[Analysis of present diagnostic methods of intrapartum fetal hypoxia]. / Analýza soucasných diagnostických metod intrapartální hypoxie plodu.

OBJECTIVE: To evaluate specificity of present diagnostic methods of intrapartal fetal hypoxia (cardiotocography--CTG, fetal pulse oxymetry--FpO2, ST-ECG analysis). DESIGN: A prospective study. SETTING: Gynecology-Obstetrics Clinic, 1st Medical Faculty and General Faculty Hospital in Prague. METHODS: The results of synchronic fetus monitoring by means of CTG, FpO2 and STAN-ST 21 were followed in 53 mothers with a risk and pathological delivering of birth in the period of April 2003 to March 2004. The study investigated, which of the methods provided the best prediction of the intrapartal fetal hypoxia. The statistical evaluation (p-mark test and Mc Namara test) was based on the assessment of correct or incorrect prediction of the Apgar score values in the first minute after birth, pH in umbilical artery and the lactate level. We also investigated results of three methods during postpartum depression, turbid or mushy amniotic fluid and the way the individual methods were made useful in indication for ending the delivery. RESULTS: In comparison with CTG there was a statistically significantly higher specificity in FpO2 and STAN in the evaluation of Apgar score in the newborn in the first minute after birth, FpO2 (p=0.007) and STAN-ST (p<0.001), in the determination of pH (a) from umbilical blood FpO2 (p=0.029) and STAN (p=0.001) and the occurrence of postpartum depression of the newborn in minute 30-60 after birth FpO2 (p=0.019) and STAN (p=0.0005). The changes in lactate level in umbilical blood were better predicated by STAN (p=0.001). FpO2 evaluated the changes in the same way as CTG. The threatening hypoxia in strongly turbid or even mushy amniotic fluid was correctly evaluated by STAN only (p=0.002). The FpO2 evaluation was not statistically significant. There was not any statistically significant difference in the indication of operation for ending the delivery among the individual methods. CONCLUSIONS: The results univocally demonstrated that the used of other method for diagnosis on intrapartal fetus hypoxia--Fetal pulse oxymetry and ST--analysis of ECG of the fetus give more precision to the diagnosis. The introduction of these methods requires a correct interpretation and the effort of the obstetrician to use these methods in clinical practice.

Does a relationship exist between ioduria, magnesiuria and calciuria?

We investigated the mutual relations between ioduria in the one hand, and calciuria, magnesiuria, and creatininuria, on the other hand in a randomly selected group of the population of the Czech Republic. The individual parameters were always determined in the sample of monitoring urine after night fasting, concentration according to the WHO/ICCIDD, we observed a parallel increase of calciuria, magnesiuria and creatininuria. The values of calciuria, magnesiuria and creatininuria correlated positively with ioduria both in children and in adults aged 6-93 years without any statistical effect of sex.

Status of magnesium, selenium and iodine saturation in the population of seven regions in the Czech Republic.

In seven regions of the Czech Republic the magnesiuria and calciuria were determined photometrically using the apparatus Merck Vitalab Eclipse, the selenuria fluorimetrically and the ioduria photometrically after alkaline mineralization in the morning sample of urine (after night fasting) in subjects aged 6-65 years (3,587 probands) selected at random. The lowest magnesiuria was found in children in Klatovy district (5.36 nmol/l +/- 0.11) and the highest magnesiuria was estimated in children from the Ustí nad Labem district (6.59 mmol/l +/- 0.16). In adults the lowest magnesiuria was in Vsetín region (3.78 mmol/l +/- 0.08). Selenuria was lowest in Jindrichüv Hradec (7.60 micrograms/l +/- 0.30) and highest in the Vsetín district (15.07 micrograms/l +/- 0.50). Adults had the lowest selenuria in the region Jindrichüv Hradec (7.67 micrograms/l +/- 0.30) and the highest in Ustí nad Orlicí (11.68 micrograms/l +/- 0.34). The lowest ioduria was estimated in children from Ustí nad Labem (94.30 micrograms/l +/- 2.06) and the highest in the Vsetín region (151.60 micrograms/l +/- 7.55). Adults from the district Jindrichüv Hradec had ioduria merely (77.7 micrograms/l +/- 2.18) and the highest ioduria was found in probands from the Znojmo region (123.30 micrograms/l +/- 4.47). As far as the dependence on age is concerned, the magnesiuria significantly decreases both in children and in adults with the increasing age. Selenuria decreases in adults significantly with growing age. Sex-related differences were estimated in children aged 6 years where girls had significantly lower selenuria than boys and girls aged 13 years had lower ioduria, magnesiuria and selenuria than boys. Women aged 18-35 years had significantly lower ioduria, calciuria and magnesiuria in comparison with men of the same age. Women have a significantly lower ioduria in comparison with men at the age 56-65 years.

