The relationship between postoperative opioid consumption and the incidence of hypoxemic events following total hip arthroplasty: a post hoc analysis.

Background: Postoperative opioid analgesia may cause respiratory depression. We assessed whether following total hip arthroplasty, placebo-adjusted reductions in morphine consumption at 48 hours with parecoxib (47.0%), propacetamol (35.1%) or parecoxib plus propacetamol (67.9%) translated into a reduction in hypoxemic events. Methods: This was a post hoc analysis of a randomized, placebo-controlled, noninferiority study. Patients were randomly assigned to receive intravenous parecoxib (40 mg twice daily), propacetamol (2 g 4 times daily), parecoxib plus propacetamol (40 mg twice daily + 2 g 4 times daily) or placebo. Dose, date and time of morphine administration via patient-controlled analgesia were monitored throughout the study. In patients not receiving supplemental oxygen, peripheral blood oxygenation was assessed continuously for 48 hours after surgery. Hypoxemia was defined as peripheral oxygen saturation less than 90%. The times and oximeter readings of hypoxemic events were recorded. Pearson correlation coefficient was used to assess for correlations between cumulative morphine consumption at 48 hours and mean number of hypoxemic events. Results: A significantly smaller proportion of patients who received the combined treatment with parecoxib and propacetamol had hypoxemia versus placebo (2.8% v. 13.2%, p < 0.05), and the mean number of hypoxemic events was significantly smaller for parecoxib (0.12), propacetamol (0.06) and parecoxib plus propacetamol (0.03) versus placebo (0.36; all p < 0.05). There was no correlation between the reduction in cumulative morphine consumption at 48 hours and the mean number of hypoxemic events in any treatment group (all p > 0.1). Conclusion: Following total hip arthroplasty, a greater than 70% reduction in morphine consumption may be necessary to translate into a corresponding reduction in hypoxemic events.

Contexte: L'utilisation d'analgésiques opioïdes en période postopératoire peut provoquer une dépression respiratoire. Nous avons voulu déterminer si, après une arthroplastie totale de la hanche, une réduction de la consommation de morphine à 48 heures par l'administration de parécoxib (47,0 %), de propacétamol (35,1 %) ou d'une combinaison des deux (67,9 %) ­ avec ajustement selon un groupe placebo ­ se traduirait par une réduction du nombre d'épisodes d'hypoxémie. Méthodes: Nous avons effectué une analyse post hoc d'une étude randomisée de non-infériorité avec témoins sous placebo. Après une répartition aléatoire, chaque patient a reçu par intraveineuse du parécoxib (40 mg 2 fois par jour), du propacétamol (2 g 4 fois par jour), une combinaison de parécoxib et de propacétamol (40 mg 2 fois par jour + 2 g 4 fois par jour) ou un placebo. Tout au long de l'étude, la dose, la date et le moment de l'administration de morphine contrôlée par le patient ont été notés. Chez les patients qui ne recevaient pas d'oxygène d'appoint, la saturation périphérique en oxygène a été surveillée de manière continue pendant les 48 heures suivant l'opération. L'hypoxémie a été définie comme une saturation inférieure à 90 %. Le moment et les données d'oxymétrie ont été notés pour chaque épisode d'hypoxémie. Le coefficient de corrélation de Pearson a été utilisé pour évaluer la présence de corrélations entre la consommation cumulative de morphine durant les premières 48 heures et le nombre moyen d'épisodes d'hypoxémie. Résultats: Une proportion significativement plus faible de patients ayant reçu le traitement combiné de parécoxib et de propacétamol ont connu des épisodes d'hypoxémie, comparativement aux patients qui avaient reçu le placebo (2,8 % c. 13,2 %, p < 0,05), et le nombre moyen d'épisodes d'hypoxémie était significativement plus faible dans le groupe ayant reçu du parécoxib (0,12), du propacétamol (0,06) ou une combinaison de parécoxib et de propacétamol (0,03), par rapport au groupe placebo (0,36, p < 0,05 pour tous). Aucune corrélation n'a été observée entre la réduction de la quantité totale de morphine consommée à 48 heures et le nombre moyen d'épisodes d'hypoxémie pour tous les groupes (p > 0,1 pour tous). Conclusion: Après une arthroplastie totale de la hanche, une réduction de la consommation de morphine de plus de 70 % pourrait être nécessaire pour obtenir une réduction correspondante du nombre d'épisodes d'hypoxémie.

