ; 16(3): 500-4, 2005 May.
Article in English | MEDLINE | ID: mdl-15915127

ABSTRACT

The complex disharmonies which affect the maxillofacial region, in the sagittal and vertical dimensions, can find further complications due to the deficit of maxillary osseous tissue in transversal direction. Surgery can be indispensable to correct the malocclusion. Various methodologies have been developed for the correction of transversal maxillary hypoplasia. Among these, the Authors mention the intraoral distraction for the treatment of a male patient with pre-maxilla agenesis and serious contraction of the upper maxillary. A particularity of this case is represented by the occurred transversal skeletal expansion, starting from a past scar, outcome of a previous surgery.


Subject(s)
Maxilla/abnormalities , Maxilla/surgery , Oral Surgical Procedures/methods , Osteogenesis, Distraction , Adult , Humans , Male , Palatal Expansion Technique , Palate/surgery
2.
Fundam Clin Pharmacol ; 16(6): 527-35, 2002 Dec.
Article in English | MEDLINE | ID: mdl-12685512

ABSTRACT

The aim of this study was to investigate the cognitive and electroencephalography (EEG) short-term effects of a calcium antagonist, nicardipine, compared to placebo and clonidine (which, having known sedative effects, acted as a negative control) for 15 days in elderly hypertensive patients with memory complaints. Nicardipine and clonidine were compared with placebo in a double-blind, randomized, three-way cross-over controlled study after a 2-week placebo run-in period. This was a phase II clinical study carried out on out-patients in a single research centre. Fifteen elderly (63 +/- 10 years) hypertensive patients, without dementia but with memory complaints, were included. Psychomotor performance and cognition were assessed using both an extensive battery of validated psychometric tests (which evaluated attention and vigilance, body sway and memory) and an EEG profile. Cardiovascular parameters measured were blood pressure and heart rate. No detrimental effects of nicardipine were found on attention, vigilance, body sway or memory. Nicardipine produced a significant increase in alpha EEG energies, which may indicate possible alerting effects. In contrast, clonidine induced well-known deleterious sedative effects in psychometric tests and in EEG analysis (decrease in alpha and increase in delta and theta waves). The two drugs produced equivalent decreases in blood pressure at steady state. In conclusion, clonidine induced well-known sedative effects, while nicardipine did not impair central nervous system activity and may have had some short-term alerting effects in elderly hypertensive patients with memory complaints. This study supports the hypothesis of a dissociation between blood pressure and direct drug effects on the central nervous system.


Subject(s)
Antihypertensive Agents/adverse effects , Clonidine/adverse effects , Cognition/drug effects , Electroencephalography/drug effects , Hypertension/drug therapy , Nicardipine/adverse effects , Aged , Antihypertensive Agents/therapeutic use , Blood Pressure/drug effects , Calcium Channel Blockers/adverse effects , Calcium Channel Blockers/therapeutic use , Clonidine/therapeutic use , Cross-Over Studies , Double-Blind Method , Female , Hemodynamics/drug effects , Humans , Hypertension/physiopathology , Hypertension/psychology , Male , Middle Aged , Nicardipine/therapeutic use , Psychomotor Performance/drug effects
3.
J Clin Endocrinol Metab ; 86(6): 2849-53, 2001 Jun.
Article in English | MEDLINE | ID: mdl-11397898

