RESUMEN
Drugs classified as calcium channel blockers (CHBs) are now among the most frequently prescribed drugs for the treatment of cardiovascular disease. Although the currently available CCBs have major differences in their structural and cardiovascular effects, they share the common property of blocking the transmembrane flow calcium ions through voltage gated L-type channels. These drugs have been approved for the treatment of hypertensive heart disease: they reduce left ventricular hypertrophy and improve its sequelae, such as ventricular dysrhythmias, impaired filling and contractility, and myocardial ischemia. Long-acting CCBs have been shown to reduce mortality and morbidity in elderly patients with systolic hypertension, appear to be extremely useful in patients with cyclosporin-induced hypertension, and can be used as alternatives to ACE inhibitors in patients with hypertension and concomitant diabetes mellitus, renal disease, Raynaud's phenomenon or migraine. Long-acting dihydropyridine have been shown to be effective and safe in the treatment classic angina pectoris and vasospastic angina, supraventricular arrhythmias, particularly reentrant AV-nodal tachycardia, others to be beneficial in patients with congestive heart failure, and all of them have potential for decreasing atherogenesis.
Asunto(s)
Bloqueadores de los Canales de Calcio/uso terapéutico , Enfermedades Cardiovasculares/tratamiento farmacológico , Dihidropiridinas/uso terapéutico , HumanosRESUMEN
Neuropeptide Y (NPY) has been recently characterised as one of the strongest circulating vasoconstrictor peptides, its elevated level may cause coronary artery spasm and increase of peripheral vascular resistance. All this contributes to ischemic myocardial damage and decrease of regional and global left ventricular function. The aim of the study was the examination of NPY plasma levels in patients with acute myocardial infarction (AMI) after thrombolytic therapy with or without reperfusion. The survey was made in 82 patients with AMI after thrombolytic therapy: 40 of them without reperfusion and 42 with reperfusion. The control group consisted of 20 healthy persons. Plasma levels of NPY were measured before thrombolysis, then 1, 3 and 5 days after, using a radioimmunologic method. All patients were treated with aspirin, glyceryl trinitrate and thrombolytic therapy (TT) with alteplase (r-TPA). In patients with AMI, NPY plasma levels were normal before and 1 day after TT, and were significant elevated 3 days after TT 5 days after TT, plasma NPY levels were still high in patients without reperfusion, but they decreased in patients with reperfusion. There was significant negative correlation between NPY level and left ventricular ejection fraction measured 5 days after AMI. During 30-days follow up systolic dysfunction of left ventricle with ejection fraction under 40% occurred in 21 patients and in 11 of them clinical symptoms of heart failure were observed. Using the multivariable regression analysis we showed that NPY concentration over 60 pg/ml is the independent factor leading to left ventricle systolic dysfunction. The results of our study suggest the contribution of NPY to the left ventricular remodeling after AMI.
Asunto(s)
Infarto del Miocardio/sangre , Neuropéptido Y/sangre , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The management of arrhythmias during pregnancy is, in principle, similar to that in nonpregnant patients, however, special consideration must be given, to avoid adverse fetal effects. In pregnant women without organic heart disease, no drug therapy is usually needed for the management of supraventricular or ventricular premature beats, but potential stimulants, such as smoking, caffeine, and alcohol should be eliminated. In patients with mitral valve prolapse beta blocker may be preferred drug. In pregnant patients with organic heart disease, paroxysmal atrial or ventricular tachycardia may induce hemodynamic changes with consequences to the fetus. In paroxysmal atrial tachycardia vagal stimulation maneuvers should tried and, if this is not effective, adenosine or beta-adrenergic blocking agents should be used. Alternatively, verapamil may be given. In pregnant with atrial fibrillation, the goal of treatment is conversion to sinus rhythm or control of the ventricular rate by digoxin. Synchronized electrical cardioversion may become necessary when signs of cardiac decompensation or hypotension were developed. Ventricular arrhythmias may occur in the pregnant women with cardiomyopathy, valvular heart disease, mitral valve prolapse and congenital Q-T prolongation. Termination of ventricular arrhythmias can usually be achieved by intravenous lignocaine or procainamide or by electrical cardioversion. To prevent recurrences, quinidine can be used if the arrhythmia was not induced by QT prolongation or procainamide.
