[The position of internal medicine in Europe. Report from a meeting of the presidents of European internal medicine societies].

K Horký

Vnitr Lek 1993, 39(4):316-319

[Indications for cornary angiography].

M Aschermann, J Humhal, J Vojácek, F Holm, F Krupicka

Vnitr Lek 1993, 39(4):320-325

This is a summary of relative indications for the selection of patients for coronary angiography. Coronary angiography is an important part of clinical evaluation of patients with ischemic heart disease, valve heart disease, cardiomyopathies. Main groups of patients with ischemic heart disease are: angina pectoris after low levels of effort despite a good medical treatment, unstable angina, variant angina, angina with high risk of acute coronary syndromes from noninvasive exercise testing. In addition coronary angiography is indicated in patients with unexplained congestive heart failure, in patients with acute myocardial infarction with mechanical...

[Inhibition of thrombocyte activity in atherogenesis and thrombogenesis using isradipine and other calcium antagonists].

N Feťkovská, L Ulicná, Z Jakubovská

Vnitr Lek 1993, 39(4):326-333

Increased platelet activity on structurally and functionally impaired endothelium leads to a release of serotonin (5HT), thromboxane A2 and growth factors from platelets. These vasoactive substances may participate in the development of atherosclerosis and thrombovascular events. Platelet aggregatory response to 5HT increases with the height of blood pressure, age, smoking and plasma cholesterol levels. Lipoprotein fractions exert disparate effects an platelets. LDL-cholesterol amplifies 5HT-induced platelet activation whereas HDL-cholesterol inhibits the amplifying effect of LDL-cholesterol. These results indicate that different effects of HDL and...

[Sick sinus syndrome and permanent cardiac pacing].

J Pella, B Stancák, Z Schroner, J Bodnár, J Sedlák

Vnitr Lek 1993, 39(4):334-339

The authors submit a retrospective analysis of 140 patients with an affection of the sinoatrial node who had a permanent cardiac pacemaker. The analysis comprises an 18-month period; the patients were from the eastern Slovakian region. The authors emphasize different affections of the sinoatrial node and discuss various ways of permanent cardiac pacing and other types of non-pharmacological treatment (e.g. electric ablation). Diseases of the sinoatrial node account for as much as 40% of implantations of a permanent pacemaker on account of bradyarrhythmia. At the clinic this implies a quantitative increase of cardiac pacing on account of diseases of...

[Captopril in the treatment of congestive heart failure in acute myocardial infarct].

J Svejda, P Václavík, V Kopal

Vnitr Lek 1993, 39(4):340-344

The extent of affection of the heart muscle by infarction with subsequent left-ventricular dilatation, remodelling and congestive failure is the decisive prognostic indicator of mortality. Inhibitors of ACE influence congestive heart failure in a favourable way and captopril reduces the morbidity and mortality in patients with still asymptomatic left ventricular dysfunction. The authors administered to a group of 23 patients with acute myocardial infarction and congestive heart failure (grade II according to Killip) small doses of captopril (4 x 6.25 mg/day)for a period of 10 days from the 1st-4th day after the onset of the disease). From ACE serum...

[Comparison of the effects and safety of atenolol and nifedipine in the treatment of angina pectoris].

M Aschermann, J Bultas, V Danzig, O Mayer, Z Lorenc, J Vortel, J Kvasnicka

Vnitr Lek 1993, 39(4):345-352

The effects of atenolol (100 mg/day) and nifedipine (60 mg/day) on angina symptoms and exercise tolerance were compared in an open, randomized study. Twelve-week treatment period was compared with two weeks of placebo treatment in 51 patients with chronic stable angina pectoris. Mean frequency of angina attacks decreased significantly from 8.3 to 1.6 attacks per week after atenolol treatment (p < or = 0.05). Both drugs increased exercise tolerance to development of signs of ischemia on electrocardiogram (p < or = 0.05) and increased maximal exercise tolerance as well (p < or = 0.05). Mean ST segment depressions at peak exercise were significantly...

[Significance of pulmonary vein flow for the determination of left ventricular filling pressure].

J Spác, H Nĕmcová, M Blaha, I Dvorák, J Cerný

Vnitr Lek 1993, 39(4):353-358

The aim of the submitted study was to evaluate the blood flow in the pulmonary veins by transoesophageal Doppler echocardiography which is the ideal method for recording the blood flow in the pulmonary veins as the ultrasound probe is closely behind the left atrium. In 35 patients with ischaemic heart disease the authors evaluated the blood flow in the pulmonary veins to assess whether the rate of the blood flow in these vessels can serve a non-invasive estimate of the end-diastolic pressure in the left ventricle (LVEDP). It was revealed that venous blood flow has in the majority of cases two anterior peaks during ventricular systole, one anterior...

[Another source of hemorrhage--risks for patients with esophageal varices].

P Svoboda, J Ochmann, I Kantorová, R Sefr

Vnitr Lek 1993, 39(4):359-363

The authors treated during the past three years 312 patients with oesophageal varices after the first haemorrhage. All patients were treated by endoscopic sclerotization of oesophageal varices and drugs which reduce the excessive portal pressure. After a minimum of two sclerotherapeutic sessions, following control of acute haemorrhage, the authors observed a relapse of haemorrhage from the upper gastrointestinal tract in 38 patients. In 20 of them the relapse of haemorrhage was again from oesophageal varices, but in 18 patients it was of different origin and would not be affected by classical treatment with a Sengstaken tube. The authors draw attention...

