The Dübendorf Study: a population-based investigation on normal values of blood pressure self-measurement.

There is evidence that self-measurement of BP increases precision, reproducibility and prognostic value of BP measurement. However, generally accepted normal values for BP values obtained by self-measurement are still missing. The present study was undertaken to investigate differences between office and self-measured blood pressure; 503 randomly selected inhabitants (265 men and 238 women, age 20-90 years, mean age 46.5 +/- 12.9 years) of the small town of Dübendorf in Switzerland were studied. The subjects were not preselected according their BP levels, only patients taking antihypertensive drugs were excluded. Self-measurement was performed at home by the subjects during 14 days in the morning between 6 and 8 am and in the evening between 6 and 8 pm (mean of 26.7 measurements). Office BP was taken before and after the two week period. Mean office BP (130.0 +/- 16.5/82.1 +/- 11.1 mmHg) was significantly (P < 0.01) higher than mean self-measured BP (123.1 +/- 14.6/77.6 +/- 10.7 mmHg). There was no significant difference between first and second office BP measurement. Morning self-measured BP was lower than evening pressure (delta 4.0/1.4 mmHg, both P < 0.01) and the mean was taken for comparison with office BP.(ABSTRACT TRUNCATED AT 250 WORDS)

[Postoperative analgesia with buprenorphine : A comparative study of epidural, patient-controlled intravenous and conventional subcutaneous administration.]. / Postoperative Analgesie mit Buprenorphin : Eine vergleichende Studie zwischen epiduraler, patientenkontrollierter intravenöser und konventioneller subkutaner applikation.

Thirty patients who had undergone elective anterolateral thoracotomy were studied in the surgical intensive care unit to compare the analgesic effectiveness of i.v. self-administered buprenorphine (group A) with that of epidural administration (group B) and of s.c. administration by a nurse of 0.3 mg buprenorphine every 3-4 h (group C, controls). Every 2 h the patients were asked to record their subjektive pain level as a percentage on an analogue scale: zero was to be used for no pain and 100% for the most severe pain they could imagine. the mean of all analogue scores for pain in the first 36 h was 19.4+/-3.1 for group A; 18.4+/-2.3 for group B and 42.0+/-7.4 for group C (P<0.025). When the mean scores were referred to time, it seemed that groups A and B suffered a little more pain immediately after the operation; however, after 4 h the mean scores for these groups were far lower than that for the control group. The amount of buprenorphine used during the first 36 h was 0.036+/-0.006 mg/h per m(2) in group A, 0.021+/-0.002 mg/h per m(2) in group B and 0.038+0.004 mg/h in the control group. The mean interval between two injections was 9.47+/-1.4 h in group A, 2.47+0.5 h in group B, and 5.18+0.7 h in group C. It can be concluded that, at least in patients in an intensive care unit, scheduled administration of pain killers is unacceptable now. The self-administration device has shown the possibility of on-demand i.v. administration, which is no more dangerous than scheduled s.c. administration. Nurses should be instructed to provide analgesic medication on demand. Epidural administration of buprenorphine is superior to self-administration in terms of the amount of drugs used and the dosing intervals. In the quality of analgesia epidural administration and self-administration are equal and superior to the control procedure.

Changes in lipoproteins induced by the remnant kidney tissue or binephrectomy in chronic uremic patients treated by hemodialysis.

The role of the remmant kidney tissue in uremic patients undergoing hemodialysis treatment has rarely been considered to influence the changes in lipoprotein and lipid metabolism. Twenty hemodialyzed patients with remnant kidneys and 11 anephric patients were studied to examine whether the presence or the absence of remnant kidney leads to qualitative or quantitative changes of the lipids and lipoproteins. Anephric patients showed a significantly higher triglyceride level, 3.66 +/- 0.49 (SEM) mmol/L v 2.34 +/- 0.09 mmol/L in patients with remnant kidneys (P less than .01), higher very-low-density lipoprotein (VLDL) triglycerides, 1.24 +/- 0.30 mmol/L v 0.69 +/- 0.09 (P less than .04), and higher HDL-triglycerides, 1.22 +/- 0.29 mmol/L v 0.66 +/- 0.09 mmol/L (P less than .04). APO-AI was significantly decreased in anephric patients, 95.2 +/- 13.3 mg/dL v 129.7 +/- 6.02 mg/dL in patients with remnant kidneys (P less than .01). APO-B was similar in both groups. All APO-C and APO-E were significantly lower in anephric patients, APO-CI 6.13 +/- 0.87 mg/dL v 8.47 +/- 0.42 mg/dL in patients with remnant kidneys (P less than .01), APO CII 1.00 +/- 0.01 mg/dL v 10.0 +/- 0.01 mg/dL (P less than .0001), APO-CIII 10.12 +/- 1.43 mg/dL v 26.0 +/- 2.86 mg/dL (P less than .0005), and APO-E 8.0 +/- 0.02 mg/dL v 12.0 +/- 0.01 mg/dL (P less than .03). These results point out important differences between women and men. In women binephrectomy promotes a decreased concentration of all APO-C but has no influence on APO-AI concentration.(ABSTRACT TRUNCATED AT 250 WORDS)

Quantitation of apolipoprotein C-III in normal and in hyperlipaemic serum samples by enzyme-linked immunosorbent assay.

