[Concentration of magnesium and lipids in blood serum in a group of young healthy medical students]

The concentration of magnesium and lipids was determined in the blood serum of 100 healthy medical students (57 women and 43 men) aged 22.3 on the average. Decreased values of magnesium concentration below 0.8 mmol/l were found in 28% of the studied subjects. In 14% of the persons magnesium concentration was below the lower range of own laboratory normal values which were 0.66 for men, and 0.70 mmol/l for women. Hypercholesterolaemia was found in 15% of the studied subjects. No relation was shown between magnesium concentration and the concentration of most blood lipids.

[Aneurysms in acute myocardial infarction (multicenter studies)]

The authors present outcomes concerning frequency of appearance and clinical course of aneurysms after acute myocardial infarction. The study population consisted of 730 patients (mean age 54 +/- 9 years) with acute myocardial infarction, including 579 men and 151 women. The diagnosis was based on the following criteria: 1) coronary artery disease history, 2) physical examination, 3) ECG, 4) 2-dimensional echocardiography, 5) biochemical data. Post-infarction aneurysm was revealed in 42 patients (5.8%, 33 men and 9 women); antero-lateral aneurysm--in 36 patients (85.7%), and inferior-posterior aneurysm--in 6 patients (14.3%). Ventricular arrhythmias in the first day of infarction had a high frequency in both groups; with aneurysm--92.9%, without aneurysm--82.2%. The frequency of arrhythmia in 21-st day of infarction decreased similarly in both groups with aneurysm--40.5%, without aneurysm--38.9%. There was no statistically significant difference among both groups. There was no correlation between localisation of aneurysms and degree of contractility disturbances of the heart muscle (dyskinesis, akinesis). Heart failure--class III and IVK (Killip-Kimball classification) occurred in 19.0% of patients with aneurysm and in 10.4% of patients without aneurysm. That was no essential correlation between localisation of aneurysms and advancement of the heart failure.

[Use of the preparation Iso Mack Retard 60 mg I 120 mg in the treatment of patients with advanced ischemic heart disease]

The purpose of the study was an evaluation of the effectiveness of the preparation ISO MACK RETARD in capsules of 60 mg and 120 mg in patients with advanced exacerbated ischaemic heart disease. The study included 72 patients, in 61 (84.7%) of them very good result treatment, estimated subjectively, was achieved. ISO MACK RETARD in capsules of 60 and 120 mg was well tolerated; in the studied group no side effects were observed.

[Overt and latent restlessness and the awareness of the meaning of life in patients with valvular heart disease]

By means of R. B. Cattell Self-Knowledge Sheet and Crumbough and Miholick Scale of the Awareness of the Meaning of Life, 25 patients were examined, prepared for surgical correction of valvular heart disease. By means of R.B. Cattell Self-Knowledge Sheet a group was isolated of patients showing high overt restlessness (OR) and high latent restlessness (LR). It was shown that the personalities of these two groups of patients demonstrated numerous common features, but very significant differences also existed. The patients with high latent restlessness (LR) demonstrated strong emotional tension caused by frustration, feeling of inferiority with low self-estimation, as well as many conflicts at super ego level, but they had strong defensive mechanisms of own personality. The patients with high overt restlessness (OR) revealed high degree of intensification of the feeling of isolation, loneliness, and existential emptiness resulting from the lost feeling of the meaning of further existence with the progress of disease. The results of our studies are guidelines for the choice of psychotherapeutic management of patients qualified for operation of valvular heart disease.

[Effect of hydrochlorothiazide on various components of the kinin system and plasma renin activity in patients with arterial hypertension treated with captopril]

Combined hypertension treatment with inhibitors of the converting enzyme (ICE) and diuretocs gives manifold advantages, the most important of them is a synergistic action of both drugs resulting in blood pressure decrease and prevention of hypokaliaemia. The purpose of the present study was assessment of the effect of hydrochlorothiazide in 50 mg daily doses on blood levels of kininogen and prekallikrein and on plasma renin activity (PRA) in hypertensive patients treated during captopril 150 mg daily alone during 3 weeks, without success. The study was carried out on 15 patients with essential hypertension stage III after WHO. A control group comprised 18 healthy subjects. The determinations were done three time: before treatment, after 3 weeks on captopril, and after 2 weeks of combined treatment with captopril and hydrochlorothiazide. It was found combined treatment with captopril and hydrochlorothiazide produced blood pressure normalization in patients insufficiently responding to captopril alone. During the combined treatment normalization of blood pressure was associated with a higher fall of kininogen concentration, higher rise of prekallikrein and PRA in relation to the values obtained with captopril alone. This evidenced a more pronounced reaction of the kinin system and the renin-angiotensin-aldosterone system to the combined treatment as compared with the response of both systems to captopril alone.

