Additive effect of diabetes and systemic hypertension on the immune mechanisms of atherosclerosis.

In order to evaluate the changes in humoral immunity due to one and two atherogenic factors (systemic hypertension and/or diabetes mellitus), we investigated 350 women divided into four groups: (1) 65 insulin-dependent (type I) non-hypertensive diabetics; (2) 92 systemic hypertensive non-diabetic subjects; (3) 64 hypertensive insulin-dependent diabetics; and (4) 129 non-hypertensive and non-diabetic women as a control group. All subjects had no coronary artery disease. The humoral immunity was evaluated by (1) circulating immune complexes, (2) total serum complement, (3) C3 fraction of complement, and (4) circulating antitissue antibodies (antivascular and antisclerotic-vascular). The patients with atherosclerotic risk factors (diabetes and/or hypertension) had significantly (P < 0.001) elevated levels of total complement, C3 fraction and circulating complexes compared with the control group. Total complement and circulating complexes levels were most elevated in patients with a combination of diabetes and hypertension. Similarly, these patients had the highest frequency of antitissue antibodies. In summary, the parameters of humural immunity were more changed in patients with two risk factors (diabetes and hypertension) compared to patients with only one risk factor. It is possible that these immunological changes appeared earlier than clinical symptoms of atherosclerosis and they could be used as an early prognostic test for predisposition to atherosclerotic vascular complications.

[Cardiological problems in pheochromocytoma patients]. / Niakoi kardiologichni problemi pri bolni s feokhromotsitom.

The course of the disease of six cases with pheochromocytoma was analyzed in patients, aged from 19 to 65, with manifestations mainly of the cardiovascular system. The diagnosis was verified in five of them at necropsy and in one of them--intraoperatively. The arterial hypertension accompanied by distinct vegetative symptomatics were the basic clinical signs and in some of the cases--disturbances in the carbohydrate metabolism. In four patients the arterial hypertension was permanent, in two of them--with paroxysmal elevation opresf blood pressure. In the other two--with hypertonic crises on the background normal blood pressure. The duration of the hypertension--from a single hypertonic crisis during pheochromocytoma attack, had a lethal end, till the fifth year. In three of the patients rhythm disorders (supraventricular tachycardia or tachyarrhythmia) originated in a pheochromocytoma paroxysm and in three--acute left ventricular insufficiency (gallop rhythm, pulmonary edema). The clinical picture resembles heart defect, myocardial infarction with congestive cardiac insufficiency and rhythm disorders, renal insufficiency with symptomatic arterial hypertension and decompensated hypertonic heart, epilepsy, coggagenosis . The authors admit that the development of acute left ventricular failure in hypertonic patients, that could hardly be explained only by the increase of the heart afterloading (in advanced age, not enlarged and no data about grve heart lesions) or the origination of severe rhythm disorders, not coped by the modern antirhythm agents, are signs, indicating, the existence of pheochromocytoma. The catecholamine affection of myocardium, that was found in three of the deceased patients, very likely, contributes to the origination of left ventricular failure.

[Hypertension, pregnancy and childbirth]. / Hypertonie, Schwangerschaft und Geburt.

Retrospective evaluation was applied to 162 pregnancies of women with hypertension at the Third Municipal Hospital of Sofia, Department of Obstetrics and Gynaecology, for a period between 1976 and 1980. The birth record in that period amounted to 9348. Hypertension was recorded from 1.7 per cent of the deliveries. All women examined were primiparae. They were subdivided by four groups: essential hypertension, organic hypertension, EPH gestosis, and plug gestosis. Sixty-two patients with an earlier record of EPH gestosis were additionally examined in a follow-up programme, between 1977 and 1980. Most of the hypertension cases were identified as having been different from EPH gestosis. An attempt is made to group hypertension during pregnancy. The authors suggest that higher accuracy of diagnosis will help to reduce the incidence of both essential hypertension and EPH gestosis. An analysis was made of diagnostic and therapeutic approaches, control of labour, and condition of the newborns.

[Clinical biochemical changes in ischemic heart disease: hyperuricemia as a risk factor]. / Kliniko-biokhimichni promeni pri bolni s IBS: khiperurikemiiata kato riskov faktor.

One hundred and sixty patients with IHD were examined--73 males and 87 females, average age for males--58.58 +/- 12.69 and for females--59.65 +/- 7.76. Elevated levels of uric acid were found in 51.5 per cent. The correlation analysis showed a positive correlation dependence between total fats and uric acid, between cholesterol and uric acid as well as between total protein and uric acid and reverse dependence between uric acid and alpha 2-globulines, beta and gamma globuline fractions. The results from the investigations carried out provided grounds to admit hyperuricemia to be one of the risk factors of IHD.

[Several factors leading to absolute arrythmia in acquired valve defects (preliminary report)]. / Niakoi faktory, dovezhdashchi do absoliutna aritmiia pri pridobiti klapni porotsi (predvaritelno suobshchenie)

Some of the most important factors leading to arrhythmia perpetua in acquired valvular diseases are discussed in the paper, with the analysis of the material from 96 patients (68 females and 28 males). A group of 98 patients (73 males and 25 females) with degenerative cardiovascular diseases was parallelly studied. The importance of the time of the onset of the first rheumatic attack is stressed upon as well as upon the number of recidivations upon the valvular defect type and upon the additional degenerative myocardial changes in the evolution of the valvular cardiopathy.