[Secondary prevention of cardiovascular diseases in the elderly]. / Sekundárna prevencia kardiovaskulárnych chorôb u starsích osôb.

Secondary prevention in cardiovascular diseases has its meaning also in elderly people. It is specific in some factors. The currently known facts gradually include measures which are not associated with old age of individuals. They include: influencing of the deteriorated adaptation of old organism to internal and external effects, decreased physical activity, restricted self-sufficiency, social isolation, incorrect life style, polymorbidity and subsequent polypragmatic therapy, etc.. Prolongation of life span of man, the struggle against CVD and the improvement of the quality of life of patients can be secured only by means of a complex of rational preventive measures. (Ref. 22.)

[Elevated levels of plasma von Willebrand factor: a new risk factor for atherosclerosis?]. / Zvýsená hladina von Willebrandovho faktora v plazme: nový rizikový faktor aterosklerózy?

The authors assessed the plasma level of von Willebrand's factor in a total of 104 patients aged 32-60 years. Of these 10 patients are free from confirmed ischaemic heart disease with no history of acute myocardial infarction and 94 patients after acute myocardial infarction. Samplings for von Willebrand's factor in patients after acute myocardial infarction were made at least two months after the infarction. The patients were subjected to: A) ergometric examination, b) to ergometric and coronarographic examination. The patients after acute myocardial infarction with minimal atherosclerotic changes or without atherosclerotic changes on the coronaries had a normal or slightly elevated plasma level of von Willebrand's factor. With the number of coronary arteries affected with atherosclerosis the plasma level of von Willebrand's factor increased. In patients after infarction with evidence of atherosclerotic changes on the coronary arteries without other risk factors the plasma level of von Willebrand's factor was also high. The results stimulate the hypothesis that high plasma levels of von Willebrand's factor could be a risk factor of atherosclerosis.

[Infectious endocarditis--new aspects of a well-known disease]. / Infekcná endokarditída--nové pohl'ady na známe ochorenie.

The authors discuss the incidence, etiology and pathogenesis of infectious endocarditis. They mention the incidence and therapeutic results in patients with infectious endocarditis hospitalized at the First Medical Clinic in Martin in 1988-1993. In the conclusion they present general principles of the treatment of infectious endocarditis.

[Large blood platelets--risk factors in myocardial infarction]. / Vel'ké dosticky--rizikový faktor infarktu myokardu.

Thrombocytes participate in the pathogenesis of myocardial infarction. Larger platelets are more active than small ones. In patients after an acute coronary a larger number of platelets was found, a medium volume of puatelets and a similar thrombocytocrite as compared with the healthy population of comparable structure and age. The MPV in patients of advanced age is statistically significantly larger. There are no significant correlations between MPV and the risk factors investigated by the authors.

[Dynamics of digoxin-like immunoactivity during the oral glucose tolerance test in pregnant women]. / Dynamika digoxínu podobnej imunoaktivity pocas OGTT u tehotných zien.

The changes of serum digoxin-like immunoactivity (DLIA) during 75g oral glucose tolerance test (OGTT), were investigated in 25 pregnant women with various glucose tolerance. 13 women had a normal glucose tolerance (NGT), 12 women had an impaired glucose tolerance (IGT) or gestational diabetes mellitus (GDM). Test was performed after 25 week of pregnancy. The results were compared with 9 nonpregnant healthy volunteers (NHV). After an oral glucose challenge, there was observed a significant decrease in serum DLIA (p < 0.01 in 1st hour), in both groups of the pregnant women. In the group of NHV these findings were not found. Our findings suggest a possible relationships between DLIA and glucose tolerance in pregnant women. However, it needs further investigation. (Tab. 1, Fig. 1, Ref. 24.)

[Lyme disease in internal medicine]. / Lymeská choroba vo vnútornom lekárstve.

The authors present a review on the aetiology, clinical aspects, diagnosis and treatment of Lyme disease. They describe three patients who were treated in their department for Lyme disease. Although this disease has been followed up in Bohemia and Slovakia only for nine years, it is probable that it is more frequent than diagnosed. Lyme disease is a disease which affects different organs. Therefore it is important that specialists in internal medicine should more frequently consider the possible presence of this disease when making differential diagnoses.

[Endogenous digitalis-like substance in relation to glycemia and insulinemia]. / Endogénna substancia podobná digitálisu vo vzt'ahu ku glykémii a inzulinémii.

The digitalis-like substance (DLS), insulin resistance, and hyperglycemia are ascribed important roles in the pathogenesis of essential hypertension. The relationship between DLS and glycemia (insulinemia) was investigated in the present study. The levels of glycemia, insulinemia and DLS were measured during oral glucose load in a group of 18 subjects with various blood pressure values. Fasting levels of glycemia and insulinemia were in each subject within the physiological range and no correlation was found to exist between the fasting levels of DLS and glycemia (insulinemia). One hour after oral glucose load the increase of glycemia and insulinemia was significantly higher in the group of subjects with SBP > 140 and/or DBP > 90 mmHg than in normotensive subjects (p < 0.001). The increase in glycemia (insulinemia) was followed by a decrease of DLS. This contrary trend could be expressed as a significant inverse correlation between the change in plasma DLS and the change in glycemia (r = -0.660 p = 0.0039), and also between the change in plasma DLS and the change insulinemia (r = -0.687 p = 0.0023). These findings are assumed to suggest certain mechanisms involved in the pathophysiology of essential hypertension. (Tab. 3, Fig. 2, Ref. 20.)