Asunto(s)
Arritmias Cardíacas/terapia , Complicaciones Cardiovasculares del Embarazo/terapia , Antagonistas Adrenérgicos beta/uso terapéutico , Consumo de Bebidas Alcohólicas/efectos adversos , Consumo de Bebidas Alcohólicas/prevención & control , Arritmias Cardíacas/etiología , Digoxina/uso terapéutico , Cardioversión Eléctrica/métodos , Femenino , Enfermedades de las Válvulas Cardíacas/complicaciones , Enfermedades de las Válvulas Cardíacas/terapia , Humanos , Lidocaína/uso terapéutico , Prolapso de la Válvula Mitral/complicaciones , Prolapso de la Válvula Mitral/tratamiento farmacológico , Embarazo , Complicaciones Cardiovasculares del Embarazo/etiología , Procainamida/uso terapéutico , Quinidina/uso terapéutico , Prevención Secundaria , Fumar/efectos adversos , Prevención del Hábito de Fumar , Verapamilo/uso terapéuticoRESUMEN
A 69-year-old patient diagnosed, in 1985, of squamous cell carcinoma of the right vocal cord (T1, N0, M0) was treated with cordectomy and radiotherapy. Eleven years later he presented with a larynx tumor of the glotto-subglottic region. Histopathological examination stated a small cells neuroendocrine tumor. We contribute with one new case to those rare laryngeal tumors, which we see often published in the specialty journals, probably due to the wide employed immunohistochemistry dyes.
Asunto(s)
Carcinoma de Células Pequeñas/patología , Neoplasias Laríngeas/patología , Tumores Neuroendocrinos/patología , Anciano , Carcinoma de Células Pequeñas/cirugía , Resultado Fatal , Humanos , Neoplasias Laríngeas/cirugía , Laringectomía/métodos , Masculino , Tumores Neuroendocrinos/cirugíaRESUMEN
Recent studies showed that coronary artery spasm may be due to disturbances of secretory and excretory endothelial activity in atherosclerotic coronary artery. However, this theory does not explain the reasons of coronary artery spasm when endothelium is not damaged. There must be other patomechanisms of coronary artery spasm. The aim of our study was examination of calcium efflux through the lymphocytic cell membrane and determination of endothelin-1 plasma levels in patients with variant angina in order to define the participation of these factors in pathogenesis of coronary artery spasm. The survey was made in 76 patients with ischaemic heart disease. All patients were divided into 2 groups. The first group consisted of 48 patients with variant angina (d.b.s.), the other consisted of 28 patients with stable angina (d.b.w.). The control group (g.k.) was composed of 25 healthy people. Patients were administered 100 ml of trometamol (TRIS, pH = 10.5) intravenously for 5 minutes. After stopping the infusion the examined patient was breathing deeply for 5 minutes at a rate of 40/min. The endothelin-1 (ET-1) plasma levels and transmembrane calcium transport in lymphocytes were determined before and just after the hyperventilation test, as well as 10 minutes after the test. ET-1 plasma concentrations were estimated with a radioimmunologic assay. The method of estimation of transmembrane calcium transport was elaborated in Laboratory of Department of Cardiology of Medical University of Wroclaw. We showed that ET-1 plasma levels and transmembrane calcium transport in patients with d.b.s. before the test were normal. There was an increase in transmembrane calcium efflux in patients with d.b.s. during coronary artery spasm that had been caused by ET-1. ET-1 plasma levels were still high 10 min. after the coronary artery spasm. Disturbances of transmembrane calcium transport and increased endothelin-1 plasma level may be the primary factors responsible for coronary artery spasm.