Wastewater generated during cleaning/washing procedures in a wood-floor industry: toxicity on the microalgae Desmodesmus subspicatus.

In industries based on dry processes, such as wood floor and wood furniture manufacture, wastewater is mainly generated after cleaning of surfaces, storage tanks and machinery. Owing to the small volumes, onsite treatment options and potential environmental risks posed to aquatic ecosystems due to discharge of these wastewaters are seldom investigated. In the present study, the effects of cleaning wastewater streams generated at two wood floor production lines on Desmodesmus subspicatus were investigated. The microalgae was exposed to different wastewater concentrations (100, 50, 25, 12.5 and 6.25% v:v) and the algae growth evaluation was based on in vivo chlorophyll fluorescence, cell density, cell size (number of cells/colony) and cell ratio (length/width). Inhibitory effects of the tested wastewaters on the microalgae were positively related to concentration and negatively related to exposure time. The EC50,24 h of blade cleaning wastewater (BCW) and floor cleaning wastewater (FCW) were 3.36 and 5.87% (v:v), respectively. No negative effect on cell colony formation was caused by BCW, whereas an increase of 90% unicellular cells was observed in FCW concentrations below 50% (v:v). At the lowest concentration (3.13% v:v) where no growth inhibition was observed, both wastewater streams caused changes in cell dimensions by increasing cell length and width. To conclude, wastewaters generated during cleaning procedures in the wood floor industries can have severe environmental impacts on aquatic organisms, even after high dilution. Therefore, these wastewaters must be treated before being discharged into water bodies.

Epidemiology of physician-diagnosed neuropathic pain in Brazil.

OBJECTIVES: Estimate the prevalence of neuropathic pain (NeP) among chronic pain patients attending Brazilian hospitals and pain clinics in São Paulo, Ceara, and Bahia and explore clinical characteristics by subtypes: painful diabetic peripheral neuropathy (pDPN), central neuropathic pain (CNP), chronic low back pain with a neuropathic component (CLBP-NeP), postherpetic neuralgia (PHN), post-traumatic neuropathic pain (PTN), and post-surgical neuropathic pain (PSN). METHODS: Physicians screened patients reporting chronic pain for ≥3 months (n=2,118) for probable NeP, using the Douleur Neuropathique 4 questionnaire and physician assessment, and reported their NeP subtype(s), symptoms, and medications. Identified NeP patients completed a questionnaire including treatment experiences, quality of life EuroQol 5 Dimensions [EQ-5D]), pain severity and interference (Brief Pain Inventory [BPI]), and Work Productivity and Activity Impairment scales. Descriptive analyses were performed by NeP subtype. RESULTS: The prevalence of probable NeP was 14.5% (n=307). NeP patients were mostly female (80.5%), middle-aged (mean [M]=52.5, SD=13.9), and Pardo (44.3%). Of those diagnosed with an NeP subtype (n=209), the largest proportions were CLBP-NeP (36.8%), followed by pDPN (18.7%), CNP (17.7%), PTN (17.2%), PSN (13.4%), and PHN (3.3%). Across subtypes, the most widely reported symptoms were numbness (range: 62.2%-89.7%) and hyperalgesia (range: 32.1%-76.9%) and the most commonly prescribed pain analgesics were NSAID (range: 18.2%-57.1%), opioids (range: 0.0%-39.3%), and antiepileptics (range: 18.2%-57.1%). PTN and PSN patients reported the least favorable EQ-5D index scores (M=0.42, SD=0.19) and BPI-Pain Severity scores (M=7.0, SD=1.9), respectively. Those diagnosed with CNP had the least favorable BPI-Pain Interference scores (M=6.0, SD=2.7). Patients with PHN reported the least impairment based on EQ-5D index scores (M=0.60, SD=0.04). Those with pDPN had the most favorable BPI scores (BPI-Pain Severity: M=4.6, SD=2.3; BPI-Pain Interference: M=4.7, SD=2.7). CONCLUSION: Evaluation of chronic pain patients in Brazil yielded a 14.5% probable NeP prevalence. NSAIDs and opioids were commonly used, and there was a high incidence of NeP-related symptoms with varying levels of dysfunction across subtypes.

