The authors investigated the effect of hyperlipoproteinaemia on the formation of free oxygen radicals to which a significant role in the genesis of atherosclerosis is ascribed. They cause among others peroxidation of blood lipids with formation of lipoperoxides with a higher atherogenity. Using the method of luminol-dependent chemiluminiscence, their spontaneous and activated production in phagocytic blood cells was examined in a group of patients investigated on a long-term basis on account of hyperlipoproteinaemia (n = 24). The results were compared with a group of healthy subjects (n = 20); concurrently also blood lipids were examined. The authors revealed a statistically significant reduction of the spontaneous production of free oxygen radicals in the group of patients with hyperlipoproteinaemia. On examination of the activated production the drop of oxygen radical formation was at the borderline of statistical significance.

Icodextrin, a glucose polymer, is an alternative osmotic agent to glucose in peritoneal dialysis solutions. Icodextrin generates ultrafiltration through colloid osmosis and is thus effective even during long-term (e. g., nighttime) dwells and in cases of high peritoneal permeability, where it prevents dialysate reabsorption into the systemic circulation. Ultrafiltration is maintained even in the presence of peritonitis. The incidence of bacterial peritonitis is not different when using icodextrin- or glucose-based solutions. Some time ago, icodextrin use was implicated in an increased incidence of sterile peritonitis. This was due to contamination of some batches of the solution by peptidoglycan present in the cell wall of G+ bacteria. Using exact isotope methods, treatment with icodextrin-based solution has been shown to improve the hydration status of peritoneal dialysis patients, suggesting a potential for improved blood pressure control. Icodextrin-based dialysis is associated with a reduction of left ventricular mass. Given the methodological flaws of trials conducted to date, the acute hemodynamic effects of icodextrin cannot be conclusively interpreted. Inclusion of icodextrin-based solution instead of the glucose-based one into the prescription of peritoneal dialysis decreases the metabolic load with glucose potentially having a beneficial effect on hyperlipidemia, hyperinsulinemia and hyperleptinemia, with improved glycemic control in patients with diabetes as an additional benefit. Function of the peritoneum as a dialysis membrane is stable during icodextrin-based treatment, possibly longer compared with glucose-based solutions. Data derived from a large-scale registry have shown lower mortality of icodextrin-treated patients; this, however, needs to be confirmed by prospective randomized controlled trials.

Aim:
To analyze factors after successful direct-current cardioversion in patients with atrial fibrillation and to explore late recurrences of the arrhythmia.
Methods:
Forty-three patients with atrial fibrillation without associated valvular heart disease, who underwent non-emergent cardioversion within the years 2002-2006, were included. We retrospectively analyzed clinical data from the medical records. Late reccurence of the arrhythmia was defined as arrhythmia in patients discharged with sinus rhythm.
Results:
Median follow-up of the patients was 33 (17, 48) months. We found 20 late recurrences of atrial fibrillation in the total group of 43 patients after successful direct-current cardioversion (46.5%). In a 6-month period after direct-current cardioversion the recurrence of arrhythmia was found in two patients, in a one-year period in 6 patients and in a period longer than one year in 12 patients. Median time to recurrence was 15 (6, 33) months. Females relapsed more frequently than males (p < 0.02), what could be explained by higher age, incidence of hypertension and thyreopathy in females. Patients with a history of thyropathy had more frequent occurrence of arrhythmia, despite normal values of TSH, as compared to patients without a history of thyropathy (p < 0.04). Patients with recurrence of the atrial fibrillation had higher systolic pressure (130 vs 120 mm Hg, p < 0.05) and pulse arterial pressure (50 vs 40 mm Hg, p < 0.01) after cardioversion. No significant difference between the two groups in age, left atrium diameter, left ventricle ejection fraction and cardiovascular, or non-cardiovascular risk factors was found.
Conclusion:
Despite successful direct-current cardioversion, the risk of late recurrence of the atrial fibrillation in a following period is at least 46.5%. Females, patients with a history of thyropathy and those with higher systolic and pulse arterial pressures are at higher risk of late recurrences.

Hyperglycaemia is the common characteristic for diabetes patients. Prolonged hyperglycaemia due to absolute or relative lack of insulin is the cause of microangiopathy. Glucose reacts with both blood vessel wall proteins and plasmatic proteins and erythrocyte haemoglobin. This characteristic of glucose is used to monitor the level of diabetes compensation. The level of glycated haemoglobin reflects glycaemia for the last 2 to 3 months. It began to be used in diabetology in the 1980's. This outline paper deals with some of the pitfalls with which glycated haemoglobin has been recently associated. The first part is dedicated to factors influencing haemoglobin glycation. The second, methodological part focuses on factors influencing its assessment and interpretation. The third part concentrates on the options for the substitution of glycated haemoglobin by other diabetes compensation markers.

