Recurrent cholestasis following ovarian hyperstimulation syndrome: case report.
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This is a case report illustrating a patient who developed recurrent cholestasis during a twin pregnancy following in-vitro fertilization (IVF) treatment. On the first occasion cholestasis developed unusually in the first trimester, and on the second occasion, it presented in the way that obstetric cholestasis (OC) is commonly seen in the third trimester. (+info)
The effect of methyldopa on retinal artery circulation in pre-eclamptic gravidae.
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OBJECTIVE: To evaluate the effect of methyldopa on retinal artery circulation in pre-eclamptic gravidae using color Doppler imaging and spectral analysis. METHODS: Fifty-three pre-eclamptic singleton gravidae of gestational age greater than 22 weeks were examined. Patients with sustained hypertension after 1-2 days hospital rest were treated with oral antihypertensive medication, 250-500 mg methyldopa, three to four times a day for a minimum of 5-7 days. The right central retinal arteries were insonated and Doppler waveform values were analysed before and after medication. RESULTS: The change of the maternal heart rate after methyldopa treatment was -3.96 +/- 7.88 beats per min (P = 0.0006). The change of fetal heart rate was not significantly altered. The change of the diastolic arterial blood pressure after treatment was -4.19 +/- 12.36 mmHg (P = 0.0169). In 36 gravidae, in whom hypotensive effects were noted after treatment with methyldopa, the increase in peak velocity, end-diastolic velocity and mean velocity of the retinal artery were 2.41 +/- 2.20 (P < 0.0001); 1.48 +/- 1.23 (P < 0.0001) and 1.70 +/- 1.42 (P < 0.0001), respectively. The decrease in pulsatility index of the retinal artery after treatment with methyldopa was -0.17 +/- 0.22 (P < 0.0001). In the remaining 17 gravidae, in whom no hypotensive effects were noted after treatment with methyldopa, the decrease in end-diastolic velocity and mean velocity were -1.50 +/- 1.70 (P = 0.0022) and -0.98 +/- 1.90 (P = 0.0488), respectively. The increase in pulsatility index was 0.34 +/- 0.30 (P = 0.0003). CONCLUSIONS: In pre-eclamptic gravidae in whom the hypotensive effects were noted after treatment with methyldopa, the mean velocity of the retinal arteries was significantly higher and the mean pulsatility index lower after treatment. We conclude that the hypotensive effect of methyldopa in pre-eclamptic gravidae is associated with a significant decrease in retinal artery vascular resistance. (+info)
Prolactin in hypertensive pregnancy.
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Plasma prolactin levels were measured in 68 pregnant women with hypertension at 32 weeks gestation. They were raised in pregnancies with pre-eclamptic features, most significantly in women with a rising plasma urate level. No correlation was found between the level of the untreated blood pressure and prolactin. Proteinuria did not influence prolactin levels independently of changes in the plasma urate. The differences in prolactin levels could not be ascribed to the drugs administered. (+info)
Effect of phenobarbital and spironolactone treatment on the oxidative metabolism of antipyrine by rat liver microsomes.
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The effects of pretreating rats with the inducers, phenobarbital or spironolactone, on the formation rate of the three major oxidative metabolites of antipyrine in vitro by hepatic microsomal fractions have been investigated. Both inducers reduced the rate of 3-methylhydroxylation of antipyrine by approximately 50%. In contrast, N-demethylation and 4-hydroxylation were enhanced 1.7-fold and 3.4-fold, respectively, in case of phenobarbital induction and 1.4-fold and 2.6-fold, respectively, following spironolactone treatment. To elucidate the role of some cytochrome P450 isoenzymes in the production of the three major metabolites of antipyrine, the effects of form selective enzyme inhibitors on antipyrine oxidation were also studied. Troleandomycin did not alter 3-methylhydroxylation but reduced both N-demethylation and 4-hydroxylation of antipyrine in microsomes from induced rat liver. Cimetidine and chloramphenicol decreased the rate of formation of all three metabolites in microsomes from induced and uninduced animal livers as well. Chloramphenicol seemed to be the most potent inhibitor of in vitro antipyrine oxidation. Alpha-methyldopa significantly enhanced the rate of formation of 4-hydroxyantipyrine and slightly reduced the rate of N-demethylation and 3-methylhydroxylation. According to the data obtained with microsomes from uninduced rat livers, the formation of the three major metabolites of antipyrine is extensively mediated by CYP2C11/C6. In microsomes from induced animal liver, CYP2B and CYP3A may contribute to both N-demethylation and 4-hydroxylation of antipyrine. (+info)
Relationship between treatment-induced changes in left ventricular mass and blood pressure in black african hypertensive patients: results of the Baragwanath Trial.
