The effects of baclofen on the feeding behaviour and body weight of vagally stimulated rats.

UNLABELLED: It is hypothesised that the GABA(B) receptor agonist baclofen increases or has no effect on food intake, and electrical stimulation of vagal nerves decreases food intake. The aim of this study was to evaluate the effects of baclofen in vagally stimulated rats. MATERIAL AND METHODS: Thirty two Wistar rats were divided into five groups: group A scheduled for microchip implantation for vagal stimulation, group B for sham operation, group C for microchip implantation and baclofen medication, group D for baclofen medication only and group E for gastric motility evaluation under influence of baclofen. The following parameters were then evaluated: food intake and body mass, gastric motility, leptin, insulin, and glucose serum levels. RESULTS: In the comparison of groups B and A, daily food intake and body weight gain decreased by 17% (p<0.05) and by 22% (p<0.05), respectively. Baclofen alone (group D) did not significantly change either food intake nor diurnal body weight compared to the controls, but when used in conjunction with the microchip (group C) it did significantly reduce effect of vagal neuromodulation (p<0.05). Furthermore, a significant decrease in leptin and glucose levels was detected in group C: 677 to 165 pg/ml (p<0.05) and 5,93 to 4,88 mmol/l (p<0.05), respectively. The administration of baclofen stimulated significantly gastric motility and elicited irregular motor migrating complex (327+/-200 against control 255+/-52 cmH2O/s). CONCLUSIONS: These results suggest that microchip vagal neuromodulation through increased vagal afferent activity induces an alteration in the feeding behaviour and decreases nocturnal food intake and body weight. These effects were partially attenuated by baclofen. The data suggests that GABA(B) receptors play an important role in the pathomechanism of attenuation of food intake induced by vagal nerve stimulation.

The effect of transcutaneous nerve stimulation (TENS) on gastric electrical activity.

UNLABELLED: TENS became widely accepted method of treatment pain syndromes in clinical practice. Lately has been shown that its affects also gastrointestinal tract by releasing NANC neurotransmitter VIP. The aim of this study was to evaluate the effects of TENS on gastric myoelectric activities measured by electrogastrography (EGG). Eighteen healthy men (mean age 23 +/- 1.7) were included in the study. Healthy volunteers were divided on 3 groups each 6 persons: with normogastria occurring at 94.5 +/- 7% of recording time--group A, with predominant bradygastria (36.6 +/- 14%)--group B and with tachygastria (33 +/- 14%)--group C. In fasted condition EGG (Synectics, Sweden) was recorded with skin electrodes. TENS 15 min was performed with use of Sinus 5 stimulator (6 Hz, 0.1 ms duration, intensities 10-20 mA, Zimmer, Germany). Stimulating electrodes were placed on non-dominant hand. RESULTS: None of the subjects during TENS reported any side effects or symptoms, during the all studies. In group A in the fasting recordings, after TENS, an decrease of the normal values in the range 2-4 cpm down to 78.5 +/- 21% of recording time (p = 0.03) occurred. The dominant frequency in the bradygastric region increased up to 17.7 +/- 7% of the total recording. In group B TENS decreased bradygastria level from 36.6 +/- 14% to 20.6 +/- 15% (p = 0.02). TENS did not significantly affect tachygastria in group C. Amplitude of the EGG signal after TENS in group B and C increased by 40 and 150% respectively (p < 0.05). Significant decrease of the amplitude was observed in group A (13%). We conclude that TENS by activating centrally mediated somato-visceral reflexes affects gastric electrical activity. Our results suggest that TENS may be useful in treatment of the gastric dysrhythmia.

Pregnancy in patients with heart disease.

