János Zatik

Blood pressure distribution in a Hungarian adolescent population: comparison with normal values in the USA.

Objectives To describe the blood pressure characteristics and distribution of all adolescent high school students (aged 15–18 years) in Debrecen (total population 230 000), Hungary. To define threshold values for normal blood pressure by age-, sex- and height-specific groups. To compare our data with results from a USA meta-analysis, which forms the basis of current guidelines. Participants and methods All young people attending high school in Debrecen (final sample n = 10 359) participated in the study. After they had rested for 10 min, three blood pressure measurements were taken from the right upper arm, separated by 5 min intervals. All measurements were obtained by a validated, automated, digital Omron M4 device. Results The 50th, 90th and 95th percentile values of blood pressure were defined by dividing the adolescent population into age-, sex- and height-specific subgroups. In comparison with USA guidelines, in our sample the systolic blood pressure of boys in the different subgroups was 6–11 mmHg greater, whereas this difference was less marked for girls (1–5 mmHg). There were no marked differences in diastolic blood pressure, but our values were slightly lower. Conclusions Our findings demonstrate the influence of geographical and ethnic variations on blood pressure. Acceptance and use of non-population-specific blood pressure distributions may lead to under- or overdiagnosis of adolescent hypertension. The use of geographically more relevant data should be encouraged.

Variable response of Hermansky-Pudlak syndrome to prophylactic administration of 1-desamino 8D-arginine in subsequent pregnancies

Hermansky-Pudlak syndrome is characterised by oculocutaneous albinism and haemorrhagic diathesis. The bleeding tendency that is associated with this autosomal recessive disease is caused by storage-pool deficiency and has been reported to be controllable by prophylactic administration of 1-desamino 8D-arginine (desmopressin, DDAVP). The DDAVP prophylaxis at the first delivery of our patient did not prevent the severe haemorrhagic sequeal requiring transfusion of packed red cells and platelets, but the same preventive measure was successful at her second childbirth. Response to prophylactic DDAVP administration varies between as well as within patients with Hermansky-Pudlak syndrome.

The prevalence of adolescent hypertension in Hungary - the Debrecen hypertension study.

Abstract Background. The aim of this study was to obtain epidemiological data and to determine the prevalence of adolescent hypertension implementing a blood pressure (BP) screening. Methods. We performed a cross-sectional, population-based survey in a major Hungarian city (Debrecen, population 230,000). After a 10-min resting period, three consecutive BP measurements were taken. Results. Complete records were obtained for 10,194 subjects (5163 boys and 5031 girls). The mean age was 16.6±1.0 years. BP for boys was higher than for girls (ΔBPsyst=11 mmHg; ΔBPdiast=2 mmHg, p<0.001). A significant decrease was observed in BP during the three consecutive measurements (time 1–3: ΔBPsyst=4 mmHg; ΔBPdiast=2.5 mmHg; p<0.001). Systolic and/or diastolic BP exceeded the age-, gender- and height-adjusted 90th percentile in 1614 (15.84%) adolescents. Following two lots of three extra measurements on 1461 subjects of this sub-sample, hypertension (systolic and/or diastolic BP exceeded the 95th percentile) was confirmed in 2.12% of the subjects (male: 2.27%, female: 1.97%). Considering there were individuals either already diagnosed with hypertension (n=19) or refusing further participation, the prevalence of hypertension was 2.53% in adolescents in the age range 15–18 years. Conclusion. Our population-based study was the first to determine the point-prevalence of adolescent hypertension in Central-Eastern Europe. Identifying and following-up cases of confirmed hypertension is inevitable to prevent or delay the manifestations of target organ damage and reduce hypertension-related mortality.

Assessment of cerebral hemodynamics during roll over test in healthy pregnant women and those with pre-eclampsia.

Objective To compare cerebral autoregulatory responses obtained during roll over tests in healthy pregnant women and those with pre‐eclampsia in order to assess the middle cerebral artery velocity changes in relation to the roll over test in normotensive and pre‐eclamptic women.