[Effect of physical exercise on aortic blood flow in patients with primary arterial hypertension]

In 40 patients (30 men and 10 women) aged to 21 to 48 years (mean 42 years) with essential hypertension stage II, according to WHO classification, blood flow was recorder in the ascending aorta by Doppler echocardiography. The investigation was done in erect position, at rest, and during 30 seconds of each phase of exercise on moving track. The control group comprised 20 healthy males aged 23-45 years (mean 38 years). In essential hypertension the values of the heart rate (T), maximal (MAX-V) and mean (ME-V) flow velocity, and systolic volume index (SVI) were significantly higher at rest than in controls. In the 3rd minute of exercise the values of heart rate (T), mean flow acceleration (ACC) and minute volume index (COI) were significantly higher in the patients than in controls. At the peak exercise MAX-V, ME-V and COI were significantly lower than in controls. On the other hand, in the 5th minute after the exercise the values of all the analysed blood flow parametres in the aorta were significantly higher in the patients. After the exercise the fall of the integral flow (INTG) and SVI greater in controls than in patients, while the rise of the mean flow acceleration (ACC) was higher in hypertension than in health.

[Myocardial infarction-related arrhythmia after rehabilitation treatment in a sanatorium]

The study involved 100 patients (80 men and 20 women), aged between 27 and 69 years treated at the Department of Cardiology, Medical Academy in Lublin for the first myocardial infarction, and classified for a 4-week rehabilitation in sanatorium. A 24-hours ECG recording with Holter technique (Medilog 3000 manufactured by Oxford Medilog Timed) was performed twice. In the first record cardiac arrhythmias ( extrasystole both supra- and ventricular, ventricular tachycardia) were more frequent in comparison with the results of the second recording carried out after a 4-week rehabilitation.

[Epidemiological analysis of the correlations between selected individual characteristics of patients with primary arterial hypertension]

The purpose of the study was to find the correlations and to evaluate their strength between the progression of hypertension and age, sex, time between the diagnosis of hypertension and the beginning of treatment, body weight and other characteristics. The study was carried out in the population of patients treated in the Cardiology Department, Medical Academy in Lublin in the period 1981-1984. The computer-assisted analysis of the obtained material was carried out in the Department of Epidemiology, Medical Academy in Lublin. The studied population comprised 320 patients with essential hypertension. In the statistical analysis the chi square test was applied for finding of statistically significant correlations and Pearson test was used for estimation of correlation strength. Statistically significant correlations were obtained between the progression of hypertension and age, sex, time between hypertension diagnosis and present treatment and body weight.

Arterial blood pressure values in children and adolescents in the Lublin population. Epidemiological studies

The frequency of arterial hypertension occurrence in the adult population is estimated at 10-20%. In the last decade attention has been called to hypertension in children and adolescents. The purpose of the present study was to determine the arterial blood pressure in the studied age groups of children and adolescents in the elementary and secondary schools in Lublin, and to establish the prevalence of hypertension in this population group.

[Evaluation of the effectiveness of delayed-action propranolol in the treatment of arterial hypertension]

The reported study was carried out in 25 patients aged 21 to 58 years with essential hypertension in second stage of WHO classification. During three months in 10-day courses they were given alternately 1 placebo tablet or 160 mg propranolol retard in one dose daily. The values of the heart rate and blood pressure were compared before and after the treatment. A significant decrease of systolic and diastolic blood pressure and heart rate was noted. The comparison of blood pressure and heart rate values after 10 days on propranolol with those before the treatment showed a statistically significant reduction of these parameters. This is an evidence that the hypotensive action of propranolol retard develops already during 10 days of treatment.

Liquid flow across the epithelium of the artificially perfused lung of fetal and postnatal sheep

