Obesity and reduced fertility of men.

OBJECTIVE: Description of the relationship between the overweight man and the reduction of his reproductive potential. DESIGN: Review article. SETTING: Center of Assisted Reproduction Sanus, Jihlava. METHODS: Approximately 15% of couples are trying to get pregnant unsuccessfully. In order to better assess the possible causes of this failure, it is vital to take into consideration the influence of owerweight and/or obesity in both men and women. Reduction of the reproductive potential of obese men occurs due to changes in hormonal levels regulating spermatogenesis, increased temperatures in the testicles, environmental toxins accumulated in adipose tissue, increased levels of oxidative stress as well as a higher incidence of erectile dysfunction. The likelihood of pregnancy is reduced even in the case of assisted reproduction methods. CONCLUSION: Obesity or overweight causes reduced fertility of men and often significantly prolongs the time required to achieve pregnancy. Prior to applying treatment for infertility, we assess all possibilities to increase the reproductive potential of overweight men. Significant weight loss in obese men results in regulated hormonal levels, moreover, in most cases, this leads to improved spermiogram parameters with increasing chances of getting pregnant.

Total globozoospermia associated with increased frequency of immature spermatozoa with chromatin defects and aneuploidy: a case report.

Globozoospermia, characterised by the presence of round spermatozoa lacking acrosomes in an ejaculate, is a known cause of male infertility. Semen analysis, including sperm chromatin structure assay, toluidine blue, chromomycin A3 and aniline blue staining and fluorescence in situ hybridisation, was performed in an infertile globozoospermic patient to establish to which extent these genetic factors contributed to his infertility. No spermatozoa capable of hyaluronan (HA) binding were detected in the HA binding assay. Increased rates of immature spermatozoa with defective replacement of histones by protamines, DNA breaks and disturbed chromatin integrity and sperm aneuploid for the sex chromosomes were observed. Intracytoplasmic sperm injection (ICSI) was used in three in vitro fertilisation (IVF) cycles, and enough morphologically well-developing embryos were obtained in each cycle. However, no pregnancy was achieved. The infertility of our couple, resistant to IVF/ICSI treatment, was most probably caused by a combination of male and female factors.

The effect of the swim-up and hyaluronan-binding methods on the frequency of abnormal spermatozoa detected by FISH and SCSA in carriers of balanced chromosomal translocations.

BACKGROUND: The swim-up and hyaluronan (HA)-binding methods are used for the selection of good quality spermatozoa to improve pregnancy rates and embryo quality and to reduce the number of miscarriages after IVF. We evaluated whether the processing of sperm by these methods reduces the frequency of spermatozoa with abnormal karyotypes and altered chromatin quality in balanced translocation carriers. METHODS: Semen samples of 12 carriers of balanced chromosomal translocations were analysed for the frequency of spermatozoa, which are chromosomally unbalanced due to the segregation of balanced translocations, aneuploidies for chromosomes 7, 8, 13, 18, 21, X or Y, diploid sperm or sperm with fragmented DNA and poorly condensed chromatin. Results obtained by fluorescence in situ hybridization (FISH) and sperm chromatin structure assay were compared between ejaculated (n = 12), swim-up (n = 12) and HA-binding processed (n = 6) semen samples of the translocation carriers and with the control group (n = 10). RESULTS: The mean frequencies of unbalanced segregation products were 17.5 and 16.5% in neat and swim-up processed samples from Robertsonian translocation carriers, and 55.4, 54.5 and 50.9% in neat, swim-up and HA-bound sperm samples from reciprocal translocation carriers. Significant decreases in the frequency of sperm showing chromosome 18 and XY disomy and of diploidy, and in the rates of high-density staining sperm were observed in the motile swim-up fractions. There were significantly more sperm showing fragmented chromatin in the group of translocation carriers than in the control group, but no differences in the aneuploidy and diploidy rates were observed. CONCLUSIONS: The swim-up method is suitable for selection of sperm with condensed chromatin and a lower frequency of some aneuploidies and of diploidy. The frequency of spermatozoa chromosomally unbalanced due to the segregation of reciprocal (but not Robertsonian) translocations is significantly lower in HA-bound sperm. However, the advantages of either method for selecting normal sperm are limited.

