Factorial analysis of N-acetylcysteine and propolis treatment effects on symptoms, life quality and exacerbations in patients with Chronic Obstructive Pulmonary Disease (COPD): a randomized, double-blind, placebo-controlled trial

OBJECTIVE

Standard treatment for chronic obstructive pulmonary disease (COPD) includes inhalation therapy along with mucoactive drugs. The aim of this study was to assess the efficacy and safety of orally administered mucolytic N-acetylcysteine and propolis (NACp) in COPD patients.

PATIENTS AND METHODS

A randomized, double-blind, prospective, interventional, 6 months study was conducted at the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia. Effects of daily NACp administration (600 mg, 1200 mg or placebo) on exacerbation, life quality (St. George's Respiratory Questionnaire-SGRQ), symptoms (COPD assessment test-CAT; Visual analogue cough scale-VAS; Leicester Cough Questionnaire-LCQ; Medical Research Council Dyspnoea scale-mMRC) and spirometric parameters in 120 COPD patients were assessed. Tests were conducted at three-time points: baseline, after three months and after 6 months of NACp treatment.

RESULTS

Repeated measures ANOVA showed that pulmonary function parameters, 6-minute walk test and mMRC score did not significantly change during the study. Cough VAS and CAT scores were significantly different between groups as within experimental groups. LCQ and SGRQ scores did not differ between placebo, and both examined groups, but within each examined group statistically significant difference was confirmed in observed parameters during therapy. Factorial analysis and subsequent binary logistic regression revealed "Symptoms related factor" as the strongest predictor of exacerbation for supplemented groups (p<0.01).

CONCLUSIONS

Treatment with high NACp for 6 months is safe and beneficial for cough and expectoration symptoms and improves the life quality. NACp significantly reduces acute exacerbation frequency in COPD patients by controlling COPD related symptoms.

Role of pretest counseling sessions on increasing subjective knowledge about HIV and hepatitis transmission among the beneficiaries of a free of charge, voluntary counseling and testing program in Constanta, Romania

OBJECTIVES

To describe the characteristics of clients who enrolled into of an opt-in, HIV, HBV & HCV Voluntary Counseling and Testing Program in Dobrogea Region, Romania (VCT) and to identify the utility of the pre-test counseling sessions in increasing subjective perception regarding transmission knowledge for the clients attending the VCT program.

METHODS

Cross sectional data collection, between August 2015 and September 2016. Sociodemographic and behavioral information were collected for the clients who enrolled at two Baylor centers. Counselors were trained regarding the delivery of standardized information during the session, to reduce variation. After the pre-test session clients evaluated the subjective level of knowledge (SK) increase regarding viral transmission.

RESULTS

3065 clients were screened at the two centers and completed the SK increase assessment after the pre-test session. About 9% of all persons tested had reactive results to any of the infections in the context of high exposure risks for 62% and low hepatitis B vaccination rates (8%). 78% of attendees perceived that their knowledge regarding HIV and viral hepatitis transmission increasing with more than 60% as the result of the pretest counselling; more information was gained about hepatitis transmission compared with HIV.

CONCLUSION

Cumulative prevalence in Dobrogea community is high. The NGO-run VCT program is helping the healthcare system to efficiently screen for undiagnosed HIV and hepatitis cases. Pre-test counselling is directly contributing to increasing SK among attendees. Routine HIV and hepatitis integrated pre-test counseling should be considered as a good-practice even in settings where it is not compulsory by law.

May inflammatory markers be used for monitoring the continuous positive airway pressure effect in patients with obstructive sleep apnea and arrhythmias?

INTRODUCTION

Obstructive sleep apnea syndrome (OSAS) is defined by recurrent episodes of significant reduction or absence of the oro-nasal airflow during sleep, in the presence of thorax and abdominal movements and snoring. The pathophysiological consequences of intermittent hypoxia determined by OSAS are represented by systemic inflammation, the release of free oxygen radicals and activation of the sympathetic nervous system. Cardiac arrhythmias are a frequent comorbidity in patients with OSAS.

