Vnitřní lékařství, 1999 (roč. 45), číslo 1
[Insulin resistance and the coronary syndrome].
J Okapcová, J Hrnciar, F Kovár, P Kurray, D Gábor, J Lepej
Vnitr Lek 1999, 45(1):3-10
The different diseases associated with the insulin resistance syndrome--diabetes mellitus or impaired carbohydrate tolerance, atherogenic lipoprotein phenotype, arterial hypertension and central type of obesity are the main risk factors of atherosclerosis. The reduced sensitivity of target tissues to the metabolic action of insulin (insulin resistance) is considered at present a separate risk factor. The authors analyze on the basis of a group of 210 coronarographic patients the influence of insulin resistance and associated etiopathogenetic risk factors on coronary lesions evaluated by the method of quantitative coronarography. From the results of...
[Relation between cytokines (TNF-alpha, IL-1 and 6) and homocysteine in android obesity and the phenomenon of insulin resistance syndromes].
J Hrnciar, D Gábor, M Hrnciarová, J Okapcová, M Szentiványi, P Kurray
Vnitr Lek 1999, 45(1):11-16
TNF-alpha (so-called cachectin), IL-1 and 6 are important regulating agents in the homeostasis of energy in the organism, as among others they control processes of apoptosis and thus also the volume of adipose and muscular tissues. They are produced not only in immunocompetent cells but also in adipocytes and muscle cells. The cytokine system is then activated not only in tumours and infections but elevated values were found also in obesity, NIDDM, in myocardial infarction and in advanced decompensated cardiac patients. By acting on phosphorylation of IRS-1 and PI-3 kinase TNF-alpha promotes significantly insulin resistance, causes deterioration of...
[Occurrence of primary aldosteronism in a group of ambulatory hypertensive patients].
A Kreze, D Okálová, P Vanuga, Z Putz, J Kodaj, J Hrnciar
Vnitr Lek 1999, 45(1):17-21
Findings pertaining to the diagnosis and treatment of primary aldosteronism are rapidly expanding. In the present work the authors focused attention on the clinical application of some progressive methods. They examined a group of 115 ambulatory patients with arterial hypertension, not suspected of secondary arterial hypertension, in the course of one year. As a screening method of primary aldosteronism they selected the aldosterone renin ratio (ARR). Using this method the authors diagnosed 125 cases of primary aldosteronism, i.e. a 13% prevalence in the examined group. Only in one instance they detected an adenoma by computed tomography (CT), in the...
[Risk factors and prevention of sudden cardiac death in patients with ventricular tachycardia after myocardial infarct].
G Kaliská, M Szentiványi, P Kmec, R Alberty
Vnitr Lek 1999, 45(1):22-29
UNLABELLED: The optimal therapeutic procedure for prevention of sudden cardiac death (SCD) after myocardial infarction involves identification of the patients with a high risk of malignant ventricular arrhythmias using non-invasive risk markers, invasive electrophysiological evaluation of high risk patients, selection of treatment (ICD, RFTA, antiarrhythmics) and evaluation of the effectiveness of treatment. The objective of this work is retrospective evaluation of the incidence of risk markers of sudden cardiac death and the importance of programmed ventricular stimulation for the prognosis of patients with malignant ventricular arrhythmias after...
[Percutaneous transluminal coronary angioplasty in the treatment of acute myocardial infarct].
F Kovár, P Kurray
Vnitr Lek 1999, 45(1):30-34
A patient with acute myocardial infarction can undergo at present one of the following reperfusion therapies: 1. Primary PTCA (as an alternative to thrombolytic treatment), 2. Emergency PTCA (when thrombolysis fails), 3. Elective PTCA (in spontaneous or post-exercise myocardial ischaemia). 4. Empirical PTCA (as prophylaxis of recurrent myocardial ischaemia). The authors submit their initial experience with the use of PTCA in the treatment of acute myocardial infarction. In a group of eight patients (5 men and 3 women), age 33-72 years (mean 51 years) where primary PTCA (5 patients) and emergency PTCA (3 patients) was used.
[Radiofrequency ablation of type I atrial flutter. Personal experience].
