Vnitřní lékařství, 2001 (vol. 47), issue 12
[Ventricular tachyarrhythmias in patients without structural heart disease. Clinical and electrophysiologic characteristics of the tachyarrhythmias and long-term results of catheter ablation].
M Fiala, P Heinc, A Bulava, J Lukl
Vnitr Lek 2001, 47(12):817-828
PURPOSE OF THE STUDY: Ventricular tachyarrhythmias without structural heart disease (SHD) form a heterogeneous group of unknown mechanism and different clinical and electrophysiological behavior. Purpose of the study was to analyze clinical and electrophysiological characteristics of the arrhythmias, and immediate and long-term results of catheter ablation.PATIENTS: Nineteen consecutive patients without SHD (7 F) aged 44.5 +/- 14.1 (18-66) years had 23 ablation procedures. Documented arrhythmias varied from incessant ventricular premature beats (1 patient) through paroxysmal nonsustained ventricular tachycardia (5 patients), incessant "repetitive"...
[Personal experience with intra-arterial locoregional chemotherapy of liver metastases from colorectal carcinoma].
I Kiss, J Marková, J Tomásek, R Vyzula, V Válek, J Boudný, Z Kala, I Hanke, T Ostrízek, J Leypold
Vnitr Lek 2001, 47(12):829-833
Locoregional chemotherapy is one of the possible ways of treatment of inoperable metastatic affection of the liver by colorectal carcinoma. The advantage of regional administration of the cytostatic is the possibility to achieve a higher local concentration of the cytostatic associated with a higher percentage of therapeutic responses. In our department we preferred combined locoregional intraarterial chemotherapy (5-fluorouracil/Mitmycin C/Doxorubicin) combined with systemic intravenous chemotherapy (5-fluorouracil/leukovirin). Locoregional cghemotherapy was administered in the majority as chemotherapy of series 2 or 3 with a very good tolerance....
[Effectiveness and tolerance of fosinopril in the treatment of arterial hypertension of mild and medium severity].
H Rosolová, J Cech, F Sefrna
Vnitr Lek 2001, 47(12):834-839
BACKGROUND: The standard of hypertension control in the population is not satisfactory, only 20% patients with hypertension achieve target values of blood pressure (BP). Extensive prospective studies revealed that diuretics, beta-blockers as well as the majority of calcium channel blockers and ACE inhibitors can significantly reduce the incidence of complications of hypertension and are therefore considered drugs of first choice in the treatment of hypertension. The additive effects of ACE inhibitors are manifested in particular after larger doses. OBJECTIVE OF TRIAL: To assess the effectiveness and tolerance of the modern long-acting ACE inhibitor--fosinopril--in...
[Adrenal gland incidentaloma].
A Kreze
Vnitr Lek 2001, 47(12):840-846
Adrenal incidentaloma is an incidentally detected formation on examination of another cause such as visualization of the adrenal glands. From 1996 till December 1999 in the Endocrinological Institute in Lubochna 60 patients with adrenal incidentaloma were examined. In 75% afunctional tumours were involved. In 16.6% (10 patients) the authors recorded an initial impairment of cortisol secretion, in 3.2% (2 patients) impaired aldosterone secretion, similarly in 3.2% (2 patients) a pheochromocytoma and in one patient (1.6%) impaired secretion of 17-hydroxyprogesterone. Functionally active incidentalomas accounted for one quarter of the investigated group.
[Changes in serum levels of IGF-I and its binding proteins and their relation to microcirculation in obese patients].
M Krsek, M Prázný, P Sucharda, J Marek, V Justová, Z Lacinová
Vnitr Lek 2001, 47(12):847-851
The IGF-I system and its binding proteins participate in the pathogenesis of vascular affections under various pathological conditions. The mechanism and mode of its action were however not elucidated in details so far and views on its role are controversial. The objective of the study was to assess the relationship of this system and the blood flow in the microcirculation in obese patients. The authors examined 21 obese patients (BMI 39.7 +/- 7.3 kg/m2) and a group of healthy volunteers. They examined: serum concentrations of total IGF-I, free IGF-I, IGFBP-1,-2,-3, and -6, total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides as well...
[Chlamydia pneumoniae and myocardial infarct? (Serologic study)].
K Zeman, L Pospísil, Z Medková, I Diblíková, M Votava
Vnitr Lek 2001, 47(12):852-855
At disposal for tests were 156 blood sera collected from patients with acute myocardial infarction (AMI samples) and 67 blood sera collected from control persons. The sera were tested by the following reactions: complement fixation test (CFT) with genus-specific antigen (C. psittaci, Bioveta, Ivanovice na Hané), ELISA in the immunoglobulin classes IgG and IgA using the MOMP (Vircell, Spain) and LPS (MEDAC, Hamburg, BRD) Chlamydia pneumoniae (C. p.) antigens, and indirect immunofluorescence test with MOMP C. p. antigen (MRL Diagnostics, USA). Eight AMI samples were not tested by CFT owing to haemolyis or lipaemia. CFT titres ranging from 1:4 to 1:16...