1. The lungs of five fetal (133-140 days gestation) and thirty-four postnatal (2-240 days) sheep were artificially perfused in situ with warmed and oxygenated sheep blood. In postnatal animals the airspace of the lung was filled with liquid similar in composition to fetal lung liquid. In fetal and postnatal animals luminal liquid volume was measured by the impermeant tracer technique. 2. Under resting conditions the pulmonary epithelium of fetal animals secreted liquid at a mean (+/- S.E.M.) rate of 2.0 (+/- 0.4) ml (kg body weight)-1 h-1, those of postnantal animals absorbed liquid at -1.8 (+/- 0.2) ml (kg body weight)-1 h-1. 3. Addition of 2,4-dinitrophenol to achieve a concentration of 1.5 x 10(-3) M in the perfusing blood in postnatal animals caused complete cessation of liquid absorption. 4. Light and electron microscopic examination of the lung after periods of up to 6 h of artificial perfusion showed no evidence of epithelial damage. From 3 h onwards, liquid accumulation was evident in the perivascular spaces. 5. Addition of adrenaline to the perfusate in fetal animals caused absorption of liquid to occur at a mean rate of -2.9 (+/- 1.3) ml (kg body weight)-1 h-1. In postnatal animals adrenaline caused the rate of liquid absorption to increase from a mean rate of -1.4 (+/- 0.2) to -2.2 (+/- 0.3) ml (kg body weight)-1 h-1. 6. In the fetus addition of amiloride (0.8 x 10(-4) M) to the luminal fluid blocked adrenaline-induced liquid absorption and caused secretion to occur at 1.3 (+/- 0.3) ml (kg body weight)-1 h-1. 7. In postnatal animals the response to amiloride was age dependent. In newborn lambs (2-14 days) amiloride blocked liquid absorption and caused secretion of liquid to occur in seven out of eight animals at a mean rate of 0.9 (+/- 0.3) ml (kg body weight)-1 h-1 (n = 8). In older animals (15-240 days) the characteristic response to amiloride was slowing of the rate of liquid absorption (mean rate of absorption,-0.2 (+/- 0.09) ml (kg body weight)-1 h-1, n = 18) with liquid secretion being seen in only three of eighteen animals.(ABSTRACT TRUNCATED AT 400 WORDS)

The personality and psychosomatic syndrome in patients with acquired valvular heart diseases

Fifty patients (36 women and 14 men) aged 16-51 with valvular heart diseases qualified from surgical treatment were studied. For determination of personality traits the Self Knowledge Card by R. B. Cattell, The Minnesota Multiphasic Personality Inventory MMPI-WISKAD by Hathaway and McKinley and The Adjectives Test ACL by Gough and Heilbrun. Using these methods it was shown that patients with acquired valvular heart diseases had a much lower tolerance threshold for frustration and stressful situations and had a tendency for autoaggressive behaviour. Somatic symptoms in these patients cause a constant feeling of danger and anxiety and difficulties in adaptation to everyday life conditions with a tendency for self-effacement. Predominating needs were demonstrated in three sets: a) defense attitudes and strong self-control, b) needs connected with goal achievement and strivings, c) needs connected with normal relations with other people. A statistical comparison of the results obtained in patients with valvular heart diseases and in healthy controls showed very significant differences between them.

Development of the lung liquid reabsorptive mechanism in fetal sheep: synergism of triiodothyronine and hydrocortisone

1. Thyroidectomy was performed on twelve fetal sheep between 111 and 115 days gestation. Measurement of fetal lung liquid secretion and absorption rates (Jv) were made at rest and during short (45 min) and long (5 h) infusions of adrenaline (0.5 micrograms/min) in a total of thirty-seven experiments, some in the absence of triiodothyronine (T3) and hydrocortisone and some at set times after the administration of the two hormones. 2. T3 was given either as an I.V. infusion (60 micrograms/24 h) or as a bolus of 30 micrograms; hydrocortisone was given as an infusion of 10 mg/24 h. Both hormones were administered together. 3. Before T3 and hydrocortisone were given short infusions of adrenaline had no effect on Jv but 4 h after exposure to the hormones secretion rate was reduced to near zero (Jv = -0.5 +/- 1.6 ml/h, n = 4) by adrenaline; after 24 h of hormone exposure, absorption of fetal lung liquid was produced by adrenaline (Jv = -3.6 +/- 2.2 ml/h, n = 4) which was even greater after 72 h, (Jv = -11.2 +/- 2.2 ml/h, n = 4). 4. During long infusions of adrenaline when T3 and hydrocortisone were given at the start of the experiment, an effect on lung liquid secretion was evident at 2 h and absorption was produced at 4 h (Jv = -4.2 +/- 2.5 ml/h, n = 3). The effect was significantly different from control long infusions of adrenaline performed the previous day in the absence of hormones. 5. After 24 or 48 h of stopping T3 and hydrocortisone administration, adrenaline no longer produced absorption of lung liquid, indicating that the effect of the two hormones was reversible within 24-48 h. 6. The protein synthesis inhibitor cycloheximide put into lung liquid (4 x 10(-5) to 3 x 10(-4) M) blunted the effect of the hormones at 4 h and prevented absorption of lung liquid at 24 h. Jv during adrenaline was -3.6 +/- 1.5 ml/h in control experiments but was +3.3 +/- 0.9 ml/h after cycloheximide, n = 4, P < 0.01. This indicated that the two hormones produced their effect through protein synthesis.

