Correlation between hydroperoxide-induced chemiluminescence of the heart and its function

The isolated perfused rat heart emits a spontaneous ultraweak chemiluminescence. When the perfusion is stopped, light emission decreases, indicating the dependency of this phenomenon on aerobic metabolism. Emitted chemiluminescence was markedly enhanced following perfusion with 0.05 mM H2O2 or cumene hydroperoxide or tert-butyl hydroperoxide; substitution of O2 for N2 in the gassing mixture of the perfusion media significantly lowered photon emission. Lipid peroxidation, which is known to be associated with chemiluminescence, was evaluated by HPLC analysis of peroxidized and unperoxidized heart phosphatidylcholines. During hydroperoxide perfusion, coronary flow and heart rate progressively decreased, while lactic dehydrogenase was released after complete cardiac arrest. The resultant morphology of this damage corresponds to the so-called 'stone heart', a pattern already described in both human and experimental pathology.

Effect of metoclopramide on serum growth hormone levels in cirrhotic men

Growth hormone (GH) secretory response to metoclopramide (MCP) administration was evaluated in 9 male patients with liver cirrhosis and in 6 normal controls. As expected, MCP did not modify serum GH concentrations in normal subjects. In contrast, a striking GH secretory response to MCP was observed in 5 out of 9 cirrhotics. In the other four patients serum GH levels did not show any variation after MCP. The different behavior between cirrhotic "responders" and "non responders" can not be interpreted on the basis of the medical history or the clinical and laboratory data. Three hypothesis are proposed: i) The effect of MCP could be promoted by estrogens and inhibited by androgens. ii) False neurochemical transmitters could affect dopaminergic system of some cirrhotics, allowing or inhibiting the GH response to MCP. iii) MCP could stimulate GH secretion by a serotonergic mechanism. These findings provide further evidence of a modification of the GH secretory pattern in patients with cirrhosis of the liver.

Nutrition in acute renal failure

The nutritional value of regimes enriched with branched chain amino acids has been evaluated in 22 adult patients suffering from acute post-traumatic renal failure. The study was carried out for 12 days. The following data were recorded and compared daily: nitrogen balance, daily blood urea nitrogen (BUN), BUN/creatinine ratio, and plasma albumin levels. Also after 6 days of dialysis and nutritional support, the plasma medium molecular weight compounds (uremic toxins) were studied. It was concluded that: (a) the combined use of parenteral and oral nutrition appears most adequate in this type of patient; (b) the nitrogen intake should provide an essential amino acid/total nitrogen ratio of greater than or equal to 4 and a branched chain essential amino acid ratio of greater than or equal to 0.5; and (c) caution is still necessary in interpreting analyses of middle molecular weight compounds in this type of patient.

Anticatabolic properties of branched chain amino acids in trauma

The anticatabolic properties of branched chain amino acids enriched protein solutions in 22 patients with multiple trauma have been evaluated. Nitrogen balance, nitrogen output, the daily change of blood urea nitrogen, plasma albumin and total protein levels were recorded daily. Each 2 days free amino acids and 3-methyl histidine urinary concentrations were measured. The results obtained in the study suggest that in trauma patients high ratios of essential amino acids/total nitrogen are needed and that amino acid solutions enriched in branched chain amino acids are most effective in preventing muscle catabolism and promoting protein synthesis.

Plasma and cerebrospinal fluid amino acid patterns in hepatic encephalopathy

Plasma and cerebrospinal fluid amino acid levels wee measured in 12 cirrhotic patients in grade 0 hepatic encephalopathy and 17 in grade 3-4 hepatic encephalopathy. In 5 of these patients amino acid determinations were performed during the evolution of the encephalopathy. No correlation was found between the degree of hepatic encephalopathy and the plasma amino acid imbalance. In the CSF of cirrhotic patients without encephalopathy, a significant increase was found in nearly all amino acids, including those known to not easily cross the blood-brain barrier; this suggests the presence of a nonspecific modification of the blood-brain barrier permeability. In patients with severe hepatic encephalopathy, the further increase only in cerebrospinal fluid aromatic amino acids and methionine levels suggests the presence of a selective stimulation of the neutral amino acid transport system across the blood-brain barrier. Finally, the good correlation between glutamine and the sum of neutral amino acids found in the cerebrospinal fluid only in the presence of encephalopathy supports the hypothesis that brain glutamine may stimulate neutral amino acid transport across the blood-brain barrier.

The combined use of hyperbaric oxygen, antibiotics and surgery in the treatment of gas gangrene

The clinical course and treatment of 21 critically ill patients suffering from gas gangrene are reported. Analysis of the results has underlined the importance of intensive care and hyperbaric management to prevent the evolution of disease and to improve patients' clinical conditions for surgical procedures.

