[Is the practice of internal medicine changing?].

S Cagán, M Pavlovic, M Lukác

Vnitr Lek 1990, 36(1):1-4

[Complications of percutaneous transluminal coronary angioplasty].

J Sochman, J Fabián, J Kovác, A Belán, P Firt

Vnitr Lek 1990, 36(1):5-12

The most frequent complication of percutaneous transluminal coronary angioplasty is acute obstruction of the artery to be dilated. The authors present their experience with the solution of this situation. In a group of 154 consecutive patients with chronic stable angina pectoris a sudden occlusion was observed in 7.7%, infarction in 5.8% and the necessity of operation arose in 5.2%. A significant position in the solution if these complications is held by cardiosurgical revascularization. As to pharmacological treatment, it is useful to administer a combination of nitrates, calcium channel antagonists and thrombolytic treatment.

[Noninvasive monitoring of the hemodynamic importance of the left atrium].

G Kamenský, S Cagán, I Riecanský, M Mikulecký

Vnitr Lek 1990, 36(1):13-23

The authors examined 112 subjects free from cardiac disease, with essential hypertension and myocardial infarction. In all subjects a 12-lead ECG at rest was made as well as a polycardiographic and echocardiographic examination. The authors found that in the group of healthy subjects there is a direct significant linear correlation between the size of the systole of the left atrium and age. The size of the left atrium and the atrial filling fraction were significantly smaller in healthy subjects than in subjects with hypertension and myocardial infarction. The authors draw attention to the necessity to re-evaluate the accepted norm of left atrial size...

[Long-term monitoring of changes in contractility of the left ventricular wall in patients with myocardial infarct].

L Elbl, V Chaloupka, S Janousek, J Toman, R Soucek, J Zák

Vnitr Lek 1990, 36(1):24-30

Using two-dimensional echocardiography, the authors made a one-year investigation of left ventricular function in a group of patients after a first transmural myocardial infarction. They evaluated subjectively and quantitatively changes in the contractility and the development of the diastolic area of the left ventricle. They revealed a certain improvement of the contractility, probably as a result of the development of a collateral circulation and altered structure of the infarction focus associated with dilatation of the left ventricle by the Frank-Starling mechanism.

[Atypical ventricular tachycardia and atrioventricular blockade].

J Pella, B Stancák, J Bodnár, I Boberová

Vnitr Lek 1990, 36(1):31-36

The authors submit a clinical and electrocardiographic analysis of five patients with atypical ventricular tachycardia with atrioventricular block of an advanced degree. The incidence is relatively rare--cca 1% patients with atrioventricular block are threatened by this type of tachycardia. In these patients there are always reduced serum potassium levels and a longer QT interval, as compared with patients without tachycardia. In two instances there was an association with the use of drugs (Furosemide and Thioridazine) and these patients developed tachycardia even during permanent pacing. Correction of the internal environment and discontinuation of...

[Experience with ablation of the bundle of His using electrical discharge].

J Lukl, B Cernosek, P Heinc

Vnitr Lek 1990, 36(1):37-44

Ablation of the bundle of His by an electric discharge was made in 10 patients (average age 64 years, range 48-80) unsuccessfully treated with 3-14 antiarrhythmic drugs or their combinations (average 8.7) on account of supraventricular tachycardia occurring repeatedly for 3-44 years (average 12.5 years). By means of a bipolar electrode inserted into the area of the bundle of His a nonsynchronized defibrillation discharge with a mean energy of 323 J (40-380) was administered. On average 2.9 discharges were used (1-9) per patient, in 1-3 sessions. The patients were followed up for a period of 15.3 months (10-19). Permanent complete a-v block was achieved...

[Electrophysiologic effects of orally administered amiodarone].

M Pleskot, V Pidrman, P Tilser

Vnitr Lek 1990, 36(1):45-51

The authors made an invasive electrophysiological examination of the heart before and after administration of amiodarone by the oral route in 18 patients (15 men and 3 women). Amiodarone was administered in maintenance doses of 200 or 400 mg/day for 3 to 13 months (mean 4.7 months). Comparison of values revealed a significant protraction of R-R, P-Q and QRS intervals on the surface ECG. A-H and H-V intervals on the electrogram of the bundle of His as well as effective refractory periods of the ventricular myocardium were significantly protracted. During high-frequency stimulation of the atria the frequency at which an a-v block grade II type I develops...

[Somatometric characteristics of patients with hypertrophic cardiomyopathies].