HYPOTHESIS

We hypothesized that the continuous positive airway pressure (CPAP) therapy has an effect on inflammatory markers (erythrocyte sedimentation rate, fibrinogen, and red cell distribution width) in patients with OSAS and cardiac arrhythmias.

EVALUATION OF THE HYPOTHESIS

We tested this hypothesis on 52 patients diagnosed with OSAS and cardiac arrhythmias, divided into two groups: group A (patients who received CPAP therapy and pharmacological therapy) and group B (only pharmacological therapy). The patients were evaluated at enrollment (T0), at 3 and 6 months. We did not find a statistically significant difference of erythrocyte sedimentation rate (ESR) and fibrinogen levels between the two groups. Regarding the red cell distribution width (RDW), the CPAP treatment seems to have improved the RDW values in patients who received this treatment. Also, in patients from group A, a significant decrease in the average heart rate was noticed after 3 months.

CONSEQUENCES

Fibrinogen and ESR cannot be used for monitoring the CPAP therapy in patients with OSAS and arrhythmias. Instead, the beneficial effect of CPAP in patients with OSAS and cardiac arrhythmias can be monitored with the help of the RDW, which could also be used for evaluating the cardiovascular risk in patients with OSAS and arrhythmias.

Modelling of airborne particulate matter concentration in underground stations using a two size-class conservation model

This study presents an attempt of predictive modelling of airborne particulate matter in underground railway stations. The aerosol is represented by a set of simple, ordinary differential equations that describe apparent emission of two particles size-classes in relation with train traffic, ventilation and deposition. The parameters of the equations are identified numerically by a genetic algorithm and comply with their respective expected order of magnitude. A quantitative comparison of numerical results with experimental data from Paris underground station exhibits a good accordance. A qualitative comparison with results from the literature also supports the model.

Cryosurgery for isolated liver tumors or associated with complex liver resection: a series of 38 patients

BACKGROUND

The aim of this prospective study is to assess the outcomes of cryosurgery for liver tumors, as a single treatment or associated to liver resections in conjunction or not with other visceral resections.

MATERIAL AND METHODS

Between 2001 and 2011, in our institution,70 hepatic tumors have been treated through cryo surgery in 38 patients. Complications and survival were assessed,according to different types of hepatic tumors and treatment complexity.

RESULTS

Operative mortality within 1 month was 2.6% related to cryosurgery. The median follow up was 25.8 months (range from 0-41.85 months). The number of complications was associated to complex treatment. The morbidity, mortality,disease-free and overall survival rates were not statistically significantly different between the different types of tumors (p value 0.05). The median disease free survival was 9.5 months, with cryosite recurrent disease in 21.5% patients, and 28.9% recurrences in other liver sites.

CONCLUSION

Cryotherapy, single or associated with liver resections combined or not with other visceral resections is an effective procedure. The antitumoral effects of treatment were demonstrated, but complications and high local recurrence rate, especially in patients with extensive disease, should caution against its use.

Prediction of brain-computer interface aptitude from individual brain structure

OBJECTIVE

Brain-computer interface (BCI) provide a non-muscular communication channel for patients with impairments of the motor system. A significant number of BCI users is unable to obtain voluntary control of a BCI-system in proper time. This makes methods that can be used to determine the aptitude of a user necessary.

METHODS

We hypothesized that integrity and connectivity of involved white matter connections may serve as a predictor of individual BCI-performance. Therefore, we analyzed structural data from anatomical scans and DTI of motor imagery BCI-users differentiated into high and low BCI-aptitude groups based on their overall performance.

RESULTS

Using a machine learning classification method we identified discriminating structural brain trait features and correlated the best features with a continuous measure of individual BCI-performance. Prediction of the aptitude group of each participant was possible with near perfect accuracy (one error).

CONCLUSIONS

Tissue volumetric analysis yielded only poor classification results. In contrast, the structural integrity and myelination quality of deep white matter structures such as the Corpus Callosum, Cingulum, and Superior Fronto-Occipital Fascicle were positively correlated with individual BCI-performance.

