A comparative study of arterial and venous blood acetate concentration in cows fed different diets close to parturition.

Blood samples were collected from the coccygeal artery and a jugular vein two weeks before expected calving, one to five days after calving and three weeks after calving of cows which were fed either a high roughage or a low roughage diet from four weeks before to 14 weeks after calving. The mean venous acetate concentration ranged from about half to three-quarters of the arterial concentration. No differences were observed at any time between concentrations of acetate in either the arterial or venous blood of the cows on the different diets.

Ketorolac: a new parenteral nonsteroidal anti-inflammatory drug for postoperative pain management.

Providing adequate pain control with minimal side effects in inpatient and ambulatory settings is a continuous challenge to the PACU nurse. Ketorolac tromethamine (Toradol, Syntex, Palo Alto, CA) is a new parenteral nonsteroidal anti-inflammatory drug (NSAID) approved for use in the United States. Ketorolac is useful in the management of short term, moderate to severe postoperative pain.

Absence of pre-dose rebound phenomena with once daily 5-ISMN in a controlled-release formulation.

To avoid the development of nitrate tolerance secondary to relatively constant elevated plasma nitrate concentrations, intermittent nitrate dosing has been advocated. However, a nitrate-free interval may induce a rebound increase in myocardial ischaemia, and thus increase anginal symptoms during the latter portion of the dosing interval. This was suggested by the results of recent studies in which nitroglycerin patches were administered intermittently with a 12 h nitrate-free interval.

Minimum heart rate and coronary atherosclerosis: independent relations to global severity and rate of progression of angiographic lesions in men with myocardial infarction at a young age.

The relations of hemodynamic factors, plasma fibrinogen concentration, serum lipoprotein levels, and clinical risk indicators to coronary atherosclerosis were studied in 56 men who had survived a first myocardial infarction before the age of 45 years and who subsequently underwent two coronary angiographies with an intervening time interval of 4 to 7 years. Presence, severity, and rate of progression of both diffuse lesions and distinct stenoses were determined by means of separate classification systems in 15 proximal coronary arterial segments. High minimum heart rate measured during a 24-hour period in connection with the reangiography was associated with progression of both diffuse lesions and distinct stenoses.

Prophylactic nitrate therapy in angina pectoris--is there an optimal treatment regimen?

1. Nitrates have a place in the prophylactic treatment of patients with angina pectoris. Their efficacy is not in doubt.

Does cardiovascular reactivity to mental stress have prognostic value in postinfarction patients? A pilot study.

The possible relationship between mental stress-induced cardiovascular reactivity and clinical prognosis was examined in a pilot study of 13 postinfarction patients. All patients had previously participated in the placebo condition of a secondary intervention trial. On completion of the trial, blood pressure, heart rate, and venous plasma catecholamines were evaluated at rest and in response to a modified Stroop test on two occasions.

Infants and young children metabolise codeine to morphine. A study after single and repeated rectal administration.

1. Codeine was administered rectally to thirteen infants and young children undergoing elective surgery. Nine infants (6-10 months old) received a 4 mg suppository and four children (3-4 years old) an 8 mg suppository.

Metoprolol-induced reduction in postinfarction mortality: pooled results from five double-blind randomized trials.

Several postinfarction trials have evaluated the effect of secondary prophylaxis with different beta-blockers. Although so called meta-analysis of the results from all the trials have shown a beneficial effect of postinfarction beta-blockade, many of the individual studies have shown inconclusive results, mainly due to low statistical power. In order to obtain an evaluation of the merits of postinfarction therapy with metoprolol, data from the five available studies with metoprolol have been pooled into one database.

Metoprolol does not reduce platelet aggregability during sympatho-adrenal stimulation.

The possibility that beta-adrenoceptor blockers, especially beta 1-selective agents might inhibit platelet function is of considerable interest, as this might be of pathophysiological importance in cardiovascular diseases. Platelet function, however, is difficult to assess and in vivo related data are scarce. The effect of one week of treatment with metoprolol 200 mg/day on platelet aggregability during mental stress (colour word conflict test; CWT) and low and high dose adrenaline infusions has been evaluated in a double-blind, placebo-controlled, cross-over study in 10 healthy male volunteers.

Fibrinogen and plasminogen activator inhibitor-1 levels in hypertension and coronary heart disease. Potential effects of beta-blockade.

The roles of fibrinolysis, fibrinogen, and plasminogen activator inhibitor-1 in the development of coronary heart disease are reviewed, and possible effects of long-term treatment with beta-blockade are discussed. Decreased fibrinolysis is associated with coronary artery disease, and coronary thrombus formation is the most frequent event precipitating myocardial infarction. Recently, it has also been shown that high levels of fibrinogen and plasminogen activator inhibitor-1 are predictors for myocardial infarction.