Asunto(s)
Angina Pectoris Variable/metabolismo , Calcio/metabolismo , Endotelina-1/sangre , Linfocitos/metabolismo , Adulto , Anciano , Angina de Pecho/metabolismo , Femenino , Humanos , Transporte Iónico , Masculino , Persona de Mediana Edad , TrometaminaRESUMEN
The accurate detection of pulmonary embolism is possible by means of non-invasive but very expensive ventilation-perfusion lung scanning or invasive and with high rate of complications pulmonary angiography. Thus monitoring of many clinical and biochemical parameters has been recently attempted to increase the probability of correct diagnosis of pulmonary embolism. The alveolar-arterial oxygen gradient is a more sensitive indicator of disturbance in oxygenation than occurrence of hypoxia in gasometry. The aim of our study was to examined the changes of the alveolar-arterial oxygen gradient in patients with pulmonary embolism. The survey was made in 35 patients aged from 41 to 75 with acute pulmonary embolism, of these 17 were men and 18 were women. We excluded patients with coexisting serious heart or lung disease. Pulmonary embolism was diagnosed on the grounds of presence of commonly known risk factors, sudden onset, findings on the chest radiography, hypoxia resistant to oxygen therapy, electrocardiography, echocardiography and catheterization of pulmonary artery using a Swan-Ganz catheter. The alveolar-arterial oxygen gradient was measured in arterial blood samples obtained 15 minutes after 100% oxygen ventilation, using standard formulae. All patients were administered heparin, oxygen and warfarine therapy. The control group consisted of 20 patients, 11 women and 9 men aged from 37 to 74, with deep venous thrombosis without coexisting heart or lung disease. In our study we showed that the alveolar-arterial oxygen gradient is a very useful parameter helping with diagnosis and monitoring efficacy of treatment in patients with pulmonary embolism without coexisting heart or lung diseases.
Asunto(s)
Consumo de Oxígeno/fisiología , Oxígeno/metabolismo , Alveolos Pulmonares/metabolismo , Arteria Pulmonar/metabolismo , Embolia Pulmonar/diagnóstico , Enfermedad Aguda , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Embolia Pulmonar/etiología , Trombosis de la Vena/complicaciones , Trombosis de la Vena/diagnósticoRESUMEN
Increased pressure in pulmonary artery is connected among other things with increased endothelin plasma concentration. The aim of the study was to assess plasma endothelin concentration in patients with pulmonary hypertension. The analysis comprised 22 patients with increased pressure in pulmonary artery in the course of pulmonary thromboembolism or chronic exacerbated left ventricular failure and 10 patients with chronic exacerbated left ventricular failure without pulmonary hypertension. Plasma endothelin concentration was measured in pulmonary artery and capillary wedge pressure were evaluated with Swan-Ganz catheter and also peripheral and pulmonary vascular resistance were calculated. Endothelin plasma concentration in peripheral vein was compared between patients and healthy volunteers. Plasma endothelin concentration in pulmonary artery, peripheral artery and vein was higher in patients with pulmonary hypertension than in patients with chronic exacerbated left ventricular failure without pulmonary hypertension. Plasma endothelin concentration in patients with chronic exacerbated left ventricular failure without pulmonary hypertension was higher in pulmonary artery than in peripheral artery and vein. At these patients plasma endothelin concentration in the peripheral vein didn't differ significantly from the healthy volunteers.
Asunto(s)
Endotelina-1/sangre , Endotelina-2/sangre , Hipertensión Pulmonar/sangre , Adulto , Anciano , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Disfunción Ventricular Izquierda/sangreRESUMEN
Heart failure is a common and increasing public problem. Neurohormonal activation plays a role in the pathophysiology of heart failure, but is probably also affected by cytokines. We studied 75 patients with heart failure NYHA functional class II and III-IV, who were treated with angiotensin converting enzyme inhibitor (enarenal), diuretics (furosemide) and digoxine. Their mean age was 63.9 years/range 65-86/, left ventricular ejection fraction in the patients NYHA functional class II and III-IV classes was 68.9% and 47.3% respectively; 12 were females. Significant improvements in NYHA classification were shown. The levels plasma TNF-alpha (tumor necrosis factor-alpha) and interleukin-6 (IL-6) were analysed before and after therapy. The authors showed increased plasma levels TNF-alpha and IL-6 in patients with chronic heart failure. After the treatment the plasma IL-6 levels decreased only in the patients III-IV NYHA functional classes, whereas the treatment had no effect on the plasma TNF-alpha levels.