PURPOSE: The study was carried out to ascertain the experience of pregnant women with cardiac disease in one referral center. METHODS: From 1986 to 2004, 242 pregnant women with heart disease were followed by the same obstetrical and cardiology center. The cardiac diagnosis was additionally confirmed with echocardiography and heart catheterization during cardiosurgery. The subjects were classified into groups with respect to the congenital heart abnormality type, and cardiovascular insufficiency according to the NYHA classification. The results from the evaluated groups were compared to a control group. RESULTS: A significant increase in percentage of congenital heart disease was found, however acquired cardiac defects prevailed. A significant increase in rate of congenital heart disease was found. A higher incidence of cesarean sections in women with underlying heart disease with respect to the control group was also found. CONCLUSIONS: In pregnant women with underlying heart disease, congenital heart disease is presently more frequent than acquired heart disease compared to the situation in the beginning of the analysis. Pregnancy duration time depends on cardiac sufficiency and it is statistically shorter in NYHA class III and IV patients.

[The degree of functional circulatory failure according to NYHA classification and the state of hemodynamic disorders in constrictive pericarditis]. / Stopien czynnosciowej "niewydolnosci krazenia" wg klasyfikacji NYHA a stan zaburzen hemodynamiki w zaciskajacym zapaleniu osierdzia.

Selected indices of left and right ventricular function and pulmonary circulation have been compared in two groups of patients with constrictive pericarditis: i.e. in 10 patients classified as NYHA functional class II and 13 patients as NYHA class III. The patients with NYHA class III showed higher average values of left ventricular end-diastolic pressure (mean + 19.4 vs 11.4 mm Hg) and right ventricular end-diastolic pressure (mean + 17.3 vs 9.5 mm Hg) as well as pulmonary systolic (mean + 39.5 vs 24.5 mm Hg) and diastolic pressure (mean + 20.6 vs 9.9 mm Hg). Mean total pulmonary resistance and left and right ventricular stiffness indices were slightly higher whereas cardiac index was slightly lower. Complaints of patients with constrictive pericarditis, fatigability and dyspnea are to a large extent determined by the level of end-diastolic pressure in both ventricles and pulmonary hypertension that is by similar direct mechanism as in congestive heart failure.

[Vascular endothelium--function, disorders and clinical modification probes]. / Sródblonek naczyniowy--funkcje, ich zaburzenie oraz kliniczne próby modyfikacji.

According to contemporary views, the endothelium is not only a barrier separating blood from surrounding tissues, but a dynamic, heterogeneous organ, which possesses many secretory, metabolic and immunologic functions. Endothelial cells produce mediators, which regulate blood flow, influence platelet adhesion and aggregation, coagulation and fibrinolysis and also immunological response. Endothelial dysfunction is defined as an imbalance between vascular relaxing and contracting factors, between procoagulant and anticoagulant mediators or growth-inhibiting and growth-promoting substances. The definition is often confined to dysfunction of the vessel wall tonus control. The endothelial dysfunction frequently proceeds structural changes in vessels, as e.g. atherosclerotic plaque formation, neointima formation and vessel wall remodelling. This dysfunction has been confirmed in systemic hypertension, atherosclerosis, cardiac syndrome X, heart failure, using various invasive and non-invasive techniques. There are pharmacologic and non-pharmacologic methods to modify endothelial functions. It is obligatory to reduce risk factors of atherosclerosis, which lead to endothelial cell damage, i.e. hypertension, hyperlipidemia, cigarette smoking, estrogen deficiency and elevated levels of homocysteine. The role of physical exercise, low-cholesterol diet, discontinuation of smoking is emphasised. Among drugs statins, angiotensin-converting enzyme inhibitors and hormone replacement therapy are considered particularly beneficial. The importance of angiotensin receptor antagonists, endothelin receptor antagonists, L-arginine, growth factors and calcium-channel blockers for the improvement of endothelial function is studied.

The effect of the year angiotensin-converting enzyme inhibitors (ACE I) intake on circadian heart rate variability in patients with primary hypertension.