Synergistic action of triiodothyronine and hydrocortisone on epinephrine-induced reabsorption of fetal lung liquid

The influence of triiodothyronine and hydrocortisone on maturation of the response to epinephrine that leads to reabsorption of lung liquid was investigated in nine chronically catheterized fetal sheep. Experiments were performed on thyroidectomized fetal sheep at 116-120 d gestation, well before the reabsorptive response to epinephrine is normally seen. After i.v. administration of either triiodothyronine (60 micrograms/d) or hydrocortisone (10 mg/d) for 3 d (three fetuses in each case), all fetuses continued to secrete lung liquid during exposure to epinephrine (secretion rate = 5.9 +/- 3.2 mL/h in triiodothyronine-treated and 4.4 +/- 1.9 mL/h in hydrocortisone-treated fetuses). However, when the two hormones were administered together in the same doses to three fetuses, a striking reabsorptive response to epinephrine was seen (absorption rate = -12.3 +/- 3.6 mL/h), similar to that observed in the mature fetus. Induction of this capacity to reabsorb lung liquid may be of importance in the management of respiratory problems of the newborn infant.

[Arrhythmias during automobile driving in patients after acute myocardial infarction]

In 90 patients after acute whole-thickness myocardial infarction suffered 3-48 months earlier 24-hour ECG recording was done for assessment of arrhythmias occurring while they were driving cars and for their comparison with the remaining recording hours. In most patients driving cars episodes of sinus tachycardia even up to 130/min were noted, in about half the patients some increase occurred in the frequency of ventricular ectopic beats, in two patients double and in one patient triple ectopic beats (salvoes) appeared, although they had not been recorded when the patients were not driving cars. The study was carried out (and is still continued) in autumn-winter, when the conditions of car driving were worse. None of the patients was in a collision-threatening situation which could increase dangerous arrhythmias.

[Arrhythmia in patients on dialysis treatment for chronic renal failure]

In 6 patients treated with repeated peritoneal dialyses 48-hour ECG monitoring was carried out. In no patient significant heart rhythm disturbances were demonstrated during the dialysis and 24 hours after its completion. On the ground of pathological results of Valsalva's manoeuvre function disturbances of the autonomic nervous system were disclosed but these showed no correlation with premature ventricular and supraventricular++ ectopic beats appearing periodically in some patients. The study showed that under conditions of sufficient control of electrolyte balance (especially potassium) the patients treated with peritoneal dialyses are not a group at risk for arrhythmia development.

[Curves of aortic and mitral flow recorded by Doppler echocardiography in patients with primary hypertension]

The systolic and diastolic left-ventricular myocardium function was assessed by Doppler echocardiography in patients with hypertension. The study was carried out on 40 patients (26 men and 14 women) aged 21-50 years (mean 45 years) with essential hypertension, stage II according to WHO classification. The control group comprised 20 healthy subjects aged 19-48 years (mean 43 years). In patients with hypertension, as compared to controls, the Doppler curve of aortic flow showed an increased maximal and mean velocity of flow, the ejection time was shortened, and the ejection time to acceleration time index was decreased. The Doppler curve of the mitral flow in the patients showed reduced maximal velocity of early diastolic flow, increased velocity of maximal end-diastolic flow, decreased fraction of rapid left-ventricular filling, and lower ration of maximal early diastolic to end-diastolic flow. Doppler echocardiography is a useful method for assessment of left-ventricular myocardium functions in hypertension.

[Dynamics of left ventricular contraction in patients with myocardial infarction after hospital rehabilitation, assessed by Doppler echocardiography]

The reported study was carried out in 30 men with myocardial infarction. In all cases after completion of rehabilitation treatment in hospital the exercise test was done on cycle ergometer and echocardiographic examination was performed (TM, 2D and Doppler). The patients were divided into two groups depending on the size of the necrotic zone (limited or extensive infarction in ECG) and physical fitness (low and high) determined by means of the PCW-170 test. In such formed groups certain left-ventricular contraction parameters (PEP, PEPI, LVET, LVETI, PEP/LVET, CO) were calculated by means of Doppler echocardiography. It was found that after hospital rehabilitation the patients with extensive myocardial infarction had significantly lower values of LVETI, SV, CO and higher PEP/LVET value in relation to patients with limited infraction zone, which suggested worse left-ventricular contraction. Moreover, patients with lower physical fitness had worse left ventricular contraction activity (significantly lower values of LVET, LVETI, SV, CO, and higher value of PEP/LVET) than patients with better fitness. Thus the indices describing the left-ventricular contraction activity calculated by means of Doppler echocardiography correlated well with fitness and infraction zone size. The method of Doppler echocardiography is useful for determination of left-ventricular contraction activity after myocardial infraction and for programming of exercises during rehabilitation treatment in hospital.

