Transcardiac gradients of N-terminal B-type natriuretic peptide in aortic valve stenosis

BACKGROUND: Plasma B-type natriuretic peptide (BNP), as well as the N-terminal part of the prohormone (Nt-BNP), are frequently elevated in aortic valve stenosis (AS). Yet, their release from the heart into the circulation has never been directly studied in AS. AIM: To assess the release of Nt-BNP in AS with focus on the identification of its main determinants. METHODS: We studied 49 adult patients undergoing preoperative cardiac catheterization for isolated AS. Blood was sampled from the aortic root and the coronary sinus for Nt-BNP determination by immunoassay. RESULTS: The mean (+/-S.E.) transcardiac Nt-BNP step-up averaged 79+/-53 pmol/l in 11 control patients free of structural heart disease, 75+/-32 pmol/l in 31 AS patients free of heart failure (HF), 236+/-62 pmol/l in 8 AS patients with diastolic HF (ejection fraction > or = 50%, pulmonary wedge pressure > 14 mm Hg) and 469+/-66 pmol/l in 7 AS patients with systolic HF (ejection fraction < 50%, wedge pressure > 14 mm Hg) (p<0.001). The transcardiac Nt-BNP gradient was independently associated with left ventricular (LV) end-diastolic pressure (beta=0.47, p<0.001) and ejection fraction (beta=-0.29, p<0.019) and with co-existent coronary artery disease (beta=0.23, p=0.050). CONCLUSION: LV diastolic and systolic dysfunction along with coronary artery disease are likely to be the key determinants of cardiac Nt-BNP release in AS. The transcardiac Nt-BNP gradient increases on average three-fold with the development of diastolic HF and six-fold in systolic HF.     

The meaning of the working cooperative for persons with long-term mental illness: a phenomenological study.

OBJECTIVE: The objective of this phenomenological study was to understand the meanings of the lived experiences of persons with long-term mental illness at a social working cooperative. METHOD: Eighteen participants were interviewed either two or three times while participating in a working cooperative in a community psychosocial rehabilitation program. Data were analyzed and interpreted using the Empirical, Phenomenological, Psychological (EPP) method (Karlsson, 1993). RESULTS: The findings revealed a meaning-structure consisting of one main constituent that characterized the cooperative as a normalizing life-world. Three phases contributed to the normalization process. In the first phase the participants experienced a shift from an unsatisfying occupational context to an enriching occupational life-world. In the second phase participants had the possibility to satisfy some of their occupational and social needs. During this phase, experiences of being productive and needed, commitment to others, development of their skills, and competence in work tasks and social activities were expressed, all of which contributed to personal growth and a more positive view of self. In the third phase, the meaning of the cooperative changed for some participants, who expressed this through their readiness to leave and take a further step into the life-world outside the cooperative. CONCLUSION: The study emphasizes that the cooperative is an important alternative to employment for participants with severe mental illness who do not have the capacity to be employed in the community or who do not want to leave the life-world of the cooperative that gives them pride, joy, and satisfaction.     

Economic outcomes from patients' perspective and health-related quality of life after total hip arthroplasty

The aim of this study was to determine the economic outcomes (service use, health care and nonhealth care out-of-pocket costs) related to total hip arthroplasty from the perspective of patients. Also, examined was the relationship between economic outcomes and health-related quality of life (HRQOL). One hundred patients, 54 female and 46 male, mean age 63.9 (SD 11.6) years, with osteoarthritis in the hip and undergoing primary or revision arthroplasty, participated in this follow-up study. The drop-out race was 13%. Patients' service use, and out-of-pocket costs were recorded, and HRQOL was measured up to 6 months. The Friedman and Wilcoxon nonparametric tests showed that use of home nursing and transportation was most frequent at 1 month, whereas physiotherapy was used most often after 1 month. The Spearman coefficient of correlation, Fisher's, Mann–Whitney U and Kruskal–Wallis tests were used to compare background factors with economic outcomes and HRQOL. Age, pain, gender, civil status, type of surgery and discharge destination showed associations with service use. Healthcare costs composed over 90% of total out-of-pocket costs, and nonhealthcare costs <10%. Age and discharge destination were related to total out-of-pocket costs. Patients' HRQOL improved after surgery. The worse it was before, or after surgery, the more services were used, but no significant correlations between costs and HRQOL were observed. When deciding the timing of surgery, patients' characteristics, especially level of pain and HRQOL should carefully evaluated, as they may predict patients' service use and ability to manage at home after surgery.     

