Myotonic dystrophy and cardiac disorders.

Myotonic dystrophy (MD) is a multisystem disease affecting numerous organs and systems. Cardiac involvement is frequent. Sudden death, due to fatal cardiac rhythm and conduction disturbances occurs in 30% of patients with MD. The aim of this study was to assess the possibilities and methods of early detection of myocardial and conduction system disturbances. ECG, 24-hr Holter monitoring, echocardiography and electrophysiologic studies of the conduction system (electrophysiologic study) were carried out in 45 patients. Analysis of late ventricular potentials was done in 36 patients. Genetic studies revealed multiplication of CTG triplets in all patients. Cardiological abnormalities were detected in 89% of our patients. Disturbances of intraventricular conduction with prolongation of HV interval were most frequent (72%). Electrophysiologic study was the most sensitive method for detecting heart involvement in MD (positive findings in 87% patients). Abnormal findings were also discovered by Holter monitoring (64%), ECG (58%), analysis of late ventricular potentials (55%) and by echocardiography in 46% patients. The results of this study indicate a high rate of cardiac involvement in MD.

Coffee consumption, alcohol use, and cigarette smoking as determinants of serum total and HDL cholesterol in two Serbian cohorts of the Seven Countries Study.

The associations between serum total and HDL cholesterol and three lifestyle factors--consumption of Turkish coffee, consumption of alcohol, and cigarette smoking--were examined in two Serbian cohorts of the Seven Countries Study. In 1988 and 1989, 319 men from Zrenjanin and Belgrade, 65 to 84 years old and free of myocardial infraction, participated. The men from Zrenjanin were originally working in a large cooperative, and the men from Belgrade were faculty members of the university. HDL cholesterol, alcohol consumption, and cigarette smoking were significantly higher in Zrenjanin than in Belgrade. Serum total cholesterol levels and coffee consumption were not different. ANCOVA showed that serum total cholesterol levels were 8.2% higher (P < .05) in men consuming two small cups of coffee per day compared with abstainers, and this was also seen after adjustment for cigarette smoking, age, body mass index, cohort, and alcohol consumption. In men consuming one or more alcoholic drinks per day (more than 10 g/d alcohol), HDL cholesterol levels were increased by 0.19 mmol/L (15.4%) compared with men consuming no alcohol (P < .001). This association was stronger in the Zrenjanin cohort than in the Belgrade cohort (P < .05). Smoking was not associated with total cholesterol or with HDL cholesterol levels. In Serbian men, boiled Turkish coffee and alcohol consumption are independently associated with serum total and HDL cholesterol levels, respectively.

Changes in major risk factors for cardiovascular diseases over 25 years in the Serbian cohorts of the Seven Countries Study.

The Serbian cohorts of the Seven Countries Study were examined four times during a 25-year period. Large changes were observed in average serum cholesterol, blood pressure and the prevalence of smoking in these ageing cohorts. Comparison of men of the same age strata e.g. men aged 50-59 examined at baseline and after 10 years of follow-up and of men aged 65-69 examined after 10 and 25 years of follow-up showed that serum cholesterol increased by about 45% in Zrenjanin, 35% in Velika Krsna and 15% in Belgrade over the last 25 years. Systolic blood pressure increased by 9% in Zrenjanin and 7% in Velika Krsna. No significant increase in systolic blood pressure was observed in Belgrade. There was no major secular trend in smoking and the changes observed during 25 years were mainly due to ageing. No major change was observed in body mass index. The increases in serum cholesterol and blood pressure observed in the Serbian cohorts during the last 25 years are compatible with the increase in cardiovascular disease mortality observed in Yugoslavian men aged 30-69 during the period 1970-1984.

[Development of internal medicine since the establishment of the Regional Hospital in Sarajevo from 1894 until today]. / Razvoj interne medicine od osnutka zemaljske bolnice u Sarajevu 1894. godine do danas.

The first bigger regular hospital in Sarajevo was built by the Bosnian vali Osman-pasha in the year 1866 and had only 32 beds. The construction expenses and keeping, according the Porta's approval was supported by Gazi-Husrevbeg's Vakuf, the name was The Vakuf's Hospital. In the year 1894, initiated by the Regional Government (Landesregierung) the Regional Hospital (Landesspital) came to existence, 1894, when opened had 238 beds, with modern outfits and technical facilities. There were 4 departments: Internal, Surgery, Dermatovenerology and Gynecology-Obstetrics. The Department for Internal Diseases had 50 beds. The first chief was Primarius Dr Geza Kobler, came from the Viennese Medical Faculty and had been assistant to Prof. Schretter. Simultaneously, he was director of the Hospital. His assistants were: Dr Berthold Haas to 1898 and Dr Heinrich Propper to 1900 and the interns were: Dr Bodo Koloman, Dr Alexander Dorner, Dr Erwin Horn, Dr Dragan Plentaj and Dr Risto Jeremic. Later, as chief was appointed Dr Ludomil Sas-Korcinski, professor of the Cracau University, his associates were to the year 1910: Dr Hamdija Karamehmedovic, later to became chief of the Department for Infectious Diseases and the Intern, Dr Mustafa Kadic. At the eve of the World War 1, in 1914, the pavilion "K" was built, where the Department housed. At that time chief was Primarius Dr Ljubo Bilic, while his associates were Dr Gavro Bozic, Dr Vjekoslav Kusan and Dr Duro Ostojic. Later, some other doctors same, having a permanent job, Dr Bogdan Zimonjic, Dr Miron Simic, Dr David Pinto, Dr Sreten Kaluräercic and Dr David Baruh.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary heart disease deaths in 25 years. The experience in the three Serbian cohorts of the Seven Countries Study.

