Influence of non-dipping pattern of blood pressure in gestational hypertension on maternal cardiac function, hemodynamics and intrauterine growth restriction.

BACKGROUND: An association between gestational hypertension (GH) and changes of maternal cardiac function was previously reported. AIM: The study assessed the effect of non-dipping pattern of blood pressure (BP) in GH on haemodynamic function and intrauterine growth restriction (IUGR). METHODS: This study included 126 women (91 with GH and 35 normotensive controls). Based on the BP values measured by ambulatory blood pressure monitoring (ABPM), all hypertensive women were classified in dipper (46 women) or in non-dipper group (45 women). All participants underwent echocardiography and ABPM during the third trimester. RESULTS: Participants with GH and non-dipping pattern had significantly lower velocity of longitudinal systolic function (s') (p<0.0005), and cardiac output index (COi) compared to dippers (p<0.0005) and controls (p=0.002). Diastolic velocities at the mitral valve annulus were also lower in non-dippers e's (non-dippers vs dippers p=0.023; non-dippers vs controls p<0.0005) and e'l (non-dippers vs dippers p=0.048; non-dippers vs controls p<0.0005). There were significant differences in the index of the left ventricle filling pressure E/e' and myocardial mass index between women with GH and controls, but with no significant difference among dippers and non-dippers. Total vascular resistance was increased in non-dipping group compared to normotensives and dippers (p<0.0005). Multivariate regression analysis revealed that the peak night-time diastolic BP, left ventricular mass index and CO index were identified as independent predictors of IUGR. CONCLUSION: Changes in maternal hemodynamics, as well as IUGR, are strongly related to the non-dipping pattern of BP.

[Incidence of surgical site infection after open heart surgery].

INTRODUCTION: Despite modem surgical techniques, preoperative preventive use of antibiotics and optimal treatment of operative site, surgical site infections (SSI) are significant medical problem in the countries worldwide. OBJECTIVE: The aim of this paper was to estimate the frequency of SSI after open heart surgery and to identify the most frequent causes of these infections. MATERIAL AND METHODS: A prospective cohort study was performed during the period from January 2008 to December 2009 at the Clinic of Cardiovascular Surgery of the Institute of Cardiovascular Diseases, Vojvodina. The surveillance was consistent throughout the study period. During hospitalization, patients were evaluated daily by the infection control nurse. Isolation, identification and sensitivity tests of causative agents to antimicrobial drugs, obtained from patients' material, were carried out by standard microbiological methods. The descriptive epidemio-logical method was used. The incidence rates of hospital infections were calculated. RESULTS: During the study period, among 23 patients, 24 SSIs were registered. The average incidence rate of patients with SSI was 0.98% and SSI rate was 1.02% (ranged from 0% to 3.7%). There was no difference in the incidence rates according to gender (p = 0.65).The mean age of patients with SSI was 64.7 years. Except one, all patients had the ASA score higher than 2. The patients with SSIs were hospitalized approximately 3.8 times longer than the patient without SSI (p = 0.03). The most common causes of SSI were: Staphylococcus aureus (30%), coagulasa-negative Staphylococcus spp, Acinetobacter spp (8%), Enterococcus spp and Klebsiella pneumoniae. CONCLUSION: Although the incidence rate of hospital infections is low, it is necessary to maintain continuous surveillance of surgical site infections and to implement the preventive measures.

Autopsy material analysis at the Cardiology Clinic in 1999.

Clinico-pathological studies serve as a valuable source of information in everyday practice of most medical institutions. The aim of this study was to correlate the clinical and pathological diagnoses of principal disease and cause of death after autopsy in patients who died during 1999 at the Cardiology Clinic, Institute of Cardiovascular Diseases, Sremska Kamenica, Yugoslavia. Medical histories and autopsy reports of dead patients were analyzed: 255 (8.46%) patients died, but only 72 (28%) underwent autopsy. In 53 patients (73%) clinical cause of death was cardiac. Among these patients, consequences of coronary (atherosclerotic) artery disease prevailed in 41 patients (77%). Noncardiac cause of death was established in 19 patients (27%) and vascular causes prevailed with 17 (23%). The comparison of clinical and principal disease established by autopsy revealed a complete concordance in 62 cases, partial concordance in 1 and no concordance in 9 cases. Thus, concordance was found in 86-87.5%. The correlation coefficient was 0.48. Comparison of clinical and autopsy diagnoses of causes of death revealed concordance in 53 patients, with correlation coefficient 0.26.

