Opinions of town residents on organ transplantation.

INTRODUCTION: Organ transplantation is connected with many very difficult ethical and social issues that evoke a lot of emotion. The aim of this work was to determine the knowledge and opinions of the 612 residents of selected towns in Podlaskie voivodeship (in northeastern Poland) on organ transplantation. MATERIAL AND METHODS: A diagnostic poll with the use of a survey questionnaire was implemented in the study. The respondents were divided into 2 groups (towns <100,000 and >100,000 residents). RESULTS: Respondents from larger towns were more often willing to donate organs of close relatives for transplantation than those from small towns (67.1% vs 32.9%; P = .022). Respondents with higher education levels accepted organ donation from close relatives after their death significantly often than those with no more than a primary education (46.7% vs 22.2%; P < .001). Of the respondents, 83% would agree to donation after death and to donating their own organs (higher with primary education, 90.6% vs 63.5%; P < .001). Of respondents from big towns, 61.0% have informed their family of the decision for donation after death compared with 38.5% of respondents from small towns. Respondents with higher education significantly more often informed their family of such decision than persons with primary education (60.9% vs 42.9%; P < .007). CONCLUSIONS: More emphasis should be on educating the communities living in small towns and people with primary and vocational education, because an adequate level of knowledge is a significant factor influencing the readiness to give one's organs for transplantation.

Determinants of prognosis in nonischemic dilated cardiomyopathy.

BACKGROUND: Dilated cardiomyopathy, a heart muscle disease of unknown cause, is characterized by high mortality and is a major cause of cardiac transplantation. It has become, therefore, increasingly important to identify patients at higher risk. The aim of this study was to assess which of the data obtained at the time of diagnosis are the best predictors of survival. METHODS AND RESULTS: One hundred forty-four patients with dilated cardiomyopathy (118 men; mean age, 39 years) were assessed clinically, noninvasively, and hemodynamically. The effect of variables derived from the evaluation on outcome (death or heart transplantation) was examined. During a mean follow-up time of 4.1 years, 68 patients (47%) died and 9 (6%) underwent heart transplantation. The 1-, 2-, and 5-year transplant-free survival rate was 79, 69, and 44%, respectively. Cox multivariate regression analysis identified three variables as independent predictors of outcome: (1) pulmonary artery systolic pressure, P = .0001; (2) left ventricular ejection fraction, P = .0013; and (3) left ventricular end-diastolic dimension, P = .007. The prognostic index was constructed from regression coefficients and parameters significant in the Cox model. The minimal prognostic index in the study group was 1.4 and the maximal was 6.0 with a corresponding 1-year survival of 98 and 18%, respectively. The validity of the prognostic index was tested in the consecutive group of 81 patients, who were followed for a mean 2.3 years. The prognostic index of the poor outcome group differed significantly from that in survivors (3.7 vs 2.9, respectively, P < .01). The sensitivity and specificity of model predictions were 68 and 52%, respectively. CONCLUSIONS: The severity of pulmonary hypertension and left ventricular dysfunction provides an independent insight into the prognosis of patients with dilated cardiomyopathy. The prognostic index is useful when assessing prognosis and may be helpful in the timing of heart transplantation.

Dilated cardiomyopathy in children: clinical course and prognosis.