M Szentiványi, G Kaliská
Vnitr Lek 1999, 45(1):35-39
The cause of Afl-I is macroentry in the right atrium. The critical site of reentry is the narrow anatomical space in the isthmic region between the posterior part of the annulus of the tricuspid valve and the vena cava inferior (isthmus TA-IVC). Radiofrequency ablation (RF) of the isthmus TA-IVC is successful on average in 90% of patients. The best criterium for evaluation of short-term and long-term effect of RF ablation is a two-way block of conduction in the TA-IVC insthmus, created by RF ablation. In case of a relapse it is possible to repeat ablation. Although a proarrhythmic effect of ablation is not assumed, the cause of the higher frequency...
[Homocysteine--a routine biochemical parameter in cardiovascular diseases?].
D Gábor, J Hrnciar, I Hricová, M Zacharová
Vnitr Lek 1999, 45(1):40-45
An elevated level of total homocysteine (tHcy) in blood-hyperhomocysteinemia, is prevalent and strong risk factor for atherosclerotic vascular disease in the coronary, cerebral and peripheral vessels and for thromboembolism (arterial and venous). Elevated total homocysteine confers a graded risk with no threshold, is independent of but may enhance the effect of conventional risk factors. Hyperhomocysteinemia seems to be a particularly strong predictor of cardiovaskular mortality. Supplementation with B-vitamins, in particular with folic acid, is an efficient, safe and inexpensive means to reduce an elevated total homocysteine level.
[Cell adhesion molecules and their role in pathophysiologic processes].
Z Marecková, S Heller, K Horký
Vnitr Lek 1999, 45(1):46-50
Cell adhesion molecules are substances with a protein character expressed on the cell surface of all tissues. They participate in the control of basic vital processes, in processes of embryogenesis, cellular growth and differentiation, they ensure the interaction of cells with the environment. At present four main classes of cytoadhesion molecules are known: integrins, the immunoglobulin group of adhesion molecules, cadherins and selectins. Cytoadhesion molecules play an important role in the pathophysiology of cardiovascular, neoplastic, infectious and skin diseases. Some cardiovascular diseases are associated with pathological impairment of the structure...
[Effect of aerobic training in top athletes on serum leptin: comparison with healthy non-athletes].
M Haluzík, D Haluzíková, P Brandejský, J Nedvídková, L Boudová, M Barácková, Z Vilikus
Vnitr Lek 1999, 45(1):51-54
Leptin is a protein hormone produced by adipocytes. Its serum concentration in the most of cases precisely reflect the total body fat content. The aim of our study was to follow up the influence of regular aerobic training on serum leptin levels. Therefore the serum leptin levels, basic anthropometric parameters and serum lipids were compared in 11 intensively trained race walkers and 10 age-matched non sporting control subjects. We have found, that serum levels, body weight, body mass index, body fat content, total and LDL-cholesterol were significantly decreased in walkers group in comparison with control subjects. Serum leptin levels positively...
[Mantle cell lymphoma as a diagnostic and therapeutic problem].
T Papajík, L Raida, E Faber, J Hubácek, M Heczko, P Slezák, I Sulovská, Z Pikalová, E Kynclová, J Dusek, M Tichý, M Jarosová, K Indrák
Vnitr Lek 1999, 45(1):55-61
The authors present the characteristics of a group of 23 patients with mantle cell lymphoma. In the group only a slight predominance of men over women was found (1.1:1), the median age was 63 years. Twenty-one (91%) of the patients were diagnosed in stage IV (Ann Arbor). In all these patients the bone marrow was affected. In 19 of them immunoflowcytometric analysis revealed the typical clone of B lymphocytes (CD5 positive)/CD 23 negative). The majority of patients had at the time of diagnosis a large tumourous mass with massive splenomegaly (61%), hepatomegaly (57%) and bulky disease (52%). The node was excised in 17 patients, but in four patients...
[A multicompartmental and multifactorial model of production of plasminogen activator inhibitor (PAI-1). II. Clinical study in patients with insulin resistance].
P Galajda, P Kubisz, M Mokán
Vnitr Lek 1999, 45(1):62-66
PAI-1 levels are closely associated with insulin resistance (IR) syndrome, including patients with obesity, hypertension, hypertriglyceridaemia and type 2 diabetes mellitus (DM). Clinical studies demonstrated PAI-1 correlations with insulin (IRI), triglycerides (TG) and body mass index (BMI) values, but these relations have not been confirmed in all studies. In obesity PAI-1 levels correlate with IRI and BMI in the relation to increased adipocyte PAI-1 production, which is dependent on stimulative insulin action. In the case of endothelial hyperproduction in patients with IR elevated PAI-1 levels correlate with TG values. Insulin inhibits induced endothelial...