Percutaneous coronary intervention triggers a systemic inflammatory response in patients treated for in-stent restenosis -- comparison with stable and unstable angina.

OBJECTIVE AND DESIGN: It is believed that the magnitude of the systemic inflammatory response induced by percutaneous coronary intervention (PCI) impacts on the long-term outcomes in patients with stable angina (SA) and unstable angina (UA). We aimed to determine whether an inflammatory response appears in in-stent restenosis (ISR) patients undergoing balloon angioplasty and to assess its pattern and magnitude in relation to SA and UA subjects. SUBJECTS: 80 patients (59 with SA, 10 with UA, 11 with ISR) were enrolled into the prospective study. TREATMENT: SA and UA patients undergoing single vessel coronary balloon angioplasty followed by stenting versus ISR subjects in whom only balloon angioplasty was performed. METHODS: C-reactive protein (CRP), serum amyloid A (SAA), tumor necrosis factor alpha (TNF-alpha) and interleukin 10 (IL-10) were measured in blood samples collected before and 6, 24 h and 1 month after the procedure. RESULTS: A comparable pattern of inflammatory response in terms of CRP and SAA concentrations in subjects undergoing PCI due to ISR and SA was discovered while in unstable patients its magnitude was substantially higher. CRP and SAA levels increased significantly in each group with the peak value at 24 h and the baseline levels remarkably correlated with the highest markers' concentrations. In contrast, preprocedural TNF-alpha concentrations were higher in ISR group when compared with SA and UA patients. Additionally, in ISR group a twofold increase in their values of borderline significance at 6 h was noted. SA and UA subjects were found to have significantly lower TNF-alpha levels at 6 and 24 h after the intervention though the marker concentrations markedly increased with peak values at 1 month. The levels of IL-10 did not differ at any time point between the groups. CONCLUSIONS: We suggest that PCI triggers a systemic inflammatory response in patients with ISR and considerable differences in its pattern when compared with SA and UA patients were demonstrated. Moreover, a high preprocedural TNF-alpha level and its increase provoked by PCI in the ISR group warrant the need for further investigation of its possible involvement in the restenosis process.

[Fibrinolytic system in bronchial asthma after prednisone treatment]. / Uklad fibrynolizy u chorych na astme oskrzelowa po leczeniu prednizonem.

Forty one patients with recently recognised bronchial asthma were studied. Activity of plasminogen activator inhibitor (PAI-1), platelet adhesion and aggregation, antigens of tissue and urokinase plasminogen activators (respectively, t-PA Ag and u-PA Ag), euglobulin lysis time (ELT), complexes of plasmin-antiplasmin (PAP) and fibrin degradation products (FDP) were tested before and after fourteen days administration of 20-30 mg/d prednisone. Statistical significant increase of PAI-1 activity, on the average about 75%, was found (8.35 +/- 9.38 U/ml before, and 14.6 +/- 13.3 U/ml after treatment; p < 0.02). In 31 asthmatic patients (75.6%), after prednisone treatment, increased of PAI-1 activity together with platelet adhesion and aggregation were observed. Among other studied fibrinolysis factors no statistical significant differences before and after treatment were found. These results suggest that in asthmatic patients after prednisone treatment raises PAI-1 activity, probability because of releasing of the increased amount of PAI-1 from activated platelet.

Fibrinolysis system in patients with bronchial asthma.

