[The information value of detection of borrelia antibodies in the healthy blood donors and in the population at risk]. / Informacní hodnota prukazu antiborreliových protilátek u zdravých dárcu krve a rizikové skupiny populace.

BACKGROUND: Geographic differences of particular species of ticks and variant strains of Borrelias impede the comparison of local and foreign experience. The authors tried to support some literary observations with their own results and designed a study aimed at determination of anti-Borrelia antibodies (AB) in the selected population samples. The goal of the study was to find and statistically evaluate: a) difference in distribution of values of AB in the sample of probands from the risk and non-risk environment (foresters in Sumava and Prague blood donors, respectively) by means of ELISA method, b) tick bite frequency in the risk and non-risk groups, c) to determine and statistically evaluate the prevalence of probands with increased levels of antiborrelial antibodies in the local study population by ELISA method and the prevalence of probands with non-normal values found by Western blot (WB) method. METHODS AND RESULTS: In the group of Prague blood donors (control group), in total 200 probands were examined; in the risk group, 71 probands from Sumava forest were examined. Blood specimens were examined in the National Reference Laboratory for Lyme Borreliosis in Prague. In all specimens, ELISA NRLB KC90 was used. Western blot assay was used for confirmation. CONCLUSIONS: On the basis of literature review from Europe and USA, it is possible to generalize the following, despite some equivocations: 1. regional differences are not significant, with the exception of high-risk territories or "occupational exposure"; 2. there is no significant difference between males and females; 3. considerable caution is necessary in comparing the control and risk groups; prerequisite for such comparison is defining the characteristics of both groups.

Significance of Borrelia infection in development of dilated cardiomypathy (a pilot study).

A heart involvement known as Lyme carditis (LC), a consequence of Lyme borreliosis (LB), is relatively rare in contrast to the involvement of skin, joints and nervous system; it accounts for < 4% of all these patients in European countries. However, the diagnosis of the disease belongs to the most difficult challenges. While various forms of AV blocks dominate in the USA as confirmed by the literature, there is a clear predominance of arrhythmias of various incidence in the Czech Republic. The authors of this article focused on the form belonging to the rarest manifestations of LC, namely dilated cardiomyopathy (DCMP). The goal was to elucidate the etiological participation of Borrelia infection in the development of DCMP, which has attracted controversial opinions so far. In total, 33 patients with DCMP were enrolled in the study, 23 males and 10 females, with mean age 57.7 years (range 24-76 years). ELISA NRLB KC 90 method was used in all blood samples for detection of Borrelia infection (BI), Western blot method was used for confirmation, followed by identification of DNA of pathogenic Borreliae using PCR method. Bioptic material was examined by electronmicroscopy with an attempt to detect Spirochaetae in myocardium. 16 patients were excluded from the study owing to the absence of signs of LB. The study group included 17 patients (3 females, 13 males) with mean age 58 years (range 43-76 years), in whom the presence of Bb was proved by identification of DNA of pathogenic Borreliae or by electronmicroscopic detection of Spirochetae in myocardial bioptic sample. The findings obtained during the study confirmed that BI very probably participated in the development of dilated cardiomyopathy. It may be concluded that most of cases were either unapparent forms of LB or insufficiently treated cutaneous forms of this disease.

Lyme borreliosis infection as a cause of dilated cardiomyopathy.

The relatively low percent of patients affected with the cardiac form of Lyme borreliosis is difficult to diagnose, especially if the disease manifests itself in ways other than atrio-ventricular blockade. The advanced stage of Lyme carditis manifesting as dilated cardiomyopathy is a special case of this affliction. The authors of this report present clinical experience with an attempt to support the working hypothesis about involvement of Lyme borreliosis infection in the development of dilated cardiomyopathy. The patients were clinically examined thoroughly with special attention to the cardiovascular system. In addition to the basic clinical methods, the following procedures have been employed: dynamic Holter's electrocardiography, exercise ECG test, coronarography, and myocardial biopsy. From laboratory methods pertaining to the detection of Borrelia, ELISA method, Western blot, PCR, electron microscopy and histopathological analysis were used. In all three cases, clinical and laboratory findings provided the evidence of the borreliosis infection involvement in the development of dilated cardiomyopathy.

[Tako-tsubo cardiomyopathy--our experience and review of current knowledge]. / Tako-tsubo kardiomyopatie--nase zkusenosti a prehled aktuálních poznatku.

