Biomedical subjects
S Lang
Publications and source records attributed to S Lang.
Intraoperative measurement of pericardial constraint: role in ventricular diastolic mechanics.
The pressure of pericardial constraint was measured in 20 patients undergoing elective cardiac surgery (10 in Group I with normal cardiac size; 10 in Group II with cardiomegaly) using a catheter with a collapsible latex end balloon. Right atrial pressure and other hemodynamic variables including right ventricular stroke work index were also measured before and after the pericardium was widely opened. The pericardium was grossly normal in all patients and only small physiologic effusions were present. In Group I mean pericardial pressure was 8 +/- 2 mm Hg as was mean right atrial pressure. In Group II mean pericardial pressure was 6 +/- 2 mm Hg versus mean right atrial pressure of 10 +/- 5 mm Hg (p less than 0.05). Excluding 2 of the 20 patients with outlying data, pericardial pressure showed linear correlation with right atrial pressure (r = 0.689). In Group I right ventricular stroke work index rose from 5.0 +/- 2.0 to 6.4 +/- 2.1 g-m/m2 (p less than 0.01) after pericardiotomy with no significant increase in mean right atrial pressure; similar findings in Group II were consistent with removal of external constraint. Thus, even in the absence of an abnormal effusion the normal pericardium exerts a significant pressure on the heart, which is often similar in magnitude to right atrial pressure. In certain notable exceptions, however, right atrial pressure far exceeds pericardial pressure. Such pericardial constraint has important implications for ventricular diastolic mechanics.
[Rupture of a thoracic aortic aneurysm with esophageal rupture].
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Formation and identification of interfacial-active glycolipids from resting microbial cells.
Resting cells of Arthrobacter sp. strain DSM2567 incubated in the presence of various mono-, di-, or trisaccharides biosynthesized different glycolipids. All eight glycolipids, containing the corresponding carbohydrate moiety and one, two, or three alpha-branched beta-hydroxy fatty acids, were produced when mannose, glucose, cellobiose, maltose, and maltotriose were used as carbon sources in a simple phosphate buffer. The structures of the compounds were elucidated by means of H and C nuclear magnetic resonance spectroscopy and by chemical ionization mass spectroscopy. In high-salinity solution, the substances showed different surfactant properties. Cellobiose and maltose monocorynomycolates reduced the interfacial tension from 42 to 1 mN/m at critical micelle concentrations below 20 mg/liter.
Investigations on the toxicity of bile salt solutions, Capmul 8210 and a bile salt-EDTA solution for common bile duct perfusion in dogs.
The following perfusion media for dissolving bile duct calculi were infused via a cutaneobiliary tube into the biliary tract of 12 mongrel dogs: 4.3% cholate solution, 0.34% chenodeoxycholate solution, Capmul, GMOC (special formulation of Capmul), BA-EDTA and 0.9% saline. Infusion lasted 50 h. Postmortem examination revealed hemorrhagic, partly phlegmonous cholangitis, acute duodenitis, necrosis and abscesses in the liver. The lesions were most pronounced after the cholate solution and with Capmul and GMOC, but were only detected to a slight extent after BA-EDTA and the chenodeoxycholate solution. 0.9% saline had no side effects. The investigations could demonstrate that it is the very irrigation media that today are recommended for treatment of bile duct stones in patients, that cause considerable morphologic side effects. The alternating administration of an EDTA solution with a Capmul preparation may diminish local toxicity of the latter.
The Yugoslav health system: public ownership and local control.
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Yugoslavia: equity and imported ethical dilemmas.
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[Medical ethics in the curriculum of the School of Medicine at the University in Zagreb].
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[Laboratory procedures with adenoviruses. X. Hemagglutination with glutaraldehyde-fixed erythrocytes].
Erythrocyte preparations from man, rat, and monkey, fixed by glutaraldehyde (0.06%, final concentration, 30 min room temperature), remained agglutinable by various human adenoviruses. While incomplete adenovirus hemagglutinins from species of subgenera A, C, and E did not react with fixed blood cells, the numerous species of subgenera B and D, in which hemagglutination and hemagglutination-inhibition are essential for identification, did so. Fixed blood cells were also agglutinable by indirect hemagglutinins of adenovirus 9 and 11; hence, hemagglutination-enhancement tests with fixed blood cells are feasible. Fixed blood cells remained stable and agglutinable up to one year; they could also be lyophilized.
[Ethical problems in medicine--how they are thought of and viewed by the teachers at the Medical School of Zagreb].
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[The conditions and problems of informing women about cancer of the reproductive organs].
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[Esophageal carcinoma in Croatia].
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Histamine release and hypotensive reactions in dogs by solubilizing agents and fatty acids: analysis of various components in cremophor El and development of a compound with reduced toxicity.