The effect of bacterial contamination of semen on sperm chromatin integrity and standard semen parameters in men from infertile couples.

A considerable proportion of male factor infertility cases are associated with inflammatory processes. The most common sexually transmissible agents causing sexually transmitted diseases in industrial countries are Chlamydia trachomatis, genital Ureaplasma and Mycoplasma spp. This study was undertaken to investigate whether these bacterial contaminants in semen affect sperm quality parameters and particularly DNA integrity (detected by sperm chromatin structure assay) in males from infertile couples (n = 293). The results showed that semen contaminations with the investigated bacterial species were not associated with sperm DNA fragmentation. However, contaminations with Mycoplasma spp. and C. trachomatis were associated with decreased sperm concentrations. Total sperm numbers in contaminated semen samples tended to be decreased, but not significantly. Mycoplasma had the highest adverse effect on sperm quality (concentration, motility, morphology and DNA condensation). Antibiotic therapy of the selected 47 men was successful in 55%, but semen quality parameters did not improve at least up to 3 months after the therapy. The presence of pathogenic bacteria in semen is primarily associated with low sperm production. Our data showed that Mycoplasma spp. contamination of semen had the highest adverse effect on sperm quality. Sperm chromatin integrity assessed by the presence of DNA breaks was not disturbed.

Male obesity and age in relationship to semen parameters and sperm chromatin integrity.

Obesity can adversely affect human health, including fertility. While obesity can disturb the hormonal profile of the female organism and is associated with fertility loss, little is known about what effect male obesity has on fertility. The present study analysed sperm samples of 153 donors. The men were selected from couples attending an infertility clinic, who had tried for 12 months or more to achieve pregnancy without success. The age of the men under investigation was recorded, and their body mass index (BMI) was calculated. All semen samples were assessed for volume, concentration, motility and morphology. Sperm chromatin integrity was measured by sperm chromatin structure assay. Quality of sperm chromatin condensation was assessed by toluidine blue, aniline blue and chromomycin A3 staining. We can conclude that the impact of elevated BMI on the parameters investigated (basic semen parameters, chromatin integrity and chromatin condensation) was not proven in this study. On the other hand, ejaculate quality appeared to be affected by ageing. The impact was reflected by chromatin integrity, which is a factor that can substantially affect fertility in men, rather than by basic sperm parameters.

Fertile bull sperm aneuploidy and chromatin integrity in relationship to fertility.

Aneuploidy is associated with spontaneous abortions, perinatal mortality, mental retardation and with embryonic and foetal mortality. Most of these abnormalities originate as a result of meiosis errors during gametogenesis. The main purpose of the study was to analyse frequency of aneuploidies of sex chromosomes and chromosome 6 by three-colour fluorescence in situ hybridization (FISH) in 47 young bulls, candidates for artificial insemination programme with cryopreserved semen and to investigate the influence of aneuploidies and disturbed sperm chromatin integrity on non-return rates, the frequencies of abortions, perinatal mortality and stillbirths. The average frequencies of spermatozoa with disomy for chromosomes X, Y, XY and 6 were 0.032, 0.005, 0.003 and 0.039% respectively. The incidence of XX66, YY66 and XY66 diploidy was 0.017, 0.006 and 0.015% respectively. Frequencies of meiotic II errors were significantly higher than meiotic I errors (p < 0.01). More X bearing spermatozoa than Y bearing spermatozoa were detected (5151 vs. 5022; p < 0.01). Sperm chromatin damage expressed by DNA fragmentation index (DFI) was 5.3 +/- 3.7 and percentage of cells with defective chromatin condensation (HDS) was 1.4 +/- 0.8. No correlation was found between sperm aneuploidy and basic sperm analysis. The relationship was found between non-return rate and total aneuploidy (r = -0.310; p = 0.036). Significant correlation was found between sex disomy, total aneuploidy (disomy of chromosomes 6, X, Y and XY spermatozoa and diploidy) and stillbirths (r = 0.390; p = 0.013; and r = 0.331; p = 0.037). Chromosome 6 disomy correlated with perinatal mortality (r = 0.317; p = 0.047). HDS correlated significantly with total aneuploidy (r = 0.449; p = 0.002). Our study indicated that aneuploidy frequencies in young fertile bull spermatozoa are relatively low. Nevertheless, there exists a variability in aneuploidy frequencies amongst bulls, which appears to be able to have an influence on the fertility of these animals.

