Prevalence of metabolic syndrome and related metabolic traits in an island population of the Adriatic.

BACKGROUND: Metabolic syndrome, a constellation of risk factors associated with cardiovascular disease and Type 2 diabetes, has reached epidemic proportions worldwide. Epidemiological studies in transitional societies will provide insight into the underlying factors that interact in its manifestation. AIMS: To estimate the prevalence of metabolic syndrome, provide a comparative analysis of two metabolic syndrome definitions and assess clustering and association of metabolic traits and cardiovascular diseases in an Adriatic island population. SUBJECTS AND METHODS: In a cross-sectional study, data on four anthropometric, blood pressure and 11 biochemical traits were obtained from 1430 adults from the island of Hvar. RESULTS: Prevalence of metabolic syndrome was 25% and 38.5% based on Adult Treatment Panel III and International Diabetes Federation definitions, respectively. Rates of abdominal obesity, elevated blood glucose and hypertension were high. Among the traits not included in the definitions, levels of LDL, total cholesterol and fibrinogen were markedly elevated. The majority of the phenotypes were significantly associated with the syndrome, the strongest being waist circumference. CONCLUSION: The Croatian islanders are characterized by a high prevalence of metabolic abnormalities. Central obesity is the strongest contributor of the syndrome. With a high prevalence of dyslipidemia and pro-inflammatory factors, the population is at substantial risk for cardiovascular diseases.

Sudden cardiac death due to physical exercise in male competitive athletes. A report of six cases.

In the period of 30 years, i.e. from 1973 to 2002, we noticed in Croatia 6 sudden and unexpected cardiac deaths in male athletes during or after training. Two were soccer players, 2 athletic runners, one was a rugby player and one was a basketball player. All of them were without cardiovascular symptoms. At the forensic autopsy, the first athlete, aged 29, had chronic myocarditis and thickened left ventricular wall of 15 mm. The second, aged 21, had an acute myocardial infarction of the posterior wall with normal coronaries and thickened left ventricular wall of 15 mm. The third aged 17, had hypoplastic right coronary artery and narrowed ascending aorta, suppurant tonsillitis and subacute myocarditis. Two athletes, aged 29 and 15, had hypertrophic cardiomyopathy and normal coronaries, and one dilated aorta. The sixth, aged 24, had arrhythmogenic cardiomyopathy of the right ventricle. All the 6 athletes died suddenly, obviously because of malignant ventricular arrhythmias. In Croatia the death rate among athletes reached 0.15/100 000, in others who practice exercise reached 0.74/100,000 and the difference is highly significant (c2=14.487, Poisson rates=3.81, P=0.00014) and in physicians-specialists reached 33.6/100,000. Preventive medical examinations are essential, especially in athletes before physical exercise, as are other investigations in every case suspicious of heart disease, including electrocardiogram (ECG), stress ECG, echocardiography and stress-echocardiography and other findings if indicated. Physical exercise is contraindicated in acute respiratory infection: in 2 of those cases had been a cause of death as a trigger.

Does any correlation exist between a high plasma digoxin level and an electrocardiogram in older and younger patients?

In a group of 171 patients aged 65 to 92 years and 58 patients aged 35 to 64 years, plasma digoxin level measuring 2.5-6.2 nmol/l correlated with the clinical symptoms and the electrocardiogram. Conduction disturbances and arrhythmias as well as the P-R interval, P-T-Q index, and corrected Q-T interval in the ECG were analyzed. Clinical symptoms of hypersaturation with digitalis were present in 55.5% of the elderly and 34.4% of the younger patients. Conduction disturbances were found in 43.2% of the elderly and 20.6% of the younger patients, while arrhythmias appeared in 40.3% of the elderly and 29.3% of the younger patients: 16.3% of the elderly and 50.1% of the younger patients were without these changes. A correlation between the P-R interval and high plasma digoxin level in the elderly (p < 0.01) and younger patients (p < 0.05), as well as between the P-T-Q index and high plasma digoxin level in the elderly (p < 0.01), was found. There was no correlation between the corrected Q-T interval and high plasma digoxin level in both groups. No correlation was found between the high plasma digoxin level and serum creatinine level in both groups, or between the high plasma digoxin level and serum potassium level in both groups, although many patients had chronic renal failure. The effect of digitalis has not been shown to be a cause of specific changes in an electrocardiogram either in the elderly or in younger patients. However, the association between prolonged P-R interval, as well as changes in the P-T-Q index, and high plasma digoxin level has been found more often in the elderly than in younger patients.