ABSTRACT

The presence of somatostatin receptors on TSH-secreting pituitary adenomas allows treatment of central hyperthyroidism with somatostatin analogs. Six women and 5 men (mean +/- SEM age, 43 +/- 3 yr) presented TSH-secreting pituitary adenomas (micro, n = 2; macro, n = 9). Seven patients had previously been treated with partial surgical removal (n = 6) and/or external radiation (n = 4) of their adenoma at least 1 yr before the study, whereas 4 patients had not been treated before somatostatin analog therapy. TSH, free T(4), and free T(3) levels were in the normal range during treatment with sc injections (n = 9) or continuous infusion (n = 2) of octreotide (280 +/- 25 microg/day). Mean thyroid hormone levels increased (P < 0.01) after the washout period (34 +/- 6 days). The patients received monthly im injections of 20 mg Octreotide-LAR. In patients with an elevated free T(4) level after 3 months (n = 1) the Octreotide-LAR dose was increased to 30 mg. After 3 months of Octreotide-LAR treatment, TSH, free T(4)/T(3), and alpha-subunit levels decreased, and 10 patients were euthyroid with normal free T(4) levels. These results remained at the same level over the next 3 months. There were no statistically significant differences in the TSH and free T(4) responses to sc octreotide or im Octreotide-LAR between previously untreated patients and patients who had undergone surgical resection and/or pituitary radiation before somatostatin analog treatment. During Octreotide-LAR treatment, minor digestive problems or moderate discomfort at the injection site, lasting less than 48 h, were reported in 6 and 5 patients, respectively. Gallbladder echographies did not reveal new gallstones during Octreotide-LAR treatment. In conclusion, this study shows that monthly im Octreotide-LAR is as effective as daily sc octreotide in controlling hyperthyroidism in patients with TSH-secreting pituitary adenomas, in both previously untreated patients and patients treated with surgery and/or pituitary radiotherapy. Octreotide-LAR is well tolerated, except for minor digestive problems or mild pain at the injection site. Therefore, Octreotide-LAR appears to be a useful therapeutic tool to facilitate medical treatment of TSH-secreting pituitary adenomas in patients who need long-term somatostatin analog therapy.


Subject(s)
Adenoma/drug therapy , Adenoma/metabolism , Antineoplastic Agents, Hormonal/therapeutic use , Octreotide/therapeutic use , Pituitary Neoplasms/drug therapy , Pituitary Neoplasms/metabolism , Thyrotropin/metabolism , Adult , Antineoplastic Agents, Hormonal/adverse effects , Cohort Studies , Delayed-Action Preparations , Female , Humans , Injections, Intramuscular , Male , Middle Aged , Octreotide/adverse effects , Thyrotropin/blood , Thyroxine/blood , Triiodothyronine/blood
4.
J Craniofac Surg ; 10(1): 87-92, 1999 Jan.
Article in English | MEDLINE | ID: mdl-10388432

ABSTRACT

Fractures of the mandibular condyle represent 20% to 35% of all mandibular fractures. There are several clinical variants of this type of fracture that give rise to different problems in relation to their classification and treatment. A sample of 16 patients (of a total of 280 patients examined and treated from 1985 through 1995) with mono- and bilateral, displaced and decomposed, condylar fractures that occurred during growth were examined by the authors, who assessed, by a 2-year follow-up, the relevant clinical, functional, and instrumental parameters. On the basis of the data gathered by this study, a plan was drawn up for treating these patients that takes into account the different situations, such as either a nonsurgical or surgical treatment (by the use of condylectomy or external rigid fixation), and points out the advantages and disadvantages of each method.


Subject(s)
Mandible/growth & development , Mandibular Condyle/injuries , Mandibular Fractures/physiopathology , Adolescent , Age Factors , Child , Child, Preschool , Female , Follow-Up Studies , Fracture Fixation/methods , Humans , Male , Mandibular Condyle/surgery , Mandibular Fractures/diagnostic imaging , Mandibular Fractures/therapy , Radiography , Retrospective Studies
5.
J Exp Clin Cancer Res ; 18(1): 85-7, 1999 Mar.
Article in English | MEDLINE | ID: mdl-10374684

ABSTRACT

An association between vitiligo and autoimmune thyroid disorders had previously been postulated. Thyroid disorders were found in 18.5% of 15,126 patients with vitiligo, on the basis of the anamnestic data. Then, we investigated 255 healthy relatives in whom we tested only T3, T4 and TSH. With the immunological investigation we detected a higher incidence of TMA in vitiligo patients and in the family members. Therefore, on the basis of the immunologic and thyroid pathology functional data, we observed a thyroid pathology in 25% of the 890 vitiligo patients and in 21.1% of their first degree relatives. Then, clinical observation enabled to discover that 3 of 15,126 patients had undergone exeresis for a thyroid carcinoma and in the 890 vitiligo patients, who had undergone particular investigations, we found a thyroid carcinoma in 3 subjects. In one case lymphnodal involvement and bone metastases in the maxillary district were found. The purpose of this work is to evaluate the incidence of thyrosis and of thyroid carcinoma in vitiligo patients observed for 20 years.


