[The level of erythropoietin in serum of patients with anemia during infective endocarditis]. / Stezenie erytropoetyny w surowicy krwi u pacjentów z niedokrwistoscia w przebiegu infekcyjnego zapalenia wsierdzia.

The infective endocarditis is a septic syndrome caused by an infection in endocardium or in heart valves. The majority of patients with infective endocarditis develop normocytic anemia. The metabolic studies in septic shock syndromes documented an intensive proteolysis of muscles, visceral organs and blood proteins, and probably of erythropoietin as a glycoprotein as well. The aim of the study was to assess the erythropoietin level in patients with infective endocarditis severe anemia and preserved renal function. Erythropoietin concentration was measured in blood serum in 12 patients (11 men and 1 woman), mean age 48 +/- 8 years, with infective endocarditis. The patients had clinical symptoms of endocarditis, positive blood bacteriological cultures and echocardiography features. All patients had serious normocytic anemia with mean hemoglobin concentration 5.40 +/- 0.48 mmol/L. The control group consisted of 7 healthy persons (5 men and 2 women), mean age 50 +/- 7 years, with hemoglobin concentration 8.70 +/- 0.60 mmol/L. The concentration of erythropoietin at the patients with bacterial endocarditis was 144.04 +/- 17.80 mIU/mL versus 67.28 +/- 6.29 mIU/mL in the control group (p = 0.0002). We conclude that in patients with infective endocarditis and serious normocytic anemia without renal insufficiency the concentration of erythropoietin is increased.

[Survival of women and men after myocardial infarction does not differ. Results of several years' observation]. / Przezywalnosc kobiet i mezczyzn po zawale serca nie rózni sie. Wyniki kilkuletniej obserwacji.

The contention that female gender is an independent factor that affects survival after acute myocardial infarction (AMI) is still controversial. The aim of this retrospective study was to assess whether or not early and late mortality after AMI is greater in women than in men. Data of 464 consecutive patients (130 women and 334 men) who had a documented acute myocardial infarction in our Department of Cardiology between 1990 and 1993 were eligible for the study. We excluded 48 patients from the study for the following reasons: the location of infarct could not be determined in 18 patients: 16 patients refused to take part in the study and we were not able to contact 14 patients. The remaining 416 patients were analyzed in the study. The mean follow-up period was 36 months (from 1 to 72 months). Women were significantly older than men (62.1 +/- 11.2 vs 58.1 +/- 11.6; p < 0.001), especially those who died in hospital (70.7 +/- 9.3 vs 64.4 +/- 8.7; p < 0.01). In hospital died 26 women (20%) and 39 men (11.7%)--p < 0.05. However, age-adjusted in-hospital mortality did not differ between women and men (p = 0.256). We did not find any significant difference in 3-year survival after AMI between women and men (22% vs 20.7%; NS). Total mortality was also similar (38% vs 30.2%; NS). QMI was diagnosed in 85 women and 234 men (73% vs 78%; NS), NQMI in 31 women and 66 men (27% vs 22%; NS). The rate complications of acute phase of AMI (acute heart failure and/or rhythm disturbances) was similar in women and men. Fibrinolytic treatment was introduced in 27.2% of women and in 26.4% of men. Hypercholesterolemia and hypertension were more often associated with female gender. In multivariate analysis we found that age, acute heart failure, previous MI, hypercholesterolemia and diabetes mellitus were significant factors which affects survival after AMI. Of these only age and diabetes mellitus appeared to be significant in women.

[Evaluation of arterial blood pressure and heart rate during exercise tests in patients with essential hypertension in different stages of hypertension]. / Ocena cisnienia tetniczego i czestosci pracy serca podczas prób wysilkowych u chorych z nadcisnieniem tetniczym samoistnym, w róznych okresach choroby nadcisnieniowej.