The preexcitation syndrome: epidemiological and genetic study.

A sample of 4210 subjects of both sexes aged 35-54 years was examined, chosen at random from six regions of Croatia. An electrocardiogram at rest was performed in all subjects and changes analyzed by the Minnesota code. A short P-R interval together with a widening QRS complex and a delta wave was found in 0.05%, while 42 (1.0%) of the examinees had a short P-R interval, but only 0.21% were symptomatic. Three years after the first examination 0.06% of the subjects had preexcitation with a delta wave, and in one subject it appeared after three years. 0.35% of the subjects had a short P-R interval after three years but only 0.18% were symptomatic and in 22 (0.65%) it had disappeared in three years. After 13 years these subjects did not appear for an examination, and the short P-R interval did not appear in any of other subjects during this period. There were more short P-R intervals: 3.22% in females and 1.96% in males, but 0.33% only were symptomatic. Antigens of the human leukocyte group A (HLA) system were analyzed in 46 patients: the Wolff-Parkinson-White syndrome was found in 35, while 11 had the Lown-Ganong-Levine syndrome. Antigens of the HLA-A, HLA-B and HLA-DR locuses were determined by the microlymphocytotoxicity method. The results of the frequency of HLA system antigens were compared to the results of the control group of a Croatian population consisting of 175 people. There was an increased frequency of HLA-A9 and HLA-B5 (P = 0.026 and 0.0092) in the investigated population as a whole. The participation of HLA-A3 antigen was significantly less among patients (P = 0.03), while HLA-B14 antigen was not found in patients with preexcitation. Within 10 HLA-DR locuses, HLA-DR7 antigen was rather more frequently present, although this was not statistically significant (P = 0.173).

Changes of the corrected Q-T interval in the electrocardiogram of patients with anorexia nervosa.

Thirty patients with anorexia nervosa and 30 controls had an electrocardiogram with the corrected Q-T interval. The aim of the study was to analyse the corrected Q-T interval in patients with anorexia nervosa compared with the findings in the control group, to compare the body mass index between two groups and to measure underlying dispersion of the corrected Q-T interval in each of the 12 ECG leads in both groups. All corrected Q-T intervals were measured in each of the 12 ECG leads and the longest values of three consecutive intervals were used for this analysis. The prolonged corrected Q-T interval was found in 12 out of 30 patients with anorexia nervosa (40%), with the longest mean values of 0.421 s (range, 0.334-0.500 s), and in 2 out of 30 patients of the controls (7%), with the longest mean values of 0.390 s (range, 0.343-0.444 s). The difference was statistically significant (t = 4.453, P < 0.001). Relative risk for prolongation of the corrected Q-T interval in patients with anorexia nervosa was high: 12 compared with control subjects. The longest values of the corrected Q-T interval in both groups, and the longest values of the prolonged corrected Q-T interval in both groups were observed in the anteroseptal leads of the electrocardiograms. The mean serum potassium level in the group with anorexia nervosa was 3.97 and in the control group was 4.15 mmol/l.(ABSTRACT TRUNCATED AT 250 WORDS)

Q-T and JT dispersion in the elderly with urban hypothermia.

