Variability of peripheral pulse wave velocity in patients with diabetes mellitus type 2 during orthostatic challenge.

Diabetes mellitus 2 (DM2) is the seventh cause of death worldwide. One of the reasons is late diagnosis of vascular damage. Pulse wave velocity (PWV) has become an independent marker of arterial stiffness and cardiovascular risk. Moreover, the previous studies have shown the importance of beat-to-beat PWV measurement due to its variability among the heart cycle. However, variability of PWV (PWVv) of the whole body hasn't been examined yet. We have studied a group of DM II and heathy volunteers, to investigate the beat-to-beat mean PWV (PWVm) and PWVv in the different body positions. PWV of left lower and upper extremities were measured in DM2 (7 m/8 f, age 68+/-10 years, BP 158/90+/-19/9 mm Hg) and healthy controls (5 m/6 f, age 23+/-2 years, BP 117/76+/-9/5 mm Hg). Volunteers were lying in the resting position and of head-up-tilt in 45° (HUT) for 6 min. PWVv was evaluated as a mean power spectrum in the frequency bands LF and HF (0.04-0.15 Hz, 0.15-0.5 Hz). Resting PWVm of upper extremity was higher in DM2. HUT increased lower extremity PWVm only in DM2. Extremities PWVm ratio was significantly lower in DM2 during HUT compared to controls. LF and HF PWVv had the same response to HUT. Resting PWVv was higher in DM2. Lower extremity PWVv increased during HUT in both groups. PWVm and PWVv in DM2 differed between extremities and were significantly influenced by postural changes due to hydrostatic pressure. Increased resting PWVm and PWVv in DM2 is a marker of increased arterial stiffness.

Status of nutrition and cardiovascular system in children from the south Moravian region of the Czech Republic: a pilot study.

Nutritional status, its assessment and its influence on numerous diseases is currently still being discussed. The aim of this study was to determine the current state of nutrition by various research methods in school children. Also, to verify the accuracy of body mass index (BMI) determination in school environment and to compare the nutritional status in two different types of school. We used a quantitative questionnaire method in 64 children from schools in the South Moravian Region. We have verified the weight and height measurement in the same group by sophisticated instruments. We have determined the basic parameters of the cardiovascular system (non-invasive continuously blood pressure recording; mutual spectral analysis for estimation of baroreflex sensitivity; applanation tonometry and cardiac polygraphy for arterial stiffness evaluation). The indicative questionnaire method encountered a problem with the weight of almost 40 % of the population approached - both obesity (14.3 %) and malnutrition (25.2 %). Cardiovascular parameters were in physiological range for the given age categories. We found increased values in BMI, % of body fat and heart rate in children from countryside type of school, respectively. We concluded that obesity/malnutrition are both common phenomena in the children population in the Czech Republic.

Non-invasive assessment of vascular system function and damage induced by anthracycline treatment in the pediatric cancer survivors.

Anthracyclines represent one of the important classes of anti-cancer drugs; however, their major disadvantage is their profound cardiovascular toxicity. This study aimed to evaluate influence of anthracyclines on cardiovascular stiffness parameters estimated from pulse wave (PW). PW was measured in 59 cancer survivors treated with anthracyclines in childhood and in 248 healthy age-matched controls. Both patients and controls were divided into three age groups (13 - 15, 16 - 18 and 19 - 24 years). Central PW augmentation index (C-AI75) and augmentation pressure (C-AP75), both normalized to heart rate 75 bpm, were calculated as parameters of arterial wall stiffness. Central Buckberg sub-endocardial viability ratio (SEVR) was calculated as a parameter of diastolic function. Patients and controls were compared in each age group. C-AI75 and C-AP75 were significantly increased in patients in age groups 16 - 18 and 19 - 24 years. SEVR was decreased in patients in the oldest age group. Our results suggest that although toxic influence of anthracyclines to arterial wall and heart are developing during childhood and puberty, they can be detected rather in the adulthood. These changes are yet subclinical; however, their presence indicates potentially increased cardiovascular risk in childhood cancer survivors treated with anthracyclines during childhood.