SIGNIFICANCE

This confirms that structural brain traits contribute to individual performance in BCI use.

A new (semantic) reflexive brain-computer interface: in search for a suitable classifier

The goal of the current study is to find a suitable classifier for electroencephalogram (EEG) data derived from a new learning paradigm which aims at communication in paralysis. A reflexive semantic classical (Pavlovian) conditioning paradigm is explored as an alternative to the operant learning paradigms, currently used in most brain-computer interfaces (BCIs). Comparable with a lie-detection experiment, subjects are presented with true and false statements. The EEG activity following true and false statements was classified with the aim to separate covert 'yes' from covert 'no' responses. Four classification algorithms are compared for classifying off-line data collected from a group of 14 healthy participants: (i) stepwise linear discriminant analysis (SWLDA), (ii) shrinkage linear discriminant analysis (SLDA), (iii) linear support vector machine (LIN-SVM) and (iv) radial basis function kernel support vector machine (RBF-SVM). The results indicate that all classifiers perform at chance level when separating conditioned 'yes' from conditioned 'no' responses. However, single conditioned reactions could be successfully classified on a single-trial basis (single conditioned reaction against a baseline interval). All of the four investigated classification methods achieve comparable performance, however results with RBF-SVM show the highest single-trial classification accuracy of 68.8%. The results suggest that the proposed paradigm may allow affirmative and negative (disapproving negative) communication in a BCI experiment.

Neural mechanisms of brain-computer interface control

Brain-computer interfaces (BCIs) enable people with paralysis to communicate with their environment. Motor imagery can be used to generate distinct patterns of cortical activation in the electroencephalogram (EEG) and thus control a BCI. To elucidate the cortical correlates of BCI control, users of a sensory motor rhythm (SMR)-BCI were classified according to their BCI control performance. In a second session these participants performed a motor imagery, motor observation and motor execution task in a functional magnetic resonance imaging (fMRI) scanner. Group difference analysis between high and low aptitude BCI users revealed significantly higher activation of the supplementary motor areas (SMA) for the motor imagery and the motor observation tasks in high aptitude users. Low aptitude users showed no activation when observing movement. The number of activated voxels during motor observation was significantly correlated with accuracy in the EEG-BCI task (r=0.53). Furthermore, the number of activated voxels in the right middle frontal gyrus, an area responsible for processing of movement observation, correlated (r=0.72) with BCI-performance. This strong correlation highlights the importance of these areas for task monitoring and working memory as task goals have to be activated throughout the BCI session. The ability to regulate behavior and the brain through learning mechanisms involving imagery such as required to control a BCI constitutes the consequence of ideo-motor co-activation of motor brain systems during observation of movements. The results demonstrate that acquisition of a sensorimotor program reflected in SMR-BCI-control is tightly related to the recall of such sensorimotor programs during observation of movements and unrelated to the actual execution of these movement sequences.

Binding interaction of indomethacin with human serum albumin

The interaction between indomethacin and human serum albumin (HSA) was investigated by fluorescence quenching technique and UV-vis absorption spectroscopy. The results of fluorescence titration revealed that indomethacin, strongly quench the intrinsic fluorescence of HSA by static quenching and nonradiative energy transfer. The binding site number n and the apparent binding constant K(A), were calculated using linear and nonlinear fit to the experimental data. The distance r between donor (HSA) and acceptor (indomethacin) was obtained according to fluorescence resonance energy transfer (FRET). The study suggests that the donor and the acceptor are bound at different locations but within the quenching distance.

[Surgical management of colonic diverticular disease]

Diverticulosis is a common condition and affects one third of patients older than age 45. The treatment of the diverticular disease and of its complications, especially the acute inflammatory ones, is both medical and surgical. It is essential to correlate the two therapeutic means and to set an adequate time for the operation. The present study evaluates in a retrospective manner a number of 231 cases, 49% of which represent complicated forms. Fifty-eight patients underwent a surgical operation, 25 of which needed an emergency intervention. The results of the study show the increase of 1-stage procedures for the complicated forms and recommend laparoscopy as an alternative to open surgery. Recent studies have challenged the prophylactic nature of surgical operations after diverticulitis indicating a need for further evaluation.

