[Treatment of autonomous thyroid gland nodules using percutaneous injections of ethanol under ultrasonography control--initial experience]. / Liecba autonómnych uzlov stítnej zlazy pomocou perkutánnych injekcií etanolu pod ultrasonografickou kontrolou--prvé skúsenosti.

The authors treated nine women with autonomous adenomas of the thyroid gland by repeated ethanol injections under ultrasonographic control. In all patients clinical and laboratory characteristics of hyperthyroidism were present. After treatment is seven patients euthyroidism was induced, in two patients subclinical hypothyroidism which persisted also during the 6-month follow-up period. In all patients ultrasonographic changes in the nodes were recorded: a reduced echogenity the development of "halo"--hypoechogenic outlines--a change of the shape and on average a 37% reduction of the volume. Treatment was feasible also under out-patient conditions: it was well tolerated by the patients, undesirable effects were not serious and only transient and receded spontaneously.

[Neurohumoral activity in liver cirrhosis]. / Neurohumorálna aktivita pri cirhóze pecene.

The authors assessed in 40 patients with cirrhosis of the liver and in 33 controls the plasma renin activity (PRA), aldosterone (PA), the atrial natriuretic factor (ANF) and the digoxin like activity (DLA) in plasma under basal conditions. In patients with cirrhosis of the liver they found significantly lower levels of PRA, PA and DLA, as compared with the control group, the ANF levels were not significantly altered. In the group with cirrhosis the highest neuroendocrine activity was recorded, in particular of PRA and PA in decompensated cirrhotics receiving diuretic treatment. Therefore it is useful to combine diuretics with preparations or measures which reduce the activity of the renin-angiotensin-aldosterone system and/or promote the activity of natriuretic substances. The authors found a negative correlation between PRA and SNa, PRA and UNaV, while ANF did not correlate with natriuresis. The main determinant of Na excretion in decompensated cirrhosis is the activity of the renin-angiotensin-aldosterone system. DLA plasma levels also correlated inversely with SNa values and Na excretion and thus also reflect the severity of fluid retention.

[Postpartum thyroiditis and the contribution of ultrasonographic examination of the thyroid gland in its diagnosis during the first half-year after delivery]. / Popôrodná tyreoiditída a prínos ultrasonografického vysetrenia stítnej zl'azy v prvom polroku po pôrode k jej diagnostike.

Changes which take place in the thyroid parenchyma of the mother from postpartum thyroiditis and which lead to a change of echogenicity can be detected by ultrasonographic examination of the thyroid gland before clinical manifestation of impaired thyroid function caused by inflammation. The authors evaluated the echogenicity of the thyroid gland in 60 women three months after delivery. From the whole group of women 47 (78.4%) had a homogenous and adequate echogenicity, 13 (21.6%) had a reduced echogenicity. A positive cytological finding, i.e. lymphocytic infiltration was found in 9 women and concurrently positive antithyroglobulin antibodies in 5 of them. During the first six months after childbirth impaired thyroid function was recorded in 4, i.e. 6.6%: 1x hyperthyroidism and 3x hypothyroidism.

Central hypothyroidism--various types of TSH responses to TRH stimulation.

Thyrotropin (TSH) levels in serum before and 20 and 60 min after the administration of 0.2 mg TRH i.v. as well as thyroid hormone (T3, T4) levels were studied in 39 patients with organic diencephalo-pituitary lesions and 27 healthy subjects. All participants gave their informed consent with the study. By the type of TSH response to TRH stimulation all patients were divided into 4 groups: 1. Normal response (n = 10): basal TSH 2.31 +/- 1.51, peak TSH 20 min after TRH 12.17 +/- 6.53, TSH 60 min after TRH 8.43 +/- 4.65 microU/ml; T3 2.02 +/- 0.48 and T4 95.9 +/- 27.73 nmol/l; 2. Blunted or absent TSH response (n = 8): basal TSH 0.82 +/- 0.42, peak TSH 20 min after TRH 1.51 +/- 0.66, TSH 60 min after TRH 1.35 +/- 0.51 microU/ml; T3 1.6 +/- 0.49 and T4 86.63 +/- 16.49 nmol/l; 3. Delayed ("diencephalic") TSH response (n = 16): basal TSH 2.69 +/- 1.27, peak TSH 20 min after TRH 7.96 +/- 3.35, TSH 60 min after TRH 10.0 +/- 3.97 microU/ml; T3 1.30 +/- 0.63 and T4 65.85 +/- 21.13 nmol/l; 4. Higher basal or stimulated TSH (n = 10): basal TSH > 10 mU/ml or stimulated values above 25 mU/ml. Mean T3 and T4 values in patients with normal or blunted TSH response did not differ significantly from the controls. Mean T3 and T4 in the group with delayed TSH response were significantly lower (P < 0.01). High TSH and low T3 and T4 levels were found in the patient with large meningioma sellae.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of endogenous digitalis-like factor in blood pressure regulation in essential hypertension.