Genetic polymorphisms influence the susceptibility of men to sperm DNA damage associated with exposure to air pollution.

The purpose of the present study was to investigate the impact of carcinogenic polycyclic aromatic hydrocarbons and volatile organic compounds on sperm quality in a group of city policemen in Prague during a period of increased concentrations of ambient air-pollutants (winter season) compared to a period of low exposure (spring). Polymorphisms in metabolic genes (CYP1A1, EPHX1, GSTM1, GSTP1, GSTT1), folic acid metabolism genes (MTR, MTHFR) and DNA repair genes (XRCC1, XPD6, XPD23, hOGG1) were evaluated in these men as potential modifiers of associations between air pollution exposure and changes in sperm quality. The study population was a group of 47 policemen working in the center of the city. Seasonal differences in exposure were verified by ambient and personal monitoring. Markers of sperm injury included semen volume, sperm concentration, sperm morphology, sperm motility, and sperm DNA damage measured with the sperm chromatin structure assay The sperm chromatin structure assay (SCSA) includes a measure of DNA damage called DNA Fragmentation Index (DFI). The % of cells with detectable DFI (detDFI) by this assay includes sperm with either medium or high DNA damage; the term hDFI is used to define the % of sperm with only high DNA damage. The assay also detects immature sperm defined by high density staining (HDS). No significant differences were found in any of the standard semen parameters between the sampling periods except for vitality of sperms. Both DFI and HDS were significantly higher in winter than in spring samples for all men and for non-smokers. At the bivariate level, significant associations between hDFI or detDFI and polymorphisms of the repair genes XRCC1, XPD6 and XPD23 were observed. In multivariate models, polymorphisms of the genes XPD6, XPD23 and CYP1A1MspI were associated with hDFI and HDS. Moreover, HDS was significantly associated with polymorphisms in GSTM1 gene.

Sperm chromatin integrity in young men with no experiences of infertility and men from idiopathic infertility couples.

Damage to the genetic component of spermatozoa seems to play the main role in a majority of cases where current approaches fail to reveal the specific cause of male infertility. In this study, we compared semen quality in men assigned to two defined groups: men from couples with unexplained infertility - idiopathic infertility (A) and young men with no experiences of infertility (B). All samples were examined by standard ejaculate analysis and sperm chromatin structure assay (SCSA). Sperm chromatin damage was significantly higher in men from group A than in those from group B. Similar results were obtained by comparison of men from group A (all men were normozoospermic) with normozoospermic men from group B. According to these results, we can suppose that chromatin disorders may be the causal factor of subfertility or infertility in some of these men. No evidence for a strong association between chromatin disorders and standard parameters of ejaculates was found. We failed to confirm a relationship between smoking and sperm quality in men from any of the investigated groups. SCSA is a method that facilitates the identification of infertile men who otherwise show normal semen variables.

Evaluation of chromatin integrity of motile bovine spermatozoa capacitated in vitro.