Still after 40 years of heart valve prostheses intensive development ideal valve substitute still does not exist. Aortic allograft represents one alternative which could be used for aortic and/or pulmonary valve replacement. This type of biological heart valve prosthesis is being currently discussed from the point of view of Tissue Banking, as well as from clinical aspects - e.g. surgical implantation technique and long term results. Live issue remains particularly the aortic allograft implantation into the aortic position. The authors discuss the aortic allograft role in the aortic valve infectious endocarditis treatment, which was widespread worldwide and accepted. Aortic allograft implantation is considered as a method of choice in that particular indication, especially in prosthetic aortic valve endocarditis and in left ventricle outlet tract destruction cases. The method is considered to be more technically demanding than routine heart valve surgery (heart valve replacement by means of mechanical or commercial biological prostheses), but literary and authors own experience in that particular group of patients looks encouraging. Aortic allografts permanent supply in our country is secured.

Introduction:
Laser Doppler flowmetry is a sensitive modern method for evaluating the function of small veins which allows for the detection and assessment of early pathological changes in microcirculation. The method uses a low power laser beam which is emitted into the tissue where it is reflected and further recollected and analysed. The objective of the study was to compare laser Doppler flowmetry parameters for patients with chronic venous insufficiency (class 2 according to CEAP, primary varices) prior to and 1 month after surgery of varicose veins.
Methodology and patient sample:
The examination was performed by a Periflux laser Doppler apparatus made by Perimed. Blood flow was examined on the dorsal side of foot fingers. A total of 42 patients were examined prior to and one month following the varicose veins surgery, of whom 28 women and 14 men. The mean age of the patient sample was 49 years. A 45 minute pre-op and postop recording of the limb was made for each patient. The protocol consisted of a 10 minute recording in rest, followed by a 4 minute ischemisation of the limb with the use of a blood pressure measuring cuff, subsequent release of the cuff, a 15 minute recording of the reperfusion and a test of vasodilatation using nitrate, and a 10 minute recording following vasodilatation. Evaluation was performed for a 4 minute period at the end of the initial rest period, for reperfusion after the release of the cuff and for the interim period of rest immediately preceding the application of nitrate, and finally for a 5 minute period after nitrate application. Statistical evaluation was performed for data acquired during the movement of blood elements and data acquired in the frequency analysis of the movement of the blood vessel wall. 3 variables were chosen for the statistical evaluation of the blood cell movement data: "the area under the curve", "the mean value of the deviation" and "the percentage change" in the different phases of the measurement, i.e. as compared with the rest recording: comparing the ischemisation and the rest recordings, comparing the vasodilatation and the rest recordings, and comparing the restitution and the rest recordings. The above variables were not assessed as absolute numbers but as the difference of values before and after the surgery. The above differences were tested in the Wilcoxon test. The intensity of blood vessel movements in the frequency range from 0.008 to 0.200 Hz and 0.210-0.420 Hz was evaluated in frequency analyses.
Results:
Significant differences in peripheral microcirculation in lower limbs were found in the evaluation of data acquired during the movement of the different blood elements before and after varicose vein surgery (p = = NS). On the contrary, evaluation of frequency analysis for both the operated and non-operated limb shows a decrease in spontaneous arterial reactivity after varicose vein surgery. This decrease is statistically significant in the frequency range from 0.102 to 0.228 on operated limbs after the removal of a varix in a T1 test (i. e. after reperfusion) as compared with the values before the surgery (p < 0.05).
Conclusion:
Varicose vein surgery results in the reduction of spontaneous vasomotion in the periphery of the operated limb.

The article informs about current views of the ethiopathogenesis of type 2 diabetes mellitus (DM). It presents diabetes as a disease which is chronic and progressive, therefore requiring a dynamic approach to treatment. Based on the above concept, the article lists the current armamentarium of oral antidiabetic drugs and the possibilities of their combining. In addition to the existing therapeutic options, it also brings information about innovative drugs from the above group to be made available in the near future.

The latest clinical intervention studies of statins have shown that more aggressive reductions in LDL-cholesterol to values lower than existing target values for persons with a high risk of cardiovascular disease produce greater success in terms of halted progression and even regression of the atherosclerotic process and fewer cardiovascular events. This has lead to a series of international and national recommendations for a further reduction in target values for LDL-cholesterol, which is often difficult to achieve with the usual dosage of statins. The combination of a statin with ezetimibe, acting as a dual inhibition mechanism against the synthesis and absorption of cholesterol, reduces LDL-cholesterol significantly more than treatment with a statin in monotherapy. This allows many more patients to achieve the target value for LDL-cholesterol. At present a drug combination comprising ezetimibe 10 mg and simvastatin in all doses (10, 20, 40 and 80 mg) is being introduced into our market under the company name Inegy®. In addition to reducing LDL-cholesterol by up to 61% this combination has a positive effect on a range of other parameters for lipid metabolism and inflamation. A typical initial dose of ezetimibe 10 mg/simvastatin 20 mg reduces LDL-cholesterol by around 50%, which is necessary for the stabilisation of atherosclerotic plaque. For patients requiring more aggressive reduction of LDL-cholesterol it is best to start with a dose of ezetimibe 10 mg/simvastatin 40 mg. The highest dose of 10 mg/80 mg is intended for patients with the highest level of risk and reduces LDL-cholesterol by around 60%. In all the studies that have been carried out so far, the combination of ezetimibe and statin was very well tolerated and the safety profile of this combination was the same a treatment with the statin alone. At present a wide range of large clinical studies are underway to test whether LDL-cholesterol reduction using the ezetimibe + statin combination will also lead to a lower risk of cardiovascular events.

