[The Diagnosis is Obvious]. / Die Diagnose liegt auf der Hand.

Clinically amyopathic dermatomyositis (CADM) is a rare entity of dermatomyositis. As a rule, CADM presents without muscular involvement. Thus, the level of creatine kinase is most commonly within the normal range. Dermal manifestations of CADM are Gottron's papules and mechanic's hands. In the case of melanoma differentiation-associated gene 5 intracellular pathogen sensor (MDa5 antibodies), CADM is often associated with a rapidly progressive and severe form of interstitial lung disease. Pulmonary function tests reveal restriction and hypoxemia of varying degree. Features of ground-glass opacities, reticulations and consolidations are detected in high-resolution CT scan. Lymphocytes are sometimes predominant in bronchioloalveolar lavage. Pathologists see a picture similar to non-specific interstitial lung disease or organizing pneumonia. Pronounced immunosuppression is the most common therapy. However, sometimes a combination of different immunosuppressive therapies is necessary. A novel strategy to treat CADM with rapidly progressive interstitial lung disease is the Janus kinase inhibitor tofacitinib. Treatment can be monitored with the level of ferritin and MDa5-antibody titer. Mortality is as high as 84 %.

Mechanical properties and microstructure of Ti-35.5Nb-5.7Ta beta alloy.

OBJECTIVE: Titanium and titanium alloys represent generally accepted metallic biomaterials for clinical dentistry and dental implantology. In this paper, we present a Ti-35.5Nb-5.7Ta alloy with a special respect to its microstructure and mechanical characteristics, such as Young modulus of elasticity. METHODS: Three thermal treatments differing in temperature and time of annealing were used during the Ti-35.5Nb-5.7Ta processing in order to evaluate the effects of ageing, melting annealing, and annealing on mechanical characteristics and microstructure. RESULTS: Using microscopy, the alloy was analyzed and the differences in shares of beta phase grains, alpha particles and precipitates evaluated. The three thermal treatments were evaluated also from technological point of view. CONCLUSION: The following thermal treatment was found optimal for the Ti-35.5Nb-5.7Ta alloy: melting annealing at 800 °C for 0.5 hour followed by a cold swaging with a 52-79 % deformation, and final hardening at 500 °C for 2 hours in water(Tab. 2, Fig. 3, Ref. 24).

[Will ECG combined with echocardiography detect viable myocardium in patients after myocardial infarct?]. / Umozní kombinované EKG a echokardiografické hodnocení odhalit viabilní myokard u nemocných s prodelaným infarktem myokardu?

The objective of the submitted trial was to use combined examination of ECG at rest and after exercise to detect a viable heart muscle in patients with a postinfarction Q wave and ST elevations. The authors found that according to the character of changes of the ST elevation in ECG after exercise it is not possible to detect patients with a viable myocardium. During the combined procedure using analysis of the kinetic disorder at rest and increase of the ST segment in ECG after exercise it is possible in patients with hypokinesia or akinesia at the site of the Q wave to differentiate successfully 66% patients with a viable heart muscle. This combined procedure can serve as a selective test for implementation of further more accurate diagnostic tests for the detection of a viable heart muscle because in common clinical practice the above data are available in these patients before indication of more complicated examinations.

Regression of left ventricular hypertrophy in hypertensive patients after 1 year of treatment with rilmenidine: a double-blind, randomized, controlled (versus nifedipine) study.