We examined plasma renin activity (PRA), plasma aldosterone (PA), atrial natriuretic factor (ANF) and endogenous digitalis-like factor (DLF) in 15 healthy subjects and 15 patients with essential hypertension (EH) to obtain basal values and values after extracellular fluid volume (ECFV) expansion caused by infusion of isotonic saline solution over a period of 2 hours (20 mg/kg). A significant increase in diuresis and natriuresis accompanied by a decrease in PRA and PA and an increase in ANF was observed in both groups. No significant differences were observed in ANF levels between normotensive subjects and hypertensive patients. Hypertensive patients showed significantly higher basal values of DLF than normotensive subjects. However, an increase in plasma DLF following ECFV expansion was observed only in the group of healthy subjects. There was a positive correlation between ANF and natriuresis and a negative correlation between ANF and systolic and diastolic blood pressure (BP). Changes in DLF correlated positively with changes in diastolic BP in both groups, while in healthy subjects a negative correlation was recorded between PRA and DLF. We conclude that the increased diuresis and natriuresis in ECFV expansion is presumably accounted for not only by suppression of PRA and PA, but also by stimulated ANF secretion, while in healthy subjects stimulation of DLF may be involved as well. The insufficient DLF response to saline infusion may indicate an exhausted DLF reserve in hypertensive patients. As a vasoactive substance, DLF can participate in the regulation of blood pressure and play a role in the pathogenesis of arterial hypertension.

[The effect of water immersion on humoral and urinary parameters in healthy persons and in patients with liver cirrhosis]. / Vplyv vodnej imerzie na humorálne a mocové parametre u zdravých osôb a chorých s cirhózou pecene.

The authors subjected 10 healthy subjects and 13 patients inflicted by liver cirrhosis in the stage of vascular decompensation (ascites and/or oedemas) to water immersion (WI). The group of healthy subjects responded during WI by a significant increase of diuresis and sodium diuresis at its maximum in the third hour, which was accompanied by a decrease of plasma aldosterone (PA) and a decrease of atrial natriuretic factor (ANF) and digoxin-like activity (DLA). The decrease of plasma vasopressin (PAVP) was not statistically significant. In patients with liver cirrhosis a significant increase of diuresis and sodium diuresis took place, whilst the response was significant already in the first hour of WI. Only 3 non-respondents were among the ill patients. In the group of liver cirrhotics also a significant decrease of AVP, PA, and an increase of ANF and DLA were recorded, the response of humoral factors was not significant due to great variability. A long term administration of diuretics (Spirolakton+Furosemid) did not decrease the serum K in ill patients. Hence, WI by means of supervention of volume expansion evokes an increase of diuresis and natriuresis in both healthy and ill subjects, the latter with decompensated liver cirrhosis which is associated with a controversial reaction of sodium diuresis and sodium retention factors. It is possible to use it as a supplementary method in the therapy of oedemas due to liver cirrhosis besides diuretic therapy. (Tab. 2, Fig. 3, Ref. 22.)

[Atrial natriuretic factor as a marker of clinical severity in cardiac failure]. / Predsienový nátriuretický faktor ako marker klinickej závaznosti srdcového zlyhania.

The authors examined plasma levels of the atrial natriuretic factor (ANF) in 26 patients with manifestations of cardiac failure. The ANF levels were high as compared with reference values (21 +/- 16.7 fmol/ml vs. 4.9 +/- 2.1 fmol/ml) and different in relation to individual functional NYHA classes, i.e. the lowest ones were in the second and the highest ones in the fourth class. Concurrently the authors revealed a statistically significant negative exponential correlation between plasma ANF levels and the left ventricular ejection fraction (r = 0.550, p < 0.01) and a bordeline correlation between ANF and the stroke volume (r = -0.45, p = 0.05). The results indicate that the plasma ANF level is a good indicator of severity of cardiac weakness and can be used in clinical work as a prognostic indicator in patients with heart failure.

[Atrial natriuretic factor in congenital heart defects in infants]. / Atrionatriuretický faktor pri vrodených chybách srdca u dojciat.

