The importance of bioimpedance (BIA) analysis and Cardio Tens (24-h ABPM and ECG) monitoring in the dialysis programme.

The authors performed bioimpedance analysis and Cardio Tens (24-h ABPM and ECG) monitoring in 66 patients (28 males, 38 females) treated in the chronic haemodialysis programme. They investigated the correlations between the body weights before, during and after dialysis, the changes of the water compartments and fat body weight, and the recorded values of blood pressure and ECG alterations. On the basis of the measurements by this non-invasive method it is concluded that, as a result of dialysis and ultrafiltration, the total body weight and total body water are decreasing in a greater extent in men than in women. By gradually decreasing the body weight, the optimal dry weight could be attained, which resulted in the reduction of blood pressure or even normotension. In the course of dialysis the values of bioimpedance and bioreactance increase. The intradialytic hypotensive indispositions were accompanied by a significant reduction of bioreactance (n = 16). The BMI, total body weight and total body water hyperlipidaemic, hypalbuminic patients with treatment-resistant hypertension are considerably larger than those of the patients with normal blood pressure (p<0.01). During Cardio Tens monitoring 53% of the patients proved to be dippers, 47% of whom had ST depression, while in 73% of the non-dippers ischaemic alterations were encountered together with high hyperbaric impact values. The total body weights and total water compartments of patients returning to dialysis with an excess body weight of more than 3.5 kg were significantly larger than of patients who were cooperative and had no oedemas. In the last hour of dialysis and during the following few hours, arrhythmias and ST depressions of the cardiovascularly instable patients appeared more frequently. The total water compartments of these patients are significantly larger than normotensive, normolipaemic patients with appropriate serum albumin concentrations. The importance of the BIA and Cardio Tens monitoring in determining the optimal dry body weight and improving the cardiovascular condition of the patients is emphasized.

Very early extubation: extubating in the OR following coronary artery bypass.

Cardiac surgery patients are being extubated earlier than ever before. This article describes how the nurses responded when the first patient to be extubated in the OR was admitted to the critical care unit. This case shows how this change is not as simple as just extubating the patient. Early extubation requires protocol changes, ethical considerations, system changes, staff education, and evaluation of patient outcomes.

Coronary artery disease in women: assessment, diagnosis, intervention, and strategies for life style change.

Coronary heart disease is reaching epidemic proportions in women. With increased longevity, more women are living many years beyond menopause, the time when heart disease peaks in women. For midlife women, it is important to determine a personal profile of unmodifiable (family history, age, and race) and modifiable risk factors. The goal for every woman must be to control coronary risk factors such as smoking, hyperlipidemia, diabetes, sedentary life style/weight control and stress, which have been proven to be amenable to modification strategies. Many women also may consider hormonal replacement but must be counseled to make informed choices concerning the benefits and risks. Finally, as nurses and as leaders in the health care of women, we must model heart healthy behaviors to encourage each other and to increase our effectiveness with the clients we serve.

Measurement of functional ability in patients with coronary artery disease.

The purpose of this study was to examine measures of functional ability in a group (n = 60) of cardiac patients undergoing treadmill exercise tests. Functional ability was defined as the degree to which the individual is able to perform physical activity in the absence of symptoms. Instruments used were the Modified Harvard Alumni Scale (MHAS), the Symptom Scale (SS) comprised of the following subscales: angina (AS), shortness of breath (SOBS), and fatigue (FS); the overall Health Rating Index (OHRI); and the Goldman Specific Activity Scale (SAS). Concurrent validity was supported by the fact that the instruments were correlated with metabolic equivalents achieved on the treadmill. Correlations were: MHAS (r = .34, P < .01), SS (r = .67, p < .01), AS (r = .54, p < .01), SOBS (r = -.41, p < .05), FS (r = -.56, P < .001) and the OHRI (r = .45, p < .001). Reliability was determined using Cronbachs, alpha and were: SS = .92, AS = .87, SOBS = .86, FS = .85 and OHRI = .88. Findings support the need for testing and evaluation of instruments measuring functional ability in diverse cardiovascular populations.

Comparison of peripheral, uterine and cord estrogen and progesterone levels in laboring and nonlaboring women at term.

