[Effect of fructose-1,6-diphosphate on myocardial purin and pyrimidin metabolism during coronary artery bypass grafting surgery]. / A fruktóz-1,6-difoszfát hatása a szívizom purinés pirimidin-metabolizmusára koszorúérmútét közben.

During ischaemia, the glycolytic pathway (Embden-Meyerhof) is up regulated in an attempt to produce ATP anaerobically. However, this is short-lived due to negative feedback on the key glycolytic enzyme phosphofructokinase by accumulating lactate. Fructose-1,6-diphosphate (FDP), a high energy intermediary metabolite of this pathway, is unique in that is enters glycolysis distal to this inhibitory site. Exogenously administered FDP should therefore theoretically yield ATP independent of lactate accumulation and thereby ameliorate ischaemic injury. Clinical benefit has been shown in coronary artery bypass grafting (CABG) surgery, congestive cardiac failure and adult respiratory distress syndrome. Ischaemia-reperfusion injury induced by cardiopulmonary bypass (CPB) presents clinically as an impairment of myocardial function in the postoperative period. At a cellular level this reflects myocardial metabolic changes and nucleotide degradation (directly linked to high energy phosphate turnover). Quantification of myocardial nucleotide catabolite release therefore provides useful information regarding intermediary metabolism and cytoprotection conferred to myocardial (inosine, uridine) and endothelial (hypoxanthine) tissue. The authors investigated the myocardial cytoprotective effects of FDP in 16 patients scheduled for elective CABG surgery. Aortic and coronary sinus blood were collected directly into liquid nitrogen and analysed by high performance liquid chromatography prior to CPB and at different time points after reperfusion. FDP was administered intravenously in 8 patients and 5% dextrose was administered in 8 other patients. Analysis of transmyocardial (coronary sinus-aortic) nucleotide metabolite levels showed increased release of inosine, hypoxanthine and uridine in both the FDP and the control groups following reperfusion. However, compared to baseline (pre-aortic clamping) values, hypoxanthine and inosine concentrations were significantly elevated at 0, 1, 5 and 10 minutes following reperfusion in the control group. This was in contrast to earlier recovery to baseline levels (after 5 minutes of reperfusion) in the FDP group. Furthermore, when compared to control group, the hypoxanthine and inosine concentrations were significantly decreased by FDP treatment. Uridine concentrations were significantly elevated at 1 and 5 minutes in the control group and no significant change was observed in the FDP group. In conclusion, these data suggest that FDP, through an intermediary metabolic effect, may contribute to myocardial and endothelial cytoprotection during the ischaemic insult of cardiac surgery.

[Inflammatory markers after surgical treatment of esophageal tumors]. / Gyulladásos markerek szintjének vizsgálata tumor miatti nyelócsómútétek után.

Oesophagectomies carry the risk of postoperative sepsis and mortality. The aim of this study was to evaluate the course of microalbuminuria, serum procalcitonin and C-reactive protein levels following oesophagectomies. Twenty one patients undergoing elective oesophagectomy were studied. Serum procalcitonin and C-reactive protein levels were determined on arrival on the intensive care unit (t0) and then daily (t24, t48, t72). Microalbuminuria (expressed as urine albumin:creatinine ratio, mg/mmol) was measured before (tpre), and after surgery (t0, t6, t24, t48, t72). For statistical analysis Wilcoxon test was used. The clinical course of the patients studied was uneventful during the first 72 hours as monitored by daily Multiple Organ Dysfunction Scores. Preoperative microalbuminuria levels were normal (< 10 mg/mmol). Levels at t0 increased significantly but then (t6-24) they returned to normal. Serum procalcitonin (normal: < 0.5 ng/ml) at t0 was slightly elevated and by t24 it increased significantly (median: 2.7 ng/ml, p < 0.05) and remained high for the rest of the study: t48-72. C-reactive protein was normal at t0 (< 10 mg/l) and by t24 it increased dramatically (up to 10-20 times to the normal value) until t48. At t72 it decreased, but still remained in the abnormal range. This study found, that the surgical insult resulted a significant increase in microalbuminuria, serum procalcitonin and C-reactive protein levels. However, the changes were not accompanied by the clinical signs of sepsis or multiple organ dysfunction in the early postoperative period following oesophagectomies.

Leukocyte flotation during gravity sedimentation of the whole blood.

