[Diagnostic significance of CK-MB isoenzyme in the early phase of myocardial infarction].
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Biomedical subjects
Publications and source records attributed to F Dienstl.
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Professional or spare time contacts with electrical appliances are, due to careless handling or technical inadequacies, potentially always associated with electrical injuries. The effects of the electric current on the body depends mainly on voltages: skin and muscle lesions predominate in high voltage injuries. Out of 23 patients, 19 with electrical injuries and 4 with lightning accidents, 18 showed normal ECGs at the time of hospital admission. There were no changes at follow-up. The remaining 5 patients had cardiac arrhythmias which disappeared after 1 1/2 to 36 hours using bedrest and symptomatic treatment only. Cardiac longterm monitoring is thus not required after electrical injuries.
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The serum myoglobin level was performed before as well as two and four hours following the beginning of intravenous tocolysis in 22 pregnant patients who were treated with the betasympathicomimetic agent, hexoprenalin because of premature labour. In six of the patients a rise of 26--140% in myoglobin was observed in comparison with the basal level. One of the patients even produced a twenty-fold rise. The value of serum myoglobin determination in the diagnosis of myocardial necroses is discussed with respect to the literature and the presented material.
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Fifty pregnant women admitted consecutively on account of threatened abortion or premature labour and treated with Ritodrine and Verapamil intravenously in the usual dosage were investigated with respect to creatine kinase activity and, in the event of a raised level, its isoenzyme creatine kinase--MB. Determinations were carried out before treatment and, in accordance with expected peak values in case of myocardial necrosis, after 6 and 12 hours. Three pathological values were recorded and these are discussed individually. Furthermore, statistical evaluation of the recorded values showed no significant differences.
After 12 cases of open-heart surgery serum activities of CK and CKMB have been registrated. To make a more exact statement about myocardial damage the portion of CKMB out of the CK-activity has been evaluated by the way of a mathematic programm. The results verify the statement that after aortic valve replacement the CKMB portion is higher than the average, and that after intraoperative complications the highest CKMB portions have been reached. No myocardial infarction occurred.
Fifty pregnant women admitted consecutively on account of threatened abortion or premature labour and treated with Ritodrine and Verapamil intravenously in the usual dosage were investigated with respect to creatine kinase activity and, in the event of a raised level, its isoenzyme creatine kinase--MB. Determinations were carried out before treatment and, in accordance with expected peak values in case of myocardial necrosis, after 6 and 12 hours. Three pathological values were recorded and these are discussed individually. Furthermore, statistical evaluation of the recorded values showed no significant differences.
The serum level of the myocardial-specific isoenzyme of creatine phosphokinase, CK-MB was determined in 50 patients with severe multiple injuries or following extensive surgery. It is concluded that whenever the proportion of CK-MB exceeds 10% of the total creatine phosphokinase activity myocardial damage has occurred, especially since equivalent ECG changes were registered in this group of patients.
Upon chemotherapy with daunorubidomycin and cytosinarabinoside, a patient suffering from acute promyelocytic leukaemia during the 28. week of pregnancy achieved complete haematological remission. In spite of complicating disseminated intravascular coagulopathy and aggressive chemotherapy a normal child was delivered by cesarian section during the 34. week of pregnancy. Specific problems in the treatment of acute leukaemia during pregnancy are discussed.
The paper deals with a new aspect in patients with polytrauma using a method to distinguish between myocardial or skeletal muscle damage. The isoenzyme CKMB of kreatine kinase is found to be characteristic for myocardial damage when increasing to more than 10% of the whole enzyme activity. It should be mentioned that this elevation is also seen in other disorders. Therefore the correlation to ECG changes is important in considering the diagnosis.
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This paper reports the case of a 55-year-old patient with complete obstruction of the aorta between the left common carotid artery and the left subclavian artery. The arterial blood supply to the lower half of the body is provided by extensive collateral networks in the region of the right hemithorax, the neck and the base of the brain. Only 10 similar cases appear to have been described in the literature; our patient seems to be the oldest so far.
The effect of 0.5 mg Ouabain (O) i.v. on sinus node function and on intracardiac conduction was studied by His bundle electrography and atrial stimulation. 7 patients with normal sinus node function and av conduction (group I), 5 patients with sick sinus syndrome (group II), and 5 patients with av block of changing degree (group III) were examined. 2 additional patients had simultaneous sinus node dysfunction and av block (group II/III). The sinus node recovery time was prolonged in 6 patients, the av block was located proximal to the His bundle in 4 patients and distal to the His bundle in 3 patients. The spontaneous sinus rate decreased in group I and remained unchanged in group II and III after O. The PA interval increased slightly after O in groups II and III, the AH interval during sinus rhythm was prolonged after O in groups II and III and in the whole group together. During atrial pacing, the stimulus-His-time was increased in each group when compared at identical stimulation rates. In 4 of 7 patients av block type Wenckebach appeared at a lower stilmulation rate after O. The HV interval remained unaltered after O, the sinus node recovery time varied after O. Phenytoin had no positive effect on the changes observed after O. Unwanted actions of O such as increased bradycardia or increased av conduction disturbances were not observed. O appears to be reasonably safe in most patients with sick-sinus syndrome and changing av block.
The effect of an intravenous bolus of 1 mg/kg Ro 11-1781, a new calciumantagonist, on sinus node automaticity and intracardiac conduction was studied by His-bundle electrography and atrial stimulation. During sinus rhythm, no significant action of Ro 11-1781 on rate, P-A-interval, A-H interval, and H-V-interval was observed. The sinus node recovery time remained unaltered. On atrial stimulation, the St-H-interval was significantly (p less than 0.001) prolonged after Ro 11-1781. Wenckebach Periods occurred at lower stimulation rates in all patients after Ro 11-1781. It is concluded that Ro 11-1781 prolongs av nodal conduction and may be of therapeutic value in the treatment of supraventricular arrhythmias.
In 1971 a population-based Ischaemic Heart Disease (IHD) Register was established in the Innsbruck area as part of the WHO international collaborative study. Demographic and geographic data covering the area, as well as the locally-applied methods are described. One hundred and seventy four cases (133 males and 41 females) of acute myocardial infarction (AMI) were registered in the age group 20-64 years. This corresponds to an annual incidence rate of 1.9(0/00) in men and 0.6(0/00) in women. These results confirm indications from the national mortality statistics that Innsbruck belongs to the group of areas in Europe with a relatively low incidence of AMI. The epidemiology of AMI in Europe is discussed. The frequency distribution of AMI according to month of the year, day of the week and hour of the day is reported for this area.
A patient with chronic active hepatitis developed vomiting, dyspnoea, tachycardia, diarrhoea and diffuse pains. For several years she had been treated with azathioprine and for a few weeks before admission with phenformin for mild diabetes. Laboratory examination revealed acute disseminated intravascular coagulation and lactacidaemia. Despite intensive treatment the patient died a few hours after admission, the post-mortem examination revealing diffuse pulmonary haemorrhages. The present case report and those published in the literature suggest that phenformin should not be given to diabetics who also have renal or hepatic disease. In any case, if phenformin is given, it should be stopped if hepatic, renal, infectious or thrombotic complications occur. In these cases and those of sudden unexplained deterioration in diabetics, hospitalisation is essential and lactic acid levels should be determined and coagulation tests performed.