Activation-induced cytidine deaminase (AID) is expressed in normal spermatogenesis but only infrequently in testicular germ cell tumours

Activation-induced cytidine deaminase (AID) is essential for somatic hypermutation (SHM) and class switch recombination (CSR) of immunoglobulin genes in antigen-dependent B-cell maturation. SHM is not restricted to immunoglobulin gene loci, raising the possibility of a function for AID in other cell types. In this study, it is shown that AID is expressed in spermatocytes in the human testis. AID was mostly cytoplasmic but nuclear AID was also observed in a proportion of cells, in keeping with the DNA deamination model of AID function. Intratubular germ cell neoplasia unclassified (IGCNU), the precursor lesion of testicular cancers, was AID-negative. Seminomas also lacked AID expression. Nuclear and cytoplasmic AID expression was observed in three of 32 mixed non-seminomatous germ cell tumours. The results provide evidence for a physiological role for AID outside the immune system. AID expression in spermatocytes points to a role in meiosis. It remains uncertain whether AID may also contribute to the genetic aberrations characteristically found in testicular germ cell tumours. The consistent absence of detectable AID expression in atypical spermatogonia of IGCNU and its rare expression in germ cell tumours suggest that continued expression of AID is not involved in the pathogenesis of germ cell tumours.

Biased estimators of quantitative trait locus heritability and location in interval mapping

In many empirical studies, it has been observed that genome scans yield biased estimates of heritability, as well as genetic effects. It is widely accepted that quantitative trait locus (QTL) mapping is a model selection procedure, and that the overestimation of genetic effects is the result of using the same data for model selection as estimation of parameters. There are two key steps in QTL modeling, each of which biases the estimation of genetic effects. First, test procedures are employed to select the regions of the genome for which there is significant evidence for the presence of QTL. Second, and most important for this demonstration, estimates of the genetic effects are reported only at the locations for which the evidence is maximal. We demonstrate that even when we know there is just one QTL present (ignoring the testing bias), and we use interval mapping to estimate its location and effect, the estimator of the effect will be biased. As evidence, we present results of simulations investigating the relative importance of the two sources of bias and the dependence of bias of heritability estimators on the true QTL heritability, sample size, and the length of the investigated part of the genome. Moreover, we present results of simulations demonstrating the skewness of the distribution of estimators of QTL locations and the resulting bias in estimation of location. We use computer simulations to investigate the dependence of this bias on the true QTL location, heritability, and the sample size.

Percutaneous coronary intervention triggers a systemic inflammatory response in patients treated for in-stent restenosis -- comparison with stable and unstable angina

OBJECTIVE AND DESIGN

It is believed that the magnitude of the systemic inflammatory response induced by percutaneous coronary intervention (PCI) impacts on the long-term outcomes in patients with stable angina (SA) and unstable angina (UA). We aimed to determine whether an inflammatory response appears in in-stent restenosis (ISR) patients undergoing balloon angioplasty and to assess its pattern and magnitude in relation to SA and UA subjects.

SUBJECTS

80 patients (59 with SA, 10 with UA, 11 with ISR) were enrolled into the prospective study.

TREATMENT

SA and UA patients undergoing single vessel coronary balloon angioplasty followed by stenting versus ISR subjects in whom only balloon angioplasty was performed.

METHODS

C-reactive protein (CRP), serum amyloid A (SAA), tumor necrosis factor alpha (TNF-alpha) and interleukin 10 (IL-10) were measured in blood samples collected before and 6, 24 h and 1 month after the procedure.

