ABSTRACT
Acute myocardial infarcrion [AMI] is an important cause of mortality and morbidity in our country and all over the world. GIK [glucose-insulin-potassium] with some positive effects on myocardial metabolism has been used in order to improve the clinical course in AMI but in spite of some clinical trials, the effect of GIK on outcome is still controversial. In this clinical trial study, 113 patients with STEMI who referred to Ghaem Hospital [during 1382-83] were divided in 4 groups; 1] GIK +SK [23/9%], 2] GIK [13/3%], 3] SK [37/1%], and 4] none [no GIK, no SK] [25/7%] and clinical [CCU and hospital admission days, post MI angina, reinfarction, heart failure, death], electrocardiographic [arrhythmia] and echocardiographic [L V systolic function] parameters were compared STK was administered to all eligible patients, but GIK patients were selected randomly. From 113 cases with mean age of 59.9 years old, 37.2% received high dose GIK and 61.1% were given STK, there was no difference in age, sex, risk factors [except for smoking], co-medication, region of MI and Killips on admission between GIK and no- GIK patients. Door to niddle time was 47.6 minutes for STK and 92.0 minutes for GIK groups. When comparing the 3 groups, GIK with or without SK and also SK itself, eeu [p=0.16] and hospital days [p= 0.39], reinfarction [p= 0.37], pulmonary edema [p= 0.73], in hospital mortality [p= 0.58], and mean LVEF [p=0.80] were not different significantly. The findings were the same in group 4 [no GIK, no SK], surprisingly. Post MI angina [p= 0.07] and arrhythmia [p= 0.06] in group that received GIK alone were slightly less than STK groups. According to the results of this study, apart from slight reduction of post M I angina and arrhythmia, GIK has no significant effect on hospital course of patients with STEMI
ABSTRACT
Introduction: Mitral stenosis is one of the most common causes of valvular heart disease in developing countries. Until the first publication by Inoue and Co-workers on percutaneous mitral commissurotomy [PMC] in 1984, surgery was the only satisfactory treatment for patients with mitral stenosis. Despite worldwide use, this technique has recently been started in Mashhad and its immediate and midterm results of the first 218 patients are going to be reported
Method and Material: Form 1988 to 2003, this descriptive study was done in Ghaem Hospital of Mashhad. The intervention was performed on fasting 218 patients with light sedation. After left and right heart catheterization, interatrial septostomy, septostomy and PMC was done via right femoral vein, by using a standard brockenbrough needle, a mullin sheat, dilator, spiral guide wire and Inoue balloon
Result: PMC was successfully performed on 213 [97.76%] of 218 cases with severe MS. The mean left atrial pressure decreased from 24. 3 +/- 6.5 mmHg to 12.1 +/- 5.4 mmHg. The mean gradient at the mitral valve level also decreased from 15.9 +/- 5 mmHg to 2.4 +/- 2.1 mmHg. The mean mitral valve area increased from 0.88 +/- 0.17cm[2] to 1.99 +/- 0.25cm2. Mitral regurgitation increased by 1 grade in 56 cases and 2 grades in 11 patients. 3 patients developed 3 grades of mitral regurgitation. No patient showed 4 grades of mitral regurgitation. One direction variance analysis showed that there is a statistically significant reverse relationship between age [P < 0.0001] of patients and increment of mitral valve area after PMC. In addition, this study showed a significant relationship between functional class of patients [P < 0. 001] and increment of mitral valve area after using this procedure. There were not any relationships between age [P = 0. 06], sex [P = 0. 890], cardiac rhythm [P= 0. 632], functional class [P = 0. 458] of these patients, and the induction or changes in severity of mitral regurgitation after PMC
Conclusion: In spite of some limitations in using the devices, the immediate and midterm results obtained from this study like other researches shows that PMC is a safe, effective and choice method in the treatment of the patients with mitral stenosis. In contrary to the other reports, thise study has also suggested that, there is a significant relationship between functional class of patients and in increment of mitral valve area after PMC