Arterial hypertension

Introduction: Pulmonary arterial hypertension (PAH) is frequently associated with thrombotic events, particularly involving the pulmonary microcirculation at sites of vascular injury. We therefore decided to analyse protease-activated receptor 1 (PAR1), a key element in the activation of human platelets by thrombin, in PAH patients in stable clinical condition. Methods: Using flow cytometry, we analyzed platelet PAR1 density, PAR1-mediated exposure of P-selectin and the formation of platelet-leukocyte aggregates in 30 PAH patients aged 11 to 78 years (median 50.5 years). The control group consisted of 25 healthy subjects with the same age range as patients. Results: In patients, total platelet PAR1 density and uncleaved PAR1 density correlated negatively with platelet count (r 2 = 0.33 and r 2 = 0.34 respectively, p b 0.0015). In patients with a low platelet count (b 150 × 10 9 platelets/L), both densities were increased relative to controls (82% and 33% respectively, p b 0.05). Thrombin peptide-induced platelet exposure of P-selectin was directly related to total and uncleaved PAR1 density (respectively, r 2 = 0.33 and r 2 = 0.29, p b 0.0025) and increased in subjects with low platelet count (46% versus those with normal platelet count, p b 0.05). Patients with low platelet count had decreased in vitro thrombin-induced formation of platelet-leukocyte aggregates (57% decrease versus controls, p b 0.05). Conclusions: There seems to be a subpopulation of PAH patients with increased propensity to thrombotic events as suggested by increased platelet PAR1 expression and PAR-mediated surface exposure of P-selectin associated with decreased platelet count.

Interchangeability between fast Fourier transform (FFT) and autoregressive (AR) analysis was assessed on series of 256 R-R intervals recorded in 56 seated subjects and in 15 men performing an orthostatic test. Low-(LF) and high-frequency (HF) components were calculated and expressed both in absolute (square milliseconds) and normalized units (NU). During orthostatic stress, the same upward trend for LF square milliseconds and LF/HF ratio and downward trend for HF square milliseconds and HF NU were observed with FFT and AR analysis. However, the values for HF square milliseconds were significantly greater with FFT, as compared with AR analysis in standing position ( P b .05). Moreover, Bland & Altman method highlighted a large discrepancy between the results of FFT and AR analysis for all heart rate variability indices in the 3 conditions. Therefore, parametric and nonparametric spectral analyses could not be considered as interchangeable at rest in healthy subjects even if they give same qualitative results. D

The purpose of this study was to assess the efficacy and safety of beraprost sodium, an orally active prostacyclin analogue, in New York Heart Association (NYHA) functional class II and III patients with pulmonary arterial hypertension (PAH). BACKGROUND Pulmonary arterial hypertension is a life-threatening disease for which continuous intravenous infusion of prostacyclin has been proven effective. However, this treatment is associated with serious complications arising from the complex delivery system.

Introduction: The purpose of this study was to examine the associations between resting blood pressure (BP), smoking, physical activity (PA) and body mass index (BMI) in Greek young adults. Materials and Methodology: A standardised questionnaire and the Greek version of IPAQ-short were given to 1500 randomly selected health science students, in order to record smoking behaviour, PA status, BMI and resting BP. All healthy young adults aged 19-30 years old were eligible. The final size of the study cohort was 1249 students (522 men). Results: Males’ BP was 129.2/77.0 mmHg, significantly higher than the females’ values of 119.9/73.4 mmHg. Approximately 17% of the total population were classified as overweight and 3% as obese. In the overall population, smoking prevalence was 35.2%, with 15.3% being heavy smokers (≥21 cigs/d). Smoking prevalence did not differ significantly between sexes. The prevalence of health-enhancing PA (high PAclass) was only 14.0%, while 42.8% of the study popul...

