High frequency of primary hyperaldosteronism among hypertensive patients from a primary care area in Sweden

Objective. To search for primary hyperaldosteronism (PHA) among previously known hypertensive patients in primary care, using the aldosterone/renin ratio (ARR), and to evaluate clinical and biochemical characteristics in patients with high or normal ratio. Design. Patient survey study. Setting and subjects. The study population was recruited by written invitation among hypertensive patients in two primary care areas in Sweden. A total of 200 patients met the criteria and were included in the study. Main outcome measures. The ARR was calculated from serum aldosterone and plasma renin concentrations. The cut-off level for ARR was set to 100, as confirmed in 28 healthy subjects. Patients with increased ARR were considered for a confirmatory test, using the fludrocortisone suppression test. Results. Of 200 patients, 50 patients had ARR >100; 26 patients were further evaluated by fludrocortisone suppression test. Seventeen of these patients had an incomplete aldosterone inhibition. Conclusion. In total 17 of 200 evaluated patients (8.5%) had an incomplete suppression with fludrocortisone. This confirms previous reports on a high frequency of PHA. No significant biochemical or clinical differences were found among hypertensive patients with PHA compared with the whole sample

Re-evaluation of the fludrocortisone test: duration, NaCl supplementation and cut-off limits for aldosterone

Objective. Primary aldosteronism (PA) is the most common form of secondary hypertension. Thus, the aims of this study were: (1) to clarify whether the fludrocortisone suppression test (FST), which confirms autonomous aldosterone secretion, is reliable when carried out during a shorter period of time and (2) to confirm the importance of NaCl supplementation. The cut-off limits already obtained for aldosterone in healthy subjects during the FST were applied in hypertensive patients with a high aldosterone to renin ratio (ARR). Material and methods. The healthy subjects were allocated to three groups. Fludrocortisone was administered 4 times daily over 4 days and sodium chloride was supplemented in 3 different doses. The result was applied in 24 hypertensive patients, in 24 healthy subjects (10 women (23-38 years old) and 14 men (23-58 years old)) and in 24 patients with hypertension and high ARR (16 women (45-74 years old) and 8 men (56-73 years old)). Blood pressure, aldosterone, renin, potassium and sodium were measured. Results. After three days of FST, there was a significant decrease in the serum level of aldosterone in the healthy subjects, regardless of high or low sodium chloride supplementation (p0.001). The decrease in serum aldosterone was significantly less pronounced in patients with PA than in healthy subjects and hypertensive patients without PA (p0.001). The 95th percentile of plasma aldosterone at the end of the test was 225 pmol/L. Conclusions. The FST can be shortened to 3 days and a daily 500 mg NaCl supplementation is sufficient. A cut-off value for aldosterone of 225 pmol/L after 4 days with FST is appropriate

Sensitization according to skin prick testings in atopic patients with asthma or rhinitis at 24 allergy clinics in Northern Europe and Asia

Skin prick tests (SPT) were performed on 2113 atopic patients (407 children and 1 706 adults) with asthma and/or rhinitis at 24 allergy clinics in Iceland, Norway, Denmark, Sweden, Estonia, Lithuania and Russia. Test extracts were Dermatophagoides pteronyssinus (D. pteronyssinus), Dermatophagoides farinae [D. farinae), cat, dog, horse, birch, timothy, mugwort, Cladosporium, Alternaria, cockroach, chironomids (red mosquito larvae, RML) and shrimp. Among the allergens, timothy followed by cat, birch and dog gave the highest number of positive SPT. Positive SPT with house dust mites (HDM), furred animals, RML and Cladosporium were more common in asthmatics than in patients with rhinitis; birch and timothy more common in patients with rhinitis. Sensitization against D. pteronyssinus, horse, timothy and Cladosporium was more common in men than in women. Although the general sensitization pattern of the atopic patients at the participating centers showed similarities, there were also significant differences between centers. Positive SPT with furred animals were most prevalent in Northern and Central Sweden and St Petersburg, and least common in Siberia and Denmark. Pollen allergy was most common in Novosibirsk and on the west coast of Sweden, and less common in Vladivostok. Sensitization against HDM was most common in Lithuania and least prevalent in Northern Sweden and Finland. Insect allergens gave the most positive reactions in St Petersburg and the least positive reaction in Novosibirsk. Sensitization against multiple allergens was found in 74% of the patients and a mono-allergy in 26%. The degree of atopy was higher in males than in females and higher in asthmatics than in patients with rhinitis. The month of birth of the patients did not influence significantly the test results. It is concluded that although the sensitization pattern shows similarities in different regions, it is also influenced to some extent by residence as well as by diagnosis, sex and age of the patients

Panitumumab and Pegylated Liposomal Doxorubicin in Platinum-Resistant Epithelial Ovarian Cancer With KRAS Wild-Type:The PaLiDo Study, a Phase II Nonrandomized Multicenter Study

OBJECTIVE: The increasing number of negative trials for ovarian cancer treatment has prompted an evaluation of new biologic agents, which in combination with chemotherapy may improve survival. The aim of this study was to investigate the response rate in platinum-resistant, KRAS wild-type ovarian cancer patients treated with pegylated liposomal doxorubicin (PLD) supplemented with panitumumab. PATIENTS AND METHODS: Major eligibility criteria were relapsed ovarian/fallopian/peritoneal cancer patients with platinum-resistant disease, measurable disease by GCIG CA125 criteria and KRAS wild-type. Patients were treated with panitumumab 6 mg/kg day 1 and day 15 and with PLD 40 mg/m day 1, every 4 weeks. RESULTS: Forty-six patients were enrolled by 6 study sites in this multi-institutional phase II trial. The response rate in the intention-to-treat population (n = 43) was 18.6%. Progression-free and overall survival in the intention-to-treat population was 2.7 months (2.5-3.2 months, 95% confidence interval) and 8.1 months (5.6-11.7 months, 95% confidence interval), respectively. The most common treatment-related grade 3 toxicities included skin toxicity (42%), fatigue (19%), and vomiting (12%). CONCLUSIONS: The combination of PLD and panitumumab demonstrates efficacy in platinum refractory/resistant patients but the skin toxicity was considerable