Selected muscle tone and asymmetry of the occlusal plane in case of intracapsular temporomandibular joint disorder

Objective: To discover the extent of the connection between occlusal plane asymmetry and the rest tone of the four muscle groups of the orofacial region with temporomandibular joint pathology.Methods: Eighty-seven subjects were divided into two groups. The following methods were applied: clinical examination, roentgenological examination, and electromyography. Data were evaluated and statistically analyzed.Results: The variability of occlusal plane inclination in relation to the porion plane was 0-4.6º.The tonus of masseter muscle was higher in the experimental group: 1.45 mV more than in the control group: 1.23 mV (p < 0.05).Conclusion: Asymmetry of the occlusal plane inclination was found for nearly all subjects in both groups. It can be compensated for by adaptation mechanisms and does not cause temporomandibular joint disorders. Undertaken research shows the existence of a proven correlation between TMJ disorders and the resting tonus of the masseter muscle.

Incremental deep learning for reflectivity data recognition in stomatology

The recognition of stomatological disorders and the classification of dental caries are important areas of biomedicine that can hugely benefit from machine learning tools for the construction of relevant mathematical models. This paper explores the possibility of using reflectivity data to distinguish between healthy tissues and caries by deep learning and multilayer convolutional neural networks. The experimental data set includes more than 700 observations recorded in the stomatology laboratory. For rigor, the results obtained from the deep learning systems are compared with those evaluated for selected sets of features estimated for each observation and classified by a decision tree, support vector machine (SVM), k-nearest neighbor, Bayesian methods, and two-layer neural networks. The classification accuracy obtained for the deep learning systems was 98.1% and 94.4% for data in the signal and spectral domains, respectively, in comparison with an accuracy of 97.2% and 87.2% evaluated by the SVM method. The proposed method conclusively demonstrates how the artificial intelligence and deep learning methodology can contribute to improved diagnosis of dental problem in stomatology.

Endothelial Dysfunction, Distensibility and Intima-media Thickness and Aetiology of Stroke

This study measured carotid artery distensibility, intima-media thickness (IMT) and flow-mediated dilatation (FMD) in patients with ischaemic stroke and evaluated if there was a relationship between these measurements and the presence of atrial fibrillation. Distensibility and IMT were measured in 89 patients with ischaemic stroke using ultrasonography; 44 patients had atrial fibrillation. Distensibility was determined using the Reneman equation. FMD was measured in a second group of 52 patients with ischaemic stroke; 20 patients had atrial fibrillation. Patients with atrial fibrillation had lower IMT values compared with patients without atrial fibrillation (0.67 versus 0.79 mm, respectively). Distensibility increased in patients with atrial fibrillation compared with patients without atrial fibrillation (0.19 versus 0.10 mm/100 mmHg, respectively). Patients with atrial fibrillation had significantly better FMD results than patients without atrial fibrillation (5.7% versus 3.2%, respectively). Measuring distensibility, IMT and FMD might be helpful in differentiating between stroke of embolic and thrombotic aetiology.

Echocardiography and Carotid Sonography in Diabetic Patients after Cerebrovascular Attacks

This study evaluated the aetiological factors for cerebrovascular attack (CVA) using echocardiography and sonography of the carotid arteries. Results from 253 patients with CVA were evaluated retrospectively and analysed according to the presence or absence of diabetes and atrial fibrillation. In patients with sinus rhythm ( n = 182), the presence of diabetes was associated with an increased incidence of atherosclerotic changes and significant stenosis of the carotid artery as well as greater intima-media thickness. In contrast, when evaluating signs of thromboembolic risk, there were no statistically significant differences in left atrial diameter or left ventricular ejection fraction between the two groups. In patients with atrial fibrillation ( n = 71), no significant differences were observed between diabetic and non-diabetic patients in any of the parameters measured. These findings suggest that the increased risk of ischaemic CVA in diabetic patients is due to atherosclerosis in the carotid vessels rather than embolism of cardiac origin.

Evaluation of the three-year experience with all-ceramic crowns with polycrystalline ceramic cores

The objective of the study was to evaluate the clinical outcomes of all-ceramic crowns three years after placement of the restoration in the oral cavity. The aim of the present clinical study were surveyed the Procera®, Cercon® and LAVA™ systems. In total, 121 crowns were followed in 33 patients (7 men and 26 women) with an average age of 53.5 years. The eighty crowns were placed in anterior and forty one crowns in posterior teeth. The crowns were fabricated in two dental laboratories and delivered in two private dental practices. The clinical trial was conducted according to American Dental Association guidelines. The patients were requested to provide their consent to the regular clinical examination including radiographic and photographic records. A total of 102 crowns were made of zirconium oxide ceramic cores - 58 Cercon®; 43 LAVA™, while 19 crowns were made of aluminum oxide cores Procera®. The veneering ceramic LAVA™ Ceram was used. The success rate was analyzed using Kaplan-Meier statistics and, in our case, the overall three-year success rate reached 96.7%. All-ceramic crowns with polycrystalline ceramic cores have low susceptibility to fracture, in this study just 3.3%.

[Acute copper poisoning by suicidal attempt]

Voluntary copper poisoning is a rare mode of suicide. We report a case of patient admitted to Metabolic Intensive Care Unit who took fatal dose of copper oxichloride. In his clinical picture dominated gastrointestinal discomfort with the profused diarrhoea leading to the excessive fluids loss exceeding 10 liters over 24 hours. The renal and liver damages typical for copper intoxication were prevented due to the early intensive treatment (2 hours after ingestion of copper oxichlorid) including the application of copper chelator Succicaptal.

The impact of early diastolic myocardial relaxation on the other parameters of diastolic function and association of tissue Doppler parameters of diastolic function with diabetes compensation and duration in type 2 diabetic patients

This study assessed the impact of tissue Doppler derived myocardial early diastolic relaxation velocity (E(m)) on the other parameters of diastolic function (preload dependent transmitral early diastolic velocity [E], tissue Doppler derived myocardial late diastolic velocity [A(m)], preload dependent transmitral late diastolic velocity [A]) and evaluated the correlation of these parameters with selected clinical variables in type 2 diabetic patients. Using tissue Doppler echocardiography, 82 type 2 diabetic patients were evaluated, divided into two equal groups of E(m) < 7.5 cm/s or > or = 7.5 cm/s. Patients with E(m) < 7.5 cm/s had significantly lower E/A and E(m)/A(m), and higher E/E(m) values. Multilinear regression showed a negative correlation between E(m) and glycated haemoglobin (Hb(A1c)) and duration of diabetes, a negative correlation of E(m)/A(m) with age, duration of diabetes and Hb(A1c), and a positive correlation of E/E(m) with age, duration of diabetes and use of diuretics. The E/A ratio only correlated negatively with age. It is concluded that E(m) is a reliable parameter of diastolic function, and that the tissue Doppler parameters of diastolic function are associated with diabetes compensation and diabetes duration.