Venous thromboembolism is an important cause of morbidity and mortality in internal medicine but antithrombotic prophylaxis is not being sufficiently used in comparison with surgical settings. In medical patients there are usually multiple risk factors, often with cumulative effect and the comprehensive risk assessment is complicated. The most important agents for pharmacological thromboprophylaxis are heparins - unfractionated and low-molecular-weight. The metaanalysis of randomised trials comparing unfractionated or low-molecular-weight heparin against control (placebo or aspirin) in medical patients has confirmed a significant risk reduction for deep vein thrombosis (56 %) as well as pulmonary embolism (58 %). Low-molecular-weight heparin is as effective as unfractionated heparin in reducing mortality as well as venous thromboembolism but has the advantage of significantly fewer bleeding complications. A novel synthetic pentasaccharide antithrombotic agent fondaparinux has been successfully proved in thromboprophylaxis in medical patients too. In most trials the duration of pharmacological prophylaxis was up to 2 weeks, the possible benefit of extended prophylaxis has not been clarified yet. Specific groups are intensive care patients; the elderly for their high thromboembolic as well as bleeding risk and significant comorbidity; the patients with acute ischaemic stroke who have very high thromboembolic risk but there are concerns about the risk of haemorrhagic transformation of stroke. The economic studies have shown that low-molecular-weight heparin in prophylactic doses in acutely ill medical patients is cost-effective strategy.

Zinc administered on a long-term basis in excess to patients with Wilson a disease blocks in a significant way copper absorption from the gut, prevents its accumulation and toxic action in the organism. The authors investigated the effect of its long-term administration on the plasma concentration of copper, zinc, and selenium, on the superoxide dismutase activity in red blood cells and glutathione peroxidase activity in whole blood. In seven patients with Wilson a disease treated with zinc sulphate, 136 mg of elemental zinc for 1.5 years (18 months), the authors assessed the plasma concentration of zinc, copper, selenium and ceruloplasmin, the activity of superoxide dismutase in red blood cells, the activity of glutathione peroxidase in whole blood and the urinary excretion of zinc and copper in 24 hours. Envisaged findings with regard to the diagnosis of the investigated patients and their treatment: elevated plasma zinc concentration and increased urinary excretion, reduced copper and ceruloplasmin plasma concentration and increased urinary copper excretion. The authors recorded also a significantly elevated selenium plasma concentration and a significantly higher concentration of superoxide dismutase in red blood cells (p < 0.05). The increase of the glutathione peroxidase activity in whole blood in the investigated patients was not significant (p < 0.05). Changes in the values of the investigated parameters in patients with Wilson s disease treated on a long-term basis with zinc indicate the possible mutual interaction of zinc with other trace elements with an impact on the activity of the corresponding metalloenzymes, i.e. in the sphere in antioxidant systems.

UNLABELLED: Primary biliary cirrhosis is a chronic liver disease, characterized by the destruction of the epithelial cells of the sublobular, interlobular and septal bile ducts and with the development of cirrhosis. The presence of anti-mitochondrial antibodies against the subunits of mitochondrial 2-oxoacids dehydrogenases is characteristic for patients with primary biliary cirrhosis. The aim of this work was to study the effect of anti-mitochondrial antibodies upon activity of the isolated mitochondrial pyruvate dehydrogenase complex after the incubation with serum from patients with primary biliary cirrhosis.
GROUP OF PATIENTS AND METHODS: The activity of the purified bovine pyruvate dehydrogenase complex was studied spectrophotometrically in presence of the serum (1: 1000) from five patients with primary biliary cirrhosis and from ten disease free controls.
RESULTS: The activity of the pyruvate dehydrogenase was decreased after incubation with the serum from patients with primary biliary cirrhosis. No similar inhibitory effect was found after incubation with serum from controls.
DISCUSSION: The inhibitory effect of the anti-mitochondrial antibodies upon activity of pyruvate dehydrogenase may broaden the spectrum of diagnostic methods in patients with primary biliary cirrhosis. Further investigations are necessary to assess the possible application of this method for monitoring of changes during the course of the disease and for assignation of the disease prognosis.