This article analyses the changes of arterial blood pressure and heart rate (HR) in 120 patients with essential hypertension during two successive exercise tests. Before and during the tests, the patients did not take any hypertensive drugs. The obtained measuring results at exercise tests and restitution were the basis for the calculating regression equations. Then the results were analyzed statistically (p < 0.05) and clinically (drop or increase of arterial systolic blood pressure value (SAP) or/and diastolic (DAP) by 5 mmHg, and HR by 5 beats per minute). The HR response was comparable in both test for all tested groups both in exercise and restitution periods. For the additional sex division the HR value in all subgroups women was lower in the second test and satisfies the condition of statistic and clinical significance. In the second test SAP was lower only in the group of mild pressure and in the group without organ changes (stage I WHO) during exercise. At restitution periods the SAP values were lower in all the tested groups with the exception of the group with borderline hypertension. DAP was lower in the second test in all the tested groups both in exercise test and in the restitution period. It is also shown that the quantity of DAP difference in the second test is the greater, the higher value of DAP at restitution is.

Results of long-term medical treatment of patients with arterial hypertension complicated by aortic dissection.

UNLABELLED: The purpose of the study was to analyse results of ambulatory treatment of patients with arterial hypertension complicated by aortic dissection. Twenty patients (19 men, one woman), aged between 39 and 72 years, underwent full physical examination. In all cases the diagnosis of aortic dissection was confirmed by at least two different imaging methods (ultrasonography, digital subtractional angiography, computer tomography or nuclear magnetic resonance). During follow-up (3-75 months, mean 34.3 months), physical examination was performed every 6-8 weeks, chest radiograph was taken once a year. All patients controlled their blood pressure (BP) at home. According to the mean number of in-home BP measurements per month all patients were divided into two groups: group I good (n = 10) and group II bad compliers (n = 10) (28 +/- 30 vs 3 +/- 2 in-home BP measurements a month). Ten patients (6 in group I, 4 in group II) underwent 24 h automatic BP measurement examination. Blood samples were collected for serum cholesterol and uric acid measurements. All patients suffered from arterial hypertension and in five cases at least one parent suffered from this disease. Only three of 20 have never smoked cigarettes. Elevated serum cholesterol was observed in 10 (50%) cases and elevated uric acid in six (30%). Proximal (type A) aortic dissection (DeBakey classification type I and II) was found in 13 patients, distal aortic dissection (type B) in seven patients. All patients were treated with beta-blockers. In 75% of 20 cases three or more hypotensive drugs were used simultaneously to control BP. In the group I lower values of mean of maximal SBP (160 +/- 10 vs 177 +/- 7 mm Hg, P < 0.05) and lower mean circadian heart rate (58.6 +/- 7.5 vs 80.9 +/- 7.9 beats/min, P < 0.005) were observed. The most frequent complaints were intermittent claudication, 9 (45%); angina pectoris 8 (40%), other chest pain, 4 (20%). During follow-up period (3-75 months, mean 34.3 months) five of 20 patients (25%) died (all had proximal, type A dissection) and 15 of 20 patients (75%) are still alive. All deaths in group II were sudden, whereas the only one in group I was because of chronic renal insufficiency. Mortality rate in the two groups were 10% (one of 10) vs 40% (four of 10), respectively, in groups I and II. IN CONCLUSION: patients who control their BP more often have the lower values as well as lower heart rate and therefore a better prognosis.

Hypertrophy or hyperplasia in cardiac muscle. Post-mortem human morphometric study.

In 103 hearts with various forms of cardiac muscle hypertrophy the following parameters were estimated: diameter, length, volume, density and number of myocytes, and density of myocyte nuclei. The values of all histometric parameters correlated well with left ventricular (LV) weight up to 350 g. In heavier hearts these parameters remained approximately of the same magnitude. The number of myocytes was significantly higher in hearts with LV weight above 250 g. The influence on LV weight of age, coronary artery diameters, degree of atherosclerosis, weight and percent of fibrous tissue was also evaluated. On the basis of a linear discriminant function, hearts were divided into three classes: (1) LV weight < or = 250 g (absence of hyperplasia, hypertrophy only); (2) LV weight 251-350 g (hypertrophy+signs of hyperplasia); (3) LV weight > 350 g (marked signs of hyperplasia). The percent of fibrosis increased proportionally to LV weight. Where LV weight was above 250 g there was a subsequent increase in the mean percent of fibrosis (approx. 26%). This phenomenon (plateau of percent fibrosis) is the result of an increased number of myocytes (myocyte hyperplasia). We suggest that, independent of aetiology, in all hearts above 350 g (patients with congestive heart failure) hyperplasia phenomenon exists.

