[Use of glucose-6-phosphate dehydrogenase and transketolase for characterization of pathologic processes in the myocardium in rheumatism]

In patients with active rheumatism the activity of the key enzymes of the pentose cycle -- glucoso-6-phosphatedehydrogenase and transketolase -- increases in the erythrocytes of the peripheral blood parallel with the severity of the inflammatory lesion of the heart. In patients with distrophic changes in the myocardium without concomitant carditis the level of glucoso-6-phosphatedehydrogenase did not change significantly, while the content of transketolase decreased considerably. Antirheumatic therapy helping to reduce the inflammatory reactions in the heart results in a reduction of the level of pentose cycle enzymes. The study of the ratio between glucoso-6-phosphatedehydrogenase and transketolase may prove valuable for an approximate evaluation of the predominance of inflammatory or dystrophic processes in the cardiac muscle.

Effect of steroid hormone on rheumatic carditis

One hundred and eleven patients with rheumatic carditis of the first attack were treated with steroid hormone. In the cases, in which the steroid hormone therapy started within 2 weeks from the onset of the disease, all except one did not reveal a residual valvular heart disease after 2 years from the treatment. It was suggested that early diagnosis and the earliest start of steroid hormone therapy with large dose on rheumatic carditis is necessary for the prevention against development of rheumatic heart disease. A therapeutic schedule for rheumatic fever is recommended.

[Clinical use of pterofen as a diuretic agent in circulatory insufficiency]

Clinical and laboratory observations were conducted using a new Soviet-made drug Pterophene as a diuretic in 30 patients with circulatory insufficiency. Stage IIB and III. Pterophene was found to produce a distinct natriuretuc and diuretic effect. With its daily intake, the effect has a prompt onset, it increases by the 3rd-4th day of therapy, persists for a long period, slightly decreasing in its potency by the 7th-10th day of its continuous administration. A valuable property of Pterophene is its potassium-retaining effect. The drug is well tolerated by the patients, and it can be combined with other diuretics. Pherophene potentiates the diuretic and natriuretic effect of Hypothiaside, Furosemide and Nuvorite, and decreases potassium excretion that was enhanced by these drugs.

Hypomagnesemia in relation to digoxin intoxication in children

Serum magnesium estimation was done in 19 children who had heart failure of varied etiology. Five of nine toxic patients and three of 10 nontoxic ones had magnesium deficiency (serum magnesium less than 1.5 mEq. per liter). Mean serum magnesium level was significantly lowered (P less than 0.01) in 19 children and it was further lowered in nine toxic patients (P less than 0.001) as well as in eight hypomagnesemic patients (P less than 0.001) than in healthy control subjects. Mean serum digoxin level in toxic patients was significantly higher than in nontoxic ones (P less than 0.05). In three cases magnesium sulfate was successfully used for the management of cardiac arrhythmias.

Penicillin-resistant oral streptococci

The tubular handling of gentamicin (G) and its intrarenal distribution were determined to elucidate the mechanism of G accumulation in the kidney. At a serum level of 11.1 ± 0.5 μg/ml (10 animals), as maintained by constant infusion for 5 h, serum Na⁺ and K⁺, arterial pressure, effective renal plasma flow and glomerular filtration rate remained undisturbed. The clearance values in milliliters per minute for G, inulin, and p-aminohippuric acid were 40.3 ± 1.8, 49.9 ± 2.8, and 132 ± 14, respectively. The ratio of clearance of G to clearance of inulin was 0.82 ± 0.04 (P < 0.005), suggesting net reabsorption of G by the renal tubules. The renal cortex/serum ratio for G was 11.9 ± 2.1, and the medulla/serum ratio was 2.7 ± 0.4, indicating greater uptake of G by the cortex. The extraction ratio of p-aminohippuric acid was 0.74 ± 0.03. In contrast, the extraction ratio of G was 0.20 ± 0.03, which was significantly lower than that of inulin (0.30 ± 0.04). It is concluded that the accumulation of G in the cortex was due to tubular reabsorption. Probably some of the reabsorbed G became trapped in the epithelial cells after crossing the luminal membrane, whereas some returned to the circulation.

[Comparative evaluation of the effectiveness of diuretics]

The study was conducted in 118 patients with cardiac and pulmonary lesions, aged 18 to 75 years. Among the diuretics the leading role belongs to Uregyt, and Lasix, as judged by their natriuretic and diuretic action, then follow Nuvorit, Hypothiaside and Brinaldix. Renese (polythiaside) produces the same diuretic effect as Nuvorit and Hypothiaside. Renese, Hypothiaside, Lasix and Uregyt enhance kaliuresis and often reduce potassium blood plasma concentrations, while Nuvorit and Brinaldix increase kaliuresis least of all, and often increase the potassium blood plasma level. Within two days of discontinuing Thriamterene nearly all body potassium that was retained under the effect of this drug is excreted. Nuvorit, Hypothiaside, Renese, Brinaldix, Lasix, Uregyt cause similar changes in the acid-base balance (respiratory and metabolic alkalosis), and produce no effect upon the acid-base balance rather seldom. Lasix and Uregyt cause metabolic alkalosis more often than other diuretics. Apart from that, Hypothiaside also causes respiratory acidosis in 1/4 of the patients.