OBJECTIVE: To assess the effect of 1-year treatment with rilmenidine, an oxazoline compound that exerts its antihypertensive effects through binding to imidazoline receptors in the brainstem, on left ventricular hypertrophy (LVH) secondary to essential, mild-to-moderate hypertension [supine diastolic blood pressure (DBP)95-115 mmHg]. METHODS: We performed a double-blind, randomized, controlled (versus slow-release nifedipine) trial. Adjustment of treatment took place every month (M) between inclusion (MO) and an evaluation after 6 months (M6), then during M9 and after 1 year (M12) to achieve supine DBP values < or = 90 mmHg. Patients were dropped from our study if they had DBP> 95mmHg during two consecutive visits or DBP>115 mmHg on one occasion. The daily dosage of rilmenidine was 1 mg, and could be increased to 2 mg/day. The daily dosage of slow-release nifedipine was started from the beginning at the maximum dosage of 40 mg/day, so that there was no true adjustment of treatment despite the allocation of patients to a different unit in the case of DBP> 95 mmHg. The primary criterion was the change in left ventricular mass index (LVMI, g/m2), assessed by echocardiography, between MO and M12 for patients who completed the trial. RESULTS: After a 1-month placebo run-in period, 76 patients were selected and 73 were included (35 treated with rilmenidine and 38 treated with nifedipine). Fifteen patients withdrew from the study and two completed the study with a major deviation from protocol, leaving 56 patients (24 treated with rilmenidine and 32 treated with nifedipine) for a per-protocol analysis. Baseline demographic characteristics and history of arterial hypertension for the rilmenidine and nifedipine groups were similar, for included patients and for those taken into account for the per-protocol analysis. Between MO and M12, DBP in members of the per-protocol population was adequately controlled for those in the rilmenidine group (102.7+/-4.6 versus 88.5+/-7.1 mmHg, respectively) and for those in the nifedipine group (102.7+/-5.1 versus 85.6+/-79 mmHg, respectively). During MO, LVMI of patients in the rilmenidine group (176.9+/-41.3 g/m2) was slightly higher than that of patients in the nifedipine group (172.6+/-35.1 g/m2). During M12, LVMI was observed to have decreased both for patients in the rilmenidine group (to 154.8+/-40.2 g/m2, a decrease of 22.1+/-23.3 g/m2, P< 0.001) and for those in the nifedipine group (to 145.6+/-36.4 g/m2, a decrease of 26.9+/-29.5 g/m2, P< 0.001) but the difference between these two groups was not significant (P= 0.5). CONCLUSION: One-year treatment with a daily dosage of 1 or 2 mg rilmenidine achieves a significant reduction of left ventricular mass, which is not statistically different than that occurring with a daily dosage of 40 mg of slow-release nifedipine.

Nebivolol in the treatment of cardiac failure: a double-blind controlled clinical trial.

BACKGROUND: Nebivolol is a highly cardioselective long-acting beta-blocker with vasodilating properties, which acts in part via the endothelial L-arginine/nitric oxide pathway. As an antihypertensive drug it is effective in once-daily dosage. Nebivolol has previously been shown to improve left ventricular function in patients with cardiac impairment. METHODS AND RESULTS: This paper reports a double-blind randomized trial comparing, in patients with heart failure, once-daily nebivolol 2.5 or 5.0 mg (initiated in all at 2.5 mg) with placebo on a constant background of digitalis plus diuretic. There was with nebivolol no overall deterioration of cardiac function or cardiac symptoms, and especially not of exercise capacity, in comparison with placebo. One patient on nebivolol 2.5 mg developed hypotension and pulmonary edema, and one patient on nebivolol 5 mg, bradycardia. All the remaining patients continued with unchanged diuretic and digitalis dosage. Nebivolol was accompanied by a trend toward clinical and functional improvement; rather better results were obtained with 2.5 than 5.0 mg. CONCLUSIONS: In view of increasing interest in beta-blockade in heart failure, nebivolol merits further study in this context. The capacity of nebivolol to enhance endothelial nitric oxide production appears potentially attractive.

[Importance of dipyridamole transesophageal echocardiography in the diagnosis of ischemic heart disease]. / Význam dipyridamolové transezofageální echokardiografie v diagnostice ischemické nemoci srdecní.

