[Myocardial metabolism during ischemia].

F Kölbel

Vnitr Lek 1993, 39(3):212-217

The heart muscle is critically dependent on energy supply from oxidative phosphorylation, which in turn requires an adequate oxygen supply. Its greatest proportion (80%) is used by mechanical work of the heart, followed by the ion pumps and protein resynthesis. Global ischaemia of the isolated heart leads within two seconds to the electron transport arrest in mitochondria and at the same time glycogenolysis, an alternative energy source, is accelerated. The content of macroergic phosphate declines rapidly, in particular that of creatine phosphate and within 10-15 seconds mechanical activity stops. The subsequent fate of ischaemic tissue depends on...

[Silent myocardial ischemia. Status in 1992].

J Vojácek

Vnitr Lek 1993, 39(3):218-223

Silent myocardial ischaemia is found in 5% of a completely symptom-free population, in 30% of patients with a history of myocardial infarction and in 60 to 100% of patients with stable or unstable angina pectoris. Only one fifth to one quarter of episodes of myocardial ischaemia is associated with angina pectoris which means that 75% to 80% of episodes take a silent course. Episodes of myocardial ischaemia take place at lower heart rates than during exercise test and they are induced by common, everyday activities of the patient. So far it is not known why some episodes of myocardial ischaemia are silent while others are associated with angina pectoris....

[Myocardial infarct in type II diabetes].

J Chlumský, A Krivohlavý, M Lomícek

Vnitr Lek 1993, 39(3):224-228

Myocardial infarction is encountered in diabetic patients more frequently and is usually associated with a higher mortality rate, as compared with the normal population. The authors investigated the relationship between myocardial infarction and diabetes in a group of 408 patients with myocardial infarction, incl. 144 (32%) type 2 diabetics most of them treated by diet or PAD. In the group of diabetics with myocardial infarction a higher incidence of hypertension was recorded and more frequent use of nitrates. The incidence of obesity, smoking angina pectoris, a previous infarction with a pain-free course and family-history were comparable in the two...

[The stress test in nuclear cardiology--present status].

S Farský

Vnitr Lek 1993, 39(3):229-237

In nuclear cardiology the exercise test is used above all to assess the diagnosis when ischaemic heart disease is suspected and to assess the extent and site of ischaemic heart disease. The objective of the submitted paper is to present new possibilities in this area where more perfect technical equipment and new methodological approaches contribute new quality to clinical decision taking. Greatest attention is devoted to tomographic analyses of perfusion of the heart muscle during the exercise test.

[The antihypertensive effect of isradipine and additional pharmacodynamic effects].

O Mayer, H Polívková

Vnitr Lek 1993, 39(3):238-243

The authors demonstrated that isradipine reduces the blood pressure assessed at rest in patients with mild to medium severe hypertension. The antihypertensive action was enhanced by administration of beta-blockers. In a loading test the pressor response to strain was reduced in particular as regards diastolic pressure; from this in may be concluded indirectly that a vasodilatating effect is involved. The authors recorded a rise of plasma renin activity which may be associated with previous vasodilatation. Parameters of lipid metabolism were influenced by isradipine. The indifference of isradipine as regards the effect on functions indicated by biochemical...

[Helicobacter pylori in the etiology of ulcer disease and gastritis].

B Fixa, O Komárková, Z Nozicka

Vnitr Lek 1993, 39(3):244-249

Helicobacter pylori (Hp) is unequivocally the most frequent cause of antral gastritis and most probably participates in the majority of cases in the aetiology of gastritis affecting the body of the stomach. The close relationship between antral gastritis and duodenal ulceration is documented by the high incidence of Hp in these patients (90-100%). The problem of Hp negative cases of duodenal ulceration was not finally resolved yet. The absence of Hp in duodenal ulcer usually implies a different aetiology (NSAID, gastrinoma etc.). Hp is eliminated by a number of drugs (bismuth preparations, some antibiotics, metronidazole), however, eradication (Hp...

[Substitution therapy in insufficient external pancreatic secretion].