RESULTS

A comparable pattern of inflammatory response in terms of CRP and SAA concentrations in subjects undergoing PCI due to ISR and SA was discovered while in unstable patients its magnitude was substantially higher. CRP and SAA levels increased significantly in each group with the peak value at 24 h and the baseline levels remarkably correlated with the highest markers' concentrations. In contrast, preprocedural TNF-alpha concentrations were higher in ISR group when compared with SA and UA patients. Additionally, in ISR group a twofold increase in their values of borderline significance at 6 h was noted. SA and UA subjects were found to have significantly lower TNF-alpha levels at 6 and 24 h after the intervention though the marker concentrations markedly increased with peak values at 1 month. The levels of IL-10 did not differ at any time point between the groups.

CONCLUSIONS

We suggest that PCI triggers a systemic inflammatory response in patients with ISR and considerable differences in its pattern when compared with SA and UA patients were demonstrated. Moreover, a high preprocedural TNF-alpha level and its increase provoked by PCI in the ISR group warrant the need for further investigation of its possible involvement in the restenosis process.

[Hepatic actinomycosis--pseudotumoral form]

Hepatic actinomycosis is a pretty rare anatomo-clinical entity that often induces a wrong pre-operative diagnosis. By presenting a case of hepatic actinomycosis, apparently primitive and diagnosed pre-operatively as a neoplastic lesion, the authors discuss the diagnosis and treatment of this disease, mentioning that in the solid, tumoral forms, the hepatic resection is necessary. The authors consider that the post-operative addition of antibiotherapy (mega doses of penicillin) is useful for the eradication of inflammatory residual hepatic parenchyma as well as for the cicatrisation of the parietal fistulae.

Inclusion complex of fenbufen with ?-cyclodextrin

An inclusion complex of fenbufen with beta-cyclodextrin (beta-CD) in aqueous solution was characterized by (1)H-NMR spectroscopy. The [1:1] stoichiometry was determined and a stability constant of several 1000s (M(-1)) was calculated. The geometry of the inclusion complex was established based on MM(+) molecular mechanics calculations.

The importance of connections: joining components of the Hutterite pedigree

We analyzed a quantitative trait (serum IgE levels), and a binary trait (asthma), in four Hutterite sub-pedigrees. A genome screen for asthma was performed using GENEHUNTER, and interesting regions were followed up using extended pedigrees and the FASTLINK package. Markov chain Monte Carlo (MCMC) methods were used to assess haplotype sharing among affected individuals (MORGAN/AUTOZYG), and to perform a combined oligogenic segregation and linkage analysis (LOKI) for log10(IgE). We found evidence for at least two susceptibility loci for asthma on chromosome 5, and a QTL for log10(IgE) on chromosome 1. Our analyses demonstrate that using the most complete pedigree structure possible is advisable, with attention to the possibility of heterogeneity among subunits of a very large pedigree.

[457 inguinal and femoral hernioplasties with synthetic prosthetic materials]

The authors retrospectively analyse 457 inguinal and femural hernioplasties with synthetic prosthesis materials, during a period of 10 years. There have been discussions going on about the prosthesis utilisation indications (advanced stages, complex inguinal hernia), type of prosthesis that has been used, the modalities of inserting a prosthesis and the surgical techniques employed. In 164 (34%) of the operations the mesh has been used as an reinforcement and 293 (64%) of the interventions were "tension-free" operations. The average reccurrence was approximately 1%, during a period ranging between 1 to 5 years.

[Giant cavernous hemangiomas of the caudal lobe. Clinical and therapeutically considerations]

The authors present two cases of giant hepatic cavernous hemangiomas with rare topography--caudate lobe. The article debates at length the natural evolution of disease, the diagnosis and the treatment. It give emphasis to the fact that, at present, we are witnessing the limitation of surgical indications far these benign vascular tumors. On the other hand, when operation is indicated, the authors prefer tumorectomy by enucleating or enucleoresection (which are limited) instead of major hepatic resections.

