[The heart in diabetics]. / Srdce diabetika.

Macrovascular complications in diabetics create a high risk for cardiovascular disease (CVD). Generally, the main risk factors for CVD include age, men's sex, elevated LDL-cholesterol and reduced HDL-cholesterol, elevated fibrinogen, hypertension, smoking, and diabetes mellitus. Clinical manifestation of coronary disease is determined by number, area, and severity of coronary stenoses, myocardial function, and presence of induced ischemia. Routine pharmacological treatment of ISHD concentrates on risk factors and hasn't been yet focused on changes in energy metabolism during ischemic situation which are important factors contributing to ischemic damage. Substances able to optmize energy metabolism of heart muscle offer a very tempting way both for ISHD treatment and for treatment of following cardiovascular complications. Optimal use of energy source in heart muscle can favour heart activity so that comparable amount of contractile work requires less oxygen. The most beneficial way of getting energy for myocardium while low consumption of oxygen is oxidation of glucose. Because of a large amount of free fatty acids (FFAs) in diabetics a more demanding way of oxidation takes place in them, the oxidation of FFAs. Therefore myocardium of a diabetic needs under normal perfusion conditions more oxygen to provide energy. Besides increase in demand of oxygen, FFAs separate glycolysis from glucose oxidation and increase undesirable production of lactate and protons. An ischemic myocardium of a diabetic has primarily bigger demand of oxygen then myocardium of a non-diabetic. Development of cell ischemia, with all the known consequences in forms of lactate acidosis, calcium overload, and depletion of ATP, leads to considerable contractile disorder. Unfavourable position of metabolic activities in myocardium of diabetics and faster and more serious progression of atherosclerosis result in a big risk of CVD in diabetics. Incidence of coronary events in diabetics without history of ISHD is as big as in non-diabetics with history of coronary events.

[Indications for laparoscopic adrenalectomy]. / Indikace k chirurgické laparoskopické adrenalektomii.

Endocrinological indication for surgical adrenalectomy is relatively rare. There is relatively little information on possibilities how to perform adrenalectomy by a minimally invasive procedure. Minimal invasive surgery made it possible to implement some operations sparing the patient. Adrenalectomy is one of these procedures. Laparoscopic adrenalectomy, which is extremely rare in other countries, as practiced in the Czech Republic, is the subject of the submitted paper.

[The effect of self-monitoring on perinatal outcome in insulin therapy of diabetic women during pregnancy]. / Vliv selfmonitoringu na perinatální výsledky u inzulínem lécených diabeticek v tehotenství.

The authors compare perinatal results in insulin treated diabetic women who were followed up in the out-patient department of the Second Gynaecological and Obstetric Clinic of the Masaryk University in Brno. In 1980-1984 148 pregnant diabetic women were followed up and in 1985-1991 when self-monitoring has become part of comprehensive treatment of pregnant diabetics in our department, 279 women were followed up. The patients were monitored during pregnancy by a diabetologist and gynaecologist. Other members of the team are a paediatrician, geneticist, psychologist, dietitian, and educational nurse. As to laboratory parameters, short-term and long-term compensation of diabetes were monitored. Systematic preconception preparation of diabetic patients, with an attempt to achieve normal blood sugar levels and genetic examination of both partners from part of comprehensive care. The results achieved in our department revealed a statistically significant decline of the incidence of foetopathies in neonates at the 5% level of significance and a decline of hypoglycaemia in foetuses at the 0.1% level.

[Prenatal preparation--a part of the care of young female diabetic patients]. / Prekoncepcní príprava--soucást péce o mladou diabeticku.

In the Second Gynaecological and Obstetric Clinic in Brno there has been for more than 15 years a specialized department for treatment of diabetes during pregnancy. The department monitors and treats pregnant diabetics from approximately two thirds of the former South Moravian region, i.e. patients with diabetes assessed before pregnancy as well as those where an impaired carbohydrate metabolism was detected during pregnancy. The authors submit an account of the organization of team work in their out-patient department.