The efficiency of in vitro embryo production is highly variable amongst individual sires in cattle. To eliminate that this variability is not caused by sperm chromatin damage caused by separation or capacitacion, chromatin integrity was evaluated. Seventeen of AI bulls with good NRRs but variable embryo production efficiency were used. For each bull, motile spermatozoa were separated on a Percoll gradient, resuspended in IVF-TALP medium and capacitated with or incubated without heparin for 6 h. Samples before and after separation and after 3-h and 6-h capacitacion or incubation were evaluated by the Sperm Chromatin Structure Assay (SCSA) and the proportion of sperm with intact chromatin structure was calculated. Based on changes in the non-DFI-sperm proportion, the sires were categorized as DNA-unstable (DNA-us), DNA-stable (DNA-s) and DNA-most stable (DNA-ms) bulls (n=3, n=5 and n=9, respectively). In DNA-us bulls, separation produced a significant increase of the mean non-DFI-sperm proportion (p

[Sperm chromatin integrity disturbances in infertile men]. / Poruchy integrity chromatinu ve spermiích infertilních muzu.

OBJECTIVE: A survey of knowledge and detection methods of sperm chromatin integrity disturbances. DESIGN: Review of literature. SETTING: Veterinary Research Institute, Brno. METHODS: A survey of experience with detection methods for human sperm chromatin integrity disturbances. CONCLUSIONS: Disturbed sperm chromatin integrity manifested as an increase in DNA strand breaks within the spermatozoa and deficient chromosome condensation in the sperm nucleus is one of the causes of male infertility. Various approaches to the detection of such defects have been described. The methods differ above all in the time and expenses required, and robustness. The review brings a survey of the most commonly used procedures, and compares advantages and disadvantages of respective methods.

n-3 PUFAs-From dietary supplements to medicines.

Although there has been a great progress in the prevention of cardiovascular diseases, the mortality of patients with acute myocardial infarction (AMI) still remains high. One of the most important underlying causes explaining this phenomenon is the sudden cardiac death. Nearly half of all cardiovascular deaths in the USA each year is attributed to this unpredictable and unexpected complication of AMI. Hence, there is an urgent medical need for a targeted therapy to reduce the incidence of sudden cardiac death. Since 1980 there have been several epidemiological and other studies concerning the benefits of n-3 polyunsaturated fatty acids (n-3 PUFAs) in cardiovascular health and prevention. Results from one of the largest studies, GISSI Prevenzione Trial show that adding the n-3 PUFAs to standard therapy of patients who survived AMI reduces sudden cardiac death (44% risk reduction, p=0.0006). In addition, significant decline in all-cause cardiovascular mortality (21% risk reduction, p=0.0064) further emphasizes the role of n-3 PUFA in cardiovascular prevention. To date, beneficial effects of n-3 PUFA are attributed to their antiarrhythmic, lipid lowering, antithrombotic and anti-inflammatory properties. To conclude, EPA and DHA improve the prognosis of cardiovascular patients in the secondary prevention of sudden cardiac death without any documented side effects.

Embryos produced in vitro from bulls carrying 16;20 and 1;29 Robertsonian translocations: efficiency and kinetics of oocyte fertilization and embryo development.

The present experiments were designed to study the effects of Robertsonian translocations on the efficiency and kinetics of in vitro fertilization and early and advanced embryo development. Spermatozoa from bulls with rob(16;20), rob(1;29) and normal karyotype (A, B and C, respectively) were used. Oocytes were matured, fertilized and cultured by the standard protocol described previously. Twenty-four hours after fertilization, adequate numbers of oocytes were fixed, stained and examined. The development of embryos was evaluated on days 2 (D2), 7 (D7) and 8 (D8) after fertilization. The rate of normally fertilized oocytes was significantly lower (p < or = 0.01) for bull A than for bulls B and C. However, no significant differences in the kinetics of fertilization were found between bulls A, B and C. The D2 cleavage rate of embryos was significantly lower (p < or = 0.01) for bull A than for bulls B and C. Both D7 and D8 blastocyst rates for bull A or bull B were significantly lower (p < or = 0.01 or p < or = 0.05) than those for bull C. The percentages of both D7 advanced blastocysts and D8 expanded blastocysts were significantly lower (p < or = 0.01) for bulls A and B than for bull C. In conclusion, for rob(16;20), the efficiency of fertilization was strongly reduced; it resulted in low early and advanced embryo development. On the other hand, for the rob(1;29), neither fertilization nor early embryo development were affected and only advanced embryo development was decreased. But for both translocations, blastocyst formation was significantly delayed.

