[Clinical experience with an alpha glucosidase inhibitor (acarbose) in the treatment of non-insulin-dependent diabetes. Multicenter study]. / Experiencia clínica con un inhibidor de la alfa glucosidasa (acarbosa) en el tratamiento de la diabetes no insulinodependiente. Estudio multicéntrico.

BACKGROUND: Acarbose, an alpha glucosidase inhibitor is a drug used in the treatment of non insulin dependent diabetes mellitus, that interferes with the intestinal absorption of monosaccharides. AIM: To study the effect of acarbose in non insulin dependent diabetic patients that had an inadequate metabolic control with diet and sulphonylureas. PATIENTS AND METHODS: Diabetic patients received acarbose, 150 mg/day during four weeks and this dose was increased to 300 mg/day during 3 months. Afterwards, patients were followed for a period of 12 weeks without acarbose. Fasting and post-prandial blood glucose and glycosilated hemoglobin were measured sequentially during the study. RESULTS: Eighty five patients were recruited for the study but 64 complied with the treatment protocol. The age of these patients was 56 +/- 8.8 years old, their diabetes duration was 7.8 +/- 8.8 years and their body mass index was 27.6 +/- 3.6 kg/m2. During acarbose treatment, glycosilated hemoglobin decreased from 8.36 +/- 1.33 to 7.71+ 1.7% (p < 0.001), fasting blood glucose decreased from 173 +/- 48 to 159 +/- 59 mg/dl (p < 0.03) and post-prandial blood glucose decreased from 254 +/- 80 to 241 +/- 80 mg/dl (NS). After discontinuing acarbose glycosilated hemoglobin and blood glucose levels returned to basal levels. Body weight and blood pressure did not change during the treatment period. Fifty nine patients had gastrointestinal symptoms (meteorism, flatulence and abdominal distention) that were mild in 59% and moderate in 39%. Episodes of hypoglycemia were not observed. CONCLUSIONS: Acarbose, associated to sulphonylureas is an effective drug to reduce blood glucose and glycosilated hemoglobin levels in patients with non insulin dependent diabetes.

Triggers of acute myocardial infarction regarding its site.

We have studied the incidence of possible triggers of the myocardial infarction regarding its site in 750 patients with anterior and 731 patients with inferior infarction. Infarctions occurred most frequently without recalling any triggering activity, especially in patients with anterior infarction (67 vs. 44%). Physical effort as the possible precipitator was also more frequent in anterior infarctions (22 vs. 16%). However, the onset of inferior infarction was more frequent during meteorological stress (9 vs. 2%), emotional stress (10 vs. 3%), after overeating (13 vs. 3%) and nicotine abuse (6 vs. 1.5%). These triggers were independent and highly significant (P < 0.02 in each case) discriminators of the site of myocardial infarction. Bimodal circadian rhythm, with primary peak between 6 and 9 h a.m. and the secondary peak between 3 and 6 p.m. was observed in patients which did not recall any triggering activity, and this was more pronounced in patients with inferior infarction. These results support the hypothesis that the influence of the vegetative tone is most pronounced in the onset of myocardial infarction of inferior wall.

[Comparison of auscultation findings using a classic stethoscope (Litmann 2120) and electronically amplified stethoscope (Medmax2)]. / Usporedba auskultacijskih nalaza stetoskopom s elektronskim pojacalom (Medmax2) prema klascnom (Litmann 2120).

Heart auscultation has one of the key roles in beside diagnosis, especially in patients with cardiovascular diseases. Sometimes, because of the human cars' low sensitivity, a problem emerges in the proper evaluation of heart sounds and murmurs of lower frequencies. Our study compared two stethoscopes, the classic acoustic stethoscope (Littmann 2120) and an electronic one with the sound amplifier and the noise filtering system (Medmax2) in 10 patients examined by 10 physicians. Significantly better detection of low frequency sounds was found in favour of electronic stethoscope (chi 2 = 17.9; p < 0.0001). It is concluded that the selective amplificator improves the stethoscope performance and has its place in everyday bedside practice, especially in departments of cardiology.

[Anterior septal myocardial infarct impairs cardiovascular function more than inferior septal myocardial infarct]. / Anteroseptalni infarkt miokarda vise od inferiornog slabi funkcijsku sposobnost kardiovaskularnog sustava.

The functional ability, expressed as percentage of expected oxygen uptake, measured on the tread-mill according to the Bruce protocol, was assessed in 30 patients with anteroseptal, and in 30 patients with inferior myocardial infarction (MI), 4 months after the incident. In comparison to those with inferior MI, the patients with anteroseptal localization exhibited significantly lower values of functional ability (68.37% +/- 14% versus 75.63% +/- 11%, p < 0.05), significantly higher activities of creatine kinase (CK: 894.7 +/- 441 versus 603 +/- 330 IU, p < 0.01), significantly lower left-ventricular ejection fraction (53% +/- 6.4% versus 58.7% +/- 6.3%, p < 0.01) and higher negative correlation between CK and functional ability (r -0.85 versus r -0.72). In conclusion, anteroseptal infarction is associated with a greater decrease in functional ability then the inferior one, which is partly due to more extensive necrosis with greater deterioration in left ventricular contratility; the mere site of infarction is probably also a contributing factor.