ECG Body Surface Mapping Changes in Type 1 Diabetic Patients with and without Autonomic Neuropathy

ECG body surface mapping (BSM) parameters in patients with diabetes mellitus Type 1 (DM1) are significantly different comparing to healthy non-diabetic subjects. Hypothesis that these changes are more pronounced in DM1 patients with autonomic neuropathy (AN) was tested. The parameters of BSM were registered by diagnostic system Cardiag 112.2 in 54 DM1 patients including 25 with AN and 30 control subjects. AN was diagnosed according to Ewing criteria when two or more Ewing tests were abnormal. In classic 12-lead ECG the heart rate was increased, QRS and QT shortened (p<0.01) and QTC prolonged in DM1 patients. The VCG measurement of QRS-STT angles and spatial QRS-STT angle showed non-significant differences. The absolute values of maximum and minimum in depolarization and repolarization isopotential, isointegral, isoarea maps were significantly different in DM1 patients in comparison with controls (p<0.01). The changes were more pronounced in DM1 patients with AN than in DM patients without AN (p<0.05). The QT duration measured in 82 leads of thorax was significantly shortened in 68 leads of both groups of DM 1 patients (p<0.01) when compared with controls. In 34 of them this shortening was more pronounced in DM1 patients with AN than in DM1 patients without AN (p<0.05). The results showed that the method of ECG BSM is capable to confirm the presence of autonomic neuropathy in diabetic patients.

[Pathophysiology of metabolic acidosis in patients with reduced glomerular filtration rate according to Stewart-Fencl theory]

AIM

Metabolic acidosis is a regular sign of renal insufficiency. Conventional assessment of acid-base balance using Henderson-Hasselbalch equation does not make identification of the cause of metabolic disorders possible as the serum HCO3- concentration might only reflect changes to the overall plasma ion spectrum. Therefore, we used the Stewart-Fencl approach that is based on a more detailed physical and chemical analysis and that showed that changes to serum HCO3- concentration are closely related to parameters not usually monitored in connection to acid-base balance. PATIENT GROUP AND METHODOLOGY: We performed a single measurement of arterial or capillary blood pH and pCO2 in 69 non-dialysed patients with glomerular filtration rate ranging from 0.04 to 0.88 ml/s/1.73 m2 according to MDRD, standard calculation of serum HCO3- concentration using Henderson-Hasselbalch equation was carried out, and serum albumin and ion concentrations (Na+, K+, Cl, Pi) plus creatinine and urea concentrations were determined from venous blood.

RESULTS

Metabolic acidosis was present in 47 patients ([S-HCO3-] < 22 mmol/l) with the mean [S-HCO3-] value of 19.6 mmol/l for the entire group. We proved a statistically significant correlation between [S-HCO3-] and [SID] (p < 0.001), and between [S-HCO3-] and the individual [SID] determining factors: [Na+-Cl-], [UA- ], [Pi-], [K+] (p < 0.01).

CONCLUSION

Reduction in [S-HCO3-] in non-dialysed patients with reduced glomerular filtration is predominantly associated with a decrease in [Na+-Cl-] difference, the quantitative contribution of which to metabolic acidosis is more significant than the strong acids retention. In addition to [S-Cl-] increase, [S-Na+] reduction too has a major role in reducing the [Na+-Cl-] difference.

[Hypoglycaemic periodic paralysis in hyperthyroidism patients]

Hypokalemic periodic paralysis (HPP) is a rare disorder characterised by acute, potentially fatal atacks of muscle weakness or paralysis. Massive shift of potassium into cells is caused by elevated levels of insulin and catecholamines in the blood. Hypophosphatemia and hypomagnesemia may be also present. Acidobasic status usually is not impaired. HPP occurs as familiar (caused by ion channels inherited defects) or acquired (in patients with hyperthyroidism). On the basis of two clinical cases we present a review of hypokalemic periodic paralysis in hyperthyroid patients. We discuss patogenesis, clinical and laboratory findings as well as the principles of prevention and treatment of this rare disorder.

[The relation between nutritional risk category identified by the modified Nutritional Screening 2002 and mortality in metabolic intensive care unit]

INTRODUCTION

The presence of malnutrition is connected with the significantly higher mortality and morbidity. Its early detection is very important for the institution of nutrition intervention that has favourable impact on patient's prognosis. The nutrition screening is the simple and fast way of nutrition risk assessment. The aim of our study was to evaluate the relation of the modified Nutrition Risk Screening 2002 (NRS 2002) with mortality of patients admitted to metabolic intensive care unit (MICU) in prospective study.

METHODS

Nutrition screening has been examined in all the patients admitted to MICU over half year period since January till June 2006. According to the screening result the patients were divided into three groups: with low, moderate and high nutrition risk. The relation of nutrition screening result with mortality in MICU was statistically evaluated.

RESULTS

Data of 291 patients admitted to MICU have been collected. The modified nutrition screening revealed low risk in 130 (45%), moderate risk in 111 (38%) and high nutrition risk in 50 (17%) patients. 28 patients (9.6%) died during stay in MICU. 3 patients (2.3%) with low, 10 (9%) with moderate and 15 (30%) with high nutrition risk passed away in MICU (p < 0.001).

CONCLUSION

The significant relation between the grade of nutrition risk evaluated by modified NRS 2002 and mortality in MICU has been found in our study.

[Experience with early enteral nutrition application in critically ill patients in medical intensive care unit]

BACKGROUND

Early enteral nutrition is recommended in patients with critical illness. Generally implementing of nutritional support algorithm is advised. The aim of study was evaluation of early enteral nutrition application in critically ill patients in medical intensive care unit.

METHODS AND RESULTS

Early enteral nutrition was given according to written protocol in medical intensive care unit. During the first 96 hours hypocaloric nutrition 20-25 calories/kg was applied, followed by increase to 25-30 calories/kg at the end of the first week of admission. Apart from the patients who reached 25-30 calories/kg we recorded the number of patients who tolerated hypocaloric enteral nutrition and evaluated the number of patients with complications due to enteral nutrition. Early enteral nutrition was given to 44 out of 99 patients admitted to intensive care unit with life threatening diasese and indication for nutrition support. Out of 44 critically ill patients (35 with sepsis, 9 with another medical emergency) 22 died during admisssion in intensive care unit (50%). Hypocaloric enteral nutrition during the first 96 hours was given to 36 patients (82%). In 8 patients enteral nutrition had to be stopped and substituted for parenteral one due to complications. Three patients suffered from abdominal distension, 2 from profused diarrhea, 1 from combination of diarrhea and abdominal distension and 2 from aspiration. Twenty seven patients tolerated the application of enteral nutrition via nasogastric tube. In 10 patients nasogastric tube had to be replaced for nasojejunal one for high gastric aspirate volume. The caloric intake of 25-30 calories/kg was reached by the end of the first week of admission in 26 patients (60%).

CONCLUSIONS

Early enteral nutrition applied according to protocol was given succesfully to the substantial number of the critical patients. In 18% of the patients enteral nutrition had to be replaced for parenteral one due to complications. The caloric intake 25-30 calories/kg was reached in 60% of patients.

[Our experience in continuous administration of insulin using infusion dispenser at a metabolic intensive care unit (MICU)]

INTRODUCTION

The article summarises the experience of the authors in the administration of insulin using an infusion dispenser at a metabolic intensive care unit (MICU) both to patients with decompensated diabetes mellitus and to patients admitted with a sepsis or other life-threatening condition of internal nature.