Asunto(s)
Insuficiencia Cardíaca/inmunología , Interleucina-6/inmunología , Factor de Necrosis Tumoral alfa/inmunología , Anciano , Anciano de 80 o más Años , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Enfermedad Crónica , Digitalis/uso terapéutico , Diuréticos/uso terapéutico , Femenino , Insuficiencia Cardíaca/tratamiento farmacológico , Humanos , Masculino , Fitoterapia , Plantas Medicinales , Plantas Tóxicas , Resultado del TratamientoRESUMEN
Endothelin-1 (ET-1) as a potent vasoconstrictor, has mitogenic and inotropic properties, stimulates the renin-angiotensin-aldosterone system and sympathetic nervous system. The results of recent studies suggest that overall hemodynamic effects of ET-1 may play a part in the control of blood pressure and the pathophysiology of hypertension. Several investigators have invoked increase level of ET-1 in human essential hypertension but the results of studies concerning hypertensive patients with normal renal function have shown that they have similar concentrations of ET-1 to those in normotensives. To establish whether ET-1 may elevate of blood pressure, the value of plasma ET-1 activity was determined in peripheral blood in 101 patients with essential hypertension. There was no significant difference between in mean level of ET-1 in patients with essential hypertension and in control group. The plasma ET 1 was significantly higher in patients with severe hypertension than that of patients with mild and moderate hypertension, and in patients with severe hypertension there was a correlation between the level of ET-1 and microalbuminuria. There was no correlation between the plasma ET-1 level and systolic blood pressure and diastolic blood pressure in the patients with essential hypertension as a whole, not was there any correlation between ET-1 and noradrenaline, aldosterone level and renin plasma activity.
Asunto(s)
Endotelina-1/sangre , Hipotensión/sangre , Adulto , Aldosterona/sangre , Femenino , Humanos , Hipotensión/diagnóstico , Masculino , Persona de Mediana Edad , Norepinefrina/sangre , Renina/sangre , Índice de Severidad de la EnfermedadRESUMEN
Early estimation of the efficacy of thrombolysis in acute myocardial infarction is of great clinical importance because the appearance of coronary reperfusion changes therapeutic and diagnostic procedures and decreases the mortality rate. Previous studies showed that the analysis of activity of creatinine kinase (CPK) measured in regular, short periods of time after thrombolysis night be useful in the diagnosis of reperfusion equally to coronary angiography. The aim of the study was to estimate the usefulness of the analysis of creatine kinase (CPK) and its isoenzyme (CK-MB) in the diagnosis of coronary reperfusion in patients with acute myocardial infarction after thrombolytic therapy. The study was performed in 50 patients with acute myocardial infarction admitted to our Cardiology Department, of these 42 were men aged from 34 to 68 and 8 were women aged from 43 to 70. 28 patients had acute inferior myocardial infarction, 22 patients--acute anterior myocardial infarction. All patients were administered 300 mg of aspirin after admission and then 150 mg of aspirin daily and 1,500,000 IU of streptokinase i.v. within 1 hour. Venous blood samples for determination of CPK and CK-MB were obtained every 3 hours during the first 48 h and once a day at 8 a.m from 3rd to 11th day. All patients underwent coronary angiography 2-4 weeks after thrombolysis. The study showed that in patients with reperfusion, activities of CPK and CK-MB three hours after thrombolysis were higher than 30% of later peak. These findings show the usefulness of this criterion in early, non-invasive estimation of efficacy of thrombolysis. Determination of activity of isoenzyme CK-MB during thrombolytic therapy is not necessary, because it evaluates similarly to CPK. We showed that electrocardiographic and enzymatic criteria are comparable in estimation of efficacy of thrombolytic therapy.