The expression and regulation of class II antigens in normal and inflammatory bowel disease peripheral blood monocytes and intestinal epithelium.

Elevated constitutive expression of major histocompatibility (MHC) class II antigens occurs in the enterocytes of patients with IBD. It has been suggested that this aberrant expression of class II molecules may play a role in the pathogenesis of IBD. We examined two possible reasons for such a finding. 1) Heightened sensitivity of IBD enterocytes to endogenous gamma interferon (gamma IFN) and 2) enhanced endogenous secretion of gamma interferon by intestinal cells in close proximity to the enterocytes (lamina propria lymphocytes). Constitutive and gamma interferon stimulated HLA-DR and DP density on intestinal epithelial cells (IEC) and peripheral blood monocytes (PBM) from UC patients (IEC n = 13; PBM n = 20), CD patients (IEC n = 14; PBM n = 18) and non-IBD controls (IEC n = 12; PBM n = 20) were measured via flow cytometry (mean channel fluorescence). gamma IFN production by PHA stimulated and unstimulated lamina propria lymphocyte (LPL) cultures of UC patients (n = 11) CD patients (n = 8) and non-IBD controls (n = 11) was measured using a vesicular stomatitis virus/WISH cell bioassay. We found significantly greater gamma IFN secretion by IBD-derived PHA stimulated LPL than from non-IBD stimulated controls (CD = 39.4 +/- 12.4u; UC41.5 +/- 6.8u; NL = 22.4 +/- 8.3u, p less than 0.05) while gamma IFN induced HLA-DR and DP upregulation was no greater in IBD-derived IEC and PBM than in non-IBD controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Indirect immunofluorescence in the investigation of rapidly progressive sensorineural hearing loss and Menière's disease.

Being aware of the conservation of antigenicity, we performed indirect immunofluorescence on non fixed non decalcified frozen hamster's cochlea. Once killed, the heads of the hamsters were immediately dipped into liquid nitrogen and then stored at -20 degrees C until cutting. The sections were done at the same temperature, with Tissue-Tek embedding the heads to avoid breaking, using a sharp tungsten knife. The immunofluorescence itself was performed with the sera of the patients which were revealed through donkey fluorescein-conjugated antiserum to human immunoglobulins. For counterstaining, we used Evans blue. Twenty patients with rapidly progressive sensorineural hearing loss (according to the clinical criteria of MacCabe) and 6 with Menière's disease were tested. Five had a specific fluorescence on the stria vascularis. A correlation with the lymphocyte transformation test on human inner ear antigen has been found (p = 0.055).

[Obtaining a fermented chickpea extract (Cicer arietinum L.) and its use as a milk extensor]. / Obtención de un extracto de garbanzo (Cicer arietinum L.) fermentado y su uso como extensor lácteo.

Chickpea (Cicer arietinum L) is cultivated in the North part of México and it is considered a good source of vegetal protein of low cost (20% average), nevertheless, the 80% used for the exportation and only the 20% less was used for animal feeding. The main objective in this study is to obtain a fermented chickpea extract for using in dairy extensor. Chickpea water absorbtion kinetics were carried out in e temperature conditions:while the conditions were established, chickpea was grounded and fermented in different amounts with its natural flora, L. casei, L. plantarum and a mixture culture of both microorganism in logarithmic phase. The results showed that the presence of microorganism of chickpea natural flora interferes during the fermentation, so before the inoculation it was necessary treat the chickpea extract (CE) terminally in a dilution 1:4 during 20 min at 7.7 kg/cm2 of pressure. The use of a mixture culture of 5% of L. casei and 5% L. plantarum inoculated in MRS broth was used to decrease fermentation time. Its addition in logarithmic phase to the sterile chickpea extract increased the lactic acid production and decreased the pH value in 6 h which was less time that one obtained with each of lactobacillus. The fermented extract obtained finally, presented similar sensory characteristics to the ones of dairy products. Therefore, chickpea is a good alternative as a extensor for this kind of products.

