Near-total reduction in verapamil bioavailability by rifampin. Electrocardiographic correlates

We evaluated the significance of the interaction between rifampin and verapamil in six volunteers who received single doses of verapamil, 10 mg intravenously (IV), then 120 mg orally two days later. Subjects were then given rifampin, 600 mg orally every day for 15 days. After 13 and 15 days of rifampin therapy, the IV and oral doses of verapamil were repeated. Electrocardiograms (ECG) were done and serum verapamil and norverapamil concentrations measured before and for 12 h after each dose. For IV verapamil, there was a small decrease in area under the serum concentration-time curve and an increase in clearance after rifampin therapy (p less than 0.05). There were no changes in elimination half-life, volume of distribution, or AUC for percentage of change in P-R interval-time curve (AUCPR). For oral verapamil, there were marked decreases in peak concentration, AUC, oral bioavailability (all p less than 0.005), and AUCPR (p less than 0.001) after rifampin treatment. There were no changes in time to peak concentration or elimination half-life. For oral verapamil, significant P-R interval prolongation occurred only before treatment with rifampin. The decrease in oral bioavailability and the abolition of ECG response confirm that a highly significant drug interaction exists between rifampin and verapamil given orally but not intravenously.     

Evaluation of the function of mitral valve prosthesis by non-invasive methods

The study was undertaken to examine the correlation between the parameters of central hemodynamics and mitral valve prosthesis functions which were obtained by invasive techniques, as well as these of physical working capacity, hemodynamics, and blood by noninvasive methods at rest and during bicycle ergometry in the graded exercise test. An examination was made of 24 patients every 0.5-8 years (mean 3.2 years) after replacement of mitral valves by xenobioprostheses. "Oxygen pulse" and cardiac index defined during exercise highly correlated with prosthetic mid-diastolic pressure gradients. A moderate correlation was found between dry erythrocytic mass and total pulmonary blood flow resistance. The findings may be useful for the early diagnosis of prosthetic dysfunctions.     

Prognostic significance of pathological and biological factors in hepatocellular carcinoma

Prognostic factors in hepatocellular carcinoma (HCC) conventionally consist of staging with the tumour node metastasis system and grading by tumour cellular differentiation. There are also other factors useful in prognostication but most of them are clinical. With new discoveries in the pathobiology of cancers and introduction of new medical technology, pathological and biological factors of HCC in relation to prognosis have been studied quite extensively. Morphological features of the tumour, both gross and histological, have been found to be significantly related to tumour recurrence and patient survival. Recently, applications of new antibodies and techniques have enabled studies on cellular proliferation using different antibodies such as those for proliferating cell nuclear antigen and Ki-67 protein. These studies on cellular proliferation, as well as assessment of argyrophilic nucleolar organizing regions, have been shown to provide good prognostic significance. Flow cytometric studies on DNA ploidy and studies on expression of genes including the p53 gene, hormone receptors and others show less unanimous results in their prognostic significance. The influence of gender on survival is also reviewed. In conclusion, pathological and biological factors are useful and help to guide clinicians in the management of patients and in assessment of long-term prognosis.     

Effect of glutaraldehyde preservation on immunogenic,physicomechanical, and functional parameters of artificial aortic heart valves

Bulletin of Experimental Biology and Medicine -     

Thyroid diseases in reproductive-age women living in Shoria mountains

AIM: To analyze prevalence and structure of thyroid pathology in women of reproductive age living in Shoria mountains. MATERIAL AND METHODS: The examination of 409 women aged 18 to 40 living in mountain Shoria included assessment of social status, heredity, actual nutrition, visit to endocrinologist, ultrasound investigation of the thyroid, tests for thyroid hormones (TTH, T3, T4) in the serum, antibodies to microsomal fractions, iodine concentrations in the morning urine. RESULTS: Significant prevalence of thyroid diseases (62.3%), high rate of diffuse nontoxic goiter of the second degree (18.0%), nodular nontoxic goiter (11.8%), autoimmune thyroiditis (6.3%), hypothyroidism (5.5%), low median of iodine excretion with urine in women refer mountain Shoria to the zone of goiter endemia. CONCLUSION: Among migrants thyroid morbidity is significantly higher than among the native population. Eradication of goiter endemia will promote reproductive health in this region.     

Trimetazidine effects on postinfarction remodeling of the left ventricle

AIM: To study effects of combined therapy including trimetazidine on morphofunctional indices of the left ventricle (LV). MATERIAL AND METHODS: Seventy five patients with primary macrofocal myocardial infarction (MI) were randomized into two groups: 38 patients of group 1 received combination of bisoprolol, a beta-adrenoblocker, and analapril, an ACE inhibitor, in individually adjusted dose under control of blood pressure (BP) and blood creatinine; 37 patients of group 2 received the same combination and trimetazidine in a dose 70 mg/day for 6 months beginning on postinfarction day 7-10. Each group contained a subgroup treated with systemic thrombolytic streptokinase at admission. MR imaging (MRI) and cine-MRI assessed morphofunctional L V parameters. RESULTS: A 6-month therapy with trimetazine resulted in a significant regress of the morphofunctional alterations associated with LV remodeling in postmyocardial infarction patients. CONCLUSION: Combined treatment including systemic thrombolysis with streptokinase within MI hours 0-6, trimetasidine on MI day 7-10 plus 6 months significantly inhibits pathological postinfarction LV remodeling.     

Comparative characteristics of stress tests--bicycle ergometry test and psycho-emotional test--in patients with ischemic heart disease

AIM: To compare efficacy bicycle exercise (BE) and psychoemotional tests (PET) in provoking myocardial ischemia and arrhythmia in patients with acute and chronic forms of ischemic heart disease (IHD). MATERIAL AND METHODS: BE and PET (mathematical count test) were performed in 108 IHD patients. 30 patients had stable effort angina (FC II-III), 48 patients had progressing effort angina and 30 patients were at the subacute stage of myocardial infarction. RESULTS: PET was less efficient in detection of myocardial ischemia but is more adequate in detecting episodes of painless ischemia and ventricular rhythm disorders compared to BE. The greatest differences in efficiency of the tests occurred in patients with acute forms of IHD. CONCLUSION: Application of different stress tests in IHD patients raises efficacy of detecting episodes of painful, painless myocardial ischemia and rhythm disorders, specifies mechanisms of coronary failure development.