Human bone marrow granulocyte-macrophageal colonies (GM-Cs) in vitro: myeloid cells in health and in cases of myeloid leukemia.

The morphological characteristics of granulocyte/macrophageal (GM-) colonies and clusters, obtained in vitro (in semi-solid agar cultures) from bone marrow hematopoietic myeloid progenitors pertain to leukocyte hemorheology of healthy persons and patients with myeloid leukemias. The morphological features of in vitro growing myeloid progenitors, granulocytes and macrophages of healthy persons differ in their cell size, shape and degree of differentiation from the cultivated marrow cells in cases of acute and chronic myeloid leukaemia. In this malignant disease, the rheological properties of leukocytes (granulocytes/macrophages) were found to provide diagnostic information. Further studies should be undertaken to examine whether the method could be useful in defining survival, prognosis and therapeutical approach in cases of myeloid leukemia.

[Choice of the anti-arrhythmia drug and antitachycardia pacemakers in persistent tachycardias]. / Podbor na antiatirmichen medikament i antitakhikardni peismeikuri pri uporiti takhikardii.

In 57 patients with recurrent tachycardiac attacks in whom the empiric medical drug treatment failed to prevent the attacks electrophysiological examination was carried out in order to specify the type of the tachycardia. This was followed up by a serial testing of drugs. In 41 patients an antiarrhythmic drug (or a combination of drugs) was found which could prevent the attacks. The prospective follow up of these patients from 3 months up to 4 years revealed that in 36 of them there were no more tachycardiac attacks (90% efficacy). In 11 patients antitachycardia pacemakers were implanted with great efficiency. 9 of the patients had pacemaker type extinguishing and the other two patients had atrio-ventricular pacemaker by a double path in the AV-node. The selection of and antiarrhythmic drug by means of electrophysiological testing and the antitachycardia pacemakers are efficient means against recurrent tachycardias.

[Reproduction of tachycardias in patients with WPW syndrome]. / Vuzproizvezhdane na takhikardii pri bolni sus sindrom na WPW.

Intracavitary electrophysiological study of the heart (IES) was carried out in 27 patients with WPW syndrome. In 17/27, permanent tachycardia, reentry type was reproduced, in 1/27--unstable and in 2/27--echo phenomenon, in 1/27--atrial fibrillation. In 6/27 no tachycardia was reproduced. In I patient the tachycardia, type reentry "detained" in atrial flutter, and in 2--in ventricular tachycardia (unstable). In all patients IES established the presence of additional connections between auricles and ventricles: to left auricle--9 patients (5 obscure connections out of them), to right auricle--6 patients, to septum--10 patients, James connection--1 and connection of Mahaim--1 patient. IES is a valuable method for reproduction of tachycardia in the existence of anatomic base (additional connection) and proper electrophysiological characteristics (short refractory phases). In parallel with tachycardia, reentry type, atrial and ventricular tachycardia could develop in the patients with WPW, making use of the additional connection. IES contributes to the elucidation of numerous diagnostic and therapeutic problems in the patients with WPW.

[Effect of 1 month's treatment with Bezalip on the serum lipids and lipoproteins of patients with different types of hyperlipoproteinemias]. / Vliianie na ednomesechno lechenie s Bezalip vurkhu serumnite lipidi i lipoproteini pri bolni s razlichni tipove khiperlipoproteinemii.

The effect of one-month bezalip (600 mg daily) outpatient department treatment was studied on serum lipids and lipoproteins of 34 patients (31 males and 3 females), aged from 30 to 60 with various types primary HLP (IIA, IIB, IV and V). After the treatment, it was established that tendency to malization of the increased concentrations of triglycerides (Tg) and cholesterol (Chol) was changed. The drug has a stronger effect on triglyceride component of serum VIDLP and LDLP as compared with the corresponding cholesterol one, due to which its treatment is with better effect in IIB, IV and V type HLP. The decrease of cholesterol concentration in the separate types HLP differs in size and mode of induction. It is stronger in the mixed types HLP (II phi and V) and is due to decreased cholesterol content of LDLP and VLDLP, whereas in IIb type HLP - the serum concentrations of total Chol was decreased as well as of LDLP-Chol with a parallel increase of the levels of LVDLP-Chol and VLDLP-Tg. In IIA and V type HLP, serum concentration of HDLP-Chol is increased but insignificantly. Bezalip treatment changes the interlipoprotein index Ka (total Chol-HDLP-Chol/HDLP-Chol) in a favourable direction as regards the atherogenic risk, in all types HLP studied.