BACKGROUND: Myocardial fractional flow reserve (FFR) is a useful method in assessment of functional significance of coronary stenosis. Deferral of intervention of angiographically intermediate lesion based on FFR measurement is safe in selected patient population as previously described. The aim of the study was to assess mid-term results after deferring coronary intervention of intermediate lesion in a non-selected patient population with no respect to the extent of coronary artery disease and to the results of stress tests if performed.
METHODS: A coronary intervention of angiographically intermediate lesion (40 - 70% according to QCA) was deferred in a group of 50 consecutive patients (33 men, mean age 60.8 +/- 10.2 y.) on the basis of FFR > or = 0.75 (mean FFR 0.89 +/- 0.06). FFR was measured in 62 lesions (mean stenosis diameter 55 +/- 7%, left anterior descending 34 lesions, circumflex artery 13 lesions, right coronary artery 15 lesions). One-vessel disease was presented in 14 pts (28%), 36 pts (72%) presented with multivessel disease (two-vessel disease in 27 pts - 54% and three-vessel disease in 9 pts - 18%). Stress test was positive in 15 pts, in 1 pts. negative, and in 3 pts. non-diagnostic. All-cause mortality, cardiac mortality, non-fatal myocardial infarction (MI) and ischemia driven target vessel revascularization (TLR) were recorded during follow-up. Severity of angina pectoris (CCS classification) and a need for antianginal treatment (beta-blockers, nitrates, calcium channel blockers) at the baseline and at the end of clinical follow-up was recorded.
RESULTS: Follow-up was completed in 49 patients (98%). Mean time of follow-up is 15.4 +/- 2 months (range 12 - 22 months, median 15 months), two patients died (4 %)--one from colon cancer, the other patient died from lung cancer, there was not any cardiac death recorded, two patients (4%) had target vessel revascularization. Estimated 22 months event-free (all-cause death, MI, TLR) survival was (mean +/- SEM) 86 +/- 7%. There was a significant difference in symptom severity--mean grade of angina pectoris at baseline was 1.8 +/- 1.3, at follow-up 1.1 +/- 1.0 (p < 0.05). There was not difference in use of antianginal drugs was same at baseline and at follow-up (1.7 +/- 0.8 vs. 1.7 +/- 0.7). Thirty-five patients (71%) were treated by statins.
CONCLUSIONS: Deferring of coronary interventions of intermediate stenosis based on FFR measurement is safe in a mid-term follow-up. Despite of the same intensity of antianginal treatment there was a significant decrease in symptom severity.

Goal of this study was to monitor levels of serum neopterin and soluble interleukin-2 receptor (sIL-2r) and to evaluate their importance in monitoring activity of systemic lupus erythematodes (SLE). Levels of serum neopterin, anti-dsDNA antibodies, C3, C4 complement components, nucleosomes antibodies, IL-10, fas ligand, soluble thrombomodulin, sVCAM-1, and sICAM-1 were measured in a group of 52 patients with SLE. Positive correlations were proved between neopterin concentrations and disease activity (ECLAM), levels of sVCAM-1, sICAM-1, sIL-2r and thrombomodulin, further between sIL-2r level and disease activity (ECLAM), and concentrations sVCAM-1, sICAM-1 and neopterin. Higher values of neopterin and sIL-2r levels were identified in patients with lupus nephritis compared to patients without kidney impairment. Statistically significant differences were identified in levels of neopterin between a subgroup (A) with minimum disease activity and a subgroup (B) with increasing disease activity (p = 0.01) and a subgroup (C) with decreasing disease activity (p = 0.003 ) and a subgroup (LN) with lupus nephritis (0.007) during the first and the third series of measurements. sIL2r levels which had in all subgroups very varied values were the lowest in the subgroup A with minimum disease activity during the whole time of monitoring. The highest levels reached the free receptor IL-2 in the subgroup B with increasing disease activity and in the subgroup with lupus nephritis. Statistically significant differences in values were identified between the subgroup A (non-active) and the subgroup LN (lupus nephritis) with p = 0.01 during the first set of the measurements. Fluctuation of sIL-2r levels in individual subgroups during the time of monitoring did not reach statistically important levels. In conclusion it could be said that potential practical utilization of the measurement of concentrations of the two mentioned molecules should be seen especially in monitoring disease activity because they don't contribute to SLE with needed information. Their always low values have favourable prognostic impact in monitoring patients with SLE and vise versa.

Celiac sprue is permanent lifelong intolerance of gluten which in some sensitive individuals leads to an inflammation of various grades followed by atrophy of jejunum mucosa. Diagnosis of celiac sprue is based on proof of histopathological changes in jejunum mucosa as a result of presence of gluten in food. In recent years, serum endogenous myosin and tissue transglutaminase antibodies were used in a diagnostic algorithm. We distinguish active, silent, latent, and potential celiac sprue. Simultaneous incidence of type I diabetes mellitus and celiac sprue has been documented in a range of studies. Both diseases have common immunology and genetic characters. Prevalence of celiac sprue in patients with type I diabetes is several times higher compared to prevalence of this disease in the population. There is the prevalence of celiac sprue 3.6-5.1% in children with type I diabetes mellitus in the Czech Republic, silent form of the disease is the most frequent one. An effect of a strict gluten free diet on a metabolic control of diabetes has not been proved. It is necessary to assess (at least once per two years) actively and on regular basis endogenous myosin and/or tissue transglutaminase antibodies in patients with type I diabetes.