[Significance of the carcinoembryonic antigen (CEA) in the diagnosis of hepatopathies]

The significance of carcinoembryogenic antigen (CEA) is assessed as a way to obtaining a better definition of neoplasia of the liver and bile ducts, and the spotting of possible malignant degeneration in chronic diseases of the liver. The literature data on involvement of the liver and bile ducts in CEA metabolism are cited, and the results of a study of 419 patients with acute and chronic diseases of varying aetiology and severity, and benign or malignant obstructive icterus are presented. CEA measurements, while associated with a tendency towards high values in liver diseases with major functional damage, do not seem to be differentiating for cirrhosis and Ca-cirrhosis, or between benign and malignant icterus. Dependable diagnosis, therefore, depends on the inclusion of CEA in a battery of tests to be coupled with appraisal of the individual clinical and instrumental findings.

Negative nitrogen balance in cirrhotics. (A correct therapeutic approach)

The aims of this study were: 1. the assessment of the nitrogen balance (NB) in both compensated and encephalopathic cirrhotics, 2. the evaluation of the efficacy of a new therapeutic approach: amino acid solutions enriched with branched chain (BCAA) but poor in aromatic (AAA) amino acids. Solutions containing only BCAA were also employed: 42 cirrhotics were divided into the following groups: 1st group (26 cases), cirrhosis without hepatic encephalopathy (HE); 2nd group (16 cases), cirrhosis with HE. Six patients (23%) in the 1st group showed a positive NB at the beginning; 20 (77%) were negative; 18 of them were fed an oral diet (0.8 g protein/kg/day; 35 cal/kg/day) as a result of which they were brought into a positive NB within 5 days (from - 7.38 +/- 0.95 to + 3.67 +/- 0.46 g N/24 h). In two cases the diet failed to give a positive NB, so it was replaced by a BCAA enriched solution infusion (NB raised from - 1.0 +/- 5.4 g N/24 h). Patients in the 2nd group were put on total parenteral nutrition (TPN); two cases receiving glucose alone achieved a positive NB only when BCAA enriched solutions were added (from - 4.0 to + 3.0 g N/24 h). Four patients treated for 3 days with BCAA alone did not achieve a positive NB; in these cases likewise, BCAA enriched solutions were added in order to achieve a positive NB (from - 0.8 to + 4.2 g N/24 h); all 14 cases treated from the beginning with glucose + BCAA enriched solutions became positive, on average, within 5 days (from - 4.82 +/- 0.89 to + 3.15 +/- 0.61 g N/24 h). In addition to the NB, other parameters (blood ammonia, BCAA/AAA ratio, blood urea, electroencephalograms) and clinical symptoms were beneficially influenced by these solutions.

Time-dependent response of coronary flow to prolonged adenosine infusion: doubling of peak reactive hyperaemic flow

In 11 anaesthetised, Open chest dogs the time course and degree of the coronary vasodilating response to intracoronary adenosine infusion was assessed. Continuous adenosine infusion, at a rate of 2.5 to 13.5 mumol . min-1, produced rapid (15 to 30s) vasodilation of the same degree as that evoked by a 30 s period of ischaemia (reactive peak hyperaemia), a finding reported previously by others. However, continuing the infusion led to further coronary vasodilation, reaching a maximum 20 to 45 min from the beginning of the infusion and remaining constant for up to 2 h, independently of further increases in the dose. This late response produced, on average, vasodilatation twice as great as that observed during reactive hyperaemia and was not associated with any haemodynamic change or with the opening of arterio-venous shunts.

THE RESULTS

1) suggest the existence of a double, time-dependent response of coronary receptor(s) to adenosine; 2) demonstrate, in the presence of a prolonged vasodilating stimulus, a possible increase in coronary blood flow to a degree far beyond that of post-ischaemic reactive peak flow, which is generally considered to be the maximal value of coronary blood flow that can be achieved.

[Serum levels of beta-methyldigoxin and contractile efficiency of the myocardium evaluated with systolic polygraphy and determination of cardiac output]

0.3 mg/day betamethyldigoxin was given per os in three daily administrations to 8 healthy subjects, and 8 compensated and 8 decompensated heart patients. Prior to the treatment, and 6 hr after the last administration, blood digoxin values were determined radio-immunologically, together with cardiac output, systolic stroke volume, cardiac index (dilution of indocyanine green), and systolic time intervals, by simultaneous recording of the ECG, carotid pulse, and the phonocardiogram. No significant change in output, stroke volume and cardiac index was noted in the healthy subjects, whereas these parameters were distinctly improved in the decompensated patients. Changes in the systolic intervals after treatment were significant in all cases though there was no significant correlation with the blood digoxin levels reached. In particular, the healthy and compensated subjects displayed a reduction in the corrected electromechanical systole (delta Q-S2), the corrected pre-ejection period (delta PEP), the corrected left ventricular ejection time (delta LVET), and their ratio (PEP/LVET), whereas in the decompensated patients the picture differed to the extent that the LVET increased owing to an augment-systolic stroke volume, the other parameters being reduced. In the healthy subjects, the polygraphic data were normal prior to the treatment, while in the compensated patients delta PEP and the PEP/LVET ratio were enhanced, and the delta LVET was less than in the normal subjects. It is felt that recording of the systolic intervals may be regarded as a sound method, owing to its simplicity and its ability to demonstrate latent cardiac failure before haemodynamic changes appear. Simultaneous determination of serum digoxin and the polygraphic data, therefore, opens the way to the commencement of appropriate, safe and timely management of as yet non-decompensated heart patients.