[Circadian changes in levels of magnesium in serum of healthy individuals]. / Dobowe zmiany stezenia magnezu w surowicy zdrowych ludzi.

Circadian changes in blood serum magnesium levels in healthy individuals. We examined circadian changes of the serum magnesium in 20 healthy subjects. Blood samples were taken every second hour during the 24 hours. Male serum magnesium concentrations increased from the lowest level (0.810 +/- 0.035 mmol/l) observed at 8.00 am to the highest level (1.028 +/- 0.084 mmol/l) at 6.00 pm. Female-we observed two peaks of serum magnesium concentrations: first at 8.00 pm (0.992 +/- 0.103 mmol/l) and second at 4.00 am. (0.982 +/- 0.094 mmol/l) with the lowest level at noon) 0.789 +/- 0.043 mmol/l. Differences between extreme levels were statistically significant.

[Confirmed and borderline hypertension found in 44% of men (aged 40-59 years) working at the H. Cegielski plant in Poznan]. / Nadcisnienie tetnicze utrwalone i graniczne stwierdzono u 44.4% mezczyzn (40-59 lat) pracowników Zakladów Cegielskiego w Poznaniu.

Blood pressure was measured in 3317 men, aged 40-59, working in H. Cegielski Metal Works in Poznan. The average systolic pressure for the whole population was 130.9 mmHg (SE = 17.90). The average diastolic pressure was 83.7 mmHg (SE = 10.03). The systolic, diastolic and mixed systolic-diastolic hypertension was found in 539 men which makes 16.3% of the study group. The borderline systolic hypertension was found in 327 men i.e. 9.9%, borderline diastolic hypertension in 267 men i.e. 8.0%. Both systolic and diastolic borderline hypertension displayed 339 men i.e. 10.2% of the study group. So, borderline hypertension (systolic, diastolic and systolic-diastolic) was found in 933 men which makes 28.1% of the population under the study.

[Hypertrophy or hyperplasia of myocytes in heart hypertrophy?]. / Przerost czy rozrost miocytów w przeroscie miesnia serca?

One of the most controversial problem in cardiac muscle pathology is the existence of myocyte hyperplasia. The term hypertrophy indicates an increase in size of the individual muscle cells without changing their total number, whereas in hyperplasia there occurs proliferation of the myocyte. This fundamental question of the character of cardiac growth remains unresolved in spite of the wide attention it has received. Contemporary views concerning the cardiac muscle hyperplasia are presented. From clinical point of view the problem is significant for two reasons. The loss of the ability of muscle cells to proliferate is responsible for the irreversible myocardial destruction after injury. From another point of view, if the increase of the heart muscle is maintained, although a complete remission of cardiac hypertrophy becomes impossible. In 103 hearts with various forms of cardiac muscle hypertrophy the following parameters were estimated: diameter, length, volume, density and number of myocytes, as well as the density of nuclei of myocytes. The values of all histometric parameters correlated well with the LV weight up to 350 g. In heavier hearts these parameters were approximately at the same magnitude. The number of myocytes was significantly higher in hearts with LV weight above 250 g than in hearts below 250 g: 5.53 x 10(9) vs 4.31 x 10(9), p < 0.001. The influence of coronary artery diameters, degree of atherosclerosis, weight and percent of fibrous tissue and age on LV weight were evaluated as well. From these parameters only coronary artery diameters significantly influenced on LV weight.(ABSTRACT TRUNCATED AT 250 WORDS)

[Value of exertional echocardiography and performance of transesophageal left atrial pacing done 3-4 weeks after acute myocardial infarction]. / Wartosc echokardiografii wysilkowej oraz wykonanej w czasie szybkiej przezprzelykowej stymulacji lewego przedsionka w 3-4 tygodniu zawalu serca.