PATIENTS AND RESULTS

Insulin was administered with the use of a dispenser to a total of 50 patients during 6 months of 2005. 13 of those patients showed signs of ketoacidotic or hyperosmolar coma in the course of diabetes mellitus. All of these patients were compensated within 24 hours and transferred to a standard ward for further treatment within 48 hours. 37 patients were admitted in a critical condition, the cause ofwhich was sepsis and a serious internal disease in 29 and 8 patients, respectively. 12 of the patients died during their hospitalisation at MICU, of which 8 in the first 3 days after admission. No significant correlation between the age, diabetes mellitus diagnosis or an associated cardiovascular morbidity and the death at MICU was discovered, but there was a very close ling between the mortality at the intensive care unit and the baseline blood level of C-reactive protein (160 mg/l; 32-352 in the patients who died, and 111 mg/l 15-168 in the patients who survived), p < 0.01. Glycaemia at admission did not differ significantly for the patients who dies and those who survived, but average glycaemia for all three measurements at MICU was significantly higher in the patients who died (10.4 mmol/l; 6.2-22.4) as compared with those who survived (7.8 mmol/l; 5.8-16.6), p < 0.01. The time of insulin administration was significantly shorter in patients who died (3.3 days; 1-6) as compared with those who survived (5.2 days; 3-10), p < 0.01. There was no significant difference between hourly insulin dose in the patients who died (2.8 j/hour; 0.6-8.6) and in those who survived (2.6 j/hour; 0.8-7.6). A trend towards lower mortality was recorded for the group of patients with average glycaemia below 8 mmol/l and/or those in whom glycaemia mostly ranged between 4.4 and 8.0 mmol/l, but the difference was not statistically significant. A significantly lower consumption of insulin was recorded for the patients with average glycaemia below 8 mmol/l and/or those whose glycaemia measurements mostly ranged between 4.4 and 8.0 mmol/l. Hypoglycaemia defined as glycaemia below 4.4 mmol/l was present in 2% of all measurements, in 11 patients on the total, and their results were not significantly associated with mortality at MICU.

CONCLUSION

Mortality of patients admitted with sepsis or other life-threatening condition of internal nature was significantly higher in the group of patients with higher average glycaemia among all the measurements performed at MICU. In patients who died, the total time of insulin administration was significantly shorter, but there was no difference between the average hourly insulin dose in the group of the patients who died and those who survived.

Multidisciplinary orofacial therapy after suicidal treatment: casuistical report

Cutting wounds and bruises in the area of neck are very specific. The overall rehabilitation of these conditions is difficult and often needs to be combined with special and customised orofacial prostheses. This case-study reports special multidisciplinary treatment. The surgical diagnosis was: a cutting wound on a neck caused by a chain saw and disruption of oropharynx. Due to contusion of the tongue root and contusion of both hypoglossal nerves, a complete paralysis of tongue occurred. The tongue was immobile and the patient has problems with swallowing fluids. A special palatal prosthesis was made to reduce the space between the tongue and the palate. The fluoroscopically monitored swallowing action helps to receive optimal patient's rehabilitation.

ECG body surface mapping (BSM) in type 1 diabetic patients

Diabetes mellitus is a risk factor of cardiovascular diseases. ECG of patients with diabetes mellitus type 1 (DM 1) shows tachycardia (block of parasympathetic innervation) and abnormal repolarization (increased QT interval and QT dispersion (QTd)) indicating a risk of ventricular tachycardia and sudden death in young people with DM 1. The aim of the present report was to measure 145 parameters of the heart electric field in 22 patients (14 men, 8 women) with DM 1 without complications (mean age 32.8+/-11.4 years) and in 22 controls (11 men, 11 women, mean age 30.1+/-3.4 years). The duration of diabetes was 13.9+/-7.8 years. The parameters were registered by the diagnostic system Cardiag 112.2 and statistically evaluated by the Student and Mann-Whitney test. Tachycardia (86.3+/-2.7 beats.min(-1)), shortening of both QRS (79.9+/-1.6 ms) and QT (349.0+/-5.9 ms) and increased QT dispersion (115+/-36 ms) were observed in DM 1 when compared with the controls (75.0+/-2.1 beats. min.(-1), QRS 89.9+/-2.7 ms, QT 374.0+/-4.4 ms, QTd 34.0+/-12.0 ms, p<0.01). The QTc was 415.2+/-4.1 ms in DM 1 and 401.4+/-6.6 ms in controls (NS). Other significant findings in DM 1 were: higher maximum of depolarization isopotential maps (DIPMmax) in the initial phase of QRS and less positive in the terminal phase, more negative minimum (DIPMmin) during QRS similarly as the minimum in depolarization isointegral maps (DIIMmin) and the minimum in isointegral map of the Q wave (Q-IIMmin), lower maximum in repolarization isopotential maps (RIPMmax) and less negative minimum (RIPMmin), more negative amplitude of Q wave (Q-IPMAM) and more pronounced spread of depolarization (activation time). Our results confirmed a decreased parasympathetic to sympathetic tone ratio (tachycardia, shortening of the activation time) and revealed different depolarization and repolarization patterns in DM 1. The differences in heart electric field parameters measured by the BSPM method in DM 1 and in the controls indicate the importance of ECG examination of diabetic patients type 1 in the prevention of cardiovascular diseases.

Implantation of central venous ports with catheter insertion via the right internal jugular vein in oncology patients: single center experience

AIM OF WORK

Evaluation of suitability and safety of venous port implantation with catheter insertion via the right internal jugular vein in oncology patients.

PATIENTS AND METHODS

One hundred one totally implantable venous ports were placed in 100 patients with malignancies from January 1, 2003 until March 31, 2005. Catheter of venous port was preferably inserted via the right internal jugular vein. We recorded a number of successful implantations using this venous approach and the rate of complications during the procedure and follow-up.

MAIN RESULTS

Ninety-seven catheters (96%) of totally implantable venous ports were inserted via the right internal jugular vein in 96 patients, and only in four cases were we not able to access this vein. We had no complications related to catheter insertion via the right internal jugular vein. Follow-up was made in all 96 patients with a total access days of 41 in 151 days (mean: 407 days). Premature catheter removal was required in six (6.2%, 0.144 per 1,000 access days) due to complications: three catheter dislocations/malfunctions (3.1%, 0.072 per 1,000 access days), one port-related sepsis, one pocket port infection, and one decubitus over port (1%, 0.024 per 1,000 access days). Six venous ports were removed after completion of the treatment at the patient's request.

CONCLUSION

The placement of totally implantable venous ports with catheter insertion via the right internal jugular vein has a high success rate without any early complications. Follow-up also demonstrates a low incidence of late complications requiring port removal.

[Effects of specific cycloxygenase-2 inhibition on the renal functions of ederly patients with renal function impairment]

BACKGROUND

Elderly patients suffering from nociceptive pain of locomotive organs and concomitantly from renal impairment represent a target population for painkilling drugs. That is why they are predisposed to nephrotoxic effects non-steroidal anti-inflammatory drugs. The aim of our study was to evaluate cycloxygenase-2 (COX-2) inhibition effect on renal function in elderly with moderate impairment of renal function.