[Ultrasound densitometry of the heel bone in a random sample of the adult Czech population]. / Ultrazvuková denzitometrie patní kosti (CUBA) u náhodne vybraného vzorku dospelé ceské populace.

To assess the state of the skeleton of 870 subjects selected at random the authors used ultrasound densitometry of the talus. The assessment was made using a Cuba Clinical apparatus (McCue Ultrasonic Ltd.UK). The assessed parameters were BUA in db/MHz (broad band ultrasound attenuation) and VOS in m/s (velocity of sound). From the results it is apparent that the BUA values in men reach their peak at the age of 31-35 years. In women the BUA values are highest between 18 and 20 years, then follows a decline and again a rise between 41 and 45 years. The VOS values in men are highest between 18 and 20 years, followed by a drop and slight increase between 56 and 60 years. In women the VOS values reach their maximum between 18 and 20 years. The assessed values obtained in a random sample of the population from three regions are the basis for evaluation of bone densitometry obtained by means of questionnaire in the adult Czech population.

Calciuria, magnesiuria and creatininuria--relation to age.

We assessed the concentration of calcium, magnesium and creatinine in 2715 samples of the first morning urine. The investigation comprised the following age groups: children one, two, four, six, ten and thirteen years old, and groups of adults aged 18-35, 36-49, 50-65, 66-75, 76-85 and 86-93 years. The choice was made by random selection of participants of both sexes from diverse regions of the Czech Republic. We found the age to have a marked influence on the value of calcium, magnesium and creatinine, including urinary concentration ratios of calcium/creatinine and magnesium/creatinine. The urinary calcium concentration was low both in the early and advanced age groups, while it reached peak values in subjects 18-35 years old. The urinary magnesium concentration was also age-dependent, with a maximum in children aged 4 years, and a subsequent decline with advancing age. The value of the ratio urinary calcium/creatinine and urinary magnesium/creatinine was highest in the youngest age group (1-4 years).

[The effect of age on levels of magnesium and creatinine in the urine]. / Vliv veku na koncentraci horcíku a kreatininu v moci.

BACKGROUND: The concentration of magnesium in urine reflects its intake from food resources. The main regulatory mechanism of magnesium homeostasis is the kidney filtration-absorption process. So far the reference values are not known of the magnesium concentration in urine in dependence on age and sex for the normal population. Therefore, we focused on investigating these problems in a randomly selected sample of persons of both sexes, aged 1-93 years. Beside magnesiuria we also assessed creatininuria. METHODS AND RESULTS: The selection of 2715 persons of both sexes aged from one to ninety three years was made by the random selection method. As we have found no statistically significant difference between men and women as regards concentrations of magnesium and creatinine in urine, the evaluated groups include persons of both sexes. The whole is divided into age groups as follows: children 1 year (n = 24), 2 years (n = 15), 4 years (n = 18), 6 years (n = 378), 10 years (n = 424), 13 years (n = 416), and adults 18-35 years (n = 396), 36-49 years (n = 482), 50-65 years (n = 453), 66-75 years (n = 53), 76-85 years (n = 42), 86-93 years (n = 14). In the morning urine after twelve-hour fasting we determined the concentration of magnesium and creatinine be using Merck Vitalab Eclipse apparatus. The concentration of magnesium in urine rises from 3.37 +/- 0.28 mmol/l at 1 years to the top value 6.64 +/- 0.58 mmol/l (p < 0.001) at 4 years, and since this age it is continuously dwindling to the value 2.35 +/- 0.17 mmol/l (p < 0.001) at the age of 93 years. The creatinine concentration in urine rises from 2.47 +/- 0.30 mmol/l at the age of one year to 15.33 +/- 0.36 mmol/l (p < 0.001) in the age group 18-35 years, and further it goes down with age to the value 6.23 +/- 0.99 mmol/l (p < 0.001) at 93 years. The highest ratio of the urine concentrations of magnesium and creatinine 1.98 +/- 0.32 is at the age of 2 years, and then it is continuously subsiding to 0.41 +/- 0.15 (p < 0.001) at the age range 66-75 years. CONCLUSIONS: When evaluating the magnesium concentration in urine as the index of a sufficient supply of organism with this ion, and also in various studies of metabolism, it is essential to consider the patient's age. The ratio of cocentrations in urine of magnesium and creatinine does not improve the meaningfulness of magnesium analysis.

