[Arterial hypertension complicated by aortic dissection. Clinical analysis, results of conservative treatment]. / Nadcisnienie tetnicze powiklane tetniakiem rozwarstwiajacym aorty. Analiza kliniczna, wyniki leczenia zachowawczego.

Detailed analysis of 21 patients suffering from arterial hypertension complicated by aortic dissection, who were treated non-surgically was performed. Signs and symptoms of aortic dissection appeared the most frequently in the age between 50 and 69. In 14 (66.7%) cases proximal (type A) and in 7 (33.3%) distal (type B) dissection were diagnosed. During acute phase 15 patients complained of pain and 6 did not. Smoking and family history of arterial hypertension were the commonest risk factors in this group. Proximal dissection was more frequently connected with painful course of the dissection whereas distal with painless. Detailed analysis of clinical data and non-invasive treatment during acute phase (first 14 days since onset of pain) was performed. During ambulatory observation which lasted 3-75 month (mean 34.3 month) 5 (25%) patients died, 15 (75%) are still alive.

Results of long-term medical treatment of patients with arterial hypertension complicated by aortic dissection.

UNLABELLED: The purpose of the study was to analyse results of ambulatory treatment of patients with arterial hypertension complicated by aortic dissection. Twenty patients (19 men, one woman), aged between 39 and 72 years, underwent full physical examination. In all cases the diagnosis of aortic dissection was confirmed by at least two different imaging methods (ultrasonography, digital subtractional angiography, computer tomography or nuclear magnetic resonance). During follow-up (3-75 months, mean 34.3 months), physical examination was performed every 6-8 weeks, chest radiograph was taken once a year. All patients controlled their blood pressure (BP) at home. According to the mean number of in-home BP measurements per month all patients were divided into two groups: group I good (n = 10) and group II bad compliers (n = 10) (28 +/- 30 vs 3 +/- 2 in-home BP measurements a month). Ten patients (6 in group I, 4 in group II) underwent 24 h automatic BP measurement examination. Blood samples were collected for serum cholesterol and uric acid measurements. All patients suffered from arterial hypertension and in five cases at least one parent suffered from this disease. Only three of 20 have never smoked cigarettes. Elevated serum cholesterol was observed in 10 (50%) cases and elevated uric acid in six (30%). Proximal (type A) aortic dissection (DeBakey classification type I and II) was found in 13 patients, distal aortic dissection (type B) in seven patients. All patients were treated with beta-blockers. In 75% of 20 cases three or more hypotensive drugs were used simultaneously to control BP. In the group I lower values of mean of maximal SBP (160 +/- 10 vs 177 +/- 7 mm Hg, P < 0.05) and lower mean circadian heart rate (58.6 +/- 7.5 vs 80.9 +/- 7.9 beats/min, P < 0.005) were observed. The most frequent complaints were intermittent claudication, 9 (45%); angina pectoris 8 (40%), other chest pain, 4 (20%). During follow-up period (3-75 months, mean 34.3 months) five of 20 patients (25%) died (all had proximal, type A dissection) and 15 of 20 patients (75%) are still alive. All deaths in group II were sudden, whereas the only one in group I was because of chronic renal insufficiency. Mortality rate in the two groups were 10% (one of 10) vs 40% (four of 10), respectively, in groups I and II. IN CONCLUSION: patients who control their BP more often have the lower values as well as lower heart rate and therefore a better prognosis.

[Unusual clinical course of ruptured aortic aneurysms--reports of three cases]. / Niezwykly przebieg kliniczny peknietych tetniaków aorty--opis trzech przypadów.

Three cases of unexpected clinical course of ruptured aortic aneurysm have been presented in patients of their 7th decade life. All of them had arterial hypertension. Signs and symptoms on admission to hospital (dysphagia, chest and interscapular pain, hematemesis, abdominal pain, elevated body temperature and diminished exercise tolerance) were non-specific of aortic aneurysm, suggesting other disease. Dramatic clinical course with hypovolemic shock in two cases led to death. One of them refused surgery. In the third one, in spite of blood effusions to pleural cavity, pericardial sac and mediastinum, effective hypotensive therapy with a preservation of the slow heart rate and fluid evacuation from pericardial sac, gave the opportunity to perform elective surgery. Aortic dissection often presents an atypical course and when suspected, all available imaging technics including computed tomography and nuclear magnetic resonance must be used.

