Comparison of enalapril and hydrochlorothiazide in mild hypertension and changes in plasma lipid concentrations during therapy.

An open, randomized, parallel clinical study comparing the antihypertensive efficacy and tolerability of the angiotensin converting enzyme inhibitor enalapril and the diuretic hydrochlorothiazide was carried out in 40 patients with mild uncomplicated essential hypertension. Changes in plasma lipid profiles were also studied. The results show that the two treatments were equally efficacious in controlling blood pressure and were generally well tolerated.

Sustained-release diltiazem compared with atenolol monotherapy for mild to moderate systemic hypertension.

The daily administration of 240 to 360 mg of diltiazem lowered blood pressure in a dose-related pattern similar to that seen in patients taking a daily dosage of 50 to 100 mg of atenolol. Sustained-release diltiazem was administered twice daily and atenolol once. Goal blood pressure was defined as less than 90 mm Hg or a reduction of greater than or equal to 10 mm Hg for patients with baseline pressures of 95 to 99 mm Hg in the supine position and was achieved in 60% of diltiazem-treated and 63% of atenolol-treated patients.

Labetalol compared with propranolol in the treatment of black hypertensive patients.

A double-blind parallel group study was conducted to examine the effects of oral labetalol, in doses from 100 to 800 mg BID, and propranolol, 40 to 320 mg, in patients with mild to moderate hypertension. The doses of labetalol (n = 74) and propranolol (n = 79) were titrated weekly to achieve a sitting diastolic blood pressure (DBP) of less than 90 mmHg or at least a 10-mmHg decrease from placebo baseline on two consecutive visits. A 2-month fixed-dose maintenance phase followed in which a diuretic could be added if the sitting DBP was greater than or equal to 100 mmHg on maximum doses of either drug.

Hypertension in blacks.

Hypertension represents a problem of special importance in the black patient primarily because of frequency and increased severity. Differences between hypertension in blacks and whites in the United States seem to be mostly epidemiological, pathophysiological, and in responsiveness to drug therapy. Black hypertensives seem to have more of a salt-sensitive, volume-dependent type of hypertension and, therefore, diuretic therapy appears to be particularly useful.

Verbal memory deficits associated with major affective disorders: a comparison of unipolar and bipolar patients.

The verbal learning and fluency of patients with unipolar and bipolar depression were compared to those of normal controls and patients with Huntington's disease. The data demonstrated that the recall and recognition performance of both groups of depressed patients were impaired relative to the performance of normal control subjects. The bipolar patients, however, were more impaired than the unipolar patients on both tasks (P less than 0.

Postmarketing survey of the effects of an atenolol/chlorthalidone combination in the treatment of hypertension.

A large-scale postmarketing survey was conducted in the United States to evaluate the antihypertensive efficacy and safety of a combination of 50 mg of the long-acting cardioselective beta-blocker atenolol and 25 mg of the monosulfonamyl diuretic chlorthalidone. The program included 28,585 patients (of whom 26,892 provided sufficient information by questionnaire for an assessment of efficacy and race), and the participation of 7,009 primary-care physicians. After four weeks of treatment, patients had a mean reduction in systolic blood pressure of 21 mmHg and in diastolic blood pressure of 13 mmHg.

Stepped care and profiled care in the treatment of hypertension: considerations for black Americans.

The stepped-care approach to the treatment of hypertension has proved to be effective in helping control hypertension and in reducing morbidity and mortality associated with hypertension and related cardiovascular disease. Nevertheless, modifications to the stepped-care approach can provide more effective care for certain patient subgroups. By applying the best principles of stepped care to a more individualized methodology, a "profiled-care" approach to treating hypertension has been made available.

Male adolescent sexual offenders: the offender and the offense.

A group of male adolescent sexual offenders were divided into three groups: Courtship Disorders (Exhibitionism, Toucherism and Obscene Phone Calls), Sexual Assaults, and Pedophilic Offenses. Group I offenders tended to come from a less disorganized family background, were better adjusted to school and in the community and were seen by clinicians as less seriously disturbed than the adolescents in the other two groups. In addition, these adolescents did not experience the offense as a sexual act.