Twenty elderly patients (12 females and 8 males, aged 65-88 years) were treated because of hypothermia: 11 suffered from moderate (35-32 degrees C) and nine from severe hypothermia (<32 degrees C). The control group consisted of 20 age and sex-matched healthy elderly persons. Twelve-channel electrocardiograms were recorded on admission and during hospitalization. In patients with moderate hypothermia Osborn wave was present in eight of 11, and minimal Osborn wave in three of 11; in severe hypothermia Osborn wave was seen in seven of nine, and minimal in two of nine. The corrected Q-T interval (Q-Tc) was analyzed according to the formula of Bazett: measured Q-T(s)/ radical R-R(s). The JT and the corrected JT interval (JTc) were measured according to the formula: JT=Q-T-QRS. The Q-T interval index (Q-TI) was measured according to the formula: (Q-TI:656)x(HR+100); and the JT interval index JTI: (JT:518)x(HR+100). The dispersion of the Q-Tc (JTc) was defined as the difference between maximum and minimum measured Q-Tc interval (JTc). The Q-Tc interval in the group with hypothermia was 651.41+/-130.06 ms, while in the control group it was 398.14+/-76.21 ms (P<0.001). The Q-Tc dispersion in the group with hypothermia was 91.39+/-51.98, and in the control group 33.21+/-10.25 ms (P<0.001). The Q-TcI in the group with hypothermia was 89.91+/-21.44, and in the control group 39.56+/-9.41 ms ((P<0.001). The JTc in the group with hypothermia was 542.66+/-132.74, in the control group: 328.06+/-76.92 (P<0.001). The JTc dispersion in the group with hypothermia was 79.35+/-46.22, and in the control group 28.53+/-7.99 (P<0.0001). The JTcI in the group with hypothermia was 93.06+/-17.38, in the control group it was 40.23+/-7.59 (P<0.001). The mean values of the Q-TcI were greater than Q-TI, and the mean values of the JTcI were greater than JTI, but the difference was not significant (P>0.10). The mean values of the JTcI were greater than Q-TcI, but the difference was not significant as well (P>0.05). There was no correlation between rectal temperature and dispersion of Q-T, Q-Tc, JT, JTc, and Osborn wave. The maximum Osborn wave and the maximum Q-T interval were registered in anteroseptal leads (V(2)-V(3)). The dispersion of the Q-Tc and of the JTc lasted more than Osborn wave. There was no correlation between rectal temperature and PR interval, RR interval and QRS duration. The prolonged dispersion of the Q-Tc (and JTc) last 24-48 h longer than Osborn wave.

The influence of atenolol and propafenone on QT interval dispersion in patients 3 months after myocardial infarction.

UNLABELLED: The aim of the study was to determine changes in QTc dispersion and QTc interval during the administration of atenolol and propafenone. METHODS: Eighty-five patients, 3 months after myocardial infarction, were randomized in 2 groups. The first group (n = 46) received atenolol 50 mg daily during 7 days and the second group (n = 39) propafenone 300 mg per os twice a day. QT interval was measured in 12 ECG leads before and after the treatment after 100% strip enlargement on a photocopy machine. For correction we used Bazett's formula. QTc dispersion was defined as the difference between the longest and the shortest QTc interval in 12 ECG leads. RESULTS: QTc dispersion increased significantly with the severity of arrhythmia (< 50 premature ventricular complexes vs. ventricular tachycardia, 82.3 (18.1) vs. 110.0 (9.0) ms (p < 0.001)). QTc dispersion significantly decreases with the administration of atenolol (72.7 (14.8) vs. 63.6 (15.3)) (p < 0.001) as well as with propafenone (75.0 (17.7) vs. 63.2 (16.4)) (p < 0.001). QTc interval also decreases with atenolol (451 (28) vs. 431 (32)) (p < 0.01) while it does not change with propafenone administration (441 (26) vs. 444 (26)). CONCLUSION: QTc dispersion is associated with ventricular tachycardia. Both atenolol and propafenone significantly decrease QTc dispersion. Atenolol also decreases QTc interval, while with propafenone it does not change.

Does any correlation exist between a high plasma digoxin concentration and an electrocardiogram in younger and older patients.