[Unusual clinical course of ruptured aortic aneurysms--report of three cases]. / Niezwykly przebieg kliniczny peknietych tetniaków aorty--opis trzech przypadków.

Three cases of unexpected clinical course of ruptured aortic aneurysm have been presented in patients of their 7th decade life. All of them had arterial hypertension. Signs and symptoms on admission to hospital (dysphagia, chest and interscapular pain, hematemesis, abdominal pain, elevated body temperature and diminished exercise tolerance) were non-specific of aortic aneurysm, suggesting other disease. Dramatic clinical course with hypovolemic shock in two cases led to death. One of them refused surgery. In the third one, in spite of blood effusions to pleural cavity, pericardial sac and mediastinum, effective hypotensive therapy with a preservation of the slow heart rate and fluid evacuation from pericardial sac, gave the opportunity to perform elective surgery. Aortic dissection often presents an atypical course and when suspected, all available imaging technics including computed tomography and nuclear magnetic resonance must be used.

[Magnesium protects myocardium during electric cardioversion but does not increase effectiveness]. / Magnez chroni miesien serca podczas kardiowersji elektrycznej ale nie zwieksza jej skutecznosci.

Transient elevation of serum enzyme level and abnormalities of repolarization following electrical cardioversion (EC) are usually observed. We aimed to alleviate these alterations by pretreatment with magnesium sulfate (MgSO4). The study group consists of 100 patients (aged 19-65 years) who had EC (300 W/sec) for chronic atrial fibrillation after mitral and/or aortic valve surgery. They were randomly divided into two sub groups: 50 patients in whom MgSO4 was administered intravenously (dose 100 m/kg b.w.) and 50 control subjects. Total serum magnesium level and CKMB level were recorded before and 8 hours after EC. Recovery to sinus rhythm, QTc interval, segment shifts were recorded immediately before and after EC. Results (mean +/- SE): [table: see text] Our results suggest that MgSO4 administered before EC has a significant cardioprotective effect and reduces abnormalities of repolarization.

[Circadian changes in levels of magnesium in serum of healthy individuals]. / Dobowe zmiany stezenia magnezu w surowicy zdrowych ludzi.

Circadian changes in blood serum magnesium levels in healthy individuals. We examined circadian changes of the serum magnesium in 20 healthy subjects. Blood samples were taken every second hour during the 24 hours. Male serum magnesium concentrations increased from the lowest level (0.810 +/- 0.035 mmol/l) observed at 8.00 am to the highest level (1.028 +/- 0.084 mmol/l) at 6.00 pm. Female-we observed two peaks of serum magnesium concentrations: first at 8.00 pm (0.992 +/- 0.103 mmol/l) and second at 4.00 am. (0.982 +/- 0.094 mmol/l) with the lowest level at noon) 0.789 +/- 0.043 mmol/l. Differences between extreme levels were statistically significant.

[Preventive pharmacological treatment after cardiac electroversion for atrial fibrillation following surgical treatment of heart defects]. / Profilaktyka farmakologiczna po kardiowersji elektrycznej migotania przedsionków po operacjach wad serca.

265 patients (168 women, 97 men) after cardiac surgery (mitral valve replacement--74 pts, mitral commissurotomy--158 pts, aortic valve replacement--6 pts, replacement of both valves--16 pts, closure of ASD--11 pts) were randomized after successful electro-conversion of atrial fibrillation to quinidine (63 pts), verapamil (56 pts), amiodarone (50 pts), digoxin (56 pts) or control group (40 pts). The groups were comparable regarding age, sex and mitral valve disease distribution, heart volume, echocardiographic left atrium size and time from cardiac surgery to electro-conversion. After one year sinus rhythm was still present in 43% receiving quinidine, 43% receiving verapamil, 40% receiving amiodarone, 22% receiving digoxin, 20% in the untreated group, and after two years in 14%, 11%, 20%, 0% and 0%--respectively. The treatment was discontinued because of side effects in 13% of pts in the quinidine group, 8% of pts in the amiodarone group and 4% of pts in the verapamil group. It is concluded that quinidine, amiodarone and verapamil compared with control group are significantly (p less than 0.05--after one year) more effective in preventing late relapses of atrial fibrillation. Digoxin is ineffective in preventing recurrence of the arrhythmia. There are no significant differences between quinidine, verapamil and amiodarone regarding its prophylactic efficacy.