METHODS AND RESULTS

Based on 24-h urine collection we assessed creatinine clearance (C(Cr), fractional excretion of sodium (FE(Na)), potassium (FE(K)), chloride (FE(Cl)), osmotic active solutes (FE(OSM)) and 24h urinary excretion of prostaglandin PGE2 and PGF(2 alpha). Under conditions of sub-maximal water load fractional excretion of electrolytes, inulin clearance (C(in)), serum cystatin C (S(cyst)) were assessed. In addition basal and stimulated plasma renin activity (PRA) and plasma aldosteron (P(aldo)) were examined. Using comparison of parameters before and at the end of 7-days rofecoxib treatment we found out C(in) 0,82 +/- 0,34 vs 0,74 +/- 0,18 ml/s/l,73 m2, FE(Na) 1,0 +/- 0,3 vs 1,2 +/- 0.4 (p=0,02), FE(OSM) 2.9 +/- 0,7 vs 3,7 +/- 1,2% (p=0,03), U(PGE2 alpha),V 663 +/- 528 vs 414 +/- 195 (p=0,059), U(PGD2) V (559 +/- 625) vs 205 +/- 174 eta g/24h (p=0,02), stimulated PRA 0.94 +/- 0,73 vs 0,4 +/- 0,27 +/- pg/l/h (p=0,019), P(aldo) 104,56 +/- 50,15 vs 56,94 +/- 27,08 eta g/l/h (p=0,008).

CONCLUSIONS

Short-term COX-2 inhibition in patients with moderate renal impairment was associated with significant decrease of tubular transport of sodium, without changing GFR and water excretion.

The association between left ventricle diastolic dysfunction and endothelial dysfunction and the results of stress myocardial SPECT in asymptomatic patients with type 2 diabetes

Diabetes mellitus is associated with a poor cardiovascular prognosis. Stress myocardial single-photon emission computed tomography (SPECT) reliably detects coronary ischaemia in asymptomatic patients. Our study aimed to evaluate the association between systolic and diastolic left ventricular function, left ventricular hypertrophy, endothelial function and the results of stress myocardial SPECT in 126 patients with type 2 diabetic patients with no cardiovascular symptoms. Thirty-three patients (26%) had abnormal SPECT results, 33 patients (26%) had intermediate (equivocal) results, and 60 patients (48%) had normal results. We found a significant association between an abnormal SPECT result, left ventricular diastolic dysfunction and impaired post-ischaemic dilatation of the brachial artery. No association was found between the SPECT result and systolic function and left ventricular hypertrophy, however. An abnormal SPECT result was significantly associated with left ventricular diastolic dysfunction and the deterioration of post-ischaemic dilatation of the brachial artery in asymptomatic patients with type 2 diabetes.

Long-term clinical evaluation of fixed dentures--two to fifteen years after insertion

Fixed denture durability is characterized as a period of time for which a dental appliance satisfies functional and esthetic requirements. First of all, its durability is based on the properties of materials it is made of, and depends, at the same time, on the characteristics of biological environment, in which the denture is placed. The purpose of this study was a long-term monitoring of changes taking place in the fixed dental constructions during their application in the oral cavity. These changes were to be evaluated for different types of materials used for fixed dentures manufacturing, namely metal alloys, ceramics, and plastics. A set of 454 full crowns from 134 patients divided in 6 clinical studies was examined and both qualitative and quantitative changes evaluated after 2 and 8 to 15 years after cementation. Clinical assessment adopted the United States Public Health Service System criteria. Alloys of precious metals veneered with ceramics are considered the optimal method of choice for both high precision of execution and consideration of future changes brought on by the use of the dentures.

[Relation between diabetes compensation, albuminuria and biochemical parameters and the results of stress myocardial SPECT in asymptomatic type 2 diabetics]

The patients with diabetes mellitus and another risk factors have significantly higher risk to suffer from ischemic heart disease. Myocardial stress SPECT represents the examination which correlates very well with the results of selective coronary angiography even in asymptomatic diabetic patients. The aim of our study was to evaluate the relation of SPECT result to diabetes compensation, presence of micro/macroalbuminuria, blood level of fibrinogen, CRP, homocysteine and uric acid. Out of 126 diabetic 2. type abnormal SPECT has been found in 33 (26%). Fasting blood sugar (9.3 +/- 1.4 mmol/l in patients with abnormal SPECT vs. 9.7 +/- 1.9 mmol/l in the other diabetics, n.s.) and HbA1c (7.5 +/- 1.3% vs. 7.5 +/- 1.3%, n.s.) are not significantly different in the patients with abnormal SPECT to the other diabetics without this finding. Micro/macroalbuminuria was significantly more frequently seen in patients with abnormal SPECT (60% of patients with abnormal SPECT and 29% in the rest of diabetics, p = 0.01). Fibrinogen was significantly more elevated in diabetics with abnormal SPECT (3.76 +/- 0.5 g/l in the group with abnormal SPECT vs. 3.23 +/- 0.43 g/l, p = 0.0003). In the diabetics with abnormal SPECT we have found significantly higher CRP (3.84 +/- 1.51 mg/l vs. 2.79 +/- 1.13 mg/l, p = 0.024) and homocysteine (13.78 +/- 3.26 micromol/l vs. 10.98 +/- 2.33 micromol/l, p = 0.006). Uric acid level was not significantly different in the group of diabetics with abnormal SPECT to the rest of the patients (361 +/- 64 micromol/l in abnormal SPECT vs. 353 +/- 51 micromol/l, n.s.). When we analyse our results we have found that abnormal SPECT is rarely discovered in the asymptomatic 2nd type diabetics with the combination of negative micro/macroalbuminuria and fibrinogen level below 3.5 g/l.

A two-year clinical study of metal-ceramic and metal-polymer crowns

The purpose of this study was to compare full metal crowns with two different types of veneering material - ceramics and polymer after a two-year period in a function. The aim was to evaluate the changes of occlusal relief, marginal adaptation, break of material, changes of shape and color and gingival status. One hundred and two crowns were examined in 34 patients immediately after cementation, and they were reviewed within two years of crown placement. These fixed restorations were checked according two modified US Public Health Service System criteria. After two years the crowns were found clinically intact in 94% for metal-ceramics versus 98% for metal-polymer. No crown was lost. There were found significant differences in positions of a crown margin between both materials and marginal adaptation between initial (baseline) and follow-up results. Gingival health at baseline was related in optimal in 67% versus 77%, after two years in 43% versus 71%. Slight mismatch in color occurred in 0 versus 60% crowns, obvious mismatch was apparent in 0 versus 21% crowns after two years. Within the limitations of this study, it was found that the examined metal crowns with two different veneerings are very stable fixed restorations, mechanical resistance and integrity of polymer material was surprisingly good but its color stability presented mismatch after two-years period. Ceramic veneering was excellent in color match but there were three visible cracks of the ceramic layer.

[Thromboelastography in liver transplantation, a comparison with conventional laboratory tests]

BACKGROUND

The aim of our study was to compare the results of conventional tests and thromboelastography during liver transplantation and to determine their importance for blood loss.

METHODS AND RESULTS

Thromboelastography and conventional laboratory tests were undertaken in 25 patients at the end of the anhepatic phase. Transfusion requirements correlated significantly only with prothrombin time and reaction time, R. These two tests likewise correlated significantly one with the other.

CONCLUSIONS

Lowered plasma levels of coagulation factors of the prothrombin complex influenced the blood losses in our patients. While not replacing conventional tests, thromboelastography can serve as an additional test for monitoring acute changes in hemostasis.

