Amlodipine, felodipine, and isradipine in the treatment of Chinese patients with mild-to-moderate hypertension.

Optimal treatment of hypertension requires the use of effective antihypertensive drugs. Calcium channel blockers are widely used in the treatment of hypertension and appear to be particularly efficacious in ethnic Chinese patients. The aim of this open-label study was to prospectively investigate the efficacy and tolerability of three dihydropyridine calcium channel blockers in sequence, using the same protocol for each. After 2 weeks of placebo treatment, 73 males and 45 females (mean age, 45 +/- 10 years; mean weight, 67 +/- 10 kg) with essential hypertension (diastolic blood pressure, 95 to 115 mm Hg) were treated with amlodipine (n = 41), felodipine (n = 38), or isradipine (n = 39) for 8 weeks, with dose titration after 4 weeks. Mean seated systolic and diastolic blood pressure decreased by 23/17, 30/17, and 20/15 mm Hg after 8 weeks of treatment with amlodipine, felodipine, and isradipine, respectively. These reductions were all statistically significant. Blood pressure was controlled (defined as diastolic pressure < 90 mm Hg at the final visit or a decrease from baseline of > or = 10 mm Hg) in 85%, 74%, and 74% of patients receiving amlodipine, felodipine, and isradipine, respectively. There were no significant changes in heart rate, plasma lipid levels, or serum biochemistry markers with any of the three treatments. No serious adverse events occurred, but mild adverse effects, including headaches, flushing, tachycardia, dizziness, and edema, were reported; 1 (2%), 6 (16%), and 5 (13%) patients receiving amlodipine, felodipine, and isradipine, respectively, withdrew from the study (P < 0.05). The results of this study indicate that all three drugs are highly effective in lowering blood pressure and are well tolerated in Chinese patients with mild-to-moderate hypertension.

Effects of flecainide on exercise hemodynamics and electrocardiography in patients without structural heart disease.

Although exercise testing has been advocated to unmask proarrhythmic potentials in patients receiving flecainide acetate, the effects of this drug on exercise parameters in individuals without structural heart disease have not been reported. This study was undertaken to assess the effects of flecainide on hemodynamics and electrocardiographic changes during exercise testing in 24 patients with paroxysmal supraventricular tachyarrhythmias, who had normal cardiac structure and sinus node function. Paired treadmill exercise tests using the Bruce protocol were performed after 1 week of treatment with flecainide (200 mg/day) or placebo in a double-blind, randomized design. Exercise testing was terminated because of either fatigue or dyspnea in all subjects. Although resting heart rate was unaffected, flecainide reduced the exercise heart rate (expressed as a percentage of age-predicted maximum) compared with placebo (84 +/- 12% vs. 92 +/- 9%, p < 0.001). Neither resting and exercise systolic blood pressure nor exercise duration were affected. PR interval shortening with exercise was not affected by flecainide, whereas QRS was prolonged compared with placebo (20 +/- 9% vs. 0 +/- 8%, p < 0.01). Compared with placebo, flecainide significantly shortened QTc (-7 +/- 12% vs. 0 +/- 8%, p < 0.05) and JTc (-34 +/- 11% vs. -21 +/- 11%, p < 0.01) intervals during exercise. During exercise, flecainide produced significant depression in the sinus node automaticity and manifested use-dependent slowing of ventricular conduction and acceleration in ventricular repolarization.

[Reproductive activities as a risk factor of endometriosis].