Development of causal interactions between systolic blood pressure and inter-beat intervals in adolescents.

Systolic blood pressure (SBP) changes control the cardiac inter-beat intervals (IBI) duration via baroreflex. Conversely, SBP is influenced by IBI via non-baroreflex mechanisms. Both causal pathways (feedback - baroreflex and feedforward - non-baroreflex) form a closed loop of the SBP - IBI interaction. The aim of this study was to assess the age-related changes in the IBI - SBP interaction. We have non-invasively recorded resting beat-to-beat SBP and IBI in 335 healthy subjects of different age, ranging from 11 to 23 years. Using a linear autoregressive bivariate model we obtained gain (Gain(SBP,IBI), used traditionally as baroreflex sensitivity) and coherence (Coh(SBP,IBI)) of the SBP-IBI interaction and causal gain and coherence in baroreflex (Gain(SBP->IBI), Coh(SBP->IBI) and coherence in non-baroreflex (Coh(IBI->SBP)) directions separately. A non-linear approach was used for causal coupling indices evaluation (C(SBP->IBI), C(IBI->SBP)) quantifying the amount of information transferred between signals. We performed a correlation to age analysis of all measures. Coh(IBI->SBP) and C(IBI->SBP) were higher than Coh(SBP->IBI) and C(SBP->IBI), respectively. Gain(SBP,IBI) increased and Coh(SBP->IBI) decreased with age. The coupling indices did not correlate with age. We conclude that the feedforward influence dominated at rest. The increase of Gain(SBP,IBI) with age was not found in the closed loop model. A decrease of Coh(SBP->IBI) could be related to a change in the cardiovascular control system complexity during maturation.

The vibration plethysmographic method of arterial compliance analysis in dependence on transmural pressure.

The aim of this study was to obtain a detailed analysis of the relationship between the finger arterial compliance C [ml/mm Hg] and the arterial transmural pressure P(t) [mm Hg]. We constructed a dynamic plethysmograph enabling us to set up a constant pressure P(css) [mm Hg] and a superimposed fast pressure vibration in the finger cuff (equipped with a source of infra-red light and a photoelectric sensor for the measurement of arterial volume). P(css) could be set on the required time interval in steps ranging between 30 and 170 mm Hg, and on sinusoidal pressure oscillation with an amplitude P(ca) (2 mm Hg) and a frequency f (20, 25, 30, 35, 40 Hz). At the same time continuous blood pressure BP was measured on the adjacent finger (Portapres). We described the volume dependence of a unitary arterial length on the time-varying transmural pressure acting on the arterial wall (externally P(css)+P(ca).sin(2pif), internally BP) by a second-order differential equation for volume. This equation was linearized within a small range of selected BP. In the next step, a Fourier transform was applied to obtain the frequency characteristic in analytic form of a complex linear combination of frequency functions. While series of oscillations [P(ca), f] were applied for each P(css), the corresponding response of the plethysmogram was measured. Amplitude spectra were obtained to estimate coefficients of the frequency characteristic by regression analysis. We determined the absolute value: elastance E, and its inverse value: compliance (C=1/E). Then, C=C(P(t)) was acquired by applying sequences of oscillations for different P(css) (and thus P(t)) by the above-described procedure. This methodology will be used for the study of finger arterial compliance in different physiological and pathological conditions.

[Baroreflex sensitivity: diagnostic importance, methods of determination and a model of baroreflex blood-pressure regulation]. / Citlivost baroreflexu: diagnostický význam, metody stanovení a model baroreflexní regulace krevního tlaku.

