[Molecular genetics of myocardial infarction]. / Molekulární genetika infarktu myokardu.

The incidence of atherosclerosis is very high and the typical risk factors such as lipids, blood pressure, smoking, dietary habits and lifestyle in general have an 80% share in its development. Heredity also has a significant share and genome-related information has been given growing attention in recent years. A number of links between polymorphisms found at certain gene positions and the probability of acute myocardial infarction at a young age have been currently described. Cross-sectional studies have been focused on the identification of particular genotypes and alleles which can be responsible for early development of atherosclerosis and acute myocardial infarction. The article summarises some of the knowledge acquired so far in the field of genetic makeup of patients with acute myocardial infarction.

Lack of association of angiotensin-converting enzyme and angiotensinogen genes polymorphisms with left ventricular structure in young normotensive men.

Left ventricular (LV) hypertrophy is a strong predictive factor for cardiovascular morbidity and mortality. LV structure and function are influenced by many variables, including genetic background. The potential role of gene polymorphisms of different components of the renin angiotensin system remains controversial. The aim of this study was to determine the influence of deletion/insertion (D/I) polymorphism of the angiotensin-converting enzyme (ACE) gene and M235-->T polymorphism of the angiotensinogen (AG) gene on left ventricular morphology and function in young normotensive men. The study included 110 normotensive healthy males (mean age 24 +/- 4 years, age range 18 to 34 years) who were assessed by echocardiography for LV structure and function. In all subjects ACE D/I polymorphism was evaluated using a polymerase chain reaction (PCR) method. M235-->T polymorphism assessment was available in 98 individuals. Significant differences between groups according to ACE I/D or AG M235-->T polymorphisms were not found for parameters of LV morphology or for parameters of systolic and diastolic function. When subjects with DD or ID genotypes were grouped, their LV mass index was higher than that in subjects with II genotypes (86 +/- 14 vs 79 +/- 15, r = 0.033, p = 0.05). There were no significant differences among other variables. In a population of young normotensive men where the influence of confounding variables such as age, gender and associated pathological conditions is minimized, the gene polymorphisms of ACE I/D and AG M235-->T are not important determinants of LV structure and function.

[Use of highly hydrated contact lenses for therapeutic purposes]. / Vyuzití vysoce hydratovaných kontaktních cocek k terapeutickým úcelum.

The paper deals with the therapeutic use of contact lenses made from a new highly hydrated material developed in the Institute of Macromolecular Chemistry in Prague. Contact lenses made from a meshed copolymer of n-vinyl pyrrolidone with acetoxyethyl meta-acrylate were applied to a group of 83 patients--a total of 87 eyes. A favourable therapeutic effect was achieved in all groups of patients--in simple traumatic erosions, superficial keratopathies, relapsing erosions, bullous keratopathies, corrosion of cornea, for mechanical protection of epithelization and in persisting ulcerations. In 71 eyes (82%) the contact lens was removed after the therapeutic effect was achieved, in 4 (5%) treatment still proceeds. In the remaining patients treatment was discontinued on account of complications, persistence of the pathological finding and frequent losses of contact lenses. In the group there was no case of complicating keratoconjunctivitis. Progressing vascularization was detected in three cases in the group with persisting ulcerations. The authors did not observe development of corneal vascularization in conjunction with application of the lens. Transient corneal oedema was revealed in the group of relapsing erosions in 6 (40%) patients and in the group of persisting superficial keratopathies in 4 (31%). The rare occurrence of inflammatory complications can be explained by the sterile application of contact lenses for the necessary length of time, the local administration of antibiotics while the defect persisted and frequent check-up examinations. Contact lenses made from the described material proved useful for therapeutic application.

[Phacoemulsification. The method of choice in cataract surgery]. / Fakoemulzifikace. Metoda volby v chirurgii katarakty.

Complications and problems in the first 300 patients operated on by phacoemulsification technique are described. In the first 100 cases the procedure began with the creation of the corneoscleral incision and the anterior capsule was opened in a "can opener" fashion. In the second group of 200 patients we preferred the scleral incision, and the anterior capsule was opened mainly by capsulorhexis. The phacoemulsification was predominantly performed in the capsular bag or in the iris plane. The wound was closed with interrupted sutures. The most common and the most serious complication as well in the first 100 cases was posterior capsule rupture (11%). Then the percentage of this most common complication was diminished significantly with increasing experience of the surgeon (2.5% in 200 cases). The same problems which the authors had in their first operations appeared again, though in a smaller amount as soon as they started to work with phacoemulsification as a method of choice of cataract surgery.