INTRODUCTION: The autonomic nervous system (ANS) disturbances have been considered as one of the important factors in development of essential hypertension. However information about the effect of antyhypertensive treatment (angiotensin-converting enzyme inhibitors--ACEI) on cardiac ANS activity is ccscarce. AIM: The purpose of the study was to evaluate the HRV circadian changes in patients with essential hypertension, treated with ACEI throughout the period of one year. METHODS: Ten patients with essential hypertension, aged 26 to 64 years (mean 54.3 +/- 12.3) and 10 healthy volunteers, matched for age and gender were qualified for the investigation. Twenty four-hour arterial blood pressure measurements with simultaneous ECG monitoring were conducted in both mentioned groups. The hypertensive patients were examined before and after 1 year of ACE inhibitor (enalapril) intake. HRV analysis was carried out by the fast Fourier transformation (FFT). The time and spectral parameters were compared in 8 examined subjects characteristic for dippers, in time periods of day (6 a.m.-10 p.m.) and night (10 p.m.-6 a.m.). RESULTS: The results obtained before the treatment, likewise in control group, presented night's increases of RMSSD (p < 0.05), pNN50 (NS, p > 0.05), VLF, LF (p < 0.05) and HF (NS) mean values with a decrease of LF/HF ratio (p < 0.05). Similar tendencies in the cardiac ANS activity were observed after 1 year of the enalapril intake. A comparison of day's HRV before and after one year of the ACE inhibition presented the increase in values of the parasympathetic system reflecting parameters: RMSSD, pNN50 (p = 0.01) and HF (NS) with a decrease of LF/HF ratio (p < 0.01). The evaluation of the night's HRV parameters presented the increase of HF mean value (p < 0.05), without any other significant changes between the trials. CONCLUSIONS: After 1-year of ACE inhibitor administration the only improvement of the day's parasympathetic activity was observed. The night's vagal activity suggested as one of the essential factor in development of hypertension remained unchanged in patients qualified into "dippers" hypertension group.

[The effect of aging on the activity of the autonomic nervous system in long distance runners]. / Wplyw starzenia sie na aktywnosc autonomicznego ukladu nerwowego u biegaczy dlugodystansowych.

The aim of the study was to evaluate the effect of endurance physical training on the autonomic function in runners. The study was performed on 20 long distance runners, divided into two groups. The first group of runners contained 12 young men of age of 20-24 years (age 21.75 +/- 1.4 years: mean S.D.--standard deviation). Into the second group 9 experienced runners, who practice long distance running for over 40 years, were qualified. The mean age of those runners was 52.9 +/- 7.2 years. Moreover two control groups, matched for age and gender were recruited. One of them was made up of 12 healthy volunteers (age 21.6 +/- 1.23 years), the second contained 9 men (age 52.9 +/- 7.2 years). In this study, the measurement of the cardiac autonomic nervous system, using the HRV computer assisted programme (Proster, Poland), was performed. The characteristics of the HRV (heart rate variability) were estimated. We have observed, that the RR intervals in runners were longer than in healthy volunteers (1033.5 +/- 185.4 ms vs. 888.1 +/- 115.3 ms. p < 0.01). We have observed a tendency towards increasing of the RR intervals with the increase of age, of the tested person, as well. A reverse tendency, a shortening of the RR intervals with ageing, was observed in the control groups. The standard deviation of the RR intervals in runners was higher than in the control group (p < 0.05). In the young runners we noticed the prevalence of parasympathetic activity, expressed by the HF (high frequency) spectra (875.7 ms2 vs. 816.7 ms2) in comparison with the healthy individuals. In the old runners the prevalence of sympathetic activity, expressed by LF (low frequency) spectra (1088.75 ms2 vs. 220.1 ms2, p < 0.05) and parasympathetic activity (920.38 ms2 vs. 294.25 ms2) in comparison with the control group, was observed. It was expressed by the increase of the LF/HF ratio (0.75 vs. 2.1). The results of our study indicate, that the autonomic, particularly sympathetic, activity in sportsmen is not affected by ageing up to the sixth decade of life.

[The influence of aging on autonomic nervous system activity and gastric myoelectric activity in humans]. / Wplyw procesu starzenia na aktywnosc ukladu autonomicznego i mioelektryczna zoladka u ludzi.

