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Abstract. Knudsen ST, Bek T, Løgstrup Poulsen P, Nørgaard Hove M, Rehling M, Mogensen CE (Aarhus Kommunehospital, Aarhus, Denmark). Effects of losartan on diabetic maculopathy in type 2 diabetic patients: a randomized, double-masked study. J Intern Med 2003; 254: 147–158. Objective. Diabetic maculopathy (DMa) is a leading cause of visual loss in the western world. Preliminary studies have suggested that angiotensin converting enzyme inhibitors might be effective in preventing the progression of diabetic retinopathy, but no studies have quantitatively assessed the effect of this treatment on macular oedema in patients with DMa. We evaluated the effect of treatment with the angiotensin II receptor antagonist losartan on macular oedema and hard exudates in patients with an advanced stage of DMa. Design. Randomized, placebo-controlled, double-masked and parallel-group trial. Setting. Academic medical centre. Subjects. Twenty-four type 2 diabetic patients with DMa. Intervention. Subjects were randomly assigned to a 4-month treatment with either losartan (50 mg o.d.) or placebo. Main outcome measures. (i) Degree of macular oedema as estimated by optical coherence tomography scanning of the retina; (ii) fundus photography and flourescein angiography; (iii) 24-h ambulatory blood pressure (BP); (iv) urinary albumin excretion (UAE); and (v) transcapillary escape rate of albumin (TERalb ). Results. Central retinal thickness increased from 244 ± 16 to 256 ± 31 μm in the losartan group, whilst there was no change in the placebo group (245 ± 36 μm vs. 242 ± 30 μm), P = 0.017. Day BP were lowered in the losartan group (from 144/83 ± 17/10 to 138/78 ± 20/11 mmHg) compared with the placebo group (140/81 ± 14/5 to 139/82 ± 13/9 mmHg), P = 0.27 for systolic and P = 0.009 for diastolic BP. Importantly, there were no changes in night BP in any of the groups. We found no changes in the number of... [ABSTRACT FROM AUTHOR]

Objective To determine renal function in patients with vesico‐ureteric reflux (VUR) during 14 years of conservative treatment (no surgery). Patients and methods Sixty patients with VUR were consecutively included between 1981 and 1982. The degree of VUR was determined by conventional voiding cysto‐uretherography (VCUG) after 3 months of prophylactic antibiotics. The VUR was grade I–IV, with grades III and IV characterized as high‐grade VUR. In all patients, any urinary tract infections and bladder‐urethral dysfunction were treated. Renal function and reflux were monitored by renal and bladder scintigraphy using 123I‐hippuran and the glomerular filtration rate (GFR) was determined using the plasma clearance of 51Cr‐ethylaminediamine tetra‐acetic acid. Results Of the 60 patients who entered the study, 51 were followed for a mean of 13.7 years; nine patients were lost to follow‐up. None of the patients underwent antireflux surgery. All patients were in good health and normotensive (except two with borderline hypertension). Of the 51 patients 21 had low‐grade, 21 unilateral high‐grade and nine bilateral high‐grade reflux. In those with low‐grade reflux both the mean renal split function on the most refluxing kidney and the GFR remained stable during the whole monitoring period. Eighteen patients who had a persistent reduction in renal split function or initially had had a significantly reduced functional share to the most refluxing kidney had their GFR re‐assessed in adolescence. However, the body surface‐corrected GFR remained constant. Total GFR and single kidney GFR increased significantly. Conclusion A conservative treatment regimen in patients with VUR can ensure stable kidney function, although kidneys with a lower renal function at referral seem to have an impaired functional growth potential. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor of the "Journal of Internal Medicine," discussing about the effects of losartan on diabetic maculopathy in type 2 diabetic patients.

An abstract of the study "Non-revascularized human hibernating and chronically stunned myocardium can adapt to long-term chronic ischemia," by H. Wiggers and colleagues is presented.