[Decentration of posterior chamber intraocular lenses]. / Decentrace zadnekomorových nitroocních cocek.

In a group of 300 patients with a posterior chamber lens in 19% its decentration was found, in 2.3% the iris capture syndrome. The author discusses possible causes of decentration of the implanted lens, possibilities of its therapy.

[Inflammatory intraocular complications after placement of retropupillary lenses]. / Zánetlivé nitroocní komplikace po aplikaci zadnekomorových cocek.

In 194 patients aged 32-81 years 200 retropupillary lenses were administered. 129 lenses were implanted into the sulcus ciliaris, 71 lenses into the lenticular capsule. The surgical technique was the same in both groups. The authors divide inflammatory postoperative complications they encountered into two major groups: cellular reactions on the anterior surface of the lens and fibrinoid reactions with the formation of membranes or synechiae. The authors discuss possible reasons for the development of these complications and possibilities of therapy.

Survival rate and causes of death in patients with pacemakers: dependence on symptoms leading to pacemaker implantation.

The survival rate of 2256 patients with pacemakers was analyzed. Patients paced for Adams-Stokes equivalents (e.g. dizziness) showed a significantly better survival rate than did patients with pacemakers implanted for Adam-Stokes attacks or heart failure (P less than 0.0001). The estimated survival of the latter two groups did not differ significantly. Of the deceased patients who had received a pacemaker for the treatment of heart failure, 54% died due to this condition despite pacemaker implantation. The relative percentage of cases of sudden death after pacemaker implantation was high in the groups with Adams-Stokes attacks (12%) and Adams-Stokes equivalents (13%). In patients paced for Adams-Stokes attacks, sudden death occurred more frequently in the first year after pacemaker implantation (P less than 0.015) than during the following years. Therefore, increased efforts should be made to monitor patients carefully after pacemaker implantation to enable prompt detection of malignant tachyarrhythmias, probably the cause of sudden death in a substantial number of patients with pacemakers.

The effectiveness of biofeedback-assisted relaxation in modifying sickle cell crises.

Eight outpatients with sickle cell disease received six EMG and six thermal half-hour biofeedback training sessions. Statistically significant changes in the desired directions were obtained for the following variables: (a) frontalis muscle tension, (b) digital temperature, (c) frequency of headache as a crisis symptom, (d) frequency of analgesic use, (e) perceived pain intensity, (f) frequency of self-treated crises, and (g) state anxiety. Nonsignificant changes in hospital chart data were found. A 6-month posttreatment follow-up questionnaire revealed the continued effectiveness of the training received regarding headaches and mild pains.

Attention and autonomic self-regulation.

To examine how various aspects of attentional functioning are affected by autonomic self-regulation procedures, this study compared the effect of two treatment programs (EMG and thermal biofeedback used in conjunction with various somatic and cognitive relaxation/self-regulation strategies, and Benson's Relaxation Response procedure) and a Waiting List control group for essential hypertensive adults on three, perhaps overlapping, attentional dimensions: the capacity to disembed figure from ground (Embedded Figures Test, Block Design, and Picture Completion WAIS subtests); the capacity to voluntarily deploy attention (Digit Span subtest of the WAIS), and capacity to sustain attention or become absorbed (as measured by the Tellegen Absorption Scale). Thirty essential hypertensive men and women were randomly placed in one of the three groups. Attentional dimensions were assessed before and after the 10-week treatment program (or waiting period) and the relationship between blood pressure and attentional changes were assessed. The only group to evidence significant blood pressure reduction, the "Biofeedback Group," became significantly more Field Independent as measured by the EFT (p less than 0.001) and the Block Design measure (p less than 0.01) and evidenced a strong trend in the same direction on the Picture Completion measure (p less than 0.052, NS). No other significant pre-post attentional changes were found. A Pearson product correlation revealed that changes in diastolic blood pressure were significantly correlated with changes in EFT (r = 0.54, p less than 0.0001) and the Picture Completion measure (r = 0.32, p less than 0.05). The cognitive effect of autonomic self-regulation is discussed. In addition, the possible role of attention in autonomic self-regulation is examined.