Asunto(s)
Creatina Quinasa/fisiología , Fibrinolíticos/uso terapéutico , Infarto del Miocardio/sangre , Infarto del Miocardio/tratamiento farmacológico , Enfermedad Aguda , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Reperfusión MiocárdicaRESUMEN
Sudden cardiac death due to ventricular arrhythmias remains a significant problem. In most studies about 50% of all death related to coronary artery disease and heart failure are sudden and unexpected and are caused by acute fatal ventricular tachycardia and fibrillation. Most of the patients suffering sudden cardiac death have some kind of structural heart disease but 80% of SCD events are associated with coronary artery disease, 10-15% with dilated and hypertrophic cardiomyopathy, and only small fraction with the less common disorders as valvular heart disease, ventricular dysplasia and cardiac involvement in sarcoidosis or amyloidosis. In some patients the anomaly responsible for sudden cardiac death is not structural but mainly electrical as in patients with the long QT syndrome, WPW syndrome or in patients with a proarrhythmic effect from antiarrhythmic drugs. In this review, data from clinical trials and other studies on on antiarrhythmic therapies have been evaluated in order to determine effective strategies for the prevention sudden cardiac death in high risk patients. Taken together with the mortality data routine prophylactic use of class I antiarrhythmic drugs in the patients survivors of acute myocardial infarction and patients with heart failure is associated with increased risk of death. Conversely beta-blockers are associated with significant reduction in nonfatal cardiac arrest in the short term trials and sudden cardiac death in long term trials. These benefits are likely due to relief ischemia, reduction of heart rate and maintenance favourable autonomic nervous system balance. Overall trial data on amiodarone suggests that this agent is effective in reducing the risk of death in survivors of cardiac arrest, post infarction patients, and patients with heart failure but the routine prophylactic use of amiodarone remains of uncertain efficacy. The physician who considers the use of antiarrhythmic medications in patients with ventricular arrhythmias must be aware of which arrhythmias are malignant or potentially malignant and which are benign and the decision to initiate antiarrhythmic therapy should be based on consideration of the patients absolute mortality risk.
Asunto(s)
Antiarrítmicos/uso terapéutico , Muerte Súbita Cardíaca/prevención & control , HumanosRESUMEN
Congestive heart failure (CHF) is growing epidemiologic and clinical problem, and is the only common cardiovascular condition that is increasing in incidence, prevalence and mortality. During last years numerous clinical trial have been conduced evaluating the effect of various treatment procedures on clinical endpoints in patients with CHF. The major risk factor for CHF are hipertension and atherosclerotic vascular diseases, and now it is clear that aggressive treatment of hypertension and hyperlipidemia can be effective in preventing CHF. Treatment strategies for CHF are aimed at preventing and delaying progression of the disease and improving survival. In the treatment of CHF diuretics are at present the first drugs line for patients with fluid retention and are necessary to relieve symptoms but cannot halt progression or improve the prognosis of CHF. Angiotensin-converting enzyme inhibitors (ACE inhibitors) therapy has been shown to decrease mortality and progression of CHF and should be used early in patients with left ventricular dysfunction whether they have symptomatic or asymptomatic CHF. Digoxin therapy is associated with decrease in the risk of worsening CHF irrespective of rhythm, systolic function, severity of CHF or therapy with ACE inhibitors. In patients with symptomatic CHF due to systolic dysfunction the addition of diuretics and digoxin appears to reducing worsening CHF without improving survival. Other than digoxin oral inotropic agents (amrinone, pimobendan, vesnarinone, ibopamine) increase mortality in patients with CHF and have not improved symptom status and other clinical endpoints during long-term therapy. Hydralazine and isosorbide dinitrate administrated in combination are less effective alternative to ACE inhibitors. Beta-blockers and particular carvedilol may prolong survival and decrease worsening CHF when used in combination with digoxine, diuretics and ACE inhibitors. Beta-blockers therapy improve hemodynamics, LVEF and functional status patients with CHF and the ideal candidate for this therapy is stable patients with NYHA II-III CHF due to nonischemic cause. Calcium antagonists do not appear to be useful in patients with CHF, although amlodipine and mibefradil appears to be safe for treatment of angina or hypertension in this group. On the basis of current data, antiarrhythmic agents should not be given to patients with CHF free from arrhythmia but those with sustained ventricular tachycardia or ventricular fibrillation amiodaron appears to be safe.
