Individually controlled aspirin in the long-term treatment of patients with chronic arterial diseases

A simple method of measuring the biological effect of acetylsalicylic acid (ASA), based on the determination of the disaggregation rate (DR) of platelet aggregation induced by adenosine diphosphate (ADP), is described. The DR was found to correlate with the inhibition of the production of malondialdehyde (MDA) by platelets (r = 0.66, P less than 0.001). Therefore, the DR was used for laboratory monitoring of the ASA effect. The study included 63 arteriosclerotic patients--patients with ischemic heart disease (IHD), peripheral arterial disease (PAD), or cerebrovascular insufficiency (CVI) -- who were analyzed before treatment and after receiving ASA in an individually controlled dosage. Before treatment the authors found an increased level of MDA and a longer euglobulin clot lysis time in patients when compared with healthy volunteers (n = 16). Extremely different doses of ASA were required to normalize initially elevated MDA levels in patients. Normalization of the MDA level corresponds to a DR of at least 50% (in comparison with 0-13% without treatment). When judging the ASA dose individually from the 50% DR, the authors demonstrated that there were no differences in the levels of cyclooxygenase- and lipoxygenase-derived eicosanoids between healthy volunteers (n = 16) and arteriosclerotic patients receiving 100-250 mg (n = 18), 500 mg (n = 17), or 750-1500 mg ASA per day (n = 6). Thus, their results support the idea of using individually controlled ASA as the most promising way of resolving the "aspirin dilemma" and provide a simple and reproducible method of measuring the biological effect of ASA.

[Behavior, personality and cardiovascular diseases]

An epidemiologic study of 1019 males, aged 45 to 59, included clinical and psychologic assessment, using Jenkins' questionnaire (JAS) and Freiburg personality identification questionnaire (FPI). Myocardial infarction survivors differed significantly from normal individuals by a number of psychological scores, such as depression, psychosomatic disturbances, anxiety, emotional lability. Anginal patients typically featured impulsiveness, psychosomatic disturbances, depression, anxiety, reserve, emotional lability. The examination of behavior determinants of arterial blood pressure in adolescents, based on cluster analysis, identified 3 groups of individuals with different behavioral syndromes. The clinical implication of these psychologic clusters was essential intercluster differences in terms of systolic and diastolic arterial blood pressure.

Bilateral atrial myxomas. Surgical correction after echocardiographic diagnosis

A case is reported of bilateral atrial myxomas diagnosed noninvasively by echocardiography and successfully removed. The excised tumor mass consisted of a mobile right atrial myxoma prolapsing into the right ventricle and a less mobile, not prolapsing myxoma in the left atrium. The operation was performed entirely on the basis of echocardiographic findings, which correlated well with the operative results. Further investigation by computer tomography verified the diagnosis, but added no extra information of importance for therapy. Diagnostic aspects of the combined application of M-mode and cross-sectional echocardiography with Doppler echocardiography are emphasized. Postoperative follow-up echocardiography showed the complete removal of the myxomas and improvement of cardiac function.

Life stress and hypertension

Based on psycho-physiological, clinical and epidemiological studies, essential arterial hypertension is considered to be a consequence of an inadequate 'person-environment fit', objectively, subjectively or both. Besides genetic predisposition, salt intake, obesity and physical inactivity, psychological factors--among them 'hyper-reactivity' of the sympathetic nervous system, predisposing behaviour patterns and stressful life-events--should be taken into account in reaching a better understanding of the causes, prediction and prevention of hypertension. It was demonstrated that a maladaptation in various functional systems, even to minor psycho-emotional stress, is an important pathogenetic link between environment, objectively defined stressors and blood pressure regulation from the earliest phases of the disease. Implications for further research and behavioural interventions, together with other lifestyle-related factors, are discussed for improving the population-based health care in cardiovascular disease in the G.D.R.

