Vnitřní lékařství, 1992 (vol. 38), issue 5
[Third generation beta blockers in the treatment of hypertension].
J Widimský
Vnitr Lek 1992, 38(5):417-425
Beta-blockers of the third generation are hybrid antihypertensive drugs which reduce the blood pressure by two mechanisms--by beta-blocking and by a dilatating action. The author presents experience assembled in Czechoslovakia with bopindolol and nebivolol which belong into the class of these substances. Treatment with beta-blockers is effective also in hypertension in elderly subjects. The author mentions a group of extensive investigations conducted abroad, comparing beta-blockers and diuretics in the treatment of hypertension. From the analysis it is apparent that beta-blockers exert a favourable effect also in primary prevention of ischaemic heart...
[Clinical manifestations of insulin resistance. The hormonal-metabolic syndrome X (5H), its prevalence and impact on cardiovascular morbidity and mortality. I].
J Hrnciar, M Hrnciarová, K Jakubíková, J Okapcová
Vnitr Lek 1992, 38(5):426-437
Insulin resistance (prereceptor, receptor, postreceptor) is a complex phenomenon. It penetrates into the clinical picture via hyperinsulinism as impaired glucose tolerance, or NIDDM, as hyperlipoproteinaemia, arterial hypertension and hirsutism in women (syndrome 5H) associated with the polycystic ovary syndrome or the HAIR-AN syndrome. Based on a group of their 480 patients with NIDDM, 108 women with hirsutism, 320 patients with myocardial infarction and the results of the national cardiovascular programme the authors estimate the prevalence of the 5H syndrome as follows: in the general population 5-10%, in patients with arterial hypertension 15-30%,...
[Hyperinsulinism as a major etiopathogenic link with arterial hypertension, hyperlipoproteinemia and hirsutism. II].
J Hrnciar, M Hrnciarová, K Jakubíková, J Okapcová
Vnitr Lek 1992, 38(5):438-447
The authors analyze mechanism by which hyperinsulinism causes NIDDM, hypertension, hyperlipoproteinaemia and hirsutism (5H syndrome). They demonstrate on a group of their 100 patients with NIDDM and arterial hypertension that, as compared with matched pairs without arterial hypertension, they have significantly higher levels of C-peptide and less favourable parameters of dyslipoproteinaemia. Hirsutism occurs in 10-15% of the adult female population, but in 18.4% women with NIDDM. However, in a group of 48 hirsutic women with NIDDM they did not find, as compared with matched pairs (i.e. women with NIDDM of analogous age, BMI and BP) significantly higher...
[Diagnosis of syndrome X using comprehensive analysis of the electrical field of the heart].
M Stojan, F Boudík, J Vojácek, J Bultas, V Vondrácek, P Stovícek, Z Anger, A Charvát
Vnitr Lek 1992, 38(5):448-457
The authors describe the clinical picture and results of some auxiliary examinations in 18 patients with the X syndrome, i.e. with angina pectoris with a normal angiographic finding on the coronary arteries. For the diagnosis of ischemic cardiac changes, which are an integral part of this syndrome, the authors used a complex analysis of the electric cardiac field by means of a Cardiac 128.1 apparatus (manufactured by ZPA-Cakovice). In patients with the X syndrome they observed a significant reduction of some potential and integral values, as compared with an equally sized group of healthy subjects. On maps of the electric manifestation of cardiac activity...
[Initial experience with adenosine triphosphate in supraventricular arrhythmia].
J Sochman
Vnitr Lek 1992, 38(5):458-465
The author presents data from the literature pertaining to the possible use of adenine nucleosides in recent years. The main action of adenosine or adenosine triphosphate is focused above all on influencing supraventricular tachycardia which developed as a result of the reentry mechanism. Based on his own observation, the author presents his initial experience with adenosine triphosphate (ATP, Spofa) in different indications: interference with supraventricular tachycardia with slim QRS complexes, interference of tachycardia with wide QRS complexes, termination of atrial flutter in digitalis intoxication and finally induction of an electrocardiographic...
[Immunogenetic study in hypertrophic cardiomyopathy].
P Gregor, E Ivasková, H Sajdlová, L Kupková, P Widimský, V Cervenka
Vnitr Lek 1992, 38(5):466-472
Results of assessment of HLA antigens in hypertrophic cardiomyopathies in the world literature are very controversial. Work dealing with this problem in sufficiently large groups of patients is lacking, i.e. work which takes into account different functional and morphological forms of the disease. The authors made therefore a detailed investigation of 60 class 1 and 2 antigens in 117 patients with this disease. Values of the relative risk and chi 2 test revealed a number of possible associations. After correction for the number of examined antigens a significantly higher prevalence was proved only in HLA-B21 in patients with the obstructive form and...
[Patients after thyroid gland surgery from the aspect of the endocrinologist].