Subject(s)
Bone Neoplasms/secondary , Maxillary Neoplasms/secondary , Thyroid Neoplasms/complications , Thyroid Neoplasms/epidemiology , Thyroiditis, Autoimmune/epidemiology , Vitiligo/complications , Adolescent , Adult , Aged , Aged, 80 and over , Autoantibodies/blood , Child , Child, Preschool , Female , Humans , Incidence , Infant , Italy/epidemiology , Male , Middle Aged , Thyroid Diseases/complications , Thyroid Diseases/epidemiology , Thyroid Diseases/immunology , Thyroid Neoplasms/immunology , Thyroid Neoplasms/pathology , Thyroiditis, Autoimmune/complications , Thyroiditis, Autoimmune/immunology , Thyrotropin/blood , Thyroxine/blood , Triiodothyronine/blood , Vitiligo/immunology
6.
J Craniofac Surg ; 10(5): 430-4, 1999 Sep.
Article in English | MEDLINE | ID: mdl-10726513

ABSTRACT

Sleep apnea syndrome (SAS) is a complex respiratory disorder that is very difficult to diagnose and to treat surgically as well as medically. SAS can affect growing patients as well as adults. SAS shows a central, an obstructive, and a mixed form. Diagnosis is based on clinical examination of the patient and instrumental examinations such as teleradiography, nuclear magnetic resonance imaging (NMR), three-dimensional computed tomography, polysomnography, rhinomanometry, and spirometry. The patient presented has an obstructive form of SAS in addition to Crouzon's disease. He underwent a Le Fort III osteotomy to obtain an advancement of the orbitomaxillary complex, allowing an increase in volume of posterior airway space at the level of the hypopharynx.


Subject(s)
Sleep Apnea, Obstructive/surgery , Craniofacial Dysostosis/complications , Follow-Up Studies , Humans , Hypopharynx/physiopathology , Infant , Male , Maxillofacial Development , Osteotomy, Le Fort , Polysomnography , Sleep Apnea, Obstructive/etiology
7.
J Craniofac Surg ; 8(4): 318-22, 1997 Jul.
Article in English | MEDLINE | ID: mdl-9482057

ABSTRACT

In the framework of malformations that concerns the craniofacial area, the orbit is often involved because it represents the border structure between the neurocranium and the splanchnocranium. In these malformations it is very easy to find hypertelorism. Tessier classified clefts rising from the anterior skullbase and involving the maxilla and the alveolar process, as medial or 0 = 14 clefts. We report on a 2-year-old patient, treated with cranial decompression at an early age, suffering from this kind of malformation. To correct it, the surgical technique of facial bipartition was used. This technique, used for the first time by Tessier and then modified by Stricker and colleagues, allows the simultaneous correction of the orbits and maxilla. It is very important to make a correct diagnosis, to plan for surgery carefully for patients suffering from this kind of pathology, and to prescribe the most effective therapy. A computerized analysis system, based on the study of teleradiographic images and on three-dimensional computed tomography, to quantify the extent of the malformation and to define surgical planning was developed.


Subject(s)
Craniofacial Abnormalities/surgery , Hypertelorism/surgery , Oral Surgical Procedures , Patient Care Planning , Child, Preschool , Cranial Sutures/surgery , Craniofacial Abnormalities/diagnostic imaging , Female , Humans , Hypertelorism/diagnostic imaging , Osteotomy , Tomography, X-Ray Computed
8.
Therapie ; 51(6): 667-76, 1996.
Article in French | MEDLINE | ID: mdl-9164003

ABSTRACT

The aim of this trial was to test the hypothesis that a reduced number of doses improves compliance in current medical practice. Compliance with twice a day dosage was compared with compliance with three doses a day. Two bioequivalent presentations of nicardipine were used, the regular presentation (t.i.d.) and the slow-release (b.i.d.). The trial was controlled, randomized, open, in two parallel groups: (1)'t.i.d.' group: one tablet of regular nicardipine, 20 mg, three times a day, three months; (2) 'b.i.d.' group: one capsule of slow-release nicardipine, twice a day, three months. 2651 general practitioners randomized 7274 hypertensive patients. The primary criterion was documented in 93.7 per cent of the cases at the end of the trial. The remaining 6.3 per cent comprised treatment withdrawal (2.8 per cent) and patients lost to follow-up (3.5 per cent). The primary criterion study was compliance, assessed by a self-questionnaire filled in by the patient and a standardised interview by the physician. Compliance was slightly better in the b.i.d. group than in the t.i.d. group (p < 0.001). Remaining pill count was also used but it was a failure. A random sample of investigators made on-site visits. Discordant data were infrequent and were limited to dates of visits. Difficulties with on-site visits were mostly due to a rather frequent lack of source records.