[The effect of selective decontamination on malignant hematologic diseases treated with aggressive chemotherapy].

H Kubesová, D Bobulová, J Mayer, J Vorlícek

Vnitr Lek 1993, 39(4):364-370

The authors analyzed the course of 100 cycles of chemotherapy administered on account of haematological oncological disease: 66 cycles with administration of selective decontamination and 34 without its administration. Based on an analysis of the gut flora they provided evidence of the necessity of concurrent administration of originally separately administered antibiotics and of the necessity to replace nystatin by amphotericin B. They found a significant reduction of the incidence of infectious complications, the number of days with a body temperature above 38 and reduced consumption of antibiotics. The authors found a different composition of the...

[Endothelial cells in tumors of the rectum and large intestine].

L Vacek, L Hrncírová, L Drápelová

Vnitr Lek 1993, 39(4):371-373

In 40 controls and 102 patients with tumours of the rectum and large intestine the number of circulating anuclear cell residues of endothelial cells was investigated. The number of these endothelia in the blood of patients was significantly higher (p < 0.001) than in healthy subjects. After successful surgery of the tumour and subsequent chemotherapy the number of endothelia in venous blood reached normal levels with in 1-2 months. Conversely in patients where despite surgery secondaries were detected in other organs, the number of endothelia remained elevated.

[Sjögren's syndrome].

E Lakata, T Hildebrand, E Merstenová

Vnitr Lek 1993, 39(4):374-379

The authors present an account on Sjögren's syndrome--clinical manifestations, diagnosis, pathogenetic aspects and treatment. The diagnosis was based on three findings: keratoconjunctivitis sicca, stomatodynia--xerostomia and other immunological, diseases. The authors used different immunological examinations, bioptic examination of the oral mucosa and parotid glands. As to gastroenterological examinations, the gastric secretion is examined according to Lambling's method, the gastroduodenum is subjected to radiographic examination, endoscopy is performed as well as a bioptic examination of the gastroduedenal mucosa.

[The effect of 2-aminoethylisothiouronium bromide on HLA antigens].

A Májský

Vnitr Lek 1993, 39(4):380-384

Lymphocytes treated with a 6% and 4% AET solution after 60 or 120 minutes at 20 degrees or 37 degrees C display polyreactivity. Polyreactivity does not develop after short-term treatment (1-10 mins.). After treatment of lymphocytes with a 3% or 2% AET solution for a period of 20 or 30 mins. at 20 degrees or 37 degrees C the specific expresivity of HLA--A, B antigens rises; they are manifested, contrary to untreated lymphocytes, also by weak HLA sera. Addition of AET to the mixture of lymphocytes--HLA serum causes in the first stage of the microlymphocytotoxic test negativity of the test due to a block of the haemolytic activity of rabbit complement.

[Therapy of refractory multiple myeloma. II. Therapy using high doses of alkylating cytostatic agents and radiotherapy in addition to interferon and bone marrow transplantation].

Z Adam

Vnitr Lek 1993, 39(4):385-400

The author presents part II of his review on the treatment of refractory myeloma. Treatment with large doses of melphalane, 140 mg/m2, was associated with a high death rate and therefore it is used nowadays only in combination with autologous transplantation or treatment with leucocytic growth factors (GM-CSF and G-CSF). Medium doses of melphalane (25 mg/m2 to 70 mg/m2) are tolerated better and are one of the possible approaches. Another possible therapeutic procedure is whole-body irradiation. The advantage of extensive irradiation is rapid regression of pain. Interferon-alpha achieves a therapeutic response in some 20% of refractory patients. Finally...

[Resistance to cytostatic agents in patients with refractory multiple myeloma and possible ways to control it].

Z Adam, J Vorlícek

Vnitr Lek 1993, 39(4):401-407

At present several mechanisms responsible for the resistance of tumour cells to cytostatics are known. Most explored is the resistance conditioned by glycoprotein-P. Under laboratory conditions it proved possible to inhibit the resistance caused by glycoprotein-P by many substances which, however, on clinical administration have serious adverse side-effects. In practice verapamil was used, its effect was most marked in haematological malignant diseases. Side-effects of verapamil, however, do not permit to attain the necessary concentration. Obviously better results will be achieved by cyclosporin A which can attain a concentration in the organism which...

[Diabetes mellitus and the digestive tract].

J Roubalík

Vnitr Lek 1993, 39(4):408-415

The author discusses in the submitted paper the important subject of manifestations of diabetes in the digestive tract--oesophagus, stomach, small and large intestine. Autonomous neuropathy, in particular a reduced tonus of the vagus, leads to a number of functional disorders which can produce diabetic dysphagia, gastroparesis, diarrhoea and constipation. The reduced tonus of the vagus, along with other factors, may lead to atrophy of the gastric mucosa and reduced gastric secretion. This explains the higher incidence of atrophic gastritis and other complications in diabetic patients. The author discusses also basic clinical aspects of these disorders...