M Tajtáková, D Trejbal, J Vajó, V Gonsorcíková, Y Machánová
Vnitr Lek 1992, 38(5):473-478
The authors examined 85 patients after a mean interval of 2.5 years following thyroidectomy. They focused attention on evaluation of the functional state using as criteria the TSH and TRH test. Simultaneously they examined by ultrasonography the volume of the remainder of the thyroid gland. In 8 patients operated on account of carcinoma the average volume of the thyroid gland was 1.3 ml. Five patients were hypothyroid despite permanent substitution. Of 77 patients operated on account of benign goitre evident hypothyroidism was found in 29 (37.7%) and latent hypothyroidism in 14 (18.2%). The volume of the remainder of the thyroid gland in these patients...
[Ultrasonography in subacute thyroiditis].
M Tajtáková, D Hancinová, V Gonsorcíková, Y Machánová, X Jandoseková
Vnitr Lek 1992, 38(5):479-484
The authors draw attention to the altered ultrasonographic (USG) picture of the thyroid gland with subacute inflammation (SAT). A typical finding in the first to third stage of the disease are irregular different sized hypoechogenic to almost echo-void foci with normal parenchyma in between. The finding is normal only in the fourth stage of the disease. In 22 patients before 1987 the USG finding of the thyroid gland was evaluated. In 17 the examination revealed the assumed SAT which was confirmed in 15 patients. Seven patients were at that time hypothyroid. The USG finding was evaluated again in 1990. Ten patients, 2.8 years after the acute stage of...
[Personal experience with treatment of autoimmune thrombocytopenia using intravenous IgG].
M Bandová, A Stachý, A Lucanský
Vnitr Lek 1992, 38(5):485-489
An immunoglobulin preparation for i.v. administration, Ivega (Imuna) was administered to 14 patients, 0.4 g/kg on five consecutive days, but also in lower doses. In all investigated patients a rapid onset of the therapeutic effect was observed--regression of haemorrhage and in 11 a concurrent rise of thrombocytes from a mean value of 20.10(9)/l to mean values of 130.10(9)/l with a maximum between the 6th and 14th day after administration. The tolerance of treatment was satisfactory and no side-effects were observed.
[Side effects of administration of gamma globulin preparations in patients with primary agammaglobulinemia].
J Litzman, D Wiedermannová, J Lokaj, V Král
Vnitr Lek 1992, 38(5):490-494
Eight patients with adverse reactions were observed in a group of 20 primary agammaglobulinaemic patients treated with gammaglobulin derivatives. In four cases only sporadic reactions were observed, but in 2 cases repeated reactions made gammaglobulin therapy impossible. In the remaining two patients a change of gammaglobulin derivatives made adequate therapy possible. Possible causes of adverse reactions during gammaglobulin treatment and their prevention are discussed.
[Systemic lupus erythematosus after thymectomy in myasthenia gravis].
P Cervinka, Z Hrncír
Vnitr Lek 1992, 38(5):495-500
The authors describe a case of systemic lupus erythematosus in a 33-year-old female patient who developed the disease 12 years after thymectomy on account of myasthenia gravis. The activity of systemic lupus erythematosus was controlled by pulsed treatment with methyl prednisolone followed by long-term oral glucocorticoid and immunosuppressive therapy. The authors discuss the risk of systemic lupus erythematosus after thymectomy on account of myasthenia gravis with regard to the HLA haplotype.
[A fistula between the aorta and esophagus--an uncommon sequela of dissection of the thoracic aorta].
J Sochman, R Ouhrabková, J Hejnal, D Urbanová
Vnitr Lek 1992, 38(5):501-504
In a patient with repeated dissection of the ascendent aorta where the first episode was resolved surgically by an intraluminal prosthesis the authors describe the rare consequence of the development of a new dissection manifested by an aorto-oesophageal fistula. In the described case an inoperable episode was involved which fully confirmed the clinical validity of the pathognomic Chiari triad.
[Tumor microembolization in the lungs--a cause of marked dyspnea, syncope, hemolytic syndrome and disorders of hemocoagulation].
J Bastecký, F Langr, L Chrobák, A Hlava, J Kvasnicka
Vnitr Lek 1992, 38(5):505-512
The authors describe the course of the disease in a 28-year-old woman who suffered two years following surgery of breast cancer from rapidly deteriorating dyspnoea, syncopes and laboratory manifestations of global respiratory insufficiency. The finding on auscultation of the lungs was normal, pulmonary angiography did not reveal signs of serious pulmonary embolization. The patient died after ten days in hospital despite comprehensive therapy and artificial ventilation. Necropsy revealed multiple microembolizations of tumourous cells into the pulmonary vessels as the main causes of the disease. Concurrently infiltration of the bone marrow by tumourous...
[Circulating heparin-like anticoagulant--2 cases of successful therapy].
A Jarosová, V Filip, V Monhart, B Limberk
Vnitr Lek 1992, 38(5):513-517
In the circulation of patients with severe haemorrhagic conditions in rare instances an anticoagulant of heparin nature can be detected, the exact origin of which has not been elucidated so far. These patients can be treated by protamine sulphate. The authors present their own observations in two women where the circulating anticoagulant of heparin nature was detected during a haemorrhagic condition after spontaneous rupture of an enlarged spleen and in scleroderma with organ affection. In both instances treatment was successful.