[Changes in urinary calcium and magnesium levels during supplementation with iodine and selenium]. / Zmeny koncentrace vápníku a horcíku v moci pri suplementaci jódem a selenem.

The authors examined 31 children aged 10-13 years before and after 5-month administration of 100 micrograms iodine (as iodide 100 Merck) and 57 university students (age 18-23 years) divided into four groups. The control group of 15 students received placebo daily, 20 students took selenium (50 micrograms selenium Merck), 8 students iodine (100 micrograms iodide) and 14 students a combination of equal amounts of both elements. The authors investigated the calciuria, mangesiuria and calcium/creatinine ratio and magnesium/creatinine ratio. They found a significant drop of magnesiuria in school children after iodine intake, and in university students there was a significant drop of the magnesium/creatinine ratio in iodine and selenium treated groups as well as those who received a combination of both elements. In the latter group there was also a significant drop of the urinary calcium/creatinine ratio. The findings assembled in a relatively small group of children and students is considered preliminary. It suggests, however, the possible influence of supplementation with iodine and selenium in commonly used amounts on calcium and magnesium excretion. Changes in the control group may be due to seasonal influences.

[The effect of insufficient iodine intake on the size and function of the thyroid gland]. / Vliv nedostatecného prívodu jódu na velikost a funkci stítné zlázy.

BACKGROUND: The supply of iodine indisputably affects the function of the thyroid gland. It is not clear, however, as to what extent a moderate iodopenia affects common thyroid parameters. OBJECTIVES, STARTING POINT AND MAIN PURPOSE: The aim of the study is to evaluate the influence of iodopenia (ioduria below 50 micrograms of iodine per litre of urine) on the values of T4, T3, TSH, the ankle-jerk time and sonographically ascertained thyroid gland volume in randomly selected sample of Czech population from 4 regions. METHODS: Ioduria was assessed by means of Sandel-Kolthoff method, total thyroxine, triiodothyronine and thyreotropic hormone by immunoluminiscence method; the volume of the thyroid gland sonographically according to Gutekunst and the ankle-jerk reflex by electromagnetic record method. RESULTS: Iodopenia affects a majority of investigated parameters in dependence on age. T4 is significantly higher in iodopenic adults, T3 is significantly higher in iodopenic children, TSH is significantly higher in iodopenic adults and the ankle-jerk time is prolonged in iodopenic adults. The statistical significance of the effect of iodopenia on the volume of thyroid gland was not proved. CONCLUSION: Iodopenia of a mediate degree affects commonly used parameters of the thyroid gland function in dependence on age and other factors which are to be more precisely analyzed using a larger sample. The statistical significance of the effect of iodopenia on the volume of thyroid gland was not proved. (Tab. 1, Fig. 5, Ref. 13.).

Changes of calcemia and magnesemia during oral glucose tolerance test (OGTT) in relation to glucose tolerance.

We have examined 56 subjects with normal glucose tolerance (NGT), 33 with impaired glucose tolerance (IGT) and 15 diabetics type II (DM) by an oral glucose tolerance test with 75 g of glucose and in addition to glycemia and C-peptide we estimated also calcemia, magnesemia, ionized calcium level (plus corrected ionized calcium level) in all time intervals. The basal glycemia and C-peptide values were different in each examined group, while the magnesium values distinguished only the DM group from the others. The corrected Ca2+ in 60 min decreased significantly in DM, while after 120 min there were no differences in the values. Magnesemia in NGT decreased after 60 and 120 min, while by IGT and DM it rised in both such intervals. The difference between IGT and DM was highly significant. Our findings give evidence about the changes in the distribution of magnesium already at an early stage of decrease glucose tolerance. The importance of this finding for an early IGT diagnostics and its further classification still remains to be definitely evaluated.

[Comparison of basic somatometric characteristics in randomly selected populations from Prague and Vsetín]. / Porovnání základních somatometrických charakteristik u náhodne vybraných osob prazské a vsetínské oblasti.

In 1991-1992 in the Czech Republic an epidemiological survey was conducted focused on prevention of iodine deficiency and the incidence of some thyropathies. The authors examined samples of the Prague and Vsetín population selected at random. The clinical examination comprised also somatometric assessment. In a group of 1,100 subjects from Prague and Vsetín anthropometry of basic somatometric characteristics was performed (height, body weight, BMI and four skinfolds). From comparison of the two groups ensues that the Vsetín population is shorter, as compared with the Prague population, the BMI values are significantly higher and so is the percentage of subcutaneous body fat.

