Merits and demerits of the converting-enzyme inhibitor captopril in antihypertensive treatment

The aim of the present investigation was to study the efficacy of captopril in a large group of hypertensive patients. The studies described are in part a continuation of Prins's studies. However in this thesis the effects of captopril on blood pressure and the cardiovascular system have especially been described during prolonged treatment. In addition, the vascular and renal responses to the drug were studied in order to gain better insight into captopril's BP lowering effects. Finally, special attention has been paid to the toxicity of captopril since this might limit clinical applicability. ... Summary

Respiratory failure in ANCA-associated vasculitis

Objective: To assess the prevalence, clinical manifestations, and course of respiratory failure in all patients who tested positive for antineutrophil cytoplasmic autoantibodies (ANCA) in our clinics in the period between January 1985 and January 1993. Design: Case-series analysis. Setting: Three teaching hospitals in the Netherlands. Patients: Two hundred twenty consecutive patients suspected of having vasculitis and/or glomerulonephritis who tested positive for ANCA by indirect immunofluorescence and enzyme-linked immunosorbent assay. Results: Sixty-two patients had pulmonary involvement. Acute respiratory failure developed in nine. Respiratory failure was related to infections in two of them and to ANCA-associated vasculitis in seven. These seven patients uniformly presented with pulmonary hemorrhage and diffuse pulmonary infiltrates. The diagnosis of systemic vasculitis was supported by the presence of a pulmonary-renal syndrome in all patients, and by detection of antibodies to the proteinase 3 or myeloperoxidase antigen in all but one patient. Antiglomerular basement membrane antibodies were absent. The mortality was high due to hypoxic respiratory failure, pulmonary superinfections, and concomitant renal failure. Conclusions: Acute respiratory failure due to vasculitis developed in one of every nine patients with ANCA-associated pulmonary disease. Patients usually present with pulmonary infiltrates and hemoptysis. A diagnosis of vasculitis may be further supported by analysis of the urinary sediment and determination of the ANCA target antigen. It remains to be proved that early detection of ANCA favorably affects the outcome