Differentiation of the facio-vestibulocochlear ganglionic complex in human embryos of developmental stages 13-15.

A study was made on 18 embryos of developmental stages 13-15 (5(th) week). Serial sections made in horizontal, frontal, and sagittal planes were stained with routine histological methods and some of them were treated with silver. In embryos of stage 13, the otic vesicle is at the rhombomere 5, and close to the vesicle is the facial-vestibulocochlear ganglionic complex in which the geniculate, vestibular, and cochlear ganglion may be discerned. These ganglia are well demarcated in embryos of stage 14. In the last investigated stage (15(th)) the nerve fibres of the ganglia reach the common afferent tract.

Correlation of ST-segment depression during ambulatory electrocardiographic monitoring with myocardial perfusion and left ventricular function.

To assess the relation between silent ischemia and objective markers of ischemia we compared ambulatory electrocardiographic (AECG) monitoring, exercise stress testing, and technetium-99m methoxyisobutyl isonitrile single-photon emission computed tomography (SPECT) in 68 patients with coronary artery disease. ST-segment depression at AECG monitoring occurred in 40%, exercise testing was positive in 88%, and SPECT was abnormal in 98% of patients. Patients with ST-segment depression had a higher incidence of 3-vessel disease (70% vs 45%, p = 0.04), shorter duration of exercise (267 +/- 109 vs 416 +/- 167 seconds, p < 0.01), lower workload achieved (5.1 +/- 1.9 vs 7.6 +/- 2.8 METs, p < 0.0002), and a greater extent of ischemia at scintigraphy (p = 0.01). Patients with a total ischemic time of >30 minutes in a 24-hour period had a lower ejection fraction (48 +/- 21% vs 70 +/- 9%, p = 0.001), a higher perfusion index at rest (2.4 +/- 0.6 vs 1.6 +/- 0.6, p = 0.001), and a greater number of segments with fixed perfusion defects (4.1 +/- 3.7 vs 1.3 +/- 1.8, p = 0.02) in comparison with those who had a shorter ischemic time. We conclude that AECG monitoring fails to identify a substantial proportion of patients with objective markers of ischemia; however, ST-segment depression reflects more significant disease. Longer total ischemic time correlates with the area of myocardial damage but not with other markers of ischemia.

The cochlear ganglion in human embryos of developmental stages 18 and 19.

The cochlear ganglion was investigated in serially sectioned human embryos at developmental stages 18 and 19 (44-46 postovulatory days). During this period the cochlear ganglion is separated from the vestibular ganglion, and it is adjacent to the cochlear duct. In embryos of investigated stages fibers of the cochlear ganglion enter the nuclei in the brain.

Initiating sequences in exercise induced idiopathic ventricular tachycardia of left bundle branch-like morphology.

Initiating sequences for VT may infer the underlying arrhythmogenic mechanisms. This study examines the initiating sequences of exercise induced idiopathic VT of left bundle branch block-like (LBBB-like) morphology and makes an attempt to relate these to clinical aspects and the mechanisms of arrhythmia. Thirty-two patients (mean age 33.4 +/- 13.2 years; 18 men) with exercise induced VT in the absence of structural cardiac abnormality on history, clinical examination, and noninvasive and invasive investigations were divided into two groups on the basis of the initiating sequence of VT on exercise. Group I consisted of patients with long-short sequence of RR intervals prior to the onset of VT (initiating/preinitiating cycle length ratio < or = 0.78). Group II consisted of patients without changes in cycle length prior to VT. Group I mechanism would suggest delayed afterdepolarizations (DADs) or reentry whereas group II mechanism triggered activity due to early afterdepolarizations. Fourteen patients (group I) had long-short sequence and 18 patients (group II) were without cycle length changes prior to VT initiated during exercise. VT axis was inferior in all 18 patients in group II but only in 9 patients in group I (P = 0.02). In these predefined patient groups, sustained monomorphic VT could not be initiated by programmed stimulation in any patient in group I, whereas four patients in group II had inducible VT. Patients in group II also had higher incidence of sustained VT on ambulatory monitoring (P < 0.05). The two groups did not differ in other respects. This study demonstrates the existence of at least two possible mechanisms of initiation of exercise induced idiopathic VT of LBBB-like morphology. VT initiated without cycle length changes is more common, more likely to have an inferior axis suggesting an outflow tract origin, and is probably related to triggered activity secondary to DADs. VT initiated with a long-short sequence is more often nonsustained and may have a superior axis suggesting an origin from the body or septal region of the ventricle. The two groups, therefore, exhibit differences in electrophysiological characteristics that may aid classification and therapy of this arrhythmia.

