[Influence of androgens on cardiovascular system in men]. / Wplyw androgenów na uklad krazenia u mezczyzn.

It is well known fact that incidence of morbidity and mortality due to coronary artery disease is higher in men than in women. For many years experimental and clinical studies have focussed on the role of androgens in cardiovascular pathology. The clinical implications of androgens' deficiency as well as the molecular mechanisms of their action have not been well established yet. However, the increasing number of evidences suggests that androgens may have beneficial effects on atherosclerosis. In this review we discuss the androgen metabolism, their effect on cardiovascular system and the relations with major risk factors of atherosclerosis.

[Effect of dihydrotestosterone treatment on exercise induced ischemia in men with stable ischemic heart disease]. / Wplyw leczenia dihydrotestosteronem na indukowane wysilkiem niedokrwienie serca u mezczyzn ze stabilna choroba wiencowa.

Many studies report the negative correlation between the endogenous testosterone (T) level and majority of risk factors for arteriosclerosis, as well as the presence and the extent of coronary artery disease (CAD) in men. Dihydrotestosterone (DHT) as a non-aromatizable androgen produces more favourable changes in the hormone profile than T. A constant level of androgens, independent on liver function, may be achieved by their transdermal administration. The aim of our study was to determine in a double-blind placebo study whether a 12-week treatment with transdermal DHT can decrease exercise-induced ischaemia in males with CAD. All patients underwent symptom-limited treadmill stress testing at the beginning of the study and after DHT treatment. The selected preliminary results are presented in this paper. Until now the study group has comprised ten men with stable CAD and decreased morning total T concentration. No side effects of treatment were noted during the study. Chronic DHT administration increased significantly: total exercise time, time to the onset of angina and time to 1 mm ST depression. Our results are consistent with the previous publications investigating T effects. The changes of heart rate and systolic blood pressure indicate rather direct coronary-relaxing effect of DHT than peripheral one.

Enalapril (10 mg/day) in systemic sclerosis. One year, double blind, randomised study (ESS-1): echocardiographic substudy--three months follow-up.

The ESS-1 study was designed to evaluate the long-term effects of the angiotensin converting enzyme inhibitor (ACEI) enalapril (10 mg per day) on the cardio-pulmonary system in patients with scleroderma (SSc). We estimated changes in heart diameters, systolic and diastolic left ventricle function and mean values of pulmonary artery pressure after 3 months treatment. The study group comprise 41 patients with SSc. 18 patients received placebo and 23 ones were given enalapril. After 3 months of treatment we did not observe statistically significant differences in heart diameters and left ventricle systolic function parameters between treated group and placebo. Enalapril therapy did not affect left ventricle diastolic function, nevertheless differences in MVA were almost of statistical significance. Echocardiographic signs of pulmonary hypertension were found in 4 patients.

Enalapril (10 mg/day) in systemic sclerosis. One year, double blind, randomised study (ESS-1): ECG exercise testing--three months follow-up.

The ESS-1 study was designed to evaluate the long-term effects of the angiotensin-converting enzyme inhibitor (ACEI) enalapril (10 mg per day) on cardiopulmonary system of patients with systemic sclerosis (SSc). Exercise testing is used not only for estimation of coronary reserve but also physical capacity--the major determinant of quality of life. In each patient included to the ESS-1 study we performed ECG exercise test on treadmill (5 times at intervals of 3 months). The first follow-up was completed by 41 patients (23 patients in enalapril group and 18 in placebo group). The exercise duration in the placebo group was 683 +/- 295 sec and in enalapril group 768 +/- 173 sec. After 3 months of study there were no significant differences in both groups (758 +/- 271 sec and 720 +/- 191 sec respectively). The analysis of ST segment deviation did not provide any significant changes after 3 months of treatment. We conclude that 3 months enalapril treatment did not improve exercise tolerance in patients with systemic sclerosis.

Enalapril (10 mg/day) in systemic sclerosis. One year, double blind, randomised study (ESS-1): pulmonary substudy--effects of three month treatment.

The ESS-1 study is designed to evaluate the long-term effects of enalapril on cardiopulmonary system of patients with systemic sclerosis (SSc). During the one year study period 5 visits are scheduled at 3 months intervals. The effect of 3 months treatment with enalapril (10 mg per day) on lung function was studied in 18 patients with SSc (enalapril group) and compared with controls--23 patients with Ssc (placebo group), mean age, SSc duration, gender and % of patients with dcSSc did not differ significantly in both groups. We performed body plethysmography for total airways resistance (Rtot), and static lung volumes (TLC, ITGV and RV), spirometry for FEV1 and FVC and we measured flow parameters (PEF, FEF). We compared initial lung function (first examination) with results after 3 months treatment (second examination) in the enalapril and in the placebo group. Mean values of Rtot, ITGV and RV did not differ significantly in the enalapril group or in the placebo group before and after treatment but FVC, FEV1 and FEF50 were significantly lower in the enalapril group and did not change in the placebo group after three months. We conclude that 3 month treatment with enalapril worsens spirometry of SSc patients. We did not observe any changes in lung functions in the control group in the same three month period.

[Bronchial hyperreactivity as a factors of chronic obstructive pulmonary disease development in the population of the Bogdanka coal miners]. / Nadreaktywnosc oskrzeli jako czynnik ryzyka rozwoju przewleklej obturacyjnej choroby pluc w populacji górników kopalni wegla kamiennego w Bogdance.

