Combined treatment with selective beta1 adrenoblockaders and beta2 adrenostimulants in patients with myocardial infarction associated with chronic obstructive lung diseases

The effect of selective beta 1-adrenoblocker metoprolol, used alone or in combination with selective beta 2-adrenostimulant terbutaline, on hemodynamic and gas exchange parameters was examined in 30 patients with acute myocardial infarction (MI) and attendant chronic pulmonary obstructive diseases (CPOD). Severe gas exchange and intracardiac hemodynamic disorders, conducive to right-ventricular decompensation, were demonstrated in this category of patients. Selective beta 1-adrenoblockers can be used as part of combined treatment for MI under the monitoring of external respiration parameters in patients with mild bronchial obstruction and moderate hypoxemia, whereas in MI patients with severe respiratory insufficiency and gas exchange disorders, the treatment with beta 1-adrenoblockers can aggravate those. Combined use of metoprolol and brikanil produces a number of favorable ventilatory and hemodynamic effects, conducive to the stabilization of clinical condition in MI patients with attendant CPOD and limits the risk of complications.     

Program for interpreting acid-base disorders and assessing blood oxygenation

The paper describes a program for the interpretation of deviations in the acid-base state (AAS) and the estimation of the blood oxygenation levels. The program was developed for the Iskra-226 microcomputer and is intended for a direct measurement of the gas composition of the blood. The program makes it possible to calculate the AAS and the blood oxygenation levels (20 parameters), to estimate the AAS deviation type and the degree of its compensation, it accumulates and stores the patient data, keeps records of case histories.     

Antigen expression in different parenchymal cell types of rat kidney and heart

Rat glomerular epithelial, and mesangial and tubular cells were isolated by steel meshes of different pore sizes and enzymatic treatment. Rat heart endothelial cells were isolated by enzymatic disaggregation. Endothelial, glomerular mesangial, glomerular epithelial and tubular cells were cultured in Minimum essential medium until they reached confluency (5 to 9 days). These different rat parenchymal cell types were characterized by morphology and antibody stainings. Endothelial cells were characterized by factor VIII positivity and mesangial cells were desmin positive. Both glomerular epithelial and tubular cells expressed the brush border and Tamm-Horsfall antigens, but in vivo injected trypan blue accumulated selectively to proximal tubular cells. Class I expression was high (84 to 95% of about 10(5) cells grown in Lab-Tek culture chambers were reactive with anti-class I antibody) in unstimulated endothelial, glomerular epithelial and tubular cells and was even higher (100%) after incubation with gamma-interferon for three days. Mesangial cells expressed class I considerably less in normal state (34%), but gamma-interferon induction upregulated it to 95%. Both the surface and intracytoplasmic expression of class I antigens were upregulated with three-day gamma-interferon treatment. Class II expression was low in all unstimulated cells (5 to 10%). The three-day gamma-interferon treatment upregulated both surface as well as cytoplasmic expression of class II antigens in all cell types.     

Hemodynamic aspects of the treatment of patients with "critical ischemia" of the lower extremities

A complex examination of 60 patients with different stages of disturbances of blood circulation (by the Fontain classification) with chronic arterial insufficiency was performed. Specific features of regional hemodynamics were revealed in patient with "critical ischemia" (3rd and 4th stages of the disease). Threshold values of the "critical ischemia" were determined, most informative of them being the malleolus index and oxygen pressure on the foot. An analysis of results of the investigation in the dynamics of the treatment performed has shown possible effectiveness of restorative operations in treatment of patients with severe stages of chronic arterial insufficiency.     

Screening or diagnostic: markedly elevated glucose loading test and perinatal outcomes.

OBJECTIVE: To determine the diagnostic value of markedly elevated 50-g glucose loading test results (>or=200 mg/dL) and associated perinatal outcomes. METHOD: This was a retrospective cohort study of 14 771 pregnancies screened for gestational diabetes mellitus (GDM) between 1988 and 2001. The positive predictive value of the 50-g oral glucose loading test (GLT) results as measured by plasma glucose value was examined. Perinatal outcomes were assessed for women with GLT results >or=200 mg/dL compared to GLT <200 mg/dL, stratified by the diagnosis of GDM. Statistical comparisons were made using the Chi-square test and Student's t-test and potential confounding factors were controlled for using multivariable logistic regression analyses. A p value <0.05 and 95% confidence intervals were used to indicate statistical significance. RESULTS: The positive predictive values for a GDM diagnosis were 62% for GLT results between 180 and 189 mg/dL, 79% for those between 200 and 209 mg/dL, and 100% for GLT results >or=230 mg/dL. Compared to women with a GLT result <200 mg/dL, among women not diagnosed with GDM but with a GLT >or=200 mg/dL the adjusted odds ratio (aOR) for cesarean delivery was 4.18 (95% confidence intervals, 1.15-15.2). These women also had higher aORs for preterm delivery <32 weeks (aOR = 8.05 (1.02-63.6)), shoulder dystocia (aOR = 15.14 (1.64-140)), and their neonates were more likely to have a 5-minute Apgar score <7 (aOR = 6.41 (1.23-33.3)). For women diagnosed with GDM and with a GLT >or=200 mg/dL, the aOR for cesarean delivery was also elevated compared to those with a GLT <200 mg/dL (aOR = 2.24 (1.19-4.21)). CONCLUSION: A GLT value of >or=200 mg/dL is not absolutely diagnostic for gestational diabetes but is associated with unfavorable perinatal outcomes.