[Retrospective analysis of prognostic factors for annual mortality in 97 patients with chronic congestive heart failure]

The aim of our study was to find clinical and biochemical factors, which are prognostically important for the annual mortality in patients with chronic congestive heart failure (CHF). The studied group consisted of 97 people with CHF (31 females and 66 males, mean age--61). The causes of the heart failure were: coronary artery disease or/and hypertension (80 patients), valvular mitral heart disease--(12 patients), dilated cardiomyopathy--(5 patients). On the first day of the hospitalization patients were classified as functional class II-IV according to NYHA classification. Patients were divided into: group 'A'--34 patients, who had died during the 1st year of observation, and group 'B'--63 patients who have survived the 1st year of observation. According to the results of our study patients from group A had lower concentration of plasma sodium, lower left ventricular ejection fraction, lower mean heart rate, higher frequency of ventricular arrhythmias (according to 3&4 Lown class).

Urinary cGMP concentrations in severe primary pulmonary hypertension

BACKGROUND

Prognostic evaluation of patients with primary pulmonary hypertension (PPH) requires right heart catheterisation. The development of accurate non-invasive methods for monitoring these patients remains an important task. Cyclic guanosine monophosphate (cGMP) is an indicator of the action of natriuretic peptides and nitric oxide on target cells. Plasma and urinary cGMP concentrations are raised in patients with congestive heart failure in whom they correlate closely with haemodynamic parameters and disease severity. The aim of the present study was to determine whether the urinary concentration of cGMP could be used as a non-invasive marker of haemodynamic impairment in patients with severe PPH.

METHODS

Urinary cGMP concentrations were measured in 19 consecutive patients with PPH, seven with acute asthma, and 30 normal healthy controls.

RESULTS

Patients with PPH had higher urinary cGMP concentrations than asthmatic patients or normal healthy controls (p = 0.001). Urinary cGMP concentrations were higher in patients with severe haemodynamic impairment--that is, those with a cardiac index (CI) of < or = 2 l/min/m2 (p = 0.002)--and urinary cGMP concentrations were inversely correlated with CI (r = -0.69, p = 0.002) and venous oxygen saturation (r = -0.65, p = 0.003).

CONCLUSION

Urinary cGMP concentrations may represent a non-invasive indicator of the haemodynamic status of patients with severe PPH.

[Pulmonary aspergilloma successfully operated on in a patient with the pentalogy of Fallot]

Fallot disease occurs in 10% of congenital heart diseases. This case showed a clinical association between Fallot disease and a pulmonary aspergilloma. A 44-years male, with a history of Fallot disease (diagnosed in childhood) and a normal life, was admitted for repeated hemoptysis during last three months. Clinical examination revealed signs of Fallot disease: cyanosis, finger clubbing. CT scan and chest X-ray revealed a cavitary image in the right upper lobe. The CT image revealed a typical aspect of cavitary aspergilloma. The patient was referred to the thoracic surgeon, a right upper lobectomy was performed, which confirmed the presence of aspergilloma. Postoperative evolution was good.

[The chronology and diagnostic round of patients operated on for bronchopulmonary cancer]

37 patients with certified diagnosis, operated for lung cancer (LC) in The Central Military Hospital Bucharest, during six months period (October 1st 1996-June 1st 1997). It was a retrospective study on the patients medical files. Sex distribution, postsurgical staging and histological type were studied. We calculated the following delays: 1. Between the first medical examination and the first suspicion (chest X-ray): 6 +/- 3 days; 2. Between the first medical examination and first hospital admission: 14 +/- 11 days; 3. Between the first hospital admission and the first admission in surgical units: 43 +/- 23 days; 4. Between the first admission in surgical units and surgery: 59 +/- 26 days; 5. The delay until bronchoscopy: 23 +/- 16 days; 6. The delay until the CT examination: 26 +/- 16 days; 7. Between the first medical examination and the surgery: 78 +/- 30 days. These delays were correlated with the specialty profile of the services which referred the patients: pulmonology, internal medicine, oncology or primary services.