Segmental pattern and nuclei in the human embryonic brain at stage 13.

Studies of serial sections and reconstructions of embryos at stage 13 (32) postovulatory days) revealed that the cranial neural tube in the investigated embryos possesses 15 neuromers: 1 telencephalic, 3 diencephalic, 3 mesencephalic, and 8 rhombencephalic. Within the primary efferent column all nuclei of the cranial nerves may be distinguished. Also fibers entering brain from cranial nerve ganglia form the common afferent tract. The relation of neuromers to the motor nuclei of the cranial nerves is following: M1-oculomotor, M2-trochlear, Rh2-trigeminal, Rh4-facial, Rh6-glossopharyngeal, Rh7-vagal, Rh8-hypoglossal.

99Tcm-sestamibi tomoscintigraphy at rest and after nitrate administration in predicting wall motion recovery after revascularization.

To evaluate whether nitroglycerin administered before the injection of sestamibi improves the detection of viable but hypoperfused myocardium, 41 post-infarction patients with left ventricular dysfunction underwent echocardiography and SPET at rest and after nitrate administration. In 25 revascularized patients, perfusion at rest and contractility were assessed 3-4 months after coronary artery bypass grafting. Perfusion (PI) and wall motion indices (WMI) were calculated for each revascularized area. There was a strong correlation between contractility and perfusion defect (r = 0.58, P < 0.0001). Nitrates significantly reduced the number of perfusion defects in hypokinetic (delta PI = 0.25 +/- 0.66) and akinetic (delta PI = 0.32 +/- 0.62), but not in dyskinetic (delta PI = 0.08 +/- 0.62), segments. Twenty-five revascularized patients had 110 asynergic segments and 136 segments with a resting perfusion defect. Function improved in 42% and perfusion in 64% of segments after surgery. Viable segments had a lower PI at rest (2.78 +/- 1.38 vs 3.86 +/- 1.29, P < 0.001) and a lower WMI (2.46 +/- 0.50 vs 2.79 +/- 0.59, P = 0.002). Nitrates reduced the number of perfusion defects slightly more in viable than non-viable segments (delta PI = 0.58 +/- 0.89 vs 0.30 +/- 0.46, P = 0.06). Contractility and perfusion at rest were the most important predictors of functional recovery. The sensitivity and specificity in predicting contractile improvement were 74% and 64% for resting SPET respectively, and 80% and 50% for nitrate SPET respectively. Nitrate administration significantly reduces perfusion defects in asynergic regions; however, its usefulness in predicting contractile recovery may be limited owing to its low specificity. Contractility and sestamibi uptake at rest were the strongest predictors of post-operative wall motion improvement.

[Evaluation of the antihypertensive efficacy of urapidil in the treatment of hypertension emergencies]. / Ocena skutecznosci hipotensyjnej urapidilu w leczeniu przelomu nadcisnieniowego.

Hypertensive crisis is defined as an acute elevation of the blood pressure involving the risk of life. Agents used to the treatment of hypertensive emergencies should lower the blood pressure under control and produce minimal adverse effect. The aim of this study was to evaluate the antihypertensive efficacy of urapidil i.v. in hypertensive emergencies. Twenty three patients (pts) with the hypertensive crisis in association with ischaemic heart disease and/or acute left ventricular failure were studied. Urapidil was given intravenously in the emergent treatment to the group of 23 pts in the mean dose of 50 mg. Systolic (RRs) diastolic blood pressure (RRd) and heart rate were measured within 4 hours after the drug administration. In this group of pts the significant decrease in RRs and RRd after 2 min. of administration of urapidil was observed and the maximum effect (p < 0.05) occurred within 40 min. The heart rate decreased by 8% and was significantly different (p < 0 > 05) at the maximum point of the drug action. Urapidil administered in 25-75 mg i.v. appeared an effective antihypertensive agent in more than 90% of patients with hypertensive emergencies. What was striking, no reflex tachycardia was observed after i.v. administration of urapidil despite its antihypertensive action.

Verapamil for the suppression of idiopathic ventricular tachycardia of left bundle branch block-like morphology.