Subject(s)
Antihypertensive Agents/therapeutic use , Nicardipine/therapeutic use , Compliance , Drug Administration Schedule , Family Practice , Female , Humans , Male , Middle Aged , Surveys and Questionnaires
9.
Eur J Clin Pharmacol ; 50(1-2): 63-7, 1996.
Article in English | MEDLINE | ID: mdl-8739813

ABSTRACT

OBJECTIVES: To compare compliance with an antihypertensive treatment administered either twice daily or three times daily. The two formulations of the antihypertensive treatment used (nicardipine) "regular tablets" (t.d.) and "slow release tablets" (b.d.) are bioequivalent at the daily dosage used in the study. STUDY DESIGN: Open, controlled, parallel designed study with centralised, randomised allocation to the treatment groups: TID group: A nicardipine 20 mg tablet, three times daily for 3 months. BID group: A capsule of slow release (SR) nicardipine, 50 mg twice daily for 3 months. PATIENTS: 7274 hypertensive patients were investigated by 2.651 general practitioners. Compliance with the nicardipine was assessed by means of standardised interviews with the patients and by a questionnaire for the investigators. RESULTS: Compliance was slightly higher in the BID than in the TID group; 71.2% and 24.5% of patients in the first group declared their compliance was 100% and 80% compared to 82.3% and 15% in the second group. A statistically significant relationship was shown between compliance with nicardipine and the decrease in blood pressure after three months of therapy. However, no significant difference was noticed between the two groups of patients in the absolute decrease in blood pressure after the treatment period: 25.7/14.7 mm Hg in the TID group compared with 25.9/15.0 mm Hg in the BID group. CONCLUSIONS: A difference in compliance between the bioequivalent BID and TID formulations of the same active agent was shown in hypertensive patients. However, the difference was not large enough to lead to a difference either in the number of controlled patients or in the decrease in blood pressure. Reducing the number of daily doses does not automatically lead to greater efficacy of treatment.


Subject(s)
Antihypertensive Agents/administration & dosage , Antihypertensive Agents/therapeutic use , Calcium Channel Blockers/administration & dosage , Calcium Channel Blockers/therapeutic use , Hypertension/drug therapy , Nicardipine/administration & dosage , Nicardipine/therapeutic use , Patient Compliance , Antihypertensive Agents/pharmacokinetics , Blood Pressure/drug effects , Calcium Channel Blockers/pharmacokinetics , Female , Humans , Hypertension/blood , Hypertension/physiopathology , Male , Middle Aged , Nicardipine/pharmacokinetics , Treatment Refusal
10.
Minerva Stomatol ; 44(11): 507-14, 1995 Nov.
Article in Italian | MEDLINE | ID: mdl-8868584

ABSTRACT

The frontal sinus is located at the level of the junction between the naso-ethmoido-orbital region, the cranial vault and the skull base and plays a particularly important role in the biomechanics of the centro-facial region. It represents a locus minoris resistentiae placed between the fronto-orbital frame, whose resistance to trauma is good, and the thin posterior fronto-ethmoidal structures. Fractures of the frontal sinus more frequently involve the anterior wall of the frontal sinus and, occasionally, also the posterior wall and the base of the sinus. Where the fracture involves the anterior sinsu wall alone, surgical reduction is indicated to correct cosmetic defects arising from an altered bone profile, either via bicoronal access or by direct attack when there are skin lesions too. If the fracture extends to the posterior wall of the sinus without causing bone displacement or dural lesion, most authors agree that only the fractures of the anterior wall should be treated to avoid obliterating the sinus cavity. When the fracture of the posterior wall is comminuted with displacement of bone fragments, there are usually dural lesions too; in this event, once dural plasty has been performed, it is necessary to cranialize the frontal sinus by demolishing its posterior wall. Fractures of the skull base, associated with a high frequency of lesion or obstruction of the sinusal ostio and severe infective complication, require cranialization of the sinus that is also separated from the cranial cavity using a median-pedicled pericranial flap. To control the point of fracture, a rigid fixation system can be employed (microplates) or osteosynthesis with metal wires that restore the eurhythm of the frontal-orbital region and simultaneously guarantee good stability of the repositioned fragments.