The study was performed on 84 healthy volunteers (33 women, 52 men) of age 20-71 years with no history of the circulatory or gastrointestinal system disease. The gastric myoelectrical activity (EGG) was recorded with the cutaneous electrodes--electrogastrography Synectics (Sweden). The activity of the cardiac autonomic nervous system was measured by HRV (heart rate variability) recorded with EGG and computer assisted programme Proster (Poland). Subject were divided into 5 groups according to the decade of age (20-70). Percentage of basal electrical rhythm (BER) dysrhythmias increased (1.9 +/- 0.5% vs 21.1 +/- 3.2% in fasting and 2.4 +/- 1.2% vs 24.6 +/- 5% postprandially but decrease of the EGG amplitude after the meal was observed (270 +/- 20% vs 90 +/- 7%) in youngest and oldest group respectively. With the ageing the cardiac sympathetic and parasympathetic activity (LF and HF) decreased in first and last group respectively. In the forth decade in man and women the sympathetic activity system prevalence expressed by the LF/HF rate increased (1.09 +/- 0.2 vs. 2.14 +/- 0.5) (p < 0.05). The results of our study suggest the deleterious influence of the ageing on the of autonomic system activity as shown by changes in HRV and dysrhythmia of the gastric slow waves in EGG.

[The effect of chronic alcohol use on heart rate variability]. / Wplyw przewleklego spozycia alkoholu na zmiennosc rytmu zatokowego serca.

A long lasting alcohol intake causes, amongst numerous systemic damages, also the autonomic nervous system (ANS) dysfunction, which causes the autonomic heart rate regulation disorders. The aim of the study was to evaluate the autonomic regulation of the circulation in chronic alcoholism. Seventeen alcoholics, 24-55 years of age (mean 43 +/- 5.2 years) were examined. They have been abstainers for 2-6 years. The cardiac ANS function was evaluated using the HRV measurement. The HRV was registered using V6 EKG lead. The recording was performed through the 15 min of resting conditions and 5 min of the deep breathing test. A group containing healthy volunteers, matched for age and gender, for the comparison of the HRV results was recruited. In the examined group, during the resting conditions, the significant RR period changes weren't observed (999.7 +/- 139.2 vs. 967 +/- 144.9; p > 0.05). The nonsignificant lower values of the spectral analysis parameters of HRV: LF (954.1 +/- 1162.6 vs. 1456.4 +/- 1327.1; p > 0.05) and HF (676.4 +/- 414.2 vs. 1557 +/- 1854.4; p > 0.05) and LF/HF ratio (1.5 +/- 1.14 vs. 1.38 +/- 1.28; p > 0.05) were also noticed. In response to the DB test, the mean value of the RR period wasn't significantly changed (921.4 +/- 152.3 vs. 930.6 +/- 137.8; p > 0.05). In DB test the significant decrease of LF (3465.8 +/- 2750.1 vs. 11558.6 +/- 7902.5; p < 0.001) and HF (406.1 +/- 366.8 vs. 1665 +/- 1757.1; p < 0.01) was observed. No significant change of LF/HF mean ratio (11.6 +/- 6.97 vs. 14.7 +/- 11.6; p > 0.05) was noticed. The results of our study indicate on the maintenance of the HRV disorders in chronic alcoholics, during the abstinence.

[Current views concerning the significance of obesity]. / Wspólczesne poglady na temat znaczenia otylosci.

The article presents a new view on relations between obesity and ischaemic heart disease. The place of obesity among cardiovascular risk factors has been specified. Definition of obesity, methods of its diagnosis, its etiopathogenesis and therapeutic approach to it (according to statement of AHA) have been discussed.

[Circadian rhythm of autonomic heart activity in patients with primary essential hypertension treated with angiotensin converting enzyme inhibitor]. / Cyklicznosc dobowa aktywnosci ukladu autonomicznego serca u chorych z pierwotnym nadcisnieniem tetniczym leczonych inhibitorem enzymu konwertujacego angiotensyne.

