Evaluation of reticulocyte parameters in iron deficiency, vitamin B(12) deficiency and beta-thalassemia minor patients.

The aim of this study was to test the clinical utility of reticulocyte parameters in differential diagnosis in iron deficiency anemia (IDA), vitamin B(12) deficiency (B12) and beta-thalassemia minor (TM). We analyzed the percentage of reticulocyte, absolute reticulocyte count, mean content hemoglobin of reticulocyte (CHr), mean corpuscular volume of reticulocyte (MCVr), corpuscular hemoglobin concentration mean of reticulocyte (CHCMr), MCVr/MCV ratio, CHr/CH ratio and CHCMr/CHCM ratio in healthy donors (n = 34), iron deficiency (IDA) (n = 41), vitamin B(12) deficiency (B12) (n = 22), and TM (n = 34). This study demonstrates that the cutoff value of CHr was 25.7 as indicative of IDA (85.4% sensitivity, 97.1% specificity). CHr and MCVr may be useful for TM (cutoff value < or = 24.8 for CHr) and B12 (>102.1, cutoff value for MCVr), respectively. Sensitivity and specificity of these parameters were 90.9, 86.4% and 97.1, 82.4%, respectively. CHCMr is useful to differentiate IDA and TM from B12. While CHr was low value in microcytic groups (mean 21.8 +/- 3.3 for IDA, 21.0 +/- 2.9 for TM), it was high in B12 (mean 32.1 +/- 5.7). However, that of CHr/CH ratio was only significantly in IDA group compared with the control (P < 0.05, mean 0.98). Therefore, there are limitations regarding CHr and CHr/CH ratio differential diagnosis in microcytic and macrocytic groups. CHr, MCVr, and CHCMr are not sufficiently sensitive and specific to differentiate TM from IDA. We conclude that measurement of reticulocyte count and parameters may be a very useful implement in the diagnosis of IDA and TM.

Therapeutic benefits of cilazapril in patients with syndrome X.

OBJECTIVES: Although the pathophysiology of syndrome X (angina pectoris, positive ECG test findings and normal coronary arteriogram) is unclear, it is generally accepted that intracellular metabolic changes resulting from abnormal constriction of prearteriolar vessels due to endothelium-dependent vasodilation abnormalities may play a role in the pathogenesis. We established the effect of long-term treatment with cilazapril, an angiotensin-converting enzyme inhibitor, which prevents the effect of angiotensin II in the tonic control of vascular resistance. METHODS: 18 patients (15 women and 3 men, mean age 43.2 +/- 4.6 years) with syndrome X were included in this study. A randomized double-blind crossover placebo-controlled trial was done. After a 1-week washout period, patients received either cilazapril 2 x 2.5 mg or placebo for 3 weeks, followed by 3 weeks of the other therapy. At the end of two periods, an exercise ECG test (modified Bruce protocol) was employed. RESULTS: The magnitude of ST segment depression was significantly decreased during treatment with cilazapril compared with placebo. On the other hand, total exercise time and time to 1 mm ST segment depression were significantly prolonged by cilazapril. However, rate pressure products were not significantly different at peak exercise at or at 1 mm of ST segment depression during both therapies. CONCLUSION: Cilazapril exerted a beneficial therapeutic effect in cases with syndrome X. The possible mechanism of this effect may be a modulation of coronary tone at the microcirculation level.

Electrocardiographic diagnosis of left ventricular hypertrophy in the presence of right bundle branch block in cases with essential hypertension.

Right bundle branch block was diagnosed in electrocardiograms of 37 of 1085 patients with essential hypertension. Echocardiographically left ventricular hypertrophy was diagnosed in 14 of these 37 patients. Eighteen electrocardiographic (ECG) criteria, which were previously recommended, were determined in these 37 patients. The sensitivities of five criteria were found to be better than 50%. These are SV1 > or = 2 mm; RV6 > RV5; S III + (R+S) maximum precordial lead > or = 30 mm; P/PR > or = 1.6; R aVL > or = 11 mm. However, their specificities ranged from 56.5% to 95.6%. When the combination of RV6 > RV5 and S III + (R+S) maximum precordial lead > or = 30 mm was used, sensitivity was 57.1 and specificity was 100%. It is concluded that the presence of right bundle branch block these ECG criteria can be used for the diagnosis of left ventricular hypertrophy.

Combination therapy with verapamil and nitrendipine in patients with hypertension.

Forty patients with mild to moderate hypertension were divided into two groups, 20 patients (group A) received 240 mg verapamil and 20 patients (group B) received 20 mg nitrendipine daily during the first six weeks. During the second six weeks, all 40 patients were given 10 mg nitrendipine plus 120 mg verapamil. After the combination therapy, group B received verapamil, 240 mg and group A nitrendipine 20 mg for a further period of six weeks. When verapamil and nitrendipine were used alone, BP decreased significantly in each group. However, BP decreased more when the combination therapy was used and increased when the treatment was changed to single drug therapy from the two-drug combination. In addition, side-effects were three to four times fewer during the combination therapy. It is concluded that the combination of two different calcium antagonists in the treatment of hypertension provides a new dimension to therapy.

Venous-phase angiography in subclavian-steal syndrome.

The value of demonstrating the venous phase of angiography in patients with subclavian-steal syndrome was evaluated in 17 patients. In patients with mild symptoms, there was no difference between the left and right jugular-vein opacification, but minimal or no opacification was observed in patients with severe symptoms. The authors believe evaluating venous phases in angiography in patients with subclavian-steal syndrome is useful because the findings correlate well with the severity of symptoms.

[Prevention by pindolol of electrocardiographic changes during bronchoscopy performed under local and general anesthesia]. / Prévention par le pincolol des modifications de l'électrocardiogramme au cours de la bronchoscopie pratiquée sous anesthésie locale et générale.

Sixty patients were studied with respect to ECG modifications during bronchoscopy under local or general anesthesia, using dynamic electrocardiography. The increase in heart rate and incidence of extra-systoles were greater under local than general anesthesia. When pindolol, a beta-blocker with practically no bronchospastic effect was administered before the procedure, there was a significant decrease in the incidence of tachycardia and extra-systoles. This drug appears to be useful before bronchoscopy.