I Simek, M Duda, K Kubias

Vnitr Lek 1993, 39(3):250-252

For assessment and monitoring of adequate enzymatic substitution the authors used repeated examinations of chymotrypsin in the faeces of 19 patients with insufficiency of external secretion (17 patients with chronic pancreatitis and two after duodenopancreatectomy on account of carcinoma of the pancreas). Adequate substitution (chymotrypsin > 6U/g faeces) is individual (1.8-7.2 g pancreatin--Kreon/day). The required dose may be higher in patients with chronic pancreatitis than in conditions following duodenopancreatectomy. When receiving adequate substitution treatment, the patients reported milder complaints, regression of pain and diarrhoea. In...

[3 questions and answers from a long-term study of cardiovascular problems in the Most District].

J Ulrich

Vnitr Lek 1993, 39(3):253-259

When processing data from the long-term follow-up of cardiovascular diseases in the Most district the author revealed: 1. In the course of 30 years the ratio of older subjects increased in the Most district (men above 60 years, women above 55 years) from 9.1% in 1961 to 17.3% in 1990; the ageing of the population in the Most district is more rapid than corresponds to average data from Czech Republic and the North Bohemian region. 2. In the course of 40 years (1950-1990) the rising trend of hospitalized morbidity on account of all cardiovascular diseases, ischaemic heart disease and myocardial infarction persists. 3. Analysis of the morbidity from cardiovascular...

[Thrombolytic therapy of acute myocardial infarct in a district hospital. Analysis of a group of patients treated with streptokinase].

D Baraniková, B Renker, E Augustín, P Brunclík

Vnitr Lek 1993, 39(3):260-265

At the intensive care unit of the hospital and policlinical department in Zilina the authors treated between May 29, 1985 and Dec. 31, 1990, 87 patients with AIM by systemic administration of streptokinase which was injected after an average period of 2.5 hours following the onset of stenocardia. As to the selection of patients for thrombolysis and tactics of treatment, the authors proceeded according to an elaborated protocol. The upper borderline of the age range is not limited. Non-invasive markers of reperfusion of the heart muscle (regression of stenocardia, regression of ECG changes, reperfusion arrhythmias) were observed in 25-80% of the patients....

[Anemia--the single symptom in celiac disease in adults].

M Jankovská, S Alusík

Vnitr Lek 1993, 39(3):266-270

The authors describe the case of a 21-year-old female patient where for several months anaemia was the only symptom of subsequently diagnosed coeliac disease. They draw attention to the possibility of a monosymptomatic course of coeliac disease and discuss similar observations reported in the literature.

[Neuroendocrine changes in chronic heart failure].

M Takác, I Tkác, J Vancík

Vnitr Lek 1993, 39(3):271-278

Chronic heart failure is a complex clinical syndrome characterized by many neuroendocrine manifestations by which the organism responds to the reduced cardiac output--the reduced minute volume. In order to ensure the blood flow to vitally important organs in several regions of the circulation vasoconstriction occurs. The plasma noradrenaline (NA) level rises and this correlates with the stage of chronic heart failure. In chronic heart failure the renin production in the kidney and vascular wall rises and thus also the angiotensin II (AG II) formation is increased. AG II is an affective direct arterial constrictor which facilitates NA release from terminal...

[Therapy of refractory multiple myeloma. I. Monotherapy with glucocorticoids and combined cytostatic therapy].

Z Adam

Vnitr Lek 1993, 39(3):279-294

Treatment of refractory myeloma is still a problem. For patients where treatment with melphalan and prednisone had no effect, many therapeutic procedures were suggested and tested. Some were more, others less successful. In the first part of this review the author summarizes clinical studies which evaluate the importance of glucocorticoids and various combinations of cytostatics administered in this indication. He considers a continual four-day infusion of vincristine and adriamycin or mitoxantrone with large doses of glucocorticoids the most effective treatment. In the primarily resistant form glucocorticoids are the most important component of treatment....

[The Saint Vincent Declaration--an invitation to participate in the care of diabetics. II].

J Rybka

Vnitr Lek 1993, 39(3):295-300