UNLABELLED: Although the immediate effects of angiotensin converting enzyme inhibitors (ACEI) on cardiac autonomic innervation have been extensively studied, little is known about circadian rhythm of heart rate variability (HRV) in these patients. The purpose of the present study was to investigate circadian changes of the autonomic activity in patients with essential hypertension treated with ACEI, which may play some role in the pathogenesis of hypertension. We studied 10 middle age patients with essential hypertension (treated with ACEI--enarenal at least 1 yr.) and 10 age, gender matched control subjects. Heart rate variability (HRV) was calculated from the 24-hr ambulatory electrocardiograms by the Fourier transformation. Power spectra were quantified at 0.003-0.04 Hz--very low frequency power (VLF), 0.04-0.15 Hz--low frequency power (LF) and 0.15-0.40 Hz--high frequency power (HF). The HF component and the ratio LF to HF were used as indices of the parasympathetic activity and balance between sympathetic and parasympathetic activities. RESULTS: The circadian rhythms of the LF, HF and LF/HF ratio differed significantly. In control group, LF, HF increased but LF/HF decreased (p < 0.05) at night, in hypertensive patients LF, HF increase was attenuated at night but LF/HF increased (p < 0.05). In control subjects when compared to hypertensive patients power spectrum HF was doubled at night. CONCLUSION: These findings suggest that in hypertension primary cardiac autonomic dysfunction might contribute to altered circadian rhythm leading to the development of cardiovascular diseases despite long term normalisation of high blood pressure.

[Pulmonary circulation in constrictive pericarditis]. / Krazenie plucne w zaciskajacym zapaleniu osierdzia.

Certain indices of pulmonary haemodynamics were determined at rest in 39 patients with constrictive pericarditis. The most frequent anomaly was raised value of total pulmonary resistance (in 82% of cases) and, in a lower percent, raised pulmonary vascular resistance. The systolic pressure in the pulmonary artery was raised in 30.8% of the patients, reaching values regarded as low or medium degree hypertension. In only 2 cases the systolic pressure in the pulmonary artery was 100 mm Hg or more. The systolic pressure in the pulmonary artery showed a slight positive correlation with the end-diastolic pressure in the left ventricle, and the subgroup with pulmonary hypertension had higher average values of the end-diastolic pressure in the left ventricle than patients with normal pressure in the pulmonary circulation (means = 21.0 +/- 5.7 vs 15.2 +/- 6.5 mm Hg). These results show a significant role of increased filling pressure of the left ventricle in the mechanism of pulmonary hypertension in patients with constrictive pericarditis.

Biochemical parameters of endothelial dysfunction in cardiological syndrome X.

UNLABELLED: The endothelial dysfunction in cardiological syndrome X has been studied mainly by invasive methods and by measuring vasoactive mediator (nitric oxide (NO), endothelin-1) levels. Other parameters evaluating this dysfunction (defined as an imbalance between vascular relaxing and contracting factors, between procoagulant and anticoagulant or growth-inhibiting and growth-promoting substances) have not been used. METHODS: Twenty-five non-diabetic patients (16 men, 9 women) with cardiological syndrome X and 10 healthy volunteers (5 men, 5 women) were examined. Biochemical parameters: ET-1, the end products of nitric oxide metabolism (NOx), VEGF, vWF, betaTG, tPA, PAI-1 were measured before and during an ECG exercise tolerance test. The blood concentrations of testosterone and estradiol in men and LH, FSH and estradiol in women were tested. RESULTS: A significantly lower basal concentration of NOx (p=0.01), lower basal NOx/ET-1 ratio (p<0.05) and higher levels of VEGF (p<0.05) were observed in patients with cardiological syndrome X. The male patients also had higher concentrations of estradiol (p<0.05). A significant decrease in tPA concentration and increase in betaTG was noticed during exercise, but with no differences between the study groups. CONCLUSIONS: Endothelial dysfunction in cardiological syndrome X manifests mainly in the regulation of vessel wall tonus. which was revealed by the decrease of NOx level and NOx/ET-1 ratio. VEGF elevation in syndrome X may result from chronic tissue ischaemia due to endothelial dysfunction. Exercise augments the prothrombotic activity of the blood, since a significant elevation in betaTG and decrease in tPA were observed after exercise.