Enhancement of myocardial energy potentials in man by glucose-insulin treatment before and after ischaemic heart arrest

Thirty-six patients undergoing aortic valve replacement were investigated to ascertain whether the addition of glucose-insulin before and after ischaemic heart arrest could aid to the functional recovery of hearts following global ischaemia. One group of patients (n = 14) received glucose plus insulin from the onset of anaesthesia until crossclamping of the aorta (1 g + 1.5 U/kg bw X h). A second dose (0.5 g + 1.0 U/kg bw) was given at the end of ischaemia. 22 patients, serving as control received glucose in the same manner but without insulin. Needle biopsies from the left ventricular apex region were obtained: before starting cardiopulmonary bypass; at the end of ischaemia; and after 10 minutes of reperfusion and analyzed for its content of ATP, CP ADP and lactate. In both groups ATP and CP were significantly decreased after ischaemia and increased after reperfusion. ADP and lactate levels were elevated after ischaemia and decreased after reperfusion in the insulin-group but not in the control-group. During the total investigation period ATP- and CP-concentrations in the insulin-group were higher compared to the control-group, whereas ADP and lactate of the control-group were above the insulin-group.     

Enoximone, a new phosphodiesterase inhibitor: the spectrum of applications during heart surgery--a comparison with dobutamine

During cardiac surgery treatment of deterioration of myocardial function is usually based on catecholamines. Development of selective phosphodiesterase-(PDE-)III-inhibitors seems to be a new aspect in treating myocardial dysfunction. Therefore the hemodynamic effects of the new PDE-inhibitor enoximone were investigated in 20 coronary surgery patients unable to be weaned from extracorporeal circulation (ECC) without pharmacological intervention (MAP less than 60 mmHg, CI less than 2.00 l/min.m2, PCP greater than 15 mmHg). After controlled reperfusion with 2.4 1/min.m2 two groups were separated in a random sequence receiving either 0.5 mg/kg enoximone as a bolus (n = 10), or dobutamine (n = 10, 5 micrograms/kg.min) as perfusion. In the dobutamine-group MAP and CI (-14%) were decreased, while HR was increased significantly (+30%). Application of enoximone was followed by a slight increase in CI (+5%), a significant decrease in TSR while HR remained almost unchanged. PCP, too, differed significantly between the groups (enoximone: -38%; dobutamine: -10%). Ten minutes after weaning from ECC additional pharmacologic therapy (calcium, vasodilators, epinephrine) was necessary in eight dobutamine treated patients in contrast to four patients in the enoximone group (calcium, epinephrine). In patients with impaired myocardial performance during weaning from ECC enoximone seems to be an alternative therapy and is judged to be of some advantage compared to dobutamine application in this situation. The mechanism for improvement appears to be enhanced contractility owing to its positive inotropic effects, as well as a decrease in left ventricular outflow resistance resulting from peripheral vasodilation.     

Arztbesuch und Medikamenteneinnahme wegen rheumatischer Beschwerden

Zusammenfassung Zwischen Mai 1986 und November 1987 wurden 4037 zufällig ausgewählte deutsche Einwohner Hannovers im Alter von 25 bis 74 Jahren postalisch nach rheumatischen Beschwerden, Arztbesuch und Medikamenteneinnahme befragt. 3426 Personen (85%) sandten einen auswertbaren Fragebogen zurück. 1828 (53%) gaben für den Befragungstag («heute») rheumatische Beschwerden an. Die grössten Anteile beschwerdebelasteter Personen fanden sich bei Frauen mittleren Alters mit einem Maximum bei den 50- bis 54jährigen. Beim Krankheitsverhalten (Arztbesuch während der letzten 12 Monate, Medikamenteneinnahme während der letzten 7 Tage) übte der Umfang der rheumatischen Beschwerden den entscheidenden Einfluss aus, das Geschlecht war hier ohne, das Alter von sehr geringer Bedeutung. Je mehr Fragen nach rheumatischen Beschwerden bejaht wurden, um so höher war der Anteil derjenigen, die angegeben hatten, einen Arzt aufgesucht beziehungsweise ein Medikament eingenommen zu haben. Dennoch antworteten von den maximal beschwerdebelasteten Probanden auf die Frage nach einem Arztbesuch 10%, nach der Einnahme antirheumatischer/analgetischer Medikamente 41% mit nein.