The vascular endothelium contributes for and it is affected by inflammatory phenomena. Alterations in the endothelial function in response to mechanical forces (arterial hypertension and shear stress) as well as immunological and biochemical factors reflect the first physiopathologic step for the activation of atherosclerosis. There is an increase of evidences indicating that the vascular inflammation can be involved in the beginning and in the development of the arterial hypertension, together with other very well established factors. Those data have been taking to the revision of the physiopathology of the arterial hypertension and its therapeutic basis. Also, it is probable that there is a potencialization of the anti-hypertensive drugs when combined as well as of its anti-inflammatory and antiatherosclerotic "parallel" effects to improve the endothelial function. Other new drugs, not necessarily anti-hypertensive, with different mechanisms may cause similar effects. Thus, pleomorphic actions of some anti-hypertensive drugs, combined or not, reinforce the importance of these mechanisms of endothelial dysfunction and deserve revision.

Артериальная гипертензия (АГ) по-прежнему занимает одно из ведущих мест в структуре общей заболеваемости. Поскольку одним из главных органов-мишеней при АГ является левый желудочек (ЛЖ), а визуальное измерение его структуры и функции несет значимую прогностическую информацию, важным аспектом считается разработка общих подходов к использованию эхокардиографии (ЭхоКГ). Совершенствование методов оценки гипертрофии ЛЖ, его систолической и диастолической функции побудило European Association of Cardiovascular Imaging (EACVI)
и American Society of Echocardiography (ASE) к созданию рекомендаций по использованию ЭхоКГ при АГ у взрослых. В документе, опубликованном в 2015 г., основное внимание уделено патофизиологическим изменениям в сердце и сосудах, возникающим при АГ, особенностям измерения массы миокарда ЛЖ (ММЛЖ), его геометрии, функции, а также оценке эффективности лечения. В представленном сообщении мы приводим обзор основных положений этого документа.

Owing to high prevalence of arterial hypertension (AH) and allergic rhinitis (AR), these diseases frequently coexist. The study aimed to assess whether improvement of AR by conventional treatment can improve blood pressure (BP) control in this population. Sixtyeight subjects of both sexes aged 35-60 years with AR and AH were randomized into two groups to receive in addition to their antihypertensive medications: treatment group (n ¼ 34) Fluticasone nasal 50 lg/spray b.i.d. and Fenoxifenadine 180 mg tablets q.d., and control group (n ¼ 34) 0.9% NaCl nasal drops b.i.d. Office BP and AR severity (using the Relative Quality of Life Questionnaire (RQLQ)) and high-sensitive C-reactive protein (hs-CRP) were measured at study entry and after 8 weeks in both groups, without changing of antihyper-tensive medications. In Treatment group an improvement in RQLQ, significant reduction of systolic BP (SBP) (DSBP 7.474.3 mm Hg, P ¼ 0.006) and reduction of hs-CRP level (DCRP 2.0571.08; P ¼ 0.028) were observed, whereas diastolic BP (DBP) remained unchanged (DDBP 0.971.7 mm Hg, P ¼ 0.7). There was a significant correlation between DRQLQ and DSBP (r ¼ 0.86; P ¼ 0.019) and between DCRP and DSBP (r ¼ 0.56; P ¼ 0.027). No statistically significant changes of RQLQ, BP and CRP were observed in the control group. In patients with coincidence of AH and AR, medications meant to improve AR attenuate low-grade systemic inflammation and can lower SBP, but not DBP.

The effects of the type 1 angiotensin II receptor antagonist Losartan potassium on intraocular pressure (IOP) were studied. Four groups of subjects were analysed: group A, ten controls; group B, ten patients with essential arterial hypertension and with IOP within the normal range; group C, ten patients with primary open angle glaucoma (POAG), but without essential arterial hypertension; group D, ten patients with arterial hypertension and POAG. The study design was held in a randomized crossover double-blind fashion. Systolic and diastolic arterial pressure, heart rate, pupil diameter, IOP and total out¯ow facility were recorded at baseline and at 1 hr intervals up to 6 hr, following the oral administration of 50 mg of Losartan potassium and/or placebo. The alternative treatment was given a week later. Drug administration signi®cantly reduced IOP in all subjects. No variation in heart rate and pupil diameter was observed during the follow-up period. Blood pressure dropped only in arterial hypertensive patients (groups B and D). Total out¯ow facility increased signi®cantly in all groups. Placebo did not induce any variation in all groups. These ®ndings demonstrate that the mechanism by which Losartan potassium reduces intraocular pressure is not mediated by a decrease in blood pressure, but rather it is more speci®c, con®rming the role of the renin-angiotensin system also in the regulation of intraocular pressure in man.