[Iodine status and incidence of thyropathies in the Czech population]. / Stav zásobení jodem a výskyt tyreopatií v nasí populaci.

Based on clinical experience on the rising incidence of some thyropathies in our population, the authors examined a random sample of the Prague population. They assessed and evaluated iodinuria, the sonographic finding of the thyroid gland, the palpation finding of the thyroid and a clinical examination which comprised a detailed case-history (a questionnaire checked during the examination) and a clinical and anthropometric examination. The results indicate that iodinuria (which reflects the iodine intake) reaches the recommended optimum (above 150 micrograms iodine/l) only in 11.4% of boys, 14% men, 6.3% girls and 5.4% women. A quite inadequate intake (less than 50 g iodine/l) was recorded in 13.2% boys, 15.2% men, 17% girls and 33.1% women. When evaluating the thyroid volume, an enlarged volume is found in 20.4-58.3% and on evaluation by palpation pathological changes are found in a considerable proportion of the examined population. The findings suggest that the iodine supply of the Prague population is inadequate and the incidence of abnormal findings on the thyroid gland is high. It will be necessary to verify these findings in other random population samples from other localities. If the adverse position will be confirmed, this will call for an urgent solution, i.e. a better iodine supply of the population.

[Diagnostic significance of osteocalcin levels in the classification of senile osteoporosis]. / Diagnostický význam hladiny osteokalcinu pri klasifikaci starecké osteoporózy.

The authors investigated the osteocalcin (BGP) serum level in 55 women with the senile type of osteoporosis. According to BGP values they divided the group into three sub-groups. Lower values were recorded in 27 subjects (50%), normal values comparable with a control group of 13 healthy women of equal age were recorded in 21 subjects (38%) and in a small sub-group of 7 women (12%) the BGP level was raised or high. Senile osteoporosis can be also heterogeneous, characterized by a reduced, normal but in some also an elevated metabolic turnover of bone. It is, however, possible that this is a question of different stages and at the time of examination the mentioned status was recorded. An opportunity to examine BGP levels would be a great asset for osteological departments, among others also for the classification of osteoporosis with regard to the rate of the metabolic turnover or remodelling activity and would provide doctors with valuable information for decision taking on rational therapy.

[The carbohydrate metabolism and stress hormone response during acute myocardial infarct in persons without diagnosed diabetes]. / Odezva sacharidového metabolismu a hormonu stresové odpovedi behem cerstvého srdecního infarktu u osob bez dosud prokázaného diabetu.

The authors examined 68 patients with a acute myocardial infarction without previously detected diabetes. They evaluated some indicators of the humoral stress response and the response of the carbohydrate metabolism during a recent infarction. They found very complicated interrelations between hormones of the stress reaction and indicators of the carbohydrate metabolism under conditions of circulatory stress. Despite this they detected some dominating trend and compared their findings with data from the literature.

[The value of the carbohydrate metabolism response for assessment of early prognosis in patients with acute myocardial infarct without previously detected diabetes]. / Význam reakce sacharidového metabolismu a humorální stresové odpovedi u osob s cerstvým srdecním infarktem bez dríve zjistené cukrovky, pro posouzení casné prognózy.

The authors examined 68 patients with a acute myocardial infarction without previously detected diabetes. They evaluated the importance of the relationship of the intensity of the stressor, humoral stress response and the response of the carbohydrate metabolism for the early prognosis of the infarction. Despite the complexity of these relations and heterogenity in the group of these patients, the authors confirmed the prognostic importance of hyperglycaemia, cortisolaemia and urinary catecholamine levels, and based on their own experience, they recommended to follow up these indicators during the first days after development of the infarction.

[The carbohydrate metabolism and stress hormone response in acute myocardial infarct--its importance in predicting permanent disorders of glucoregulation]. / Odezva sacharidového metabolismu a stresových hormonu behem cerstvého srdecního infarktu--význam pro predpoved trvalé poruchy glykoregulace.

The authors examined in a group of 68 patients with a acute myocardial infarction (without confirmed diabetes) some indicators of the humoral stress reaction and the response of indicators of the carbohydrate metabolism during circulatory stress. After three years they re-examined 48 of these patients with special attention to their carbohydrate metabolism. Based on the assembled results, the authors sought a relationship between findings during the acute circulatory stress and the level of the carbohydrate metabolism after three years. In future diabetics they found during the period of the acute infarction higher levels of immunoreactive insulin, a reduced IRI/blood sugar ratio and a higher excretion of urinary catecholamines. In the OGTT performed one week after the infarction they found a higher sum of C-peptide, a shift of the peak of IRI secretion and reduced IRI/blood sugar ratio. These finding could indicate the development of a permanently impaired glycoregulation and lang-term prognosis of these patients.