Fetal arterial redistribution indicating true umbilical cord knot

True umbilical cord knot often remains undiscovered prenatally due to a lack of characteristic clinical or ultrasound signs. We present a pregnancy with favorable outcome in which a non-stress test (NST) found non-reassuring fetal status. Abnormal Doppler blood flow patterns in the descending aorta and in the middle cerebral artery revealed fetal arterial redistribution with normal circulation in the umbilical artery despite a true cord knot. The benefit of fetal Doppler assessment is discussed. Increased aortic-cerebral ratio may reflect acute hypoxic compromise caused by the transitory constriction of the true umbilical cord knot with unrecognized morphologic and circulatory signs.

The impact of serum homocysteine on intima-media thickness in normotensive, white-coat and sustained hypertensive adolescents

Abstract Background and purpose. In recent decades, elevated levels of homocysteine (Hcy) have been found to be associated with an increased risk of vascular events. Additionally, in some case–control studies, hyperhomocysteinaemia has been found to be related to higher intima-media thickness (IMT), but the results are inconclusive. Therefore, in the present study we intended to assess the relationship between serum levels of Hcy and IMT in normotensive and hypertensive adolescents. Patients and methods. 59 normotensive 47 white coat hypertensive and 73 sustained hypertensive adolescents were included in our study. IMT of the common carotid arteries was measured by B-mode ultrasonography. Plasma NOx as well as homocysteine levels were measured in all cases. The relationship between IMT and Hcy and NOx were assessed by a pooled analysis. Additionally, serum levels of Hcy and NOx were compared between normotensives and hypertensive subgroups. Results. IMT was elevated in hypertensive adolescents (means ± SD: 0.055 ± 0.01 cm) compared with normotensives (0.048 ± 0.008 cm, p < 0.01). Higher serum concentrations of homocysteine were measured in hypertensive teenagers (11.9 ± 7.25 µmol/l for hypertensive and 9.85 ± 3.12 µmol/l for normotensives respectively, p < 0.01). In contrast to this, serum NOx was lower in patients (28.8 ± 14.9 µmol/l) compared with controls (38.8 ± 7.6 µmol/l, p < 0.01). The pooling of homocysteine and IMT data of hypertensive and normotensive adolescents revealed a significant positive relationship between the two parameters (r = 0.43, p < 0.001). Conclusions. We conclude that elevated serum levels of homocysteine may play a role in increased IMT in adolescent hypertension.

Factors influencing adolescent blood pressure: the Debrecen Hypertension Study.

Aim: To obtain epidemiological data on the blood pressure (BP) status of high school students and factors influencing BP. Methods: Subjects filled out a questionnaire and three repeated BP measurements were taken. All high school attending students in Debrecen (final sample n = 10,194, mean age 16.6 ± 1.0 years) participated in the study. Results: Boys had significantly higher systolic BP (+11.3 mm Hg) and diastolic BP (+2.2 mm Hg) than girls (p < 0.001). There was a positive correlation between weight and BP (rsyst = 0.42, rdiast = 0.29), height and BP (rsyst = 0.33, rdiast = 0.15), body mass index (BMI) and BP (rsyst = 0.31, rdiast = 0.27). Multiple regression was used for statistical analysis. Gender (β = 0.36), BMI (β = 0.25), hypertension of parents (father β = 0.04 and mother β = 0.02), smoking, alcohol consumption and age determined systolic outcomes in descending order. For the diastolic model, BMI remained a strong determining factor (β = 0.25) and gender was also significant (β = –0.09). Entering independents together accounted for 28.2% of the total variance in systolic and for 18.1% in diastolic BP. Conclusion: Body weight is central to determining BP. Because that is an alterable cardiovascular risk factor, we presume that lifestyle modification will not only result in reduced weight, but also in decreased BP.