Two-dimensional echocardiography during exercise (ECHO W) and left atrial pacing (ECHO S) was done in 30 patients 3-4 weeks after acute myocardial infarction. Sensitivity of these methods to detect fresh myocardial ischemia was compared. Their prognostic value during 2 years after myocardial infarction was determined too. Both methods increase sensitivity of simultaneously performed ecg. Sensitivity of ECHO S (80%) was higher than ECHO W (67%). Sensitivity of the two methods altogether was higher (93%) then each method independently. Coexistence of worsening systolic wall motion abnormalities and a decrease in ejection fraction during both examinations may suggest worse clinical course and prognosis 2 years after myocardial infarction.

[Comparison of the diagnostic value of echocardiographic, ecg and enzymatic investigations in acute myocardial infarction]. / Porównanie wartosci diagnostycznej badania echokardiograficznego, EKG i ezymatycznego u chorych ze swiezym zawalem serca.

Two dimensional echocardiography (ECHO 2D) was performed in 133 patients 1-2, 3-5, 7-10, 21-28 days and 3, 6, 9, 12, 18 and 24 months after myocardial infarction. Standard ecg examination was carried out at the admission time, every 15 minutes during the first 2 hours, 3, 6, 12, 24 and 48 hours later, and afterwards in the same time as ECHO 2D. At the admission time and 4, 8, 12, 16, 20, 24, 36, 48, 60, and 72 hours later creatine kinase activity was determined. It is concluded that a relation exists between severity and extensiveness of myocardial infarction in ecg and severity and the asynergy area in the ECHO 2D study. In transmural anterior infarction large concordance exists in necrosis location estimated by both methods. In the inferior myocardial infarction asynergy concerns inferior, posterior and lateral LV wall and RV walls. V5-6 ecg leads appear of little value in infarct location. The lack of infarct evolution in ecg coexists with exacerbation of LV asynergy and extension of the LV asynergy area. Sensitivity of ECHO 2D in detecting myocardial infarction in the first day was 90%, ecg - 83%, enzymatic examination - 98%. 2 or 3 methods all together have high sensitivity (99%-100%).

[Selected hemodynamic parameters in overweight patients with mild and moderate hypertension treated with low caloric diet]. / Wybrane parametry hemodynamiczne u chorych z nadwaga i nadcisnieniem tetniczym lagodnym i umiarkowanym leczonych dieta niskokaloryczna.

Basic haemodynamic parameters - blood volume (BV), cardiac output (CO), stroke volume (SV), and total peripheral resistance (TPR) were studied in two groups of overweight patients with mild and moderate hypertension. Each group consisted of 15 subjects. The patients of the first group were kept on low caloric diet (1000-1100 cal per day). Patients of the second-control-group were treated with propranolol (120 mg per day). The duration of each study was 24 weeks. Blood pressure fell due to body weight reduction. BV, CO and SV decreased without changes in TPR. In the control group treated with propranolol in which the body weight did not change a fall in blood pressure, cardiac output, and stroke volume was seen without changes in blood volume and total peripheral resistance values.

[Value of two-dimensional echocardiography in predicting the clinical course and fates of patients 2 years after myocardial infarction]. / Wartosc echokardiografii dwuwymiarowej w przewidywaniu przebiegu klinicznego i losów chorych w okresie 2 lat od zawalu serca.

133 patients with acute myocardial infarction, admitted to hospital 24 hours or less from the beginning of chest pain were investigated. Two-dimensional echocardiography (ECHO 2D) was performed 1-2, 3-5, 7-10, 21-28 days and 3, 6, 9, 12, 18 and 24 months after myocardial infarction. Relations between ECHO parameters, clinical course and prognosis. 2 years after myocardial infarction were analysed. Worse clinical course and prognosis during 2 years after myocardial infarction predict high values of 1) asynergy index (greater than or equal to 1), 2) percentage of asynergy segments (greater than or equal to 50) and 3) percentage of left ventricular (LV) akinetic and (or) dyskinetic segments (greater than or equal to 37.5). Right ventricular asynergy and maintenance or increase of LV asynergy degree aggravate clinical course and prognosis too.

[Dynamics of disorders of ventricular contraction studied by two-dimensional echocardiography 2 years after myocardial infarction]. / Dynamika zaburzen skurczu komór serca w obrazie echokardiograficznym dwuwymiarowym w okresie 2 lat od zawalu.