[Changes in serum lipoproteins in patients with ischemic heart disease at an early age]. / Promeni na serumnite lipoproteini pri bolni s iskhemichna bolest na surtseto v mlada vuzrast.

The serum lipoprotein profile was determined in 37 patients with chronic ischemic heart disease (IHD) and 100 practically healthy subjects, aged from 18 to 45. HLP was found in 59.5 per cent of the patients examined, 50 per cent in males and 100 per cent in females. Type IV has the highest incidence (54.5%), followed by type IIB(36.4%) and type IIa (9.1 per cent). In 27 per cent of the patients with no HLP determined, less significant changes in LDLP and VLDLP were found, admitted to be dyslipoproteinemia (DLP). HLP and DLP were confirmed in 86.5 per cent of the patients examined. In all patients serum concentration of HDLP-Chol was decreased (mostly in DLP and type IV HLP), whereas the level of HDLP-Tg was increased in most of the cases. As a result, the intralipoprotein index 1(2)(=HDLP-Chol/HDLP-Tg) was decreased, reaching the lowest values in IIa and type IV HLP. The only index of all studied, being changed (elevated) with a statistical significance in all groups of patients with IHD, in those with normolipoproteinemia (NLP) including, was the lipoprotein index II(=LDLP-Chol and VLDLP-Chol/HDLP-Chol). With the morbid process progressing, assessed by ECG data, the functional stage of stenocardia, the degree of the constriction and the number of the pathologically altered coronary arteries, the incidence of NLP, DLP and type IV HLP distinctly decreased, whereas IIa and IIB type HLP increased.

[Determination of the effect of furanthril on myocardial infarct lesion size according to precordial electrocardiogram (mapping) and enzyme activity findings]. / Otchitane vuzdeistvieto na furantrila vurkhu goleminata na lezionnata zona pri surdechen infarkt po danni na prekordialnata elektrokartograma (meping) i enzimna aktivnost.

The ECG Mapping from 30 precordial points in 56 patients with recent anterior transmural infarctions was followed up as well as the level of the enzymes, acid phosphokinase, SGOT and LDH-iso during the first 6 days after the origination of the cardiac infarction. Thirty six patients were treated according to the generally adopted treatment schedule of cardiac infarction (group without furanthril) and 20 patients were administered, in addition to the generally adopted schedule, one tablet furanthril daily during the first six days (group with furanthril. Though no manifested discrepancies were observed in the indices studied in both groups (without and with furanthril)--in patients administered furanthril systematically--a better manifested drop was found in ECG Mapping indices and the enzyme activity in the course of the cardiac infarction, as compared with the group without furanthril. In some of the cases that tendency was with a statistical significance. According to clinical data, extensive lesion of myocardium and cardiac rupture were more frequently found in the group without furanthril whereas grave rhythm disorders were more frequent in the group with furanthril. The systematic administration of furanthril, in the first several days after the origination of the cardiac infarction, revealed some favorable tendencies in its course (possible restriction of lesion zone according to ECG Mapping data, restriction of necrosis according to enzyme activity data), but, at the same time, the unfavourable arrhythmia became more frequent, necessitating the control of rhythm and electrolytes as well as timely antirhythm treatment.

[Electrophysiologic characteristics of the syndrome of ventricular preexcitation]. / Vurkhu elektrofiziologichnata kharakteristika na sindroma na kamernoto predvuzbuzhdane.

In nine patients with syndrome of ventricular over-excitation of intracavitary electrocardiographic investigation was carried out, including recording of Hiss bundle potentials, right and left auricle, programmed, increment and high frequent stimulations. The anatomic characteristic of the additional connection, on the base of the deformation of QRS-complex and the type of the retrograde conduction in case of ventricular stimulation showed that the connection started from the right auricle. In five--it terminates in the left ventricle, and in four--in the right. In the majority of the patients it is with an effective refractory phase under 300 msec., corresponding to the electrophysiological characteristic of a direct connection between auricles and ventricles. The problem of the origination of the phenomenon of circling excitation in the patients with the syndrome of ventricular overexcitation is discussed.