Baroreflex regulation of blood pressure primarily moderates its fluctuations and also affects mean blood pressure. Heart rate baroreflex sensitivity is described as changes of the inter-beat interval induced by a change of blood pressure of 1 mmHg (BRS). BRS is decreased in many cardiovascular diseases (hypertension, diabetes mellitus, obesity, cardiac failure, etc.). Decreased BRS in disposed individuals, especially after myocardial infarction, increases the risk of sudden cardiac death. Therefore, early diagnosis of BRS decrease gains in importance. This article describes different methods of determination of baroreflex sensitivity. The methods are based on evaluation of the spontaneous fluctuation of heart rate and blood pressure (spectral, sequential or nonlinear methods), or of primary changes of blood pressure induced by a vasoactive substance or a physiological manoeuvre and corresponding changes of cardiac intervals (Valsalva manoeuvre, phenylephrine administration). Each method has its advantages and disadvantages resulting from a different difficulty of calculation or from inclusion of different deviations in the results, which are not directly linked with baroreflex. Baroreflex regulating total peripheral resistance is less described. A mathematical model of baroreflex blood pressure regulation by fluctuation of heart rate and peripheral resistance is presented in this paper.

Diagnostic significance of a mild decrease of baroreflex sensitivity with respect to heart rate in type 1 diabetes mellitus.

Decreased baroreflex sensitivity is an early sign of autonomic dysfunction in patients with type-1 diabetes mellitus. We evaluated the repeatability of a mild baroreflex sensitivity decrease in diabetics with respect to their heart rate. Finger blood pressure was continuously recorded in 14 young diabetics without clinical signs of autonomic dysfunction and in 14 age-matched controls for 42 min. The recordings were divided into 3-min segments, and the mean inter-beat interval (IBI), baroreflex sensitivity in ms/mm Hg (BRS) and mHz/mm Hg (BRSf) were determined in each segment. These values fluctuated in each subject within 42 min and therefore coefficients of repeatability were calculated for all subjects. Diabetics compared with controls had a decreased mean BRS (p=0.05), a tendency to a shortened IBI (p=0.08), and a decreased BRSf (p=0.17). IBI correlated with BRS in diabetics (p=0.03); this correlation was at p=0.12 in the controls. BRSf was IBI independent (controls: p=0.81, diabetics: p=0.29). We conclude that BRS is partially dependent on mean IBI. Thus, BRS reflects not only an impairment of the quick baroreflex responses of IBI to blood pressure changes, but also a change of the tonic sympathetic and parasympathetic heart rate control. This is of significance during mild changes of BRS. Therefore, an examination of the BRSf index is highly recommended, because this examination improves the diagnostic value of the measurement, particularly in cases of early signs of autonomic dysfunction.

[Long-term outcomes at not-penetrating glaucoma surgery]. / Dlouhodobé výsledky u nepenetrujících operací glaukomu.

OBJECTIVE: To evaluate the long-term compensation and efficacy after non-penetrating deep sclerectomy using different types of implants. METHODS: Patients were divided in 3 groups: deep sclerectomy without implant (DS): 34 eyes, deep sclerectomy with Staar implant (DS+STAAR): 31 eyes, deep sclerectomy with T-flux implant (DS+T): 27 eyes. Postoperatively was evaluated: IOP, therapy and efficacy. RESULTS: The data are described by the relative quantity, continuous data by median, 5th and 95th percentile, always in order of groups: DS; DS+STAAR; DS+T, resp. Age at the time of surgery was 65.6 (44.9; 77.9); 64.5 (44.8; 85.0); 72.1 (51.8; 77.0) years. Follow-up period was 84 (36; 145); 96 (36; 141); 81 (36; 134) months. IOP was 26 (20; 32); 26 (20; 34); 26 (21,34) mmHg postoperatively. IOP was 14 (4; 18); 14 (4; 22); 8 (2; 16) mmHg at 1 month postoperatively. IOP was 17 (13; 23); 17 (12; 21); 14 (12; 18) mmHg at 96 months. IOP was 18 (1; 20); 18 (10; 22); 15 (13; 16) mmHg at 132 months. Completely without therapy were 0; 7.1; 42.9 % of eyes at 120 months. Complete success rate was 0; 7.1; 18.2 % at 96 months. Qualified success rate was 87.5; 89.5; 100 % at 96 months. CONCLUSION: Deep sclerectomy is a good surgical technique to reduce the IOP in patients with glaucoma. Use of T-flux implant provides the best results in our groups.