Two-dimensional echocardiography (ECHO 2D) was performed in 133 patients 1-2, 3-5, 7-10, 21-28 days and 3, 6, 9, 12, 18 and 24 months after myocardial infarction. During 2-years observation after myocardial infarction a gradually diminishing occurrence of left ventricular (LV) systolic wall motion abnormalities, is seen mostly--akinesia. Dyskinesia is the most persistent form of asynergy appearing with similar frequency during the whole study period. Improvement, worsening or no changes of LV asynergy are found with similar frequency in hospital phase. Favourable asynergy changes predominantly++ in the ambulatory phase. Right ventricular (RV) asynergy is found rarely (5%) in transmural inferior infarction only. It coexists with enlargement of RV. RV asynergy is always associated with LV asynergy, mostly of its inferior or posterior wall.

[Coronary lumen diameter and cardiac mass in various forms of cardiac hypertrophy]. / Swiatlo tetnic nasierdziowych a masa miesnia sercowego w róznych formach jego przerostu.

Morphometric evaluation of the epicardial arteries is described in detail in 103 patients with various forms of cardiac hypertrophy. Coronary lumen diameter increases with aging regardless of the cardiac mass. Such an increase is observed in some particular types of cardiac hypertrophy and presumably is caused by the changes of intramuscular vessels and diminished perfusion. In patients with so called myocardial atherosclerosis correlation between coronary lumen diameter age and cardiac mass is opposite. In some forms of cardiac hypertrophy the increment of coronary lumen diameter is accompanied by the increase of the cross sectional area of the artery. In this pattern the increase of lumen diameter is not due to passive vessel dilatation because significant thickening of its wall can be seen. Age appeared to be the most important factor influencing the coronary lumen diameter within the whole population, although this correlation can hardly be seen in patients with "myocardial arteriosclerosis".

[Comparative evaluation of coronary arteriosclerosis in arterial hypertension and ischemic heart disease. Morphometric analysis of 4062 coronary artery specimens]. / Porównawcza ocena miazdzycy tetnic wiencowych w nadcisnieniu tetniczym i w chorobie niedokrwiennej serca. Morfometryczna ocena 4062 preparatów tetnic wiencowych.

We performed a postmortem study on 61 hearts from patients who died of acute ischemic heart disease (IA). Chronic ischemic heart disease (IB) and from hypertensive patients who died of heart infarction (IIA) and other hypertensive complications (IIB). Control group consisted of 16 pts. who died of non cardiac diseases. 4062 coronary artery specimens were estimated. Irrespective of the clinical course of ischemic heart disease the mean percent of coronary artery stenosis was similar in both ischemic groups and significantly higher than in control group. In hypertensive pts. who died of heart infarction it was also significantly higher and similar to ischemic pts. We found the highest percent of segments with critical stenosis in the left anterior descending coronary artery in group IA, IB, IIA. It was also significantly higher in the left main coronary artery in the group of ischemic pts. (IA, IB).

[The effect of intravenous streptokinase on selected echocardiographic and clinical parameters of patients followed up for 2 years after myocardial infarction]. / Wplyw podanej dozylnie streptokinazy na wybrane parametry echokardiograficzne i kliniczne oraz losy chorych w okresie 2 lat po zawale serca.

54 patients (pts) aged 70 years or younger with acute transmural myocardial infarction and onset of chest pain less than 12 hours were assigned in a blind manner to streptokinase group (SK), 54--to control group, 34 pts received intravenous infusion of 1,500,000 IU of SK/hour, 14 pts--2,000,000 IU/hour, and 6 pts--3,000,000 IU/2.5 hours. Intravenous streptokinase reduced left ventricular (LV) asynergy during hospital phase, decreased LV thrombus formation, and limited myocardial necrosis size 2 years after myocardial infarction. Its effect on clinical course and prognosis after myocardial infarction was of small importance.

[Myocardial infarction in patients with arterial hypertension. Changes in the creatine kinase MB isoenzyme activity in relation to myocardial hypertrophy]. / Zawal serca u chorych z nadcisnieniem tetniczym. Dynamika zmian aktywnosci izoenzymu MB kinazy kreatynowej a przerost miesnia serca.