The importance of dipyridamol echocardiography in the diagnosis of ischaemic heart disease (IHD) was described repeatedly. Nevertheless in roughly 20% patients the transthoracic echocardiographic examination at rest is inaccurate or cannot be carried out because the ultrasonic visibility is poor. In these patients transoesophageal dipyridamol echocardiography (TEE Dip) can provide a suitable alternative. This is why the authors evaluated 36 patients examined on account of IHD before and after administration of 0.80 mg/kg dipyridamol. The left ventricle was visualized in the transgastric short axis and from the apical view. Angiography revealed significant stenosis of the coronary arteries in 23 patients. In 18 patients after administration of dipyridamol new motility disorders developed, in 5 patients with motility of the left ventricular wall, impaired at rest, no new disorder of kinetics developed, i.e. the test was falsely negative. Thirteen patients had no signs of stenosis of the coronary arteries and three developed disorders of the motility of the left ventricular wall. The sensitivity of TEE Dip for the diagnosis of left ventricular ischaemia was 78% and the specificity 79%. Dipyridamol load transoesophageal echocardiography is a method suitable for clinical application with a still satisfactory sensitivity and very good specificity and it can be implemented without involving the risk of serious side-effects.

[Comparison of dynamic and isometric loading in echocardiographic examinations in patients with ischemic heart disease]. / Srovnání dynamické a izometrické záteze pri echokardiografickém vysetrení nemocných s ischemickou chorobou srdecní.

The objective of the work was to compare functional indicators of the left ventricle during isometric (HG) and dynamic (Ergo) echocardiographic load examinations in patients with different grades of ischaemic heart disease. In group A they compared results in 34 patients with affection of three coronary arteries and in group B 15 patients with 1-2 coronary arteries affected. They evaluated the systolic, diastolic blood pressure, heart rate (HR), the index of the diastolic end volume EDV/m2, the index of the systolic end volume ESV/m2, Limacher's index for evaluation of left ventricular motility and the left ventricular ejection fraction (EF) at rest and after both types of loads. The EDV/m2 index increased in group A by 5.2 ml during an isometric load and by 10.4 ml during a dynamic load, in group B it increased by 1.6 and 7.0 ml resp. The values of the ESV/m2 index increased in group A by 8.5 ml during the isometric load and by 14.0 ml during the dynamic load, in group B by 4.1 and 10.8 ml resp. EF values at rest were similar in both groups: group A: 51.4%, B: 51.5%. During the isometric load the EF declined to 45.3% in group A and to 47,1% in group B. During the dynamic load the EF declined to 42% in group A and 42.5 in group B. The dynamic load produces, as compared with the isometric one, a statistically more significant drop of Limacher's index and greater volumetric changes of the left ventricular cavity in the group with 1-2 affected coronary arteries, as compared with the isometric load. In patients with three affected coronary arteries the volumetric changes during an isometric load are comparable with changes after a dynamic load.

[The effect of dipyridamole on pulmonary venous flow in patients with ischemic heart disease]. / Vliv dipyridamolu na toky v plicních zilách u nemocných s ischemickou chorobou srdecní.

In 56 patients with ischaemic heart disease the authors evaluated the blood flow in the pulmonary veins, using transoesophageal echocardiography by the pulsed Doppler technique in the left upper pulmonary vein. They assessed the peak systolic velocity (pVS), the systolic integral time-velocity (S-VTI), the peak diastolic velocity (pVD) and the integral time velocity in the diastolic part of the flow (D-VTI). They found a statistically significant correlation between the ratio pVS/pVD and the LVEDP assessed by the invasive method (r = 0.812). In 36 patients the authors evaluated the flow rate and time-velocity integral at rest and after administration of 0.78 mg/kg dipyridamol by the i.v. route. In 17 patients with affections of 2 or 3 coronary arteries (group A) after the administration of dipyridamol an increase of the maximal flow rate occurred in the diastolic portion of the flow (at rest 54.7 +/- 12.5, after dipyridamol 64.9 +/- 14.8 cm/s). The systolic flow velocities did not change in this group of patients (at rest 52.2 +/- 3.0, after dipyridamol 54.3 +/- 14.0 cm/s). In 19 patients with a negative coronarographic finding (group B) or with stenosis of one coronary artery after dipyridamol administration the systolic peak velocity increased (from 58.0 +/- 10 to 70.2 +/- 14.8 cm/s). The pVD values increased slightly after dipyridamol (at rest 42.5 +/- 14.3, after dipyridamol 52.1 +/- 15.6 cm/s).(ABSTRACT TRUNCATED AT 250 WORDS)

Global dimensional complexity of the EEG in healthy volunteers.