[Echocardiographic evaluation of delayed outcome of artificial valve implantation in patients with aortic semilunar valve insufficiency]. / Ocena echokardiograficzna odleglych wyników wszczepienia sztucznej zastawki w przebiegu niedomykalnosci platków pólksiezycowatych aort.

An average follow-up period of 16 patients was 28 months following an implantation of the artificial aortic valve for its insufficiency. In 10 operated patients who were able to continue their occupation exercise tolerance increased by two classes, according to NYHA. Blood pressure gradient decreased significantly from 61.8 to 37.5 mmHg, cardiac volume index decreased from 639 to 602 ml/m2. Echocardiographically measured muscle mass of the left ventricle, end-diastolic and end-systolic volumes, and the left atrial dimensions decreased significantly following surgery. A significance of the relation of the left ventricle volume to its mass <4 as a prognostic factor in aortic valve replacement has also been confirmed.

[Electric cardioversion after surgical correction of the mitral valve defect. Prognostic value of the two-dimensional and Doppler echocardiography in the assessment of its long-term effectiveness]. / Kardiowersja elektryczna po chirurgicznej korekcji wady mitralnej wartosc prognostyczna (ocena skutecznosci odleglej) echokardiografii dwuwymiarowej i metody dopplera.

In 82 patients after mitral valve surgery (59--commissurotomy, 23--valve replacement--Björk-Shiley or St. Jude prosthetic valve), 2-D and Doppler echocardiography were performed one day before electrical cardioversion. Regular sinus rhythm was maintained to 180 days in 28 patients (34%), over 180 days in 54 patients (66%). The statistical differences (p less than 0.05) between the following echocardiography parameters of these two groups were determined: parasternal long axis view: aortic, atrial, right and left ventricular dimensions (not significant--NS); apical four-chamber view: left and right atrial, left and right ventricular areas--NS; apical two-chamber view: left atrial area--p less than 0.05; pulmonary valve: peak flow velocity--NS, acceleration time--NS; mitral valve: effective area--p less than 0.05, pressure half-time--p less than 0.05, mean gradient--NS, mean flow--NS, E-wave max. flow velocity--NS. These data suggest, that left atrial area less than 30 cm2 derived from two-chamber view and Doppler effective mitral area more or equal 2, 10 cm2 may be important and good predictors of long-term results of cardioversion in patients after mitral valve surgery.

Cardiopulmonary bypass-induced complement activation. Evidence for C5a participation.

Plasma activity inducing polymorphonuclear neutrophils (PMN) aggregation, augmenting PMN adherence, plasma chemotactic activity as well as peripheral PMN count were estimated in patients during cardiopulmonary bypass. In the course of the surgical procedure the chemotactic activity and the activity inducing PMN aggregation were detected in plasma. The top of these two activities was always followed by the significant fall of the peripheral PMN count. The increase of the activity augmenting PMN adherence was observed in a part of cases, but when noticed, always preceded the maximum of the remaining evaluated activities.

[Afferents of vagus nerve to intercalary nucleus]. / Afférences du nerf vague an noyau intercalé

In 11 rabbits operations of intracranial transection of IXth and Xth cranial nerves and transections of vagal nerve on its several levels were performed. After survival 271-327 days karyometric investigations of neurons, astrocytes and oligodendrocytes contained in intercalary nuclei of both sides of medulla were performed. It was stated that after transection of the vagus nerve on the levels proximally to the arising of the recurrent laryngeal nerve the volume of cross-area of neurons and nuclei of astrocytes decreases on the operated side. The authors concluded that atrophic changes found in the intercalary nucleus may be probable of transsynaptic in character. It indicated, that intercalary nucleus receives afferents from the vagus nerve.