[Controlled comparison of nicardipine and propranolol in the treatment of arterial hypertension]. / Kontrolirana usporedba nikardipina i propranolola u lijecenju arterijske hipertenzije.

A randomized collective comparative study between nicardipine (N) and propranolol (P) was conducted over a period of 7 weeks in thirty hypertensive patients of both sexes, aged from 20 to 65 years, with the diastolic pressure over 100, but below 120 mmHg. Thirteen examinees were given N (60-120 mg daily) and seventeen P (120-240 mg daily); the groups were comparable according to a series of relevant parameters. In the placebo-period the mean arterial pressure (MAP) was slightly lowered, by 4.4% (p greater than 0.20). MAP was, however, considerably lowered already at the end of the second week of active treatment both in the N group (from 135.1 +/- 7.4 to 116 +/- 10.8 mmHg, or by 19.1%; P less than 0.01), as well as in the P group (from 131.6 +/- 8.1 to 117 +/- 9.1 mmHg, by an average of 11.1%; P less than 0.05). The values continued to decrease, and at the end of the seventh week of the study MAP averaged 108.5 +/- 6.5 mmHg (-19.7%; P less than 0.01) in the N group, while it was 109.7 +/- 9.1 mmHg (-16.6%; P less than 0.01) in the P group. The heart rate became considerably slower in the P group only, from the initial 84.5 +/- 9.2 to 66.9 +/- 2.7 beats per minute at the end of the seventh week (-20.8%; P less than 0.01), but it was unexpectedly, although not significantly lowered also in the N group, from the initial 78.3 +/- 6.5 to 74.2 +/- 4.0 beats (-5.2%; P greater than 0.20).(ABSTRACT TRUNCATED AT 250 WORDS)

[The role of the diagonal ear lobe crease in the clinical evaluation of coronary risk]. / Mjesto dijagonalne brazde usne resice u klinickoj procjeni koronarnog rizika.

Two hundred and forty-three prospective patients (143 with proved coronary heart disease and 100 without coronary disease) were analysed for the presence or absence of ear lobe crease, a possible aural sign of coronary artery disease. The crease was present in 72.7% of the coronary and 48% of the noncoronary examinees (p less than 0.001). The crease was more prevalent in older (greater than 50) than in the younger patients. The positive predictive value of this sign averages 70% and the negative one 60%.

[Comparison of the antihypertensive effects of bopindolol and metoprolol in the treatment of arterial hypertension]. / Usporedba antihipertenzivnih ucinaka Bopindolola i Metoprolola u lijecenju arterijske hipertenzije.

A randomized, double blind clinical trial included 40 hypertension patients of both sexes, aged 18-70 years, with diastolic blood pressure persistently above 100 (13.33 kPa) and below 120 mm Hg (15.99 kPa). After a run-in period on placebo, one half of them was treated with bopindolol (single daily dose 1-3 mg), and the other half with metoprolol (100-300 mg daily in two divided doses). After 4 weeks of formal trial both beta blockaders had significantly decreased the elevated arterial pressure, e.g. the mean arterial pressure in the bopindolol group dropped from an average of 129.1 +/- 6.9 (17.20 +/- 0.92) to 111.6 +/- 6.1 mm Hg (14.87 +/- 0.81 kPa) or by 13.6% and in the metoprolol group from 129.8 +/- 7.1 (17.30 +/- 0.94 kPa) to 114.5 +/- 6.4 mm Hg (15.26 +/- 0.85 kPa) or by 11.8% (p less than 0.02). After 12 weeks the mean pressure was ulteriorly lowered to some 104.3 mm Hg (13.90 kPa) on bopindolol and to some 106.0 mm Hg (14.12 kPa) on metoprolol. The heart rate was expectedly slowed down, from an average of 95 to 69 b.p.m. with bopindolol (27.4% decrease, p less than 0.001) and from 99 to 67 b.p.m. with metoprolol (32.3% decrease, p less than 0.001). The other parameters, including the laboratory results did not change appreciably during this study. Clinically relevant side-effects were not registered, and the observed between-group differences did not reach the level of statistical significance. It is concluded that bopindolol and metoprolol are beta-adrenergic blockaders of comparable antihypertensive efficacy.

Sindrome de Weill-Marchesani: cuatro casos clinicos familiares. / Weill-Marchesani syndrome: 4 familial clinical cases

Se presenta el arbol genealogico de una familia originaria de Bucalemu, de la que se examino a 34 personas, encontrandose en 13 de ellos branquimorfismo solo, y en 4, braquimorfismo y microesferofaquia, que corresponden a las alteraciones musculoesqueleticas y oculares del sindrome de Weill-Marchesani. El objeto de esta presentacion es llamar la atencion sobre la escasa frecuencia de este sindrome y sobre la importancia de un diagnostico y tratamiento precoz para evitar las complicaciones y conservar la buena vision