Every inflammatory process, including that in the course of bronchial asthma may disturb the balance in blood coagulation and fibrinolysis system. The aim of the present study was to evaluate fibrinolysis in patients with bronchial asthma. The study group consisted of 41 patients with bronchial asthma, hitherto untreated (25 women, 16 men, at mean age 37.37 +/- 12.4 years) and 22 healthy adults (control group). In these subjects, the following parameters were established: euglobulin lysis time (ELT), the concentration of tissue plasminogen activator antigen (t-PA Ag), the concentration of urokinase plasminogen activator antigen (u-PA Ag), the activity of plasminogen activator inhibitor type 1 (PAI-1), the concentration of plasmin-antiplasmin complex (PAP) and fibrinogen/fibrin degradation products (FDP). It was found that patients with bronchial asthma had statistically significantly higher mean values of FDP (9.25 +/- 6.7 micrograms/ml vs. 5.0 +/- 5.9 micrograms/ml; p < 0.001), ELT (123.5 +/- 42.7 min vs. 97.4 +/- 27.1 min; p < 0.001), t-PA Ag (8.36 +/- 3.66 ng/ml vs. 5.5 +/- 3.71 ng/ml; p < 0.01) and PAP complexes (250.3 +/- 95.8 ng/ml vs. 193.4 +/- 60.7 ng/ml; p < 0.02). Mean u-PA Ag concentration in patients with bronchial asthma was significantly lower than in control group (0.24 +/- 0.16 ng/ml vs. 0.53 +/- 0.18 ng/ml; p < 0.01). No statistically significant differences were observed as to PAI-1 activity between patients with bronchial asthma and healthy subjects. The results of the present study suggest that increased concentrations of t-PA Ag, PAP and FDP complexes are the evidence for greater activity of fibrinolysis system in subjects with bronchial asthma.

[Changes in platelet function, activated partial thromboplastin time and plasminogen activator inhibitor in patients with bronchial asthma after prednisone treatment]. / Zmiany funkcji plytek krwi, czasu czesciowej generacji tromboplastyny i inhibitora aktywatora plazminogenu u chorych na astme oskrzelowa po leczeniu prednizonem.

Twenty patients with recently recognised bronchial asthma and 22 age and sex-matched healthy control subjects were studied. In both groups the activated partial thromboplastin time (APTT), prothrombin ratio (INR), fibrinogen, euglobulin lysis time (ELT), platelet number and platelet adhesion and aggregation, tissue plasminogen activator antigen (t-PA Ag) and activity of plasminogen activator inhibitor (PAI-1) were tested and compared. Statistically significant differences between asthmatic and control groups concerning adhesion, aggregation, APTT and ELT were found. In asthmatic group after 14 days of prednisone administration in a dose of 20 mg/d statistically significant (p < 0.05) shortening of APTT, and a significant increase of adhesion, aggregation and PAI-1 activity were found. These results suggest that in asthmatic patients after prednisone treatment platelet activity appeared in a form of intensification of adhesion and of aggregation degree, also the activity of PAI-1 probably of the platelet origin increased.

[Evaluation of the circulatory system in workers in the cellulose-paper industry]. / Ocena stanu ukladu krazenia u pracowników przemyslu celulozowo-papierniczego.

The effect of occupational exposure on the circulatory system disorders was evaluated in 802 workers (675 men and 127 women). Occupational histories were analysed, as well as physical and X-ray examinations, laboratory tests (fasting blood cholesterol, triglycerides and glucose) and ECGs were performed. In doubtful cases echocardiography and stress tests on an ergonometer were carried out. Ischaemic heart disease was diagnosed in 1.37% and symptoms suggesting this disease in 6.48% of workers. The incidence of hypertension, anginal pain and dysrhythmias reported were significantly related to workers' age and duration of employment. Smoking, obesity, hypercholesterolaemia and positive family history were found to be most frequent risk factors. Arterial hypertension was diagnosed in 9.48% of workers. Non-occupational factors seem to be mainly responsible for the circulatory system disorders, however, the effects of occupational factors occurring in the cellulose and paper industry which may accelerate the development of ischaemic heart disease, arterial hypertension and dysrhythmias cannot be excluded.

[The usefulness of certain diagnostic tests for diagnosis of bronchial asthma in epidemiologic investigations]. / Przydatnosc niektórych testów diagnostycznych w rozpoznawaniu astmy oskrzelowej w badaniach epidemiologicznych.