[Nutritional intervention in patients with cerebrovascular stroke]

The patients with acute cerebral stroke suffer from stress situation which may induce the catabolic state. The aim of our study was to evaluate the influence of the nutrition intervention and follow-up of the nutrition parameters in the patients with acute ischemic cerebral stroke. We have examined 30 patients with acute ischemic cerebral stroke, the average age 71.4 +/- 8.6 years. In all the patients we have measured some antropometric, biochemic and immunologic parameters of the nutrition status on admission. At the same time we have evaluated the size of the neurological deficit with NIH stroke scale and Barthel index. Every day we have monitored in all the patients the nutrition intake. In case the food intake has not reached 30 kcal/kg/day we have started the nutrition intervention by giving polymer enteral nutrition: either like sipping or if necessary through nasogastric tube. The nutrition intervention has been necessary in 18 patients (60%). The measurement of antropometric, biochemical and immunologic parameters have been repeated after 14 days. The evaluation of nutrition parameters have shown no significant changes since admission. The changes of the nutrition parameters in this group of the patients we have compared with the earlier reported group of the patients where no nutrition monitoring and intervention were applied and the nutrition parameters have deteriorated significantly in 2 weeks. By comparing we have confirmed that the careful monitoring of nutrition intake and in the majority of patients also nutrition intervention are necessary, especially because the improvement of the neurological deficit have been noticed more in the group of the monitored and intervened patients. The nutrition intervention can stabilize the followed nutrition parameters which may play the significant role in the speed and efficacy of the rehabilitation.

[Importance of measurement of carotid artery distensibility]

Affections of the structure of the major blood vessels can be assessed non-invasively by ultrasound. The authors assessed the thickness of the intima-media (IMT) and distensibility (D) of the carotid arteries in patients with ischaemic heart disease (IHD) and a cerebrovascular attack (CVA). Duplex sonography was used in 234 patients (145 patients with IHD and 89 patients with CVA) incl. assessment of IMT and D. 59 patients had type 2 diabetes and 64 had atrial fibrillations. D was evaluated according to Raneman's formula (mm/100 mm Hg). Diabetic subjects had a poorer D in the group with IHD (0.16 vs. 0.20, p < 0.05) as well as in the CVA group (0.14 vs. 0.17, p < 0.05) and the finding correlated with IMT. Insulin treatment as compared with PAD treatment did not influence D in a significant way (0.15 vs. 0.16, NS). Th presence of atrial fibrillation in patients with IHD did not affect the investigated parameters (IMT 0.72 vs. 0.74 mm, NS, D 0.19 vs. 0.18, NS). In patients with CVA, as compared with patients with a sinus rhythm, better IMT findings were recorded (0.67 mm vs. 0.79 mm, p < 0.05) and D (0.19 vs. 0.10, p < 0.05). The results indicate that IMT an D correlate indirectly and this is made more apparent by the presence of diabetes. In patients with CVA the different findings in relation to the presence of atrial fibrillation indicate the possibility to use these parameters to differentiate an embolic and thrombotic etiology of the attack. The results assembled by the authors do not support a better informative value of D as compared with IMT.

[The comparison of clinical and echocardiographic changes in diabetics 2nd type and nondiabetics in patients with shortness of breath due to left ventricular failure]

In our study we have examined 198 patients admitted to hospital for shortness of breath at rest due to left ventricle failure. We have divided the patients into two groups according to the presence of diabetes mellitus. We have excluded the patients with noncardiac cause of pulmonary congestion, with valvular or congenital heart disease and with acute coronary syndromes. We have evaluated the presence of hypertension, value of blood sugar on admission, systolic and diastolic blood pressure, heart rate and medication given for heart insufficiency. We have also compared two dimensional transthoracal echocardiogaphic examination in diabetics to nondiabetics. Finally we compared hospital mortality in both groups. Diabetes mellitus (all the patients were type 2 diabetics) was present in 94 patients (47,5 %), in the group of diabetics there were 50 women, in nondiabetics 52 women (n.s.). The average age of diabetics was 75,5 +/- 8 years and 76,6 +/- 10,1 years in nondiabetics (n.s.). History of hypertension had 45 nondiabetics (43 %) and 69 diabetics (73,5 %), p < 0.05. Systolic blood pressure was significantly higher in diabetics 151 +/- 20,8 mm Hg to 140,5 +/- 18,4 mm Hg in nondiabetics, p < 0.05. The values of diastolic pressure and heart rate were comparable in both groups. We have not noticed any significant difference in the application of ACE inhibitors, beta blockers and diuretics for heart failure in both groups. Echocardiographic examination revealed the significantly higher ejection fraction of left ventricle in diabetics as well as the thicker septum and posterior wall of left ventricle. These findings support the role of the diastolic dysfunction in pathogenesis of left ventricle failure. In hospital mortality rate was 8,5 % in diabetics and 7,6 % in nondiabetics (n.s.). Our results confirmed that in pathogenesis of left ventricle failure hypertension and elevated systolic blood pressure play the important part. Apart from the complex secondary prevention of ischemic heart disease the correct treatment of hypertension represents the very important part of the prevention of left ventricle failure. The role of the proper compensation of diabetes mellitus in the prevention of left ventricle failure is also discussed.

[Comparison of short-term and long-term results after aortocoronary bypass in ischemic heart disease in diabetics and non-diabetics]

In the presented study we have evaluated short-term and long-term results of the multiple aortocoronary bypass surgery in the patients with ischemic heart disease. We have compared the incidence of the preoperative and postoperative complications, short-term and long-term mortality in the group of diabetics in comparison to nondiabetics as well as the entry characteristics of both groups. Among 2518 patients who were treated with aortocoronary bypass surgery there were 773 (30.6%) diabetics. The diabetic patients were significantly elder, we have found more women among them, more frequent presence of hypertension, chronic heart failure and peripheral vascular disease. Contrary in the incidence of the previous myocardial infarction we have not found any significant difference between both groups. The patients with diabetes mellitus had lower ejection fraction of the left ventricle and significantly more extensive coronary artery disease which explains that in this group of patients the number of coronary bypasses was significantly higher. Comparing the incidence of preoperative complications we have not seen any significant difference between the patients with and without diabetes mellitus. Out of the postoperative complications we have noticed significantly more renal failure, infectious complications, low cardiac output syndrome and bleeding disorders in the diabetic patients. The duration of hospitalisation in the intensive care unit was significantly longer in diabetics (55.11 +/- 89.09 hours to 47.84 +/- 65.18 hours in nondiabetics, p < 0.05). 30 days mortality in diabetics was 3.75% and 2.4% in nondiabetics (p < 0.05). This difference was mainly due to the significantly higher incidence of multiorgans failure as a cause of death among diabetics (1.3% in diabetics, 0.5% in nondiabetics, p < 0.05). 89.1% of nondiabetics and 86.9% of diabetics lived 2-6 years after aortocoronary bypass surgery (n.s.). We have found the significantly higher long-term cardiovascular mortality (2-6 years) in diabetics (10.3%) then in nondiabetics (7.6%, p < 0.05).