The authors examined the level of the atrio-natriuretic factor (ANF) in 7 infants with inborn heart disease at the age of 3 weeks to 5.5 months. As controls they examined 9 convalescent infants aged 1-10 months. Congenital heart disease was confirmed by clinical methods (ECG and X-ray) and echocardiographically (one-dimensional, two-dimensional and pulsed Doppler echocardiography, 5MHz probe, Kontron Co.). Although a small group is involved, elevated ANF values were recorded in infants with inborn heart disease, as compared with controls.

[Patients after thyroid gland surgery from the aspect of the endocrinologist]. / Chorí po operácii stítnej zl'azy z hl'adiska endokrinológa.

The authors examined 85 patients after a mean interval of 2.5 years following thyroidectomy. They focused attention on evaluation of the functional state using as criteria the TSH and TRH test. Simultaneously they examined by ultrasonography the volume of the remainder of the thyroid gland. In 8 patients operated on account of carcinoma the average volume of the thyroid gland was 1.3 ml. Five patients were hypothyroid despite permanent substitution. Of 77 patients operated on account of benign goitre evident hypothyroidism was found in 29 (37.7%) and latent hypothyroidism in 14 (18.2%). The volume of the remainder of the thyroid gland in these patients was on average smaller than 4 ml, while in patients who were euthyroid after thyroidectomy the mean volume of the remaining thyroid was more than 4.5 ml.

[Ultrasonography in subacute thyroiditis]. / Subakútna tyreoiditída v ultrasonografickom obraze.

The authors draw attention to the altered ultrasonographic (USG) picture of the thyroid gland with subacute inflammation (SAT). A typical finding in the first to third stage of the disease are irregular different sized hypoechogenic to almost echo-void foci with normal parenchyma in between. The finding is normal only in the fourth stage of the disease. In 22 patients before 1987 the USG finding of the thyroid gland was evaluated. In 17 the examination revealed the assumed SAT which was confirmed in 15 patients. Seven patients were at that time hypothyroid. The USG finding was evaluated again in 1990. Ten patients, 2.8 years after the acute stage of SAT had a normal USG finding and were euthyroid. Five patients, not more than one year after the acute stage of SAT had still a pathological USG finding. Four of them were hypothyroid. Based on USG examination it is possible to identify before the cytotogical examination at first ill defined hypothyroidism or hypothyroidism as SAT in stage 1 to 3.

Plasma cortisol and prolactin response to insulin-induced hypoglycemia in neurosis.

Prolactin (PRL) and plasma cortisol response to insulin induced hypoglycemia were studied in 14 patients with various somatic and vegetative complaints of neurotic character and in 12 controls. In all examined subjects glucose level fell below 50% of basal values and below 2.2 mmol/l. Significant PRL and plasma cortisol response were present in all controls. Plasma cortisol increase in control group was at least 1.5 fold higher than basal values and the difference between basal concentrations and highest values after stimulation was at least 0.25 mumol. Individual peak of PRL values in group of controls was 1.8-10 fold greater than basal levels. In the group of 14 patients in 11 cases no PRL response to challenge was found and in 4 cases also plasma cortisol response was blunted. In two patients extremely exaggerated PRL reaction was found. Different PRL responses to insulin-induced hypoglycemia are probably a manifestation of different types of neurotransmitter metabolism breakdown.

[Plasma renin activity and aldosterone in patients with essential hypertension]. / Plazmatická renínová aktivita a aldosterón u chorých s esenciálnou hypertenziou.

The authors examined the plasma renin activity (PRA) in 80 patients and plasma aldosterone (PA) in 27 patients with essential hypertension (EH). They confirmed the significant drop of stimulated PRA with age. The PA levels of hypertonic patients did not change with age and did not change significantly in relation to PRA. In obese hypertonic patients a satisfactory response of PRA to stimulation was lacking, while PA reacted adequately. The PA levels are thus in older age groups as well as in obese subjects much higher, as compared with relatively low PRA levels. In relation to the stage of EH the authors did not find any significant differences of PRA levels.

[The prolactin and TSH response to stimulation in patients with hypophyseal tumors]. / Odpovede prolaktínu a TSH na stimuláciu u chorých s tumorom hypofýzy.

The authors examined the prolactin (PRL) and thyrotropin (TSH) response to stimulation with chloropromazine and thyreoliberin in 10 patients with pituitary tumours. They observed a hypothalamic response instead of the expected pituitary response. These findings may be of importance for the understanding of the aetiopathogenesis of pituitary tumours. As we are able to influence nowadays some expansive pituitary processes by conservative treatment, these findings may in the near future be important in clinical practice.