Development of in vivo derived diploid and tetraploid pig embryos in a modified medium NCSU 37.

The aim of this study was to assess development of diploid and tetraploid in vivo derived pig embryos cultured in a modified medium NCSU 37 in an atmosphere with reduced concentration of oxygen. The tetraploid embryos were produced by electrofusion of two-cell embryos that had been cultured in vitro from the one-cell stage before fusion (cultured two-cell embryos) or by fusion of freshly recovered two-cell embryos. Development to blastocyst stage of tetraploid embryos, generated from the cultured two-cell embryos was significantly inferior to the development of control one-cell embryos (29.1 +/- 9.7% versus 66.8 +/- 9.7%; P < 0.05). However, development of tetraploid embryos produced from the freshly recovered two-cell embryos and control two-cell embryos was very similar (89.9 +/- 6.1% versus 81.3 +/- 3.4%). Detection of chromosomes 1 and 10 by in situ hybridization showed that more than 85% of the cultured control embryos were diploid while 15% of the embryos were mosaic. Among the fused embryos 50% were tetraploid, 29% mosaic and 21% diploid. These data indicate that the modified medium NCSU 37 provides optimum environment for pre-implantation development of pig diploid and tetraploid embryos.

[Preimplantation genetic diagnosis (PGD) of chromosomal aberrations using the fluorescence in situ hybridization method (FISH)--introduction to problems, sampling methods and examination techniques]. / Preimplantacní genetická diagnostika (PGD) chromosomálních aberací metodou fluorescencní in situ hybridizace (FISH)--úvod do problematiky, prehled metod pri odberu materiálu a technika vysetrení.

OBJECTIVE: Presentation of preimplantation genetic diagnosis and the set of laboratory processes like aspiration, preparation and evaluation of polar bodies, sperm cells and blastomeres using FISH method (fluorescent in situ hybridization) in ART. DESIGN: Review. SETTING: Sanatorium REPROMEDA, Brno, Veterinary Research Institute, Brno. METHODS: Overview of published data and own clinical experience with the cell aspiration methods, evaluated sample preparation and the proper chromosomes visualisation using FISH method. CONCLUSION: The review brings an overview of conditions and methods including sample obtaining, FISH analysis preparation and implementation, processed during PGD.

[Analysis of heart rate variability during the head-up tilt test in patients with vasovagal syncope]. / Analýza variability srdcovej frekvencie pocas head-up tilt testu u pacientov s vazovagálnou synkopou.

Changes of the autonomous nervous tonus are considered the most important factor in the pathogenesis of vasovagal syncope. In order to investigate changes of the autonomous tonus the authors examined in patients with vasovagal syncope the variability during the head-up tilt test (HUT). In 35 patients with assumed vasovagal syncope the authors used a passive HUT (45 mins., 60 degrees) and subsequently nitroglycerin-stimulated HUT (0.4 mg s.l, 15 mins.). The heart rate variability was evaluated before the onset of the test in a horizontal position, immediately after tilting the patient (0 min.), during the 5th, 10th, 15th minute of the passive test, during the 5th minute of the nitroglycerin test, during the appearance of symptoms and after termination of the test in a horizontal position. They compared the results between a group of 20 patients with positive HUT (13 men, 36 years) and in 15 patients with a negative HUT (7 men, 32 years). The parameters of heart rate variability were during the development of the syncope (mean 6.4 mins. after administration of NTG) as compared with corresponding values in patients with negative HUT (during the 5th minute after administration of NTG) as follows: RR interval 759.6 +/- 248.1 ms vs. 552.1 +/- 88.7 ms (p = 0.01), SDNN 44.8 +/- 49.6 vs. 29.9 +/- 18.3 (p = 0.001), RMSSD 31.8 +/- 34.9 vs. 15.2 +/- 10.2 (p = 0.03), LF 4.44 +/- 0.66 lnms2 vs. 4.38 +/- 0.53 lnms2 (p = 0.82), HF 4.44 +/- 0.57 lnms2 vs. 4.39 +/- 0.45 lnms2 (p = 0.82), LF/HF 0.99 +/- 0.03 vs. 0.99 +/- 0.02 (p = 0.90). On development of the first presyncopal manifestations the statistical parameters of heart rate variability in patients with positive HUT were significantly higher as compared with patients with negative HUT, which suggests an increase of the parasympathetic autonomous tonus during the development of the vasovagal syncope.