Asunto(s)
Antagonistas Adrenérgicos beta/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Bloqueadores de los Canales de Calcio/uso terapéutico , Cardiotónicos/uso terapéutico , Diuréticos/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , HumanosRESUMEN
In acute myocardial infarction may increase the synthesis of cytokines, which can enlarge the myocardial lesion owing to their direct toxic action on myocytes or induction of inflammatory changes that lead to myocardiofibrosis. All this may quickening the appearance of congestive heart failure after myocardial infarction. The aim of the study was examination of tumor necrosis factor (TNF-alpha) and interleukin 6 (IL-6) plasma levels in patients with acute myocardial infarction and analysis of correlation between concentrations of these cytokines and myocardial lesions during infarction. The study was made in 94 patients admitted to the Department of Cardiology with acute myocardial infarction (AMI). Of these, 40 were women aged from 41 to 85 (mean 67 years) and 54 were men aged from 39 to 86 (mean 63 years). Anterior AMI was diagnosed in 40 patients, inferior AMI was diagnosed in 54 patients. 63 patients underwent the thrombolytic therapy, reperfusion appeared in 45 patients, 24 patients were excluded from the thrombolytic therapy. Control group consisted of 28 healthy persons aged from 35 to 76 (mean 61 years). Blood samples for determination of TNF-alpha and IL-6 plasma levels were taken just after admission prior to the treatment. Then patients were taken streptokinase or tissue-type plasminogen activator with typical doses. Blood samples for determination of cytokines were obtained in 3. and 7. day after treatment. TNF-alpha and IL-6 plasma levels were determined with radioimmunological assay. Creatine kinase activity were monitored in patients with AMI as well as ejection fraction was checked in echocardiography in 3. and 7. day after treatment. We showed increased plasma levels of TNF-alpha and IL-6 in patients with AMI with maximum in 3. day of infarction. Concentrations of cytokines were higher in patients with anterior AMI than in patients with inferior AMI. In anterior infarction concentrations of cytokines were significantly lower after thrombolytic therapy with reperfusion than after treatment without reperfusion. There is a correlation between infarct size and concentrations of TNF-alpha and IL-6.
Asunto(s)
Interleucina-6/sangre , Infarto del Miocardio/sangre , Factor de Necrosis Tumoral alfa/análisis , Adulto , Anciano , Anciano de 80 o más Años , Creatina Quinasa/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/terapia , Terapia TrombolíticaRESUMEN
Angioplasty and bypass surgery have become standard methods of treating patients with symptomatic coronary atherosclerosis but restenosis remains the major limitation of percutaneous coronary revascularization. In pharmacological management of restenosis after coronary intervention multiple agents have been tried, with mostly discouraging results. Aspirin, dipyridamole, ticlopidine, heparin. Hirudin, and warfarin has failed to show beneficial effects on restenosis. Of all antithrombotics, only an inhibitor of the platelet IIb/IIIa integrin, which may lead to early vessel changes, leading to decrease restenosis. Antiproliferative agent (trapidil and angiopeptin) and probucol have also resulted in improved restenosis rate. In patients after bypass surgery with some degree of hyperlipidemia intensive lipid-lowering therapy is beneficial in slowing the late progressions of atherosclerosis as well as graft occlusion.
Asunto(s)
Angioplastia/métodos , Arteriosclerosis/cirugía , Puente de Arteria Coronaria/métodos , Enfermedad Coronaria/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Falla de Prótesis , HumanosRESUMEN
Adrenomedullin is a potent vasodilator and natriuretic peptide that may an important role in cardiovascular disease. To investigate the role of adrenomedullin in the pathophysiology of congestive heart disease, plasma levels of adrenomedullin were measured in patients with congestive heart failure. Venous blood samples at rest were obtained before and after treatment from patients with congestive heart failure in New York Heart Association functional class II (n-23), III (n-26) and IV (n-14) and from normal subjects (n-30). Plasma adrenomedullin, endothelin-1,2, and atrial natriuretic peptide were determined by radioimmunoassay, plasma noradrenaline by radioenzymatic assay. Left ventricular ejection fraction was measured by echocardiography. The mean plasma level of adrenomedullin in normal subjects was 8.2 pmol/l, tended to be increased in patients with congestive heart failure those in class II (12.9 pmol/l) and were significantly increased in classes III and IV (21.3 and 29.9 respectively). Plasma adrenomedullin was correlated strongly with endothelin-1,2, atrial natriuretic peptide, and noradrenaline, and relatively weakly with left ventricular ejection fraction. Plasma adrenomedullin levels significantly decreased after treatment. These findings indicate that plasma levels of adrenomedullin are elevated in congestive heart failure and may be involved in the defense mechanism against further peripheral vascular resistance elevation in congestive heart failure.
