Twenty-four hour ambulatory blood pressure monitoring in young and elderly hypertensive subjects.

The aim of our study was to compare blood pressure (BP) measured by 24-h ambulatory monitoring in young and elderly hypertensives and to find a dependency between left ventricular mass (LVM) and different pressure ratios. We also estimated the calcium ionized concentration and serum lipids in all subjects. Two hypertensive groups divided accordingly by age were studied. The duration of hypertension was similar in both groups. The Oxford Medilog ABP was used for the arterial BP recordings. Mean arterial BP, BP loads and night/day mean arterial pressure ratio were evaluated. In both groups left ventricular mass index (LVMI) were calculated. The serum calcium ionized concentration (Ca++) was estimated and serum lipids were determined. We found 10 non-dippers in the young group and seven non-dippers in the elderly hypertensives. LVM and LVMI were comparable in both groups. We showed the correlation of the nocturnal mean arterial pressure with LVM in elderly hypertensives and the dependency of nocturnal BP load with LVM in this group. Serum calcium ionized concentration was significantly decreased in the elderly patients, and LDL-cholesterol was significantly higher in this group. We found a negative correlation between serum calcium and triglycerides in young and elderly hypertensives. We found more non-dippers in the young hypertensives and a positive correlation between LVM and nocturnal mean arterial pressure and nocturnal BP load in elderly subjects. These results suggest the cardiovascular prognosis is not good in both groups. The prognosis in elderly hypertensives was also worsened by the low serum calcium ionized and high LDL-cholesterol concentrations.

[Clinical characteristics of patients with hypertension resistant to antihypertensive drug therapy]. / Charakterystyka kliniczna chorych z nadcisnieniem tetniczym opornym na leczenie hipotensyjne.

Two groups of hypertensive patients: 137 responsive (on one or two drugs) and 162 resistant on antihypertensive treatment in the similar age were compared. Resistant patients (on three or more drugs) characterize by significantly higher body weight and BMI, longer history of hypertension, more frequent hypertension prevalance in family members and lower education. Level of triglycerides in resistant on antihypertensive treatment patients was significantly higher than in responsive patients. Insulin level in blood in 31 patients with essential hypertension was significantly higher than in 36 healthy persons and 20 patients with renovascular hypertension and resistant on antihypertensive therapy. In 14 patients with essential hypertension resistant to treatment insulin level one hour after oral glucose load was significantly (p < 0.01) higher than in 16 patients with essential hypertension responsive to antihypertensive treatment.

[Estimation of 24-h excretion of some promotors and inhibitors of crystallization and degree of urine saturation with calcium oxalate in calcium urinary calculi]. / Ocena wydalania niektórych prekursorów zlogów kamiczych i inhibitorów krystalizacji oraz stopnia nasycenia moczu szczawianem wapnia w wapniowej kamicy moczowej.

UNLABELLED: The aim of the study was to estimate the renal citrate excretion in basal condition and to find out the relationship between their excretion and excretion of calcium, oxalate, magnesium and phosphate in patients with calcium stone disease and in control group. In 93 patients with urolithiasis and 46 healthy subjects 24-h excretion of calcium, magnesium, oxalate, phosphate and citrate as well as the degree of urine saturation with calcium oxalate was evaluated. 24-h renal excretion of calcium was significantly higher in patients with urolithiasis than in control group (p < 0001). Excretion of magnesium, phosphate and oxalate were'nt significantly different between patients with urolithiasis and healthy subjects. Daily excretion of citrate was significantly lower in patients with calcium stone disease (p < 0.01) and the degree of urine saturation with calcium oxalate was significantly higher in this group (p < 0.001). Hypocitraturia was observed in 61.3% stone-formers. A significant positive correlation was observed between excretion of citrate and calcium (r = 0.2760 p < 0.01) as well as citrate and oxalate (r = 0.5310 p < 0.001) in patients with urolithiasis. CONCLUSIONS: 1. In 61.3% of patients with urolithiasis the daily citrate excretion was reduced. In 50% of patients with urolithiasis and reduced citrate excretion "idiopathic" hypocitraturia was recognized. The daily citrate excretion was reduced in 70.2% of stone-formers with infected urine. 2. The positive correlation between 24-h excretion of calcium and citrate suggests that high excretion of lithogenic factor is accompanied by high excretion of this inhibitor of crystallization.

[Hyponatremia and hypernatremia in the elderly]. / Hiponatermia i hipernatermia u chorych w wieku podeszlym.