---

Physician consultation and use of drugs because of rheumatic complaints

Summary Between May 1986 and November 1987 we asked 4037 randomly sampled 25–74 year old german residents of Hannover (FRG) by a mailed questionnaire for back, neck and joint pain, for joint swelling and morning stiffness. Further we asked for the consultation of a pysician during the past 12 months and for the use of drugs during the past 7 days because of rheumatic complaints. 3426 members of the sample (85%) returned the questionnaire. 1828 (53%) reported at least one symptom «today» (= «the day you fill out this questionnaire»). The highest rate of persons suffering from complaints of the locomotor system was found among middle-aged women, with the maximum of 74% in the age group 50–54 years.For the illness behavior-physician consultation, use of drugs-the extent of complaints was of decisive importance. Sex was without, age of very low influence. The rate of those who reported the consultation of a physician and/or the use of drugs was increasing with the amount of positive answers to the questions on rheumatic complaints. Nevertheless, of those who had answered in the affirmative all questions on complaints, 10% had denyed the question on physician consultation, 41% had denyed the question on the use of analgetic/antirheumatic drugs.

---

Consultation médicale et prise de médicaments pour plaíntes de nature rhumatismale

Résumé Entre mai 1986 et novembre 1987, un échantillon représentatif de 4037 habitants de Hanovre, de nationalité allemande et âgés de 25 à 74 ans, a été interrogé par questionnaire postal sur les affections rhumatismales, les visites médicales et la prise de médicaments. Parmi les 3426 répondants (85%), 1828 (53%) font mention d'une plainte rhumatismale au jour même de l'interview. La plus grande partie des personnes se plaignant sont des femmes d'âge moyen, avec un maximum entre 50 et 54 ans. Du point de vue de la consommation de soins (consultations médicales durant les 12 derniers mois, prise de médicaments durant les 7 derniers jours), l'importance des plaintes rhumatismales est décisive, alors que ni le sexe ni l'âge ne semblent avoir un effet déterminant. Il existe une relation directe entre le nombre de réponses positives aux questions concernant des plaintes de nature rhumatismale et la consultation médicale d'une part, la prise de médicaments d'autre part. On relèvera cependant que dans le groupe présentant des plaintes maximales, 10% n'avaient consommé aucune consultation médicale et 41% n'avaient pris aucun médicament anti-rhumatismal ou analgésique.

     

Blood conservation in cardiac operations. Cell separation versus hemofiltration

The effects of hemoconcentration performed during and after extracorporeal circulation by either centrifugation (cell separation group, n = 20) or hemofiltration (n = 20) were investigated in 40 patients undergoing elective aorta-coronary bypass grafting. Interest was focused on the quality of the blood concentrated from the blood remaining in the extracorporeal circuit and on the reaction of the patients after retransfusion of the concentrated products. Hemofiltration was easy to perform and produced whole blood quicker than the cell separation technique. Coagulation studies revealed no significant differences in heparin concentration, levels of fibrinogen and antithrombin III, or platelet counts. Various coagulation parameters tended to normalize completely and more quickly after hemofiltration than after centrifugation. None of the patients had severe bleeding postoperatively. Free hemoglobin levels were not affected by hemofiltration; elastase concentration was higher only immediately after retransfusion of the concentrated blood, with no effect on organ function. We conclude that both methods were effective means of hemoconcentration during extracorporeal circulation and in salvaging the diluted pump blood after extracorporeal circulation. Loss of plasma fraction is an important disadvantage in the centrifugation technique, which can be avoided by hemofiltration; derangement in colloid osmotic pressure and coagulation parameters was less pronounced after hemofiltration. Costs were lower, as well. Therefore, when a high volume of cardioplegic solution and two-stage cannulation are used, hemofiltration seems to be the method of choice for blood conservation during cardiac operations.     