[Complications of deep nonpenetrating sclerectomy]. / Komplikace u nepenetrujících hlubokých sklerektomií

OBJECTIVE: The purpose of this retrospective study was to evaluate an incidence of complications after deep nonpenetrating sclerectomy with different type of implant. METHODS: A total of consecutive 92 eyes (76 patients) that underwent deep sclerectomy were divided into 3 groups according to the type of nonpenetrating surgery. The first group underwent deep sclerectomy without implant (34 eyes, 29 patients), the second group underwent deep sclerectomy with absorbable collagen implant Staar© (31 eyes, 25 patients) and the third group underwent deep sclerectomy with non-absorbable implant T-Flux© (27 eyes, 22 patients). The complications were divided into 3 types - peroperative, early postoperative and late postoperative. RESULTS: The incidence of complications in above mentioned 3 groups was as follows: Peroperative complications: Perforation of trabeculo-Descemets membrane (2.6; 4.2; 3.7 % respectively). Early postoperative complications: Filtrating operating wound (no occurrence in our groups), Choroideal detachment (17; 19; 16 % resp.), Hypotony (10; 8; 5 % resp.), Hyphaema (7; 3; 0 % resp.), Infectious complications (no incidence of blebitis or endophthalmitis in our groups), Flat anterior chamber (7; 5.7; 5.5 % resp.), Dislocation of implant (1 case of dislocation of Staar©, 1 case of dislocation of T-Flux©). Late postoperative complications: Fibrosis of filtering bleb (30; 36; 24 % resp.), Encapsulated filtering bleb (2.9; 10.3; 0 %), Peripheral anterior synechiae (0; 4.2; 3.7 % resp.), Cataract progression (total incidence 5.5 %), there was no incidence of chronic hypotony, scleral ectasia and late endophthlamitis in our groups. CONCLUSIONS: Deep sclerectomy allows effective lowering of intraocular pressure, without necessity of opening anterior chamber. It brings lower incidence of complications compared to classical penetrating trabeculectomy. Use of implant increases success of surgery due to intrascleral fibrosis reduction. We documented better effect of non-absorbable implant T-Flux© compared to absorbable collagen implant Staar©. The highest incidence of intrascleral fibrosis was in group of patients that underwent deep sclerectomy without implant.

[Aging eye--its specific features and diseases]. / Stárnoucí oko--jeho specifika a choroby.

Practically oriented overview of the anatomical and physiological changes in the eye during aging is presented together with the description of diseases typical for the advanced age. The growing number of patients with eye diseases of advanced age and the comparatively low awareness of this fact within the medical community brought us to the publishing of the presented overview. It is necessary to increase the understanding of geriatric problems among ophthalmologists as well as to enhance the awareness of the age related changes in the eye during ageing among the physicians--non-ophthalmologists (namely among the general practitioners, internists, geriatrists) who treat seniors for other diseases. Namely they can meet in their everyday praxis the problems of drug interaction and the general and ophthalmologic side effects of various types of treatment. The use of ophthalmologic drugs (e.g. anti-glaucoma remedies) is connected with undesirable effects on the organism in any age and namely in elderly patients.

[Comparison of clinical results between LASIK method and ICL implantation in high myopia]. / Srovnání klinických výsledku metody LASIK a implantace ICL u vysoké myopie.