[Diagnosis and therapy of gestational diabetes mellitus]

In 1999-2000 at the Medical Clinic Motol Faculty Hospital in collaboration with the Gynaecological Clinic of the Hospital a group of 55 pregnant women with the diagnosis of gestational diabetes (GDM) were followed up. The objective of the investigation was to find out how in the investigated area (detachment area of the Gynaecological and Obstetric Clinic Motol Faculty Hospital) GDM is diagnosed at present, how it is treated and what is the percentage of perinatal morbidity in the investigated group. The mean age of the investigated women was 32.3 +/- 4.5 years. The presence of risk factors for the development of GDM was found in 59.8% of the examined women. 65.7% women had a positive gynaecological case-history. GDM was detected most frequently during the 30th week of pregnancy, in 25% women in the 35th and later week of gestation. In 52% the diagnosis of GDM was established only on hospital admission on account of complications of pregnancy. The mean HbA1C level during detection of gestational diabetes was 6.81 +/- 0.41%. The majority of women -91.1%--were treated by diet, 8.9% women had insulin treatment. The prevalence of diabetic foctopathy was 48.3%. The mean weight of the offspring of diabetic mothers was 3350 g +/- 248 g, the mean length was 49.6 +/- 6.3 cm. No stillbirth was recorded. One infant suffered from an inborn developmental defect (morbus Down). The results provide evidence not only of late diagnosis of GDM (after the 28th week of gestation) but also of inadequate screening in the field, as GDM is frequently detected only during complications of pregnancy.

[Sonography findings in the carotid arteries in diabetics before aortocoronary bypass]

Neurological complications of patients during cardiac operations are closely associated with affections of the carotid arteries. The relationship of diabetes to these findings was not investigated so far. During the period between July 1 and Dec. 31 2000 the authors examined sonographically 127 patients indicated for aortocoronary bypass on account of affection of three arteries. Diabetes mellitus type 2 was present in 44 patients. A significant stenosis was detected in 4 (5%) without diabetes and in 5 (11%) patients with diabetes (p < 0.05), moreover in two patients with diabetes complete obstruction of the inner carotid was found. An insignificant stenosis (up to 70% was found in 3 (3%) of the patients without diabetes and in 3 (7%) patients with diabetes (p < 0.05). The thickness of the intima and media (IMT) was in patients with diabetes insignificantly greater (0.76 vs. 0.89 mm, NS). The mean index of echogenicity of plaques was in diabetic patients also insignificantly greater (2.1 vs. 2.9 NS). Atherosclerotic plaques greater than 2 mm were more frequent in diabetics (7.8% vs. 8 (18%), p < 0.05). A significantly more frequent finding of carotid stenosis or larger plaques was proved in patients with a history of CMP. Sonographic findings on the vertebral arteries were not associated with the presence of diabetes.

CONCLUSION

Carotid sonography in patients of three arteries reveals in diabetic patients and in those with a history of CMP more frequent significant stenosis and the presence of major atherosclerotic plaques.

[Pulmonary edema caused by laryngospasm]

The authors report on a case of non-cardiac pulmonary oedema that developed in a young athletic man at an operating theatre. This unusual condition resulted from a laryngospasm followed by strenuous ventilation retractions. Diagnostic routine, differential diagnosis and treatment are described.

[Diabetes mellitus in the elderly]

Diabetes mellitus is one of the most frequent chronic diseases of the elderly population with a high prevalence after the age of 65 years. In this group it is a serious cause of increased mortality and morbidity. More than 90% of patients suffer from type 2 diabetes mellitus. The disease takes frequently for a long time an asymptomatic course and if it persists for long it may lead to microvascular complications and is an important risk factor of cardiovascular and cerebrovascular diseases. The objective of treatment of diabetes in old age is in particular to restrict symptomatic hyperglycaemia, but at the same time we must not forget prevention of hypoglycaemia. It is also important to diagnose and treat diabetic complications. As elderly diabetic patients are usually polymorbid, diabetes mellitus in old age calls for a comprehensive approach not only to the treatment of hyperglycaemia but also of hypertension, dyslipidaemia and other associated diseases.

[Ethylene glycol poisoning]

Ethylene glycol is a common substance in various antifreeze preparations. Intoxication is caused by ingestion either as a suicide attempt or by an accident. The clinical course of intoxication is always severe, however, immediate launching of proper treatment can reverse the poor prognosis. Intoxication clinically proceeds in three stages: 1. Depressive CNS disturbances that can lead to coma. 2. Organ manifestations. 3. Acute renal failure. The case report of 46-year-old man admitted after ingestion of ethylene glycol in suicidal attempt summarises the essential principles of therapy--monitoring of vital functions, administration of ethanol solution as an antidote and hemodialysis to remove toxic components.

[Reversible long-term tachycardia and hypertension as a symptom of autonomic neuropathy in combination with sensorimotor polyneuropathy in a patient with newly discovered type 1 diabetic mellitus]

The case of 22 years old woman admitted with ketoacidotic coma and newly diagnosed insulin dependent diabetes mellitus is described. The signs of mixed sensoromotoric polyneuropathia in this patient have been discovered. After the correction of ketoacidotic hyperglycemic coma the significant tachycardia and hypertension with the abnormalities of diurnal rhythm with necessity of the intensive treatment persisted for the period of the several monthes. These changes we attributed to the significant dysfunction of the autonomic system. In the course of 1 year of good diabetes compensation the above mentionned hemodynamic changes subsided completely. In the same time the signs of mixed polyneuropatia and the incipient retinopathia disappeared. The causes of the described changes are discussed, mainly the importance of reversible microvascular changes.

[Echocardiography and sonography of the carotid arteries in diabetics with cerebrovascular stroke]

The incidence of cerebrovascular attacks (CVA) in diabetics is 2-3 times higher as compared with the non-diabetic population. The objective of the present work was to evaluate etiological factors by means of echocardiography and sonography of the carotid arteries. The authors evaluated retrospectively findings of these examinations in 253 patients with CVA in a group of diabetic and non-diabetic patients as well as in a group of patients with atrial fibrillations or sinus rhythm. In patients with a sinus rhythm the presence of diabetes was associated with a more frequent finding of atherosclerotic changes, significant stenoses of the carotid vessels (2% as compared with 8%, p < 0.05) as well as thickness of the intima in the carotid bulbus (0.78 as compared with 0.96 mm, p < 0.05). Conversely when evaluating signs of thromboembolic risk, i.e. the size of the left ventricle (42 vs. 40 mm, n.s.) and ejection fraction of the left ventricle (55% vs. 50%, n.s.) no statistical significance in the difference of parameters was found. In the sub-group of patients with atrial fibrillation, who accounted for 28% of the group, the authors did not find when comparing diabetic and non-diabetic patients, any difference as regards the presence of significant stenoses in the carotid arteries nor in the thickness of the intima. There was no statistically significant difference in the size of the left atrium and left ventricular function. The findings suggest the possibility that the increased risk of ischaemic CVA in diabetic patients is caused by the atherosclerotic process in the carotid vessels and not a higher risk of embolism of cardiac origin.

[Secondary hemophagocytic syndrome in a systemic disease]

20 year old man 2 years treated for the seropositive rheumatoid arthritis was admitted for fever accompanied with jaundice, anemia and leukopenia. The underlying disease has been compensated already for long period of time, before his admission only Prednisone (in the dose of 5 mg daily) and Methotrexate (15 mg once a week) was given. His physical examination of admission was without any significant abnormalities, out of the routine laboratory examination the value of leukocytes count was 2.1 x 10(9)/L, erythrocytes 3.7 x 10(12)/L, hemoglobin 95 g/l, hematocrit 0.29, platelets 156 x 10(9)/L. Since admission to hospital the hepatic enzymes ALT, AST, GMT, ALP were about ten times elevated comparing to normal values, the coagulation examination has shown the decrease of Quick test to 55%. With respect to the permanent leukopenia the bone marrow aspiration was taken with the finding of the increase number the RES elements (18.4%) with the signs of hemophagocytosis. The phagocytic reticulum absorbs blood elements erythrocytes, normoblasts, granulocytes, platelets. According to the literature experience we started the combination of the immunosuppressive treatment consisting of corticosteroids and Cyclosporine. Already the day following the application of the high dose of corticosteroids the fever subsided, icterus went away gradually with the normalization of the liver tests. After 20 days of hospitalisation the patient was discharged in good shape. Now, after 4 months the is stabilized on the follow-up treatment of Prednisone a Cyclosporine.

