[Exercise cardiorespiratory parameters in children motivated to physical activity after treatment for acute lymphoblastic leukemia]. / Zátezové kardiorespiracní parametry u detí motivovaných k pohybové aktivite po prelécené akutní lymfoblastické leukémii.

BACKGROUND: Children treated for acute lymphoblastic leukemia (ALL) with anthracycline antibiotic agents must be followed up for the danger of late cardiotoxic effects of the treatment. Another threat represents the consequence of the protective upbringing and inactive lifestyle. The aim of present study was to assess the exercise cardiorespiratory indexes and anthropometric variables in previously treated children without clinical, ECG and echocardiographic signs of cardiotoxicity, who had been motivated to physical activity. METHODS AND RESULTS: 29 children (12.3 +/- 2.7 years old) previously treated for ALL with anthracyclines were examined. The cumulative dosis of anthracyclines was 224 +/- 39.4 mg/m2. The treatment was finished before 4.8 +/- 2.1 years and after this period no signs of the late cardiotoxicity were detectable. Both children and their parents were encouraged to the regular physical activity of submaximal intensity. 29 age- and sex-matched control subjects were healthy children, never limited in their activities, but without special physical training. As soon as the basic anthropometric data had been verified, both groups completed a progressive exercise test with the assessment of submaximal and maximal spiroergometric indexes. In all parameters followed we failed to prove any significant differences between the two groups. The treated children exhibited only slightly lower body height, higher body weight and higher percentage of body fat. They reached lower respiratory exchange ratio (R), with higher oxygen uptake on both submaximal and maximal load levels. CONCLUSIONS: When sufficiently motivated, children surviving five years after the treatment with anthracycline for ALL, who have no signs of cardiotoxic effects, have their functional cardiorespiratory capacity approximately comparable to that of healthy children.

[Magnesium balance in patients with spasmophilia. Relation to results of electromyography]. / Magneziová bilance u nemocných se spazmofilií. Vztah k výsledkum elektromyografie.

BACKGROUND: The pathophysiological basis of spasmophilia is frequently magnesium deficiency and the therapeutic administration of magnesium salts has usually a favourable effect. However the parameters of magnesium balance are not always consistent with the results of electromyography. The objective of the present work was to test and interpret the relationship of results of these two basic diagnostic procedures indicated when spasmophilia is suspected. METHODS AND RESULTS: Thirty-three subjects (9 men and 24 women) with suspected spasmophilia were examined by non-invasive electromyography, using the technique of surface electrodes. All subjects had concurrently biochemical examinations: serum calcium and ionized calcium, serum magnesium (S-mg), magnesium in erythrocytes (ery-Mg) and magnesium in the blood haemolysate (H-Mg). In 29 patients and oral magnesium loading test was made with evaluation of the urinary Mg excretion after a constant Mg load (U-Mg). Statistical evaluation of the investigated parameters of the magnesium balance revealed a highly significant relationship between ery-Mg and U-Mg and H-Mg and ery-Mg (p < 0.005). A less close relationship was found between H-Mg and S-Mg (p < 0.05). Total and ionized calcium was in all examined subjects within the range of the arbitrary normal range. The EMG finding was positive (the finding of two and more multiplets in the ischaemic and hyperventilation test resp.) in 30 instances, i.e. in 91% of the examined subjects. In 72% there was agreement of the positivity of the EMG and magnesium deficiency (i.e. reduced values of ery-Mg and U-Mg), positivity of EMG combined with normal parameters of the Mg balance was recorded in 18%. In 6.1% of the examined subjects magnesium deficiency was confirmed combined with a normal EMG finding. CONCLUSIONS: Concurrent positivity of EMG and magnesium deficiency in 72% justifies the therapeutic administration of magnesium. In patients with a normal magnesium deficiency and positive EMG another cause of spasmophilia must be taken into consideration, incl. technical errors of interpretation of EMG results. A negative EMG associated with magnesium deficiency can suggest the central form of tetany, where magnesium treatment is also unequivocally indicated.

[The oral magnesium loading test for detecting possible magnesium deficiency]. / Perorální zátezový magnéziový test ke zjistení mozného magnéziového deficitu.

In 26 top sportsmen (volleyball players, rower) aged 15-18 years the serum magnesium level and urinary Mg excretion before and after oral administration of 5 g Mg lactate was assessed (oral magnesium load test). In 11 sportsmen (42.3%) a low percentage of excretion of administered Mg was found, suggesting magnesium deficiency, irrespective of the basal serum Mg levels. After subsequent 10-day Mg supplementation 6 volleyball players responded by a markedly lower retention after an identical Mg load, again without marked changes of the serum Mg level. The authors consider the magnesium load test a more sensitive indicator of latent Mg deficiency than the serum Mg level which is maintained at a relatively stable level and declines only in severe deficiency. The test assumes normal renal function and intestinal absorption.