[Development of a soup pasta based on the taste and nutritional requirements for aged people]. / Desarrollo de una pasta para sopa diseñada de acuerdo a los gustos y recomendaciones nutricias para los ancianos.

The objective of this project was to elaborate a soup paste product based on cereal/leguminous mixture by cold extrusion method according to the preferences and limitations of the senescent population. Formulas were obtained by a computation food mixtures program; the limitations applied were: protein quantity and quality. Selected mixtures has to contain protein values over 13.2 g/100 g and a chemical assessment of leucine, lysine and methionine-cistein not lower than 75% of the FAO/OMS 1973 recommendations, because they are the limitant aminoacids of the amaranth, the wheat and the beans, respectively. Chemical, physical, microbiological, farinografics and sensorial tests were applied to evaluate the characteristics of the mixtures. The selected mixture was made up of: 70% wheat semolina (Triticum durum), 20% beans (Phaseoulus vulgaris L) and 10% amaranth (Amaranthus hypochondriacus). The manufactured paste allowed 20% of the nutritional requirements of the elderly people of protein, carbohydrates, calcium, iron and vitamins A, B1 and C; it was highly accepted (95%) by the elderly people and was microbiologically stable for 12 weeks period at 25 degrees C and 55% RH in cellophane packages. We can conclude that the soup paste may be a vehicle to add substances and deficient nutriments to the habitual diet of the elderly people in our country.

[Development of an intermediate moisture product for the elderly based on texturized soybeans]. / Desarrollo de un picadillo de humedad intermedia para ancianos con base en soya texturizada.

In accordance with the fact the aging process is closely related to the individual nutrition, it is possible to infer that the daily diet could help and improve, to a certain degree, to the elderly well-being. Based on this and making use of the food technology expertise, the development of a low cost, easily prepared and preserved product, in accordance with the taste and needs of the elderly people was considered. The objective of this project was to elaborate an intermediate moisture food (IMF) based on texturized soy protein with carrots, potatoes and peas, adding humectants and microstatic agents according to the moist and dry infusion methods. Fried bacon was added to some formulas in order to evaluate the sensorial preference of the product with and without bacon by elderly people and effect of the bacon on the water activity (aw) reduction. The aw for the product with added bacon was 0.859 and 0.896 for the one with no added bacon. The product with added bacon allowed 20% of the nutritional requirements of the elderly people of protein, vitamin A and thiamine. Both formulas were equally highly accepted by the elderly people (80%) and were microbiologically stable for 8 weeks period at 25 degrees C and 55% RH in aluminium/cellophane/polyethylene and polyester/polyethylene flexible packages. We can conclude that IMF may be an alternative to improve the diet of the elderly people.

[The role of endorphins in the etiopathogenesis of circulatory diseases]. / Udzial endorfin w etiopatogenezie schorzen ukladu krazenia.

At the beginning of the 70-ties various studies showed the existence of endogenous opiates in central nervous system. The chemical structure of first endogenous pentapeptides called enkephalins (met-enkephalin and leu-enkephalin) and their receptor was already known in 1975. Further investigations confirmed the existence of opiates (endorphins) in brain, pituitary gland, spinal cord and other tissues. Endorphins may exert various effects: analgesic (especially dynorphin and b-endorphin), antidiuretic, depressive on respiratory center, constipative, they also cause physical and mental dependence. These peptides, which are not known thoroughly may play a big part in the regulation of many biochemical and hemodynamic processes. Many of these mechanisms are already described and changes in concentrations of endorphins, for example in patients with silent myocardial ischaemia, are basic in the pathogenesis of this disease. Many of these mechanisms are controversial, the role of endogenous opiates in pathogenesis of hypertension or congestive heart failure is still unknown. This study summerizes the present knowledge endorphins and tries to answer whether changes in the concentration of endorphins are primary or secondary to the biochemical and hemodynamic disturbances in 2 diseases.

[Alveolar-arterial oxygen gradient in patients with clinical symptoms of pulmonary embolism]. / Gradient pecherzykowo-tetniczy u chorych z klinicznymi objawami zatorowosci plucnej.