Anaphylactoid reactions in man following administration of drugs solubilized with cremophor El (polyethylenglycolglycerol riconoleate) are a considerable clinical problem. Since these reactions occur in dogs on first exposure and in pigs on second exposure, the 'dog model' was used in this communication to analyse components and chemical modifications of cremophor El and its components for their clinical effects, their hypotensive actions and their histamine-releasing capacity. Two series of experiments in 1978 and 1980 were performed in 144 adult mongrel dogs of both sexes. In these studies histamine release was not related to the effect of the solubilizing agents as tensides and was elicited by rather low doses (about 10--100 mg/kg i.v.). The effect of these substances on blood pressure and on blood histamine levels was connected with distinct chemical features: the most potent compounds were oxethylated and additionally esterified unsaturated or hydroxylated fatty acids. Several phases in hypotensive reactions were observed, including an immediate response, a delayed blood pressure response and a late response about 15--20 min after injection. Only the delayed response was associated with histamine release. The combination of cardiovascular effects and histamine release was fatal on some occasions indicating that histamine release can be dangerous. Compared to cremophor El, the tenside effect was equal, but the toxicity was reduced in oxethylated 12-hydroxystearic acid. It is recommended that this solubilizer should be used in further extended studies in animals and - if these are successful - in clinical trials.
[The new polyclinic--a challenge for the advancement of medicine in the Clinical Hospital Center].
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Circulating reverse triiodothyronine in humans during exercise.
Circulating thyroxine (T4), triiodothyronine (T3) and reverse triiodothyronine (rT3) as well as blood lactate and glucose concentrations were measured in a group of 12 trained volunteer subjects prior to and after swimming 0.18 or 0.9 km, to determine if increase in metabolic activity was accompanied by diversion of T4 monodeiodination from the active (T4 to T3) to the inactive (T4 to rT3) pathway. The resting T4, T3, and rT3 levels were 8.5 micrograms . 100 ml-1, 108 ng . 100 ml-1, and 57 ng . 100 ml-1, respectively, whereas after 0.18 km of swimming the corresponding levels were 9.5 micrograms . 100 ml-1, 135 ng. 100 ml-1 and 70 ng . 100 ml-1. After 0.9 km of swimming, T4, T3, and rT3 levels were 9.0 micrograms . 100 ml-1, 126 ng . 100 ml-1, and 66 ng . 100 ml-1, respectively. The swimming was accompanied by hemoconcentration and increase in blood lactate but not in glucose concentrations. In two other investigations thyroid hormones were measured prior to and after 60 or 90 min of moderate exercise on a bicycle ergometer. This exercise had no effect on circulating thyroid hormone levels. Free thyroxine (FT4) concentration and thyroxine binding globulin (TBG) capacity were unaltered after exercise. In conclusion, brief strenuous swimming or moderate bicycle exercise had minor or no effect on thyroid hormone concentrations when consideration was given to the attendant hemoconcentration. Even when exercise induced small T3 and rT3 changes were noted, they were in the same direction (increase) thus demonstrating a lack of diversion of peripheral T4 monodeiodination.
Detrimental incidents, including falls, in an elderly institutional population.
In a Canadian Geriatric hospital, the report forms on the 2,177 untoward incidents occurring during the 1976-78 period were analyzed. The incident and fall rates were respectively 51.1 and 42.7/10,000 patient-days. Falls were the most common incident (82.9 percent). Of the patients who fell, 40.4 percent were over the age of 80 and another 27.5 percent were in the 71-80 age group. The majority fell more than once. Most falls occurred during the waking activity hours, and many were associated with the changing of the position or posture, notably in the course of using a wheelchair. Alcohol was a factor in 4.2 percent of the incidents. Nevertheless, the rate for mortality and serious morbidity were low. Patients' rooms and toilets should receive extra surveillance, and the caretaker staff should exercise special care in the use of wheelchairs and assistive devices. More attention should be given to recording cases of postural hypotension, cardiac arrhythmias or drug side effects.
Identification of a vasoactive substance (vasopressin) in a brain extract containing an unknown inhibitor of Na,K-ATPase.
An endogenous inhibitor of the Na,K pump, postulated to be involved in the etiology of some hypertensive states, has been reported in extracts of mammalian brain. This encouraged us to test its effects on arterial muscles. An acid-acetone extract of guinea pig brain inhibited Na,K-ATPase derived from canine kidney and evoked responses in arterial strips similar to those produced by ouabain. Unlike ouabain, however, it did not prevent muscles in K-free solutions from relaxing when K was re-added. Bioassays on strips of arteries, uterus and portal vein indicated that the extract did not contain sufficient concentrations of norepinephrine, dopamine, serotonin, prostaglandins, angiotensin II, oxytocin or the Na,K-ATPase inhibitor to account for the observed vascular effects. This could not be said of vasopressin. Furthermore, vasopressin and the vasoactive component of the extract were equally sensitive to several peptidases, and conditions which cleave disulfide bridges. A radioimmunoassay verified that the extract contained sufficient vasopressin to cause contractions. Vasopressin did not inhibit the kidney Na,K-ATPase activity. Finally, the Na,K-ATPase inhibitor, but not the vasoactive substance, was present in extracts of vasopressin-deficient Brattleboro rat brains. Therefore, the Na,K-ATPase inhibitor and the vasoactive substance in these extracts were distinctly different.