Blood Glucose, Insulin, Antidiuretic Hormone and Renin Activity Response During Caesarean Section Performed Under General Anaesthesia or Epidural Analgesia

Glucose loacling caused a significant increase in insulin response (IRI) in patients undergoing caesarean section, both under general Anaesthesia and under epidural analgesia. After a fast intravenous glucose loacling given j ust before the administration of epidural bupivacaine, similar but more variable serum immunoreactive insulin levels were found as compared with those determined after a slower intravenous glucose infusion in patients under general anaesthesia. Plasma renin activity values did not change significantly in either group, but, differing from general anaesthesia, antidiuretic hormone levels (ADH) increased significantly in patients under epidural analgesia. The changes in IRI and ADH response may be caused by a higher psychic stress reaction of the conscious patients during caesarean section under epidural analgesia.     

Effect of oral contraceptive containing a new progestin (ORG 2969) on plasma renin activity, growth hormone and immunoreactive insulin.

Plasma renin activity (PRA), Growth hormone (GH) and immunoreactive insulin (IRI) were studied in seven healthy subjects during the ovulatory menstrual cycle and during the first and third cycles of oral contraception with 0.05 mg of ethinylestradiol and 0.100 mg or 0.125 mg of a new progestogen, 17 alpha-ethinyl-18-methylene-4-estren-17 beta-ol. The PRA level in the second half of the control cycle was significantly higher than in the beginning of the cycle. At the end of the treated cycles it was significantly higher than at the end of the control cycle. Neither GH nor IRI showed significant changes during the control cycle. GH was significantly higher at the end of the first and third treated cycles than at the end of the control cycle. IRI was significantly higher both in the beginning and at the end of the first treated cycle than the corresponding IRI levels in the control cycle. IRI at the end of the third treatment cycle was not significantly different from corresponding means at the end of the control cycle or the first treated cycle.     

Stimulation of wound healing by the immunomodulator LS-2616 (Linomide)

LS-2616 (Linomide), a quinoline-3-carboxamide, is an immunomodulator that has been suggested to act on macrophage-like cells. Based on a hypothesis that LS-2616 would stimulate macrophages in the wound and affect the healing process, the effects of LS-2616 on developing granulation tissue were evaluated using a wound model in rats. Subcutaneously implanted cylindrical cellulose sponges were used as an inductive matrix for the ingrowth of granulation tissue. LS-2616 was continuously present at a concentration of 1.2 mg/ml in the drinking water either for 7 days before implantation or starting at the implantation of sponges. Seven days after implantation LS-2616 treatment increased the mean amounts of nitrogen and collagen hydroxyproline over the control level 1+20% (p<0.05) and +59% (p<0.05), respectively]. The effect was less pronounced in the rats receiving LS-2616 in advance [+7% (NS) and +38% (p<0.05), respectively]. The mean amounts of nucleic acids and protcoglycans tended to decrease in the rats receiving LS-2616 in advance compared to the control rats [-12% to 13% (NS) and-25% (p<0.05), respectively]. It was concluded that continuous oral administration of LS-2616 enhanced wound repair in the rat. This immunoenhancement of round healing results in increased accumulation of collagen.