Comparative study of the blood pressure effects of four different vegetable fats on young, spontaneously hypertensive rats

Following the suckling period, four groups of male four-week-old spontaneously hypertensive rats (SHR) were fed semisynthetic diets with 14% (by weight) of either sunflower seed oil [46% 18:2(n-6); linoleic acid (LA)-rich], linseed oil [62.5% 18:3(n-3) + 12.9% 18:2(n-6); alpha-linolenic acid (LNA)-rich], evening primrose oil [9.2% 18:3(n-6) + 71% 18:2(n-6); gamma-linolenic acid (LNA)-rich] or hydrogenated palm kernel fat [1.5% 18:2(n-6); polyunsaturated fatty acid (PUFA)-deficient], respectively, up to an age of 18 wk. All diets enriched with PUFA provoked an attenuation of hypertension development. The effect was lowest in the LA-rich group and highest in the gamma-LNA-rich group. Differences in fatty acid composition of renal phospholipids between groups reflect the fatty acids present in the respective dietary fats. Renomedullary production of PGF2 alpha was significantly reduced in alpha-LNA-rich and slightly diminished in gamma-LNA-rich fed rats. Aortic formation of 6-keto-PGF1 alpha and TXB2 was increased in animals fed the gamma-LNA-rich diet. Thus, the attenuation of hypertension development cannot be explained only by changes in prostanoid formation. Other mechanisms possibly involved should be pursued.

Different changes of n-6 and n-3 fatty acids in adipose tissue from spontaneously hypertensive (SHR) and normotensive rats after diets supplemented with linolenic or eicosapentaenoic acids

In spontaneously hypertensive (SHR) and normotensive rats of the Wistar-Kyoto (WKY) and Wistar-Schönwalde (WSCHOE) strain, diets supplemented with n-3 fatty acids of different chain length (alpha-linolenic acid, LNA--C 18:3, n-3 with linseed oil and eicosapentaenoic acid, EPA--C 20:5, n-3 with cod liver oil) were fed over a period of 22 weeks. After the LNA-rich diet, among the long-chain n-3 fatty acids EPA in epididymal adipose tissue remained unchanged, whereas docosapentaenoic (DPA) and docosahexaenoic acids (DHA) fell. The n-6 fatty acids linoleic (LA) and arachidonic acid (AA) both appeared decreased. After the EPA-rich diet, all n-3 fatty acids, i.e. not only EPA, DPA and DHA, but also LNA were augmented when compared with controls fed commercially available pellets. Among the n-6 fatty acids LA was extremely depressed, whereas AA appeared increased. The p/s-ratio was elevated after the LNA-rich diet, but decreased after the EPA-rich diet. The data indicate a differential effect of dietary n-3 fatty acids of different chain length on the supply of other n-3 fatty acids, of LA and AA as well as on the p/s-ratio in adipose tissue of rats. Blood pressure was not influenced by either diet in either SHR or in both normotensive strains of rats.

Influence on serum lipids, lipoproteins and blood pressure of mackerel and herring diet in patients with type IV and V hyperlipoproteinemia

Eight patients with type IV and V hyperlipoproteinemia were put on a mackerel and herring diet of an isocaloric regimen for 2 weeks, in a cross-over design. At the end of the dietary periods a predominant increase of eicosapentaenoic acid (EPA - C20:5, n-3) in cholesterol esters and of docosahexaenoic acid (DHA - C22:6, n-3) in serum triglycerides, being more pronounced after mackerel as compared to herring diet, could be confirmed. After mackerel diet serum triglycerides and total cholesterol were significantly lower, returning to basal levels 3 months later. High density lipoprotein (HDL) cholesterol appeared slightly increased after mackerel diet and decreased to initial values thereafter. After herring diet, which contained half as much EPA as compared to mackerel diet, the differences were minor. The decline of free fatty acids (FFA) and insulin at the end of the mackerel period reached the level of significance 60 min and 120 min, respectively, after glucose load. A significantly lower systolic blood pressure in recumbent and upright position after the mackerel period could be found, whereas diastolic pressure and blood pressure after herring diet remained unchanged.

Blood pressure lowering effect of eicosapentaenoic acid-rich diet in normotensive, hypertensive and hyperlipemic subjects

A mackerel diet or a herring diet in which two cans of fish fillet were consumed daily over 2 weeks within a prescribed regimen, in a crossover design, were given to 15 normotensive volunteers, 14 patients with mild essential hypertension and eight patients with type IV and V hyperlipoproteinemia (HLP). In normotensives a markedly lower systolic and diastolic blood pressure at the end of the period on the mackerel diet could be observed, whereas in hypertensive and hyperlipemic subjects only systolic blood pressure was significantly decreased. After the herring diet, which served as control, changes in blood pressure were of a minor degree.

