The mechanism of the silent zone on Lorenz plots in atrial fibrillation.

Lorenz plot is an acknowledged method of the evaluation of sequences of ventricular beats in cardiac arrhythmias, particularly in atrial fibrillation. Lorenz plots are scatterplots that show the R-R intervals as a function of the preceding R-R intervals. The authors of this paper conducted studies of 83 cases of atrial fibrillation; histograms of 500 consecutive R-R intervals were made, determining the mean R-R interval, the functional refraction period (FRP) of AV node and Lorenz plots. In 22 cases (26.5%) the presence of the silent zone on a Lorenz plot was observed, similarly to the study of Nakatsu and al. The silent zone appeared only in cases when the statistical distribution of R-R intervals was reflected by a bimodal histogram (less frequently by a trimodal histogram). The silent zone was never observed in cases of monomodal distribution of R-R intervals. The authors discuss Nakatsu's findings and argue that the silent zone in a Lorenz plot is a morphological expression of bimodal distribution of R-R intervals in atrial fibrillation. The silent zone may be caused by pharmacotherapy (e.g. digoxin), increased parasympathetic tension or other factors prolonging FRP. The presence of the silent zone is not a predictor of a spontaneous termination of atrial fibrillation.

The dynamics of isolated systolic hypertension during the 10-year period of geriatric treatment.

The aim of the study was to analyse the course of isolated systolic hypertension in old age and its influence upon quoad vitam prognosis. A group of 100 persons over 60 was chosen and observed systematically for the period of 10 years in the geriatric out-patients centre. On the basis of pattern of arterial pressure in the 10-year-period the patients were qualified into several types of hypertension. Isolated systolic hypertension occurred mostly in the late old age over 70 and was characterized by irregular occurrence of periods of hypertension alternately with periods of normotension without any tendency to increase hypertension with the advance of old age. Cases of death caused directly by hypertension were found more frequently in the group with systolic-diastolic hypertension (56%) than in the group with isolated systolic hypertension (36%).

[20-year cooperation between the I Department of Internal medicine of the District Hospital and the Department of Pathological Anatomy, Medical Academy, in Bialystok (analysis of diagnostic consistency)]. / 20 Lat wspólpracy i Oddzialu Chorób Wewnetrznych Wojewódzkiego Szpitala Zespolonego z Zakladem Anatomii Patalogicznej am w Bialymstoku (analiza zgodnosci rozpoznan).

Statistical analysis of 1421 deaths (98% of all who had died at the Ward) of patients during 1965-1984 was performed. The material was divided into 3 groups according to the age: up to 59 years, from 60 to 69 and over 70 years. Among those who had died men prevailed (55.1%), but both among women and men the age was over 70 years. In the 2nd decade of the analysed period the authors found gradual increase of death percentage among elderly people, that can be ascribed to "geriatrization" of the Ward and higher accessibility to the hospital for this group of patients. Statistical analysis which included a 10-year period (1975-1984) dealt with the causes of deaths according to the clinical and pathological recognition. There dominated deaths of cardiovascular diseases (59.4%), twice increased the percent of deaths due to neoplasia and diabetes complications. On the other hand, the proportion of decreased of heart infarction fell (from 33% to 16.9%) as did of cardiac defects (from 9.5% to 5.9%). This decrease was the effect of hospital structure changes, i.e.a creation of the Ward of Cardiology and Intensive Cardiological Care in 1981. During 1981-1984 the proportion of deaths of complications of arterial hypertension, mainly in the persons at very old age, increased threefold. In this group of age there dominated deaths of cardiac infarction and circulatory insufficiency. The authors made an analysis of the conformability of clinical diagnosis and the results of autopsy. Out of 1421 deaths in 1149 cases (80.8%) the results of autopsy fully agreed with clinical diagnosis. As partially conformable the clinical diagnosis was in 15.5%, and divergent in 3.7% of cases. The latter, according to the authors, resulted from an incomplete or unproper interpretation of diseases symptoms influenced by several objective factors. As could be expected, the highest proportion of divergent diagnosis was found in the group of the eldest patients afflicted with cardiovascular and malignant diseases.

[Health-resort therapy and its importance for geriatric prophylaxis (author's transl)]. / Die Rolle der Kurottherapie in der geriatrischen Prophylaxe.

The authors report on the influence of a single or repeated health-resort therapy in geriatric sanatoria on the subjective condition, the state of health, and the biochemical parameters.