Según la revisión de Cowley y col. (1995), la función renal es generalmente normal en estados tempranos de muchas hipertensiones, pero claramente perturbada a largo plazo. Muchos estudios han establecido que la médula renal juega un rol importante en la homeostasis de sodio y agua y el control de la presión arterial sistémica a largo plazo. La flujometría laser﷓Doppler para medir los flujos sanguíneos corticales y medulares, junto con otras técnicas han servido para medir los cambios de flujo ante diversas sustancias. Los primeros cambios en la función renal de ratas espontáneamente hipertensas es la reducción del flujo sanguíneo medular, sin cambios en el flujo cortical. Lo sorprendente es que el flujo de la médula renal interna compromete menos del 1% del total del flujo renal, cambios en esta región tienen grandes efectos en la homeostasis del sodio y agua y, el control de la presión arterial a largo plazo. Las estrategias experimentales, continúan Cowley y col. (1995), se pueden dividir en 5 grandes líneas: 1) reducir la excreción de sodio y agua manteniendo a valores normales la presión arterial, esto incluye: la hipertensión de Goldblatt, el corte de aorta, la infusión a largo plazo de vasocontrictores como angiotensina II, vasopresina y norepinefrina (sólo si es infundida intrarenalmente). 2) en humanos y en los distintos modelos genéticos de hipertensión en ratas, la natriuresis es deprimida y la presión arterial aumentada. 3) administración de drogas antihipertensivas que promuevan la excreción de sodio y agua, con lo que logran bajar la presión arterial, algunas de estas drogas son inhibidores de enzima convertidora, bloqueadores de receptor de angiotensina II, diuréticos y vasodilatadores. 4) una adecuada administración contínua y a largo plazo de hormonas que ayudan a retener sodio y agua como angiotensina II y vasopresina﷓arginina, aumentan la presión de perfusión y restauran el balance de fluidos y electrolitos y previenen el desarrollo de una hipertensión. 5) transplantes de riñones hipertensivos en ratas normotensivas aumenta la presión arterial del animal y riñones normotensivos en ratas hipertensivas les baja la presión arterial, también ocurre en humanos y otros modelos genéticos de hipertensión en ratas. Existiendo otro modelo reciente de estudio en ratón, según Borkowski y col. (1995), la disrrupción homocigótica o, según Alfie y col. (1996), el "knochout" del gen que codifica el receptor B2 para bradicinina que bloquea la respuesta a bradicinina en muchos órganos.
La estrategia experimental 5) ha determinado y radicado el problema de la hipertensión en el riñón, ya que la evidencia experimental Es tremendamente concluyente.

The aim of present study was to formulate and evaluate oral multiparticulate pulsatile release of ramipril based on chronophamaceutical approach for the treatment of hypertension. In the present study the immediate release core mini tablets were prepared by direct compression by using various proportions of different superdisintegrants. The optimized core tablets were then coated with pH sensitive polymers like Eudragit -S100 and Eudragit-L100. To achieve the desired dissolution profile, various parameters like coating duration and coat thickness studied. The coated tablets were evaluated for hardness, thickness, friability, weight variation, drug content, and disintegration time and in-vitro drug release. In-vitro drug release was found to be 98 % from coated tablets in 20 min after 5 hrs lag time. FT-IR spectra revealed that there is no chemical incompatibility between the drug and other excipients. Scanning electron micrograph of optimized tablet shown that the thickness level in the coating. The results concluded the programmable pulsatile release has been achieved from coated tablets after a lag time of 5 hrs, which is consistent with the demands of the chronotherapeutic drug delivery and increasing bioavailability. Prasad et al___________________________________________________________________ BBB[1][1][2013]005-017