Prevention of sudden death using beta-blockers. Review of possible contributory actions.

Coronary artery disease is the most serious complication of hypertension; therefore, the treatment of hypertension should be directed toward reducing the mortality from this disease. Since the majority of deaths occurring in post-myocardial infarction patients and hypertensive patients are sudden, the key objective is coronary artery disease treatment that will reduce the risk of sudden death. Several pharmacological interventions have been tested to determine whether they reduce the risk of sudden death.

Role of sympathoadrenal medullary activation in the initiation and progression of atherosclerosis.

Clinical and epidemiological investigations provide evidence that psychosocial factors influence the development of coronary heart disease and underlying atherosclerosis, an association that appears to be independent of the effects of other coronary disease risk factors. It has been hypothesized that sympathoadrenal medullary activation mediates behavioral influences on coronary disease, perhaps by potentiation of atherogenesis. This article summarizes four recent studies of the effects of psychosocial stress and sympathetic arousal on atherogenesis in cynomolgus monkeys (Macaca fascicularis) and rabbits.

Myocardial infarction. Effects of beta-blockade.

By the mid 1960s a beneficial effect of post-myocardial infarction treatment with beta-blockade had been proposed. However, it was not until 1981 that large clinical trials clearly demonstrated a beneficial effect both in terms of reduction in mortality and morbidity. Today treatment with beta-blockers both in the acute phase of acute myocardial infarction as well as in the stable post-myocardial infarction patient is well established.

The supervisory process reflected in dreams of supervisees.

The study supports the notion that what may be concealed in the supervisory process may be revealed in the dreams of supervisees. Supervision as well as patient work mean an intense emotional experience for supervisees, especially for beginners in psychotherapy. This emotional experience was reflected in dreams.

Immunohistochemical detection of macrophages and T lymphocytes in atherosclerotic lesions of cholesterol-fed rabbits.

Human atherosclerotic plaques contain significant numbers of T lymphocytes and monocyte-derived macrophages. Cytokines released from activated T lymphocytes induce aberrant expression of major histocompatibility complex class II (Ia) antigens by vascular smooth muscle cells and may also regulate cell proliferation and metabolism in the vessel wall. We have analyzed the arteries of cholesterol-fed rabbits to study the sequence of lymphocyte and monocyte entry into the forming atherosclerotic lesion.

Is there an optimal prophylactic nitrate therapy?

Nitrates have a place in the prophylactic treatment of patients with angina pectoris. Their efficacy is not in doubt. However, there may be some practical problems associated with their use, such as unreliable absorption, short duration of action, treatment-induced headache, development of nitrate tolerance and a suggested rebound phenomenon observed during intermittent dosing.

Metoprolol versus thiazide diuretics in hypertension. Morbidity results from the MAPHY Study.

The present study in hypertensive men (40-64 years old) with untreated diastolic blood pressure above 100 mm Hg was aimed at investigating whether metoprolol (n = 1,609) given as initial treatment would lower the risk for coronary events (sudden death and myocardial infarction) more effectively than thiazide diuretics (n = 1,625). A substantial part of this study was the metoprolol arm of the Heart Attack Primary Prevention in Hypertension (HAPPHY) study. The HAPPHY study was a pooling of the effect of different beta-blockers, mainly metoprolol and atenolol, in which no favorable effect in relative risk was observed for atenolol as compared with diuretics.

Primary prevention of sudden cardiovascular death in hypertensive patients. Mortality results from the MAPHY Study.

In a randomized primary prevention trial including 3,234 men with mild to moderate uncomplicated hypertension, the effect of the beta-blocker metoprolol or a thiazide diuretic as an initial antihypertensive therapy was compared regarding the risk of sudden cardiovascular death during a follow-up ranging from 2.3 to 10.8 years (median of 4.

Evaluation of the antianginal effect of nifedipine: influence of formulation dependent pharmacokinetics.

Nifedipine capsules t.d.s.

Persistent left superior vena cava--an unusual location of central venous catheters in children.

The incidence of central venous catheters inadvertently placed in a persistent left superior vena cava (PLSVC) was found to be 1.0% in a pediatric population requiring central venous catheterisation. Two well documented cases are presented and the possible association of PLSVC with other non-cardiovascular malformations is suggested.

Platelet aggregability in humans: contrasting in vivo and in vitro findings during sympatho-adrenal activation and relationship to serum lipids.

Platelet aggregability was studied in 18 healthy volunteers during mental stress (a colour word test; CWT) and low- and high-dose adrenaline infusions using an ex vivo technique (filtragometry) and conventional in vitro aggregometry. CWT and high-dose adrenaline (3.4 nmol l-1 in plasma) shortened filtragometry readings, suggesting increased platelet aggregability in vivo.