[Effect of the treatment with propranolol and pindolol on selected hemodynamic parameters in patients with primary arterial hypertension]

On the basis of echocardiographic investigations changes were analysed of certain haemodynamic parameters in 40 patients aged 21-50 years, mean 44 years, with primary arterial hypertension in stage II according to WHO classification. All patients were randomly chosen to receive for 6-9 weeks propranolol 120-480 mg daily, mean dose 280 mg, or pindolol 10-35 mg daily, mean dose 22 mg daily. The changes developing during the treatment with both drugs in relation to the initial values included the mean arterial blood pressure, the heart rate, the index of cardiac output and the systolic left-ventricular tension. In the studied patients treated with propranolol the heart rate and the ejection volume were decreased more than during pindolol treatment. Propranolol increased evidently the total peripheral vascular resistance and decreased the ejection fraction and the mean velocity of shortening of the circumferential fibres. Pindolol decreased slightly the peripheral vascular resistance and increased the ejection fraction and the mean velocity of shortening of the circumferential fibres. Pindolol, in relation to propranolol, had a more favourable effect on haemodynamics in patients with primary hypertension.

[Value of Doppler echocardiography in evaluating pulmonary arterial pressure in patients with mitral valve defect]

In 40 patients aged 25-52 years (mean 36 years) with mitral valve disease but without overt circulatory failure haemodynamic studies and echocardiographic examinations were carried out recording the blood flow in the pulmonary artery and the blood flow through the tricuspid valve by pulsating and continuous-wave methods. From the obtained curves the time was calculated from the beginning of the flow to its maximum (TPV), the pre-ejection time (RPEP) and the right-ventricular ejection time (RVET), and the indices TPV/RVET and RPEP/RVET. Moreover, in 14 patients with coexistent insufficiency of the tricuspid valve the systolic pressure in the pulmonary artery was calculated by determining the systolic gradient across the tricuspid valve. On the basis of the results of haemodynamic examination the patients were divided into two groups: with normal (24 patients) and with raised (16 patients) pressure in the pulmonary artery. In the group of mitral valve disease and pulmonary hypertension a significantly shorter TPV, lower values of the TPV/RVET index and greater values of the RPEP/RVET index were found as compared with the patients with mitral disease and normal value of the systolic arterial pressure in the pulmonary artery. The systolic arterial pressure in the pulmonary artery determined on the basis of Doppler echocardiography with measurement of the regurgitation wave in tricuspid valve insufficiency showed a high agreement (r = 0.94) with the pressure recorded during cardiac catheterization.

[Value of sustonit in the treatment of patients with stable angina pectoris]

The clinical trial was carried out in 40 men with stable angina receiving for three weeks Sustonit mite or forte. Before and after three weeks of the treatment the exercise test was done on cycle ergometer, followed by echocardiography (for evaluation of left ventricular function) noting also the number of anginal pains and the number of nitroglycerin tablets taken as emergency treatment. In the light of the obtained results it was estimated that Sustonit reduced anginal pains in 82.5% of the patients with stable angina, and exerted a beneficial effect on the left ventricular function as evidenced by increased mean velocity of shortening of the circumferential fibres and reduced number of echocardiograms with segmental contractility disturbances in the ventricular septum and posterior wall of the left ventricle after 3 weeks of treatment. Moreover, Sustoinit treatment increased significantly the amount of work done until reaching of submaximal heart rate and working time during submaximal exercise, as well as the greatest workload necessary for reaching of submaximal heart rate. The drug had no significant effect on the heart and arterial blood pressure. Sustonit mite and forte is regarded as highly valuable and effective drug in the treatment of patients with stable angina.

Unknown syndrome: Hirschsprung's disease, microcephaly, and iris coloboma: a new syndrome of defective neuronal migration

We describe three children with Hirschsprung's disease and microcephaly, two of whom also have an iris coloboma. Two of the children, one with a coloboma and one without, are from the same consanguineous pedigree. The third case is unrelated and was identified by the matching program of the London Dysmorphology Database. This is the first report of this combination of features which are considered to be secondary to defective neuronal migration. An autosomal recessive mode of inheritance is proposed.