The aim of the study was to assess the role of bronchial hyperreactivity in the development of chronic airflow obstruction in the population of the Bogdanka (Lublin Basin) coal miners. The population examined consisted of 1456 coal miners working underground in the Bogdanka colliery. The methods of the study included plethysmographic measurements of total airway resistance (Raw), spirometric measurements of forced expiratory volume in one second (FEV1), and determination of forced expiratory flowa at 75, 50 and 25 per cent of vital capacity (FEF75, FEF50 and FEF25%VC). The measurements were repeated twice--before and after administration of 0.2% solution of methacholine (1 min inhalation). Pulmonary function tests were also performed 8 years after initial measurements. The increase in the Raw value above 0.6 kPa/l/s was observed in 5.5% of the population examined. In this group of subjects the skin prick tests with common allergens, measurements of total immunoglobulin E (IgE) levels and determination of blood eosinophils count were performed. Only 12% of all hyperreactives (Raw increase > 0.6 kPa/l/s) showed features of atopy--positive skin prick tests, raised IgE levels, and increase in blood eosinophils count. Using a survival analysis as a statistical tool we evaluated for how long the pulmonary function tests remained within normal ranges in two groups: hyperreactives and controls. All hyperreactives (atopic and non-atopic) showed significantly higher risk of lung function decrease below the normal values as compared with the control group.

[Dihydrotestosterone therapy of men with coronary artery disease and processes of peroxidation]. / Terapia dihydrotestosteronem mezczyzn z choroba wiencowa a procesy peroksydacyjne.

In 11 men after myocardial infarction (mean age 58.8 years) influence of 3 months transdermal dihydrotestosterone (DHT) treatment on malondialdehyde (MDA), total cholesterol, HDL cholesterol, triglycerides and platelets was estimated. Decrease in MDA concentration after DHT treatment only in men with low (< 13 nmol/l) testosterone (T) level (p = 0.06) was observed. MDA concentration after 3 months DHT treatment was significantly lower in hypotestosteronemic in comparison to normotestosteronemic men (p < 0.05). Plasma lipid levels and platelet count were not affected by DHT administration. Decrease serum MDA concentration in low testosterone men with coronary artery disease may suggest that DHT treatment in this group has beneficial effects on peroxidation processes.

Right ventricular function in systemic hypertension.

The aim of the study was the assessment of right ventricular (RV) structure and diastolic function in hypertensive subjects. The study group consisted of 44 patients with untreated, mild to moderate essential systemic hypertension. All the patients were in sinus rhythm, no symptoms of congestive heart failure, ischaemic or valvular heart disease and lung disorders were found. Twenty-six healthy subjects were the control group. M-mode echocardiographic measurements of the right ventricular wall (RVW) diastolic thickness, right ventricular outflow tract diameter (RVOTD), left ventricular (LV) structure and LV systolic function were performed. Pulsed Doppler echocardiography was used to measure peak early (TE) and peak atrial (TA) right ventricular diastolic filling velocities as well as velocity-time integrals (VTI-TE and VTI-TA). TE:TA and VTI-TE:VTI-TA ratios were calculated. Similar parameters of the left ventricular diastolic filling were recorded at the level of mitral annulus. Mean pulmonary artery pressure (MPAP) was measured non-invasively by the estimation of pulmonary artery systolic flows. We demonstrated in hypertensive patients significantly thicker RVW (3.94 vs 2.8 mm, P < 0.001) and increased LV mass. In the hypertensive, increased TA and VTI-TA and diminished TE:TA and VTI-TE:VTI-TA ratios were recorded, indicating the abnormalities of RV diastolic function. RV diastolic filling parameters correlated positively with corresponding parameters of LV filling. The results of our study demonstrate that impairment of LV diastolic function, the common finding in systemic hypertension, is associated with diastolic disturbances of the right ventricle. RVW thickening and hypertrophy of interventricular septum seem to be major factors influencing RV diastolic function.

[Clinical picture of acute myocardial infarction depending on the use of pharmacologic treatment schemes]. / Obraz kliniczny swiezego zawalu serca w zaleznosci od zastosowanego schematu leczenia farmakologicznego.

The aim of the work was a retrospective comparison of the clinical course of acute myocardial infarction depending on the applied schema of pharmacological treatment: streptokinase, heparin, antiplatelet drugs. The analysis included 409 patients (261 men and 148 women aged 31-85 years; mean age 61 years). Twelve-lead ECG records were analysed: 24 hours, 48 hours, 72 hours, 7 days and 14 days after the onset of the disease. The sum of ST segment elevations, sum of Q wave amplitude and the sum of R wave amplitude in the leads showing signs of infarction were taken into account. The mean was calculated from the highest values of AspAT and AlAT. The haemodynamic, arrhythmic and other early and late complications occurring during the treatment were subjected to analysis; the per cent index of deaths in each group was also calculated. In the patients treated with streptokinase, in comparison to the patients treated with heparin and antiplatelet drugs, earliest stabilization was observed of the ECG pattern in the form of: reduction of ST segment elevation, reduction of R wave height, and formation of a stable Q wave. AspAT and AlAT values were highest in the group of patients treated with streptokinase in relation to the remaining groups of patients. Arrhythmic and haemodynamic complications occurred less frequently in the patients treated with streptokinase and heparin than in those treated with antiplatelet drugs. On the other hand, late and other early complications were observed less frequently in the patients treated with antiplatelet drugs. The mortality during hospitalization period was similar in individual groups of patients, being 7.2% for the patients treated with streptokinase, 7.5% for those treated with antiplatelet drugs, and 9% for those treated with heparin.