Three cohorts of men aged 40-59 at entry examination were enrolled between 1962 and 1964 in the Serbian section of the Seven Countries Study of Cardiovascular Diseases. They were a sample in the rural village of Velika Krsna (n = 511), the workers in an agro-industrial cooperative in the city of Zrenjanin (n = 516), and the University professors of Belgrade (n = 536). At entry examination and then after 5 and 10 years, some cardiovascular risk factors were measured while the follow-up for mortality and causes of death was continued for 25 years. The 25 year standardized death rates from coronary heart disease (CHD) were higher in Zrenjanin (177 per 1000) and lower in Belgrade (118) and Velika Krsna (122). The multivariate prediction of CHD mortality by the Cox model in the lumped samples showed significant coefficients for age, body mass index, systolic blood pressure and cigarette consumption. The coefficient of serum cholesterol did not reach a statistically significant level. An unknown but significantly protective factor was identified for the Belgrade sample, likely bound to the higher social class of this group. Changes of systolic blood pressure in the first 10 years of follow-up were positively and highly related to the deaths occurred in the subsequent 15 years. The three population groups showed, between year 0 and year 10 follow-up, large increases in mean levels of blood pressure and mainly of serum cholesterol (+30 mg/dl in Velika Krsna; +36 mg/dl in Belgrade and +61 mg/dl in Zrenjanin). The sample in Zrenjanin started from intermediate levels (168.7 mg/dl) but attained the greatest increase and reached the highest CHD death rate in 25 years.

[The role of echocardiography in the evaluation of cardiac damage in Lyme disease]. / Uloga ehokardiografije u proceni ostecenja srca u lajmskoj bolesti.

Lyme disease is an infectious, multisystem disease involving the skin, heart, joints, and nervous system. With its ability to assess cardiac anatomy, chamber sizes and myocardial and valvular function, echocardiography is a powerful noninvasive tool to investigate possible cardiac involvement in this disorder. We studied by echocardiography 15 patients, (6 women and 9 men, mean age 28.5 years, range 17 to 42) with clinical and electrocardiographic changes compatible with acute myocarditis or myopericarditis. 14 patients (pts) had transitory complete heart block and one patient had ventricular extrasystolic arhythmia. A first patient group (n = 6) who had a tick bite (Lyme antibody titers were found in three patents) was compared with a group (n = 9) without such confirmation. In first group two pts had small pericardial effusion and two pts had a nonspecific, discrete and small myocardial fibrosis after 3-6 months echocardiographic follow-up. Chambers sizes and indexes of left ventricular systolic and diastolic function were normal. Similar findings were found in the other group. We concluded that echocardiographic findings is not specific for Lyme disease, but echocardiography is an excellent tool for assessing the presence and degree of cardiac dysfunction and therefore provides essential information for the management of these patients.

[Hemorheologic changes in diabetes mellitus]. / Hemoreoloski aspekt promjena kod diabetes mellitus-a.

78 diabetics and a healthy control group of 100 were evaluated according to their haemorrheological parameters (whole blood viscosity, plasma viscosity, aggregability and rigidity of erythrocytes). Diabetics were divided according to type of diabetes, quality of metabolic control and expression of microangiopathy. Hyperviscosity was noted in both groups of diabetics as compared to the control group. Changes in patients with IDDM were more pronounced in erythrocyte rigidity, while in patients with NIDDM they were more expressed in cell aggregability. These changes were present even before the clinical onset of the late complications of diabetes, although they were more expressed in patients with complications. Changes in patients with good metabolic control, were less expressed in comparison to those with poor metabolic control. The conclusion is that metabolic derangements in diabetes have an important influence on haemorrheological properties. Thus, reducing blood viscosity in these patients, may be a promising approach to improving microcirculation and delaying the progression of microangiopathy.

[Insulin--its past, present and future]. / Insulin--njegova proslost, sadasnjost i buducnost.

Since the invention of insulin and further, the numerous research workers have been trying to get the hormone in the most possible purest form and to make it more convenient for the treatment. By gel-filtration and ion-exchange chromatography can be obtained maximum purified insulin the so-called monocomponent insulin which possesses considerably less antigen characteristics than the conventional insulins. The human insulins obtained by semisynthesis and biosynthesis through genetic engineering the further progress in the treatment of diabetes mellitus by insulin. The intensified insulin therapy is applied nowadays by repeated injections of insulin, through application of insulin pumps in the so-called open systems and by application of artificial pancreas in the so-called closed systems. The complete normalization of glycemia can be achieved only by means of the closed system and that is the system which would work at the principle of glucose-insulin feed back. Unfortunately, these devices are very big and their use for nowadays in everyday practice is not possible yet.