Vnitřní lékařství, 1992 (roč. 38), číslo 11
[The dilemma of syndrome X].
J Hrnciar
Vnitr Lek 1992, 38(11):1041-1044
The term X syndrome involves several dilemmas. The terminological dilemma is that this term is used to describe microvascular angina pectoris, as well as Reaven's metabolic-hormonal syndrome and our 5H syndrome [association of hyperinsulinism with arterial hypertension, hyperlipoproteinaemia, hyperglycaemia (NIDDM) and hirsutism]. It is probable that the coronary X syndrome is frequently conditioned by the hormonal-metabolic X syndrome. The pathogenetic dilemma is that it is not clear why in microvascular angina pectoris the coronary circulation does not possess an adequate reserve for vasodilatation during exercise or in response to some pharmacological...
[Long-term effect of drug therapy in supraventricular dysrhythmia evaluated by diagnostic esophageal cardiac pacing].
R Stípal, T Minarík, A Martínek
Vnitr Lek 1992, 38(11):1045-1049
The authors investigated the long-term therapeutic effect in 33 patients after a medicamentous reversal of recent atrial fibrillation and 18 patients after reversal of an attack of supraventricular tachycardia (SVT). None of the patients had signs of cardiac failure. A change to sinus rhythm was achieved in the group with atrial fibrillation by digoxin with verapamil, in the group with SVT by verapamil. Treatment was then adjusted, based on testing by means of diagnostic oesophageal pacing. The basic drug for long-term use in atrial fibrillation was digoxin either as monotherapy or in combination; the majority of patients with SVT had verapamil treatment....
[Directed sympathetic denervation of the heart--an actual therapeutic method or myth?].
M Janota, M Vrána, I Vaněk, Z Vránová
Vnitr Lek 1992, 38(11):1050-1055
Aimed sympathetic denervation of the heart, i. e. bilateral removal of the stellate ganglion Th 1-Th 3 was used in Czechoslovakia since 1981 in eight patients who were followed up for prolonged periods. The patients were operated on account of angina at rest which caused deterioration of the quality of their lives. In case of extensive affection of the coronary arteries surgical treatment was not feasible and pharmacological treatment did not bring relief. At the time of a five-year check up 7 patients survived. All patients reported relief and their efficiency during ergometry improved. Four of the patients worked for several years. The authors discuss...
[Hyperinsulinism and the coronary syndrome].
J Hrnciar
Vnitr Lek 1992, 38(11):1056-1065
In one third of patients who suffered an infarction NIDDM and arterial hypertension are present. In the absolute majority of patients with IHD, as apparent from the IRI and C-peptide response after a glucose load, hyperinsulinism is present. The blood sugar response can have the character of diabetes or of impaired glucose tolerance, the curve may be very flat or normal while the IRI and C-peptide response are excessive. Hyperinsulinism has a hypersecretory origin as suggested by the concurrently elevated C-peptide level but also reduced insulin utilization in the liver and peripheral target organs. Hyperinsulinism is thus a regular associated phenomenon...
[24-hour effect and tolerance for perindopril (Prestarium) in mild and moderate essential hypertension].
J Widimský, R Cihák, V Fedelesová, K Lefflerová, O Mayer, O Uhlír
Vnitr Lek 1992, 38(11):1066-1071
A multicentre investigation of antihypertensive treatment by perindopril was conducted in three centres of Czechoslovakia. The investigation comprised 51 patients with mild to moderate essential hypertension (diastolic pressure 95-115 mmHg) who were taking perindopril for a period of three months, the initial dose being 4 mg (1 tablet per day). If the blood pressure did not drop to normal levels (dBP < 90 mmHg), the dose was increased to 8 mg after 1 month and if after 2 months of treatment the blood pressure did not reach normal levels, a thiazide diuretic was added. The antihypertensive effectiveness was assessed 24 hours after ingestion of the...
[Gestational diabetes mellitus and disorders of glucose tolerance in pregnant women with essential hypertension].
K Janků, J Bělobrádková, B Podrouzková, V Sochorová, A Roztocil, P Horký
Vnitr Lek 1992, 38(11):1072-1076
The authors revealed during dispensarization of pregnant women suffering from essential hypertension that the disease is relatively frequently associated with some metabolic disorders, i. e. obesity, gestational diabetes or impaired glucose tolerance. They draw attention to a similarity with Reaven's syndrome in non-pregnant women. The authors recommend to screen for diabetes all obese pregnant women and those with hypertension to detect an impaired glucose metabolism and prevent foetopathies in neonates of thus affected mothers. The authors consider obesity one of the subsidiary criteria in the differential diagnosis of essential hypertension and...
[The effect of self-monitoring on perinatal outcome in insulin therapy of diabetic women during pregnancy].
J Bělobrádková, B Filipenský, A Roztocil, P Horký, K Janků, L Pilka, V Sochorová
Vnitr Lek 1992, 38(11):1077-1081
The authors compare perinatal results in insulin treated diabetic women who were followed up in the out-patient department of the Second Gynaecological and Obstetric Clinic of the Masaryk University in Brno. In 1980-1984 148 pregnant diabetic women were followed up and in 1985-1991 when self-monitoring has become part of comprehensive treatment of pregnant diabetics in our department, 279 women were followed up. The patients were monitored during pregnancy by a diabetologist and gynaecologist. Other members of the team are a paediatrician, geneticist, psychologist, dietitian, and educational nurse. As to laboratory parameters, short-term and long-term...
