Is Dupuytren's disease an occupational illness?

BACKGROUND: There is growing evidence for the risk of Dupuytren's disease (DD) from occupational exposure. For workers exposed to hand-transmitted vibrations (HTVs) and heavy manual work (HMW) who develop the disease, the inclusion of DD in hand-arm vibration syndrome and diseases of skeletal muscle overload could be beneficial for compensation purposes. AIMS: To assess the risk of DD in workers exposed to HTVs and HMW, and to evaluate the length of exposure times that may significantly affect the development of DD. METHODS: This study included male workers in Kosice, Slovak Republic. Participants were divided into three groups: those exposed to HTVs, those exposed to HMW and controls. We evaluated the association between DD and HTVs, HMW, cardiovascular diseases, metabolic diseases, epilepsy, smoking and alcohol consumption for all groups. We also compared the length of exposure time to HTV and HMW between workers with and without DD. RESULTS: The sample was comprised of 515 men, with 13% suffering from DD. Significant associations were found between DD and HTVs (OR 4.59 [95% CI 2.05-10.32]) and HMV (OR 3.10 [95% CI 1.21-7.91]). Highly significant associations were found between DD and older ages and alcohol consumption as well. No associations were found for the other variables. Exposure times greater than 15 years significantly increased the risk for DD (P < 0.01). CONCLUSIONS: This study confirms a significant association between DD and both HTVs and HMW after long exposures. We suggest that DD should be considered as an occupational disease.

Beta 3 subunit of G-protein and its influence on autonomic nervous system in patients with vasovagal syncope.

OBJECTIVES: The aim of this prospective study was to investigate the impact of genetic polymorphisms of ß3 subunit of G-protein on the occurrence of vasovagal syncope, hemodynamic parameters and heart rate variability during head-up tilt test (HUT). BACKGROUND: G-proteins play an important role in the intracellular transmission of impulses in cardiovascular autonomic reflexes. METHODS: In 157 patients with suspected vasovagal syncope HUT was performed. Ninety-one patients (38 men, 53 women, mean age 48 ± 17 years) had positive HUT. Control group consisted of 109 subjects (69 men, 40 women, mean age 37 ± 16 years) with no history of syncope. Results of HUT, hemodynamic parameters and LF, HF, LF/HF, SDNN, RMSSD parameters of heart rate variability were compared in patients with different genotypes. C825T polymorphism of ß3 subunit of G-protein was determined in the study subjects. RESULTS: There was no significant difference in the distribution of genotypes between patients and control group. Also, there was no significant difference in hemodynamic parameters. A statistically significant difference was found between genotypes in LF/HF in the early HUT (mean rank CC: 48.68 vs CT: 35.51 vs TT: 34.14; p = 0.039) and at RMSSD at the time of syncope (mean rank CC: 32.38 vs CT: 42.74 vs TT: 18.50; p = 0.026). CONCLUSIONS: In this study, the relation of C825T polymorphism of ß3 subunit of G-protein to vasovagal syncope was not documented (Tab. 2, Fig. 4, Ref. 37).

Reduced baroreflex sensitivity in patients with vasovagal syncope.

OBJECTIVES: The evidence is conflicting regarding the role of baroreflex in patients with vasovagal syncope. The aim of the study was to measure baroreflex sensitivity (BRS) and hemodynamic parameters during head up tilt test (HUT) with nitroglycerine stimulation. METHODS: Nitroglycerine stimulated HUT was performed in 51 patients with the history of recurrent syncope (mean age 46±19 years, 18 men, 23 women). Cardiac output (CO), stroke volume (SV), left-ventricular ejection time (LVET) and total peripheral resistance (TPR) were assessed during HUT by volume-clamp method using a beat-to-beat photopletysmography. Spontaneous BRS sensitivity was computed using a sequential BRS calculation. RESULTS: HUT was positive after nitroglycerine administration in 28 patients and negative in 23 patients. BRS was lower at the time of syncope in HUT positive group compared to end-test values in HUT negative group (0.54±0.27 vs 0.72±0.35, p=0.03). At the time of syncope, CO was significantly lower in HUT positive patients compared to HUT negative patients (2.6±1.4 vs 4.3±1.4 l/min, p<0.0001), similarly as SV (34.7±14.7 vs 49.2±19 ml, p=0.005). LVET was significantly higher in syncopal patients (282.27±26.2 vs 240.5±58.8 ms, p=0.002) and TPR did not differ between two groups. CONCLUSIONS: Reduced BRS may contribute to the development of the vasovagal syncope by inability to adequately counteract hypotension resulting from decreased cardiac output at the time of syncope (Tab. 3, Ref. 18).

