Objective-To determine the effect of moderate dietary sodium restriction on the hypertension of non-insulin-dependent (
Fifty hypertensive Type 2 (non-insulin-dependent) diabetic patients were allocated, in a controlled trial, to a treatment diet of high fibre, low fat and low sodium composition, or to a control diet by the hospital dietitian. After 3 months treatment, the modified diet-treated group showed a highly significant reduction in mean systolic (180.5 +/- 19.0 to 165.0 +/- 20.7 mmHg) and diastolic blood pressure (96.6 +/- 9.3 to 88.0 +/- 10.5 mmHg), accompanied by significant reductions in urinary sodium excretion (183.0 +/- 62.1 to 121.7 +/- 65.8 mmol/day) glycosylated haemoglobin (12.4 +/- 3.1 to 10.5 +/- 2.9%), weight (74.6 +/- 13.5 to 71.7 +/- 12.1 kg) and serum triglyceride levels (p less than 0.05). The mean values of diastolic pressure (p less than 0.01), urinary sodium/potassium ratio (p less than 0.001), urinary potassium (p less than 0.01) was significantly reduced at 3 months compared to control. No changes in serum HDL-cholesterol levels were observed. The number of patients with normal blood pressure at 3 months was greater in the modified diet-treated group (ten versus five). Treatment of mild hypertension in diabetic subjects with this form of dietary regimen has a hypotensive response, with improvement in glycaemic control and no side effects. This modified diet may be an attractive alternative to anti-hypertensive drug therapy as a first line treatment.
245attacks. Oestrogens may increase the plasma concentrations of some of the coagulation factors with shortening of the prothrombin time. Toy et al2 found this effect with synthetic oestrogens but not with "natural" oestrogen (oestriol succinate). Thus it is improbable that this mechanism was responsible for thromboembolic episodes in our patient. The oestrogen preparation she was taking was a naturally occurring one (conjugated equine oestrogen), and the patient's prothrombin times remained within the therapeutic range, at levels similar to those maintained in the past without embolic symptoms.An increase in platelet adhesiveness, which can be shown during oestrogen therapy,3 was probably responsible for the appearance of embolic phenomena in our patient. The importance of platelets in the genesis of emboli from prosthetic heart valves is further illustrated by reports that patients being treated with dipyridamole in addition to oral anticoagulants derive greater protection from nonfatal thromboembolism than those taking anticoagulants alone.4In an extensive review of reports on oestrogen treatment in postmenopausal women, Shoemaker et a15 concluded that there was no proved risk of thromboembolic disease on such treatment. While this may be true for most women, it does not necessarily apply in those with an additional predisposing factor, such as a prosthetic heart valve. Our case illustrates the potential risks of oestrogen therapy in patients with valve prostheses. Anticoagulation with warfarin or phenindione alone should not be considered to protect these patients adequately against thromboembolic complications of oestrogen treatment. Non-essential oestrogen administration should be avoided in all patients with prosthetic heart valves.We are grateful to Dr J P Lee-Potter for providing haematological data, and to Mrs B Davies for her help in preparing this paper. Case reportsCase 1-A 30-year-old Caucasian housewife presented with a three-week history of blurring of vision of the left eye, two weeks' morning nausea and vomiting, and three days' haematuria. She had no history of hypertension and was taking no medication. She smoked five cigarettes daily. She had a sinus tachycardia of 124/min, blood pressure of 270/175 mm Hg, and clinical and electrocardiographic features of left ventricular hypertrophy. Fundoscopy showed grade IV hypertensive retinopathy, and visual acuity was decreased in the left eye. After admission to hospital she received methyldopa 500 mg by mouth six-hourly (figure). The next day she was confused and drowsy but there were no new focal neurological signs. Methyldopa was withdrawn and propranolol 80 mg eight-hourly and Moduretic two tablets daily given. Thirty-six hours after admission her conscious level was normal but she complained of total loss of vision and hallucinations. The pupils were bilaterally dilated and unresponsive to light. Fundal appearances were unchanged. Dexamethasone 4 mg six-hourly was given from the fourth day without measurable benefit. The only other neurological...
Fourteen patients with Cushing's disease treated by trans-sphenoidal hypophysectomy between 1962 and 1975 were reviewed in 1983. Complete ablation had been attempted. There were no surgical deaths and one episode of bacterial meningitis. Two patients required a second operation for a cerebrospinal fluid leak. There have been three late deaths from unrelated causes. All patients had a biochemical remission of their Cushing's disease postoperatively and no relapse has been recorded. Most patients need some hormone replacement but residual pituitary function and sella radiography have remained stable. This treatment seems satisfactory and the evidence implies a pituitary aetiology of the syndrome.
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