Enzyme-linked immunosorbent assay for detection of Streptococcus pneumoniae antigen.

An enzyme-linked immunosorbent assay (ELISA) was developed for the detection of Streptococcus pneumoniae polysaccharide antigen in cerebrospinal fluid and serum. Sensitivity and specificity were determined for purified antigen preparations. Specificity was also evaluated in the rabbit meningitis model, and the sensitivity was compared to counterimmunoelectrophoresis, using the infected rabbits' cerebrospinal fluid and serum. The ELISA was a specific technique for detecting S. pneumoniae antigen. ELISA was 25 times more sensitive than counterimmunoelectrophoresis for purified antigen and resulted in an increased positivity of the cerebrospinal fluid and serum from infected rabbits. ELISA should prove very useful in the diagnosis of pneumococcal infections.     

Pediatric assist with the Medos and Excor systems in small children

Pediatric long-term ventricular support with paracorporeal assist devices is performed in only a few institutions. We report on our experience with two pediatric paracorporeal devices, which have been implanted in neonates, infants, and small children. Seven children with ages ranging from 2 weeks to 6 years and a body weight of 3 to 19 kg were provided with either a Medos or a BerlinHeart System. The underlying heart diseases included dilative cardiomyopathy (n = 3), endocardial fibroelastosis (n = 2), Ebstein anomaly, and status post redo aortic valve replacement (n = 1). All children were in New York Heart Association class IV and were inotrope dependent. Three children were provided with a Medos system and 4 children with a BerlinHeart Excor device. In 6 cases, left ventricular support, and in 1 case, right ventricular support was performed. All patients were stabilized with univentricular mechanical support. The perioperative course was uneventful, and end-organ function was well recovered. Reexploration for bleeding and evacuation of mediastinal blood clots was necessary in all three neonates but not in any of the older infants. Severe thromboembolic events were only noticed in the neonates. Successful bridge to transplantation was performed in 6 of the 7 patients (87.5%). Our late results have been quite encouraging, as they readily prove that pediatric long-term mechanical support is possible with a high quality of life and an acceptable low complication rate.     

Heart transplantation after Fontan's procedure with bilateral cavopulmonary connections

We present a young female patient with three caval drainages after complete Fontan's procedure and with bilateral bidirectional cavopulmonary connections who underwent orthotopic heart transplantation. Instead of reconstructing the hypoplastic innominate vein the persistent left superior caval vein was reanastomosed via the recipient's coronary sinus into the right atrium.     

The influence of body temperature on transient evoked otoacoustic emissions

Thirty patients undergoing open heart surgery under induced hypothermia had transient evoked otoacoustic emissions (TEOAE) recorded during cooling to 26.07 degrees C (standard deviation (SD) 4.25 degrees C) vesically measured temperature and 24.86 degrees C (SD 4.7 degrees C) nasopharyngeally measured temperature respectively. Subsequently tè patients were rewarmed until normal body temperature was reached again. There was a clear influence of body temperature on the amplitudes and reproducibilities of the TEOAE. The relationship of temperature and amplitude or reproducibility during the cooling phase was significantly different from that during rewarming. No TEOAE were measurable during cooling at a mean temperature lower than 33.41 degrees C (SD 2.04 degrees C) vesical temperature and 30.16 degrees C (SD 3.0 degrees C) nasopharyngeal temperature respectively. During rewarming the echoes became recognizable again at a mean temperature of 28.75 degrees C (SD 3.38 degrees C) vesical temperature and 27.49 degrees C (SD 2.99 degrees C) nasopharyngeal temperature. These results suggest a hysteresis in the relationship between the amplitude of TEOAE and temperature, similar to the well-established relationship between evoked potentials and temperature.