[Echocardiographic evaluation of left ventricular function in patients with arterial hypertension and normal left ventricular mass index]. / Ehokardiografska procena funkcije leve komore u bolesnika s arterijskom hipertenzijom i normalnim indeksom mase miokarda leve komore.

UNLABELLED: Data about disturbances of the diastolic function of the left ventricle (LV) are well known in literature and registered even in the limited form of hypertension i.e. before the occurrence of myocardial hypertrophy. The aim of this work was to check this hypothesis in patients with arterial hypertension and normal LV mass index. The total number of examined patients was 144. The control group consisted of 30 patients, while the number of hypertensive patients in the other group was 114. The following parameters were observed: blood pressure, heart rate, systolic and diastolic dimensions of LV, wall thickness, left ventricular mass index, wall stress, endsystolic and enddiastolic volume index, cardiac index, ejection fraction, shortening fraction, velocity peak of early and late diastolic filling and their mutual relationship, integral of speed-time of early and late diastolic pressure, as well as the index of early and late filling. A significant difference was found in the size of LV mass index, wall stress, velocity peak of early diastolic filling and the relationship of velocity peak of early and late filling. It should be noted that the values of the observed parameters were in normal ranges, but those in the group of hypertensive patients were closer to pathological values. CONCLUSION: Microstructural changes of LV myocard mass can be registered in hypertensive patients before the significant enlargement of LV mass index. Diastolic disfunction of the left ventricle precedes myocardial hypertrophy.

[Echocardiographic evaluation of the effect of treatment with captopril in patients with essential hypertension]. / Ehokardiografska procena efekata lecenja kaptoprilom u bolesnika s esencijalnom hipertenzijom.

Numerous antihypertensive drugs act through different mechanisms so it is natural to expect their various effects on consecutive myocardial changes. This study included 40 patients with mild or moderate hypertension: 30 patients (19 male--63.3% and 11 female--36.7%), their mean age 40.1 year, who were treated with Kaptopril (Zorkaptil), and 10 patients (6 female--60% and 4 male--40%), their mean age 37.7 years, who received placebo. Before the beginning of the treatment and three months later the following data were analyzed: blood pressure, the left ventricular mass, the left ventricular mass index, shortening fraction, ejection fraction and the endsystolic left wall stress. Three months later in the group treated with Kaptopril significant reduction of blood pressure, left ventricular mass, left ventricular mass index and endsystolic left wall stress (p < 0.05) was found. The changes concerning ejection fraction and shortening fraction were not significant. Three months later, in the group which received placebo no changes could be found. It can be concluded that Kaptopril is an effective antihypertensive drug for treating some cases of mild and moderate hypertension as monotherapy not only because it control the blood pressure, but also because it significantly reduces the wall thickness of the left ventricular mass and of the endsystolic left wall stress.

[Beta-adrenergic blockers in congestive heart failure: pro et contra?]. / Beta-adrenergicki blokatori u zastojnoj insuficijenciji srca: za ili protiv?

In every patient with congestive heart failure there is a secondary neurohumoral response including increase in serum noradrenaline, renin, angiotensin, aldosteron and antidiuretic hormone or arginine-vasopressin values. Plasma and urine noradrenaline levels are increased proportionally to the severity of ventricular dysfunction, but its reserve is often reduced in the myocardium as well as the density of beta receptors and sensitivity to catecholamines and inotropic responses to the stimulation of adrenergic nerves. Down-regulation of beta-adrenoceptors in the myocardium, verified by the technique of radioligands, with the reduced number of beta-adrenoceptors, is accompanied by the appearance of refractoriness and desensitization to endogenous and exogenous catecholamines. Chronic beta-blockade may improve haemodynamic and clinical function in patients with dilated cardiomyopathy or congestive heart failure, because beta-blockers have potentially beneficial actions: protection of the myocardium from damage by chronic excessive catecholamine stimulation, restoration toward normal of the down-regulated membrane beta-receptor density often seen in heart failure, reduction in the risk of potentially lethal ventricular arrhythmias and beneficial effects on substrate utilization. Our results of investigation in 20 patients with congestive heart failure treated with beta-blockers short and long-term (average 22 months) gave substantial increases in ejection cardiac index and improved functional class and also improved working capacity.

[Structural analysis of external fixators of bones and the anatomy of the olecranon process]. / Strukturalne analize vanjskih fiksatora kostiju i anatomske kukaste plocice za olecranon.

Shown is the structural analysis of the broken bone metal fixator and of the anatomic hooked metal sheet for olecranon, from the structural engineering point of view. The FE models are structurally examined using the ICES STRUDL system and the COMPUTERVISION for graphics simulations.