[Diclofenac 75mg. and 30 mg. orfenadine (Neodolpasse) versus placebo and piroxicam in postoperative analgesia after arthroscopy]. / Diklofenak 75 mg s orfenadinem 30 mg (NEODOLPASSE) versus placebo a piroxikam v pooperacní analgezii u artroskopií.

PURPOSE OF THE STUDY: Arthroscopy is often performed in an out-patient department or as one-day surgery. Opioids often used as postoperative analgesics may have unwanted side effects that may postpone the patient's discharge from hospital. This study was designed to evaluate a substitute for the most frequently used opioid pethidine. For pain relief, non-steroid anti-inflammatory drugs are recommended, but they offer a limited choice for parenteral administration. We used a new agent (Neodolpasse) based on diclophenac and orphenadine, and compared its efficacy with piroxicam and placebo. METHODS: A total of 119 patients scheduled for knee joint arthroscopy were included in this prospective study. In a randomized, double-blind manner, they received piroxicam (P), Neodolpasse (combining 75 mg diclophenac and 30 mg orphenadine; N) or placebo (C). The number of patients in groups P, N and C were 44, 35 and 40, respectively. The effect of therapy was evaluated on the basis of the following criteria: duration of post-operative analgesia until a request for another analgesic, pain intensity (0-10 VAS), side effects and the patient's satisfaction with analgesia. The efficacy was evaluated for 24 hours after arthroscopy; premedication and analgesia induction and administration followed the same anesthetic protocol in all groups. The ethic committee approved the study and patients gave their informed consent. The results were statistically evaluated using the ANOVA analysis of variance completed by a multiple comparison of levels of significance according to Bonferroni. The presence of side and unwanted effects was analyzed by the chi-square of Fisher's exact test. A p value les than 0.05 was regarded as statistically significant. RESULTS: There were significant differences in the number of patients not requiring further analgesic medication after arthroscopy (P 52.3% vs. C (11.7%) p < 0.05, N (68.6%) vs. C p < 0.001), lower average postoperative pain (0 to 10-point scale, P 2.4 vs. C 2.9 p < 0.05, N 1.5 vs. C p < 0.05) and fewer side effects (N vs. both P and C, p < 0.05). DISCUSSION: The combination of diclophenac with orphenadine for intravenous application has only recently been available in the Czech Republic. The addition of a central muscle relaxant to a peripheral analgesic has a better effect than diclophenac alone. This may also account for a longer duration of analgesia in comparison with piroxicam reported to have significantly longer analgesic effects. The new medication also had fewer side effects. It was interesting to record that even the patients who had more pain and shorter postoperative analgesia were satisfied with the therapy provided. CONCLUSIONS: The main result of this study is the finding that Neodolpasse significantly reduces the intensity of postoperative pain and increases the duration of postoperative analgesia after knee joint arthroscopy.

[Treatment of paroxysmal ventricular tachycardia]. / Moznosti liecby paroxyzmálnej komorovej tachykardie.

The authors present a retrospective evaluation of the risk stratification and therapy of 53 patients with ventricular tachycardia. They present the diagnostical algorithm used for the detection of risk of sudden death. The most frequently used drug in the set of patients was amiodarone in monotherapy or in combination with other drugs. Sotalol was used for both, its antiarrhythmic nature, and for its ability to reduce the defibrillation threshold in patients with an implanted automatic implantable cardiovertor-defibrillator (AICD). Antiarrhythmic drugs of class I in monotherapy were used in patients with non-coronary causes of ventricular tachycardia and with normal left ventricular function. The authors, on the basis of sudden death of three patients with low ejection fraction of the left ventricle which were recorded even despite Holter apparatus and electophysiologically confirmed supression of ventricular tachycardia, recommend to consider in this group of patients the primary AICD implantation. (Tab. 4, Fig. 2, Ref. 13.)

[The head-up tilt test with nitroglycerin provocation in the diagnosis of vasovagal syncope]. / "Head-up tilt" test s provokáciou nitroglycerínom v diagnostike vazovágovej synkopy.

The study compares the diagnostical values of "head-up tilt" tests both with or without nitroglycerin the provocation. On the basis of the comparison of a group of 60 patients and 20 healthy people we can state that the "head-up tilt" test with the provocation by nitroglycerin is appropriate for the statement of diagnosis of the cardioinhibitory type of vasovagal syncopes. (Tab. 4, Ref. 14.)

[Prevention of polymorphous ventricular tachycardia in patients with congenital long QT interval syndrome]. / Moznosti prevencie polymorfnej komorovej tachykardie u pacientov s kongenitálnym syndrómom dlhého QT intervalu.

Patients with the Romano-Ward long QT interval syndrome run a high risk of sudden cardiac death. Beta-blockers of the sympathetic nerve are effective treatment. Some patients die suddenly despite this treatment. The treatment of choice is a combination of beta-blockers of the sympathetic nerve and cardiostimulation. The authors describe a group of their own five patients from three families with the Romano-Ward syndrome. The course was favourable. The stimulation rate needed for normalization of the QT interval and a favourable clinical development was 78 +/- 6 imp./min. Based on data in the literature and their own experience the authors recommended combined treatment with beta-blockers and cardiostimulation in patients with the Romano-Ward syndrome, if monotherapy with beta-blockers is not effective.

[Microvascular angina pectoris and insulin resistance]. / Mikrovaskulárna angina pectoris a inzulínová rezistencia.

The authors examined 29 patients with the syndrome of microvascular angina pectoris. In 12 patients (41.4%) they recorded hyperinsulinaemia as a manifestation of insulin resistance. The body weight, HDL cholesterol level, LDL cholesterol and triglycerides did not differ significantly in the two groups and were at the upper borderline of the range of reference values. The authors analyze mechanisms common to the pathophysiology of the syndrome of microvascular angina pectoris and the syndrome of insulin resistance.