[Postural trauma and rhabdomyolosis causing acute renal failure]

Rhabdomyolysis (damage of the muscles of various origin) leads to the efflux of the intracellular fluids in the circulation. The common complication of this status is the renal failure. The early diagnosis and the proper treatment makes the fall of renal function reversible. That is why the possibility of the rhabdomyolysis must be consider. The case report describes the development of renal failure in young, previously healthy men, followed by trauma mechanism after drug and alcohol abuse.

[The effect of ambulatory nutritional intervention using defined enteral nutrition on the nutritional status of selected adult patients with cystic fibrosis]

The prevalence of mild and serious nutritional disorders in patients with cystic fibrosis is high. One of the possible ways how to supplement the necessary nutrients is the administration of defined supplementary enteral nutrition. The objective of the presented work is to evaluate the effect of supplementary domiciliary enteral nutrition in adult patients with cystic fibrosis. To eight patients with cystic fibrosis, mean body weight 51.77 +/- 10.63 kg, mean age 24.7 +/- 1.9 years for a period of 6 +/- 1 months enteral nutrition was administered (containing 40 and 55.1% energy as fat) with a caloric density of 10 kcal/kg as supplementary domiciliary nutrition. The mean body weight increased from 51.77 +/- 10.63 to 53.13 +/- 10.59 kg (p < 0.02), the mean skinfold thickness increased from 7.98 +/- 6.04 to 8.65 +/- 6.30 mm (p < 0.05) and the mean serum albumin concentration increased from 33.66 +/- 0.97 to 37.29 +/- 3.33 g/l (p < 0.05). No undesirable side-effect associated with the administration of enteral nutrition were observed. The nutritional intervention by domiciliary enteral nutrition produced no undesirable side-effects and led to a statistically significant improvement of parameters of the nutritional status.

[A negative interference effect of pathologic levels of bilirubin on the determination of serum creatinine]

BACKGROUND

Negative interference of bilirubin with assessment of creatinine concentration is generally known from the biochemical aspect. The objective of the presented work was to find the bilirubin level and creatinine concentration where this phenomenon has actually a clinical impact.

METHODS AND RESULTS

In 200 samples selected at random the bilirubin and creatinine levels were examined by the classical Jaffé method and a method where the effect of bilirubin is suppressed. After dividing the group into 8 sub-groups by bilirubin and creatinine concentrations it was revealed that the interference plays a statistically significant role (p < 0.01) already at total bilirubin concentrations above 70 mumol.l-1. In abnormal creatinine levels the interference is manifested only at bilirubin concentrations above 150 mumol.l-1 (p < 0.001). The degree of interference in the whole group is directly proportional to the bilirubin level (r = 0.5497, p < 0.001).

CONCLUSIONS

At bilirubin levels above 70 to 150 mumol.l-1 its interference with assessment of the creatinine concentration can be so significant that it must be taken into account when evaluating the patient's renal function.

[Evaluation of nutritional state in hospitalized patients with cerebrovascular stroke]

The cerebrovascular stroke is serious disease with the high mortality and resulting in invalidity. The result of its treatment is not yet encouraging. The stress situation which is characteristic for the acute stage of disease leads to catabolic status. This condition can be worsen if nutritional parameters are not properly monitored and the nutrition is not sufficient. We examined 30 patients admitted to our medical ward with the diagnosis of ischemic cerebrovascular stroke. We have not applied any nutritional intervention. We measured some anthropometric, biochemical and imunological parameters of nutrition at the time of admission to ward and after 14 days of hospitalization. Our results showed that nutritional status has worsen during this period according to the significant deterioration of the followed anthropometric and biochemical parameters. Malnutrition has the detrimental impact on rehabilitation and mobilization of the patients and extends time of hospitalization. Nutritional status should be monitored and corrected since the start of disease, preferably in intensive care unit.

[Malnutrition in a patient with short-bowel syndrome]

The short bowel syndrome is a relatively frequent complication of extensive resection and by reducing the absorption capacity the function of the gut is markedly impaired. An important part of postoperative care is therefore to ensure nutrition of these patients. The authors demonstrate on the case-history of a 40-year-old patient after repeated revision of the abdominal cavity on account of adhesions the development of severe malnutrition after jejunotransversoanastomosis. As the small intestine was not resected (concurrent blind loop syndrome), the patient was indicated for surgery. After surgery all complaints disappeared and the nutritional status improved.

[Tissue amino acids in patients with colorectal carcinoma]

Different catabolic conditions have their special characteristics of intracellular biochemical changes. The objective of the presented work is to assess the concentration of free amino acids in muscles of patients with colorectal carcinoma. In a group of 17 patients the free amino acid level was assessed in tissues and plasma. Material was collected on operation by biopsy of the rectus abdominis muscle, the concentration of different amino acids was assessed by the HPLCV method with fluorescent detection. For statistical evaluation the T-test was used. From the results ensues that in patients with colorectal cancer in plasma statistically significantly lower taurine, glutamine, valine, tyrosine levels were found, intracellularly significantly reduced levels of taurine, glutamic acid, methionine and ornithine were recorded. Significantly elevated intracellular levels of valine, isoleucine, leucine, tyrosine and phenylalanine were found. Assessment of the tissue aminoacidogram is the first step when attempting to influence the intracellular amino acid concentration by defined dietetic preparations.

[Realimentation in patients with anorexia nervosa and critical malnutrition--personal experience]

The objective of the work is to find a suitable realimentation procedure for patients with anorexia nervosa and critical malnutrition, whose mortality is round 6%. In a group of 10 patients aged 22.3 +/- 2.33 years during hospitalization for 10.0 +/- 6.11 days a weight increment of 5.0 +/- 1.16 kg was achieved. According to hitherto assembled experience and consistent with data in the literature it is best to start immediately after admission complete parenteral nutrition with a hyperalimentation regime regardless of the amount of food ingested by the patient. Thus within the shortest time maximum weight increments are achieved and the patients can be referred to the care of psychiatrists, which is the only causal treatment. Attempts of realimentation by enteral nutrition or increased oral ingestion in these patients were not successful and led only to a prolonged period of hospitalization.

[Metatarsus Varus among Forefoot Adduction Deformities in Children.]

The author identifies main etiologic factors causing intoeing in children. The levels hip joint and proximal femur-tibial torsion and foot deformities are followed. Among foot deformities metatarsus varus in pointed out and described, as the literature is not yet uniform about strict criteria. The clinical appearance is shown and X-ray signs-subluxation of os naviculare laterally on talus and changes of shape of os cuneiforme primum are mentioned. Discussed is conservative therapy-excersises and plaster casts. Key words: metatarsus varus, pes equinovarus, forefoot adduction, X-ray, torsional deformities.

[Possibilities of correction of forefoot adduction deformity in children.]

