Stress hyperglycaemia in patients with first myocardial infarction.

OBJECTIVE: To investigate the incidence of stress hyperglycaemia at first acute myocardial infarction (MI) with ST-segment elevation, occurrence of stress hyperglycaemia as a manifestation of previously undiagnosed abnormal glucose tolerance (AGT), and its relation to stress hormone levels. MATERIALS AND METHODS: The population of this prospective cohort study consisted of 243 patients. On admission glucose, adrenaline, noradrenaline and cortisol levels were measured. Patients without previously diagnosed diabetes (n = 204) underwent an oral glucose tolerance test on day 3 of hospitalisation and 3 months after discharge. RESULTS: Abnormal glucose tolerance at day 3 was observed in 92 (45.1%) patients without a previous diagnosis of diabetes mellitus and resolved after 3 months in 46 (50.0%) patients (p < 0.0001). Stress hyperglycaemia, defined as admission glycaemia ≥ 11.1 mmol/l, affected 34 (14.0%) study participants: 28 (54.9%) patients with diabetes vs. 3 (8.8%) subjects with newly detected impaired glucose intolerance (p < 0.00001) and 1 (2.2%) person with AGT at day 3 (p < 0.000001). Multivariable analysis identified elevated glycated haemoglobin (HbA(1c) ; p < 0.0000001), anterior MI (p < 0.05) and high admission cortisol concentration (p < 0.001), but not catecholamines, as independent predictors of stress hyperglycaemia. The receiver operating characteristic curve analysis revealed the optimal cut-off values of 8.2% for HbA(1c) and 47.7 µg/dl for admission cortisol with very good and sufficient diagnostic accuracies respectively. CONCLUSIONS: Newly detected AGT in patients with a first MI is transient in 50% of cases. Stress hyperglycaemia is a common finding in patients with a first MI with ST-segment elevation and diabetes mellitus, but is rarely observed in individuals with impaired glucose tolerance or transient AGT diagnosed during the acute phase of MI. The risk factors of stress hyperglycaemia occurrence include elevated HbA(1c) , anterior MI and high admission cortisol concentration.

[Von Willebrand factor in hemodialysed patients with chronic renal failure]. / Czynnik von Willebranda u chorych hemodializowanych z powodu przewleklej niewydolnosci nerek.

The aim of the work was to evaluate the von Willebrand factor antigen (vWF Ag) concentration in the blood plasma of hemodialysed patients with chronic renal failure. The study was performed in the group of 43 patients (means aged 42.8 years) with chronic renal failure dialysed means 4 hours 3 times a week. The blood was obtained before and after hemodialyze and in 11 patients additionally after 1 year of systematic hemodialyze. The control group consisted of 51 healthy volunteers means aged 35.6 years. In the citric blood plasma concentration of vWF Ag was determined using immunosorbed enzyme-linked assay (ELISA). In the blood plasma of patients with chronic renal failure significantly higher concentration of vWF Ag than in controls was observed. 4-hours and 1-year dialyze did not influence the level of vWF Ag in patients with chronic renal failure.

Comparison of fentanyl and droperidol mixture (neuroleptanalgesia II) with morphine on clinical outcomes in unstable angina patients.

The objective of the study was to compare the influence of a fentanyl and droperidol mixture (neuroleptanalgesia) with morphine on the in-hospital instability, development of acute myocardial infarction (AMI), and mortality during a 30-day and 12-month follow-up in unstable angina patients. The study was performed in 112 unstable angina patients. In addition to standard therapy for unstable angina (aspirin, heparin, nitroglycerin, and oxygen), 53 patients (63.2 +/- 9.7 years; 32 males) were randomized to receive neuroleptanalgesia (0.025 mg fentanyl and 1.25 mg droperidol in a volume of 1 mL) and 59 patients (58.6 +/- 11.5 years; 41 males) to receive morphine. Neuroleptanalgesia was started i.v. with 2 mL and could be followed by 1 mL every 4 hours. Morphine was started i.v. with 10 mg and could be followed by 5 mg every 4 hours up to angina resolution during 24 hours of hospitalization. Another 1 mL of neuroleptanalgesia or 5 mg of morphine could be administered on demand if angina lasted or reappeared earlier than the next scheduled dose. Odds ratios with 95% confidence intervals (95% CI) adjusted for the age, sex, smoking, previous myocardial infarction, and hypertension were evaluated for all study outcomes. The odds ratios for clinical in-hospital instability (5.93, 95% CI: 2.49-14.15; P = 0.0001), 12-month AMI development (3.57, 95% CI: 1.51-8.45; P = 0.0038), and 12-month mortality (6.00, 95% CI: 1.63-22.09; P = 0.0070) were significantly increased in the neuroleptanalgesia group compared with the patients on morphine. It is concluded that neuroleptanalgesia negatively influences disease course, AMI development, and total mortality in unstable angina patients.

[Level of copper and zinc in plasma of patients with lung cancer]. / Stezenie miedzi i cynku w osoczu krwi chorych na raka pluca.

Microelements metabolic disorders, including copper and zinc, constitute an important field of cancer studies. Efforts are undertaken to identify cancer markers. Found changes in plasma copper and zinc levels in patients with lung carcinoma may have clinical implications, and help in the diagnosis despite the fact that there are no reports in the literature confirming specificity of these two elements for lung carcinoma. Plasma copper and zinc levels were determined in blood samples of 94 patients with lung carcinoma with atomic absorption technique. The obtained results were compared with those in 20 healthy blood donors, and were analysed statistically and plotted graphically. Statistically significant differences in patient's plasma vs control group were noted.