[Recording of the potential of the bundle of His in patients with disordered atrioventricular conduction]. / Registratsiia na potentsiala na snopa na Khis pri bolni s narusheno predsurdno-kamerno provezhdane.

The potentials of His bundle were recorded in 25, out of 105 patients with intracardial electrophysiological examination, carried out. The standard electrocardiographic devices were used, being reconstructed for the purpose. The patients with AV block, stage I and partial AV block, Wenckebach type manifested blocking (slow down) above His bundle. The patients with AV block, Möbitz type II and the patients with chronic AV block manifested blocking both above and beneath His bundle. With auricle stimulation with alternative frequency, latent pathological disorders of auricle-ventricular conduction could be manifested. The method allows the localization of the level of the block, aiding the solution of prognosis problems, further behaviour and eventually the setting of artificial guide of cardiac activity.

[Assessment of sinus node function using electrophysiological methods]. / Otsenka na funktsiiata na sinusoviia vuzel s pomoshtta na electrofiziologichni metodi.

Intracardial electrophysiological examination was conducted in 50 patients with suspicious or confirmed data about disturbed function of sinus node--namely: short-term auricular stimulation for determination of sinoatrial time (SAT) and long-term auricular stimulation with increasing frequency with analysis of the phenomena in the post-stimulation period--time of sinus node recovery (TSNR), corrected recovery time of sinus node (CRTSN=TSNR minus the basal cycle of auricle before stimulation), emerging of ectopic rhythm leaders and secondary pauses. The following data were obtained in the two groups of patients formed: Group I--26 patients with ECG data about disturbed function of sinus node (periods of sinus bradycardia under 40 beats (minute and/or sinus pauses over 1800 msec): SAT identical to 375 +/- 168; TSNR = 2714 +/- 562; CRTSN = 1684 +/- 347; SAT over 400 msec was found in 8 out of 22 patients; TSNR over 1400 msec in 20 out of 26 patients, CRTSN over 550 msec in 20 out of 26 patients. Ectopic rhythm leader occurred in the poststimulation interval in 5 out of 26 patients and in 4 patients--secondary pauses over 1800 msec were observed; Group II--24 patients, with no data about disturbed function of sinus node (according to the upper criteria): SAT = 254 +/- 91; TSNR +/- 1082 +/- 168; CRTSN = 326 +/- 108; SAT over 400 msec was observed in none of the patients from that group. TSNR over 1400 msec (but under 1700 msec) was found in one patient, CRTSN in the same patient and in the rest of that group was under 550 msec. No ectopic rhythm leaders and secondary pauses over 1200 msec were found in that group of patients during the poststimulation interval. SAT, TSNR and CRTSN were shortened with a statistical significance in both the patient groups after the administration of atropine--I mg intravenously and the reexamination but in 5 patients from group I TSNR, CRTSN were paradoxically lengthened and became pathological. The electrophysiological methods for the studies on sinus node and the electrophysiological parameters, obtained via them, could contribute to the characterization and assessment of the functional potentialities of sinus node as well as to a better understanding of the mechanism of its injury.

[Comparative study of the therapeutic effect of antiangina agents]. / Sravnitelno prouchvane na terapevtichniia efekt na niakoi antianginozni sredstva.

The therapeutic effect of obsidan (25 to 250 mg/24 h), cordanum (75 to 300 mg/24 h), nitropenton (30 mg/24 h), combination of obsidan with nitropenton, prenylamin (180 mg/24 h), stenopril (180 mg/24 h), cordaron (600 mg/24h) and corvaton (4 mg/24 h) was studied according to clinical asessment in 127 patients with stenocardia and in 44 of them by loading tests (veloergometry or treadmill). According to the clinical assessment -- very good (abating of stenocardia paroxysms) and good effect (less frequent paroxysms nitroglycerin necessary every one-two days) was established in 82 per cent of those treated with obsidan, in 78 per cent of the treated with cordanum, in 86 per cent of those treated with the combination obsidan with nitropenton, in 44 per cent of the treated with nitropenton, in 42 per cent of the treated with prenylamin, in 46 per cent pf the treated with stenopril, in 7 out of 9 patients treated with cordaron as well as in 7 out of 9 patients treated with corvaton. According to the data from the loading tests--very good (increase of capacity, not limited by pain and ST depression) and good effect (considerable increase of capacity but limited by pain and ST depression) was found in 77 per cent of the patients administered obsidan, in 67 per cent of those administered cardanum and in 33 per cent of the patients administered tenopril and prenylamin. Beta--blockers significantly excel the therapeutic effect of stenopril, prenylanin and nitropenton, both according to clinical assessment (P < 0,02 to p < 0,001) and to the data from the loading tests (P < 0,02). Beta-blockers dosage was individually determined but 80 per cent of the patients with a favourable effect by obsidan or cordanum had received 60-120 mg/24 h and 150 mg/24 h respectively. The individual effect of the patients is presented so that even the small number of cases observed with cordaron and corvaton treatment shows it reasonable to include new preparations in antianginose treatment.