Granulocyte lysosomal factors and plasma elastase in uremia: a potential factor of catabolism

In uremic intoxication proteolytic activity in plasma and striated muscle is enhanced. To get further insights into the underlying mechanisms the lysosomal factors of polymorphonuclear (PMN) leukocytes and the plasma elastase-alpha 1-proteinase inhibitor complex were investigated in patients with acute and chronic renal failure. Lysosomal activity was evaluated in peripheral blood smears by the lysis of erythrocytes and plasma (halo formation) around each neutrophil induced by 0.25 M NaC1 borate buffer. In about half of the patients with chronic renal insufficiency on dietary treatment lysosomal activity of PMN leukocytes was reduced. The plasma concentration of elastase-alpha 1-proteinase inhibitor complex was normal in most subjects, but increased in three patients with the highest serum creatinine levels (greater than 13 mg/d1). In the patients with acute renal failure (ARF) of various origin (postoperatively, septicemia, pancreatitis, or dye-induced) halo formation was either reduced or absent. The plasma elastase-alpha 1-proteinase inhibitor complex was increased in 5/6 of the patients by a factor of two to four. Also in the patients on regular hemodialysis treatment halo formation of PMN leukocytes was substantially reduced, whereas the plasma levels of elastase-alpha 1-proteinase inhibitor complex was slightly increased. The finding of reduced lysosomal activity of PMN neutrophils in uremia may be partly due to an enhanced release of neutral proteinases into the circulation as indicated by the elevated plasma levels of elastase-alpha 1-proteinase inhibitor complex in some patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Release of granulocyte neutral proteinases in patients with acute and chronic renal failure

In uremic intoxication proteolytic activity in plasma and striated muscle is enhanced. To get further insight into the underlying mechanisms the neutral proteinases of polymorphonuclear (PMN) leukocytes were investigated in patients with acute and chronic renal failure. The following studies were performed: 1. Neutral proteolytic activity of PMN neutrophils in blood smears (according to Klessen, 1978). 2. Serum levels of elastase alpha 1 proteinase inhibitor complex (Neumann et al., 1981). In about half of the patients with chronic renal insufficiency on dietary treatment the proteolytic activity of PMN leukocytes (halo formation are due to digestion of erythrocytes and plasma) was reduced. The serum concentration of elastase alpha 1 proteinase inhibitor complex was normal in most subjects, but increased in 3 patients with the highest serum creatinine levels (greater than 13 mg/dl). In the patients with acute renal failure (ARF) of various origin (postoperatively, septicemia, pancreatitis or dye induced) halo formation was either reduced or absent. Serum elastase alpha 1 proteinase inhibitor was increased in 5/6 patients by a factor of two to four. Also in the 15 patients on regular hemodialysis treatment halo formation was substantially reduced, while the serum levels of elastase alpha 1 proteinase inhibitor complex was slightly increased. The finding of reduced proteolytic activity of PMN neutrophils in uremia is probably due to an enhanced release of proteinases into the circulation as indicated by the elevated serum levels of elastase alpha 1 proteinase inhibitor complex in some patients. The release of proteinases might be in part due to the effect of "uremic toxins". In the RDT patients the contact of the blood with the dialyzer (cuprophane) membrane might be an additional factor. In the patients with ARF the underlying disease (infection, shock, trauma) contributes to the release of proteinases. These disturbances may be harmful for the patient, if the blood concentration or function of the most important proteinase inhibitors (alpha 1 proteinase inhibitor, alpha 2 macroglobulin) is reduced.

