Acceptability and tolerance of ambulatory blood pressure measurement in the hypertensive patient.

OBJECTIVE: To establish the acceptability and tolerance of ambulatory blood pressure monitoring (ABPM). METHODS: A two-part questionnaire was completed by the doctor; one part before ABPM and the second after the recording. The pre-recording data concern the demographic data of the patient: previous illness, symptoms, reaction of the patient, anthropometric data, treatment details and the reason for ABPM. The second part of the questionnaire records the type of monitor used, the conditions of the recording and any difficulties for, or adverse effects on, the patient. SUBJECTS: Six hundred and seventy-two patients considered hypertension by World Health Organization criteria (diastolic blood blood pressure >/=90 mmHg, systolic blood pressure >/=140 mmHg), were considered for the first descriptive part of the study; a total of 654 patients were considered for the second part related to tolerance; 18 patients refused to reply to the questions concerning the second questionnaire. The general characteristics of the population were as follows: 345 men (51.5%), 327 women (48.5%) and mean age 54+/- 15 years. RESULTS: The devices used were SpaceLabs (63%), Novacor (19.3%), Nippon Collin (6.3%) and other machines (11.2%). The difficulties caused by the machine were classified as 'nul', 'moderate' or 'important'. The levels of difficulty defined as 'important' were 32% related to the cuff, 14% to the awkwardness of the machine and 6% to the noise of the monitor. Difficulty in driving was reported in 9% of cases and difficulty related to comments by colleagues in 6%. Analysis during sleep hindered sleep in 55%, with a very disturbed sleep pattern (more than three reported awakenings) in 14% of cases. Regression analysis allowed examination of the links among the different variables, taking into account the type of machine or the profile of the subject. Thus, it was possible to differentiate among the elements that could influence or predict intolerance. CONCLUSION: Recording-related problems are not negligible but can be reduced by an approach oriented towards each individual patients, taking into account specific information for particular circumstances.

Interaction of vasculotropin/vascular endothelial cell growth factor with human umbilical vein endothelial cells: binding, internalization, degradation, and biological effects.

Vasculotropin/vascular endothelial cell growth factor (VAS/VEGF) is a newly purified growth factor with a unique specificity for vascular endothelial cells. We have investigated the interactions of VAS/VEGF with human umbilical vein endothelial cells (HUVE cells). 125I-VAS/VEGF was found to HUVE cells in a saturable manner with a half-maximum binding at 2.8 ng/ml. Scatchard analysis did show two classes of high-affinity binding sites. The first class displayed a dissociation constant of 9 pM with 500 sites/cell. The dissociation constant and the number of binding sites of the second binding class were variable for different HUVE cell cultures (KD = 179 +/- 101 pM, 5,850 +/- 2,950 sites/cell). Half-maximal inhibition of 125I-VAS/VEGF occurred with a threefold excess of unlabeled ligand. Basic fibroblast growth factor (bFGF) and heparin did not compete with 125I-VAS/VEGF binding. In contrast, suramin and protamin sulfate completely displaced 125I-VAS/VEGF binding from HUVE cells. VAS/VEGF was shown to be internalized in HUVE cells. Maximum internalization (55% of total cell-associated radioactivity) was observed after 30 min. 125I-VAS/VEGF was completely degraded 2-3 hr after binding. At 3 hr, the trichloroacetic acid (TCA)-soluble radioactivity accumulated in the medium was 60% of the total radioactivity released by HUVE cells. No degradation fragment of 125I-VAS/VEGF was observed. Chloroquine completely inhibited degradation. VAS/VEGF was able to induce angiogenesis in vitro in HUVE cells. However, it did not significantly modulate urokinase-type plasminogen activator (u-PA), tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor (PAI-1), and tissue factor (TF). Prostacyclin production was only stimulated at very high VAS/VEGF concentrations. Taken together, these results indicate that VAS/VEGF might be a potent inducer of neovascularization resulting from a direct interaction with endothelial cells. The angiogenic activity seems to be independent of the plasminogen activator or inhibitor system.

[Comparison of in vitro activity of 4 oral beta-lactams on microorganisms responsible for broncho-pulmonary infections in children]. / Activité comparée in vitro de quatre bêtalactamines orales vis-à-vis de germes responsables d'infections broncho-pulmonaires en pédiatrie.

MIC 90 and MBC 90 of amoxicillin, cefaclor, cefadroxil and cefuroxime axetil have been determined by the microdilution method against 48 organisms responsible of acute respiratory tract infections in children: 17 E. coli, 15 K. pneumoniae, 16 H. influenzae. An inoculum effect and an inhibitory index in blood and bronchial secretions were determined. An inoculum effect was more important for amoxicillin and cefadroxil than for cefuroxime axetil and cefaclor. Against H. influenzae, cefuroxime axetil and cefaclor have a similar activity. Against Enterobacteria, cefuroxime axetil has the lowest MIC 90 and MBC 90 and the highest inhibitory index.