The original Westergren blood sedimentation technique was modified to assess leukocyte sedimentation properties. The relative change of leukocyte and erythrocyte counts was measured in the upper half section of blood column in vertically positioned sedimentation tubes in 10-minute-intervals for 60 minutes. During the first 20 minutes of gravity sedimentation, the leukocytes taken from critically ill patients showed upward flotation, however, healthy individuals' leukocytes demonstrated slight sedimentation. The upward flotation rate of leukocytes seemed less dependent on erythrocyte sedimentation during the first 15 minutes of sedimentation time than after it. Based on this observation, the sedimentation properties of leukocytes were characterized by the leukocyte antisedimentation rate taken at the 15th minute of sedimentation time (LAR15). Erythrocyte aggregability index, plasma fibrinogen concentration and native leukocyte count did not correlate to LAR15 in healthy volunteers (n = 25). However, LAR15 was correlated to leukocyte adherence (p < 0.01), to whole blood viscosity (p < 0.05), to hematocrit (p < 0.05) and to the conventional erythrocyte sedimentation rate (p < 0.05).

[Dipyridamole test in the early detection of cerebrovascular disorders?]. / Dipyridamol-teszt az agyi keringészavarok korai felismerésében?

The diagnosis of transient ischaemic attack (TIA) is mainly based on the clinical symptoms presented by the patient. Professionals in nuclear medicine have made a successful attempt to detect TIA by single photon emission tomography (SPECT) imaging. Improved sensitivity of the examination using stress test (e.g. acetazolamide) is well known in the literature. The dipyridamole stress test combined with SPECT imaging was regularly performed in patients (n = 100) with ischaemic heart disease. After injecting dipyridamole intravenously it found various forms of transient neurological deficits in 23% of the patients with considerably higher incidence reported previously in the literature (1.22/10,000). The so called "TIA positive" patients were examined further using the combination of dipyridamole stress test and brain SPECT imaging. The aim of this study was to analyse the relationship between transient neurological symptoms provoked by DPD test and the change in regional cerebral blood flow indicated by brain SPECT imaging. It is emphasized, that perfusion abnormalities revealed by brain SPECT were topographically consistent with the neurological deficits. In this article the attention was drawn to advantages of this test which may be suitable to provoke TIA safely. Combined with brain SPECT it may have an important role in the neurologic diagnostic procedures and in the prevention of stroke.

[Comparative study of verapamil and bisoprolol in the secondary prevention of myocardial infarction]. / A verapamil és bisoprolol összehasonlító vizsgálata szívinfarktuson átesett betegek szekunder prevenciójában.

The effect of Ca-antagonist, long-acting verapamil and the selective beta-1 blocking bisoprolol were investigated and compared in the secondary prevention after myocardial infarction. Eighty-seven patients were enrolled, 27 patients were not included because of the exclusion criteria, 30 patients were treated with verapamil and 30 patients with bisoprolol. During the 540 days of follow up period treadmill ergometry and dobutamine stress-test with SPECT investigation were performed two times. Both clinically and the data of our investigations the effect of the two drugs in the secondary prevention was good, and even at the 540th day the protective effect was still excellent.

[Leukocyte migration during erythrocyte sedimentation]. / Leukocyták mozgása vörösvértest-süllyedés folyamán.

Sedimentation properties of leukocytes was measured with a new, simple and reproducible method. The increment of leukocyte concentration was determined in the upper 100 mm section of the sedimentation blood column after one hour gravity sedimentation of the whole blood. The result (leukocyte antisedimentation rate, LAR) was expressed in percentage of the original, presedimentation leukocyte concentration. Blood samples taken from 35 healthy adults were investigated and 12.5% and 17.4% increments were found in total leukocyte count and in granulocyte concentration respectively in the upper half of the sedimentation blood column. The mean coefficient of variation of LAR measurements was 3.2% LAR was found significantly higher in a mixed group of patients than in healthy controls. The sedimentation properties of leukocytes were in significant correlation with leukocyte adherence (p < 0.01), with whole blood viscosity, hematocrit, and erythrocyte sedimentation rate (each p < 0.05) when blood samples of healthy individuals and postoperative intensive care patients were analysed in combination. In vitro pre-treatment of patients' blood samples with prednisolone and lidocaine resulted in a significant diminishment of LAR in a concentration dependent manner.

[Lifesaving thrombolysis--in the light of contraindications]. / Eletmentö thrombolysis--a kontraindikációk tükrében.

The authors review the different methodological suggestions concerning thrombolysis, especially from the aspects of the absolute and relative contraindications of the treatment. They present case reports to prove that in patients with life threatening thromboembolic diseases some points of contraindications may be disregarded. They suggest a new strategy of absolute and relative contraindications be made considering the currently available recently introduced thrombolytic therapy.

[Analysis of costs of drug therapy in patients with acute respiratory insufficiency]. / Az akut légzési elégtelenség kezelésének gyógyszerköltség-elemzése.