CONCLUSION

1. Most patients come from pulmonology units (22 out of 37 patients); 2. There are significant delays until bronchoscopy and CT scan, the availability of these services is still limited; 3. The primary care medical network is still inefficient in early diagnosis of LC; 4. The overcrowding of thoracic surgery unit (scheduling for surgical intervention). All of these are arguments for developing more efficient and faster circuits of LC diagnosis, especially for high risk patients.

[The clenbuterol treatment of patients with the chronic obstructive syndrome]

We have studied the effect of a new long acting bronchodilator: CLENBUTEROL, in 10 patients suffering from chronic obstructive diseases. All patients received 1 tablet of Clenbuterol, then we measured the following parameters in each patient, 2 and 6 hours after the drug administration: VC (vital capacity), FEV1 (forced expiratory volume in the first second of forced expiration), FEV1 x 100/VC, Raw (airways resistance), RV (residual volume). In all patients, excepting one of them, we registered a modification of all or some of the parameters 2 hours after drug administration. The bronchodilator effect was still present at 6 hours after drug administration. This data suggest that Clenbuterol induced a significant and long acting improvement of chronic obstruction; this drug might offer the advantage of sustained effect in patients suffering from chronic bronchospastic obstruction.

[Congestive heart failure and ventricular arrhythmia in relation to magnesium, potassium and sodium in serum and erythrocytes]

The aim of this study was to determine magnesium, potassium and sodium in plasma and erythrocytes in patients (14 male, 12 female; the average age 60.3) with congestive heart failure (CHF) (NYHA class II/III, III, IV) who were treated with digitalis, diuretics and vasodilators. All patients were subjected to 24 h ECG monitoring and ventricular arrhythmias classified according to LOWN, were analyzed in relation to electrolyte contents in erythrocytes and serum. Control group consisted of 20 persons (17 male; 3 female: the average age 58.7 years). Plasma and erythrocyte K and Na were determined by flame spectrophotometer; Mg was assayed by atomic absorption spectrophotometer. Statistical analysis was made by t-Student test. Results obtained suggest that patients with CHF require supplementation K+ with Mg2+ (tab. I). Our study has not revealed expected interrelationships between ventricular arrhythmias and electrolyte disturbances in patients with CHF. It should be stressed, however, that the small numbers of patients in the subgroups in our study might have blurred the possible relationship.

[Magnesium, potassium and sodium in serum and erythrocytes in acute myocardial infarction]

Serum concentration and erythrocyte contents of Mg++, K+ and Na+ was measured on day 1, 3 and 14 in patients with transmural myocardial infarction. The study group consisted of 72 patients (15 females and 57 males) with the diagnosis of myocardial infarction based on WHO criteria. The control group consisted of 52 healthy subjects (11 females and 41 males). Measurements of sodium and potassium were made using flame photometer, magnesium was measured with atom adsorption spectrophotometry. Lowest magnesium and potassium concentrations (in serum and in erythrocytes) were found on day 1 and day 3 with almost full normalization on day 14. Sodium serum concentration and erythrocyte contents varied; lowest serum concentration appeared on day 1 and day 3, erythrocyte contents was highest on day 1.

[The etiological spectrum of mitral insufficiency: a 10-year retrospective study]

The incidence, etiology and data on the severity and therapeutic implications of the mitral insufficiency were investigated in the patients admitted in the clinic during 10 years. The diagnosis was based mainly on clinical and echocardiography mode M data. 595 patients suffering from mitral insufficiency (below 2% of the total of the patients admitted) were recorded. In 65% of the cases mitral insufficiency had a rheumatic etiology (the majority associated polyvalvulopathies), in 14.8% an ischaemic origin, and in 10.9% an organic-functional one (the left ventricle was dilated). The primary prolapse of the mitral valve appeared in 6.9% of the cases (the low incidence was explained by the severe criteria applied in positive diagnosis). 4 cases of rupture of the subvalvular apparatus are described in the patients suffering from prolapse. All of them had a sudden onset, by severe cardiac insufficiency without a clear cause, appeared under conditions of seemingly complete health. Intense therapy followed by valvular prosthesis, resulted in a spectacular recovery of the heart function.