Although a direct effect of steroid hormones on the initiation of labor has been shown in animals, conclusive data on human parturition are lacking. To elucidate steroid changes associated with human labor, venous serum samples were obtained at cesarean section from the maternal peripheral and uterine veins and umbilical cord vein of seven laboring and seven nonlaboring women at term. Assays of estradiol (E2), estriol (E3) and progesterone (P) revealed that: (1) there is a major concentration difference in all the steroids between peripheral and local values, (2) labor is associated with a significant rise in systemic and local E2 but no change in P, and (3) the increased production of E2 does not appear to be from a fetoplacental source. These data strongly support a modulating role for alterations in steroid hormones at the onset of human labor. The results demonstrate an increase in estrogen, rather than the classic "withdrawal", as the prime factor in E2:P ratio changes associated with labor and suggest that the source of the estrogen increase may be maternal rather than fetal.

Absorption, distribution, excretion and metabolism of orally administered 14C-beta-cyclodextrin in rat.

The absorption, distribution, excretion and metabolism of orally administered universally labelled 14C-beta-cyclodextrin and 14C-glucose were compared in rat. The maximum radioactivity of the blood derived from 14C-beta-cyclodextrin was observed between 4th and 11th h and the value of the maximum in different experiments ranged between 5 and 17 0/00 of the total administered radioactivity. Following 14C-glucose treatment radioactivity reached the maximum within half-an-hour, with values of 15 to 82 0/00. In the 8th h after a high dose (313.5 mg/kg) of beta-cyclodextrin no more than 3-50 ppm beta-cyclodextrin was detectable in the blood by HPLC. After 14C-beta-cyclodextrin treatment 4.2-4.8% of the administered total radioactivity was excreted by the urine and about the same quantity (2-3.6%) in case of 14C-glucose. No specific accumulation was observed after 14C-beta-cyclodextrin treatment in the different organs. The large intestine contained 10-15% of the cyclodextrin radioactivity while this value was only 2% in case of 14C-glucose. Following p.o. administration of different doses of 14C-beta-cyclodextrin the radioactivity peak was detected in the exhaled air between the 4-6th and 6-8th h, respectively, depending on the administered doses, while in case of 14C-glucose treatment it was observed within 2 h. The total radioactivity exhaled by 14C-beta-cyclodextrin treated animals in 24 h was 55 to 64% of the administered radioactivity and 58% in case of 14C-glucose. It is assumed that beta-cyclodextrin is metabolized in rats slower but similarly to glucose, therefore p.o. administered beta-cyclodextrin cannot induce toxic symptoms.

Study of nucleic acid metabolism in two astronauts.

During the last years data have evidenced that alteration in nucleic acid metabolism, expecially increased urinary excretion of modified nucleosides reflects physiological changes in living organism. In relation with the Soyuz-36-Salyut-6-Soyuz-35 mission in 1980 urinary nucleoside excretion of two astronauts /B.F., V.K./ were traced. Individual daily urine samples were collected for 4 days before starting and 6 days after landing and were analysed with improved analytical procedures /affinity chromatography, high Performance liquid chromatography/. Levels of 1-methylinosine, 1-methylguanosine and N,2,2-dimethylguanosine in urine were determined. Thus recorded changes differ considerably at two astronauts. One of the /V.K./ excreted nucleosides normally, another /B.F./ showed increase to 200-400 % levels excretion of above nucleosides on the second day after landing. The peak values disappeared on the 3-6 days after. To interpret this phenomenon extreme factors of space-flight /weightlessness, stress, radiations, etc./ have to be taken into consideration. However, we attach importance to training of astronauts. During the last decade data have evidenced that alterations in the metabolism of nucleic acids especial increased urinary excretion of modified nucleosides reflects physiological and in some cases pathological changes in living organism. In relation with the Soyuz-36-Salyut-6-Soyuz 35 mission urinary excretion of certain modified nucleosides of two astronauts /B.F. and V.K./ were measured. The aim of the measurements was: how the metabolism of transfer ribonucleic acids /tRNAs/ referring to cosmic flight, how it is reflected in urinary excretions of modified nucleosides. For these purposes we studied the excretion of methylguanosine, dimethylguanosine and methylinosine. These nucleosides are the normal minor components of tRNA.