The clinical profile of 19 patients with dilated cardiomyopathy ages 2-18 years (mean 13.4 +/- 4 years) was reviewed to detect any factors that might be predictive for their survival. Follow-up range from 5 to 105 months (mean 39 +/- 33 months). Routine treatment consisted of digitalis and diuretics: 14 patients received antiarrhythmics, 6 received vasodilators, and 12 were managed with immunosuppression. There were 12 survivors and 7 nonsurvivors: The 1-year mortality was 21.2% and the 2-year mortality 35.8%. All deaths were within first 2 years. Of the 12 patients who survived 2 years, a significant improvement was noticed in 9. In 3 patients tachycardia-induced cardiomyopathy was diagnosed, and abolition of supraventricular tachycardia was followed by improvement and regression of cardiomegaly. Endomyocardial biopsy was performed in 16 patients. Four with a histologic diagnosis of active myocarditis survived, and in 3 of them a considerable improvement was noticed. Of the 12 patients with nonspecific histologic findings, 6 died (p < 0.05). There were no significant differences between survivors and nonsurvivors for any of the following parameters: incidence of severe heart failure (NYHA class III-IV) and severe ventricular arrhythmias (Lown class III-V), relative heart volume, echocardiographic left ventricular diastolic diameter and shortening fraction, and the hemodynamic parameters of cardiac index, left ventricular ejection fraction, left ventricular end-diastolic pressure, and left ventricular end-diastolic volume index.

[Familial dilated cardiomyopathy with autosomal mode of inheritance. Case report]. / Kardiomiopatia rozstrzeniowa z dominujacym autosomalnym sposobem dziedziczenia. Opis rodziny.

Familial occurrence of dilated cardiomyopathy is estimated by 2-20%. We present a family with dilated cardiomyopathy inherited in an autosomal dominant way. We examined 9 members of the family, most of them are asymptomatic.

[Electrophysiologic methods in differential diagnosis of syncope]. / Róznicowa diagnostyka elektrofizjologiczna stanów o symptomatologii synkopalnej.

The purpose of the study was the assessment of the diagnostic possibilities and usefulness of 24-hour cassette EEG/ECG recording in the differential diagnosis of short attacks of consciousness disturbances and/or syncopal states, and demonstration of interrelations between arrhythmias and seizures of cerebral origin. 24-EEG/ECG was obtained in 71 patients, including 34 with cardiological history who had above disturbances. Recording of 24-EEG/ECG made possible establishing of correct diagnosis in 15 cases (21.1%): in 1 case it was sinus arrest, in 14--epilepsy. In another 5 cases (7%) arrhythmia or conduction disturbances were found which could have been the case of their attacks, they all were patients with cardiological history. The analysis of EEG/ECG records of 47 epileptic seizures in 16 patients showed that in 11 of them (69%) the seizures were associated with sinus tachycardia without other arrhythmias. These results demonstrated the complex cause-effect relationship of cardiocerebral disorders in the aetiology of these states, and the usefulness of 24-EEG/ECG in their detection.

[Electrical ablation with high frequency (radiofrequency) in patients with recurrent atrioventricular nodal reentrant tachycardia--introductory information]. / Ablacja pradem wysokiej czestotliwosci (radiofrequency) u chorych z nawrotnym czestoskurczem wezlowym--doniesienie wstepne.

In 10 patients (pts) with atrioventricular nodal reentrant tachycardia type slow/fast (AVNRT) refractory to the antiarrhythmic treatment, radiofrequency current catheter ablation was performed. Adult pts (mean age 31 years) suffered from paroxysms of AVNRT for 2 to 18 years (mean 8 years). Episodes of arrhythmia recurred from 2-3 times a week to 1 for several months during antiarrhythmic therapy. The mean rate of the tachycardia was 243/min. 3 pts had syncope and 5 fainted during the tachycardia. In 2 females mitral valve prolapse was diagnosed. Programmed stimulation of the right atrium on the basic rate 130/min revealed ERP of the slow pathway mean 238 ms and ERP of the fast one mean 346 ms. The tachycardia has been induced with right atrium stimulation--most often programmed or burst stimulation--200 and 220/min, sometimes with incremental pacing. Successful radiofrequency energy ablation was performed in all 10 pts. Average number of the impulses for one pt was 7.7 (from 1 to 18 impulses). The total average time of the ablation was 216 s. The temperature of effective ablation was average 65 centigrade. The effect of the ablation was evaluated during repeated electrophysiological study before and after intravenous injection of atropine. Ablation was considered successful when no tachycardia was induced. P-R interval did not change and no episodes of AVNRT was observed in the 1-3 months follow-up. No complications were observed during the ablation and after the procedure, especially no thromboembolism was noticed. The echocardiographic evaluation revealed no damage to the heart structure. The pts receive no antiarrhythmic treatment and they are systematically controlled.