Subject(s)
Frontal Sinus/injuries , Maxillofacial Injuries/surgery , Accidental Falls , Accidents, Traffic , Adult , Bone Plates , Fracture Fixation/methods , Fractures, Comminuted/etiology , Fractures, Comminuted/surgery , Frontal Sinus/surgery , Humans , Male , Maxillofacial Injuries/etiology , Paranasal Sinuses/injuries , Paranasal Sinuses/surgery , Surgical Flaps/methods , Tomography, X-Ray Computed , Wounds, Gunshot
11.
Minerva Stomatol ; 44(11): 551-8, 1995 Nov.
Article in Italian | MEDLINE | ID: mdl-8868590

ABSTRACT

The authors stress the fact that the clinical course of a monolateral TMJ ankylosis tends to be more severe in young people. In this paper we analyze the diagnostic procedure for a tridimensional observation of any morphological and spatial alteration. The surgical procedure that permits the simultaneous correction of ankylosis and associated facial deformities is discussed.


Subject(s)
Ankylosis/complications , Facial Asymmetry/complications , Temporomandibular Joint Disorders/complications , Adolescent , Ankylosis/diagnostic imaging , Ankylosis/surgery , Cephalometry , Facial Asymmetry/diagnostic imaging , Facial Asymmetry/surgery , Female , Follow-Up Studies , Humans , Mastication/physiology , Temporomandibular Joint/physiology , Temporomandibular Joint Disorders/diagnostic imaging , Temporomandibular Joint Disorders/surgery , Tomography, X-Ray Computed
12.
J Craniofac Surg ; 6(6): 473-6, 1995 Nov.
Article in English | MEDLINE | ID: mdl-9020736

ABSTRACT

Firearms induce severe morphological and structural alterations on both soft and bony tissues of the face. It is therefore essential to restore their previous functionality. In our experience, maxillofacial lesions due to firearm shooting must be divided, from a locational point of view, into those lesions involving the upper third, those involving the medium third, and those involving the lower third of the face. Lesions of soft and bony tissues must be evaluated precisely through instrumental diagnostic examinations and axial and coronal computed tomographic projection, preferably with a three-dimensional construction, to be able to restore the previous functional integrity of the maxillofacial region. At a subsequent surgical time, it may be necessary to plan aesthetic corrections for recovery of the previous facial harmony.


Subject(s)
Maxillofacial Injuries/surgery , Surgery, Plastic/methods , Wounds, Gunshot/surgery , Adult , Humans , Male , Maxillofacial Injuries/classification , Maxillofacial Injuries/etiology , Tomography, X-Ray Computed , Wounds, Gunshot/classification
13.
J Craniofac Surg ; 6(6): 506-9, 1995 Nov.
Article in English | MEDLINE | ID: mdl-9020744

ABSTRACT

The incidence of intraosseus hemangiomas is very low. The mandible, the zygoma, the maxilla, and the frontal bone are the most frequent areas of localization in the craniomaxillofacial region. Surgery, without preoperative embolization, is always the best treatment for intraosseus hemangiomas of the zygoma. The radical removal of the tumor frequently causes a contour defect that has to be corrected. Calvarial grafts provide a good solution to the problem of reconstruction of bone loss. They are easy to prepare, near to the implant zone, and they do not require changes in the patient's position during the operation. The implants fixed by micro- and minifixation systems provide a good functional and aesthetic result. We, after a review of the literature on intraosseus hemangiomas of the craniomaxillofacial region, report two cases of intraosseus hemangiomas of the zygoma in which removal of the tumor and reconstruction with calvarial grafts have been performed.


Subject(s)
Hemangioma/surgery , Skull Neoplasms/surgery , Zygoma/surgery , Adult , Bone Transplantation , Female , Hemangioma/diagnostic imaging , Hemangioma/pathology , Humans , Male , Middle Aged , Skull Neoplasms/diagnostic imaging , Skull Neoplasms/pathology , Tomography, X-Ray Computed , Zygoma/diagnostic imaging , Zygoma/pathology
14.
Arch Mal Coeur Vaiss ; 88(10): 1425-30, 1995 Oct.
Article in French | MEDLINE | ID: mdl-8745614