[Digoxin concentration in the blood during the treatment of cardiac insufficiency]

Blood concentrations of Digoxin were determined by radioimmuno-assay in 80 patients with different stages of circulatory insufficiency receiving maintenance therapy with Digoxin, 0.25-0.75 mg/day. The range of Digoxin concentration fluctuations is very wide--from 0.25 to 2.4 ng/ml. Some elevation of Digoxin concentration in blood was observed when the dose of the drug was increased, both in different groups of patients, and in the same patients when the maintenance dose was altered. Studies conducted during digitalis intoxication in 4 patients demonstrated different levels of Digoxin concentration in blood--from 0.8 to 2.6 ng/ml. The obtained results permitted to conclude that the concentration of Digoxin in blood has no significance in choosing the optimum therapeutic dose, unless the clinical data are taken into account.

[Treatment of refractory chronic circulatory insufficiency]

An analysis of archives material (1,500 case reports of patients with circulatory insufficiency) revealed that 200 patients (13%) had persistent, refractory circulatory failure. The revealed factors providing for the development of the refractoriness were: relapsing rheumocarditis, pneumonias, pulmonary infarctions in patients with rheumatic heart diseases, extended cicatrical changes in the myocardium of patients with atherosclerotic cardiosclerosis, or the underlying pathological process in cases of idiopathic myocardial lesions. These factors were taken into account, along with individualization of the therapeutic regimens of cardiac glycosides.

[Use of glucagon in cardiac insufficiency]

Data derived from a study into the efficacy of glucagon in 50 patients with acute and chronic cardiac insufficiency are offered. In all of these cases there existed a grave cardiac insufficiency refractory to therapy with cardiac glycosides, mostly attended by deranged rhythm and conduction. Clinical and instrumental investigations (basic hemodynamic indices established through the dye-dilution method and integral rheography, polycardiography) proved glucagon to be a truly cardiotonic agent in dealing with patients of this category. A greater effect was achieved in cases involving acute cardiac insufficiency associated with myocardial infarction than it could be obtained in instances of a long-standing chronic decompensation. The use of glucagon is particularly indicated in cases when cardiac glycosides produce complications, or cannot be employed due to the already existent derangements of the rhythm and conduction.

[Fluid redistribution between the extracellular medium and the cells in the diuretic therapy of cardiac insufficiency]

The antipyrine and thiosulphate spaces were measured in patients with circulatory insufficiency of the II B and III stages before and after medication with cardiac glycosides and diuretics, used in various combinations and in courses of different duration and also in 2-week long courses of treatment with ethacrine acid and aldactone in order to study the nature of changes in the water-electrolyte exchange in cardiac insufficiency following diminution of edemas occurring under the effect of an effective therapy. The main indication of cardiac insufficiency, the expansion of the extracellular space, was found to continue even after a clinically effective treatment and complete disappearance of edemas. When myocardial contractility continues to be at a low level and the aldosterone activity is high--the removal from the organism of a large quantity of fluid with the help of diuretics, while reducing the external clinical manifestations of the edematous conditions, aggravates at the same time the pathological nature of the fluid distribution between the extracellular medium and the cells, this being due, in the main, to the reduction in the amount of fluid in the cells. The differences between ethacrine acid and aldactone find their expression not only in a greater of smaller effectiveness of their diuretic action, but also in the influence which they exert on the regulation of water metabolism in cardiac insufficiency.

[Use of cardiac glycosides in chronic circulatory insufficiency]

Features specific for the action produced by the most widely employed cardiac glycosides (strophanthin, corglycon, proscillardin A, methyl- and acetyldigoxine, isolanide, digoxine and digitoxin) on the hemodynamics, peripheral resistance, electrolyte composition, acid-base equilibrium, the blood adenyl system, etc were studied in 375 patients with different stages of chronic circulatory insufficiency. The data thus made available allowed some suggestions to be made as to the choice of cardiac glycosides, the duration of their application, possible combinations thereof, and also to propose a number of measures aimed at preventing the development of poisoning with cardiac glycosides.

[Treatment of resistant forms of cardiac insufficiency with a combination of diuretics]

The possibility of treating resistant forms of cardiac insufficiency by a combination of furosemide and brinaldix was studied. The efficacy of the diuretics was appraised with reference to diurnal diuresis, sodium-potassium- and chloruresis on the days of taking the diuretics. In making investigations the method of dispersion analysis (permutation trial test) was used. The final results show that the proposed combination (80 mg of furosemide and 40 mg of brinaldix) is effective and warranted in dealing with patients resistant to many diuretics including furosemide. The action of this combination continues for a long time in the presence of signs of cardiac incompetence and is not accompanied by the development of a marked hypokalemia.

[Effect of sodium salicylate on the cerebral blood circulation (an experimental and clinical study)]

The effect of sodium salicylate (100 mg/kg intravenously) on the circulation rate of the cerebral blood flow, total arterial pressure, oxygen tension in the cerebral tissue (by the polarographic method) and on the pressure in the brain venous vessels was studied on anesthetized cats with controlled respiration. In rheumatic patients the action of the drug (10 ml of a 10% solution, intravenously) on the rheoencephalographic findings and the total arterial pressure was investigated. Sodium salicylate was shown to raise the tonicity of the intra- and extracranial vessels, to lower the amplitude of the pulse fluctuations and to highten the total arterial pressure. The cerebral circulation depends upon changes in the tonicity of the cerebral vessels and on the total arterial pressure, i. e. with a significant rise of the latter it increases in spite of a greater vascular resistance. Changes in the blood flow are followed by corresponding variations in the PO2 of the brain tissue. No significant changes of the pressure in the venous system of the brain could be established.