[Electrocardiography of high resolution in the diagnosis of arrhythmogenic dysplasia of the right ventricle]. / Elektrokardiogram o wysokiej rozdzielczosci w rozpoznawaniu arytmogennej dysplazji prawej komory.

UNLABELLED: To assess the diagnostic value of high resolution ECG in ARVD which is a rare and diagnostically difficult disease, cardiac micropotentials were evaluated in 32 pts with ventricular arrhythmias with LBBB pattern and right axis deviation. Typical ECG-, ECHO-, angiographic features of ARVD were found in 9 pts (mean age 36 y, VT 8 pts, MAS-5). Normal right ventricle (NRV) (Echo, Tc99) was seen in 23 pts (mean age 36 y, VT-14 pts, MAS-6). 25 healthy man (mean age 28 y) served as control (C). RESULTS: [table: see text] Morphology of total QRS complex in pts with ARVD, comparing to NRV pts and C, was exceptionally characteristic: it was composed of high frequency notches seen not only as prolonged LP but also within fundamental QRS complex. CONCLUSION: In pts with ARVD beside presence of LP, significantly prolonged TVAT and characteristic notches within QRS complex are observed, therefore the high resolution ECG is a promising method in noninvasive diagnosis of ARVD.

[Increased tension on the sympathetic nervous system in arrhythmogenic right ventricular dysplasia. Participation in etiopathogenesis?]. / Wzmozone napiecie ukladu sympatycznego w arytmogennej dysplazji prawej komory. Udzial w etiopatogenezie?

UNLABELLED: To evaluate the suspected role of sympathetic nerve tone in pathogenesis of arrhythmogenic right ventricle dysplasia (ARVD), noradrenaline (NOR) and adrenaline (AD) plasma levels were determined by radioenzymatic method in 10 pts with ARVD (mean age 36 y, VT-8 pts, syncope-5) at rest and during peak exercise. 9 healthy men (mean age 28 y) served as control. RESULTS: [table: see text] CONCLUSION: Significant increase of norepinephrine serum level during peak exercise suggests essential role of sympathetic nerve tone in pathogenesis of ARVD.

[Diagnostic value of 24-hour simultaneous EEG and ECG monitoring of patients with heart diseases and atypical consciousness disorders]. / Znaczenie diagnostyczne calodobowego jednoczasowego monitorowania EEG i ECG u osób z chorobami serca i nietypowymi zaburzeniami swiadomosci.

In 24 patients with diagnostically not clear, short, recurrent episodes of consciousness disturbances and heart diseases and/or a history of arrhythmia simultaneous 24-hour recording was done of eeg and ecg. In the differential diagnosis epilepsy was considered, especially since in most cases routine eeg records demonstrated slight episodic changes. During 24-hour recording in 8 cases typical episodes of consciousness disturbances developed but in none of them these episodes were associated with arrhythmia which ruled out their cardiogenic origin. In 2 cases EEG recording served for establishing the diagnosis of partial complex seizures, 2 patients had hyperventilation syncope, one had TIA, in the remaining 3 cases absence of eeg and ecg changes during these episodes and coexistence of anxiety neurosis suggested functional origin. So the combined 24-hour eeg+ecg recording made possible establishing of diagnosis in 1/3 of these patients, enabling adequate treatment to be instituted.

Simultaneous determination of mexiletine and four hydroxylated metabolites in human serum by high-performance liquid chromatography and its application to pharmacokinetic studies.