ABSTRACT

The antihypertensive efficacy of calcium antagonists could depend on the concentration of circulating renin. To investigate this hypothesis, 102 hypertensive men or women were included in this study. After an initial 2 week placebo period, the patients were administered slow-release nicardipine, 50 mg twice a day for twelve weeks. The blood pressures were measured with a mercury sphygmomanometer at inclusion (S2) and after 12 weeks of treatment (S14), in addition to home automeasure during the week before inclusion and the two weeks preceding the final visit. The plasma renin activity (RA) was measured at S2 and S14. Its value at inclusion was used to differentiate patients with low renin (< or = 11 ng/l) from those with normal (> 11 < or = 17 ng/l) or high renin activity (> 17 ng/l). The blood pressure measured by sphygmomanometer or automeasure was significantly lower at the end of the active treatment period (SBP: -8 mmHg; DBP: -9.5 mmHg; and SBP: -5.8 mmHg; DBP: -5.7 mmHg respectively); the reduction in blood pressure was significantly higher in the group with low RA than in the group with high RA. The reductions in SBP measured in the morning and evening and in DBP measured in the morning were significantly greater in the group with low RA than in the group with high RA. The reduction of SBP measured in the morning at midday, and in the evening was correlated to the basal value of RA. Mild side effects were observed in 20 patients leading to the interruption of treatment in 11 cases because of headache. The best antihypertensive response is observed in patients with low plasma RA. This could explain the good response to calcium antagonists usually observed in elderly hypertensives.


Subject(s)
Calcium Channel Blockers/therapeutic use , Hypertension/drug therapy , Nicardipine/therapeutic use , Renin/blood , Blood Pressure/drug effects , Blood Pressure Monitoring, Ambulatory , Calcium Channel Blockers/blood , Calcium Channel Blockers/pharmacology , Female , Humans , Male , Middle Aged , Nicardipine/blood , Nicardipine/pharmacology , Placebos , Posture , Sensitivity and Specificity , Time Factors
15.
Minerva Stomatol ; 44(4): 171-4, 1995 Apr.
Article in Italian | MEDLINE | ID: mdl-7659054

ABSTRACT

We report a clinical case of severe medullary aplasia complicated by fungal antritis. The treatment adopted for this patient consists in a clean operation of the infective focus and the local instillation of Amfotericina B during the post operative period. In this way the systemic circulation is not interested by the use of Amfotericina B, which is extremely important to avoid the inevitable onset of several unwanted side-effects; besides, we avoid the progression of the infective focus and its systemic diffusion.


Subject(s)
Aspergillosis/surgery , Aspergillus flavus , Bone Marrow Diseases/complications , Fusarium , Mycoses/surgery , Opportunistic Infections/surgery , Sinusitis/surgery , Adult , Amphotericin B/therapeutic use , Aspergillosis/drug therapy , Aspergillosis/etiology , Bone Marrow Diseases/therapy , Combined Modality Therapy , Humans , Immunosuppression Therapy , Male , Mycoses/drug therapy , Mycoses/etiology , Opportunistic Infections/drug therapy , Opportunistic Infections/etiology , Recurrence , Sinusitis/drug therapy , Sinusitis/etiology
16.
Minerva Stomatol ; 43(12): 591-4, 1994 Dec.
Article in Italian | MEDLINE | ID: mdl-7739494

ABSTRACT

Osteopetrosis is an extremely rare condition characterized by an increase in osseous cell density. It shows three different hereditary patterns. Diagnosis is made by means of a 3D CT and an accurate study of hepatic and renal functions, as well as audiometric and labyrinth examination. In the frequent case of serious osseous alterations of the facial profile, surgical treatment is essential in order to obtain the best aesthetic and functional results.


Subject(s)
Esthetics , Mandibular Diseases/surgery , Osteopetrosis/surgery , Adolescent , Face , Female , Humans , Mandibular Diseases/diagnosis , Mandibular Diseases/physiopathology , Osteopetrosis/diagnosis , Osteopetrosis/physiopathology
17.
Blood Press Suppl ; 2: 61-8, 1994.
Article in English | MEDLINE | ID: mdl-8061848