To determine the impact of gender, nutritional anomalies, puberty and socio-economic status on the levels of blood pressure, fat distribution and heat rate in African school children and adolescents. This study also identified the risk factors of arterial hypertension in African adolescents. Design: A cross-sectional study carried out between April and July 1996. Setting: Randomly selected schools of the semi-urban area of Kinshasa Province, capital of the Democratic Republic of Congo. Subjects: 1535 school children and adolescents. Outcome measure: Height, weight, waist circumference, hip circumferences, blood pressure and heart rate were measured. Body mass index, and waist-hip ratio, and Z-scores of NCHS/WHO for different levels of malnutrition were calculated for gender and age. Results: High rates of malnutrition forms and overweight/obesity coexisted. Boys with chronic malnutrition had significant higher blood pressure levels. Children with pooled types of malnutrition had higher waist circumference, waist-hip ratio and heart rate values. Children from the low socio-economic status had higher blood pressure and heart rate levels than those from high socio-economic status. Overweight/ obesity was more (p b 0.05) prevalent among female adolescents (68.5%) than male adolescents (24%). Obese male adolescents had higher blood pressure and heart rate levels than their non-obese male counterparts. 39% of variations of systolic blood pressure of male adolescents were explained only by body mass index, whereas 56% of variations of diastolic blood pressure of male adolescents were explained only by age. Only low socio-economic status was identified as a significant risk factor of arterial hypertension among these African adolescents (OR = 1.2; 95% CI 1.1 to 1.3; p b 0.01). Conclusion: Intervention strategies to combat poverty and high cardiometabolic risk may need to be developed for these African school children and adolescents.

Purpose: The aim of this study was to describe the clinical features and video-oculographic findings in patients with anterior semicircular canal benign paroxysmal positional vertigo (BPPV). Materials and methods: Study Design. This is a prospective case series. Setting. The study was set at an outpatient clinic in a general hospital. Patients. Fourteen individuals with symptoms of BPPV and positional downbeating nystagmus (pDBN) were included in the study. The diagnosis was based on a history of brief episodes of vertigo and the presence of pDBN confirmed in the videooculographic examination during Dix-Hallpike test (DH) or head-hanging maneuver. Intervention. Patients were treated by particle repositioning maneuver and the effectiveness was evaluated at 7, 30, and 180 days posttreatment. The treatment was repeated up to 4 times if pDBN was persistent. Main Outcome Measures. The main outcome measure is the number of patients without pDBN at 30 and 180 days. Results: Video-oculography showed a predominant pDBN in response to DH. Of the 14 patients, 7 had arterial hypertension, and 5 of 14 cases presented abnormalities on the caloric test. Horizontal spontaneous nystagmus was found in 3 of 14 individuals. Positional nystagmus at different positional test was observed in 5 of 14 individuals, suggesting the involvement of several canals. Of the 14 patients, 10 (71%) did not present vertigo, and the positional tests were negative at 30 days. However, 3 cases presented a positive DH with persistence of BPPV episodes and pDBN at 30 days, and another developed a contralateral posterior canal affectation. One of the patients maintained a persistent pDBN at 180 days despite the repeated maneuvers. Conclusions: Video-oculography demonstrates that anterior canal BPPV is characterized by a predominant downbeating nystagmus in response to DH. These individuals may show alterations in the vestibular caloric, and they can have multicanal affectation. D