A high-performance liquid chromatographic method has been developed for the simultaneous determination of mexiletine and its four hydroxylated metabolites in human serum. The method involves a single-step extraction of mexiletine, hydroxymethylmexiletine, p-hydroxymexiletine and their corresponding alcohols with diisopropyl ether-dichloromethane-propan-2-ol (2.5:1.5:0.5, v/v). Separation of the compounds on a deactivated Supelcosil LC8-DB column is accomplished by high-performance liquid chromatography with ultraviolet detection at 203 nm. Overall the recovery of each compound is reproducible and greater than 75%. The lower limit of detection is 2 ng/ml for mexiletine and its metabolites. The application of the method is shown by measuring the concentrations in serum of mexiletine and its metabolites over 24 h in a healthy volunteer after a single intravenous injection of the drug and by monitoring serum concentrations in patients receiving long-term treatment by mouth of the drug.

[Disturbances of myocardial perfusion by exertion scintigraphy in patients with hypertrophic cardiomyopathy and their relationship with sudden death risk factors]. / Zaburzeniom perfuzji miesnia sercowego w kardiomiopatii przerostowej towarzysza czynniki ryzyka naglej smierci.

Heart muscle perfusion was studied by exertion scintigraphy Tal-201 in 24 patients, 16M and 8F, aged 16-45 years, means--28 +/- 7.4 years with hypertrophic cardiomyopathy. The relationship between perfusion disturbances and sudden death risk factors occurring in this group of patients was evaluated. Disturbances of heart muscle perfusion were found in 20 pts (83%); 2 pts had permanent perfusion defects, in 18 pts these defects were completely or partially reversible at rest. Only 4 pts (17%) had normal heart muscle perfusion. In patients with perfusion disturbances there was found a significantly more frequent occurrence of the following sudden death risk factors: 1. syncope (p less than .01) 2. ventricular arrhythmia of IV b class according to Lown (p less than .01) 3. advanced hypertrophy of intraventricular septum (p less than .01) 4. sudden death in patients families (p less than .05) The evaluation of the heart muscle perfusion confirmed the occurrence of myocardial ischemia in most of the examined patients. Normal coronaro-angiography in all the patients over 35 years as well as the young age of the other patients exclude atherosclerosis as the cause of myocardiac ischemia in the group under study. This is a confirmation of nonatherosclerotic etiology of myocardiac ischemia in hypertrophic cardiomyopathy patients. The correlation between perfusion disturbances and sudden death risk factors points to the role of ischemia in the natural course of disease and the value of exertion scintigraphy TI-201 in prognosing patients with hypertrophic cardiomyopathy.

[Dilated cardiomyopathy in children and adolescents. Diagnostic problems, clinical course and prognosis]. / Kardiomiopatia rozstrzeniowa u dzieci i mlodziezy. Problemy diagnostyczne, przebieg kliniczny i rokowania.

UNLABELLED: The clinical profile of 19 patients with dilated cardiomyopathy from 2 to 18 years old (mean age 13.4 +/- 4 years) was reviewed to detect any factors that might be predictive for their survival. Follow-up study ranged from 5 to 105 months (mean 39 +/- 33 months). All patients received digitalis + diuretics, 12 were managed with immunosuppression, 16 with antiarrhythmics. There were 12 survivors and 7 nonsurvivors: the 1-year mortality was 21.2%, the 2-years mortality was 35.8%. All deaths were within first 2 years. In 12 patients who survived 2 years, significant improvement was noticed in 9 cases. Endomyocardial biopsy was performed in 16 patients. Four of them with histological diagnosis of myocarditis survived and in 3 of them a considerable improvement was noticed. Half of 12 patients with nonspecific histological findings died (p less than 0.05). There was no significant difference between survivors and nonsurvivors in all following parameters: the incidence of severe heart failure (NYHA class III-IV) and severe ventricular arrhythmias (Lown III-IV), relative heart volume, echocardiographic LVDD, haemodynamic parameters--CI, LVEF, LVEDP, LVEDVI. CONCLUSIONS: Clinical, electrocardiographic, echocardiographic and haemodynamic data are nonpredictive for survival. The most dangerous period are the first two years of illness. In long term, improvement was noticed in half of patients.