[Choice of first-line antibiotic therapy in the treatment of bone and joint infections in children]. / Choix de l'antibiothérapie de première intention dans le traitement des infections osseuses et articulaires de l'enfant.

Because of the frequency of Haemophilus influenzae and Staphylococcus aureus in joint and bone sepsis in children, a prospective study of first line antibiotic therapy was performed. In a series of 23 cases, including 8 osteomyelitis and 15 arthritis, Gram stain on joint fluid or antigen detection was helpful in reaching a decision about initial therapy in only 3 cases (Haemophilus influenzae). In 20 of the 23 patients, the first line antibiotic therapy was cefotaxime (100 mg/kg/day) and fosfomycin (100 mg/kg/day) in combination. In 6 of them, the bacteriologic culture was positive (3 Staphylococcus aureus, 1 Haemophilus influenzae and 2 Streptococcus pneumoniae) and the initial antibiotic therapy was changed according to the antibiotic susceptibility testing. In the others 14 cases, from whom no agent was isolated, this combination was continued during about 15 days, then followed by pristinamycin and amoxicillin-clavulanic acid in combination during one month. The C. reactive protein dosage was performed in each patient. All children cured. In view of these first results, cefotaxime and fosfomycin in combination seems to us to be interesting in first line antibiotic treatment without initial orientation.

Early synergistic killing activity at concentrations attainable in CSF of amoxicillin or cefotaxime and aminoglycosides against Haemophilus influenzae.

Rapid eradication of bacteria from the CSF is critical for the outcome of Haemophilus influenzae meningitis in children. In 15 patients studied, the mean H. influenzae colony counts in CSF were 10(5) CFU/ml (range: 10(2) to 10(9) CFU/ml). Time-kill curves were determined for amoxicillin and cefotaxime alone and in combination with gentamicin or amikacin, against 60 clinical isolates of H. influenzae at concentrations equivalent to those found in CSF following systemic administration. Against beta-lactamase-negative strains (n = 44) a bactericidal effect was observed at 18 h for amoxicillin alone, at 5 h for amoxicillin plus aminoglycosides and at 2.5 h for cefotaxime with or without aminoglycosides. Against beta-lactamase-positive strains a bactericidal effect was observed at 18 h for cefotaxime, at 5 h for amoxicillin plus aminoglycosides and at 2.5 h for cefotaxime plus aminoglycosides. It appears that despite low concentrations of gentamicin or amikacin in the CSF, the accelerated killing of H. influenzae provides a rationale for the initial use of the combination of cefotaxime and aminoglycosides in the initial treatment of H. influenzae meningitis.

[Evaluation of the bactericidal curves of beta-lactam and aminoglycoside combinations at the concentrations obtained in the cerebrospinal fluid in Haemophilus influenzae meningitis]. / Intérêt des courbes de bactéricidie des associations beta-lactamines-aminosides aux concentrations obtenues dans le liquide céphalorachidien dans les méningitis à Haemophilus influenzae.

The prognosis and sequelae of patients with Haemophilus influenzae meningitis were related to concentrations of bacteria in the cerebrospinal fluid (CSF). Rapid bacterial killing and rapid reduction of organisms in vivo in CSF are critical to the outcome. In our patients colony counts of Haemophilus influenzae in CSF were 10(2)/ml - 10(9)/ml (mean 10(5)/ml). Killing kinetics were determined for amoxicillin and cefotaxime, alone and in combination with amikacin, against 35 clinical strains of Haemophilus influenzae (43% beta-lactamase-positive) at concentrations of these antibiotics comparable to those attained in the CSF following systemic administration. Antibiotics concentrations were: amoxicillin: 5 mg/ml, cefotaxime: 3.8 mg/l, amikacin: 1.8 mg/l. Mean killing curves with beta-lactamase-negative strains showed that a bactericidal effect was observed at 18 h for amoxicillin, at 5 h for cefotaxime, at 5 h for amoxicillin plus amikacin and at 2 h 30 for cefotaxime plus amikacin. Against beta-lactamase-positive strains a bactericidal effect was observed at 5 h for cefotaxime, at 2 h 30 for cefotaxime plus amikacin and at 18 h for amoxicillin plus amikacin. The finding of significantly increased killing rates of Haemophilus influenzae by amikacin at low concentration in the presence of either ampicillin or cefotaxime suggests that combined therapy may be beneficial in the treatment of meningitis caused by Haemophilus influenzae.