Cuff BP has variable accuracy for measuring either brachial or aortic intra-arterial BP, and this adversely influences correct BP classification. These findings indicate that stronger accuracy standards for BP devices may improve cardiovascular risk management.

Thrombotic thrombocytopenic purpura is a serious, potentially fatal disease, and conventional plasma exchange appears to be the best initial therapy. Following this approach, survival in 90% of patients is available. In patients with relapse and treatment failure to plasma exchange, splenectomy is recommended. The rationale for splenectomy and the relevant pathomechanisms involved are obscure. In the present paper two patients with TTP are reported who first responded to conventional treatment strategies but later relapsed. Resumption of previous therapy was not able to continuously maintain normal platelet levels. Thus, splenectomy was considered to be indicated. In contrast to former reports, repeated cycles of conventional plasma exchanges were performed until a transient steady state (12 hrs) of the platelet counts occurred. Then splenectomy was performed immediately and, in contrast to former reports, no reinstitution of treatment was necessary after splenectomy. In addition no postoperative complications (bleeding, neurologic impairment) have been observed. This favorable outcome might be due to the strategy of repeated conventional plasma exchange procedures. The follow-up shows now event free disease for 2 years.

In 9 healthy subjects the effect of smoking one cigarette (nicotine content 0.9 mg) on blood pressure, heart rate and total and muscle blood flow in the forearm was measured. Blood flow was measured by a new noninvasive plethysmographic method that simultaneously gives quantitative data about total and muscle blood flow. Smoking the cigarette did not significantly affect blood pressure or heart rate. Total blood flow in the forearm did not change but the flow to the muscle was increased and resistance in this vascular bed was decreased. The pattern of haemodynamic changes in the forearm indicates that epinephrine may be the mediator of the circulatory effects of nicotine.

Testing the accuracy of the automatic blood pressure measuring device Bosotron2®, we performed simultaneous, same–arm, comparative blood pressure measurements with three instruments (A, B, and C) of the device and by auscultation in the antecubital fossa by a trained observer in 24 volunteers each. The volunteers were evenly matched for age, sex, and blood pressure level. The mean systolic differences and their standard deviations (24 subjects each, n = 288 single measurements) were –1.32±3.8 mm Hg for instrument A, –0.99±3.9 mm Hg for instrument B, and –1.12±5.0 mm Hg for instrument C. The corresponding values for the diastolic differences were –2.71±4.4, –3.46±4.3, and –2.72±3.9 mm Hg, respectively. Combining the results for the three instruments, the comparison yielded a good accuracy (mean difference) and sufficient repeatability of the differences (standard deviation) for the systolic and diastolic blood pressures (systolic –1.14±4.3 mm Hg; diastolic –2.96±4.2 mm Hg). In addition to the British Hypertension Society protocol, in 33 patients with coronary artery disease the measurements using the three Bosotron 2 devices were compared with measurements within the aortic arch. The mean systolic/diastolic differences (±SD) were +1.45±4.3 and +7.27±4.7 mm Hg for instrument A, +4.70±12.8 and +1.73±7.4 mm Hg for instrument B, and –3.74±8.0 and +5.61±2.6 mm Hg for instrument C. Combining the results of the three instruments, the blood pressure was determined to be only slightly higher (systolic +1.74±9.6 mm Hg; diastolic +4.87±5.6 mm Hg) by the Bosotron 2® device as compared with the aortic arch pressure. The Bosotron 2® device seems to be suitable for clinical use and for monitoring blood pressure during clinical–pharmacological studies.

No abstract