In contrast to the single-channel dimensional complexity, the global dimensional complexity is calculated from a multichannel EEG. The intention with the method is to measure the spatial distribution of information processing in the brain. The method seems to be of interest in psychopharmacological research, but the interpretation of the results in physiological terms is rather difficult. To get a more detailed information on the physiological significance of the EEG complexity measures, the influence of well-known physiological factors was studied in a group of 14 healthy subjects aged from 1.5 to 61 years. It was found that the correlation dimension was somewhat higher in older individuals, but the correlation with age was not statistically significant. However, the global correlation dimension was significantly lower during full alertness than during drowsiness. These results might reflect the changes in spatial structure of information processing, a high complexity suggesting a 'disorganisation' during drowsiness. As regards the age-dependent changes of the correlation dimension, the spatial 'flexibility' of information processing was also studied, using the differences between the 'alert' and 'drowsy' parts of the same EEG as indicator. It was found that the differences 'drowsy minus alert' were significantly related to age. A plausible interpretation seems to be that the spatial distribution of information processing is more changeable, or more flexible, in adults than in children.

[Evaluation of physical rehabilitation in myocardial revascularization using echocardiography]. / Hodnocení telesné rehabilitace po revaskularizaci myokardu zátezovou echokardiografií.

The authors investigated 155 patients, mean age 50.6 years, after revascularization of the myocardium. The group was divided at random into a group with a high intensity of physical rehabilitation (A) and a medium and low rehabilitation group (B). The rehabilitation programme comprised physical exercise at least three times per week for at least 30 mins. with a dynamic load up to 80% of the maximum heart rate in group A and up to 40% in group B. The mean initial haemodynamic indicators in both groups were equal (LVEDP 17.5 mm Hg and 16.5 resp. and EF 52.3% and 50.5% resp. in group A and B). Six months after revascularization the mean values of work tolerance increased in group A more than in group B (58.6 kJ, as compared with 44.2 kJ) and this difference is even greater after three years (70.4 kJ as compared with 51.5 kJ). The mean values of the ejection fraction (EF) at rest do not differ in the two groups after 6 months nor after 3 years (51.3% in group A, as compared with 54.6% in group B after 6 months, and 55.2% vs. 53.7% resp. after three years). The EF after a dynamic load after 6 months and 3 years does not differ in the two groups either (57.2% vs. 56.4% after 6 months and 55.1% vs. 54.5% after three years). Similar results were also obtained on evaluation of the mobility index of the walls at rest and after a dynamic load.(ABSTRACT TRUNCATED AT 250 WORDS)

[Significance of pulmonary vein flow for the determination of left ventricular filling pressure]. / Význam toku v plicních zilách pro odhad plnícího tlaku levé komory srdecní.

The aim of the submitted study was to evaluate the blood flow in the pulmonary veins by transoesophageal Doppler echocardiography which is the ideal method for recording the blood flow in the pulmonary veins as the ultrasound probe is closely behind the left atrium. In 35 patients with ischaemic heart disease the authors evaluated the blood flow in the pulmonary veins to assess whether the rate of the blood flow in these vessels can serve a non-invasive estimate of the end-diastolic pressure in the left ventricle (LVEDP). It was revealed that venous blood flow has in the majority of cases two anterior peaks during ventricular systole, one anterior peak during diastole and one negative peak during atrial contraction. In patients with normal LVEDP the peak rate and integral time-velocity of the flow curve is greater during systole, while in patients with a higher LVEDP these parameters are higher during diastole. Dopplerian assessment of the flow in the pulmonary veins is safe, relatively non-invasive and simple. This method makes possible rapid visual estimates of the end-diastolic pressure in the left ventricle.

Global dimensional complexity of multi-channel EEG indicates change of human brain functional state after a single dose of a nootropic drug.