Asunto(s)
Insuficiencia Cardíaca/fisiopatología , Péptidos/sangre , Adrenomedulina , Anciano , Factor Natriurético Atrial/sangre , Ecocardiografía , Endotelina-1/sangre , Endotelina-2/sangre , Femenino , Insuficiencia Cardíaca/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Norepinefrina/sangre , Radioinmunoensayo , Volumen Sistólico , Resistencia VascularRESUMEN
Considering the limited results achieved up to now in the treatment of advanced ENT-cancer, with the classic customary procedures, the AA. suggest a new therapeutic schedule (within the concurrent radio-chemotherapy context) in which the selected cytotoxic drug, the carboplatin, is a part of each therapeutic fraction. A group of 36 patients suffering advanced ENT-cancer (2 cases stage III and 34 stage IV) were studied between Mars 1993 and September 1995, and the outcomes assessed after a 18 months mean follow-up (30 months maximum). There were 11% surgically rescued cases, being the full dosage administered twice daily 8.050 cGy plus 700 mg carboplatin. Tolerance was very good, so 100% of the patients received a complete treatment. Initial response was also fine resulting 93% full remissions on primaries, 96% on neck adenopathies (6% surgical rescues). Regarding the actuarial control after 30 months were controlled 88% of neck adenopathies, control loco-regional amounted for 69%, control on primaries 63% and actuarial survival amounted 55%. The AA. drawn out 10 conclusions, underlining the good tolerance of the therapeutic sketch proposed, because the antineoplastic results are by far better than those experienced with whichever modality of management of tumors of these sites and staging.
Asunto(s)
Antineoplásicos/uso terapéutico , Carboplatino/uso terapéutico , Fraccionamiento de la Dosis de Radiación , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Neoplasias de Cabeza y Cuello/radioterapia , Neoplasias Orofaríngeas/tratamiento farmacológico , Neoplasias Orofaríngeas/radioterapia , Neoplasias de los Senos Paranasales/tratamiento farmacológico , Neoplasias de los Senos Paranasales/radioterapia , Neoplasias Faríngeas/tratamiento farmacológico , Neoplasias Faríngeas/radioterapia , Adulto , Anciano , Terapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de NeoplasiasRESUMEN
Angiotensin-converting enzyme (ACE) inhibitors are now established drugs in the treatment of hypertension and heart failure. The renin-angiotensin-aldosterone system is complex and acts as a circulating hormonal system, a local endogenous tissue system and neuromodular. Current experimental evidence suggests that ACE inhibitors reduce the risk associated with atherosclerotic cardiovascular disease. The antiatherogenic action of ACE inhibitors is related to complex effects mediated by these agent, including an antiproliferative and antimitotic action, beneficial effects on endothelial function, plaque-stabilizing effects and the action of these agents on the sympathetic nervous system. The role of ACE inhibitors in preventing the clinical sequale of atherosclerotic cardiac disease has been evaluated in various patient populations. Several small trial assess the effects of ACE inhibitors in severity of angina pectoris have reported conflicting results, with benefit is some patients and no benefit or even exacerbation of angina in others, indicating that ACE inhibitors do not have consistent antianginal effects in short-term study. ACE inhibitors have the theoretical potential to prevent restenosis after PTCA but they do not prevent restenosis and has no effect on overall clinical outcome. New data suggest that ACE inhibitors may be effective therapy fir patients following acute myocardial infarction. The renin-angiotensin system, is activated during new myocardial infarction and has an impact on the process of remodeling of the left ventricle which causes ist dysfunction and heart failure. In most of the large mortality trials the rationale for early treatment with ACE inhibitors after myocardial infarction was stated. ACE inhibitors have a positive effect in preventing the ventricular dilatation and they reduce the rate of reinfarctions and the mortality rate.
Asunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Enfermedad Coronaria/tratamiento farmacológico , Enfermedad Coronaria/fisiopatología , Humanos , Pronóstico , Recurrencia , Sistema Renina-AngiotensinaRESUMEN
Hypertension is an important risk factor for vascular disease. Primary goal of hypertension treatment is to prevent or delay the onset of blood pressure-related morbidity and mortality. It has been well demonstrated that the responses rate to any single class of antihypertensive agent, give as monotherapy is approximately 45% to 55%, and in half of hypertensive population a second will be required. The data from clinical trials clearly demonstrate that two-drug combination, usually with low-dose diuretics with any one of the other first-line agents increases the response rate to about 80% to 85% and reduces the likelihood of adverse events and alteration in lipid, carbohydrate and electrolyte metabolism. Of the various combinations being given that of an diuretic and ACE inhibitor, and ACE inhibitor and non-dihydropyridine calcium channel blockers seems particularly attractive. Some combinations are inappropriate, such as diuretic and calcium channel blockers, and beta-blocker with verapamil and diltiazem. Combination of ACE inhibitor and a non-dihydropyridine calcium channel blockers may provide benefit in regression left ventricular hypertrophy diabetic nephropathy, and post myocardial infarction.
Asunto(s)
Antihipertensivos/administración & dosificación , Hipertensión/tratamiento farmacológico , Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Bloqueadores de los Canales de Calcio/administración & dosificación , Quimioterapia Combinada , HumanosRESUMEN
Disturbances of Na(+)-K(+)-ATPase activity in patients with respiratory insufficiency may cause the hypertonia of non-striated muscles, which leads to increased peripheral resistance or bronchoconstriction, and also may inhibit the uptake of catecholamines and therefore may intensify their action on the respiratory and circulatory systems. All this is very harmful in respiratory insufficiency. The aim of the study was the examination if there are any changes in sodium efflux through lymphocytic cell membrane in patients with chronic respiratory insufficiency and if retraction of insufficiency can influence the activity of Na(+)-K(+)-ATPase. The study was performed in 40 patients with chronic respiratory insufficiency, of these 11 were women aged from 58 to 72 years and 29 were men aged from 62 to 77 years. Control group consisted of 31 healthy persons, of these 9 were women aged from 37 to 55 and 22 years were men aged from 21 to 60 years. In the study we included patients with exacerbation of chronic obstructive pulmonary disease (COPD). Blood samples were obtained during the exacerbation of COPD and after partial improvement. We determined arterial blood gases and rates of total, ouabain-sensitive and furosemide-sensitive sodium efflux through lymphocytic cell membrane in venous blood. The rates of sodium efflux were estimated with the method described by Haegerty et al. In the study we showed that in patients with exacerbation of COPD rates of total and ouabain-sensitive sodium efflux through lymphocytic cell membrane were decreased, but after improvement of the disease these rates normalized. In patients with exacerbation of COPD rates of furosemide-sensitive sodium efflux were normal. Disturbances of activity of Na(+)-K(+)-ATPase in patients with exacerbation of chronic pulmonary insufficiency are due to hypoxia.
Asunto(s)
Enfermedades Pulmonares Obstructivas/metabolismo , Linfocitos/metabolismo , ATPasa Intercambiadora de Sodio-Potasio/metabolismo , Adulto , Anciano , Membrana Celular/efectos de los fármacos , Membrana Celular/metabolismo , Femenino , Furosemida/farmacología , Humanos , Linfocitos/efectos de los fármacos , Masculino , Persona de Mediana Edad , Ouabaína/farmacología , Sodio/metabolismoRESUMEN
One of the reasons of ventricular arrhythmias and coronary artery spasms in patients with acute myocardial infarction (AMI) may be the lower Na(+)-K(+)-ATPase activity, which causes decrease of potassium intracellular concentration and increase of calcium intracellular concentration. The aim of the study was the examination of the rate of sodium efflux through the lymphocytic cell membrane in patients with AMI after thrombolytic therapy. The survey was made in 50 patients with AMI after thrombolytic therapy: 30 of them with reperfusion (group I) and 20 without reperfusion (group II). The control group consisted of 31 healthy persons. Rates of total, ouabain-sensitive and furosemide-sensitive sodium efflux through the lymphocytic cell membrane were measured before thrombolysis, then 3 and 5 days after, using the method elaborated by Haegerty et al. All patients were treated with aspirin, glyceryl trinitrate and thrombolysis therapy with alteplase (r-TPA). In all patients with AMI rates of total and ouabaine-sensitive sodium efflux through the lymphocytic cell membrane were decreased, but rates of furosemide-sensitive sodium efflux were normal. In patients after thrombolytic therapy with reperfusion, 3 and 5 days after thrombolysis the decreased rates were normal, but they were still decreased in patients without reperfusion.