Negative effects of diuretic drugs on metabolic risk factors for coronary heart disease: possible alternative drug therapies.

The results of 8 major hypertension treatment trials, all using diuretics as first-line therapy, show a clear-cut reduction in stroke and congestive heart failure, but coronary heart disease (CHD) is not consistently benefited. It is unclear why CHD is not controlled, but diuretics can subtly upset metabolic risk factors for CHD, among which are lipid and glucose concentrations. Although these metabolic disturbances appear clinically unimpressive, risk table analysis reveals that they can offset or even reverse the benefits of reducing blood pressure.

Immunoregulatory factors derived from human tumors. II. Partial purification and further immunobiochemical characterization of a human sarcoma-derived immunosuppressive factor expressing HLA-DR and immunoglobulin-related determinants.

An immunoregulatory factor (IRF) that suppresses Con A-mediated peripheral blood mononuclear cell (PBM) proliferative responses was partially purified by DEAE anion exchange chromatography and affinity chromatography from a 3 M KCl extract of a human liposarcoma. The factor (m.w.

Improvement of glucose tolerance and lowering of glycohemoglobin and serum lipid concentrations after discontinuation of antihypertensive drug therapy.

Diuretic-based antihypertensive drug therapy causes a disturbance in glucose tolerance and in serum lipid and lipoprotein concentrations. To determine the reversibility of the glucose intolerance and to identify mechanisms of the metabolic alterations, we examined a short glucose tolerance test and insulin, glycohemoglobin and lipid concentrations during the supervised withdrawal of long-term drug therapy in 35 patients with primary hypertension. An average of 7 weeks after stopping drugs, glucose tolerance and glycohemoglobin improved, total cholesterol decreased 18 mg/dl, triglyceride decreased 27 mg/dl, and the ratio of total to high-density lipoprotein cholesterol decreased (p less than 0.

The detection of thoracic abnormalities using posterior-anterior (PA) vs PA and oblique roentgenograms.

A reading trial was conducted as part of the 1978 Bay Area Asbestos Screening Project to evaluate the utility of adding oblique-view roentgenograms to standard posterior-anterior (PA) views. Chest films from a sample of 555 workers with histories of long-term asbestos exposure were read twice as PA and twice as PA + oblique sets, providing a basis for assessing reliability through intrareader, interreader, and intermethod agreement. The ancillary use of oblique view films resulted in higher rates of detection of asbestos-related abnormalities than with PA films alone, but the increased rates were gained at the expense of reliability in the interpretation process.

Acute respiratory effects of exposure to diesel emissions in coal miners.

A study was conducted to determine if acute respiratory effects, measured in terms of changes in forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and maximal expiratory flow rate at 50% of forced vital capacity (Vmax50), were related to exposure to diesel emissions in coal miners. Sixty coal miners exposed to diesel emissions and 90 miners not exposed were tested before and after a work shift for ventilatory function changes. Significant work shift decrements in ventilatory function did occur in miners in both groups who smoked cigarettes, but there were no significant differences in the ventilatory function changes between those miners exposed to diesel emissions and those not exposed either in the aggregate or under control by smoking status.

Antihypertensive therapy and the risk of coronary heart disease.

Diuretic drugs, when used in the treatment of hypertension, cause an increase in the serum concentration of total cholesterol and sometimes of triglyceride. High density lipoprotein (HDL) cholesterol remains stable with thiazide-type diuretic drugs. Treatment with furosemide, spironolactone, reserpine, and methyldopa does not affect serum total cholesterol or triglyceride concentrations.

Methods for determining the frequency of sexual intercourse and activities of daily living in young women.

To determine whether the frequency of sexual intercourse and other activities of daily living could be reliably measured in a population of women with or without prior urinary tract infections, a prospective pilot, case-control study was undertaken in a family practice clinic. Intensive self-recording of daily activities for one week was consistent with data collected for five more weeks spaced one month apart. Frequency of sexual activity was significantly higher on weekends.

Starting a hospice requires tenacity, high standards.

Before a hospice program can be developed, the term "hospice" must be applied to a given program with a particular organizational base. Programs must then identify a target population needing care, decide whether to seek licensure or to cooperate with licensed institutions, and train an energetic, dedicated staff.

In vitro studies of cell-mediated immunity to Moloney murine leukemia virus and Moloney leukemia-associated surface antigens.

Cell-mediated immunity to Moloney murine leukemia virus (M-MuLV) and to tumor-associated surface antigens of leukemia cells induced by the virus was studied with an in vitro migration inhibition factor assay. Spleen cells of C57BL/6N mice at Day 14 following inoculation with Moloney murine sarcoma virus, produced migration inhibition factor in response to M-MuLV. The Moloney murine sarcoma virus-immune spleen cells, however, did not respond to other murine type C viruses, to AKR and Rauscher viruses, or to murine mammary tumor virus.

Mercy Hospice: a hospital-based program.

Coordinating the features of the hospice concept within the standard practices and policies of a general hosptial challenged those who developed the Mercy Hospice program at St. John's Hospital, Oxnard, CA. After two years' experience, they report on a program that has evolved to serve many different needs of terminally ill patients and their families both within the health care facility and in patients' homes.

Raised serum lipid concentrations during diuretic treatment of hypertension: a study of predictive indexes.

1. The serum concentrations of cholesterol and triglycerides were measured before and during the treatment of hypertension. Thirty-six patients were treated with hydrochlorothiazide and 29 with spironolactone.

Vesicular-arbuscular mycorrhizae of Easter lily in the northwestern United States.

The vesicular-arbuscular (VA) mycorrhizal fungi of commercially grown Easter lily (Lilium longiflorum Thunb.) were studied. Soil and root samples were collected monthly from March through September 1975 from five fields in the coastal area of southern Oregon and northern California.

Elevation of serum lipid levels during diuretic therapy of hypertension.

In a study attempting to improve coronary risk status, serum cholesterol and triglyceride levels were measured before and during treatment of 74 patients with mild primary hypertension. In 35 patients there was a satisfactory reduction in elevated blood pressure levels with diet therapy alone. In the remaining 39 patients a diuretic drug was required in addition to the diet.

Increase in serum-lipids during treatment of hypertension with chlorthalidone.

Fasting concentrations of serum cholesterol and triglyceride were measured before and during therapy in 63 patients with uncomplicated primary (essential) hypertension. The patients were divided into two groups, and diet therapy was applied equally to both groups. One group of 31 patients received no other therapy; the other 32 received chlorthalidone in addition to diet.

Ultrastructural findings in storage pool disease and aspirin-like defects of platelets.

Previous studies have shown that abnormalities in collagen-induced platelet aggregation may be due to an impaired release of storage pool ADP, the agent ultimately responsible for platelet aggregation. In some patients and in normal subjects who ingest aspirin, the storage pool of ADP is present in normal amounts, but the mechanism for releasing it appears to be defective ("aspirin-like" defect). In these subjects, the centripetal reorientation of the platelet granules, which may be early structural changes of the release reaction, failed to occur.