Leslie Dornfeld

The Effect of Weight Reduction on Blood Pressure, Plasma Renin Activity, and Plasma Aldosterone Levels in Obese Patients

We investigated the relation between changes in the renin-aldosterone axis and reduction in blood pressure in 25 obese patients placed on a 12-week reducing diet; sodium intake was either medium (120 mmol) or low (40 mmol). Plasma renin activity (PRA) declined with weight loss, so that by 12 weeks there was a significant decrease in PRA (P less than 0.01) as well as plasma aldosterone (P less than 0.05), regardless of sodium intake. Weight loss with low sodium intake was equal to that with medium intake. The reduction in PRA but not in aldosterone correlated with weight loss in both sodium-intake groups (r = 0.58). Mean arterial pressure fell significantly and equally in both groups, correlating with weight loss throughout the study (r = 0.56) and with PRA from the fourth through 12th weeks (r = 0.48) These results demonstrate that weight loss is accompanied by reductions in PRA and aldosterone; PRA reductions, irrespective of sodium intake, may contribute to the decline in blood pressure.

Pomegranate juice consumption inhibits serum angiotensin converting enzyme activity and reduces systolic blood pressure

Consumption of pomegranate juice which is rich in tannins, possess anti-atherosclerotic properties which could be related to its potent anti-oxidative characteristics. As some antioxidants were recently shown to reduce blood pressure, we studied the effect of pomegranate juice consumption (50 ml, 1.5mmol of total polyphenols per day, for 2 weeks) by hypertensive patients on their blood pressure and on serum angiotensin converting enzyme (ACE) activity. A 36% decrement in serum ACE activity and a 5% reduction in systolic blood pressure were noted. Similar dose-dependent inhibitory effect (31%) of pomegranate juice on serum ACE activity was observed also in vitro. As reduction in serum ACE activity, even with no decrement in blood pressure, was previously shown to attenuate atherosclerosis, pomegranate juice can offer a wide protection against cardiovascular diseases which could be related to its inhibitory effect on oxidative stress and on serum ACE activity.

Solitary intraparenchymal pulmonary plasmacytoma associated with production of an M‐protein. Report of a case

A case of a 40‐year old man who underwent surgical extirpation of a solitary intraparenchymal pulmonary plasmacytoma is reported. To our knowledge, this is the first reported case associated with the production of an M‐protein. The production of protein fell dramatically following removal of the tumor.

Immunologic considerations in renovascular hypertension.

For decases certain diseases, such as glomerulonephritis, polyarteritis nodosa, scleroderma and serum sickness, have been linked with autoimmune pathogenesis. During recent years a host of additional diseases traditionally thought to have some genetic predisposition but with obscure etiology have been suspected of being autoimmune in nature. Rheumatoid arthritis, diabetes, myasthenia gravis and thyroiditis are diseases of widely divergent organ systems, yet may well have common pathways of pathology via immune complexing mechanisms. Herein we present evidence supporting the concept that renal artery stenosis (occurring primarily in association with the middle aortic syndrome or after renal transplantation) is of immune etiology. Although the specific antigenic agent is still to be defined there is growing acceptance of the theory that medium and large vessels are subject to autoimmune vasculitis in many aspects similar to the autoimmune affections of small vessels. Several cases are presented. Some of these suggest an immune reaction by the natural history but without evidence of immunochemical reactants in the involved vessels, presumably because active disease was arrested at the time to study. In other cases immunofluorescent preparations demonstrate reactants in the walls of the vessels to document the hypothesis more convincingly.

The effects of marked caloric restriction on lipoprotein lipase-activators in obese subjects

Abstract Lipoprotein lipase plays a major role in the clearance of triglyceride rich lipoproteins, chylomicrons and very low density lipoproteins, from the circulation and also contributes to production of high density lipoproteins. To be functional lipoprotein lipase requires an activator which is present in the serum. Generally, serum triglyceride correlates positively with serum lipoprotein lipase-activator levels. During caloric restriction both serum triglyceride and adipose tissue liproprotein activity decrease. Affect of caloric restriction on serum lipoprotein lipase activator levels in not known. In this study we have evaluated the effect of marked caloric restriction on the levels of serum triglyceride, total cholesterol high-density lipoprotein cholesterol and lipoprotein lipase-activator in morbidly obese subjects. Initially, twenty subjects were included in the study. Twenty subjects consumed a 320kcal protein supplemented modified fast diet for three weeks, fourteen subjects for seven weeks and eight subjects for eleven weeks. Weight loss was continuous throughout the study. Serum triglycerides decreased during the first three weeks (Baseline 156±9 mg/dl, third week 119±9 mg/dl, p Thus, it appears that severe caloric restriction in morbidly obese subjects was associated with a significant decrease in the serum total cholesterol, a significant decrease in HDL-cholesterol in women. These decreases seen in serum lipids were limited to the first five weeks despite a continuous weight loss throughout this study. Serum lipoprotein lipase-activator level increased steadily and changes in serum lipoprotein lipase activator levels did not follow the changes in serum triglyceride levels during the caloric restriction.

Pheochromocytoma and Vasodepressor Response to Saralasin

Excerpt To the editor: Although a severe delayed hypertensive crisis has been reported in a patient with a pheochromocytoma after saralasin infusion (1) we have seen a patient with both renovascula...

Psychotherapy as an adjunct to supervised fasting for obesity

Abstract This study evaluated the effect of individual and group crisis-oriented psychotherapy as an adjunct to medically supervised fasting in 72 obese patients. Individual crisis-oriented psychotherapy related significantly to successful completion of the program, to a higher percentage of excess weight lost, and to a higher percentage of patients approaching the ideal weight. The authors discuss crisis points to be anticipated in a fasting program and offer suggestions for therapeutic strategies.

Recurrent renovascular hypertension. Report of an unusual case.

A 7-year-old girl with histologically proved fibromuscular dysplasia underwent renal autotransplantation with prompt return of the blood pressure to normal. Two months later, immediately after tonsillectomy, severe hypertension recurred with marked narrowing of the previously patent anastomosis. After 4 weeks on antihypertensive therapy, the patient became normotensive again and remained so for 18 months, with marked widening of the anastomosis. It is possible that this complication might be explained on an immunologic basis.