In a group of 152 elderly patients (age range between 65 to 92 years) and 54 patients (aged 35 to 64 years) plasma digoxin level measuring 2.5-6.2 nmol/1 were correlated with the clinical symptoms and the electrocardiogram. The conduction disturbances and arrhythmias as well as the P-R interval, P-T-Q index and corrected Q-T interval in the ECG were analyzed. The clinical symptoms of hypersaturation with digitalis were present in 54.6% of the elderly and 35.2% of the younger patients. Conduction disturbances were found in 42% of the elderly and 22.2% of the younger patients, while arrhythmias appeared in 40.1% of the elderly and 31.5% of the younger ones. 17.8% of the elderly and 46.3% of the younger patients were without these changes. The correlation between P-R interval and high plasma digoxin level in the elderly (p < 0.01) and younger patients (p < 0.05), as well as between the P-T-Q index and high plasma digoxin level in the elderly (p < 0.01) was found. There was no correlation between the corrected Q-T interval and high plasma digoxin level in both groups. No correlation was found between a high plasma digoxin level and serum creatinine level in both groups, neither between a high plasma digoxin level and serum potassium level in both groups. The effect of digitalis has not been shown to be a cause of specific changes in an electrocardiogram neither in the elderly nor in younger patients. However, the association between prolonged P-R interval as well as changes in the P-T-Q index and high plasma digoxin level has been found more often in the elderly than in the younger patients.

A prospective study of S-T segment depression in the electrocardiogram and mortality in the population.

A prospective study was carried out of all degrees of horizontal or descending depression of the S-T segment in the electrocardiogram (more than 1 mm or 0.1 mV, 0.5-0.9 mm or 0.05-0.05 mV and up to 0.5 mm or 0.05 mV) in a sample of 2414 subjects of both sexes, aged 35-54 years, (1326 females and 1088 males) in six Croatian regions on three occasions during a 13-year period: 1969, 1972 and 1982, according to the Minnesota code. S-T segment depression in the ECG was found during the first examination in 10.69% of females and 4.13% of males; during the second examination in 12.66% females and 6.24% males, and in the third examination in 19.06% females and 12.12% males. S-T segment depression of up to 0.5 mm was dominant and twice as frequent in females than in males, and the difference was significant. S-T segment in the ECG was also analyzed in a sample of 239 subjects (141 males and 98 females) who died during the period between the second and third examination, and for whom ECGs had been recorded in 1969 and 1972. In the group of females who died during the period between the first and second examination, 16.32% had all degrees of S-T segment depression, while in the group of surviving females this amounted to 10.6%. In the group of deceased males this finding was found in 4.24% of deceased and 4.13% of surviving males. In the group of females who died between the second and third examination, S-T segment depression was found in 18.36% of deceased and 12.66% of surviving females, and 10.62% in deceased males and 6.24% in surviving males (depression of 1 mm or deeper and 0.5-0.9 mm was found in 7.08% of deceased and 1.28% surviving males). The relative risk of mortality in middle-aged females with S-T segment depression of 0.5 mm or deeper, was 3.65 times higher than in females without such ECG changes, while the relative risk of mortality in males of the same age with the same finding was 5.85 times higher than in those without such ECG changes.

Sudden death due to recreational exercise in physicians.

In a period from 1982-2002 we noticed five dead among Croatian male physicians aged 34 to 67, during or after recreational physical exercise: swimming, soccer, tennis and jogging. Three of them who were autopsied, have been non-smokers and without previous symptoms. In all coronary heart disease was found. The left descending anterior artery was stenotic in one and occluded in two, with myocardial scars in one. An acute myocardial infarction was found in none of them, and in two-left ventricular hypertrophy 15 and 18 mm. We could not find a recent medical record in those physicians including a clinical finding and other findings. Two physicians who were not been autopsied, had possible an alcohol cardiomyopathy. Both of them were smokers. In Croatia about 7% of the whole population are engaged in recreational physical exercise. In a period of twenty years (1982-2002) we noticed 43 sudden and unexpected deaths during or immediately after physical exercise: it reached 43/6,300,000 sudden death in Croatia in twenty years or 2.15/315,000 yearly among persons engaged in physical exercise. In Croatia there are 4,957 male physicians-specialists, and a rate of sudden cardiac death during or immediately after physical exercise in this group reached 5/99,140 in 20 years or 1/19,828 every four years. A medical check up before recreational physical exercise is essential including a clinical examination, a serum concentration of risk factors and other risk factors, an electrocardiogram at rest, a stress test and echocardiography in clinical indication, as are medical controls over persons taking exercise. This study shows that medical evaluation is important because of the underlying problems such as sudden death during exercise. In non-trained persons and in the elderly a physical exercise should be recommended of a gradually intensity, which could not exceed 6 METs.

