Bei Studien zum Mechanismus der Gluconeogenese wurde in Übereinstimmung mit anderen Autoren [25, 40] eine Erhöhung der Pyruvatcarboxylase-Aktivität der Leber und Niere alloxandiabetischer Ratten beobachtet. Nach Glucocorticoidgaben konnten wir dagegen keine Aktivitätszunahme des Enzyms der Rattenleber beobachten. Glucagon bewirkte eine deutliche Steigerung der Gluconeogenese aus Laktat in der isolierten Rattenleber. Dieser Effekt war nicht von einer Aktivitätszunahme der Pyruvatcarboxylase begleitet. Die Dissoziation von Gluconeogenese und Pyruvatcarboxylase-Aktivität läßt andere Mechanismen als die einer hormonellen Enzyminduktion für die Regulation der Gluconeogenese primär bedeutungsvoll erscheinen. Eine Modifikation der Isotopenmethode zur Bestimmung der Pyruvatcarboxylase [nach 16] in tierischen Geweben wird angegeben.
Sixteen patients, 8 males and 8 females were referred for surgery with the diagnosis of Ebstein's malformation of the tricuspid valve. The intervention was necessary because of deterioration of the clinical status. The age of the patients at the time of surgery ranged from 4 to 51 years. In 11 patients valvuloplasty was performed, in 5 patients the tricuspid valve was replaced with a bioprosthesis. One patient, with end-stage disease prior to surgery, died 2 days postoperatively rendering total mortality at 6.25%. Subsequent follow-up ranging from 8 months to 8 years was uneventful in the 15 survivors. Only 2 patients showed evidence of dysrhythmias, and demonstrated cardiothoracic ratios greater than 0.65. Cardiac catheterization in 3 patients, at one or 5 months postoperatively revealed normal pressure in the right heart. Provided the anterior tricuspid leaflet is of adequate size, surgical repair of Ebstein's anomaly through valvuloplasty appears to be feasible. The valvuloplasty consists of forming a monocusp valve with the anterior leaflet and plicating the atrialized portion of the right ventricle.
Ultrasonic debridement of aortic valve stenosis allows precise and energy-controlled removal of calcium, increased doubly the valve area and decreased of peak and mean gradients statistically significant. The advantages of preserving the native aortic valve in elderly patients are relative good arguments; although a longer follow-up is necessary to establish this procedure.
The application of phrenic nerve pacing is an effective method of respiratory support in adults with certain forms of acquired failure of automatic ventilation. The experience with one infant suffering from congenital central hypoventilation (Ondine's syndrome) is summarized in this report. Stimulation electrodes were implanted on the thoracic portion of each phrenic nerve. After a cumbersome period of intensive medical care and conditioning of the phrenic nerve-diaphragm-system, the patient could be weaned off the respirator. Severe upper airway obstruction, however, required tracheostomy. Bilateral simultaneous pacing has been effective now for more than 2 years providing the desired normal ventilation during sleep. The state of the art of phrenic nerve pacing is described.
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