Objective To evaluate the efficacy of fetal intervention using fetal cystoscopy or vesicoamniotic shunting in the treatment of severe lower urinary obstruction (LUTO). Methods (ARR, 1.16 (95% CI,; P = 0.33)). In cases in which there was a postnatal diagnosis of posterior urethral valves, fetal cystoscopy was effective in improving both the 6-month survival rate and renal function (ARR, 4.10 (95% CI, P < 0.01) and 2.66 (95% CI,; P = 0.01) respectively) while vesicoamniotic shunting was associated only with an improvement in the 6-month survival rate (ARR, 3.76 (95% CI,; P < 0.01)) with no effect on renal function (ARR, 1.03 (95% CI, P = 0.93)

SUMMARY Diltiazem is a calcium slow-channel blocking drug that may be effective in the treatment of chronic stable angina pectoris. To evaluate the therapeutic efficacy 3 hours after a single oral dose of 120 mg, 12 men with chronic stable angina pectoris performed a maximal exercise test on a bicycle ergometer after ingesting either placebo or diltiazem administered in a double-blind fashion. During submaximal exercise at a fixed work load, diltiazem decreased the average heart rate response from 119 ± 17 to 107 ± 14 beats/ min (p < 0.01), systolic blood pressure from 182 ± 15 to 175 ± 15 mm Hg (p < 0.05) and the rate-pressure product from 21.8 ± 4.2 to 18.8 ± 3.2 x 10-3 units (p < 0.01). The average submaximal work load at which significant ST-segment depression (0.1 mV) first appeared was increased from 355 ± 142 to 525 + 143 seconds (p < 0.01) after diltiazem. At peak exercise after diltiazem, the average depth of ST-segment depression in any one lead and the extent of myocardial ischemia observed in all 12 ECG leads were decreased (p < 0.01), even though the average work load was increased by 29% (p < 0.01). Peak heart rate, systolic blood pressure and rate-pressure product were similar with placebo and diltiazem. The plasma diltiazem concentration was 139 ± 29 ng/ml 3 hours after ingestion and was significantly (p < 0.05) related to the increased time to the onset of important ST-segment depression (r = 0.65) and to the decrease in the extent of myocardial ischemia observed in all 12 ECG leads (r = -0.61) compared with placebo. Thus, diltiazem is effective in treating chronic stable angina pectoris. It decreases myocardial oxygen requirements during upright exercise and appears to increase myocardial oxygen delivery.THE EFFECTIVENESS of diltiazem, a calcium slowchannel blocking drug, in the prevention of coronary spasm is well documented.' It decreases systemic arteriolar resistance, increases coronary artery blood flow and has a negative chronotropic effect.t fThese properties have justified its study in the treatment of exertional angina in patients with fixed coronary artery stenoses.]-1' Repeat oral-dose studies of diltiazem show an increase in the time to the onset of angina or to significant ST-segment depression during standard multistage exercise testing.7-9 Both the total daily dose and schedule appear to influence the drug's efficacy and ability to reduce indexes of myocardial oxygen demand during exercise. Hossack and Bruce7 found a greater effect using 60 mg four times daily than smaller doses and with a schedule of 30 mg four times daily vs 60 mg three times daily. Single-dose studies'0 " with 60 and 90 mg of diltiazem have not shown a significant decrease in the indexes of myocardial oxygen demand during exercise.Therefore, in the present study, we compared, after 3 hours, the effects of a single oral dose of 120 mg of diltiazem vs placebo on the time to the onset of significant ST-segment depression (0.1 mV) and to peak exercise; the indexes of myocardial oxygen consumption at a fixed submax...

No abstract

No abstract

No abstract