In a retrospective study, the authors analysed the clinical data of 38 patients who were admitted to a surgical intensive care unit (SICU) for mechanical ventilation lasted for at least 72 hours. The APACHE III score was calculated on the basis of clinical data documented during the first 24 hour of the treatment and the cost of drug administrations per patients per day was also determined by analysing all the drugs prescribed on the first 5 days of intensive care. The patients admitted to SICU with polytrauma or with abdominal septic focus required significantly higher cost of drug treatment than the patients after cardiopulmonary resuscitation or with bronchial asthma or pneumonia. The APACHE III score of the patients died at the SICU was significantly higher compared to the survivors who needed more expensive drug therapy than the non-survivors required. Antibiotic treatment, blood transfusions, and human plasma proteins caused the highest drug expenditure. There was no significant correlation between the APACHE III score and the cost of drug treatment.

[Complications from physiological and rate responsive pacemaker implantations]. / Fiziológiás és frekvenciaválaszos pacemaker implantációk szövödményei.

One hundred eighteen surgical complications of 209 patients underwent 249 physiological and rate responsive pacemaker implantations are discussed. In 27.9% of total complications represented the dislodgement of atrial leads occurred particularly in the early period of the observation time which decreased significantly later in the second period of the survey. This high complication rate of bifocal pacemakers was found due to a high incidence of the generator preerosion beside the dislodgment of the atrial electrodes. Complication rate could be reduced by the improvement of surgical technics, and with the implantations of new types of leads and smaller generators, however the number of complications remained higher compared to the pacemaker systems with one lead. The implantation procedure of ventricular rate responsive pacemakers is simple, and significant improvement in working capacity could be observed by the restoration of the chronotropic capacity during exercise. Physiological and atrial rate responsive pacemakers provide many advantages in the hemodynamic state even at rest which exceed all disadvantage of the expected complications, which might occur.

Altered filtrability of white blood cells after myocardial infarction.

Abnormal white blood cell rheological behaviour has been implicated as a cause of blood flow disturbances under conditions of ischaemia and reduced perfusion pressure. Accordingly, we have tested the mechanical properties of white cells following myocardial infarction by measuring the rate at which suspension of these cells cause plugging of Nuclepore filters. The number of clogging particles in a standard white cell suspension increased by the third day after infarction but subsequently decreased to the control levels. Since white cells can cause blockage of narrow blood vessels, it is assumed that such changes in cellular properties may influence the eventual extent of infarction.

A new simplified assay for evaluation of motile activity of human polymorphonuclear leucocytes.

We studied the adaptation of a filtration instrument to an assay for cell migration experiments. The commercially available Nuclepore filter holders were modified so that isolated human polymorphonuclear leucocytes (PMNs) were allowed to penetrate a porous filter membrane and to enter a compartment under the membrane. The total number of PMNs which had passed the pores during an hour of incubation could be counted. In this way we carried out experiments using Shigella sonnei lipopolysaccharide and dilutions of E. coli culture supernatant as chemoattractants for healthy human PMNs. These studies showed that the method can distinguish between random and directed movements of PMNs and it is sensitive to the concentrations of chemoattractant. Furthermore, the data obtained using PMNs from the same subject on different days seem to be comparable.

Impaired metabolic activity of phagocytic cells after anaesthesia and surgery.

Peripheral blood leucocytes and their phagocytosis-associated metabolic activity were studied in 65 patients after elective surgery representing similar degrees of surgical trauma. Halothane (group A) or neurolept (group B) anaesthesia were given to 50 patients. Fifteen patients had extradural blockade only (group C). Leucocytosis was observed immediately after surgery in group B: patients in groups A and C responded more slowly. The higher 2nd-day values were followed by a decrease in leucocyte numbers on the 5th day. Although patients in groups A and B showed immediate decreases in nitroblue tetrazolium reduction, recovery was noted only in group B on the 5th day after operation. It is postulated that leucocytes with damaged membranes and receptors are probably lacking in the necessary functional integrity to fight invading microorganisms.

Ftorafur therapy in acute pancreatitis.

The authors tested Ftorafur (N1-2'-furanidyl-5-fluorouracyl) in patients with acute pancreatitis on the basis of experimental and clinical data. The daily dosage was 200 mg (3-4 mg/kg body weight). In the course of treatment the serum and urine levels of amylase and the changes in WBC were studied. The results were compared to that obtained in patients with acute pancreatitis but were not given Ftorafur. Urine amylase levels decreased significantly in response to Ftorafur treatment over three days. The decrease of serum amylase levels and WBC was not significant in either group. The advantages of Ftorafur treatment are as follows: levels of amylase in serum and urine are normalized earlier, the duration of treatment, hence costs are decreased, Ftorafur produced a cytoprotective effect due to the inhibition of protein synthesis in the pancreas.