Preeclampsia consists in a pathological disorder of pregnancy that is potentially harmful and life-threatening. It is the major cause of maternal-fetal morbidity and mortality. Clinical symptoms are now better documented, yet its physiopathology remains controversial. A generalized vascular injury, mainly at the endothelial level, is considered to be responsible for the persistence of cardiovascular manifestations such as arterial hypertension. This disease does not develop without the placenta, which represents the first organ that serves as a medium for exchange between the mother and the embryo, later the foetus. Inflammatory and immune reactions, along with gene expression that take place during normal pregnancy, are usually harmonious and limited, but an imbalance, probably from multifunctional origin, could lead to an insufficient development of helical arteries, which is necessary for the foetal growth. It appears plausible that a local hypoxia and oxidative stress will generate an increased inflammation, initially local and later generalized at the maternal systemic level. Then activated cells, such as leucocytes, platelets as well as the reactive oxygen species, induce the endothelial dysfunction. The vascular injury is also the consequence of the enhanced anti-angiogenic placental proteins, which primarily inhibit placental development. The general cell activation enters a vicious circle, originating microparticles of various phenotypes, which contribute to enhance a pathological systemic reaction, and vascular inflammation, which lead to complications such as eclampsia. It seems that the anti-angiogenic factors and microparticles may currently serve as a basis for research and development of therapeutics research. © 2007 Société de réanimation de langue française. Publié par Elsevier Masson SAS. Tous droits réservés.

a Inserm U820, centre de référence des maladies rénales rares « néphrogones », hôpital Femme-Mère-Enfant, hospices civils de Lyon, université Claude-Bernard Lyon 1, 59, boulevard Pinel, 69677 Bron cedex, France b Unité maladies entériques, alimentaires et zoonoses, département des maladies infectieuses, institut de Veille Sanitaire, 94410 Saint-Maurice, France c Service des urgences et réanimation pédiatriques, hôpital Femme-Mère-Enfant, 69677 Bron cedex, France Disponible sur Internet le 14 mai 2011

Reçu le 28 novembre 2001 ; accepté le 23 juin 2002 Résumé Propos. -Analyser les aspects anatomocliniques et évolutifs de l'atteinte rénale associée à la maladie de Behçet à travers 6 observations colligées dans le service de néphrologie de 1985 à 2000 et faire une revue de la littérature.

Table 2 Factors influencing prognosis Risk factors Subclinical Organ Damage Systolic and diastolic BP levels Electrocardiographic LVH (Sokolow-Lyon > 38 mm; Cornell > 2440 mm M ms) or: Levels of pulse pressure (in the elderly) Echocardiographic LVH8 (LVMI M ! 125 g/m 2 , W ! 110 g/m 2 ) Age (M > 55 years; W > 65 years) Carotid wall thickening (IMT > 0.9 mm) or plaque Smoking Carotid-femoral pulse wave velocity >12 m/s Dyslipidaemia Ankle/brachial BP index < 0.9 -TC > 5.0 mmol/l (190 mg/dl) or:

Wpływ wieloletniego treningu na strukturę i funkcję mięśnia sercowego sportowców weteranów w porównaniu z efektami długotrwającego nadciśnienia tętniczego -ocena echokardiograficzna The influence of many years' sport training on myocardial structure and function in veteran sportsmen in comparison to the effects of long-lasting arterial hypertension -echocardiographic evaluation Summary Background The changes in myocardium connected with sport training refer particularly to its structure and they are the consequence of physical training. The aim of our study was to compare echocardiographic findings in veteran sportsmen (n = 90), persons with longlasting arterial hypertension, that never practiced sport activity (n = 60) and control group (n = 35). Material and methods All study participants underwent physical examination, arterial hypertension measurement and echocardiography with cardiac cavities, wall thickness, LVM, EF and diastolic function estimation. Results LVDd was significantly different in all groups; the highest values belonged to the hypertension group. There were no significant changes between sportsmen and control group in IVS thickness and PW thickness. The highest values of IVS and PW thickness corresponded to the hypertension group. Remaining parameters (LA, Ao, LVM and LVMI) reached the highest values in hypertension group and the difference was statistically significant between all study groups. Conclusions The highest heart cavities parameters were observed in hypertension group. The only one exception was RVDd in sportsmen group. In spite of many years physical training the changes in myocardium in sportsmen are less advanced in comparison with hypertensive patients. key words: physical training, systolic and diastolic left ventricle function, estimation of diastolic function, arterial hypertension Arterial Hypertension 2008, vol. 12, no 2, pages 87-93.