[Ambulatory 24-hour blood pressure monitoring in patients with resistant hypertension]. / Rejestracja 24-godzinna cisnienia tetniczego krwi u chorych z tzw. Opornym nadcisnieniem tetniczym.

The aim of the study was to assess the usefulness of 24-hour blood pressure (BP) and heart rate (HR) monitoring in patients with "resistant" hypertension. 30 patients (44.1 +/- 9.9 years) with diastolic BP 100 mm Hg or more in spite of treatment with three or more antihypertensive drugs were studied. Ambulatory recording of BP and HR was performed by means of Del Mar Avionics monitoring system 9000. Mean recording time was 21.5 hours and mean number of measurements during one recording--56.7. Mean ambulatory systolic and diastolic BP values were significantly lower than mean value of three casual measurements (146.0 +/- 24.6 vs 171.5 +/- 21.2 mm Hg for systolic and 97.2 +/- 11.3 vs 110.4 +/- 7.5 mm Hg for diastolic BP p less than 0.01) In 14 (46.6%) systolic BP and in 10 patients (33.3%) diastolic BP were normal. The patients with normal and abnormal ambulatory BP recordings did not differ in regard to age and mean clinic BP levels. However, patients with abnormal ambulatory BP recordings were more often overweight and showed a greater frequency of left ventricular hypertrophy and family history of hypertension and its complications. The results of the study show that ambulatory BP monitoring may be of value in assessing the response to antihypertensive treatment in patients with so called resistant hypertension as judged on the basis of clinic pressure.

Determination of amiodarone and its metabolite desethylamiodarone in human plasma and serum.

A liquid chromatographic method for the assay of antiarrhythmic drug amiodarone and its metabolite desethylamiodarone in human plasma or serum has been developed. The method is simple and sufficiently sensitive for pharmacokinetic studies. Amiodarone, desethylamiodarone and added internal standard L 8040 were twice extracted at various pH from serum or plasma. The extract after evaporation was reconstituted in the mobile phase and chromatographed on reversed phase Hibar LiChrosorb RP-8 column with UV detection, at 254 nm. The method is specific and can detect approximately 30 ng of amiodarone and desethylamiodarone in 1 ml of plasma or serum.

[Twenty-four hour automatic recording of blood pressure and cardiac rhythm in patients with borderline hypertension]. / Calodobowa automatyczna rejestracja cisnienia tetniczego krwi i rytmu serca u chorych z granicznym nadcisnieniem tetniczym.

The aim of the study was to evaluate the usefulness of 24-hour automatic recording of blood pressure and cardiac rhythm in patients with borderline hypertension. The study was performed in 50 patients aged 38.8 +/- 13.1 using the Del Mar Avionics device. Mean time of recordings was 21.3 hours, and the mean number of blood pressure measurements per one patient was 52.4. Great fluctuations of systolic blood pressure (from 92.1 +/- 12.6 to 191 +/- 37.0 mm Hg) and diastolic one (from 57.3 +/- 11.4 to 118.9 +/- 13.8 mm Hg) were observed. Mean systolic blood pressure (125.6 +/- 10.6 mm Hg) was significantly lower than the mean value of last three ambulatory measurements (141.9 +/- 9.8; p less than 0.001). Also mean diastolic pressure was lower than that obtained in the out patient clinic (84.7 +/- 9.7 vs 91.9 +/- 3.2 mm Hg; p less than 0.001). Mean heart rate during the day was 86.2 +/- 10.7 and at night 69.7 +/- 10.5 beats per minute. Ventricular and/or supraventricular cardiac arrhythmias were observed in 14 (28%) of examined patients. Results of the study indicate, that 24-hour automatic blood pressure recording is the valuable method, affording possibilities for more precise estimation of blood pressure and its 24-hour fluctuations in patients with borderline hypertension.