[Echocardiographic determination of morphologic and functional indicators in competitive runners with mild hypertension]. / Echokardiografické stanovení nekterých morfologických a funkcních ukazatelu závodních bezcu s mírnou hypertenzí.

The authors examined four groups of 30-60-year-old men who different by the blood pressure at rest and the amount of physical activity: a control group of healthy inactive subjects (n = 10), healthy contesting endurance runners (n = 10), inactive men with mild essential hypertension (n = 10) and contesting endurance runners with mild essential hypertension who had been active for at least 8 years and had dispensary care (n = 10). Indicators of left ventricular hypertrophy were evaluated by one-dimensional echocardiography and also some functional indicators (pulse volume, systemic vascular resistance and fractionated reduction), using the method of pulsed Doppler echocardiography. The hypertonic runners had in all investigated indicators of left ventricular hypertrophy the highest values but differed significantly only from the control group (p less than 0.01). Individual prevalence of values which are beyond the accepted physiological range are however surprisingly low (10-20%). From the functional aspect they are characterized by a significantly higher pulse volume as compared with controls, in the remaining indicators they do not differ significantly. Echocardiographic examination of runners with mild hypertension can help to detect subjects with left ventricular hypertrophy which may already be a complication of the basic disease. Contest activities should not be permitted, unless it is possible to test left ventricular function by a haemodynamic loading test.

[Echocardiographic monitoring of treatment of mild hypertension using nifedipine]. / Echokardiografická kontrola lécby mírné hypertenze nifedipinem.

Forty men with hypertension and a BPd lower than 14.66 kPa (110 mmHg) were treated for six months with nifedipine, 30 x 10 mg, with echocardiographically controlled changes of the minute output of the heart and the peripheral vascular resistance at rest and during an isometric load. In the group a wide range of values of cardiac output and peripheral vascular resistance was recorded. In patients with a high peripheral vascular resistance (group B, n = 11) a substantially better therapeutic effect was proved than in patients with a low initial vascular resistance (group A, n = 20). Nifedipine is indicated in patient with a slow heart rate at rest which does not markedly change after an isometric load. In patients with a more rapid heart rate preparations from the group of beta-blockers are more suitable.

Carotid and lower extremity arterial disease in hypertensions.

Atherosclerotic changes of carotid and lower extremity arteries were studied in the selected industrial population represented by 58 men with arterial hypertension. Affection of peripheral arterial system was detected by means of non-invasive ultrasound methods. Stenoses of carotid arteries were recorded in 19% of cases (11 of 58), stenoses of lower extremity arteries in 7% (4 of 58). Hypertonic individuals did not show neurological symptomatology, including one patients with total occlusion of the arteria carotis interna. One man underwent the attack of cerebrovascular ischemia. Stenoses of lower extremity arteries were also in the subclinical stage and without intermittent claudications. A high number of risk factors of atherosclerosis was found in the series: obesity in 90%, smoking 57%, hypercholesterolemia in 47%. Peripheral arterial changes were associated with combined risk factors (two and more). This indicates their involvement in the origin and development of atherosclerotic lesions.

[Echocardiographic control of treatment of mild hypertension with trimepranol]. / Echokardiografická kontrola lécby mírné hypertenze trimepranolem.

Forty men with hypertension, diastolic BP lower than 14.66 kPa, were treated for six months with Trimepranol, 10 mg three times per day, with echocardiographic checking of changes of the cardiac minute output and the peripheral vascular resistance at rest and during an isometric load. In patients with a low baseline vascular resistance (group A, n = 20) a substantially better therapeutic effect was recorded than in patients with a markedly elevated peripheral resistance (group B, n = 11). Trimepranol is indicated in patients with a higher heart rate at rest and with a significant increase of the latter during isometric loading tests.

[Left ventricular systolic function during exertion in persons with mild and medium levels of hypertension]. / Systolická funkce levé komory pri zátezi u osob s mírnou a strední hypertenzí.

In a group of 34 men aged 30-59 years with essential hypertension of a mild or moderate degree the authors evaluated the behavior of the left ventricular ejection fraction and the rate of shortening of the circumferential fibre, using radionuclide ventriculography during exercise. The results were compared with a control group of 19 subjects lacking signs of cardiovascular disease. Asymptomatic hypertonic patients without signs complicating IHD have on average a small statistically insignificant reduction of values of the ejection fraction at rest and of the shortening of the circumferential fibre. However, they respond to a load by a significantly lower rise of the resting values than the control group. In 12% of the patients the authors found an abnormal reaction of the ejection fraction, i.e. a decline as compared with original values. The above differences can be ascribed to a reduction of left ventricular systolic function during chronic overload as a result of arterial hypertension. This functional reduction is not related to the values of the systolic or diastolic pressure at rest nor to the duration of hypertension.