[Interactions between propranolol, isosorbide and nitroglycerin]. / Interakcja propranololu z izosorbidem i nitrogliceryna.

We studied interactions between propranolol and nitrates, used in subjects with stable angina pectoris on effort. Basal pharmacokinetic indexes were estimated on measured levels of propranolol concentration. It was found, that nitrates used with propranolol at the same time decrease its concentration in serum and bioavailability, and increase propranolol clearance calculated for whole body, its distribution volume and shorten propranolol life half-time in the blood serum.

[Echocardiographic evaluation of the size and systolic and diastolic function of heart muscle i patients with acromegaly]. / Echokardiograficzna ocena wielkosci i czynnosci skurczowej i rozkurczowej miesnia serca u chorych na akromegalie.

In 20 patients with acromegaly, morphology of the heart and its systolic and diastolic function were studied by echocardiography, and growth hormone concentration was examined in the serum. Increased muscle mass of the left ventricle was found and that increase depended on disease duration and the growth hormone serum concentration. An increase was also shown of the left ventricular end-diastolic dimension, and the dimensions of left ventricle posterior wall and intraventricular septum, as well as an increase of end-systolic left ventricular dimension and of the size of the left atrium. Out of systolic function parameters, an increase was shown of stroke volume, cardiac output and cardiac index. In 40% of the studied patients an impairment was shown of left ventricular diastolic function but in a half of them no diseases other than acromegaly were found which could have been its cause.

Clinical experience with the silicone tracheal prosthesis.

The superiority of using the patient's own tissue for tracheal reconstruction is acknowledged. When this is impossible an alternate method is mandatory. From 1970 to 1988, 62 patients with benign and malignant tracheal stenosis had airway continuity established with a silicone tube. A straight graft was used in 48 patients. Twenty-eight had strictures, two tracheoesophageal fistulas and strictures, five primary malacia, and 13 malignant tumors. In 20 with noncancerous tracheal obstruction the airway was resected and a graft interposed. Distal suture line granulomas developed in six of these patients. Two had subglottic granulomas. One had graft dehiscence after dissolution of absorbable suture material. This graft was replaced with a silicone T tube. Four patients with end-to-end anastomosis of the graft to the trachea died in 6 to 12 months. Six others were lost to follow-up. In 15 of the 48 with benign disease the stent was placed within the lumen. Six in this group died. Thirteen of the 48 patients had a malignant tumor. In six the tube was used for palliation; none are alive. Seven underwent resection; five are living 1 to 8 years after the operation, two died of their disease in 1 1/2 to 2 years, and two of the five living are undergoing irradiation for recurrent cancer. Fourteen individuals with tracheocarinal malignancy received a bifurcated graft. All six patients with a palliative intraluminal stent died. Among eight individuals, four died of disease in 1 to 4 years. Four are alive, but two have suture line granulomas and two are undergoing irradiation for residual carcinoma. Mediastinal infection, mucus encrustations of the intraluminal prosthesis, and impedence of pulmonary secretions across long tubular segments have not been manifest. These silicone tubes are well tolerated and function satisfactorily as an airway.