Heart failure (HF) is a disease of the elderly and an important public health problem, due to a greater life span and multiple risk factor prevalence in developed societies, particularly arterial hypertension and coronary disease. The clinical syndrome of Acute Heart Failure (AHF) may present as acute new onset HF or as decompensated Chronic Heart Failure. Diagnosis is made mainly in a clinical basis, supported by complementary diagnostic tests, namely plasma brain natriu- retic peptide (BNP), chest X-ray, electrocardiogram (ECG) and

We present the case of a 69 year-old woman who had two recurrent Miller Fisher syndrome and arterial hypertension. The clinical findings at emergency admission were headache, dyplopia, and gait disorder. Clinical examination showed the classic triad ophtalmoplegia, ataxia and arreflexy. We describe neuroimaging, spinal fluid, electromyography and anti gangliosid GQ1b antibody results. Clinical recovery was total and she is

We hypothesize that pulmonary arterial hypertension (PAH)-associated genes identified by expression profiling of peripheral blood mononuclear cells (PBMCs) from patients with idiopathic pulmonary arterial hypertension (IPAH) can also be identified in PBMCs from scleroderma patients with PAH (PAH-SSc). Gene expression profiles of PBMCs collected from IPAH (n=9), PAH-SSc (n=10) patients and healthy controls (n=5) were generated using HG_U133A_2.0 GeneChips and processed by RMA/GCOS_1.4/SAM_1.21 data analysis pipeline. Disease severity in consecutive patients was assessed by functional status and hemodynamic measurements. The expression profiles were analyzed using PAH severity-stratification, and identified candidate genes were validated with real time PCR (rtPCR). Transcriptomics of PBMCs from IPAH patients was highly comparable with that of PMBCs from PAH-SSc patients. The PBMC gene expression patterns significantly correlate with right atrium pressure (RA) and cardiac index (CI), known predictors of survival in PAH. Array stratification by RA and CI identified 364 PAH-associated candidate genes. Gene ontology analysis revealed significant (Z score > 1.96) alterations in angiogenesis genes according to PAH severity: MMP9 and VEGF were significantly upregulated in mild as compared to severe PAH and healthy controls, as confirmed by rtPCR. These data demonstrate that PBMCs from patients with PAH-SSc carry distinct transcriptional expression. Furthermore, our findings suggest an association between angiogenesis-related gene expression and severity of PAH in PAH-SSc patients. Deciphering the role of genes involved in vascular remodeling and PAH development may reveal new treatment targets for this devastating disorder.

Scorpion envenomation is common in tropical and subtropical regions. Cardio-respiratory manifestations, mainly cardiogenic shock and pulmonary edema, are the leading causes of death after scorpion envenomation. The mechanism of pulmonary edema remains unclear and contradictory conclusions were published. However, most publications confirm that pulmonary edema has been attributed to acute left ventricular failure. Cardiac failure can result from massive release of catecholamines, myocardial damage induced by the venom or myocardial ischemia. Factors usually associated with the diagnosis of pulmonary edema were young age, tachypnea, agitation, sweating, or the presence of high plasma protein concentrations. Treatment of scorpion envenomation has two components: antivenom administration and supportive care. The latter mainly targets hemodynamic impairment and cardiogenic pulmonary edema. In Latin America, and India, the use of Prazosin is recommended for treatment of pulmonary edema because pulmonary edema is associated with arterial hypertension. However, in North Africa, scorpion leads to cardiac failure with systolic dysfunction with normal vascular resistance and dobutamine was recommended. Dobutamine infusion should be used as soon as we have enough evidence suggesting the presence of pulmonary edema, since it has been demonstrated that scorpion envenomation can result in pulmonary edema secondary to acute left ventricular failure. In severe cases, mechanical ventilation can be required.

Reliable clinical or laboratory markers of chronic idiopathic urticaria (CIU) duration are not available. Angioedema, autologous serum skin test (ASST) results, and antithyroid antibodies have been inconsistently associated with longer urticaria duration.