Viewing the multi-channel EEG as a sequence of momentary field maps corresponds to the concept of a trajectory in K-dimensional state space (K = number of channels). This approach permits a quantitative, single value measure of complexity of the brain state trajectory, the global correlation dimension that describes the ensemble characteristics of all recorded channels. In 5 normal volunteers, 4 records of 16-channel resting EEG were obtained during each of 4 randomized sessions (double blind design) after a single dose of placebo or 2.9 g or 4.8 g or 9.6 g piracetam. The global correlation dimension of a 40 sec epoch from each record was estimated, using 50 computational runs with 8192 point pairs. The results were combined for the two intermediate doses and averaged over repeated records. The dimensionality decreased from placebo (median = 5.89) to low dose (median = 5.72) to high dose (median = 5.59), significant in a Friedman ANOVA at P < 0.02, with significant differences between placebo vs. high and low vs. high dose. Thus, the subtle change of brain global functional state after a single dose of piracetam is reflected by the non-linear measure of global dimensional complexity of the multi-channel EEG.

Dimensional complexity of EEG brain mechanisms in untreated schizophrenia.

The dimensional complexity of left temporal-parietal and parietal-occipital electroencephalographic (EEG) recordings was assessed by computing the correlation dimension during 20 sec in six recording conditions from 15 first-episode acute schizophrenics before medication, 12 other medication-free individuals clinically and socially remitted after a first schizophrenic episode, 17 medication-free neurotics and 17 controls. The correlation dimension of the temporal-parietal EEG differed between groups [analysis of variance (ANOVA)] (p < 0.004), whereas neurotics (different from schizophrenics at p < 0.002) and remitted schizophrenics showed intermediate values. There was no overall significant difference between groups in the parietal-occipital EEG. Differences of the correlation dimension of the temporal-parietal versus the parietal-occipital EEG were significant between groups (ANOVA p < 0.05); first-episode schizophrenics differed from controls (p < 0.002) and remitted patients (p < 0.08). Increased dimensional complexity of schizophrenic EEG was found in one of two examined brain regions. The higher dimensional complexity of functional brain mechanisms in schizophrenics versus normals is reminiscent of the loosened organization of thought, and of suggestions of certain superior abilities in the patients.

[Transesophageal stress echocardiography]. / Transezofageální zátezová echokardiografie.

The authors submit their initial experience with the work protocol of transoesophageal loading echocardiography, which they used in 148 patients. The method is meant in the first place for individuals where the records of classical transthoracic echocardiography in 10-25% are difficult to visualize by echocardiography or patients who for any reasons cannot be subjected to common loading examinations. The informative capacity of this method is almost 100%. It makes it possible to evaluate every accurately filling and ejection indicators as well as changes in the motility of cardiac walls.

[Echocardiographic evaluation of the left ventricle in mild hypertension treated with physical exercise]. / Echokardiografické ukazatele levé komory pri lécbe mírné hypertenze telesným tréninkem.

The authors submit findings of haemodynamic changes during long-term treatment of mild hypertension by physical training. Using this method, blood pressure was normalized in all subjects. The authors conclude that physical activity has a similar impact on the haemodynamics of mild hypertension as drugs which reduce the tension of the sympathetic nerve. A surprising finding was the diminution or complete disappearance of cardiac hypertrophy in this treatment.

Pharmacokinetics and tolerance of 7-methoxytacrine following the single dose administration in healthy volunteers.

7-methoxy-tetrahydroaminoacridine (7-MEOTA) is a new reversible cholinesterase inhibitor. Forty-eight young male volunteers divided into six dosage groups were included into a single-dose pharmacokinetic study with either oral (p.o.) or intramuscular (i.m.) administration. The dose of 7-MEOTA was 2, 4 or 8 mg/kg body weight p.o. or 0.5, 1 or 2 mg/kg body weight i.m. in the respective six dosage groups. The plasma levels data were fitted to an open one-compartmental model. The compound showed cholinomimetic adverse effects in 2 subjects with the blood levels exceeding 1,500 micrograms/l. The red blood cells levels paralleled those in plasma and were 2.5 times higher. The tmax was 4 hours and 1 h, t1/2 8.7 +/- 3.9 hours and 6.5 +/- 5.8 hours in case of p.o. and i.m. administration, respectively. The apparent clearance (D/AUC) was 5 times higher following p.o. administration, reflecting the differences in bioavailability.