A specific and sensitive Sandwich enzyme-linked immunosorbent assay (ELISA) for the quantitative determination of apolipoprotein C-III, a major apolipoprotein of human very low density lipoproteins is described. The assay is non-competitive and it uses the same affinity isolated sheep antibody both for coating the wells and as conjugate with alkaline phosphatase. Total serum apo C-III was determined in a normal population of 24 men and 21 women. The difference was not statistically significant. In both sexes apo C-III concentration correlated positively with the serum triglyceride levels. In patients with hyperlipoproteinemia, apo C-III levels were increased.

Enzyme-linked immunosorbent assay for apolipoprotein C-I.

A non-competitive sandwich enzyme-linked immunosorbent assay for apolipoprotein C-I was developed. Sheep antibody to this apolipoprotein C-I, purified by affinity chromatography, was used for coating the wells of a microtiter plate and as a conjugate with alkaline phosphatase. The linear range of the assay was from 80 ng to 15 ng. It was sensitive down to 5 ng. The intra-assay variation coefficient was 2.8%, and the inter-assay variation coefficient 5.3%. The mean concentration of apolipoprotein C-I was 61 +/- 20 mg/l in healthy normal males, and 65 +/- 19 mg/l in females. Apolipoprotein C-I levels were positively correlated with the total cholesterol concentration in both sexes (p less than 0.002). A significant correlation with triacylglycerol was only observed in males (p less than 0.05). A significant increase of apolipoprotein C-I was observed in type V hyperlipoproteinaemia, and in the only studied case of type III.

[Management of hypercholesteremia by extracorporeal immune adsorption]. / Behandlung einer Hypercholesterinämie durch extrakorporale Immunadsorption.

Reduction of plasma cholesterol by extracorporeal immune elimination of low density lipoproteins (LDL) as an efficient approach to the treatment of familial hypercholesterolemia is described. LDL was removed from the plasma by immune adsorption on Sepharose-bound sheep antibodies against apo B, the protein fraction of LDL. To prevent the possibility of sensitization by the sheep antibodies, F(ab')2 fragments were used and the antibody containing Sepharose was underlaid by LDL containing Sepharose. Within a treatment time of 4 1/2-5 hours a reduction of the total plasma cholesterol by 70-80% was obtained. The mean reduction of the cholesterol concentration was more than 40% with a 14-day interval between two treatments. The concentration of other plasma proteins was not affected. The 11 treatments achieved so far were well tolerated and no side effects could be observed.

Quantitation of apolipoprotein B by polyclonal and monoclonal antibodies.

A non-competitive sandwich enzyme linked immunosorbent assay for the quantitation of apolipoprotein B with polyclonal and monoclonal antibodies was developed. Polyclonal antibodies were used as 'coater'. In the assay with polyclonal antibodies, the same antibody was used as conjugate with alkaline phosphatase. For studies with monoclonal antibodies, enzyme conjugated anti-mouse immunoglobulin had to be used, since monoclonal antibodies lost their reactivity upon enzyme conjugation. Two murine monoclonal antibodies were employed: MAB B-1 with specificity for apolipoproteins (Apo) B-48 and B-100 and MAB B-5 with specificity for B-100 (Radioimmunoassay Inc.). In a reference group Apo B values of 0.82 +/- 0.20 g/l were measured with polyclonal antibodies, 0.68 +/- 0.19 g/l and 0.95 +/- 0.33 g/l with MAB B-1 and MAB B-5. In pure hypercholesterolemia, a similar increase was found with all three antibodies, while in combined hyperlipoproteinemia MAB B-5 gave greater than 40% lower values. Differences were also found with respect to the correlation between Apo B and cholesterol or triglycerides.

[Humidifier lung]. / Die Befeuchterlunge.

Breathing air from a humidifier or an air conditioning unit contaminated by various microorganisms can cause an acute lung disease involving fever, cough and dyspnea, termed "humidifier fever". This type of hypersensitivity pneumonitis was first described in 1959 by PESTALOZZI in the Swiss literature and subsequently by BANASZAK et al. in the Anglo-American. Here a chronic form of this disease which led to pulmonary fibrosis is described: A 37-year-old woman who works in a cheese shop presented with dyspnea which had been progressive over two years, weight loss, a diffuse reticular pattern radiographically and a severe restrictive defect in lung function tests. Open lung biopsy revealed chronic interstitial and alveolar inflammation with non-caseating granulomas and fibrotic changes. Circulating immune complexes and precipitins against the contaminated humidifier water and cheese mites were found, but no antibodies suggesting legionnaires' disease. Two out of five otherwise healthy employees of this cheese shop, where a new humidifying system had been installed 7 years earlier, also had precipitins against the contaminated water from the humidifier and the cheese mites. Despite ending of exposure and longterm steroid and immunosuppressive therapy, the signs and symptoms of pulmonary fibrosis persisted. Contrary to the acute disease, this chronic form is termed "humidifier lung". The importance is stressed of investigating the possibility of exposure to contaminated humidifiers or air conditioning units in all cases of newly detected pulmonary fibrosis.