This study examines the efficacy of verapamil for the suppression of idiopathic ventricular tachycardia (VT) of left bundle branch block LBBB-like morphology. Forty-two patients (mean age 36.2 +/- 12.1 years; 20 men and 22 women) with VT and without any underlying cardiac abnormality on clinical examination and noninvasive investigation were studied. The inducibility of clinical VT was examined by treadmill exercise testing and programmed ventricular stimulation (PVS). In 29 patients VT was inducible by exercise testing, in 24 by PVS, and in 23 there was evidence of VT on Holter monitoring. After baseline testing, patients were treated with verapamil 120 mg thrice daily for at least 5 half-lives for the drug to load before evaluation. With Holter monitoring, 74% of patients with evidence of VT at baseline testing demonstrated a change of status from nonsustained VT to no VT or from sustained VT to nonsustained VT. Four patients had nonsustained VT during verapamil treatment but no VT at baseline. There was a significant reduction in the number of ventricular ectopic beats over 24 hours (baseline: 15,541 +/- 17,599 vs verapamil treatment: 8892 +/- 15,582, p < 0.01). Exercise-induced VT was suppressed in 56% of patients with VT during baseline testing, but no effect of verapamil on the tachycardia was observed in 26%. The remaining patients demonstrated a partial response to verapamil; the rate of VT was unchanged, although the duration of the runs was reduced. Sustained monomorphic VT was inducible in only 5 patients, of whom 4 were rendered noninducible; 1 patient remained inducible.(ABSTRACT TRUNCATED AT 250 WORDS)

The vestibulocochlear ganglion in human embryos at stage 13.

In embryos at stage 13th vestibulocochlear ganglion forms a complex structure with the geniculate ganglion. The geniculate ganglion is placed rostrally and may be distinguished from the vestibulocochlear ganglion. Also at this stage there is a sign of differentiation of the vestibular and cochlear ganglia.

[Non-invasive evaluation of function in both cardiac ventricles and arrhythmias in patients with dilated cardiomyopathy]. / Nieinwazyjna ocena czynnosci obu komór serca oraz zaburzen rytmu u chorych na kardiomiopatie rozstrzeniowa.

Resting echocardiography with M-mode technique under the control of bidimensional picture and pulsating Doppler ultra sound and a 24-hour ECG with Holter technique were performed in 19 patients with dilated cardiomyopathy (6 females and 13 males; mean age 46 years, mean duration of the disease 23 months). A group of 7 patients with electrocardiographic features of the left ventricle hypertrophy, according to Sokolov index, was distinguished and compared with a group of patients without ventricular hypertrophy. The symptoms of pulmonary hypertension with progressing dilatation and failure of the right cardiac ventricle were found in patients with dilated cardiomyopathy without coexisting hypertrophy, despite of significant deterioration of the contractive function. Cardiac arrhythmias and thrombotic disorders which are hazardous for life were significantly more frequent (78% and 22%, respectively) in this group. Percentage of sudden deaths in these patients was high (56%).

[Value of two-dimensional echocardiography in predicting the clinical course and fates of patients 2 years after myocardial infarction]. / Wartosc echokardiografii dwuwymiarowej w przewidywaniu przebiegu klinicznego i losów chorych w okresie 2 lat od zawalu serca.

133 patients with acute myocardial infarction, admitted to hospital 24 hours or less from the beginning of chest pain were investigated. Two-dimensional echocardiography (ECHO 2D) was performed 1-2, 3-5, 7-10, 21-28 days and 3, 6, 9, 12, 18 and 24 months after myocardial infarction. Relations between ECHO parameters, clinical course and prognosis. 2 years after myocardial infarction were analysed. Worse clinical course and prognosis during 2 years after myocardial infarction predict high values of 1) asynergy index (greater than or equal to 1), 2) percentage of asynergy segments (greater than or equal to 50) and 3) percentage of left ventricular (LV) akinetic and (or) dyskinetic segments (greater than or equal to 37.5). Right ventricular asynergy and maintenance or increase of LV asynergy degree aggravate clinical course and prognosis too.

[The effect of intravenous streptokinase on selected echocardiographic and clinical parameters of patients followed up for 2 years after myocardial infarction]. / Wplyw podanej dozylnie streptokinazy na wybrane parametry echokardiograficzne i kliniczne oraz losy chorych w okresie 2 lat po zawale serca.

54 patients (pts) aged 70 years or younger with acute transmural myocardial infarction and onset of chest pain less than 12 hours were assigned in a blind manner to streptokinase group (SK), 54--to control group, 34 pts received intravenous infusion of 1,500,000 IU of SK/hour, 14 pts--2,000,000 IU/hour, and 6 pts--3,000,000 IU/2.5 hours. Intravenous streptokinase reduced left ventricular (LV) asynergy during hospital phase, decreased LV thrombus formation, and limited myocardial necrosis size 2 years after myocardial infarction. Its effect on clinical course and prognosis after myocardial infarction was of small importance.