ABSTRACT

In a randomized, double-blind, crossover study, 20 patients with mild to severe essential hypertension received 3 weeks of treatment with each of four dosages of spirapril (3, 6, 12 and 24 mg once daily) or placebo. Standing and supine blood pressures were measured by use of both an automatic oscillometric instrument (Dinamap) and a mercury sphygmomanometer over a 24-hour period. Spirapril at 6, 12 and 24 mg once daily produced similar reductions in systolic and diastolic blood pressure. At most time points, there was a statistically significant difference between the reductions with spirapril compared with placebo. Spirapril at 3 mg once daily was less effective than the higher dosages, producing a lower mean blood pressure reduction and a shorter duration of antihypertensive action, mainly as regards systolic pressure. Spirapril was well tolerated and no patients withdrew from the study because of adverse effects. These data suggest that, although all four evaluated spirapril dosages effectively lowered supine and standing blood pressure in patients with mild to severe hypertension, the blood pressure-lowering effect of the 3 mg/day regimen was less than optimal. There were only minor variations in efficacy between dosages > or = to 6 mg/day, which may be attributable to the variability of blood pressure. Further investigations of larger numbers of patients are required to verify these results.


Subject(s)
Angiotensin-Converting Enzyme Inhibitors/administration & dosage , Enalapril/analogs & derivatives , Hypertension/drug therapy , Adolescent , Adult , Aged , Analysis of Variance , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Blood Pressure/drug effects , Blood Pressure/physiology , Blood Pressure Determination , Drug Administration Schedule , Enalapril/administration & dosage , Enalapril/adverse effects , Enalapril/blood , Female , Humans , Hypertension/blood , Hypertension/physiopathology , Male , Middle Aged , Renin-Angiotensin System/drug effects
19.
Arch Mal Coeur Vaiss ; 85 Spec No 2: 139-41, 1992 Sep.
Article in French | MEDLINE | ID: mdl-1285694

ABSTRACT

Animal models of atherosclerosis have improved our understanding of the pathogenic mechanisms involved in the formation of the atherosclerotic plaque. However, extrapolation of these data to the clinical situation is difficult. In addition, evaluation of the prevention or regression of atherosclerosis raises methodological problems. Although improved techniques provide a better evaluation of the extension of the plaques and their functional consequences, a number of points remain undecided: when to intervene, in which patients and how to extrapolate the results. A standardisation of the methods of evaluation of the atherosclerotic plaque is essential as is the fact that the benefit observed should be a reduction in cardiovascular complications and not simply the progression or regression of an angiographic lesion.


Subject(s)
Arteriosclerosis/therapy , Clinical Trials as Topic/methods , Animals , Arteriosclerosis/diagnosis , Arteriosclerosis/prevention & control , Clinical Trials as Topic/standards , Disease Models, Animal , Humans , Rabbits , Remission Induction , Risk Factors
20.
Arch Mal Coeur Vaiss ; 84(11): 1569-74, 1991 Nov.
Article in French | MEDLINE | ID: mdl-1763923

ABSTRACT

The beneficial effects of physical exercise on the blood pressure are widely recognised. Nevertheless, some athletes remain hypertensive and the treatment of this population makes special demands with respect to treatment efficacy and tolerability, the respect of athletic performance and problems of proscribed substances. For example, the Athletic Boards have prohibited betablockers and diuretics in competitive athletes. The aim of this study was to assess nicardipine LA 50 mg administered twice daily in the special context of hypertensive athletes. Thirty-eight athletes with mild or moderate hypertension undergoing endurance training were included in this double blind trial versus placebo. After two months treatment, the systolic and diastolic blood pressures were significantly lower at rest in the nicardipine than in the placebo group (delta SBP = -18.9 vs -4.1 mmHg, p less than 0.001; delta DBP = -15.7 vs -4.1 mmHg, p less than 0.01). In addition the maximum SBP on effort was significantly lower in the nicardipine group (200 vs 215 mmHg, p less than 0.05). On the other hand, no difference was observed between the two groups as regards the maximum oxygen consumption (delta VO2 max = 6.2 vs -0.4 ml/min/kg, NS) and duration of effort (13.75 vs 12.32 min, NS), showing that athletic performance was unchanged in the group treated by nicardipine LA. These results suggest that treatment with nicardipine LA fulfills the special criteria of hypertensive athletes.


Subject(s)
Hypertension/drug therapy , Nicardipine/therapeutic use , Physical Exertion/drug effects , Sports , Adult , Blood Pressure/drug effects , Delayed-Action Preparations , Double-Blind Method , Drug Tolerance , Exercise Test , Heart Rate/drug effects , Humans , Male , Middle Aged , Nicardipine/administration & dosage , Oxygen Consumption/drug effects , Placebos
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