In a retrospective study the authors evaluate clinical results of the LASIK (laser in situ keratomileusis) and the implantation of the implantable posterior chamber contact lens phakic IOL (ICL) (STAAR Surgical) to correct high myopia. The purpose of the study was to assess which of those two methods is more reliable in patients to correct myopia in the range -10.0 to -23.0 diopters. The LASIK method was presented of a group of 70 eyes of 48 patients with preoperative spherical equivalent average of -12.9 +/- 3.8 diopters (Dsf) and average astigmatism of -0.99 +/- 1.2 cylindrical diopters (Dcyl). The group was divided into two parts: one part was with the desired postoperative emmetropia--46 eyes (65.7%), and part two was with the desired postoperative residual myopia up to -3.0 Dsf--24 eyes (34.3%). The method of ICL implantation was presented of a group of 36 eyes of 21 patients with preoperative spherical equivalent average of -15.21 +/- 4.0 Dsf and average astigmatism of -0.92 +/- 0.69 Dcyl. Also this group was divided into two parts: One part was with the desired postoperative emmetropia--25 eyes (69.4%), and part two was with the desired postoperative residual myopia up to -3.0 Dsf--11 eyes (30.6%). The developments of postoperative refraction in time (1 week to 3 years after the surgery), the final postoperative refraction and its stability and (6 months to 3 years after the surgery) as well as the occurrence of complications in both studied groups were evaluated. In the assessment of the postoperative refraction development in groups of desired emmetropia, the average uncorrected visual acuity (UCVA), average postoperative spherical equivalent and astigmatism were evaluated. In the groups with desired residual myopia the average best-corrected visual acuity (BCVA), average postoperative spherical equivalent, and astigmatism were followed. Three years after the surgery in groups with desired emmetropia, the average postoperative spherical equivalent was -0.99 Dsf and reduction of myopia by 92.0% in the LASIK method, and -0.52 Dsf and reduction of myopia by 96.1% in ICL implantation respectively. In cases of desired residual myopia those final values were -1.74 Dsf with reduction of myopia by 86% for LASIK, and -1.58 Dsf with reduction myopia by 90.7% for ICL implantation. Final postoperative BCVA (given in lines of Snellen optotypes) was in 1.7% (1 eye) loss of 2 lines, in 17.1% (12 eyes) 1 line loss, in 55.7% (39 eyes) without change, in 22.9% (16 eyes) improvement by one line. In ICL implantation, the BCVA was unchanged in 25% (9 eyes), in 72.3% (26 eyes) improved by 1 line, and in 1 eye improved by 2 lines. In the group with LASIK method, in 17.1% (12 eyes) a reoperation followed, and in the group with ICL implantation, in 2.7% (1 eye) the other operation followed (ICL explantation). From the results emerged that for high myopia over -10 Dsf is the ICL implantation more appropriate because of its faster postoperative visual rehabilitation, more stabile and better final postoperative refraction and lower complications ratio.

[Implantation of the Starr Surgical intraocular posterior chamber lenses for phakic eyes in medium and higher levels of myopia and hyperopia]. / Implantace intraokulární zadnekomorové cocky pro fakické oko firmy STAAR surgical u stredních a vyssích stupnu myopie a hyperopie.