[Prenatal preparation--a part of the care of young female diabetic patients].
A Roztocil, P Horký, K Janků, L Pilka, V Sochorová, J Bělobrádková, B Filipenský
Vnitr Lek 1992, 38(11):1082-1085
In the Second Gynaecological and Obstetric Clinic in Brno there has been for more than 15 years a specialized department for treatment of diabetes during pregnancy. The department monitors and treats pregnant diabetics from approximately two thirds of the former South Moravian region, i.e. patients with diabetes assessed before pregnancy as well as those where an impaired carbohydrate metabolism was detected during pregnancy. The authors submit an account of the organization of team work in their out-patient department.
[Ablation of the accessory bundle of Kent using radiofrequency current in a 17-year-old boy with type A Wolff-Parkinson-White syndrome].
B Vítek, M Suchánek, P Vít, Z Jelínek
Vnitr Lek 1992, 38(11):1086-1090
The authors describe the in Czechoslovakia so far not used therapeutic catheterization ablation method of the accessory atrioventricular pathway in patients with tachycardia with the Wolff-Parkinson-White syndrome. They performed successful ablation of the accessory bundle of Kent located by electrophysiological examination behind the left atrium and left ventricle in a 17-year-old boy with WPW Syndrome type A. They severed the accessory pathway by radiofrequency current using a catheter inserted from a retrograde approach into the left ventricle beneath the mitral valve. After ablation the boy suffers no longer from tachycardia, the ECG tracing in...
[Subphrenic abscess--a complication of intensive cytostatic treatment in acute leukemia].
Z Adam, T Nebeský, E Krahulcová, J Vorlícek
Vnitr Lek 1992, 38(11):1091-1095
The authors describe the slow development of an abscess in the left subphrenic space in a patient with acute myeloid leukaemia. The patient suffered several months before the diagnosis was established from pain in the left subcostal region and was on account of this pain examined repeatedly by clinical methods and sonography. During the last sonographic examination in this area a hypoechogenic formation was detected. The diagnosis was than established more accurately by computer tomography by visualization of the abscess cavity. The case-history and relatively thick wall of the cavity suggested a long-term process. The abscess cavity was evacuated...
[A new concept of atherogenesis: the role of oxygen radicals].
E Ginter
Vnitr Lek 1992, 38(11):1096-1104
The author discusses a new concept of atherogenesis which is based on older hypotheses (lipid infiltration hypothesis), theory of impaired endothelial barrier, role of immunological and thrombocytic factors) and supplements it by new findings on the role of oxygen radicals in the development of atherosclerosis. The atherogenity of native low density lipoproteins (LDL) is enhanced substantially by their post-secretory changes caused by the action of free oxygen radicals on unsaturated fatty acids in the outer layer of LDL particles. The development of lipid peroxides on the surface of LDL leads to a changed orientation of the metabolism of LDL particles:...
[Insulin resistance as a risk factor in atherosclerosis].
V Spustová
Vnitr Lek 1992, 38(11):1105-1110
Clinical complications of atherosclerosis are the main cause of mortality in the most advanced countries. Epidemiological data supported by extensive perspective investigations suggest the role of hyperinsulinaemia as an independent risk factor in the development of atherosclerosis. The authors summarize the trends in research of insulin resistance, its possible diagnostic and treatment.
[Therapy of developed atherosclerosis].
R Dzúrik
Vnitr Lek 1992, 38(11):1111-1118
Atherosclerosis is a reversible process and is an excessive response to damage of the vascular wall. It comprises a number of cellular processes and humoral modulations/regulations the pathogenesis of which is intensively studied. The reversibility of atherosclerosis changes fundamentally the approach to its prevention and therapy, and the effectiveness of anti-aggregation and antihyperlipaemic therapy has been proved. Other preventive and therapeutic procedures are intensively studied.
[New pathogenic findings on the mechanism of heart failure and their importance in therapy].
J Dúbrava, S Cagán
Vnitr Lek 1992, 38(11):1119-1126
Activation of the neuroendocrine system participates in a decisive way in the pathogenesis of cardiac insufficiency. The authors draw attention to the basic therapeutic impact of the phenomenon of so-called "down-regulation" of myocardial beta-adrenoreceptors which takes place during chronic cardiac insufficiency, contrary to acute cardiac failure. The authors deal from the pathogenetic aspect with different groups of positive inotropic substances used in the treatment of cardiac insufficiency with special attention to digoxin and cardiac glycosides. They evaluate the effect of digoxin as a neurohumoral modulator in acute and chronic cardiac insufficiency....
[Pathogenesis and fundamentals of treatment in acute myocardial infarct].
S Cagán, J Dúbrava, H Spitzerová, J Filová
Vnitr Lek 1992, 38(11):1127-1137
Recent findings which extend and render more accurate factors which influence the genesis and course of experimental and clinical acute myocardial infarction change in a significant way the treatment and management of patients with acute infarction. The authors discuss the basic factors and complex of interactions which play the most important part in the pathophysiology of acute infarction. They pay attention also to other factors which can influence in a significant way the course of acute infarction and the patient's prognosis (residual thrombosis, rethrombosis, extension, expansion of the infarction and remodelling of the left ventricle). In recent...