[ECG Holter monitoring during endoscopic examination]. / Monitorowanie zapisu EKG systemem Holtera w czasie badan endoskopowych.

The aim of the study was an evaluation of ECG changes during endoscopy. In 57 hospitalized patients (34 female, 18 male, mean age 54) who had gastroscopy (n = 23), endoscopic retro-cholangiopancreatography (ERCP) (n = 17) or colonoscopy (n = 17) two hours before and two hours after the examination, an ECG monitoring by Holter method was done. The patients also filled a questionnaire to measure their level of anxiety. Arrhythmias and ST depression/elevation were seen in 37 (65%) patients during endoscopy. In 12% complex arrhythmias (III, IV A and IV B type Lown) were recorded. Complex arrhythmias and/or horizontal ST depression greater than 1 mm were observed more frequently (p less than 0.01) in the group of patients with clinically evident diseases of the cardiovascular system; this group was older than the group without cardiac symptoms. There was no correlation between ECG changes and the level of anxiety before the examination. During ERCP ECG changes were more complex than during colonoscopy (p less than 0.01) or gastroscopy (p less than 0.05).

[Myocardial infarction in patients with arterial hypertension. Changes in the creatine kinase MB isoenzyme activity in relation to myocardial hypertrophy]. / Zawal serca u chorych z nadcisnieniem tetniczym. Dynamika zmian aktywnosci izoenzymu MB kinazy kreatynowej a przerost miesnia serca.

The aim of the study was to investigate the relationship of arterial hypertension coexisting with myocardial hypertrophy to the infarct size evaluated by serial CK-MB measurements. The group of 98 patients (72 males and 26 females) with the first Q-wave infarction was selected from 137 patients admitted to I Clinic of Cardiology of Poznan Medical School with acute myocardial infarction (AMIO). Age of the patients ranged from 35 to 82, mean 60 years. Time from the onset of symptoms to admission to the hospital varied from 1 to 8 hours, mean 4. Enzymatic tests were performed on admission, every 4 hours during the first 24 hours, every 6 hours during the second and the third day and every 8 hours during the 4th and the 5th day. Anterior infarction was diagnosed in 46 patients and inferior infarction in 52 patients. The type of CK-MB curve, maximal CK-MB activity and the mass of necrotic tissue was evaluated for every patient using Sobel formula modified by Norris. Total mass of the left ventricle was calculated from echocardiographic measurements (2-D and M-mode) and the ratio of LV mass per square meter of the body surface was was calculated according to Horton's formula. The subgroup of 44 patients (25 males and 19 females) with the history of hypertension was selected. Ophthalmic examination revealed angiopathic changes of I and II grade K-W. This group, as compared to remaining patients with AMI was characterised by higher left-ventricular mass (198.0 +/- 28.6 vs 151.0 +/- 16.9 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

[Echocardiographic studies and electrocardiographic examination by the Holter method of patients with insulin-dependent diabetes mellitus]. / Badanie echokardiograficzne i elektrokardiograficzne metoda Holtera u chorych z cukrzyca insulino-zalezna.

The aim of the study was to evaluate the left ventricular function and cardiac arrhythmias in patients with insulin-dependent diabetes, but without observable changes of the circulatory system in clinical examination. 30 patients underwent the study with the insulin-dependent diabetes treated for 2 months--30 years. There was no evidence of hypertension, renal and hepatic failure. Well controlled diabetes was stated in all of them. The control group consisted of 20 healthy persons. M-mode echocardiographic examination and 24-hour Holter ecg monitoring was performed in all patients. Decreased left ventricular compliance and complex ventricular arrhythmias were stated in patients with insulin-dependent diabetes.

[Myocardial infarction in patients with hypertension]. / Zawal serca u chorych z nadcisnieniem tetnicyum.

Hypertension is a well known risk factor of coronary artery disease. The aim of the study was to evaluate a clinical course and prognosis in hypertensive patients with acute myocardial infarction (MI). 100 consecutive patients with acute MI underwent the study. In 38 of them (28 males and 10 females) a history of hypertension and intermittent rises of arterial blood pressure in a course of MI were stated. All patients underwent 2-DE examination and 24 hours Holter ecg monitoring. Clinical characteristics consisted of the heart failure and arrhythmias occurrence as well as the in-hospital mortality. Significantly higher rate of MI in the past and/or angina pectoris as well as a diabetes mellitus was stated in hypertensive patients. In these patients inferior, transmural MI was more often observed, while there was no difference in life-threatening arrhythmias, pulmonary edema and cardiogenic shock between normotensive and hypertensive patients.