Background: Several novel criteria can improve detection of subclinical atherosclerosis. In particular, the clinical interest has focused on lipoprotein(a), a modified LDL particle which presents a structurally homologue protein to plasminogen.
Aim: The aim of our work was to evaluate the levels of lipoprotein(a), in hypertensive patients with or without atherogenic dyslipidemia comparative with a control group and to estimate the relationship of Lp(a) with other biological and functional parameters.
Methods: The study included 40 hypertensive patients with atherogenic dyslipidemia (HTN+DYS), 43 hypertensive patients without atherogenic dyslipidemia (HTN-DYS) and 35 control subjects, aged and sex matched. The hypertensive patients were not receiving pharmacological therapy and had no clinical signs of associated pathologies or organ damage. We determined in all groups the levels of Lp(a), apolipoprotein A-I and apolipoproteinB and fibrinogen. Lipoprotein(a) was measured by enzyme immuno assay (ELISA) test. Using B-mode ultrasonography we determined carotid intima-media thickness (IMT) and flow mediated vasodilatation (FMD) in all patients.
Results: Lp(a) was significantly higher in HTN+DYS group than in HTN-DYS group and than in control group (77.18 ± 48.51 mg/dL versus 58.14 ± 47.31 mg/dL versus 22.64 ±11.86 mg/dL versus , p<0.001). A significant correlation was found between Lp(a) and IMT (r = 0.64, p < 0.001), between Lp(a) and fibrinogen (r = 0.78, p < 0.001), and between Lp(a) and brachial FMD (r = -0.29, p < 0.001). Lp(a) levels were not correlated with total cholesterol, LDL-cholesterol, HDL-cholesterol, apolipoproteins A-I or B or apoA-I/apoB.
Study Limitations: Potential limitations of our study are the relative small number of patients and controls and missing apo(a) phenotype.
Conclusion: Lp(a) levels are related to early structural changes of the carotid arteries as shown by ultrasound measurements of IMT and to early functional changes evaluated by brachial FMD and can be considered an emerging risk factor for premature atherosclerosis.

Maturity-onset diabetes of the young (MODY) is a form of non-insulin-dependent diabetes mellitus (NIDDM) characterized by early onset, usually before 25 years of age and often in adolescence, and by autosomal dominant inheritance . Although commonly thought to be a relatively rare form of NIDDM, recent studies suggest that it may not be that uncommon and 2-5 % of patients with NIDDM may in fact have MODY . Mutations in genes on chromosomes 20, 7 and 12, designated MODY1, MODY2/glucokinase (GCK) and MODY3, respectively, can cause this form of diabetes . Moreover, there are likely to be additional MODY genes since there are families in which MODY does not cosegregate with markers tightly linked to the three known MODY loci . , Illinois tions of diabetes. Obesity, arterial hypertension and dyslipidaemia are also uncommon in this form of NIDDM. [Diabetologia (1997) 40: 217-224] Abbreviations: NIDDM, Non-insulin-dependent diabetes mellitus; MODY, maturity-onset diabetes of the young; GCK, glucokinase gene; IGT, impaired glucose tolerance; IDDM, insulin-dependent diabetes mellitus; bp, base pair. a Sequence of mutation at splice donor site in family F553: G[TGGGCCGGGT]GGAGGGGCA → GGGAGGGCA The three classes of stop codons are amber (AM), ocher (OC) and opal (OP)

Oblicza zespołu rakowiaka u chorych z nadciśnieniem tętniczym Faces of the carcinoid syndrome in patients with hypertension Summary Background Carcinoids are neuroendocrine tumors which develop in many different parts of gastrointestinal tract and lungs. They occur with the frequency of 1-3/100 000. Their common feature is the ability to production and secretion of hormone-like peptides and neurotransmitters. The carcinoid syndrome is caused by dissemination of serotonin producing neuroendocrine tumor. Symptoms of carcinoid, such as: skin redness on the face and neckflash, tachycardia, vertiges, hyperhidrose and bronchospasm are paroxysmal (periodic). Blood pressure elevation is not a patognomic sign of carcinoid, but if it is, one should be classified as secondary cause of arterial hypertension. The measurement of: serotonin, it's metabolite in the urine-5-hydroxyindoloacetic acid, chromogranin A levels and computed tomography, nuclear magnetic resonance, ultrasonography, somatostatin receptor scintigraphy (SRS) are crucial in the diagnostic process of carcinoid and in localization of metastases. Material and methods Sixty four-years old man was admitted to the hospital because of cough attacks with slight production of sputum which contained small amount of blood, diarrhea, abdominal pain, paroxysmal redness of the face and high blood pressure. Another patient, 69-years old woman was hospitalized because of dyspnea, fatigue and high blood pressure.