[Selected anthropometric findings in women with disorders of glucose tolerance with hypertension]. / Vybrané antropometrické nálezy u zen s porusenou glukózovou tolerancí a s hypertenzí.

In a group of 26 women with an impaired glucose tolerance anthropometric measurements of basic somatometric characteristics were made with special attention to the subcutaneous fat distribution and compared the findings with the healthy Czech population. Changes in body build, BMI, subcutaneous body fat distribution were evaluated and the causality of the relationship between blood pressure and gluteofemoral and abdominal obesity was investigated. From the author's observations ensues that in the group of women with impaired glucose tolerance overweight was recorded, as compared with the normal population, disproportions in the circumferences of the trunk and extremities, an excessive percentage of body fat, well developed muscles. In abdominal obesity a significant increase of the blood pressure and BMI was found.

[The effect of streptozotocin-induced diabetes treated with insulin on the metabolism of calcium, magnesium and phosphorus]. / Vliv streptozotocinového diabetu léceného inzulínem na metabolismus vápníku, horcíku a fosforu.

In a group of rats with streptozotocin induced diabetes the excretion of calcium, magnesium, phosphorus and creatinine in urine was investigated and the calcium, magnesium and phosphorus content of bone in relation to the duration of the disease. The authors observed that in diabetic rats the urinary losses of calcium, magnesium and phosphorus increase significantly. The creatinine excretion is also significant but lower in relation to calciuria and therefore the value of Nordin's index in diabetic rats rises markedly. Bone of diabetic rats in the early stage of diabetes (32 days) loses magnesium, while the calcium and phosphorus content does not change significantly. During longer persistence of severe diabetes (70 days) a significant drop of all three minerals in bone was observed. The bones of diabetic animals on the 70th experimental day were macroscopically smaller and were very fragile. The authors' findings suggest a marked influence of streptozotocin diabetes on calcium phosphate metabolism and bone metabolism, in particular on account of STZ diabetes, on an early drop of magnesium in bone. The possible impact of this finding for clinical practice will have to be tested further.

[Changes in magnesium and ionized calcium serum levels in disorders of glucose tolerance]. / Zmeny sérové hladiny horcíku a ionizovaného vápníku pri poruchách glukózové tolerance.

In a group of 58 subjects with a strictly defined glucose tolerance (38 normal--nGT, 10 impaired glucose tolerance--pGT, 10 type II diabetics treated by diet) the authors investigated the mutual relationship between changes in the blood sugar level and insulin serum level in relation changes of calcium, ionized calcium, magnesium and total proteins. In addition to expected differences in the native blood sugar level and insulinaemia, the authors found in pGT group in reduction of ionized calcium and magnesium on fasting. In the course of the oGTT in pGT group there is a rise of ionized calcium and magnesium and thus the changes, as compared with the initial value, differ significantly from changes in subjects with a normal glucose tolerance and in type II diabetics. The differences in the pattern total calcium are less marked, the changes of total protein did not differ. Evaluation of correlations revealed a only significant relationship between the change of ionized calcium and blood sugar level after 120 mins, in DM II. The findings suggest a different calcium and magnesium metabolism after a glucose load in subjects with an impaired glucose tolerance. It is not clear whether a cause of the disorder is involved or a possible compensatory mechanism. The clinical impact will have to be examined.

[Cardiac function and adrenergic regulation in incipient hyperthyroidism]. / Srdecní cinnost a adrenergní regulace u pocínající hypertyreózy.

The authors investigated in 14 euthyroid women the action of triiodothyronine administered for 7 days, 100 micrograms per day. It was revealed that after the administration of triiodothyronine the duration of the preejection period of the systole was reduced as well as the index of the preejection period and the index of the electromechanical systole, and the weight declined. At the same time the authors recorded a drop of the plasma noradrenaline and adrenaline level, of the serum cholesterol and thyroxine concentration. The serum triiodothyronine level increased and correlated inversely with the duration of the preejection period. Triiodothyronine administration had no effect on the heart rate, Q-Kd interval, blood pressure and plasma concentration of cyclic adenosine monophosphate. The authors conclude from the findings that in triiodothyronine-induced hyperthyroidism the first cardiac effect of the administered hormone is enhanced contractility of the heart, this change being due to the direct effect of triiodothyronine not mediated by catecholamines.