BACKGROUND: Tako-tsubo cardiomypathy is a relatively novel heart syndrome characterized by acute onset of reversible left ventricular apical ballooning, in the absence of significant epicardial artery stenosis that mimics acute coronary syndromes. The most common clinical presentations are chest pain and dyspnoea, frequently preceded by an episode of emotional or physiologic stress, ST-segment elevation or T wave changes in the precordial leads, minor cardiac biomarker release, and transient wall-motion abnormalities involving the left ventricular apex and mid-ventricle despite the absence of obstructive epicardial coronary artery disease. The syndrome more often affects postmenopausal women. The in-hospital course is uncomplicated; mortality rate seems to be low, as does the risk for recurrence. METHODS AND RESULTS: In this paper, we present case series of 6 consecutive patients admitted to our institution with acute onset of transient left ventricular apical ballooning in the absence of epicardial coronary artery involvement. CONCLUSIONS: Demographic characteristics, clinical features and course of disease were consistent with description of tako-tsubo cardiomyopathy.

Lyme borreliosis--waiting for Lyme carditis? A long-term prospective study.

A long-term prospective study of patients with confirmed non-cardiac form of Lyme disease (n=221) over a mean follow-up period of 40.6 months is reported. The study revealed no case of Borrelia-related cardiac involvement developed after several years in patients who had received antibiotic therapy in the early period. Therefore, these patients do not need follow-up by a cardiologist.

[Value of duplex ultrasound examination of the proximal part of the common carotid artery]. / Význam duplexní sonografie pro urcení poruch pruchodnosti proximálního úseku spolecné karotické tepny.

A significant part of patients with carotid artery stenosis is operated on without preoperative angiography, to reduce the risks and cost of such examination. Duplex ultrasound often cannot reliable visualise the proximal parts of the aortic arch vessels. We evaluated the ability of duplex ultrasound to identify those types of lesions and ascertain their prevalence. We analysed retrospectively carotid duplex scans and carotid angiography in 448 carotid arteries. 17 significant proximal lesions (3.89%) were identified on the duplex scan and confirmed by angiography. Lesions of the proximal parts of the aortic arch vessels are rare and may be reliably detected by duplex ultrasound.

[Cardiac abnormalities of lyme borreliosis]. / Postizení srdce v prubehu lymeské borreliózy.

The article summarizes basic characteristics of Lyme borreliosis, its incidence, epidemiology, pathogenesis and clinical image. Particular attention is given to the review of papers aimed at the cardiac abnormalities--the Lyme carditis. Though they are not very frequent, due to the variability of their clinical course and due to various forms, which are difficult to diagnose, they can represent a specific problem. Major part of the article is given to the authors' own experience with the dilated cardiomyopathy of the Borrelia origin and namely to the perspective study of the patients after the skin form of the disease erythema migrans, who were treated "lege artis" in the early phase of the disease with antibiotics. Authors were interested how many of those patients would develop later the cardiac abnormalities.

[Mobile thrombus at the origin of the internal carotid artery]. / Mobilní trombus v odstupu vnitrní karotické tepny.

Stroke is the third leading cause of death in many countries worldwide. The vast majority of acute strokes is ischaemic, caused often by embolisation from the large arteries of the head and neck, less frequently by cardiogenic embolisation. A case report of a patient with mobile thrombus at the origin of the internal carotid artery diagnosed by duplex sonography is presented. The patient refused surgery, two days later a recurrent severe stroke occurred caused by embolisation of the found thrombus.

[Multiple extrarenal complications in Wegener granulomatosis]. / Mnohocetné extrarenální komplikace Wegenerovy granulomatózy.

This is a case report of a patient with Wegener's granulomatosis (WG), who initially presented with a corneal perforation. In addition to the eye involvement, the pauciimmune necrotizing glomerulonephritis with crescent formation, E.N.T. and pulmonary involvement were diagnosed. The patient also suffered from the acute myocardial infarction, most likely due to coronal arteritis. In addition to the coronal ischaemia she also had vasculitis of the aortic valve due to the WG. Another rare complication was the massive intestinal bleeding. The patient had also a skin vasculitis and non-specific symptoms such as artralgias and fever. The correct diagnosis was supported by positive cANCA. A clinical and laboratory remission of the disease was achieved by combined immunosuppressive therapy. Subsequently, she developed a subglotic stenosis possibly due to reparative changes.

Borrelia infection as a cause of carditis (a long-term study).

