Central and peripheral levels of plasma catecholamines, cortisol, insulin and non-esterified fatty acids

Circadian variations of interleukin 6 in coronary circulations of patients with myocardial infarction

We hypothesize that higher morbidity of patients with ST-segment elevation myocardial infarction (STEMI) in the out-of-office hours differences in outcome after myocardial infarction may depend on the concentrations of inflammatory cytokines. The aim of the study was to determine the relation between the time of percutaneous coronary intervention (PCI) and local concentration of interleukin 6 (IL-6) and its soluble receptors (sIL-6R and sgp130) in patients with STEMI.

METHODS AND RESULTS

The study included 32 patients with invasively treated left anterior descending artery occlusion and no significant co-morbidities. Blood samples were drawn from coronary sinus and aorta before and after intervention. Patients admitted in the afternoon (13-20) presented significantly higher mean IL-6 levels in all samples than patients admitted in the morning. There was a positive correlation between time of intervention and concentrations of IL-6 in all samplings, but also with transcardiac IL-6 gradient at the end of procedure and IL-6 increase during PCI. We did not find any significant association between time of PCI and concentrations of sIL-6R and sgp130, time from pain to balloon, angiographic parameters or medical history.

CONCLUSIONS

Coronary concentration of IL-6 in patients with STEMI is significantly higher in the afternoon than in the morning. This might be involved in increased morbidity of those patients.

Urethral supersensitivity and occult urethral neuropathy

The phenomenon of postural increases in urethral tone in patients with neuropathic bladder dysfunction has been investigated and, using the technique of simulated alterations in posture, a humoral response of urethral smooth muscle has been demonstrated. Serial measurements of circulating catecholamines have shown that a close correlation exists between the contraction of urethral smooth muscle and the variations in circulating catecholamines brought about as part of cardiovascular homeostasis. Identical urethral responses have been recorded in a group of neurologically intact patients who have urethral outflow obstruction, and it is speculated that these patients may have an occult urethral neuropathy.

Outflow obstruction in neuropathic bladder dysfunction: the neuropathic urethra

Urethral pressure profiles were recorded in a series of patients with traumatic lesions of the spinal cord producing vesico-urethral dysfunction. Patients were classified into groups depending upon the relationship of the lesion to the sympathetic outflow to the bladder and urethra from the spinal cord. Using alpha-adrenergic blocking agents, the smooth muscle contribution to the maximum urethral pressure was ascertained in each group and differences in both the configuration of the profile, and the smooth muscle component, were found. Increases in the maximum urethral pressure in response to a change in posture were also investigated, and the extent of the increase found to vary according to the level of the spinal lesion in respect of the sympathetic outflow, and with the integrity of the sacral cholinergic reflex arcs. The hypothesis that these changes may be due to urethral "decentralisation supersensitivity" from alterations in circulating catecholamine levels is suggested.