The study was carried out to assess accuracy of questionnaire, bronchial inhalation challenge, physical examination and spirography in identifying subjects with bronchial asthma of 582 chemical industry workers, compared with 80 persons with atopic bronchial asthma in epidemiologic screening study. It was found, that based on standards against which tests have been verified, none of them have shown 100% sensitivity and specificity in recognition of asthma in screening group. The best accurate tests in recognition of asthma were bronchial inhalation challenge (sensitivity 47%, specificity 96%) and questionnaire (sensitivity 68%, specificity 88%). Bronchial hyperreactivity showed the highest positive predictive value (82%) in prevision cases of the disease. In conclusions, standard mostly close to bronchial asthma in epidemiologic surveys should contain bronchial hyperreactivity and typical asthmatic symptoms according to the questionnaire.

[Efficacy of flunisolide in treatment of patients with bronchial asthma]. / Skutecznosc flunizolidu w leczeniu chorych na astme oskrzelowa.

In 30 patients with bronchial asthma an influence of flunisolid (Bronilide) on spirometric values, bronchial reactivity and pathological signs was evaluated. No changing in spirometric values and bronchial reactivity and decrease complaints during the treatment with higher doses of Bronilide were noticed. No significant side effects were observed.

[Therapeutic effectiveness of molsidomine in patients with exercise-induced angina pectoris]. / Dorazna skutecznosc molsidominy u chorych z wysilkowa dusznica bolesna.

Exercise tolerance was tested with cycloergometer, and ECG recorded in 33 patients with exercise-induced angina pectoris. Patients' age ranged from 36 to 65 years. Tests were performed prior to and after a single oral dose 2 mg of molsidomine or placebo. Molsidomine reduced the number of patients with exercise-induced coronary pain from 33 to 25, i.e. from 84.5% to 27.27%. Pain-free period was significantly longer in patients given molsidomine whereas postexercise pain and total duration of the coronary pain were significantly shorter. Total work was markedly higher, and maximum ST depression in ECG record following exercise was significantly lower than the values noted prior to molsidomine administration and in placebo group. Heart rates both resting and during exercise did not differ in molsidomine and placebo groups. Molsidomine may be considered as an effective drug preventing exercise-induced anginal pain within 1 hour after administration.

[Occurrence of early and late asthmatic reaction after provocation with antigen and the status of pulmonary ventilation in patients with hay fever after the pollination season]. / Wystepowanie reakcji astmatycznej wczesnej i póznej po prowokacji antygenowej i stan wentylacji pluc u chorych na pylkowice poza sezonem pylenia.

Pulmonary ventilation and asthmatic reaction under laboratory conditions have been investigated in 23 patients with allergic rhinitis hypersensitive to grass pollen. Pulmonary ventilation has been assessed with the aid of VCin, FVC, FEV1, FEV1/VCin, PEF, MEF50, and MTT. Asthmatic reaction has been produced by an inhalation of allergens mixture with dose-response technique. An early reaction has been diagnosed, when FEV1 decreased by at least 20% or MEF50 by 30% within 10 minutes, and late reaction when the same parameters decreased after 6 or 24 hours. An early asthmatic reaction has been noted in 2 patients (8.7%), late--in 4 patients (17.4%), and double (both early and late) reaction in 2 patients (8.7%). Pulmonary ventilation has been normal in all examined patients, except two of them with peripheral airways obstruction (MEF50 less than 70% of the normal value). Results suggest, that asthmatic reaction may be provoked in the laboratory in patients with pollinosis and normal pulmonary ventilation after pollen season. Such a reaction may also be expected during a natural exposition to pollens.

Allergy to cockroach antigens in asthmatic patients.

Cockroach allergy was investigated in a group of 56 patients with atopic bronchial asthma (37 men and 19 women with ages ranging from 16 to 65) all allergic to house dust antigen. In all patients, both intracutaneous tests and bronchial provocation tests were performed with cockroach antigen prepared from the species most common in Poland, Blattella germanica and Blatta orientalis. Positive skin reactions to cockroach antigen were found in 17 patients while an immediate bronchoconstrictive response was noted in 11. In the authors opinion, cockroach antigens may be partly responsible for the antigenic properties of house dust and may play a causative role in some cases of atopic asthma.