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Resumen El LS-2616 (Linomide, una quinolina-3-carboxamida) es un inmuno-modulador que aparentemente actúa sobre los macrófagos y células similares. Con base en la hipótesis de que el LS-2616 podria estimular los macrófagos en la herida y afectar el proceso de cicatrización, se investigaron los efectos del LS-2616 sobre el desarrollo del tejido de granulación utilizando un modelo de herida en ratas. Esponjas cilíndricas de celulosa fueron implantadas en el espacio subcutáneo como matriz de inducción para el crecimiento del tejido de granulación. El LS-2616 se mantuvo continuamente presente en concentración de 1.2 mg/ml en el agua de beber a siete días antes de la implantación o comenzando con la implantación de las esponjas. Siete días luego de la implantación, el tratamiento con LS-2616 incrementó las cantidades medias de nitrógeno y de hidroxiprolina del colágeno sobre los niveles controles (+20%, p<0.05 y+59%, p<0.05, respectivamente). El efecto fue menos pronunciado en las ratas que recibieron LS-2616 previamente (+7%, NS y +38%, p<0.05, respectivamente). Las cantidades medias de ácidos nucleicos v de proteoglicanos tendieron a disminuir en las ratas que recibieron LS-2616 previamente en comparación con las ratas control (-12–13%, NS y-25% p<0.05, respectivamente).En conclusión, la administración oral continua de LS-2616 estimula la reparación de la herida en la rata. Tal immunoincremento de la cicatrización resulta en una mayor acumulación de colágeno.

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Résumé Le LS-2616 (Linomide, une quinoline 3 carboxamide) est un immunomodulateur qui agit probablement sur des cellules macrophage-like. Sclon l'hypothèse que le LS-2616 pourrait stimuler les macrophages dans une plaie et influencer la cicatrisation, les effets du LS-2616 sur le développement de tissus de granulation ont été évalués expérimentalement sur la plaie de rats. Des éponges de cellulose cylindriques implantées en sous-cutanée ont été utilisées pour induire le tissue de granulation. On a administré du LS-2616 par l'intermédiaire de l'eau de boisson des rats à la concentration de 1.2 mg/ml soit pendant 7 jours avant l'implantation soit en commencant le jour de l'implantation. Sept jours après l'implantation, le LS-2616 provoquait une augmentation d'azote et d'hydroxyproline collagène par rapport aux animaux contrôles (+20%, p<0.05 et +59%, p<0.05, respectivement). L'effet était moins prononcé chez les rats recevant le LS-2616 plus précocement (+7%, NS et +38%, p<0.05, respectivement). Les taux moyens d'acides nucléaires et de protéoglycans avaient tendance à décroître chez les rats recevant le LS-2616 précocement par rapport aux rats contrôles (-12–13%, NS et-25%, p<0.05), respectivement. En conclusion, l'administration continue de LS-2616 améliorait la cicatrisation des plaies chez le rat. Le résultat de cette immunomodulation est un stockage de collagène.

     

The relationship between uterine volume, plasma progesterone and intrauterine pressure. A preliminary report

8 nulliparous women, all approximately 15 weeks pregnant, were administered 350 ml Macrodex intraamniotically during a period of 15-30 minutes to increase uterine volume. 4 of the patients aborted following a decrease in plasma progesterone and an increase in resting pressure, active pressure, and oxytocin response. In 2 patients, plasma progesterone increased while resting pressure, active pressure, and oxytocin response did not increase, and pregnancy continued undisturbed. It is concluded that increasing uterine volume may induce a compensatory synthesis of progesterone in the palcenta provided that: 1) the osmotic action of the injected hypertonic solution does not suppress placental function to a degree equal to that of the stimulatory effect of increasing volume; 2) the osmotic increase in volume is slow enough to permit the time-dependent increase in progesteronegenesis; and 3) the increase in intrauterine pressure and clinical progress in abortion does not suppress placental endocrine function. Further experiments are necessary to verify this interpretation.     

Hysterography in evaluating the uterine cavity in patients with endometrial carcinoma

In 49 patients with endometrial carcinoma hysterographic study was performed. This finding was correlated with fractional curettage, hysteroscopy and surgery. The best correlation was noted between hysterography and hysteroscopy. The flow into the tubes or abdominal cavity using low pressure was found in 20% of the cases. In our opinion hysterography is a useful aid when examining the uterine cavity and cervical canal, and, thus, important when planning treatment and determining clinical stage.