[Recurrent prosthetic endocarditis in a 21-year old patient with renal transplantation treated with allogeneic homograft]. / Recidivujúca protetická endokarditída u 21-rocného pacienta s transplantovanou oblickou riesená alogénnym homograftom.

Prosthetic infective endocarditis is a possible complication of implantation of a prosthetic cardiac valve. Without early and effective treatment, it can have fatal consequences. One treatment option is use of an allogeneic cryopreserved homograft. This case report presents a 21-year old patient after kidney transplantation due to hereditary nephrotic syndrome and aortic valve replacement with aortic conduits. After fever was noted in the patient, prosthetic infective endocarditis was diagnosed by echocardiography and also confirmed by CT-3D examination. The cryopreserved aortic homograft was implanted at the Department of Cardiac Surgery. This along with additional conservative management effectively treated the infection. Based on literature data and our own experience, we believe that the treatment of prosthetic endocarditis after aortic valve replacement with cryopreserved homograft can be a method of choice.

Periodicity of arrhythmias in healthy elderly men at the moderate altitude.

The 24-hour periodicity of supraventricular (SVPB) and ventricular (VEB) extrasystoles in healthy elderly men (age 49-69 years) was studied at two altitudes during 24 h Holter ECG monitoring. At the low altitude (200 m, n = 26), SVPB were more frequent than VEB. The highest occurrence of SVPB was at 17:00 h, the lowest at 01:00 and 02:00 h (P<0.001). The highest occurrence of VEB was at 09:00 h, the lowest one at 04:00 h (P<0.001). At 1350 m (n=9) the incidence of both SVPB and VEB was approximately twofold higher compared to that at the low altitude (P<0.001). The highest occurrence of SVPB was at 13:00 h, the lowest at 06:00 h (P<0.001). VEB were the most frequent at 10:00 h and 13:00 h, while the lowest frequency was observed at 06:00 h (P<0.001). Our results indicate that the incidence of SVPB and VEB in healthy persons at the moderate altitude is twofold and its periodicity is shifted compared to the low altitude. The cause of increased occurrence of extrasystoles is probably due to beta-adrenergic activation of the heart at the higher altitude.

[Diagnosis and therapy of esophageal diseases]. / Diagnostika a liecba ochorení ezofágu.

In reflux disease the authors emphasize the following diagnostic procedures: a satisfactory case-history, endoscopy, aimed biopsy, radiographic evidence of reflux, radionuclide reflux scintigraphy and pH-metry. As to subsidiary examinations, they recommend Bernstein's perfusion test. In 50% of the patients with non-coronary chest pain the complaints are caused by diseases of the oesophagus. The latter include achalasia, dysphagia, idiopathic diffuse spasm, hyperdynamic oesophagus and irritable oesophagus. In the treatment of reflux disease the stage of the disease is decisive. Treatment is prolonged and the doses of drugs are higher than in duodenal ulcers. The basis are H2 blockers. In severe forms treatment with omeprazole is indicated. Surgery is indicated only in severe mucosal complications. In achalasia of the oesophagus this is disruption of the sphincter by the method of pneumatic dilatation or surgical myotomy. Idiopathic diffuse spasm and other disorders of oesophageal motility respond in different ways to treatment with calcium autagonists and nitrate treatment.

Spirometric alterations in patients with reduced renal function.

Spirometric parameters were measured in 49 patients with reduced renal function. The patients were divided according to their glomerular filtration rate (GFR) into two groups: (A) GFR < 0.2 ml s-1-end stage renal failure; (B) GFR > or = 0.2 ml s-1. FEV1 and FEF25-75 were significantly lower in the end-stage renal failure group of patients. 80% of the patients with GFR < 0.2 ml s-1 and 31% of the patients with GFR > or = 0.2 ml s-1 had spirometric evidence of small airways dysfunction. In multiple stepwise regression analysis with ventilatory parameters as dependent variables and renal function, total protein, urea, creatinine, sodium, and hemoglobin levels, proteinuria, diuresis, and history of left ventricular failure as independent variables only GFR and total protein correlated significantly with FEV1 and FEF25. In conclusion, our study demonstrates that impairment of spirometric function in patients with renal insufficiency is continual, with reduction of GFR, and thus small airways dysfunction may be expected not only in patients with end-stage renal failure, but also in those with moderate GFR reduction.