The accurate detection of pulmonary embolism is possible by means of non-invasive but very expensive ventilation-perfusion lung scanning or invasive and with high rate of complications pulmonary angiography. Thus monitoring of many clinical and biochemical parameters has been recently attempted to increase the probability of correct diagnosis of pulmonary embolism. The alveolar-arterial oxygen gradient is a more sensitive indicator of disturbance in oxygenation than occurrence of hypoxia in gasometry. The aim of our study was to examined the changes of the alveolar-arterial oxygen gradient in patients with pulmonary embolism. The survey was made in 35 patients aged from 41 to 75 with acute pulmonary embolism, of these 17 were men and 18 were women. We excluded patients with coexisting serious heart or lung disease. Pulmonary embolism was diagnosed on the grounds of presence of commonly known risk factors, sudden onset, findings on the chest radiography, hypoxia resistant to oxygen therapy, electrocardiography, echocardiography and catheterization of pulmonary artery using a Swan-Ganz catheter. The alveolar-arterial oxygen gradient was measured in arterial blood samples obtained 15 minutes after 100% oxygen ventilation, using standard formulae. All patients were administered heparin, oxygen and warfarine therapy. The control group consisted of 20 patients, 11 women and 9 men aged from 37 to 74, with deep venous thrombosis without coexisting heart or lung disease. In our study we showed that the alveolar-arterial oxygen gradient is a very useful parameter helping with diagnosis and monitoring efficacy of treatment in patients with pulmonary embolism without coexisting heart or lung diseases.

[Plasma concentrations of endothelin-1 and endothelin-2 in patients with pulmonary hypertension]. / Stezenie endoteliny-1,2 w surowicy chorych na nadcisnienie plucne.

Increased pressure in pulmonary artery is connected among other things with increased endothelin plasma concentration. The aim of the study was to assess plasma endothelin concentration in patients with pulmonary hypertension. The analysis comprised 22 patients with increased pressure in pulmonary artery in the course of pulmonary thromboembolism or chronic exacerbated left ventricular failure and 10 patients with chronic exacerbated left ventricular failure without pulmonary hypertension. Plasma endothelin concentration was measured in pulmonary artery and capillary wedge pressure were evaluated with Swan-Ganz catheter and also peripheral and pulmonary vascular resistance were calculated. Endothelin plasma concentration in peripheral vein was compared between patients and healthy volunteers. Plasma endothelin concentration in pulmonary artery, peripheral artery and vein was higher in patients with pulmonary hypertension than in patients with chronic exacerbated left ventricular failure without pulmonary hypertension. Plasma endothelin concentration in patients with chronic exacerbated left ventricular failure without pulmonary hypertension was higher in pulmonary artery than in peripheral artery and vein. At these patients plasma endothelin concentration in the peripheral vein didn't differ significantly from the healthy volunteers.

[The study of the activity of creatine kinase in diagnosis of coronary reperfusion in patients with acute myocardial infarction after thrombolysis]. / Badania aktywnosci kinazy kreatynowej dla oceny przywrócenia krazenia wiencowego u chorych na zawal miesnia serca leczonych trombolitycznie.

Early estimation of the efficacy of thrombolysis in acute myocardial infarction is of great clinical importance because the appearance of coronary reperfusion changes therapeutic and diagnostic procedures and decreases the mortality rate. Previous studies showed that the analysis of activity of creatinine kinase (CPK) measured in regular, short periods of time after thrombolysis night be useful in the diagnosis of reperfusion equally to coronary angiography. The aim of the study was to estimate the usefulness of the analysis of creatine kinase (CPK) and its isoenzyme (CK-MB) in the diagnosis of coronary reperfusion in patients with acute myocardial infarction after thrombolytic therapy. The study was performed in 50 patients with acute myocardial infarction admitted to our Cardiology Department, of these 42 were men aged from 34 to 68 and 8 were women aged from 43 to 70. 28 patients had acute inferior myocardial infarction, 22 patients--acute anterior myocardial infarction. All patients were administered 300 mg of aspirin after admission and then 150 mg of aspirin daily and 1,500,000 IU of streptokinase i.v. within 1 hour. Venous blood samples for determination of CPK and CK-MB were obtained every 3 hours during the first 48 h and once a day at 8 a.m from 3rd to 11th day. All patients underwent coronary angiography 2-4 weeks after thrombolysis. The study showed that in patients with reperfusion, activities of CPK and CK-MB three hours after thrombolysis were higher than 30% of later peak. These findings show the usefulness of this criterion in early, non-invasive estimation of efficacy of thrombolysis. Determination of activity of isoenzyme CK-MB during thrombolytic therapy is not necessary, because it evaluates similarly to CPK. We showed that electrocardiographic and enzymatic criteria are comparable in estimation of efficacy of thrombolytic therapy.