Secondary Hodgkin's disease in childhood acute lymphoblastic leukemia.

Improved survival in childhood acute lymphoblastic leukemia has led to the occurrence of second malignancies in these patients. Hodgkin's disease is very rare as a second malignancy. We report three patients with acute lymphoblastic leukemia in remission who developed Hodgkin's disease.

A social services-public health partnership in child protection: a rural model.

It is widely recognized that the amelioration of individual and family problems which contribute to child abuse and neglect requires a multidisciplinary effort. Unfortunately, however, these efforts are often sporadic or disjointed. This article is a description of a county social service-public health partnership in rural Minnesota which can serve as a model for other agencies interested in developing more interactive relationships with one another to the benefit of dysfunctional families and vulnerable children.

Allocation of feeding pumps: an ethical question.

Situations arise in clinical practice that force the dietitian to make a moral/ethical decision. Traditional undergraduate dietetic programs have not routinely included learning activities on ethical decision making. Therefore, a dietitian confronted with such an issue may defer to someone else the responsibility for finding a viable ethical solution.

Anaerobic osteomyelitis in sickle cell disease: association and pathophysiology.

A 10-year-old boy with sickle cell disease developed osteomyelitis of the humerus associated with blood cultures positive for Bacteroides fragilis. Clinical and radiological resolution followed a 10-day course of intravenous clindamycin. Attention is drawn to the definite but poorly recognized association between sickle cell disease and anaerobic osteomyelitis, and the probable pathophysiology is described.

What is the incidence of holoprosencephaly?

The incidence of holoprosencephaly with normal chromosomes has been estimated at between 1 in 16 000 and 1 in 53 394 live births. It has been found that during a 3-year period in the Bristol and Weston Health District there were six cases of holoprosencephaly, two of which were familial, and these cases are described. This represents an incidence of 1 in 5200 and during the preceding 3-year period the incidence in the same area was 1 in 14 520 births.

Transient erythroblastopenia of childhood: varied pathogenesis.

The mechanism of anemia in four patients with transient red cell aplasia of childhood ("erythroblastopenia") was studied at the time of diagnosis by assessing the colony growth of marrow erythroid progenitors in methylcellulose tissue cultures. Marrow from Patient 1 yielded high normal numbers of BFU-E colonies that were completely abolished on addition of autologous serum or IgG. Patient 2 had normal BFU-E growth that markedly declined when autologous serum or IgM was added to the cultures, but growth remained unchanged with added autologous IgG or peripheral blood mononuclear cells (PBMC).

Ribonuclease inhibition of erythropoiesis in anemia of uremia.

The anemia of chronic renal failure was studied by assessing the effect of uremic serum on proliferation of human marrow erythroid stem cells into colonies in vitro. Of 50 sera tested, 46 inhibited "CFU-E" colony formation by a mean of 72%, and 42 inhibited "BFU-E" colonies by a mean of 53.5%, compared to normal sera.

Anemia of chronic renal failure: inhibition of erythropoiesis by uremic serum.

The pathogenesis of anemia in patients with end-stage renal disease was studied by assessing the effect of uremic serum on the proliferation and maturation of erythroid progenitor cells, BFU-E and CFU-E, into colonies in vitro. Nucleated peripheral blood cells from 10 anemic patients produced normal or increased numbers of BFU-E colonies in response to added erythropoietin when cultured in control serum, but declined a mean of 63% when autologous uremic serum was substituted. Uremic sera from 90 patients cultured with normal human marrow produced a mean decrease in BFU-E colony growth of 72%, and of CFU-E colony growth of 82%, compared to control serum.

Serological survey of the prevalence of Toxoplasma gondii antibodies in rams in sheep flocks in New South Wales.

Serum samples from 5724 rams on 534 farms in New South Wales were tested in the indirect fluorescent antibody test for toxoplasmosis. Nine per cent of rams had titres of 64 or higher and 41% of flocks had either one or more rams with a titre of 64 or higher. There were significant differences in the geographical distribution of infected flocks, ranging from 57.