[Clinical characteristics, immediate therapeutic results and the outcome in rhythm and conductivity disturbances in myocardial infarct]. / Klinichna kharakteristika, neposredstveni terapevtichni rezultati i izkhod pri niakoi narusheniia na rituma i provodimostta pri infarkt na miokarda.

Certain rhythm and conduction disorders in 252 patients with myocardial infarction were studied. Twenty one of them had auricular fibrillation, influenced by medicaments, with the exception of one, six had relapses and 4 of the patients died. Ventricular extrasystoles (frequent, polytopic, more than three one after the other, R of T) were found in 48 patients. Regardless of the reported good result from the treatment of ventricular extrasystoles, ventricular tachycardia originated in 10 and ventricular fibrillation--in 9 patients. Ventricular fibrillation (a total of 29 patients) was more frequent in patients with cardiac insufficiency (25%) as compared with those (6.1%). With the combination of cardiac insufficiency and ventricular extrasystole, a very high risk group is formed--every third patient develops ventricular fibrillation. Four patient out of 22 patients, were discharged with timely initiated treatment of the ventricular fibrillation. Complete atrioventricular block was recorded in 12 of the patients with a lethality of 50%. Conclusions are drawn as regards the duration of prophylaxis and treatment of rhythm and conduction disorders and in-patient days of the patients in the intensive care unit.

[Clinical use of electrical atrial stimulation]. / Vurkhu klinichnoto prilozhenie na elektricheskata perdsurdna stimulatsiia.

Electric auricle stimulation (EAS) was realized in a total of 77 patients. In 60 of the patients EAS was performed as a hypoxic test (step-wise increase of heart rate, with ECG registration and in many of the cases -- registration of certain indices of general and intracardial hemodynamics) with a view to precise diagnosis of ischemic heart disease and assessment of myocardial contraction function. In 91 per cent of the patients with stenosed coronary pathology on coronarogram, the symptoms of coronary insufficiency were positive (pain attack, ECG changes via ischemic type and/or deterioration of the myocardial functional curve) with the aid of EAS. Various correlations were established between the manifestations of coronary insufficiency and the deterioration of the functional curve of left ventricle. Furthermore, in the majority of the cases, one way results, among the data of veloergometry, coronarography and EAS, were recorded. In some cases EAS provided additional data for coronary insufficiency with negative veloergometric test (7 patients) and negative coronarography (5 patients). EAS could be applied in the diagnostics of ischemic heart disease, and in a hemodynamic aspect, via EAS a myocardial loading is realized with a minimum change of cardiac index and aortic pressure. In 16 patients EAS was applied with a view to the investigation of the functional state of sinal node and heart conduction system. In 13 patients, data about the syndrome of morbid sinal node were found (pathologic time of sinal node restoration) or for a latent lesion of heart conduction system. In the other three patients the suspicion of syndrome of morbid sinal node was not confirmed. The data obtained contributed to the determination of the therapeutic approach of those patients. In 5 patients a high frequency auricle electrostimulation was applied successfully in the interruption of paroxysms of supraventricular tachycardia. EAS was concluded, on the base of the data obtained, to be appropraite for application and precise diagnosis of ischemic heart disease, as well as in the studies on sinal node state and heart conduction system. In some rhythm disturbances, resistant to medicamentosus treatment, the electric auricle stimulation could prove a valuable therapeutic method.