[Frequency of silent ischemic heart disease in patients with diabetes mellitus]. / Czestosc wystepowania bezbólowej postaci choroby niedokrwiennej serca u chorych na cukrzyce.

Early detection of silent ischaemia plays an important role in prevention of sudden cardiac death and acute myocardial infarction. More frequent occurrence of silent ischaemia in patients with diabetes mellitus and manifestations of ischaemic heart disease has been relayed in several studies. No studies aimed at frequency of occurrence of silent ischaemia in diabetic patients without clinical symptoms of ischaemic heart disease have been performed yet. Objectives of this study were the examination of the latter case. This study involved 67 patients with diabetes mellitus without clinical symptoms of ischaemic heart disease. The average duration time of diabetes mellitus was 11 years. The patients were divided in two groups. The first group included 26 patients with insulin dependent diabetes mellitus. The second group included 41 patients with non insulin dependent diabetes mellitus. The first control group consisted of 35 non diabetic patients with ischaemic heart disease, and the second control group consisted of 22 healthy volunteers. 24-hours ambulatory Holter monitoring and ECG exercise test were performed in all subjects. The diagnosis of silent ischaemia was established in patients with positive results of both examinations in ECG-records without any following pain. In case of only one positive results the dipyridamole stress echocardiography test with ECG was carried out to prove the diagnosis. It was proved, that silent ischaemia occurs in 19.2% of patients with insulin dependent diabetes mellitus and in 22% non insulin diabetic patients. No statistic differences between frequency of silent ischaemia occurrence in both groups were revealed. The application of 24-hours Holter monitoring combined with ECG-exercise stress test seems to be the best method in early recognition of silent ischaemia in diabetic patients.

Oncostatin M in bronchoalveolar lavage correlates with the severity of sarcoidosis.

BACKGROUND: Recent studies have shown that oncostatin M (OSM) might have a role in T cell-mediated inflammatory processes in which mast cells are also involved. Patients with severe sarcoidosis might develop fibrotic changes in the lung. We assessed whether there was a correlation between mast cells expressing OSM in bronchoalveolar lavage (BAL) and the severity of sarcoidosis. PATIENTS AND METHODS: Twelve consecutive patients with new diagnosis of sarcoidosis were eligible for the study. All underwent complete lung function tests, angiotensin converting enzyme (ACE), and bronchoscopy that included BAL and biopsies. Cytospins of BAL were prepared. All samples were incubated with the primary antibody rabbit anti-human c-kit, CD117 and stained for total mast cell count. The mouse anti-human Oncostatin M was applied and activated mast cells were counted. Clinical sarcoidosis parameters including ACE and lung functions were correlated with mast cells in BAL, as well as with OSM positive mast cells. RESULTS: FEV1 % was correlated with the percentage of activated mast cells, as well as with the percentage of OSM positive mast cells (r=0.61, p=0.033, 95% CI: 0.06-0.87; r=0.58, p=0.04, 95% CI: 0.015-0.86, respectively). FVC and FEV1/FVC correlated with activated mast cells (r=0.58, p=0.05; r=0.63, p=0.028, respectively). CONCLUSIONS: Direct correlation was found between clinical parameters including lung function tests (FEV1 and FVC) and OSM secretion from mast cells in patients with sarcoidosis. These findings suggest that mast cells and OSM have a role in sarcoidosis. Further studies to confirm these preliminary results are suggested.

[Levels of B-endorphin in patients with silent myocardial ischemia]. / Stezenie beta-endorfiny u chorych z bezbólowa postacia choroby niedokrwiennej serca.