The aim of the study was to investigate the relationship of arterial hypertension coexisting with myocardial hypertrophy to the infarct size evaluated by serial CK-MB measurements. The group of 98 patients (72 males and 26 females) with the first Q-wave infarction was selected from 137 patients admitted to I Clinic of Cardiology of Poznan Medical School with acute myocardial infarction (AMIO). Age of the patients ranged from 35 to 82, mean 60 years. Time from the onset of symptoms to admission to the hospital varied from 1 to 8 hours, mean 4. Enzymatic tests were performed on admission, every 4 hours during the first 24 hours, every 6 hours during the second and the third day and every 8 hours during the 4th and the 5th day. Anterior infarction was diagnosed in 46 patients and inferior infarction in 52 patients. The type of CK-MB curve, maximal CK-MB activity and the mass of necrotic tissue was evaluated for every patient using Sobel formula modified by Norris. Total mass of the left ventricle was calculated from echocardiographic measurements (2-D and M-mode) and the ratio of LV mass per square meter of the body surface was was calculated according to Horton's formula. The subgroup of 44 patients (25 males and 19 females) with the history of hypertension was selected. Ophthalmic examination revealed angiopathic changes of I and II grade K-W. This group, as compared to remaining patients with AMI was characterised by higher left-ventricular mass (198.0 +/- 28.6 vs 151.0 +/- 16.9 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

[Myocardial structure in various forms of hypertrophy. I. Myocyte hypertrophy or hyperplasia? Pathophysiological aspects and the methods of study]. / Struktura miesnia sercowego w róznych formach jego przerostu. Cz. I. Przerost czy rozrost miocytów? Podstawy patofizjologiczne, metodyka badania.

One of most controversial problems in cardiac muscle pathology is the existence of myocyte hyperplasia. The term hypertrophy indicates an increase in size of the individual muscle cells without changing their total number, whereas in hyperplasia proliferation of the myocyte occurs. This fundamental question of the character of cardiac growth remains unresolved in spite of the wide attention in has received. Contemporary views concerning the cardiac muscle hyperplasia are presented. From clinical point of view the problem is significant for two reasons. The loss of the ability of muscle cells to proliferate is responsible for the irreversible myocardial destruction after injury. From another point of view, if the increase of the heart muscle is maintained, although a complete remission of cardiac hypertrophy becomes impossible. In the light of these controversies we undertook the attempt to solve this complicated problem. Morphometric evaluation of the cardiac myocyte is described in detail.

[Myocardial structure in various forms of hypertrophy. II. Myocyte hypertrophy or hyperplasia? Results of the study]. / Struktura miesnia sercowego w róznych formach jego przerostu. Cz. II. Przerost czy rozrost miocytów? Wyniki badania.

In 103 hearts with various forms of cardiac muscle hypertrophy the following parameters were estimated: diameter, length, volume, density and number of myocytes, as well as the density of nuclei of myocytes. The values of all histometric parameters correlated well with the LV weight up to 350 g. In heavier hearts these parameters were approximately at the same magnitude. The number of myocytes was significantly higher in hearts with LV weight above 250 g than in hearts below 250 g: 5.53 x 10(9) vs 4.31 x 10(9), p less than 0.001. The influence of coronary artery diameters, degree of atherosclerosis, weight and percent of fibrous tissue and age on LV weight were evaluated as well. Only coronary artery diameters significantly influenced on LV weight. On the basis of linear discriminant function, three classes of hearts were separated: 1) LV weight 250 g - absence of hyperplasia, only hypertrophy 2) LV weight 251-350 g - hypertrophy + signs of hyperplasia 3) LV weight 350 g - marked signs of hyperplasia Among 18 patients with the LV weight above 350 g (all patients with congestive heart failure), 11 suffered from valvular disease, 3 were postinfarction patients, 2 suffered from primary hypertension and 2 from primary congestive cardiomyopathy. It indicates that, irrespective to the etiologic factor, hyperplasia is a simple result of the cardiac muscle mass increase.