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Any hypertension with hypokaliemia or resistant to the therapeutic requires the investigation of a primary hyperaldosteronism. The first step is to eliminate the absorption of liquorice, alkaline compounds or diuretics. The next step is to verify that the therapeutics are compatible with hormonal measurements and that urinary sodium and potassium are normal. The diagnosis is confirmed by the elevation of plasma or urinary aldosterone and a low renin concentration. Conn adenoma is present in 2/3 of the cases and is treated by surgery, whereas bilateral adrenal hyperplasies require distal diuretics. The 2 aetiological forms are distinguished by CT scan and dynamic hormonal measurements.

With aerosolized administration of medicines, direct access to the lung is possible. Depending on the intrapulmonary behavior of each molecule, the aerosol mode of administration makes possible either a pulmonary topical action or a systemic action, thanks to the lung's wide vascular network. An inhaled molecule's pulmonary behavior is not predictable and must be studied on its own. Some medicines with a systemic aim have a topical effect after aerosol administration: furosemide, amiloride, morphine, interferons, cyclosporin and prostacyclin. Other medicines have systemic effects after aerosol administration: insulin, growth hormone, LHRH, calcitonin and nicotine. Heparin can be classified in either group depending on the dose and type of use.

This study had, as its aim, to test twelve nebulizers (6 jet, 6 ultrasonic) which are used in the treatment of cystic fibrosis. Devices were connected to a respirator in order to mimic the ventilation of a child and of an adult suffering from cystis fibrosis. Three medications: tobramycine, colistine and amiloride were nebulised. The volume of the recommended solution varied between 1.5 and 13 ml according to the manufacturer. During a session of ten minutes the ultrasonic nebulizer delivered an inhaled volume which was significantly greater than the jet (2.72 +/- 0.98 ml vs 1.22 +/- 0.59 ml, p < 0.0001) for the three drugs. Regarding granulometry, the fraction of particles between 0.5 and 5 microns, was higher with ultrasonic than with pneumatic nebulizer for tobramycine (67.1 +/- 10.7 vs 55.5 +/- 11.5%, p < 0.001) and amiloride (66.4 +/- 9.2% vs 58.1 +/- 15%, p < 0.05%). The variation of concentration due to nebulisation were independent of the type of apparatus but influenced by the drug since concentration was increased for tobramycine (+10.5 +/- 18.6%) and amiloride (+13.4 +/- 8/9%). In summary the effective fraction resulting from the inhalable fraction, from granulometry and from changes in concentration was significantly greater for ultrasonic than for jet nebrulizer (17.3 +/- 6.7% vs 9.7 +/- 9.6%, p < 0.001). This study underlines the great variability of the performance of aerosols generators and therefore the need for an accurate evaluation of nebulizer performances in order to prescribe the best nebulizer/drug association in clinical practice.

The objective of this study was to assess the performance of a new pneumatic nebuliser NL9 Atomisor. The performance was assessed in terms of particle distribution, fraction nebulised, fraction inhaled and percentage of particles of a diameter of between 1 and 4 microns for the nebulisation of physiological serum, colistin, tobramycin and amiloride. The solutions were nebulised in the approved formula for their reconstitution as used in the clinic after the addition of sodium pertechnetate. The validity of this indirect isotopic method has been shown before. The nebuliser was coupled, during the nebulisation, to a pump respirator with six settings. The fraction nebulised was defined as the percentage of the volume of the solution which had left the aerosol generator at the end of the nebulisation. The fraction inhaled was defined as a percentage of the volume of the solution which was gathered at the end of the nebulisation on a filter placed in the inspiratory circuit of the aerosol generator. The study of the distribution of aerosol particle sizes was carried out using a cascade impactor at ten stages. Each of these parameters was determined in triplicate for the four solutions studied. The nebulised fraction consisted of between 33.5 and 58.6% (mean 49.7 +/- 8.1%). The inhaled fraction consisted of between 14 and 30.4% (mean 24.5 +/- 5.5) and the duration of nebulisation was between 10 and 20 minutes. The MMAD was between 1.6 microns with tobramycin 3.5 microns with physiological serum.(ABSTRACT TRUNCATED AT 250 WORDS)