Morphological and Functional Aspects of Heart Homograft Adaptation to Hamster Cheek Pouch

Atrial homografts from newborn hamsters, transplanted into cheek pouches of adult Syrian golden hamsters, were studied using intravital and electron microscopy. Half of the transplants survived up to 1 year, performing spontaneous pulsatile activity. The transplants could be influenced by β-receptor activating or blocking substances applied intravenously to the host animal. For morphological analysis homografts were taken 3, 6, and 12 months after transplantation. Irregular arrangement of the myofibers occurred, and the T system was seen to be replaced by plasmalemmal and sub-plasmalemmal vesiculations. There was some evidence for hypoxia in the grafts. Dedifferentiation of atrial cardiocytes, somehow resembling smooth muscle cells, is discussed. Despite these morphological changes the specific contractile function of the grafts was preserved.

Proteolytic enzymes and catabolism: enhanced release of granulocyte proteinases in uremic intoxication and during hemodialysis

Proteinases are classified into four groups according to their catalytic mechanisms: the serine, cysteine (thiol), aspartic (carboxyl), and metallo-proteinases. Neutrophil granulocytes contain a variety of neutral proteinases and two acid proteinases. Lysosomal proteinases are released from cells during phagocytosis, cell death, or exposure to antigen-antibody complexes, complement factors, and toxins. Under pathological conditions, massive proteinase release may cause tissue injury and degradation of plasma proteins. Plasma proteolytic activity is controlled by inhibitors of blood systems (antithrombin III, C1 inhibitor, and plasmin inhibitor) and by inhibitors against proteinases of various body cells (alpha 1-proteinase inhibitor, alpha 1-antichymotrypsin, beta 1-collagenase inhibitor, and inter-alpha-trypsin inhibitor). Intracellular proteinases are controlled by different cytosolic inhibitors. In hypercatabolic states (septicemia, trauma, burns), the concentrations of many plasma proteins, including proteinase inhibitors, are decreased. Kallikrein-kinin, complement, and fibrinolytic systems may be activated, probably due to enhanced proteinase activity. In acute renal failure, there is a release of granulocyte neutral proteinases. The plasma concentration of the elastase-alpha 1-proteinase inhibitor complex is simultaneously increased. Granulocytes of chronically uremic patients treated with diet or regular dialysis have a slightly to markedly reduced proteinase content as compared with normal controls. There is a dramatic rise of the plasma elastase alpha 1-proteinase inhibitor complex during hemodialysis treatment.

[Post-traumatic cholecystitis]

Post-traumatic cholecystitis occurs mostly in young males 8-16 days after severe injury. Gallstones are of no importance in its pathogenesis. Circulatory shock causes severe damage to the small bowel and the liver, particles of the destroyed cells becoming endogenous toxins. Presumably an increased excretion of lysosomal proteases in the biliary duct takes place. This excretion reaches the gallbladder via the accessory ducts and may cause necrosis. Pain in the right upper quadrant, septic temperature and an increase of leucocytes, bilirubin and gamma-GT in the serum suggest this complication.

[Unfolding of the brain and secondary mandibular joint and face development in mammals: a synergetic and synchronous event]

The connection of phylogenesis and ontogenesis is discussed in terms of the interdependence of the development of face, secondary mandibular joint, and brain. The results show that phylogenesis can be explored from preadaptations which become functionally effective during ontogenesis. Therefore phylogenetically "old" functions will not be eliminated but functionally changed and then integrated into new ones. This is discussed as "synergetic events". Changes in the genetic material cannot be correlated with these functional changes, they are acausally connected. This is termed "synchronizition". Synergetic and synchronistic events together cause new functions thus forming archetypical organisms continuing evolution. It is further discussed that the essential role of ontogenesis during phylogenesis could be facilitated by an immaturity of the genome in the early embryological stages.

An evaluation of coronary regulation by the 99mTc bolus technique

A new non-invasive method for investigating total coronary blood supply is presented. This method is based on the principle of indicator dilution of a radio-nuclide bolus (99Tc), requiring a scintillation camera with high sensitivity and high picture resolution. The first findings obtained from 83 patients are shown. With 4.61 +/- 1.19% of cardiac output the mean values of the rates of coronary perfusion obtained at rest in subjects with a normal heart differed significantly from those obtained for patients with certain coronary occlusions (8.18 +/- 3.99% of cardiac output) and from those obtained for hypertensive patients (Stages I-III). Double examinations carried out on 20 patients yielded an adequate reproducibility. The mean deviation of the double examinations from one another was 16%.