Plasma beta-endorphin levels were estimated in patients with painless myocardial ischaemia. The survey was made in 90 patients with coronary artery disease: 55 of them after myocardial infarction and 35 with chronic stable angina pectoris. The control group comprised 22 healthy persons. Plasma beta-endorphin level was determined in all examined patients immediately before the exercise test, just after finishing exercise test, and 6 minutes after the termination of the exercise test. Beta-endorphin plasma levels has been determined with a radioimmunologic method by the means of "beta-endorphins [125J]RIA Kit" manufactured in NEN Research Products. Study showed that in the patients with silent myocardial ischaemia plasma beta-endorphin level was higher than in patients with painful myocardial ischaemia both at rest during exercise test. Increase of plasma beta-endorphin in examined patients can be one of etiopathogenetic factors of silent myocardial ischaemia.

[Levels of endothelins in plasma of patients with variant angina]. / Stezenie endoteliny w surowicy chorych na dusznice bolesna spontaniczna.

One of the causes of artery spasm in patients with the variant angina could be disordered interaction between the vasodilating action of endothelial derived relaxing factor and vasospastic action of endothelin. The aim of this study is to see whether endothelin participates in etiopathogenesis of the coronary artery spasms in patients with variant angina. The survey was made in 39 patients with variant angina with or without history of myocardial infarction. The control group consisted of 26 patients with chronic stable angina pectoris and 20 healthy persons of the same age and sex as patients with variant angina. One hour before examination a venous catheter had been inserted. Then Tris (pH = 10.5) was given by 5 minutes intravenous infusion followed by hyperventilation, during which the person under test was breathing for 5 minutes with a frequency of 40/min. Endothelin 1 and 2 plasma level was determined immediately before the hyperventilation test, immediately after the termination of the test and 6 minutes later. The appearing of coronary artery spasm was detected on continuous electrocardiographic monitoring. Endothelin 1 and 2 level in plasma was determined with radioimmunologic method ("Endothelin 1.2 high sensitivity (125I) assay system" manufactured in Amersham). The study showed clinical and electrocardiographic symptoms of coronary artery spasm after hyperventilation and Tris buffer infusion in all 39 patients with variant angina--but neither in those with chronic stable angina pectoris nor in healthy persons. Patients with variant angina had higher plasma endothelin 1 and 2 levels after hyperventilation and Tris infusion than those with chronic stable angina pectoris.(ABSTRACT TRUNCATED AT 250 WORDS)

[Activity of transmembrane calcium transport and levels of endothelin-1 in patients with variant angina]. / Aktywnosc przezblonowego transportu jonów wapnia i stezenie endoteliny-1 u chorych na dusznice bolesna spontaniczna.

Recent studies showed that coronary artery spasm may be due to disturbances of secretory and excretory endothelial activity in atherosclerotic coronary artery. However, this theory does not explain the reasons of coronary artery spasm when endothelium is not damaged. There must be other patomechanisms of coronary artery spasm. The aim of our study was examination of calcium efflux through the lymphocytic cell membrane and determination of endothelin-1 plasma levels in patients with variant angina in order to define the participation of these factors in pathogenesis of coronary artery spasm. The survey was made in 76 patients with ischaemic heart disease. All patients were divided into 2 groups. The first group consisted of 48 patients with variant angina (d.b.s.), the other consisted of 28 patients with stable angina (d.b.w.). The control group (g.k.) was composed of 25 healthy people. Patients were administered 100 ml of trometamol (TRIS, pH = 10.5) intravenously for 5 minutes. After stopping the infusion the examined patient was breathing deeply for 5 minutes at a rate of 40/min. The endothelin-1 (ET-1) plasma levels and transmembrane calcium transport in lymphocytes were determined before and just after the hyperventilation test, as well as 10 minutes after the test. ET-1 plasma concentrations were estimated with a radioimmunologic assay. The method of estimation of transmembrane calcium transport was elaborated in Laboratory of Department of Cardiology of Medical University of Wroclaw. We showed that ET-1 plasma levels and transmembrane calcium transport in patients with d.b.s. before the test were normal. There was an increase in transmembrane calcium efflux in patients with d.b.s. during coronary artery spasm that had been caused by ET-1. ET-1 plasma levels were still high 10 min. after the coronary artery spasm. Disturbances of transmembrane calcium transport and increased endothelin-1 plasma level may be the primary factors responsible for coronary artery spasm.