BACKGROUND: Although the frequency of Lyme carditis is not high, it is one of the most challenging conditions in terms of diagnosis. No long-term studies that would help expand our body of knowledge concerning the circumstances of its development and the natural course of this form of Lyme borreliosis (LB), the most widespread anthropozoonosis in Central Europe, have been reported to date. AIM: The authors sought to describe and assess the consequences of a less common form of Lyme carditis (LC). An assessment of the following aspects was made: a) the forms, natural history and sequelae of the less common clinical appearances of LC, b) the role of antibiotic therapy with reference to the late manifestations of LB. METHODS: Three patients were selected from a group of 60 consecutive patients with demonstrated LC during a follow-up period from 1987 to 2000. Patient no. 1 was being followed for myocarditis with frequent ventricular extrasystoles, patient no. 2 for pericarditis, and patient no. 3 for dilated cardiomyopathy as a late manifestation of LB. In addition to routine examination at entry, the patients were subjected to a standard 12-lead ECG, continuous 24-hour Holter ECG monitoring, exercise testing (bicycle ergometry), investigations of antibodies using ELISA and Western blot, investigation of thyroid (T3, T4, TSH tests) and mineral levels. RESULTS: The study showed no significant correlation between the clinical course and levels of specific antibodies. It confirmed the concept that inadequate or no therapy with antibiotics in the initial stage of the disease has a significant effect on the development of late sequelae. CONCLUSION: Based on the long-term treatment of three patients with less common, yet clinically urgent findings, the authors conclude that even a relatively serious clinical course is associated with no major limitations for affected individuals after an interval of several years.

Borrelia burgdorferi as a cause of Morgagni-Adams-Stokes syndrome. Long time follow-up study.

According the literature atrio-ventricular blockade (AVB) is the most frequent and well-known symptom of Lyme carditis. Typical signs of complete AVB include fatigue, lethargy and syncope- Morgagni-Adams-Stokes syndrome (MAS). The authors present their results and experience with 5 patients selected from a long-term study (conducted between 1987 and 1998) comprising 58 patients who developed MAS. The authors tried to evaluate the changes especially in the cardiovascular system. They correlated the clinical state with ECG findings, as well as with the levels of the Borrelia burgdorferi antibodies. The following results were obtained: 1) all patients had typical syncope, 2) the clinical course was not complicated (except one patient who developed ventricular fibrillation), 3) two patients had frequent symptomatic and asymptomatic arrhythmia including chest pain and episodic rest dyspnea, 4) subjective difficulties (usually palpitations) correlated with ECG findings (Lown 3a, 3b). The authors also looked for any relationship between clinical difficulties and levels of antibodies. The results obtained with an early permanent pacemaker were less favourable than those reported in the literature. Despite early treatment 2 patients had repeated palpitations and ECG correlates during the next years.

[Structure and dynamics of electrocardiographic changes in patients with Lyme carditis (pilot study)]. / Struktura a dynamika elektrokardiografických zmen u nemocných s lymeskou karditidou. (Pilotní studie).

A maximum of 10% of the patients suffering from Lyme borreliosis suffer from cardiac damage. This affection is usually the source of diagnostic doubts, mainly because of the significant variability of clinical manifestations, the objectivization of which is difficult. Great variability is pathognomic also for electrocardiograms. For a three-month period 7 patients aged 43 years (29-53) were followed up under conditions of ambulatory ECG monitoring, i.e. using Holter s dynamic electrocardiography (HM) and ECG transmission by telephone (TTM). The focus of interest and objective of this pilot study was evaluation of the structure and dynamics of ECG changes, in particular from the aspect of types and frequencies of ectopic activity of the atria and ventricles and the ECG correlate of symptomatic events. Findings pertaining to the incidence of symptomatic (total 67) as well as asymptomatic events (total 25) are valuable. Systematic ECG checks of patients with Lyme carditis revealed a relatively large number of cases of impaired rhythm with a completely asymptomatic course.

[Borrelia burgdorferi as a cause of sick sinus syndrome?]. / Borrelia burgdorferi jako prícina sick sinus syndromu?

The authors describe the case of a 42 years old man, who was implanted a permanent pacemaker on the basis of the sick sinus syndrome, suspected to have been induced by the infection with Borrelia burgdorferi. The review of world literature has indicated that it is an exceptional indication of permanent cardiac stimulation.

[Thromboembolic complications in nephrotic syndrome]. / Tromboembolické komplikace nefrotického syndromu.