Endometrial ablation has emerged as a viable alternative to hysterectomy in the treatment of medically intractable dysfunctional uterine bleeding. However, this procedure cannot guarantee complete removal of the entire endometrium. Cases of endometrial cancer after endometrial ablation have been reported in the literature. We reviewed the cases of patients who underwent hysteroscopic endometrial ablation by endometrial resection for abnormal uterine bleeding from 1994 to 2005 at the Department of Obstetrics and Gynecology, Polyclinique, Clermont-Ferrand University. Of the 3769 patients having had hysteroresections, four developed endometrial cancer after complete endometrial ablation (1.06 out of 1000). All four of these patients showed histological evidence of endometrial polyps at endometrial resection, and all of them presented risk factors for endometrial carcinoma, such as obesity and/or arterial hypertension. Endometrial cancer after hysteroscopic endometrial ablation is a rare but possible occurrence, even a long time after the operation. Close monitoring of patients who have undergone endometrial ablation for endometrial polyps and who present risk factors, such as obesity or hypertension, even after apparent total ablation of the endometrium is strongly recommended, independently of the presence of abnormal bleeding that can represent a late symptom of advanced endometrial cancer.

Background: Hypertension is an extremely common clinical problem, affecting approximately 1 billion individuals worldwide. An estimated 1% to 2% of patients with chronic hypertension will at some time develop hypertensive crises (Hypertensive urgency and emergency). Hypertensive urgency and emergency are differentiated by the absence or presence of acute end-organ damage, respectively. The blood pressure of patients with hypertensive emergencies should be reduced rapidly during the treatment. It should not be reduced to the normal value, but by approximately 20-30% of the baseline value. The reason for a stepwise reduction in blood pressure is the fact that patients with chronic hypertension have an altered auto regulation curve.

Background: The arterial hypertension varies in according to the circadian cycle, presenting physiologic fall of blood pressure (BP) during sleep (dipping). The absence of this fall or its increase associates to higher incidence of target-organ damages.

To describe the advances in research into the physiological role of white adipose tissue, with emphasis on its endocrinal role in inflammatory processes, feeding behavior, insulin sensitization and modulation of the atherogenetic process. To deal with the potential role of adipose tissue as a source of stem cells for regeneration of tissues, with special emphasis on adipogenesis and its consequences for development of obesity.

A 16-year experience in the follow-up of survivors with acute radiation syndrome (ARS) caused by the Chernobyl Nuclear Power Plant accident is presented. Oncohematological diseases and sudden cardiac death were at the top of the list as causes of death. In the 16th year after the accident, the number of people with hematological syndromes was halved in comparison with the earliest 2 years observation. The radiation-induced combined immunodeficiency of 1986 -1987 decreased in the later period of recovery. Nervous system disorders were characterized by a gradual increase in organic changes in the central nervous system. Endocrine system diseases were nodular goiter, thyroid carcinoma, hypothyroidism and diabetes. A slow increase of cardiovascular pathology was discovered during the post-accident years, mainly due to arterial hypertension and ischemic heart disease. Inflammatory and erosive-ulcerous pathological processes of stomach and duodenum have essential ratio in the total morbidity structure of the digestive system. From 1987 to 2002 the bronchopulmonal pathology increased from one-third to one-half of the survivors depending on the degree of ARS. Late skin changes after acute radiation lesion were characterized by atrophy, hyperand hypopigmentation, peeling, telangiectases and trophic ulcers. The number of radiation cataracts correlated directly with ARS severity. Possible trends in international cooperative investigations of ARS patients are discussed. D