BACKGROUND AND AIM: In the recent years several studies showed the association between body iron stores, represented by serum ferritin, and atherosclerosis. It was proposed that iron bound to ferritin catalyzes the formation of highly reactive forms of oxygen free radicals which subsequently cause the oxidative modification of atherogenic lipoproteins. Aim of our study was to compare serum ferritin concentrations and certain markers of oxidative stress in patients with and without coronarographically assessed coronary vascular disease.
METHODS AND RESULTS: Measurements were performed in 216 subjects at the age of 35-60 years. The patient group included 76 patients with coronarographically assessed coronary vascular disease (CVD) (mean age 51.16 +/- 5.713 years) and 140 healthy controls (mean age 50.21 +/- 5.331 years). The plasma concentration of ferritin was higher in patients (169.04 +/- 63.899 micrograms/l) than controls (87.70 +/- 41.394 micrograms/l), p < 0.001. The group of patients revealed significantly lower plasma concentrations of anti-oxLDL antibodies, nitrites/nitrates, tocopherol and high density lipoprotein cholesterol (HDL-cholesterol) than controls; on the contrary patients had significantly higher concentrations of hemoglobin, thrombocytes and triacylglycerols. In the whole cohort of investigated subjects, ferritin correlated positively with retinol, body mass index (BMI), total-cholesterol, triacylglycerols, low density lipoprotein cholesterol (LDL-cholesterol), blood glucose, creatinine, uric acid, alaninaminotransferase (ALT), aspartateaminotransferase (AST), hematocrite, erythrocytes, with occurrence of CVD and with sex. Inverse correlation was observed between ferritin and HDL-cholesterol.
CONCLUSIONS: Our observations are consistent with the hypothesis that high stored iron levels, measured by serum ferritin concentrations, may contribute to the oxidative stress and thus elevate the risk for development of CVD.

Coeliac disease is a disease of small intestine requiring life-long strict gluten free diet to avoid acute and chronic complications. To reach maximum adherence to the diet is in some of coeliac patients, especially adults, difficult because it requires distinct changes in eating habits. To diagnose coeliac disease tests of antigliadin and anti-endomysial antibodies in serum are used. Authors monitored levels of antibodies in 32 adults 3, 6, and 12 month after histology validation of coeliac disease and after recommendation of a gluten free diet. The results were compared with data from nutritional history. Maximum adherence to the diet indicated 24 patients (75%), occasional consummation of gluten indicated 6 patients (19%) and more frequent breaking a diet indicated 2 patients (6%). In a group which adhered to the diet the most rapid was a decline in levels of anti-endomysial antibodies, less rapid was a decline in levels of IgA-class antigliadin antibodies, and the least rapid was a decline in levels of IgG-class antigliadin antibodies. In the group with occasional intake of gluten was the decline slower and in the group with frequent dietary mistakes levels of antibodies have not declined at all. Adherence to the diet positively correlated with level of accomplished education of patients. Monitoring of titter kinetics proved to be a good indicator of discipline and cooperation of patients during treatment with gluten free diet.

Authors monitored a case of a 25 years old woman who was admitted for swelling of lower limbs. Laboratory results showed hypoproteinemia, elevation of liver enzymes, and prolonged prothrombin time. Ultrasound examination proved hepatomegalia with diffusely hyperechogenic liver without central lesion. Computer tomography confirmed hepatomegalia with diffusely hyperechogenic liver and a suspicion of liver steatosis was expressed. Liver biopsy confirmed serious diffuse large droplet steatosis of unclear genesis. Carried out examinations excluded infectious and autoimmune liver diseases, metabolic diseases, and congenital liver diseases (Wilson's disease, porphyria, haemochromatosis etc.). Laboratory results showed gliadin, endomysin, and reticulin antibodies. An enteroscopy picture showed villi decrease. Histology examination of a biopsy specimen confirmed total villi atrophy with non-differentiated enterocytes and round-cell cellulisation of epithelium and proprium. Histology and histochemical findings were distinct proves of coeliac disease. A patient was prescribed a gluten free diet. Her metabolic parameters (normalisation of albumine levels, prothrombine time, and trace elements) and anino transferase levels gradually improved. This case documents development of a serious liver disorder as a result of malnutrition which developed in a young woman as a result of unrecognised coeliac disease.