[Ambulatory blood pressure monitoring in a young population].
J Parenica, L Kubecová, J Spinar, H Nĕmcová
Vnitr Lek 2001, 47(12):856-862
Ambulatory twenty four hour blood pressure monitoring (ABPM) is an exact method, enabling by repeated measurements to create blood pressure profile, which shows a close correlation with end organ damage. Normal values were taken from clinical trials, where the mean age of probands was highly above 30 years. The aim of this trial was to determine mean values for ABPM in population aged 18-30 years and to create "normal values" for this population. We have examined 162 probands. The mean office blood pressure was 128.18 +/- 11.2/82.91 +/- 8.29 mm Hg, the mean ABPM (24 hours) was 118.51 +/- 9.11/70.59 +/- 6.30 mm Hg. Systolic, mean and pulse pressure...
[Absence of a decrease in nocturnal arterial pressure as an independent prognostic factor in hypertension].
J Veselý
Vnitr Lek 2001, 47(12):863-867
Considerable evidence has accumulated indicating that the lack of the normal nocturnal fall in blood pressure (non-dipper) may represent an important prognostic factor in hypertension. This review focuses on clinical studies showing close association between a non-dipper pattern of blood pressure and cardiovascular events such as glomerular capillary hypertension, cerebrovascular events, left ventricular hypertrophy and ventricular arrhythmias. A close relationship between impairment of the circadian rhythm of blood pressure and that of natriuresis is described. The therapeutic profit from the knowledge that a given patient is a non-dipper and/or salt-sensitive...
[Hypertension and cerebrovascular strokes].
M Soucek
Vnitr Lek 2001, 47(12):868-874
Cerebrovascular attacks are worldwide one of the main causes of death and invalidity. The incidence rises exponentially with age. Hypertension is the main risk factor which increases the risk of cerebrovascular attacks as much as four times. Treatment of hypertension reduces the incidence of all types of cerebrovascular attacks. The author discusses different types of cerebrovascular attacks, primary and secondary prevention with emphasis on possible influencing of high blood pressure.
[Extravascular lung water in acute respiratory distress syndrome: pathophysiology, monitoring and therapeutic possibilities].
A Krouzecký, M Matĕjovic, R Rokyta, I Novák
Vnitr Lek 2001, 47(12):875-879
Excessive amount of extravascular lung water (EVLW) resulting from increased permeability of alveolo-capillary membrane is a pathophysiological hallmark of acute respiratory distress syndrome (ARDS). Increased EVLW produces hypoxemia by interference with gas exchange. During shock resuscitation, in disorders in which microvascular endothelial integrity is impaired, large volumes of intravenous fluids needed to restore tissue perfusion may also be associated with the risk of increased accumulation of EVLW. The presented paper briefly reviews the mechanisms involved in lung edema formation and describes current options to measure EVLW. In addition, it...
[Treatment of paroxysmal nocturnal hemoglobinuria (PNH)].
L Chrobák, P Dulícek, P Zák
Vnitr Lek 2001, 47(12):880-886
Paroxysmal nocturnal hemoglobinuria is an acquired clonal disorder of the hematopoietic stem cell in which intravascular hemolysis is due to an intrinsic defect in the membrane of red cells that makes them increasingly susceptible to lysis by complement. The phenotypic hallmark of PNH cells is an absence or marked deficiency of GPI-anchored proteins such as CD 59+, CD 55+ and others which normally protect cells from the action of complement. PHN is closely associated with aplastic anemia. Some degree of bone marrow failure is always present. Management of PNH is complicated by a highly variable clinical picture and course. Some patients have severe...
[Aspects of treatment of hypertrophic obstructive cardiomyopathy with emphasis on the role of percutaneous transluminal ablation of the myocardial septum].
J Veselka
Vnitr Lek 2001, 47(12):887-891
The prevalence of hypertrophic cardiomyopathy is approximately 0.2% whereby the obstructive form accounts for one quarter. The basic treatment involves administration of negatively inotropic drugs (beta-blockers and/or verapamil), which reduce the intraventricular pressure gradient and have a positive impact on the symptomatology. In patients refractory or intolerant to medicamentous treatment surgical or catheterization is used. Percutaneous transluminal septal myocardial ablation reduces significantly the symptomatology of dyspnoea and stenocardia, increases load tolerance and improves the left ventricular diastolic function. In none of the mentioned...
[An unusually long survival after surgery in post-infarct rupture of the interventricular septum and resection of a left ventricular aneurysm].
J Fabián
Vnitr Lek 2001, 47(12):892-893
In the submitted case-history the author describes a patient who 15 years previously underwent after an extensive myocardial infarction with rupture of the interventricular septum and a left ventricular aneurysm a plastic operation of the interventricular rupture and aneurysmectomy. This man, at present 70 years old, lives without any significant restrictions. The author advocates an active, intensive and aggressive diagnostic and therapeutic approach in all thus vitally threatened patients for whom this arsenal offers a much greater hope for extension and improvement of life than the classical conservative therapy.