[Thyroid disorders in women with breast cancer]. / Tyreopatie u zien s karcinómom prsníka.

AIM: Increasing prevalence of non-malignant thyroid disorders in women with breast cancer has been known for several decades; it is said to be associated with a better prognosis of the cancerous disease. The aim of this work was to analyse associations between thyropathies found in women with breast cancer and particular prognostic factors. PATIENTS AND METHODS: A group of 110 women with breast cancer were tested for autoimmune thyroiditis (AIT) and functional changes of the thyroid gland. Presence of thyroid-peroxidase autoantibodies (TPOAb), serum levels of thyroid-stimulating hormone (TSH) and free thyroxine (FT3, FT4) were determined after the surgery but before adjuvant cancer treatment (radiotherapy, chemotherapy or hormone therapy) initiation. Conventionally evaluated prognostic factors of breast cancer, including histological grading and molecular predictive factors (i.e. the status of the hormone receptors and the human epidermal growth factor receptor) were assessed - these were divided into four basic categories. RESULTS AND CONCLUSIONS: The incidence of AIT and subclinical hypothyroidism in the study group was 37.3% and 20%, respectively, i.e. higher than in the general population. The only correlation found was between thyropathies and the specific prognostic factors was that with G1 breast cancer grading.

[The importance of contractile reserve in patients with resynchronization therapy]. / Význam globálnej kontraktilnej rezervy u pacientov s resynchronizacnou liecbou.

INTRODUCTION: Contractile reserve of the myocardium is a strong prognostic factor in patients with heart failure. The presence of a significant amount of myocardial fibrosis might lead to insufficient response to resynchronization therapy We assumed that pre-implantation examination of global contractile reserve will allow prediction of the response to resynchronization treatment. METHODS: 25 symptomatic patients (NYHA III) with severe systolic dysfunction [ejection fraction (EF) 28.9 ± 6.9%] with signs of electric asynchrony (QRS 120 ms) went through dobutamine echocardiography prior to resynchronization treatment. The global contractile reserve was determined from the change to EF at rest and at the peak of pharmacological burden (40 µg/kg/min). Patients with a rise in EF of more than 5% and/or endsystolic volume reduction of more than 15% after three months of resynchronization treatment were considered responders. RESULTS: Compared to non-responders, responders had higher increase in EF during dobutamine stress echocardiography (Δ 12.8 ± 7.4 % vs. Δ 3.4 ± 7.1 %, p = 0.0042). Three months from the initiation of resynchronization therapy, the global myocardial contractile reserve also significantly correlated with EF increase (r = 0.67, p = 0.007). The 6% increase in EF during dobutamin stress echocardiography predicted responders to resynchronization therapy with 83% sensitivity and 75% specificity. CONCLUSION: The global contractile reserve may play an important role in prediction of a response to resynchronization therapy.

[Resynchronization therapy for heart failure--still many question marks]. / Resynchronizacná liecba srdcového zlyhávania-- stále vel'a otáznikov.

At present, the potential benefit of resynchronization therapy, i.e. an improved quality of life and prolonged survival in patients with heart failure, is not achieved in every patient. The 30% non-response has prompted a search for new criteria predicting patient response to resynchronization treatment. An absence of mechanical dyssynchrony, viability of the myocardium and an inadequate positioning of the intracardiac left ventricular lead probably limit the response to resynchronization therapy. ECG remains essential for the selection of suitable patients.