Humoral mechanisms in the pathogenesis of postprandial hypotension in patients with essential hypertension.

OBJECTIVE: To examine the role of catecholamines and insulin in the development of postprandial hypotension (PPH) in hypertensive patients. PATIENTS: Forty patients with essential hypertension (25 men, 15 women, mean age 68 +/- 2 years). METHOD: Blood pressure and heart rate were recorded in all subjects immediately after a 1903 kJ test meal and at 15-minute intervals for up to 1 hour after the meal. At these time points, circulating levels of norepinephrine, epinephrine, dopamine and C-peptide were measured. RESULTS: Twenty-three patients (58%) had PPH. By 15 minutes norepinephrine had significantly increased in PPH-negative subjects while it rose more slowly in PPH-positive patients and peaked by 45 minutes after the meal. Norepinephrine levels in 15 minutes were lower in PPH-positive than in PPH-negative ones (159.8 +/- 9.7 vs. 212.3 +/- 21.1 pg/ml, p = 0.01). Epinephrine levels rose only in PPH-negative subjects and did not differ significantly at the different time points. However, the area under curve analysis showed significantly lower epinephrine values in PPH-positive subjects (2903 + 247 pg.min.ml-1 vs. 3710 + 284 pg.min.ml-1, p = 0.03). Dopamine increased in both groups, although it was lower in subjects with PPH during the entire study (15 minutes: 68.6 +/- 3.7 vs. 93.7 +/- 11.7 pg/ml, p = 0.02; 30 minutes: 68.8 +/- 3.7 vs. 86.1 +/- 7.7 pg/ml, p = 0.03; 45 minutes: 60.5 +/- 4.2 vs. 79.7 +/- 5.2 pg/ml, p = 0.006). The postprandial C-peptide response did not differ between patients with PPH and those without PPH. CONCLUSIONS: In patients with essential hypertension, a marked decline in postprandial systolic blood pressure is associated with lower postprandial levels of norepinephrine, epinephrine and dopamine as compared to subjects without postprandial hypotension. This indicates that impaired sympatho-adrenal activation after ingestion of a meal may contribute to the development of PPH. Insulin appears not to be involved in the pathogenesis of postprandial hypotension.

[Mitral stenosis evaluated with three-dimensional echocardiography]. / Mitrálna stenóza hodnotená trojrozmernou echokardiografiou.

The authors evaluated the possibilities of three-dimensional echocardiography in the assessment of the severity of mitral valve stenosis. In 45 patients, the Doppler pressure half-time method was compared with two three-dimensional echocardiographic methods in the measurement of mitral valve orifice: anyplane echocardiography and surface rendering. There was significant relation between them: r = 0.74 and r = 0.70, both p < 0.0001. In addition, mitral valve stenosis was also quantified by two new indices, such as the doming volume of the mitral apparatus and mitral valve volume. Subgroup analysis revealed relation between atrial fibrillation and decreasing doming volume as well as significantly higher mitral valve volume in patients with critical stenosis. Associated valve abnormalities did not influence the mitral orifice measurement neither by Doppler method nor three-dimensional echocardiography. In conclusion, three-dimensional echocardiography allows reliable assessment of mitral stenosis and moreover provides new quantitative indices, which can be clinically important in the assessment of three-dimensional geometry of the mitral apparatus.

