[Plasminogen activator inhibitor (PAI-1) and diabetes mellitus. II. PAI-1 in insulin resistant conditions]. / Inhibítor plazminogénového aktivátora (PAI-1) a diabetes mellitus. II. PAI-1 pri inzulínrezistentných stavoch.

Insulin resistance (IR) is associated with an elevated PAI-1 level and by correlation with insulin and triacylglycerol (TG) levels. While in IR non-diabetics this relationship is close, in patients with NIDDM the mutual relationship is less marked and there are other factors which raise the PAI-1 levels such as proinsulin, oxidation stress or cytokines. Therefore achievement of satisfactory metabolic control, reduction of insulin and TG levels need not be associated with normalization of PAI-1. As it is an independent risk factor of atherosclerosis, further examinations are necessary in order to differentiate in more detail the possible causes of its rising level in order to obtain a rational basis for effective therapy.

[Glutamic acid decarboxylase autoantibodies (antiGAD-Ab) in patients with non-insulin dependent diabetes mellitus (NIDDM)]. / Autoprotilátky proti dekarboxyláze kyseliny glutámovej (antiGAD-Ab) u pacientov s non-inzulín dependentným diabetes mellitus (NIDDM).

AIM OF STUDY: To assess the prevalence of markers of autoimmune destruction of pancreatic beta-cells in patients with non-insulin dependent diabetes mellitus (NIDDM). SUBJECTS: 127 hospitalized NIDDM patients subdivided to the following subgroups: non-obese with C-peptide < 0.3 nmol/l (NIDDM-(-)), non-obese with C-peptide > 0.3 nmol/l (NIDDM-(+)), obese with C-peptide < 0.3 nmol/l (NIDDM+(-)) and obese with C-peptide > 0.3 nmol/l (NIDDM2+). METHODS AND MEASURED PARAMETERS: Age, BMI, C-peptide, autoantibodies to glutamic acid decarboxylase (antiGAD-Ab), autoantibodies to islet cells (ICA), markers of specific cellular immunity CD4, CD8, CD19, CD4/CD8, CD4/CD45/RA+, CD4/CD45/RA-, NK (CD16+56), CD3/HLADR, organ specific/non-specific autoantibodies. RESULTS: AntiGAD-Ab were positive in 5/15 (33.3%) NIDDM-(-), 1/32 (3.1%) NIDDM-(+), 2/9 (22.2%) NIDDM+(-) and in 3/71 (4.2%) NIDDM2+. The positivity of antiGAD-Ab in NIDDM-(-) and NIDDM+(-) was significantly higher (p < 0.05) than in NIDDM-(+) and NIDDM2+. CONCLUSION: Some patients with manifestation of diabetes in older age initially classified and treated as having NIDDM may have in fact slowly evolving autoimmune insulin-dependent diabetes mellitus (LADA). These patients can be identified by measurement of antiGAD-Ab or other markers (ICA, IA-2) of autoimmune destruction of pancreatic beta-cells (AID). Moreover, in some patients both AID and insulin resistance may coexist in parallel.

[Plasminogen activator inhibitor (PAI-1) and diabetes mellitus. I. Regulation of PAI-1 levels]. / Inhibítor plazminogénového aktivátora (PAI-1) a diabetes mellitus. I. Regulácia hladín PAI-1.

Elevated PAI-1 levels were described in different insulin resistant conditions, incl. diabetes mellitus type II. In its formation probably several stimulating factors participate. Hitherto accomplished studies suggest not only the important effect of insulin acting synergically with very low density. lipoproteins (VLDL) on hepatocytes but also the importance of the endothelial pool where the action of proinsulin, VLDL and cytokines in synergy with Cai-dependent stimuli (oxidation stress, thrombin) is involved. Under certain circumstances also another adipocyte compartment may play a role, and a significant role of thrombocytes in raising the PAI-1 level cannot be ruled out either. A more detailed analysis of the raised PAI-1 level in different patients could extend the possibilities of therapeutic reduction of levels of this important risk factor of atherosclerosis.

[Sepsis. II. Complications and treatment of sepsis]. / Sepsa. II. cast. Komplikácie a liecba sepsy.

Sepsis and its complications are serious medical problem of intensive medicine. Therefore recently several therapeutic procedures were tested in sepsis and its complications such as syndrome of multiorgan dysfunction or septic shock. The authors review possibilities how to treat these complications.

[Sepsis. I. [Definition of the concept and comments on pathophysiology]. / Sepsa. I. cast'. Vymedzenie pojmu a patofyziologické poznámky.

