Retrograde versus antegrade crystalloid cardioplegia in coronary surgery: value of troponin-I measurement.

BACKGROUND: The optimal route for delivery of cardioplegia is still in debate in patients with ischemic heart disease. Cardiac troponin-I is a new marker with the potential for detection of minor differences in myocardial ischemia. METHODS: In a prospective randomized trial 58 patients undergoing elective coronary artery bypass grafting for two- or three-vessel coronary artery disease were divided into groups with antegrade (group A, n = 29) and retrograde (group R, n = 29) application of crystalloid cardioplegia (St. Thomas II). Patients with major risk factors were excluded. In addition to routine electrocardiogram monitoring, cardiac troponin-I and creatine kinase-MB activity were measured in all patients preoperatively at 2, 5, 8, 24, and 48 hours after aortic cross-clamp release, and at hospital discharge. RESULTS: In both groups, there were no differences regarding operative parameters. A significantly higher cardiac troponin-I concentration was observed in the antegrade group at 24 hours after cross-clamp (8.2 +/- 8.5 microg/L vs 3.2 +/- 3.1 microg/L; p = 0.02). Patients with subtotal stenosis or occlusion of one or more main coronary arteries showed significantly lower cardiac troponin-I levels after retrograde application. CONCLUSIONS: Lower concentrations of the cardiac troponin-I marker after retrograde application of cardioplegia indicate advantages of myocardial protection in ischemic heart disease.

[Changes in insulin-glucose quotients in a glucose tolerance test in the third trimester]. / Veränderungen der Insulin-Glukose-Quotienten während eines Glukosetoleranztests im III. Trimenon.

OBJECTIVE: In comparison a higher insulin-glucose-index is usually associated with an increased insulin resistance. In the present study changes in insulin-glucose-indices were examined in relation to a defined glucose tolerance in the last trimester of pregnancy. MATERIAL AND METHODS: 249 pregnant women were challenged with a 75 gm oral glucose tolerance test (oGTT). Serum samples for glucose (glucose-dehydrogenase-method) and insulin measurements (RIA) were drawn before and at 30, 60, 120, and 180 minutes after glucose load during oGTT. Patients were assigned to five groups with increasing glucose intolerance according to maximal glucose levels during the test. RESULTS: There were no significant differences in insulin-glucose-indices prior to glucose load. Pregnant women with gestational diabetes were shown to have significantly lower insulin-glucose-indices in the early and intermediate phase of the challenge test while the indices were higher in the final phase of the test. CONCLUSIONS: Women with gestational diabetes demonstrated an initial delay in insulin secretion in combination with a higher insulin-glucose-index, corresponding to an increased insulin resistance, only in the end of the test. These characteristics may possibly be a cause of the observed disorder in glucose metabolism in these patients.

[Genetic disposition to chronic polypoid sinusitis and alpha 1-proteinase inhibitor deficiency types]. / Genetische Disposition zu chronisch polypöser Sinusitis und Mangeltypen des alpha 1-Proteaseinhibitors.

Chronic polypoid sinusitis is often accompanied with bronchitis, asthma and various allergies. All of these disorders have immunologic defects in common. The present study was devised to measure the genetically determined parameter of alpha-1-protease inhibitor by isoelectric focusing. Genetic polymorphism of alpha-1-antitrypsin is the source for biochemically less active types of the protease inhibitor. In this investigation the alpha-1-protease inhibitor type of 86 patients from Niedersaxony and 95 patients from Schleswig-Holstein was determined. All patients required sinus surgery as treatment for chronic polypoid sinusitis. The alpha-1-protease inhibitor deficiency types PI-MS and PI-MZ were found five times more frequently in patients from Niedersachsony and three times more often in patients from Schleswig-Holstein than in a control (normal) group of 127 subjects (p < 0.01). These findings were comparable to data in other publications. Results clearly showed a connection between alpha-1-protease inhibitor deficiency types and chronic polypoid sinusitis. These findings indicate that a genetic predisposition to chronic polypoid sinusitis is somehow correlated with the gene locus for alpha-1-protease inhibitor.

[Quantitative analysis of fibrinmonomer in Arwin-therapy (author's transl)]. / Bestimmung der Fibrinmonomere im Plasma bei Arwin-Therapie.

The quantitative measurement of plasma fibrin monomeres in three patients with Arwin-treatment by affinity chromatography on agarose fixed fibrinogen and the "tüpfel method" demonstrated high specifity and sensitivity. Plasmafibrinmonomer concentration clearly differs both before and during treatment from results reported in the literature. The method results in a better control of dangerous situation, especially with additional application of fibrinolytic agents.