The authors concentrate on surgical approach to adduction deformity of the forefoot in children. They follow 42 children surgically treated - 14 for metatarsus varus and 28 for a residual adduction of the forefoot after treatment for pes equinovarus congenitus. In both groups they compare two operations -Lisfranc joint capsulotomy after Heyman-Herndon-Strong and metatarsal osteotomies after Berman-Gartland. The angle of adduction of the axis I. metatarsal compared to longit. axis of talus has been 35 degrees, both surgical approaches corrected the deformity in a satisfying way, but as more reliable we consider the metatarsal osteotomies, which show a narrow spectrum of postoperational angle values. For structural changes of I. metatarsal base after Heyman capsulotomy we do not consider it a clearly soft tissue operation. As very interesting the authors describe rotation of I. metatarsus round os cuneiforme primum in Heyman capsulotomy, leaving the original articular surface as medial, the lateral side of os cuneiforme primum functioning now as the new articular cuneometatarsal surface. The functional results of surgical treatment of the forefoot adduction deformity in children are satisfactory, as all children fully weight bear without pain. Key words: metatarsus varus, adduction of forefoot, pes equinovarus, Lisfranc capsulotomy, MT osteotomies.

[BCG Osteomyelitis after an Interval of 14 Years.]

In the introduction the authors give an account of immunization against tuberculosis in post-war Czechoslovakia up to the present time from the aspect of the epidemiologist. After a 14-year interval the authors evaluate the results of the investigation and treatment of children with osseous complication after immunization with the BCG vaccine type Moscow. The group comprises four children who were hospitalized years ago at the Orthopaedic Clinic in Hradec Králové for assessment of the diagnosis and initiation of comprehensive treatment. In addition to two patients described in 1986 in this journal there were another two patients who completed the number of detected cases of BCG osteomyelitis in the region. During the follow-up and treatment complications were recorded such as the formation of abscesses and fistulae. A unique complication was the development of a calcified abscess on the leg which was removed surgically. Follow-up of the children to adolescent age made it possible to evaluate the influence of a specific inflammation on the growth plate. The method and period of treatment, complications and permanent sequelae do not differ essentially from tuberculosis of the bones. Key words: BCG osteomyelitis, BCG calcified abscess, osseous complications after BCG vaccination type Moscow.

[Autotransfusion in cardiosurgery procedures]

BACKGROUND

The use of autotransfusions for planned surgery is becoming quite common. The objective of the present work was to find out whether autotransfusions are safe for cardiosurgery and what is their value.

METHODS AND RESULTS

On average 2.3 transfusion units (T.U.) of blood were taken from 62 patients (52 men and 10 women, age 53.7 +/- 10 years) with a planned revascularization of the heart muscle (54x) or valvular operations (8x). During 129 blood collections a drop of systolic pressure occurred (141 +/- before and 134 +/- 21 mm Hg after blood sampling, p < 0.02). The diastolic BP and pulse rate did not change. In nine instances (7%) the authors recorded minor side-effects. After an initial drop of haemoglobin (p < 0.001) during subsequent sampling no further drop was recorded (139.4 +/- 11.8, 130.6 +/- 9.8, 129 +/- 10.5, 130.3 +/- 11.8 g/l). The iron levels, binding capacity and ferritin were within a normal range. During operation 26% of the patients, i.e. 16 (15 men and one woman) did not need a transfusion of homologous blood. The patients were younger (44.7 +/- 8.6 years) and the extracorporeal circulation was shorter (65 +/- 29 min.) than patients with transfusions of homologous blood (37 men, 9 women, 56.8 +/- 8.6 years, 91 +/- 24 min., p < 0.001).

CONCLUSIONS

When contraindications are respected autotransfusions before cardiosurgery are safe. In some patients they can replace homologous blood.

[Infectious endocarditis and congenital heart defects in adults]

BACKGROUND

Infective endocarditis still remains a cardiological menace. However, the type of predisposing diseases has changed: the incidence of rheumatic heart disease in advanced countries has declined, advances made in the surgical and medicamentous treatment of inborn heart disease are the reasons why we are encountering, with increasing frequency, infective endocarditis which develops on their background.

METHODS AND RESULTS

The objective of the investigation was to assess the frequency of infective endocarditis and predisposing diseases. During the time interval between 1987 and 1991 16 patients (50% younger than 50 years) were hospitalized with the diagnosis of infective endocarditis. Rheumatic valvular damage and inborn heart disease were the predisposing factor in 25%. All patients were younger than 30 years (mean 24, range 18-30), and half the patients suffered from defects of the ventricular septum. Other defects were tetralogy of Fallot and inborn aortic stenosis. In 10% of the patients infective endocarditis developed on the background of a mitral valve prolapse with regurgitation. Echocardiographic examination confirmed the diagnosis in almost 70% by revealing vegetation. Bacteriological examination revealed the agent in 60%, most frequently it was Streptococcus viridans. The mortality rate in the group was 13%.

CONCLUSIONS

The recorded incidence of infective endocarditis, 1.5 pro mille, is consistent with data in the literature. Corrected and not corrected heart disease plays an important role as predisposing disease. Despite the opportunity of intensive antibiotic treatment, the mortality remains high--13%.

[Relation between the blood coagulation status in hemodialyzed patients and arteriovenous fistula thrombosis--prospective study]

BACKGROUND

In a number of haemodialyzed patients occlusion of arteriovenous fistulae for different reasons occurs. In these patients many haemocoagulation changes are described. The objective of the present work was to assess whether these occlusions are due to hypercoagulation.

METHODS AND RESULTS

The investigation comprised 49 men and 32 women aged 49.3 +/- 9.3 years with renal insufficiency which had persisted for 28 +/- 17 months. Before the fistula was made, some parameters of haemocoagulation were examined. Depending whether within 6 months occlusion of the fistula occurred, the patients were divided into two groups. In a group of 18 patients with thrombosis of the fistula euglobulin fibrinolysis without stimulus (340 +/- 48 min.) was longer, also after veno-occlusion (199 +/- 50 min.), as compared with the group without thrombosis (277 +/- 38 and 121 +/- 27 min. resp.) and the level of the inhibitor of the plasminogen activator (PAI-1) differed: 3.3 +/- 0.6 i.u. as compared with 2.6 +/- 0.8 i.u. P < 0.001 in all three parameters. In the other parameters no significant differences were found (haematocrit, fibrinogen, F VII, AT III, protein C, number and aggregation of thrombocytes) al in all instances P > 0.05. The sum of hypercoagulation findings was higher in the first group (5.3 +/- 1.5) than in the second group (3.5 +/- 1.5, P < 0.001).

CONCLUSIONS

The authors assume that apart from other factors thrombosis of the fistula is influenced also by the haemocoagulation status, in particular fibrinolytic parameters. The latter may be supported also by other hypercoagulation factors which alone are ineffective.

[Congenital heart defects in pregnancy]

The authors investigated a group of 95 pregnant women with congenital heart disease. In two induced abortion was indicated fur cardiac reason (major left-to-right shunt in ASD II and in a patient with a non-corrected TOF with a significant right-to-left shunt). In the remainder the course of pregnancy was not complicated. From the total number of 132 deliveries only six were by Caesarean section, five times on obstetric grounds. One infant died, delivery during the 29th week by Caesarean section on account of premature escape of amniotic fluid--mother with a history of radial correction of TOF. Other relevant data are summarized in a table. In the conclusion the authors summarize basic provisions indicated in pregnant women with congenital heart disease.