Sudden death due to physical exercise in the elderly.

Physical exercise has a beneficial effect to the humans. Sudden death in healthy persons engaged in physical exercise is extremely rare since healthy heart is protected from complications. The records of five elderly men who died during or immediately after exercise in the period between 1988-2001 in our region have been given, out of 23 men (and no one woman) aged 14-68 who died due to physical exercise in that time. They have been engaged in tennis, jogging and swimming recreatively. In all of them coronary heart disease has been found by the forensic autopsy. Only one has had arterial hypertension, symptoms of chest pain few years before accident and acute myocardial infarction has been found. The other four have been without symptoms. In three of them myocardial scars have been found of past myocardial infarctions. In all of them the thickness of the left ventricle wall was 15 mm or more (from 15 to 25 mm). It seems that the thickness of the wall of the left ventricle increases cardiovascular risk in persons without symptoms. In Croatia about 7% of the whole population are engaged in recreation. In this population 13% are elderly: 40,950. The reported five deaths due to recreational physical exercise in the elderly reached 1/114,660 persons every three years, or 1/573,300 persons during fourteen years.

Urban hypothermia and hyperglycemia in the elderly.

From December 1993 to March 1999 we treated 18 elderly patients aged 66-87 years, suffering from urban hypothermia: 11 women and 7 men. Ten patients suffered from moderate hypothermia (rectal temperature 32-35 degrees C), and eight from severe hypothermia (rectal temperature < 32 degrees C). Regarding consciousness, in the group suffering from moderate hypothermia, 3 were somnolent and 6 in various degrees of comatose states. In the group suffering from severe hypothermia, 3 patients were somnolent or soporous and 5 in comatose states of various degrees. Values of arterial blood pressure in the group with moderate hypothermia was normal in one, in 3 arterial hypotension was observed and 6 were in a state of shock. In the group with severe hypothermia, 3 presented arterial hypotension and 5 were in a state of shock. In the group with moderate hypothermia the blood glucose level was elevated in six: 9.3-10.2-10.7-17.9-21.3-99.0, and in one patient the blood glucose level was low: 2.3 mmol/L, in correlation with hypoglycemic coma. In the group with severe hypothermia in all eight patients the values were elevated: 6.7-7.4-7.6-8.7-9.1-11.2-12.4-17.9 mmol/L.

The usefulness of biochemical bone markers in predicting the response of hormone replacement therapy in perimenopausal cigarette smoking healthy women.

The purpose of our study was to evaluate the effects of orally administered combined sequential estradiol (2 mg 17 beta estradiol) with progestin (1 mg norethisteron acetate) daily during ( +/- SD) 15.34 +/- 13.89 months on bone markers in perimenopausal cigarette smoking women. The control group consisted of cigarette smoking perimenopausal women without hormone replacement therapy (HRT). The following biochemical bone markers were analyzed in hormone replacement users (N = 35) and non-users (N = 28): serum total calcium (Ca), total alkaline phosphatase (ALP), procollagen I C-terminal propeptide (PICP), cros-linked carboxyterminal collagen I telopeptide (ICTP) and osteocalcin (OC). When we compared the results of bone markers in the cigarette smoking current users and non cigarette smoking non-users, we found statistically significant lower levels of bone formation markers, ALP and OC, and lower level of bone resorption marker; ICTP in users than in non-users. In perimenopausal cigarette smoking women on HRT lower levels of new biological markers reflected less intensive bone remodelling and probable decrease in bone loss than in non-users. These results indicate that the measurement of biological bone markers are useful to identify risk women for osteoporosis who may have special benefit from the treatment with hormone replacement therapy, even when they smoke.

The corrected Q-T interval in the elderly with urban hypothermia.