Bopindolol: Czechoslovak experience with a new beta blocker in the treatment of hypertension.

Bopindolol is a nonselective beta blocker with mild intrinsic sympathomimetic activity. One of the drug's main benefits is its prolonged effect, lasting for 24 hours, which makes it possible to administer bopindolol in a single daily dose, a fact that may improve patient adherence to therapy. A double-blind study was performed in two centers, comparing bopindolol with metoprolol in 86 hypertensive patients. Baseline diastolic blood pressure (BP) was 100 to 120 mm Hg. The effects of bopindolol or metoprolol on BP and heart rate were similar: return to normal values was achieved in 70% of patients with either drug. A 6-month study at another center found that bopindolol did not affect the levels of total cholesterol, low-density and high-density lipoprotein cholesterol or triglycerides. Another 12-month study documented a decrease in total cholesterol, apolipoprotein (apo) A1 and apo B. The apo A/B ratio rose, thus improving the atherosclerotic index. No deterioration of glucose tolerance or immunoreactive insulin response to glucose was seen after 6 months of bopindolol administration. Bopindolol satisfactorily modifies not only resting but also exercise BP during isometric and isotonic load, thus reducing BP fluctuation during physical activities of the hypertensive patient. The drug exerts no effect on renal and liver function, electrolyte balance and hematologic parameters. Bopindolol is a very useful drug of first choice in mild and moderate hypertension. Bopindolol's main advantages include its prolonged action, good tolerance and a beneficial effect on risk factors of atherosclerosis (lipid and carbohydrate metabolism).

Antihypertensive effect of isradipine on blood pressure at rest and during exercise.

After three months of treatment with isradipine, 20 patients with mild hypertension had reduced their resting blood pressure (BP) from 157/103 to 132/85 mm Hg and their BP during isometric exercise from 192/124 to 166/105 mm Hg. The isradipine dose necessary to normalize BP (both at rest and post-exercise) was 1.25 mg twice daily (2 x 1/2 tablet) in 50% of patients and 2.5 mg twice daily (2 x 1 tablet) in 25%. In the remaining 25% of patients, isradipine was combined with 1 mg/day bopindolol. There were virtually no accompanying side effects; in particular, reflex tachycardia was negligible or absent. It is concluded that isradipine is a reliable antihypertensive treatment in mild-to-moderate hypertension.

Isradipine in monotherapy and in combination with bopindolol: results of a 3-month multicentre study in hypertensives.

The antihypertensive effect and safety of treatment of hypertension with isradipine, a Ca antagonist of dihydropyridine group in monotherapy and in combination with the betablocker bopindolol was assessed in a multicentre study joined by six Czechoslovak centres. When administered alone to 102 patients with essential hypertension stages I and II, isradipine was effective in 59%. Forty-one per cent of patients required combined therapy. The treatment led to a marked decrease in diastolic BP in smokers and non-smokers alike. A significant rise in ALP was observed during therapy in both therapeutic regimens. A significant decrease in cholesterolaemia was found in patients treated with the isradipine-bopindolol combination. No serious adverse effects were seen during three-month follow-up.

[Use of the postural test in stress echocardiography]. / Vyuzití polohového testu v zátezové echokardiografii.

The authors introduced and evaluated the clinical importance of the echocardiographic positional test for the detection of left ventricular insufficiency after exercise. They found that in decompensated ischaemic patients, contrary to healthy subjects, left ventricular ejection indicators deteriorate. Latent left ventricular weakness in ischaemic patients without clinical signs of heart failure is revealed by positional reduction of the rate of shortening of the circumferential fibre. The authors conclude that this test does not fully replace the work load examination. The change of position is, however, a simple, preliminary functional test which may be useful in patients with ischaemic heart disease for checking treatment, rehabilitation and the selection of subjects for further aimed examinations.