A case-control study, involving 203 cases of pelvic endometriosis and 406 randomly selected and age-matched community controls, was conducted. The results were as following: 1) A decreased risk for endometriosis was found to be related to pregnancy. The relative risk was 0.34 for para 1 and 0.08 for para 2 or more. A similar tendency was also showed in the analysis of gravidity, but this protective effect totally disappeared after adjustment for parity. Therefore, it may be revealed that it is the parity but not the gravidity which protects the women against the endometriosis. 2) There was an increased risk of 15.35 for endometriosis in women with infertility. 3) No relation emerged with age at first pregnancy to the occurrence of endometriosis as indicated in the literature. 4) The frequency of induced abortion was 42.4% in the cases and that was 63.7% in the controls. The association with the risk of the disease adjusted for education, menstruation, parity and contraception was not significant by a attentive stratification the data. 5) Two groups were relatively similar with respect to recorded condom and oral contraceptive use. However, more cases than controls did not use any contraception or only used rhythm method and coitus interruptus, and more controls than cases used an intrauterine device. The results of multivariate analysis did not approve of opinion that IUD is a risk factor of endometriosis. The results did not negate the likelihood of diminished chance of developing endometriosis in women with using oral contraceptives.

[Intestinal metastasis and surgery in ovarian cancer: analysis of 62 cases].

Sixty-two cases of ovarian cancer with intestinal metastatic tumors larger than 2 cm in diameter were treated from January, 1982 to October, 1987, accounting for 28.1% of a total of 221 cases of ovarian cancer admitted during the same period. Metastasis to the large intestine was observed in all 62 cases, of which the rectosigmoid was involved in 59(95.2%). Metastasis to the small bowel was observed in 26. A complete or optimal resection of the intraperitoneal tumors was achieved in 46(74.2%). Resection of the metastatic tumors of intestine was performed in 40 cases. Resection of the bowel was carried out in 22 and a colostomy was done in 6. During followup, 17 patients (27.4%) survived, 39 died and 6 had recurrent disease. The mean survival time for 17 patients achieving complete remission was 30.3 months. Of these, 10 have survived for more than 2 years and 7 for more than 3 years. The role and feasibility of bowel surgery in the treatment of ovarian cancer are discussed.

Gestational trophoblastic disease: a case-control study from the People's Republic of China.

A case-control study involving 331 patients with complete hydatidiform mole and 662 community controls matched to the cases on age and timing of pregnancy was conducted in Beijing, China. A history of a term birth was associated with reduced risk (odds ratio = 0.6, 95% confidence interval 0.4 to 0.9), with some evidence of further decrease with multiple births. Previous spontaneous abortions were not related to risk, although those with a prior induced abortion were at elevated risk, particularly if two or more abortions were involved (odds ratio = 2.8, 95% confidence interval 1.4 to 5.7). A history of having sought medical advice for infertility was associated with reduced risk (odds ratio = 0.5, 95% confidence interval 0.2 to 0.8), but those who reported use of herbal medicines during a first trimester of a previous pregnancy were at excess risk (odds ratio = 2.2, 95% confidence interval 1.3 to 3.6). In addition, a statistically significant trend in risk was observed with years of oral contraceptive use (odds ratio = 2.6, 95% confidence interval 0.9 to 6.9 for greater than or equal to 4 years of use). Dietary habits and family histories of cancer or trophoblastic disease were not related to risk in this study.

Kinetics of antiviral state in cells activated by interferons in vitro.

It was found that development of antiviral state in cells activated by IFN alpha and beta were quite rapid. After 6-7 h treatment IFN alpha and IFN beta protected cells completely and their effects lasted for another 9-12 h after removing them from the cultures. Then the effect declined, but some protective action remained after 48 h of incubation. IFN-gamma was different from IFN alpha or beta. It activated cells much more slowly, and could not protect cells completely before 24 h of treatment. When we compared three concentrations of IFN-alpha, the cells could not be protected completely by 5 IU/ml, and kinetics were similar with 250 and 25 IU/ml. When we added anti-IFN-alpha serum before IFN treatment, the development of the antiviral state was inhibited. The results suggested that one should adopt different ways when titrating and using different forms of IFN, and it might not be needed to use maximal tolerated doses and daily administrations, and to keep the high level of IFN for a long time. We think that these results might be useful for the clinicians considering the optimal schedule for IFN treatment.