Z Smahel, P Gregor

Vnitr Lek 1990, 36(1):52-58

The authors evaluated anthropometric data from 43 men and 17 women aged 20-45 years suffering hypertrophic cardiomyopathy. The affected individuals had a higher body weight associated with larger circumferences of trunk and arms, but smaller circumferences of the lower extremities. The deviations could be due to a lower physical activity of the patients and consistent with this, they were recorded only in the subgroup of patients with subjective complaints. Contrary to these findings, after classification of the patients according to the extent of myocardial hypertrophy, higher body weight was found only in patients with mild affection. The difference...

[Plasma renin activity, creatinine and uric acid in the serum of patients with essential hypertension].

M Pjescák, I Suchmanová, J Mechír, R Tkácová, E Rajnová

Vnitr Lek 1990, 36(1):59-63

The authors examined the plasma renin activity (PRA), serum uric acid and creatinine in 53 patients with essential hypertension (EH). They recorded low renin EH in 28%, normorenin EH in 53% and high-renin EH in 19% of the hypertensive patients. Assessment of basal PRA levels does not suffice for the classification of EH because the PRA response after stimulation is not related to its basal values. The authors found significantly higher levels of serum creatinine in low-renin EH. They did not confirm a relationship between PRA and the uric acid serum level in any form of EH.

[Acute hemodynamic changes after nifedipine in older men with essential hypertension].

P Schnapp, M Dúbrava, P Cernák

Vnitr Lek 1990, 36(1):64-69

The authors selected from a group of 40 hypertonic patients 9 men (mean age 67 years, range 60-73 years) with reliably evaluated echocardiographic tracings without valvular defects and without impaired left ventricular kinetics. After two weeks on placebo every patients was given a single dose of 20 mg nifedipine. The echocardiographic examination, concurrently with a blood pressure reading, was made at the end of the placebo interval and 2.5 and 7 hours after nifedipine administration. As compared with placebo, nifedipine significantly reduced at each time intervals the end systolic stress of the wall and the blood pressure without accelerating the...

[The effect of quinidine on digoxin plasma levels after discontinuation of digoxin therapy].

I Markuljak, J Květenský, V Licko, J Dvorský, S Funiak, V Záhradný

Vnitr Lek 1990, 36(1):70-74

The authors submit a report on the effect of quinidine on plasma digoxin. The investigation was made in 20 patients wit supraventricular dysrhythmia. After initial digoxin treatment they proceeded with quinidine six hours after the last digoxin dose. Although they did not administer digoxin, the digoxin level increased during quinidine treatment in the course of 12 hours from 2.4 +/- 1.6 ng/ml to 3.8 +/- 12.4 ng/ml. The authors draw attention to the importance of following up digoxin levels in the mentioned drug combination which is supposed to prevent serious complication caused by possible digoxin intoxication.

[Diagnosis of lung injury due to amiodarone--contribution of bronchoalveolar lavage].

V Kolek, J Dusek, M Dusková, A Václavík, Z Vomácka

Vnitr Lek 1990, 36(1):75-80

Based on the authors' own observation of a patient with pulmonary affection during amiodarone treatment, they demonstrate contemporary possibilities of early diagnosis of this potentially serious condition. They emphasize the importance of bronchoalveolar lavage, a non-invasive diagnostic method which provides information on the conditions in the peripheral portions of the lungs. The authors give an account of data in the literature on the pathogenesis of side effects of amiodarone in the lungs and draw attention to the need of systematic pneumological check-up examinations during treatment. If the drug is discontinued in time, all side-effects may...

[Plasmocellular leukemia with IgD paraproteinemia].

F Matěja, M Tichý, J Novotný, T Foukal

Vnitr Lek 1990, 36(1):81-87

The authors describe the case of an 80-year-old woman with a plasmocytoma IgD-lambda, which developed into plasmocellular leukaemia. The laboratory finding reminded at first of chronic lymphatic leukaemia. The correct diagnosis was assisted by marked leucocytosis with the release of a major number of plasmatic cells into the peripheral blood stream. The finding was confirmed on the basis of sternal puncture, cytochemical examination, immunochemical examination of the blood and urine and X-ray of the skull. Treatment led to marked clinical and laboratory improvement. The patient died, however, from pneumonia three months after establishment of the diagnosis....

[Use of monoclonal antibodies in HLA immunology].

J Prazák

Vnitr Lek 1990, 36(1):88-92

The author gives an account of the classification and use of HLA monoclonal antibodies. In experimental work the author demonstrates the contribution of investigations of the expressivity of histocompatible antigens class I and II and their changes in sound and tumourous tissues. In clinical practice they are important in particular in transplantology--cleaning of bone marrow, follow up of the GvH reaction, monitoring of patients. HLA monoclonal antibodies serve to reveal the polymorphism in the HLA sphere and the follow up of general biological laws.