The study aimed at evaluating an incidence of hypo- and hypernatremia in the elderly and the results of therapy. Hyponatremia. The studies involved 18 patients aged 69.8 +/- 5.9 years with hyponatremia of 126.8 +/- 2.7 mmol/L. The main causes of hyponatremia were: diuretics, diarrhoea, and vomiting. Sodium deficit was calculated prior to the treatment in all patients. An analysis of hyponatremia incidence indicates that hyponatremia was diagnosed in 1.39% of patients over 60 years, hospitalized within 1989-1990. Sodium deficit in this group was 495.5 +/- 167.7 mmol. Sodium chloride solution was given intravenously to 12 patients, according to the "free correction" principle (a mean increase in serum sodium level was 0.17 +/- 0.07 mmol/L per hour). Mortality in such treated patients was 33%. Sodium chloride was not given to 6 out of examined patients. In 12 patients (66.6%) hyponatremia developed prior to hospitalization, in 6 patients (33.3%) during hospitalization. Mortality rate was 16.6% and 50%, respectively. This confirms higher mortality rate of the rapidly developing hyponatremia in the hospitalized elderly patients. In some cases hyponatremia may constitute iatrogenic complication, especially in the elderly given diuretics in an uncontrollable way. Own experience suggests that elderly patients with a risk of hyponatremia require close monitoring and early compensation of the electrolyte disorders. Hypernatremia. The studies involved 20 patients aged 71.4 +/- 7.7 years with hypernatremia of 155.6 +/- 8.4 mmol/L. A total water deficit (DH20) was calculated in this group. An analysis of hypernatremia incidence showed that this state was diagnosed in 1.55% of patients treated at the Department of Arterial Blood Hypertension within 1989-1990. Total water deficit was 3.9 +/- 1.9 L. A 5% glucose was given intravenously to 15 patients whereas oral fluid therapy was carried out in 5 patients. A mean corrected DH2O in the first day was 46.0 +/- 21.0%. Mortality rate in this group was 65%. It is worth mentioning that 37% of patients with chronic hypernatremia which developed prior to hospitalization died while in case of the acute hypernatremia developed in the hospital mortality rate was 83%. A significant effect on the results of therapy plays an early correction of hypernatremia. Mortality rate in case of DH2o supplementation below 30% during the first 24 hours is about 66%., if DH2o supplementation is 31-60%, a mortality rate is 63%, and in DH2o supplementation over 60% mortality rate is 100%. The obtained results suggest that hypernatremia in the elderly is related to the high mortality rate (65%). An early decrease of water deficit increases mortality rate in patients with hypernatremia.

[Effect of urine alkalization on excretion of renal citrate and degree of urine saturation with calcium oxalate in patients with calcium-oxalate urolithiasis and in healthy subjects]. / Wplyw alkalizacji moczu na wydalanie cytrynianów i stopien nasycenia moczu szczawianem wapnia u chorych ze szczawianowo-wapniowa kamica moczowa i u osób zdrowych.

The aim of the study was to compare the renal citrate excretion and the degree of urine saturation with calcium oxalate in patients with active calcium oxalate urolithiasis and in healthy subjects under basal conditions and after alkalization. There were 20 women before menopause with calcium stone disease aged 33.5 +/- 7.1 in the first group and 20 healthy women aged 32.3 +/- 7.6 in the second one. Sodium bicarbonate was administrated intravenously in a dose 16.8 g during 2 h. 24h excretion of calcium, magnesium and citrate, the degree of urine saturation with calcium oxalate and pH of urine before and after alkalization were evaluated. Hypocitraturia occurred in 45% of patients under basal conditions. The degree of urine saturation with calcium oxalate was significantly higher in women with nephrolithiasis (p < 0.01). A significant increase of citrate excretion (p < 0.001) and a decrease of calcium excretion (p < 0.05) after alkalization took place in both groups. The degree of urine saturation with calcium oxalate decreased significantly in patients with urolithiasis and in healthy subjects. During acute alkalosis, induced by sodium bicarbonate, increase of citrate excretion was observed in patients with urolithiasis in spite of hypocitraturia under basal conditions. This indicates that kidney function following alkalization is normal in "stone kidney". Significantly decreased saturation of urine with calcium oxalate was due to the decrease of calcium excretion and the increase of citrate excretion. In conclusion, the results show that the use of alkalizing factors in prevention of recurrent calcium urolithiasis is justifiable.

[Malignant mesothelioma of the pericardium--diagnostic problems]. / Miedzybloniak zlosliwy osierdzia--trudnosci diagnostyczne.

A case of the malignant mesothelioma of pericardium is presented as this is rare primary neoplasm of pericardium. Diagnosis of the malignant mesothelioma of pericardium is a difficult clinical problem. The authors discuss the value of various diagnostic techniques used in diagnosis of the malignant mesothelioma of pericardium.

[Comparison of calcium oxalate values as indicators of risk for calcium oxalate calcinosis and the degree of urine saturation in patients with calcium urolithiasis and in healthy patients]. / Porównanie wartosci wskaznika zagrozenia kamica szczawianowo-wapniowa i stopnia nasycenia moczu szczawianem wapniowym u chorych na wapniowa kamice moczowa i u osób zdrowych.

Daily excretion of calcium, magnesium, oxalates, and citrates together with daily urine output were determined in 37 patients with calcium urolithiasis and in 25 healthy individuals. Basing on the obtained values, a degree of urine saturation with calcium oxalate with Marshall and Robertson technique and a value of risk factor with Tiselius technique were calculated. It was found that daily diuresis and excretion of calcium with the urine are significantly higher in patients with urolithiasis where as daily excretion of citrates with the urine is significantly lower than in healthy individuals. Risk index proved two-fold higher in the examined patients than in the healthy individuals (p greater than 0.001) while the degree of urine saturation with calcium oxalate did not differ significantly in both groups. The authors, discussing causes of seemingly different changes in both tested parameters, stressed diagnostic value of risk index which includes excretion of crystallization inhibitors (magnesium, citrates) and contrary to the degree of urine saturation is independent of daily urine output.

[Evaluation of risk index according to Tiselius in patients with calcium urinary stones]. / Ocena wspólczynnika ryzyka wedlug tiseliusa u chorych na wapniowa kamice moczowa.

Daily calcium, oxalates, magnesium, citrates and creatinine excretion with the urine was determined in 36 patients with calcium renal stones and in 25 healthy individuals. Then, risk index according to Tiselius was calculated. It was found that daily calcium excretion is significantly higher and daily citrates excretion is significantly lower in patients with calcium renal stones. Daily excretion of oxalates, magnesium and creatinine with the urine did not differ in both groups. Risk index according to Tiselius was two-fold higher in patients suffering from urolithiasis than in healthy individuals (p greater than 0.001) and better illustrated the tendency to stone formation than the analysis of metabolic disorders.