Bronchial inhalation of amiloride chlorhydrate has been suggested for a number of years in the treatment of the pulmonary disease in cystic fibrosis. However, physiotherapy remains invaluable in the struggle in containing pulmonary infections in this disorder. Physiotherapy may lead to a transient fall in the arterial oxygen as can sessions of nebuliser therapy which precedes physiotherapy. The originality of the system studied and proposed here for the administration of medication depends on an electronic control which guarantees that there is the nebulisation of a constant volume of medication with each inspiration. Triggered by inspiration the active principle nebulised is perfectly co-ordinated to the inspiratory cycle. A comparative chromatography carried out in this slides of silica-gel have enabled us to verify the absence of any degradation of the active principle contained in the nebuliser solution during the ten minutes period of aerosol therapy. Thus a quantification of the administered dose of Amiloride Chlorhydrate is made possible. In association with oxygen it enables an efficacious preparation of respiratory physiotherapy to children. As the expiratory tubing ends in a filter the fraction of the oxygen inhaled by the patient remains very high; 80% (V/V) of the medication is emitted in the form of liquid particles whose diameter lies between 0.5 and 5 micrometers. In practice in order to humidify the sputum and to restore the oximetry before the physiotherapy sessions, it seemed to us an interesting possibility to administer Amiloride Chlorhydrate and oxygen simultaneously. This is achieved in hospital by using wall-mounted oxygen (at a gas pressure of 3.5 bars).(ABSTRACT TRUNCATED AT 250 WORDS)

The treatment of hypertension requires in many cases a therapeutic combination. This survey, carried out in 96 cases, shows the interest of a fixed combination including a thiazide diuretic (hydrochlorothiazide), a potassium sparing (chlorhydrate of amiloride) and a beta-blocking agent (timolol maleate) as compared to therapy with a beta-blocking agent or diuretic alone. This combination, logical from a pharmacological view point, has proved significantly more effective (81% of patients were normalized) and as well tolerated (none additional side effect) as each of its components. As it simplifies prescription by reducing the number of tablets, it appears a considerable contribution to hypertension therapy.

In 59 out of 80 patients with recurrent renal calcium stones studied between 1977 and 1982 and followed up for 4,5 to 7 years, an index has been used to determine the activity of the disease, before and after treatment with diet, high water intake, thiazide and/or allopurinol. As estimated by variations of the "activity index", the treatment was effective in all groups studied: patients with idiopathic hypercalciuria were prescribed a low purine and oxalate diet and a large water intake associated or not with thiazide; hyperuricosuric patients were treated by the same diet and allopurinol; patients with no metabolic abnormality were submitted to diet and/or thiazide and/or allopurinol. The association of thiazide and allopurinol seems to be a more effective therapy in recurrent stone formers with primary hyperoxaluria than high diuresis and succinimide.

In the context of a controlled antihypertensive drug trial, blood pressure readings obtained by the physician in his office were compared with ambulatory blood pressures recorded with the semi-automatic Remler device. The beta-adrenoceptor blocking agent timolol or methyldopa were administered in double-blind fashion to 30 patients with uncomplicated essential hypertension. All exhibited a diastolic office blood pressure of greater than 95 mm Hg at the end of a 4-week placebo period. All patients then received a combination of hydrochlorothiazide (25 mg/d) and amiloride (2.5 mg/d). After 4 weeks of diuretic therapy, timolol (10 mg/d, n = 14) or methyldopa (250 mg/d, n = 16) were added randomly for 6 weeks. The dose of all antihypertensive agents was doubled after 2 weeks of therapy with diuretics combined with timolol (n = 7) or methyldopa (n = 16) because of the persistence of diastolic blood pressure levels of greater than 90 mm Hg at the office. When assessed in the office, the antihypertensive effect of timolol and methyldopa was similar. During ambulatory blood pressure monitoring, however, pressure levels tended to be lower in the patients given timolol (p less than 0.05 for the diastolic). These data show that ambulatory blood pressure monitoring may be very useful in comparing the antihypertensive efficacy of different drugs.

Multicenter study in 10294 hypertensive patients conducted by 2000 G.P.'s throughout France. This trial permitted to compare the effectiveness and tolerance of 3 types of antihypertensive therapy: a beta-blocker, a diuretic and a central antihypertensive agent. It also permitted to study a certain number of socio-epidemiological characteristics in that patient population, in particular with regard to cardio-vascular risk factors.