ECHOCARDIOGRAPHIC MYOCARDIAL CHANGES IN ACROMEGALY: A CROSS-SECTIONAL ANALYSIS IN A TERTIARY CENTER IN BULGARIA.

CONTEXT: Cardiomyopathy is the most frequent cardiovascular complication in acromegaly. OBJECTIVE: We aimed to compare some echocardiographic markers in acromegaly patients with controls and find a correlation with disease duration, disease activity, levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1). DESIGN: We conducted a cross-sectional case-control study for the period of 2008-2012. SUBJECTS AND METHODS: Acromegaly patients altogether 146 (56 men and 90 women), were divided into four groups according to disease activity and the presence of arterial hypertension (AH). The control group included 83 subjects, matching the patient groups by age, gender and presence of AH. GH was measured by an immunofluorometric method, while IGF-1 by IRMA method. All patients and controls were subjected to one- and two-dimensional transthoracic echocardiography, color and pulse Doppler. RESULTS: We found a thickening of the left ventricular walls and an increase in the left ventricular mass. However, these changes were not statistically significant in all groups and no correlation with disease duration could be demonstrated. As markers of diastolic dysfunction, increased deceleration time and isovolumetric relaxation were registered, which were dependent mainly on age in a binary logistic regression analysis, but not GH or IGF-1. Using absolute values, ejection and shortening fractions were increased in some groups. Using cut-off values, a higher percentage of systolic dysfunction was demonstrated in patients compared to their corresponding controls. Engagement of the right heart ventricle was also found - increased deceleration time and decreased e/a tric ratio. CONCLUSIONS: In conclusion, functional impairments of both ventricles were present, with a predominance of left ventricular diastolic dysfunction.

[Effect of antihypertensive drugs on insulin secretion and efficacy]. / Vliianie na niakoi antikhipertenzivni medikamenti vurkhu insulinovata sekretsiia i efektivnost.

The action of some of the most frequently used antihypertensive drugs (reserpine, clonidine, furosemide, propranolol, verapamil) on carbohydrate metabolism in diabetics was studied in an acute experiment with the help of artificial endocrine pancreas (Biostator). The aim of the study is to facilitate the selection of the most suitable drug to be used in the combination of diabetes and hypertension. 42 patients with diabetes mellitus type II were studied divided into 5 groups of 7 patients each according to the number of drugs examined and a control group also of 7 patients. The drugs propranolol and furosemide exert an unfavourable action both on the beta-cell function and the peripheral insulin efficiency. Verapamil and clonidine influence mainly the insulin secretion by a minimum effect on insulin efficiency. Only the drug reserpine practically does not influence the insulin secretion and efficiency.

Opioid peptides in experimental myocardial infarction. I. The effect of naloxone.

The effect of intravenous administration of the opioid antagonist naloxone in rats with acute left coronary artery ligation was studied. The results demonstrated that naloxone in a dose 2 mg/kg b. w. affords its protection on infarcted animals by two mechanisms: Reduces by 22% the incidence of early arrhythmias that occur within 15-20 minutes of acute myocardial ischaemia, and are responsible for the early (up to the 30th minutes) postligation death; Reverses the hypotension that results from the development of cardiogenic shock after 30 minutes myocardial infarction. The total mortality after naloxone treatment was significantly reduced by 22%. Naloxone does not influence significantly the size of the infarcted area but the incidence of left ventricle wall perforations was decreased by 38%. Both effects of naloxone are attributed to the antagonism of opioid receptors either directly on the myocardium or through blocking the central action of beta-endorphin. A direct effect of naloxone on the cardiac muscle action potential cannot be excluded.

[Dissociation between absorption of 131I-19-iodocholesterol and hormonal activity in corticosteroma patients]. / Disotsiatsiia mezhdu poglushchaneto na 131I-19-iodkholesterol i khormonalnata aktivnosti pri bolni s kortikosterom.

A case is described without clinical and hormonal data about Icenko-Cushing syndrome, with a scintigraphy of adrenals demonstrating the image, characteristic for corticosteroma (decompensated node). The most probable explanation of the finding is that the tumour is with restricted secretory possibilities and secrets mainly biologically inactive hormones, and furthermore it is not with an autonomous, but ACTH-dependent hormonal production.

[Combined acute myocardial infarct and pulmonary thromboembolism with fatal outcome]. / Suchetanie na ostur miokarden infarkt i belodroben tromboembolizum,zavurshilo letalno.

A retrospective clinical and pathologicoanatomic analysis was made of 37 patients with the combination of acute myocardial infarction (AMI) and pulmonary thromboembolism (PTE), that had a lethal end. The following facts were established: The combination of AMI with PTE is established in 7.89% in AMI. All patients have several preconditioning factors for PTE, advanced age including. PTE advances usually in extensive anterior and anterior-posterior myocardial infarction, complicated with cardiac insufficiency. In rare cases, a reverse succession is likely--massive PTE with a following, most frequently posterior-inferior AMI. The percentage of the undistinguished PTE in case of AMI is high--46%. The diagnosis of PTE in AMI is made, with a high probability, in acutely advancing respiratory distress, tachycardia (tachyarrhythmia, pulmonary hypertension, loading of right ventricle, arterial hypotension, phlebothrombosis in the absence of data for extension of the myocardial infarction. ECG, roentgenography, laboratory investigations do not essentially improve the possibilities of making the diagnosis of PTE in AMI.