[Catecholamine plasma levels during the tilt-table test in patients with vasovagal syncope]. / Plazmatické hladiny katecholamínov pocas testu na naklonenej rovine u pacientov s vazovagálnou synkopou.

BACKGROUND: The head-up tilt test (HUT) makes it possible to diagnose vasovagal syncope. The objective of the trial was to follow up changes of catecholamine plasma levels during HUT and test their importance in the pathogenesis of vasovagal syncope. METHODS AND RESULTS: In 25 patients with syncope of obscure etiology during HUT the noradrenalin, adrenalin and dopamine levels were followed up. In 125 patients (8 men and 7 women, mean age 34.3 years) HUT was positive. The control group was formed by 10 patients with negative HUT (4 men, 6 women, mean age 41.1 years). The catecholamine levels were assessed by the method of high resolution liquid chromatography during minutes 0, 5 and after completion of the test (i.e. during development of the syncope or the 45th minute). On comparison by the t-test no statistically significant difference between the group with vasovagal syncope and the control group was found. Noradrenalin 0 min: 186.4 +/- 61.6 pg/ml vs. 190.5 +/- 67.4 pg/ml (n.s.), 5th min. 506.3 +/- 178.9 pg/ml vs. 566.8 +/- 195.6 pg/ml (n.s.), end of test 457.3 +/- 154.1 pg/ml vs. 352.3 +/- 169.9 pg/ml (n.s.). Adrenalin 0 min. 54.0 +/- 12.6 pg/ml vs. 54.9 +/- 13.6 pg/ml (n.s.), 5th min. 114.3 +/- 35.6 pg/ml vs. 128.1 +/- 41.0 pg/ml n.s., end of test 98.2 +/- 40.6 vs. 783 +/- 31.2 pg/ml (n.s.). Dopamine 0 min. 113.9 +/- 36.5 pg/ml vs. 158.4 +/- 67.2 pg/ml (n.s.), 5th min. 318.1 +/- 72.7 vs. 328.5 +/- 119.7 pg/ml (n.s.), end of test 279.4 +/- 93.8 pg/ml vs. 231.7 +/- 98.5 pg/ml (n.s.). CONCLUSIONS: Catecholamine plasma levels in patients with vasovagal syncope did not differ from the control group. The importance of catecholamines in the pathogenesis of vasovagal syncope thus cannot be confirmed.

[Interferon in the treatment of Loeffler's endocarditis]. / Interferón v liecbe Löfflerovej endokarditídy.

The authors describe their own experience with the administration of recombinant alpha 2c interferon in the treatment of Loefller's endocarditis. Based on their analysis (as well as in keeping with the spares data in the literature-as a rare disease is involved), the authors consider this procedure as a qualitative advance of treatment. They consider their account as preliminary because of the short period of time, and therefore in future strict dispensary care of the patient is essential.

[Diagnostic sensitivity of 24-hour electrocardiographic Holter monitoring in indications for coronarography]. / Diagnostická citlivost' 24hodinového elektrokardiografického Holterovho monitorovania pre indikáciu na koronarografiu.

The authors evaluated 24-hour ECG monitoring (Holter monitoring) in 70 patients indicated for coronarography. They assessed the sensitivity, specificity, positive and negative predictive value of Holter monitoring. They compared the findings with data reported in the literature and with the sensitivity of the ergometric test for indication of patients for coronarographic examination. Although the sensitivity and specificity of Holter monitoring does not exceed generally reported values of sensitivity and specificity of bicycle ergometry, in the discussion the authors mention conditions where Holter monitoring is an asset for indication of patients for coronarographic examination.