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Explore the source record for details and available documents.
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In clinical studies stress-induced myocardial ischemia in patients with coronary artery disease is used to evaluate the severity of this disease. The discussion on the importance of some parameters measured during this intervention is controversial, other parameters are difficult to obtain. On the basis of an experimental model of stress-induced myocardial ischemia, we tried to find an index that reflects best this cardiac state. We therefore compared in eight anesthetized open-chest dogs control conditions with three other hemodynamic states with increasing imbalance between myocardial oxygen demand and oxygen supply: severe stenosis on circumflex coronary artery, 60 s cardiac sympathetic nerve stimulation (CSNS) with a severe stenosis on circumflex coronary artery, and 60 s complete occlusion of circumflex coronary artery. Using a one-way analysis of variance, we found two significantly changed parameters during the stress-induced ischemia: Regional lactate extraction was turned to production (32 +/- 4 vs. -4 +/- 1%) and the ratio of dP/dtmin to dP/dtmax was decreased (1.13 +/- 0.05 vs. 0.67 +/- 0.05; control vs. CSNS with a severe stenosis on circumflex coronary artery). We conclude that the ratio of dP/dtmin to dP/dtmax is an easily accessible, sensitive, and dynamic index for characterization of an stress-induced myocardial ischemia.
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Peritoneal dialysis treatment is as efficient as hemodialysis if properly administered; therefore, psychological aspects of peritoneal dialysis must be taken into account if this is to be the best treatment for patients suffering from terminal renal disease. This paper presents these aspects from the view of logotherapy and existential analysis. The description of the change in viewing patients from a medical aspect is followed by an outline of basic logotherapy and existential analysis. The consequences to patients and their current problems are described, together with theoretical basics and practical guidelines for communication with patients.
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Spinal neurons, lethally challenged with excitatory amino acids (EAAs) or with high-K+, underwent a biphasic rise in free intracellular calcium concentration ([Ca2+]i). In contrast to the initial rise in [Ca2+]i which recovered, the secondary, irreversible [Ca2+]i increase was unaffected by antagonists of EAA receptors or Ca2+ channels. Also, it correlated highly with cell death, but preceded vital staining with trypan blue and ethidium homodimer, reflecting damaged cellular Ca2+ regulation rather than plasma membrane leakiness. Our findings suggest that delayed Ca2+ overload is the end-product rather than the cause of Ca(2+)-triggered neurotoxic processes.
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To investigate whether high bone turnover could be a predictor of cortical bone loss and a candidate risk factor for fractures of the proximal femur, 33 7.5-mm transiliac biopsies taken at fracture fixation from 48 patients who participated in a study of potential risk factors have been quantitated. Twenty-four of the 33 patients made good recoveries and about 6 weeks postoperatively consented to bone densitometry of the forearm midshaft. Forearm bone density correlated negatively (r = 0.77, P = 0.001) with the surface of trabecular bone covered with osteoid, which in osteoporotic patients with crush fractures of the vertebrae was previously shown to relate both to rates of bone formation and resorption. An important minority of these femoral fracture patients appeared to be suffering from high rates of iliac trabecular bone resorption. Thus, high bone remodelling activity could lead to excessive cortical thinning. This has pathogenetic implications which may be clinically important.