Intra-aortic balloon counterpulsation (IABP) was used in 20 patients with acute myocardial infarction and cardiogenic shock, after four hours of drug treatment. In all instances the abnormal haemodynamic state had been demonstrated. Four patients were successfully treated and finally discharged home. In two with post-infarction ventricular septal defect and cardiogenic shock, IABP also successfully reversed the shock state, while in seven the shock state was reversed but they died 2-8 days after IABP had been stopped. IABP failed in seven patients who died during its application. In those in whom IABP failed there had been no significant fall in pulmonary-artery pressure and no significant increase in stroke volume. The post-mortem examinations demonstrated that cardiogenic shock was irreversible where more than 50% of the left ventricular myocardium had been infarcted.
Zusammenfassung: Aus Messungen der Radioaktivität im Blut normaler und alloxandiabetischer Ratten nach oraler Zufuhr von [U-14 C]Gluconat bzw. [U-14 C]Glucono-6-lacton und der 5 h nach der Zufuhr im Darminhalt und Kot enthaltenen Restaktivität ist zu schließen, daß das Lacton intestinal besser resorbiert wird als das Gluconat-Anion. Entsprechend dieser besseren Membranpermeation und der im Blut erreichten höheren Konzentration ist der Verteilungsraum des Lactons größer als der des Gluconates (50 bzw. 41% des Körpergewichtes) und ist nach Lactonzufuhr sowohl eine höhere Retention in den Geweben als auch ein höherer Verlust im Harn festzustellen. Auch der Einbau in Leberglykogen ist nach Lacton-höher als nach Gluconatzufuhr, und zwar besonders ausgeprägt bei diabetischen Tieren. Das durch eine Latenzperiode von 7 bzw. 4 h verursachte initiale Defizit der Oxidation von Gluconat gegenüber der des Lactons wird in den darauffolgenden 8-9 h völlig ausgeglichen. Der oxidative Umsatz von Gluconolacton und von Gluconat ist in diabetischen Tieren signifikant gesteigert. Die bessere Verwertung im diabetischen Stoffwechsel ist z. T. auf eine Erhöhung des im Hunger und Diabetes herabgesetzten Gewebsgehaltes der Glykolysemetabolite in der Leber zurückzuführen. Limitierender Schritt des Gluconatumsatzes ist die initiale Phosphorylierung. Möglichkeiten für einen diätetischen Einsatz von Gluconsäure in Form eines apolaren Derivates (Lacton, Ester) werden diskutiert.
Investigations on the utilization of D-gluconate and D-glucono-S-lactone in the metabolism of the normal and alloxan diabetic ratSummary: Radioactivity was measured in the blood of normal and alloxan diabetic rats, after the oral administration of [U-14 C]gluconate and [U-14 C]glucono-5-lactone, respectively. Radioactivity was also measured in the intestinal contents and feces 5 h after ingestion of the radioactive materials. It was concluded that the lactone is better absorbed from the intestine than the gluconate anion. According to this enhanced membrane permeation and the higher concentration reached in blood, the space of distribution of the lactone is larger than that of gluconate (50 and 41 % of body weight, respectively); a higher retention in tissues and a greater loss in urine was also observed after administration of the lactone. Incorporation into liver glycogen is also higher from the lactone than from gluconate after oral administration, particularly in diabetic animals. The initial deficit in the oxidation of gluconate compared to that of the lactone, caused by a lag period of 7 and 4 h, respectively, is completely compensated during the following 8-9 h. The oxidative turnover of glucoiiolactone and of gluconate is significantly enhanced in diabetic animals. The better utilization in diabetic metabolism is in part explainable by a rise of glycolytic intermediates in the liver, which are decreased in starvation and diabetes. The limiting step of gluconate metabolism is the initial phosphorylation. Possibilities are discussed for the dietetic use of gluco...
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