PURPOSE: To assess the incidence and prognostic significance of osseous Hodgkin's lymphoma.
METHODS AND MATERIALS: The authors retrospectively analyzed 85 patients treated at their institutions between 1995-2001. They assessed the incidence of bone involvement, involved localities and basic characteristics of the subgroup (age, gender, stage, histology). All patients were treated according to the protocols of the German Hodgkin Study Group (GHSG). Treatment response, disease free- and overall survival were evaluated with special attention to predictive and prognostic significance of bone involvement.
RESULTS: From the total of 85 eligible patients 10 cases of bone involvement were recorded of who seven were diagnosed primarily and three at relapse. Most frequently involved were lumbar vertebrae. Diagnosis was based on CT and bone scan, biopsy was performed only in one case. In the evaluated subgroup, there was apparently higher incidence of advanced stage disease, other parameters did not differ from the control group. Of the 10 patients, six achieved complete remission, two uncertain complete remission and two progressed primarily. At present, eight patients are alive in complete remission, one is being treated with salvage chemotherapy and high dose therapy with autologous stem cell transplantation. One patient expired due to progressive disease. Median overall survival is 12 months.
CONCLUSION: Bone involvement is not an adverse predictive factor for treatment response in Hodgkin's lymphoma. Because of short follow-up period seems preliminary to evaluate its prognostic power for disease free- and overall survival.

World Health Organization (WHO) defined the criteria for screening (i.e. the location of asymptomatic individuals) of the diseases seriously endangering the public health condition. The decisive criterion is the decrease of mortality with the disease the screening is made of. The programme based on the testing the asymptomatic individuals for the presence of the fecal occult bleeding (FOBT), which was introduced also in Czech republic, meets the criterion at the screening of colorectal cancer (CR-CA), which has been proved since the year 1993 by the two case-control studies and further particularly by the three prospective, randomized, controlled studies which independently proved the decrease of mortality for CR-CA in the screened population by 15-33%. This programme has been introduced in Federal Republic of Germany since 1977 as a part of free anticancer examination. In 1995 the programme was recommended by the commission of the independent specialists of US Department of Health and in 1998 by the commission of experts of the European Group for Colorectal Cancer Screening. In 2001 the commission of independent specialists of the US Department of Health analysed the contemporary preventive programmes in USA according to the importance of the disease monitored for the condition of public health and the effectiveness of the preventive programme. Based on these criteria there were defined 8 priority preventive programmes and as for the organ malignities there was only CR-CA screening filed there. All the screening programmes are based on the colonoscopic examinations in various time intervals, depending on familiar anamnesis, polyps size and their histologic structure. An alternative to the colonoscopy is a combination of flexible sigmoideoscopy and irigography, but this technique did not establish itself in a larger scale. On the contrary the developed countries offer--in the frame of the large studies as well as standardly--the screening colonoscopy as an alternative to the occult bleeding examination. The predictive ability of the less invasive imaging methods e.g. virtual CT colography is also assayed. The screening programme in the frame of Czech republic has been standardized and as a reccommendation available to the professional community since 2000.

Testosterone increases muscle mass and decreases fat mass by mechanism including androgen receptors. Testosterone induces skeletal muscle fibre hypertrophy and increases the number of satellite cells. It also promotes the differentiation of mesenchymal multipotent cells into myogenic lineage and inhibits their differentiation into the adipogenic lineage. Meta-analyses of clinical trials provide evidence that testosterone treatment, depending on dose, increases the skeletal muscle mass and to some degree also muscle strength. The most frequent adverse effects of testosterone treatment in aging men are an increase of hematocrit and increased risk of prostate events.

The authors Castaldo et al. (Clin. Chem., 1994, 30: 478-83) state, that the ascitic lactate dehydrogenase and ascitic cholesterol association correctly identified 100% of malignant ascites from ascites associated with cirrhosis and/or hepatocellular carcinoma, with help of stepwise multiple linear discriminant analysis. The free software Capsules--Ascites is via internet available (http:¿www.leeds.ac.uk/acb), which use the mathematical formula from this article. As we argue, Castaldo's state is not correct. Three independent multidimensional statistical methods--bivariate reference regions (program EVAL-KIT), cluster analysis (program BioAnalyst), geometrical distance classification (program GEODICLA) applicated on Castaldo's original data showed that lactate dehydrogenase and cholesterol have not satisfactory absolute discriminative power between malignant from nonmalignant ascites in general, but the probability to determinate the right diagnosis is about 91-93%. Research conducted in correctly selected probands should provide information which is valid not only for the selected sample but for the entire population, to achieve more generally valid conclusions, useful for practical decisions. In addition, in the compiled table show we sensitivity and specificity of different laboratory parameters publicated in 11 original articles in the nineties, all with diagnostic efficiency less 100%.