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BACKGROUND: In a single-center study, we compared to what extent changes in conventional and ambulatory blood pressure (BP) predicted regression of left ventricular mass (LVM) index in response to antihypertensive treatment in previously untreated and treated patients with sustained hypertension. METHODS AND RESULTS: We enrolled 173 black African patients who, off treatment, had a daytime diastolic BP ranging from 90 to 114 mm Hg. Antihypertensive drugs were titrated and combined to reduce the daytime diastolic BP below 90 mm Hg. Echocardiograms were obtained at baseline and follow-up. Mean systolic/diastolic clinic BP, 24-hour BP, and LVM index were similar in previously untreated (n=64) and previously treated (n=109) patients and averaged 171/102 mm Hg, 151/97 mm Hg, and 118 g/m2, respectively. At 4 months, these values had decreased (P<0.001) by 26/12 mm Hg, 23/14 mm Hg, and 14 g/m2 in previously untreated patients and by 22/9 mm Hg, 21/13 mm Hg, and 19 g/m2 in previously treated patients. In the previously untreated patients, the regression in LVM index correlated to a similar degree (P=0.09) with the decreases in the conventional (r=0.34; P=0.005) and the 24-hour (r=0.26; P=0.04) systolic BP. In the previously treated patients, the corresponding correlations were 0.02 (P=0.82) and -0.10 (P=0.32), respectively. Compared with the 24-hour systolic BP, automated oscillometric measurements of systolic BP obtained at the clinic yielded similar results. CONCLUSIONS: In previously untreated patients with sustained hypertension followed at a single center, reductions in clinic and ambulatory systolic pressure in response to antihypertensive treatment equally predicted the regression in LVM index. (+info)
Cardiovascular effects of dopamine after central administration into conscious cats.
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Dopamine (30 and 45 mug) administered intracerebroventricular (i.c.v.) to a group of 10 conscious normotensive cats caused dose-related increases in blood pressure and heart rate. In 4 of these animals the initial cardiovascular stimulant effects of i.c.v. dopamine were followed by hypotension and bradycardia. 2 alpha-Methyldopamine (30 and 45 mug i.c.v.) produced qualitatively similar responses to dopamine except that the cardiovascular stimulant effects were smaller and the secondary depressant effects somewhat more prolonged. 3 Both stimulant and depressant effects of i.c.v. dopamine and alpha-methyldopamine were greatly inhibited by autonomic ganglion blockade or by adrenergic neurone blockade. 4 The cardiovascular stimulant effects of both i.c.v. dopamine and i.c.v. alpha-methyldopamine were selectively inhibited by beta-adrenoceptor blocking agents whilst the cardiovascular depressant effects of these substances were abolished by the alpha-adrenoceptor blocker phentolamine or by the dopamine-beta-hydroxylase inhibitor disulfiram. 5 Haloperidol by either i.c.v. or the intravenous route abolished both cardiovascular stimulant and depressant effects of i.c.v. dopamine, whilst pimozide by either route inhibited only the cardiovascular stimulant effects. 6 In 2 cats, injection of dopamine into the cisterna magna produced predominantly depressant effects on the cardiovascular system except with a higher dose which induced biphasic responses. (+info)
Isolation of isoflavones inhibiting DOPA decarboxylase from fungi and streptomyces.
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By screening of culture filtrates of fungi and streptomyces for activity in inhibit dopa decarboxylase the following isoflavone compounds were obtained: psi-tectorigenen (I), genistein (II), orobol (IV), 8-hydroxygenistein (V) and a new compound (III). III was elucidated to be 3', 4', 5, 7-tetrahydroxy-8methoxy isoflavone. Among these isoflavones, IV and III showed the strongest activity in inhibiting dopa decarboxylase. All these isoflavones also inhibited histidine decarboxylase and catechol-O-methyltrasnferase. Activities of these compounds to inhibit tyrosine hydroxylase and dopamine beta-hydroxylase were examined. Orobol which showed no or only slight inhibition of tyrosine hydroxylase and dopamine beta-hydroxylase exhibited a significant hypotensive effect on spontaneously hypertensive rats. (+info)
The effect of antihypertensive drugs on the fetus.
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A critical review of the literature on the effects of antihypertensive drugs on the fetus in pregnant women is presented. The survey covers the alpha-adrenergic receptor agonists, beta-blockers including topical eye medications, alpha-beta blockers, calcium antagonists, diuretics, and angiotensin-converting enzyme (ACE) inhibitors. The lack of data on angiotensin II receptor blockers is noted although effects are considered to be similar to those reported with ACE inhibitors and therefore to be avoided. Analysis of the literature underscores that some antihypertensive drugs can be used safely at certain stages of pregnancy, while others are suspect and to be avoided at all costs. The lack of placebo-controlled studies on the treatment of severe hypertension in pregnancy due to ethical considerations is discussed against the background of the pressing need to treat these women despite the possible deleterious effects of antihypertensive drugs. (+info)