Effect of coronary collateral circulation on exercise stress test.

In this study, patients who have recovery-only ST segment depression in exercise stress test were chosen. It is proposed that coronary collateral circulation could improve with stress-increased coronary perfusion, and accordingly, patients with recovery-only ST segment depression were evaluated by coronary angiography for grading the coronary collateral circulation. Twenty-one men and five women were assigned to the study group. Sixteen men and two women who had exercise-induced ST segment depression were assigned to the control group. Age and gender of both groups were not statistically different (p>0.05). The reason for terminating the exercise stress test was chest pain in two of 26 patients in the study group versus 15 of 18 in the control group (p<0.001). In both groups coronary collateral frequency and grade were directly correlated with the severity of the coronary artery disease (p<0.001 in the study group, and p<0.05 in the control group). When both groups were compared for the frequency of significant coronary collateral circulation, 14 of 26 patients in the study group versus 4 of 18 patients in the control group had significant coronary collateral circulation (p=0.035). The authors conclude that recovery-only ST segment depression correlates well with the frequency of significant coronary collateral circulation, and coronary collaterals may prevent myocardial ischemia during exercise.

Relationship of ambulatory blood pressure monitoring data to echocardiographic findings in haemodialysis patients.

BACKGROUND: The present study was performed to assess the value of ambulatory blood pressure monitoring (ABPM) in determining the adequacy of blood pressure (BP) control, and its relationship to echocardiographic findings in haemodialysis (HD) patients. METHODS: We studied 40 non-diabetic adult patients who had been on regular HD treatment for a median duration of 43 months. Twenty-four-hour ABPM was performed using a non-invasive ABP monitor (Pressurescan, ERKA). Casual BP (cBP) was defined as the average of two measurements obtained at two HD sessions, one preceding and one following the ABP recordings, and was calculated for both the predialysis and postdialysis phases. Two-dimensional and M-mode echocardiography were performed in each patient to determine interventricular septal thickness (IVS), left ventricular posterior wall thickness (LVPW), left ventricular fractional shortening (FS), and left ventricular mass index (LVMI). RESULTS: According to average 24-h BP levels, 50% of the patients had systolic hypertension (HT) (> 139 mmHg), and 72.5% had diastolic HT (> 87 mmHg), while only 25% had been diagnosed as HT by cBP measurements (P < 0.01 and P < 0.0001 respectively). Diurnal variation in BP was not present in about 80% of the patients. Echocardiography was normal in only four patients (10%). LVMI and LV wall thickness were correlated to ABPM data better than to cBP measurements. Using stepwise linear regression analysis, LVMI and IVS were positively correlated with systolic BP load (P < 0.0001 and P = 0.0001 respectively), and LVPW was positively correlated with night-time systolic BP level (P < 0.001). CONCLUSIONS: ABPM is necessary to assess the adequacy of BP control, and is well correlated to end-organ damage of HT in HD patients.

Percutaneous endoscopic gastrostomy in elderly patients.

Percutaneous endoscopic gastrostomy (PEG) was performed on 28 elderly patients (mean age 82 years) who were dysphagic and intolerant of naso-gastric feeding. Twenty-six patients were recovering from a stroke; the interval between the onset of stroke and PEG averaged 63 days. The procedure was successful and well tolerated by all patients. Nineteen (68%) still had a functioning PEG a median of 14 weeks after placement. One patient whose swallowing recovered had the tube removed 6 months after its insertion. Seven patients (25%) subsequently died from their underlying disease, a mean of 92 days following PEG. There was one procedure-related death from peritonitis. PEG is a useful alternative to surgical gastrostomy in selected elderly patients with dysphagia who are intolerant of naso-gastric feeding.

Early morning hyperglycaemia "dawn phenomenon" in non-insulin dependent diabetes mellitus (NIDDM): effects of cortisol suppression by metyrapone.

To assess the effect of metyrapone on the early morning plasma glucose (PG) rise, seven NIDDM patients were studied from 2400 to 0900 h on two separate occasions one week apart. During the control study nights, patients received conventional therapy only (diet plus sulphonylurea) whereas on treatment nights, patients received in addition 30 mg/kg metyrapone orally at 2400 h. The plasma glucose (PG) levels from 0530 to 0900 h were significantly higher during the control night than the corresponding values following metyrapone. The control mean PG concentrations increased continuously from a nadir 8.4 +/- 1.1 mmol/l at 0400 h to a maximum of 9.4 +/- 1.1 mmol/l at 0800 h (p less than 0.01). In contrast following metyrapone administration a continuous decline in the PG concentration was noted from 2400 to 0800 h. The plasma glucose levels fell from 9.0 +/- 1.2 at 0400 h to 7.7 +/- 1.0 mmol/l at 0800 h (p less than 0.05). The mean overnight cortisol levels were 167.2 +/- 13.2 and 55.9 +/- 6.4 nmol/l (p less than 0.001) during the control and treatment studies, respectively. The cortisol levels were significantly higher during the control study at all time points from 0400 to 0900 h. No significant changes in insulin, C-peptide, glucagon, GH or catecholamine levels were observed between the two study periods. We conclude that the physiologic early morning rise in plasma cortisol possibly contributes to the pathogenesis of the dawn phenomenon in NIDDM patients.