To estimate status and intake of selenium in inhabitants of the most Western region of the Czech Republic (Cheb region) 241 serum, 404 urine and 30 hair samples from randomly selected persons in the age between 6 and 65 years is performed. Serum and hair samples were analysed by means of instrumental neutron activation analysis (INAA), while Se in urines was detected by means of fluorimetry. Urine iodine was determined in the same group by Sandell-Kolthoff method for the possibility to detect concomitant Se and I deficiency and/or correlations between these two essential trace elements necessary for metabolism of thyroid hormones. Average values of Se indexes are low (55.4 ± 13.8 μg Se/L serum; 15.4 ± 5.7 μg Se/L urine; 13.6 ± 6.0 μg Se/g creatinine; 0.268 ± 0.051 μg Se/g hair) and prove Se deficiency in the searched population. Statistical evaluation of Se in subgroups of boys, girls, men and women proved significant differences as far as age is concerned, gender differences were found only between boys and girls. Some significant and highly significant differences were found also in subgroups according age and gender (males and females in the age of 6, 10, 13, 18-35, 36-49 and 50-65 years). On the other hand, urine iodine average value (126 ± 65 μg/L) is on the lower optimum level. By the use of correlation analysis, slight but significant correlations were found between Se and I in urine and some of thyroid hormone parameters and their influence on the organism.

The aim of the present study was to determine the relationship between plasma levels of adipocytokine adiponectin and the degree of insulin sensitivity in patients with anorexia nervosa (AN). AN is a psychiatric disorder characterized mainly by severe malnutrition and loss of body fat. We measured fasting plasma adiponectin, insulin and glucose levels in ten women with a restrictive type of AN and in twelve healthy normal-weight women. Plasma adiponectin levels were significantly increased in patients with AN compared to healthy women (p < 0.01) and were negatively related to body mass index and percent body fat in both groups. Plasma adiponectin levels were negatively related to plasma insulin levels in the AN group only. Using homeostasis model assessment of insulin resistance (HOMA-IR), we found significantly increased insulin sensitivity in patients with AN compared to control women (p < 0.05). In conclusion, hyperadiponectinemia in patients with AN might contribute to increased insulin sensitivity in these patients.

Insulin resistance characterized by a decreased biological response to insulin is caused by genetic and exogenous factors influencing the target tissues for insulin, like the muscle, adipose tissue and the liver. A hyperbolic relationship was found between insulin secretion and insulin action. The insulin hypersecretion caused by short-time B-cell stimulation with free fatty acids is associated with hyperinsulinemia and worsening of insulin resistance. On the contrary, longtime exposure of B-cells by free fatty acids is followed by a decreased secretion and thus by hypoinsulinemia. Triglyceride infiltration of the muscle tissue and B-cells further worsens the insulin resistance and impairs the insulin secretion. Lipotoxicity worsens the whole metabolic disorder including the glucose tolerance and causes apoptosis of the islet cells. Free fatty acids are causative factor in the pathogenesis of insulin resistance as well as of Type 2 diabetes.

Macrovascular complications in diabetics create a high risk for cardiovascular disease (CVD). Generally, the main risk factors for CVD include age, men's sex, elevated LDL-cholesterol and reduced HDL-cholesterol, elevated fibrinogen, hypertension, smoking, and diabetes mellitus. Clinical manifestation of coronary disease is determined by number, area, and severity of coronary stenoses, myocardial function, and presence of induced ischemia. Routine pharmacological treatment of ISHD concentrates on risk factors and hasn't been yet focused on changes in energy metabolism during ischemic situation which are important factors contributing to ischemic damage. Substances able to optmize energy metabolism of heart muscle offer a very tempting way both for ISHD treatment and for treatment of following cardiovascular complications. Optimal use of energy source in heart muscle can favour heart activity so that comparable amount of contractile work requires less oxygen. The most beneficial way of getting energy for myocardium while low consumption of oxygen is oxidation of glucose. Because of a large amount of free fatty acids (FFAs) in diabetics a more demanding way of oxidation takes place in them, the oxidation of FFAs. Therefore myocardium of a diabetic needs under normal perfusion conditions more oxygen to provide energy. Besides increase in demand of oxygen, FFAs separate glycolysis from glucose oxidation and increase undesirable production of lactate and protons. An ischemic myocardium of a diabetic has primarily bigger demand of oxygen then myocardium of a non-diabetic. Development of cell ischemia, with all the known consequences in forms of lactate acidosis, calcium overload, and depletion of ATP, leads to considerable contractile disorder. Unfavourable position of metabolic activities in myocardium of diabetics and faster and more serious progression of atherosclerosis result in a big risk of CVD in diabetics. Incidence of coronary events in diabetics without history of ISHD is as big as in non-diabetics with history of coronary events.

Dyslipoproteinemia is the common part of metabolic syndrome, it appears probably due tu high level of free fatty acids. The typical lipid disorders are: high trigylcerides concentration, low HDL-cholesterol level, elevation of small dense LDLs particles and elevation of apolipoprotein B100 and non-HDL cholesterol. LDL-cholesterol concentration is usually normal. This type of dyslipoproteinemia is very aterogenic. Weight reduction, diet and regular physical activity is the most effective way how to treat this type of dyslipoproteinemia. When non-pharmacologic treatment is not successful, treatment with hypolipidemic drugs is necessary to prevent atherosclerotic complications. Fibrates are recommended in typical dyslipidemia to lower high triglycerides level and to elevated low HDL-cholesterol concentration. But when high LDL-cholesterol is present, statins are needed. In some patients with combined hyperlipidemia treating with fibrate and statin together is needed to reach target lipid levels.