Thromboembolic complications of nephrotic syndrome are very frequent. They can occur in the arterial or venous circulation. Venous thromboses are frequently asymptomatic and are manifested only by pulmonary embolism. Thrombosis of the renal vein may be dramatic and include renal failure. For the diagnosis various isotope, X-ray and ultrasound methods are used. Anticoagulation or thrombolytic treatment is used; in some instances also thrombectomy may be used. In patients with albumin levels lower than 20-25 g/l prophylactic administration of acetylsalicylic acid is useful. The clinical picture and therapeutic procedure are demonstrated on three brief case-histories.

[Transmission of the electrocardiogram via telephone. Analysis of 10 years' experience]. / Prenos electrokardiogramu pomocí telefonu. Rozbor desetiletých zkuseností.

BACKGROUND: The problem of impaired cardiac rhythm is in recent years in the foreground of the interest of cardiologists. This was influenced not only by the conclusions of the CAST study which changed the therapeutic pattern used for some years but above all the diagnostic pitfalls of impaired rhythm as regards detection and identification. The objective of the present study was to provide evidence of the advantages and usefulness of the method of telephone transmission of the electrocardiogram within the complex of other diagnostic procedures. METHODS AND RESULTS: The group was formed by 251 patients, incl. 186 men and 65 women, average age 51.7 years (range 19-85 years). The transmission of the ECG by phone was implemented by the system TESLAR (VUIS-CVUT) which comprises recording units and a terminal with a graphic outlet. A total of 3,727 electrocardiographic tracings were assembled. During their analysis the arithmetic mean was used as the characteristic of the position of the group or groups on the scale, the error of the mean expressing the ratio of the standard deviation to the number of cases. In nominal variables most frequently percentage expression was used, frequently with a confidence interval obtained from tables. Evidence of the usefulness of the method is the high rate of detected arrhythmias within emergency calls (88.5%), as compared with normal calls (10.6%) where the yield is close to that of Holter monitoring, however, with the advantage of time ad libitum and thus also a higher yield. CONCLUSIONS: The presentation of long-term experience with electrocardiograms by telephone confirms unequivocally the assumption that the method extends existing diagnostic possibilities in short-term, symptomatic, but sporadic arrhythmias, that it makes possible dispensarization of risk patients as well as patients with permanent pacemakers and that it improves the tactics of antiarrhythmic treatment.

[Lyme carditis]. / Lymeská karditida.

The authors present in the submitted paper the basic characteristics of Lyme carditis as one of the forms of Lyme borreliosis. They mention briefly the clinical symptoms, diagnostic possibilities and causal and symptomatic therapeutic procedures. In the second part they present conclusions which they obtained by comparison of data in the literature and their own experience with dispensary care of 50 patients during several years. In the conclusion they emphasize the great interindividual variability of the clinical picture not only in the acute stage of the disease but also for years after treatment.

A thrombus in the right pulmonary artery and its follow-up using transoesophageal echocardiography.

Using transoesophageal echocardiography, the authors documented development of a right pulmonary artery thrombus in a patient with pulmonary hypertension due to chronic obstructive lung disease. This case confirms the potential of transoesophageal echocardiography in diagnosing pulmonary artery diseases.

[Arrhythmia as a major manifestation of Lyme borreliosis]. / Arytmie jako vedoucí projev lymeské borreliózy.

The submitted case-history is focused on one of the leading manifestations of cardiac affection in Lyme borreliosis. The authors recapitulate and analyze the patient's complaints, her electrocardiographic and other findings and confront them with data from the literature on this "new" nosological unit.

[Initial experience with modification of dosage of anti-arrhythmic agents using telephone transmission of the electrocardiogram]. / Nase první zkusenosti s úpravou dávky antiarytmika pomocí prenosu elektrokardiogramu po telefonu.

Despite the doubtless advances in the knowledge of cardiac electrophysiology, the mechanism of action of antiarrhythmia and the considerable clinical experience with these drugs, treatment of arrhythmia remains on a trial error basis. The authors tried to use the system serving the transmission of one lead electrocardiograms by telephone as a means of checking and correcting antiarrhythmia treatment. It is a method which despite its unpretentious character and reliability is used on a very limited scale. As compared with other contemporary means of the control of the effect of antiarrhythmia treatment, i.e. above all Holter's method or investigation of plasma levels of antiarrhythmia drugs, it is less time consuming and cheaper. The preliminary results of the authors, based on initial experience, are encouraging.