Implantation of an Intraocular Posterior-chamber Lens for a Phacik Eye from STAAR Surgical Co. in Medium and Higher Grades of Myopia and Hyperopia Implantation of an intraocular Collamer lens for a phacic eye produced by STAAR Surgical (ICL) co. is a modern method of correction of medium and high-grade refractive defects--myopia and hyperopia. The authors evaluate the results of implantation of ICL Staar Surgical in 20 eyes of 13 patients (1 man and 12 women). Their mean age was 31.36 +/- 9.21 years and the follow-up period 1-54 months (mean 28.8 months +/- 12.42). The group was divided into two sub-groups--hyperopia (8 eyes) and myopia (12 eyes). The mean value of refraction before surgery was 28 D +/- 2.03 and +0.25 Dcyl manifest (in cycloplegia +7.6 +/- 2.28 D) (from 3.75 D to 10.0 D) in the group of hyperopia and -14.25 D +/- 5.68 and -1.81 Dcyl (from -5.5 D to -25.0 D) in the myopic group. The required postoperative refraction was in 17 eyes emmetropia and in 3 eyes residual myopia up to -3.0 D with regard to incipient presbyopia. The authors evaluate the resultant best corrected visual acuity (BCVA), the resultant postoperative refraction, the incidence of postoperative complications and changed density of endothelial cells in the centre of the cornea in the course of time. In the group of hyperopia improvement of the BCVA as compared with the preoperative value occurred by one line in two eyes (25%), in 5 eyes (62.5%) BCVA remained unchanged. In one instance deterioration by one line occurred due to a diminution of endothelial cells in the centre of the cornea after surgery. In the group of myopia in 7 eyes (58.3%) improvement by 1 line occurred, in 2 eyes (16.7%) by 2 lines and in 3 cases (25%) BCVA remained unchanged. The mean value of postoperative refraction in the myopic group in required emmetropia (9 eyes) was -0.77 +/- 1.62 D and in required residual myopia (3 eyes) -1.5 +/- 1.32 D. The mean value of postoperative refraction in the group of hyperopia was +0.57 +/- 0.5 D for far sight and +1.28 +/- 0.58 D for near sight. The most frequent early postoperative complications included keratitis striata in 5, epithelopathy in 3 and residues of viscoelastic material behind the ICL in 3 eyes. As to late postoperative complications, in 2 eyes a change in endothelial cell density was involved, in 12 eyes the syndrome of pigment dispersal and in one eye late decentration of ICL occurred with subsequent anterior subcapsular cataract. The change in density of endothelial cells was most markedly expressed 3 months after surgery in the hyperopic group. The advantage of ICL implantation is rapid postoperative visual rehabilitation, reversibility of the operation, preserved accommodation and satisfactory stability of the postoperative refraction.

[Glaucoma and pitfalls in therapy in the elderly with multiple morbidity from the viewpoint of the geriatrician]. / Glaukom a úskalí jeho lécby u multimorbidních senioru z pohledu geriatra.

Glaucoma in multi-morbid patients is frequently treated by specialists non-ophthalmologists. The growing number of elderly patients with glaucoma and comparatively small knowledge on this disease among the medical workers brought us to review recent findings on the aetiology, pathogenesis, risks of development and namely the problems of glaucoma treatment, possible drug interactions and their side effects. Considering the growing incidence of glaucoma with age, general practitioners, internists, geriatrists and other specialists will face the problems of drug interactions and global or ophthalmological side effects during the polypharmacological treatment of their multi-morbid seniors. The article gives basic information on the problems of using antiglaucoma drugs and their effects on the organism and eyes. Effects of some foodstuff and medicaments used in therapy of other diseases on the intraocular pressure and glaucoma are also summarise.

[Laser trabeculoplasty--present and future perspectives]. / Laserová trabekuloplastika--soucasnost a perspektiva.

Laser trabeculoplasty has been used in the treatment of various types of glaucoma for nearly 20 years. It's intraocular pressure lowering effect through enhancement of aqueous outflow is well documented. In spite of this, the precise effect of laser trabeculoplasty in the trabecular meshwork is only partially understood. It is related to laser wave length, laser power, burns location, number of shots etc. The effectiveness of laser trabeculoplasty diminishes over time, but can be renewed with re-treatment. Laser trabeculoplasty has connected with minimum complications and it is most effective in patients with primary open-angle glaucoma, pigmentary glaucoma and the exfoliation syndrome glaucoma, though the long-term results of this microsurgery laser treatment are not quite indisputable.

[Combined use of ultrasound and radiodiagnostic methods in the diagnosis of posterior dislocation of the lens]. / Kombinované pouzití ultrazvuku a radiodiagnostických metod v diagnostice zadní luxace cocky.

In a case record the authors present an account on a patient with an opaque media of the left eye on account of seclusion and occlusion of the pupil. The cause of the unilateral chronic uveitis was elucidated by ultrasonic examination with visualization type A. The cause was a calcified lens dislocated into the vitreous body and fixed to the posterior wall of the eye. The finding was confirmed by a negative X-ray picture and positive finding of a small foreign body with high density on CT. Dislocation of the lens occurred after a blow on the left eye during boxing 15 years before the patient sought medical assistance on account of a painful practically blind eyeball.