Celiac sprue may be defined as a model autoimmune disease with known trigger (gluten), a tight genetic linkage (with HLA-DQ2 and HLA-DQ8) and a specific humoral autoimmune response (autoantibodies to tissue transglutaminase, tTG). Gliadin peptides are repeatedly presented to HLA-DQ2 and HLA-DQ8 positive cells and induce an immune response in small-intestinal mucosa. tTG is a specific endomysial autoantigen released during cellular stress and by deamidation of gliadin peptides as well as by binding with them facilitates their interaction with HLA-DQ2 and HLA-DQ8 cells. CS is the consequence of an inappropriate by T-cells mediated immune reaction to gluten. The diagnosis is based on criteria of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition revised in 1990. The availability of sensitive and specific detection methods of serum antibodies to endomysium (AEA) and tTG (AtTGA) was followed by recognition of a broad spectrum of both the clinical presentation and histologic changes of intestinal mucosa in CS. The majority of patients have atypical clinical symptoms. The present prevalence of CS amounts to approximately 1:250. The following forms of CS are distinguished: classic (typical), latent, potential, subclinical, and silent. CS is frequently associated with other diseases and many of them are also of autoimmune origin. Serologic testing is indicated in subjects with atypical symptoms and autoimmune diseases. In cases with distinct suspicion biopsy should be always performed irrespective of the serologic tests. In refractory sprue the cryptic form of enteritis associated T-cell lymphoma should be excluded. Gluten-free diet is the cornerstone of CS therapy. The Alimentary Codex in individual countries admits different amounts of residual gluten in gluten-free products. In future years new basic knowledge as well as practical diagnostic and therapeutic recommendations may be expected.

Atrial macroreentry tachycardias (AMRT) independent of the conduction across the subeustachian isthmus represent a relatively rare group of different reentry circuits developing from individual arrhytmogenic substrates.
The purpose of the study is to present causes, mapping facilities, and the results of catheter ablation of these arrhythmias.
Patients and methods:
Forty-two patients (11 females), aged 57.2 ± 12.8 years, presenting with clinically significant AMRT, were referred to mapping and catheter ablation. Eighteen patients had known structural heart disease, in other 24 patients, no significant structural heart disease could be detected. Electroanatomic mapping was used in 33 (67 %) of 49 ablation procedures.
Results:
In 49 ablation procedures, 59 critical isthmuses were targeted and 70 morphologies of 61 rates of mappable AMRT were eliminated. Fifty-six AMRT morphologies (41 in the right atrium and 15 in the left atrium) of 49 rates (35 in the right atrium and 14 in the left atrium) were eliminated with linear radiofrequency (RF) lesion. Fourteen AMRT morphologies of 12 rates (in the right atrium) were eliminated with focal lesion. Type I atrial flutter was also ablated in 20 patients. Anatomical approach using linear lesions for unmappable AMRT was simultaneously employed in six of the patients. Immediately at the end of the last ablation procedure, noninducibility of any AMRT was achieved in 37 (88 %) patients; in 31 (97 %) of 32 patients with right AMRT, and in 6 (60 %) of 10 patients with left AMRT. During long-term follow-up of 34 ± 24.7 months, AMRT did not recur in 39 (93 %) patients. Seven (17 %) patients had paroxysmal atrial fibrillation in the postablation period.
Conclusion:
AMRT can occur as a result of different cardiopathies as well as without association with any significant heart disease, typically in multiple morphologies and rates. Anatomy of the atria and the propagation of the electric impulse during AMRT can be truly electroanatomically reconstructed and AMRT can be eliminated by focal or linear lesion with high success rate. Long-term outcome of catheter ablation is favorable and propensity to the atrial fibrillation is low.

In 1959 Prinzmetal described a syndrome of chest pains with typical ST segment elevation on ECG that is due to spasm of large epicardial or septal artery. Currently the term vasospastic angina (VSA) is used more often in literature. VSA can lead in acute myocardial infarction, it can be accompanied with serious cardiac arrhythmias and even sudden death is described in these patients. Pathogenesis of this syndrome is not completely clear. Effect of endothelial dysfunction, inflammatory factors, disorder of coagulation mechanisms, smoking and low level of magnesium belongs among suggested mechanisms of disease. ECG and Holter ECG monitoring is the basic examination of VSA, ergometry is not beneficial. Selective coronarography (SKG) with ventriculography performed during paroxysm proves focal spasm. SKG can be combined with spasm provocation (ergonovine, acetylcholine or hyperventilation). Provocative agent can be used also in combination with other imaging method, such as echocardiography or nuclear methods. The most widespread provocative agent in the world is ergonovine maleate, the test having sensitivity up to 100%. Nitrates and calcium antagonists are used in the treatment. Opinion on the use of beta-blockers and acetylsalicylic acid is not unified. Some authors recommend magnesium, estradiol supplement or vitamin E in the treatment.