During the past five years a marked development occurred as regards knowledge on sepsis and its complications. A new term was introduced-SIRS (systemic inflammatory response syndrome). Two substantial changes pertain to the following facts. First the clinical picture of sepsis need not be due only to infection, and the patient is not an innocent victim of infection, but the organ damage is the results of the patient's active fight with the inducing cause. The authors review recent views regarding the pathophysiology of sepsis.

[Infectious endocarditis--new aspects of a well-known disease]. / Infekcná endokarditída--nové pohl'ady na známe ochorenie.

The authors discuss the incidence, etiology and pathogenesis of infectious endocarditis. They mention the incidence and therapeutic results in patients with infectious endocarditis hospitalized at the First Medical Clinic in Martin in 1988-1993. In the conclusion they present general principles of the treatment of infectious endocarditis.

[Dynamics of digoxin-like immunoactivity during the oral glucose tolerance test in pregnant women]. / Dynamika digoxínu podobnej imunoaktivity pocas OGTT u tehotných zien.

The changes of serum digoxin-like immunoactivity (DLIA) during 75g oral glucose tolerance test (OGTT), were investigated in 25 pregnant women with various glucose tolerance. 13 women had a normal glucose tolerance (NGT), 12 women had an impaired glucose tolerance (IGT) or gestational diabetes mellitus (GDM). Test was performed after 25 week of pregnancy. The results were compared with 9 nonpregnant healthy volunteers (NHV). After an oral glucose challenge, there was observed a significant decrease in serum DLIA (p < 0.01 in 1st hour), in both groups of the pregnant women. In the group of NHV these findings were not found. Our findings suggest a possible relationships between DLIA and glucose tolerance in pregnant women. However, it needs further investigation. (Tab. 1, Fig. 1, Ref. 24.)

[Lyme disease in internal medicine]. / Lymeská choroba vo vnútornom lekárstve.

The authors present a review on the aetiology, clinical aspects, diagnosis and treatment of Lyme disease. They describe three patients who were treated in their department for Lyme disease. Although this disease has been followed up in Bohemia and Slovakia only for nine years, it is probable that it is more frequent than diagnosed. Lyme disease is a disease which affects different organs. Therefore it is important that specialists in internal medicine should more frequently consider the possible presence of this disease when making differential diagnoses.

[Immunologic indicators in ascites]. / Imunologické ukazovatele v ascitoch.

The authors investigated specific and non-specific immunological parameters in malignant, cirrhotic, cardial and nephrogenic ascites. At the same time bacteriological and cytological examinations of ascites were made. In the submitted paper the authors compare, using statistical methods, immunological parameters of ascites in different patient groups and pay attention to their relationship with positive bacteriological and cytological findings in ascites. The authors recorded the largest number of positive bacteriological cultivation in cirrhotic and malignant ascites which correlates with lower values of some non-specific immunological parameters in ascites.

[Renin and aldosterone in the first 24 hours after acute myocardial infarct]. / Renin a aldosteron v prvých 24 hodinách cerstvého infarktu myokardu.

The authors investigated the levels of plasma renin activity and aldosterone in patients with a fresh myocardial infarction during the first 24 hours of hospitalization. The values of plasma renin activity and aldosterone were correlated with values of the control group. At the time of admission to the clinic both hormones were significantly elevated, as compared with the control group, in plasma renin activity p less than 0.001 and in aldosterone p less than 0.01. During the subsequent time intervals, i.e. after 3, 6 and 24 hours, the values of plasma renin activity did not change substantially, while the aldosterone values declined during the 6th and 24th hour (significance p less than 0.05). No significant relationship was found between plasma renin activity an aldosterone. With regard to persisting elevated values of plasma renin activity the authors discuss the possible use of blockers of the angiotensin converting enzyme in order to inhibit in the initial stage of a new infarction the formation of endogenous pressor substances.

[Validity of biochemical examinations in ascites in clinical practice]. / Validita biochemických vysetrení ascitu v klinickej praxi.

The authors examined, using biochemical, cultivation and cytological methods, ascites in 94 patients. They divided the patients into four groups: group 1 (36 patients)--malignant ascites, group 2 (35 patients)--cirrhotic ascites, group 3 (11 patients)--cardial ascites, group 4 (12 patients)--nephrogenic ascites. The authors tried to differentiate malignant ascites from non-malignant, based on biochemical parameters. As the composition of ascites is influenced by some factors (diuretics, dialysis) the authors recommend the use of biochemical analyses of ascites in clinical practice.