Practice vs ambulatory blood pressure measurement under treatment with ramipril (PLUR Study): a randomised, prospective long-term study to evaluate the benefits of ABPM in patients on antihypertensive treatment.

The usefulness of ambulatory blood pressure monitoring (ABPM) vs casual blood pressure measurement in the physicians practice (PM) for the routine management of patients with hypertension concerning total mortality and morbidity has been compared in a prospective, randomised, open multicentre study with a 5-year follow-up. The study was performed in general practitioners offices in Germany from 1991 to 1997. A total of 1298 patients with essential hypertension were included. Cardio- and cerebrovascular events, total mortality/morbidity and drug-saving effects in hypertensives treated according to two different methods of blood pressure measurement were the primary and secondary endpoints of the study. A total of 239 patients from group 1 (ABPM, n = 651), and 208 from group 2 (PM, n = 647) prematurely discontinued the study. The reason for discontinuation in 55 of these patients (20 from group 1 and 35 from group 2) was that they reached the main endpoint (total mortality/morbidity and cardio- and cerebrovascular events) of the study. The difference was statistically significant (P = 0.037) in favour of group 1. Cardio- and cerebrovascular events also occurred in a lower number of patients (n = 14) in group 1, as compared to group 2 (n = 24). The difference however was not significant (P = 0. 097). A difference in a direct drug-saving effect could not be observed between the two groups but 22% of the initially screened patients were detected with the ABPM to have white coat hypertension and thus these patients did not receive antihypertensive treatment.

International guidelines on post-authorisation research and surveillance. European Economic Community.

Recently, post authorisation research and surveillance has become more and more important. This article investigates which common standards already exist and which methods and tools are used in this context. This paper focusses on a draft version of the "Notice to applicants for marketing authorisations for medical products for human use in the European Community" which will be mandatory for all EC member countries after its finalization.

[Fatal sodium azide poisoning in a hospital: a preventable accident]. / Tödliche Natriumazid-Vergiftung im Krankenhaus: ein vermeidbarer Zwischenfall.

A case of fatal sodium azide poisoning is reported. From the hospital staff, a 57 year old patient had obtained 1 g of sodium azide in order to put it as a preservative, in his 24 hour urinal. Probably due to an error, he swallowed the total dose. A cardiovascular collapse was cause of the death after five hours of intensive treatment and reanimation. Azide anions were found in blood (traces, less than 0.5 mg/L), vitreous (10 mg/L) and cerebrospinal fluid (20 mg/L). The use of sodium azide for disinfection of urine samples should be regarded as obsolete. Less toxic substances for disinfection are available. To avoid chemical disinfection, urine samples can be kept at 4-8 degrees C prior to rapid analysis.

Meta-analysis of environmental and occupational epidemiological studies: a method demonstrated using the carcinogenicity of PCBs as an example.

A method for a meta-analysis of several environmental or occupational epidemiological studies with small prevalences and/or incidences and long latency periods is presented. A combination of statistical evaluations of small prevalences should be done in the following way: (1) selecting relevant and comparable studies, (2) computing exact p-values of Poisson tests and aggregating them by Fisher's method, (3) estimating overall relative risks (or SMRs) by pooling the data of the individual studies and by using weighted sums of the logarithms of the individual risks, and (4) calculating confidence intervals and confidence curves for the overall risks. An example illustrates this technique by investigating the association of exposure to polychlorinated biphenyls (PCBs) at work and cancer mortality in men.

Decline in CD4+ cell numbers in cats with naturally acquired feline immunodeficiency virus infection.

T-cell subsets were studied by fluorescence-activated cell sorter analysis in 57 feline immunodeficiency virus (FIV)-seropositive cats with naturally acquired FIV infection to see whether CD4(+)-CD8+ alterations were comparable to those observed in human immunodeficiency virus-infected patients. CD4+ values were decreased and CD8+ values were increased. The CD4+/CD8+ ratio was reduced to 1.6, compared with 3.3 in 33 FIV-seronegative control cats. Variance analysis of data showed a significant influence of FIV seropositivity, sex, and spaying of female cats on CD4+ values. CD8+ values were significantly influenced by FIV seropositivity, age, and breed. These findings indicate a similarity between FIV and human immunodeficiency virus infections, as far as alterations of T-cell subsets are concerned.

[T-helper and T-suppressor lymphocyte subpopulations in the peripheral blood of spontaneously FIV-positive cats]. / T-Helfer- und T-Suppressor-Lymphozyten-Subpopulationen im peripheren Blut spontan FIV-positiver Katzen.

Reduced CD4(+)-T-helper-lymphocyte- and increased CD8(+)-T-suppressor-lymphocyte-subsets were found in peripheral blood of 47 FIV-seropositive cats with naturally acquired FIV-infection. The CD4+/CD8+ ratio was decreased, too. Variance analysis of data included the variables reaction in FIV-test, age group, and race. Similarities with HIV-infection were discussed.

[Hemorrhage from the upper gastrointestinal tract as a cause of sudden death]. / Die Blutung aus dem oberen Gastrointestinaltrakt als Ursache des plötzlichen Todes.

During the period from 1971 to 1988 there were 212 fatalities out of 24,822 obductions because of gastrointestinal bleeding. Bleeding from oesophagus varices was most often found, followed by bleeding from duodenal ulcer (16%), gastric ulcer (14%) and haemorrhagic gastritis (11%). The sex-ratio was 2:1 in favour of men. In most cases alcohol related problems were found (with organic diseases such as fat liver, liver cirrhosis, pancreatitis as well as social deprivation, sometimes with acute alcoholization.

Effects of road traffic noise on prevalence of hypertension in men: results of the Luebeck Blood Pressure Study.

Within the Luebeck Blood Pressure Study - a cross-sectional study of 2,315 Luebeck citizens, aged 30-69 years, response 83.3% - the association between blood pressure and exposure to road traffic noise at home was investigated. Road traffic noise was grouped as HIGH and LOW exposure, hypertension was defined as either SBP greater than or equal to 160 mm Hg and/or DBP greater than or equal to 95 mm Hg and/or on antihypertensive medication. A comparison of the crude prevalence of hypertension showed an increase of prevalence for men from 25.5% in the LOW to 31.1% in the HIGH exposure group (odds ratio: 1.32; 90% CI: 1.03-1.69), which was statistically significant at the alpha-level of 0.1. After univariate analyses the variables age, BMI, alcohol consumption, years of education, duration of residence, and employment status were considered as possible confounders or effect modifiers. A logistic regression model was fitted by using a backward stepping procedure. Prevalence were adjusted by using this logistic regression model. Differences between adjusted prevalences in LOW and HIGH exposure groups were similar to the crude differences. The odds ratio computed by the coefficients of this model was also similar to the corresponding odds ratio above. To validate the model we simultaneously stratified the remaining variable of the final model and combined the resulting odds ratios by Mantel-Haenzel. The results were again similar. According to the results of this study a positive association between exposure to road traffic noise and prevalence of hypertension in men is probable.