Comparison of Cerebral Blood Flow Velocity as Measured in Preeclamptic, Healthy Pregnant, and Nonpregnant Women by Transcranial Doppler Sonography

Aim: To test the hypothesis that the middle cerebral artery blood flow velocity (MCAV) is altered in preeclamptic pregnant women as compared with healthy pregnant and nonpregnant women. Methods: Preeclamptic (n = 21) and healthy pregnant (n = 17) as well as healthy nonpregnant (n = 29) women underwent transcranial Doppler MCAV measurements. The mean MCAV values were compared between the different groups. Anova combined with Bonferroni correction was used for statistical analysis. Results: The MCAV was significantly higher in nonpregnant women (mean ± SE 73.0 ± 2.12 cm/s) as compared with healthy pregnant women (67.0 ± 1.8 cm/s, p = 0.0356). Preeclamptic women showed significantly higher MCAV values (83.5 ± 2.1 cm/s) as compared with nonpregnant females (73.0 ± 2.12 cm/s, p = 0.0014). Similar to nonpregnant women, healthy pregnant women showed lower MCAV values (67.0 ± 1.8 cm/s) as compared with preeclamptic women (83.5 ± 2.1 cm/s, p = 0.001). After Bonferroni correction the MCAV values in patients suffering from preeclampsia were still statistically significantly higher as compared with the two other groups. Conclusions: We detected increased resting MCAV values in pregnant women with preeclampsia. In our opinion, this finding refers to arteriolar dilation of the resistance vessels of the brain. Further studies are needed to prove altered vasoreactivity responses of the brain resistance arterioles in preeclampsia.

Intracardiac operation with the use of cardiopulmonary bypass

Study Methods: Quantitative and qualitative methods were combined to provide depth and numerical credence to the data. In the qualitative component, a broad spectrum of society, including compliers and noncompliers, were purposively selected. 22 focus group discussions, 7 key informants, 8 critical incidents and 6 Venn diagrams provided data and guided questionnaire development. The survey was subsequently conducted with 244 recently delivered women attending under 5 clinics. Only women referred during their pregnancy for delivery at the district hospital were included. Results: 54% (CI 47.3 60.6%) of high risk women complied with referral advice. Primagravidas and grand multiparas demonstrated highest non-compliance. 32% expressed fear of cesarean section, 17% cited distance and transport as problems, and 14% claimed poor provision of information. Other issues affecting compliance included fear of pain, altered body image and sexual pleasure following episiotomies, and enforced tubal ligation. Husbands played an important role and contributed to non-compliance fearing that absence of wives would lead to sexual infidelities. Educational status had a strong association with non-compliance as did attitude of staff (p=O.OOl). Women suggested that improved staff attitude and interpersonal communication were critical to referral compliance. Conclusions: The accuracy and utility of the high-risk approach has provoked much international debate. Unless significant efforts are primarily directed towards addressing user perspectives of quality, efforts to improve high-risk identification cannot impact upon maternal mortality irrespective of issues of sensitivity and specificity.

P3.19.01 Comparison of maternal middle cerebral artery blood flow velocity as measured in preeclamptic, healthy pregnant and non-pregnant women by transcranial Doppler sonography

Objective: Establishment of a following-up system for squamous intraepithelial lesion (SIL) of the uterine cervix by retrospective study. Method: Between 1984 and 1994, we have been mass-screened 177,340 subjects for uterine cervical cancer, and detected 798 cases of low SIL and high SIL (excluding cases of CIS) of the uterine cervix at the Tokyo Metropolitan Cancer Detection Center (detection rate 0.45%). We followed 860 cases, including cases that were referred to us. The following criteria were used in evaluating the outcome of SIL. Cases in which both cytological and colposcopical results were negative at least 3 times and continuously for at least 2 years were evaluated as regressing. Cases in which intraepithelial carcinoma or worse was confirmed histologically were evaluated as progressing. Cases which did not progress nor regress during at least 2 years of follow-up were evaluated as persisting. The average follow-up period for SIL was 49.8 months. Results: 1) Out of 383 cases of low SIL, 12 cases (3.1%) progressed, 97 cases (25.3%) persisted and 274 cases (71.4%) regressed. 2) Out of 194 cases of high SIL, 39 cases (20.1%) progressed, 68 cases (35.1%) persisted and 87 cases (44.8%) regressed. 3) Of the 361 cases that regressed, 301 did so within 2 years of follow“P. 4) Of the 51 cases that progressed, the operative histologic diagnosis was established in 44 cases. The breakdown was; CIS, 31 cases; MIC, 5 cases; SCC lb, 4cases. Conclusion: High SIL is a lesion that progresses at a rate of approximately six times that of low SIL. Closely controlled follow-up of high SIL is possible, but medical treatment is indicated if there is no regression within 2 years.