[Immunologic indicators in ascites]. / Imunologické ukazovatele v ascitoch.

The authors investigated specific and non-specific immunological parameters in malignant, cirrhotic, cardial and nephrogenic ascites. At the same time bacteriological and cytological examinations of ascites were made. In the submitted paper the authors compare, using statistical methods, immunological parameters of ascites in different patient groups and pay attention to their relationship with positive bacteriological and cytological findings in ascites. The authors recorded the largest number of positive bacteriological cultivation in cirrhotic and malignant ascites which correlates with lower values of some non-specific immunological parameters in ascites.

[Renin and aldosterone in the first 24 hours after acute myocardial infarct]. / Renin a aldosteron v prvých 24 hodinách cerstvého infarktu myokardu.

The authors investigated the levels of plasma renin activity and aldosterone in patients with a fresh myocardial infarction during the first 24 hours of hospitalization. The values of plasma renin activity and aldosterone were correlated with values of the control group. At the time of admission to the clinic both hormones were significantly elevated, as compared with the control group, in plasma renin activity p less than 0.001 and in aldosterone p less than 0.01. During the subsequent time intervals, i.e. after 3, 6 and 24 hours, the values of plasma renin activity did not change substantially, while the aldosterone values declined during the 6th and 24th hour (significance p less than 0.05). No significant relationship was found between plasma renin activity an aldosterone. With regard to persisting elevated values of plasma renin activity the authors discuss the possible use of blockers of the angiotensin converting enzyme in order to inhibit in the initial stage of a new infarction the formation of endogenous pressor substances.

[Primary prevention of ischemic heart disease in a homogeneous young military population group]. / Primární prevence ischemické choroby srdecní u homogenní skupiny mladé vojenské populace.

The authors submit a report on the implementation of primary preventive provisions against ischaemic heart disease in a homogeneous group of young soldiers. The investigation was pursued for five years. After screening of risk factors the implementation of principles of primary prevention was started: a rational diet, control of smoking and control of obesity: Aimed comprehensive psychological and educational provisions were made in the whole group. Physical activity was increased to improve their physical fitness. The following other parameters were monitored: laboratory values, ECG tracing, somatic examination, etc. The results obtained in the intervention group were compared with those obtained in the control group, where the comprehensive preventive provisions were not made. The investigation revealed some possibilities how to implement primary prevention in practice. Positive and negative experience is discussed.

[Validity of biochemical examinations in ascites in clinical practice]. / Validita biochemických vysetrení ascitu v klinickej praxi.

The authors examined, using biochemical, cultivation and cytological methods, ascites in 94 patients. They divided the patients into four groups: group 1 (36 patients)--malignant ascites, group 2 (35 patients)--cirrhotic ascites, group 3 (11 patients)--cardial ascites, group 4 (12 patients)--nephrogenic ascites. The authors tried to differentiate malignant ascites from non-malignant, based on biochemical parameters. As the composition of ascites is influenced by some factors (diuretics, dialysis) the authors recommend the use of biochemical analyses of ascites in clinical practice.

[The effect of quinidine on digoxin plasma levels after discontinuation of digoxin therapy]. / Vplyv chinidínu na plazmaticku hladinu digoxínu po vynechaní digoxínovej liecby.

The authors submit a report on the effect of quinidine on plasma digoxin. The investigation was made in 20 patients wit supraventricular dysrhythmia. After initial digoxin treatment they proceeded with quinidine six hours after the last digoxin dose. Although they did not administer digoxin, the digoxin level increased during quinidine treatment in the course of 12 hours from 2.4 +/- 1.6 ng/ml to 3.8 +/- 12.4 ng/ml. The authors draw attention to the importance of following up digoxin levels in the mentioned drug combination which is supposed to prevent serious complication caused by possible digoxin intoxication.

[The relation between economics and medicine in the implementation of a nationwide cardiovascular program]. / Vztah ekonomiky a medicíny pri realizaci celospolecenského kardiovaskulárního programu.

The health services, being part of the tertiary sphere, must rely as far as material resources are concerned on the results of the economic policy of the state. This has, however, also a feedback effect: economics can have favourable results only when the health status of the population permits the implementation of pretentious economic targets. Thus dialectic relations are involved. Nationwide health programmes must among others promote the health status of the population. It is, however, not possible for the health services to ensure these programmes self-handed. Every section of the population must be responsible for its share. This implies to legal, moral, economic professional, training and finally also political responsibility. The authors discuss the most important problems associated with ensuring mutual relations of these section in the implementation of the cardiovascular programme.