During winter time in the period from 1993 to 1998, 18 elderly patients: 11 female and 7 male aged 65-88 years, were treated because of hypothermia. Rectal temperature on admission was 20-34.5 degrees C. Ten patients suffered from moderate hypothermia (35-32 degrees C), and eight suffered of severe hypothermia (< 32 degrees C). Arterial hypotension was recorded in 7, and shock in 11 patients. In all of them, and in 18 controls, an electrocardiogram was analyzed with the special reference to the corrected Q-T interval. Decompensated metabolic acidosis was observed in 7/8 patients with severe hypothermia and in 4/10 with moderate hypothermia. Among patients with moderate hypothermia, sinus tachycardia was present in 2, sinus bradycardia in 2, idioventricular rhythm in 2 and atrial fibrillation in 4/10 patients. In patients with severe hypothermia, sinus tachycardia was present in 2, sinus bradycardia in 3, idioventricular rhythm in one, and atrial fibrillation in 2/8 patients. In moderate hypothermia Osborn's or Tomaszewski's J wave was present in 7/10, and it only appeared in 3/10 patients; in severe hypothermia it was present in 6/8 and only appeared in 2/8 patients. The corrected Q-T interval in the group with hypothermia ranged 0.450-0.688 s, in the control group 0.343-0.444 s. The X minimum (s) in the group with hypothermia was 0.508 +/- 0.079, in the control group it was 0.371-0-139 s, and the difference was statistically significant (p < 0.001). The X maximum (s) in the group with hypothermia was 0.576 +/- 0.067 s, in the control group 0.390 +/- 0.019 s, and the difference was also statistically significant (p < 0.0001). In both groups the most significant prolongation of the corrected Q-T interval in the majority of patients was found in anteroseptal leads. The dispersion of the corrected Q-T interval in the group with hypothermia was 87.19 +/- 28.44 ms, in the control group it was 32.06 +/- 8.94 ms, and the difference was statistically significant (p < 0.001).

Body composition and functional abilities in terms of the quality of professional ballerinas.

The objective of this research was to determine the variability of the sample of professional ballerinas in the space of characteristics of their body composition and some functional characteristics according to the requirements of their roles in ballet. The sample of examinees was comprised of 30 professional ballerinas, members of the Croatian National Theatre Ballet (15 soloists and 15 members of the corps de ballet). The data showed that the soloists were characterized by a significantly larger knee diameter, significantly lower thickness of skin folds on the trunk and the lower fat body mass percentage, as well as by greater grip strength. Aerobic capacity was only moderately more developed than in fit people who participated in physical exercising because of recreational reasons, and there were no differences between soloists and the members of the corps.

Hypothermia and acute renal failure in the elderly.

During 1993-1998, in winter time 14 elderly patients: 8 female and 6 male aged 65-88, were treated because of hypothermia. Rectal temperature on admission was 20-34.9 degrees C. Sopor was present in 2 and various grades of coma were present in 10 patients. Arterial hypotension was recorded in 5, and shock in 9 patients. Increased serum creatinine level was found in 8 patients. The mean rectal temperature in the whole group was 31.3 degrees C +/- 4.7, ranging from 20.0 to 34.9 degrees C, and the mean serum creatinine level was 172.2 +/- 93.5, in range of 66.0 to 360.0 mumol/L. Negative correlation between those two parameters was found: r = -0.572. In 2 of them parameters of renal failure were analyzed: urine sodium concentration, creatinine urine/plasma ratio, urine osmolality, urine/plasma osmolality ratio, renal failure index and fractional excretion of filtered sodium. In one of the patients all parameters were within the range of functional oliguria, in an other the urine sodium concentration serum showed acute renal failure, but all other findings showed borderline values between functional oliguria and acute renal failure. Twelve out of 14 patients died within 1-216 hours from admission.

[Ethylene glycol poisoning treated with hemodialysis]. / Otrovanje etilen glikolom lijeceno hemodijalizom.

The paper deals with the course of illness in a patient aged 56 years who had ingested accidentally an unknown amount of alcoholic drink followed by 150 ml of 95 percent solution of ethylene glycol. The patient was admitted to the intensive care unit 28 hours after the accident. The serum ethylene glycol concentration reached 14 mg/100 ml. The slow elimination of ethylene glycol during 28 hours before haemodialysis could be explained by the protective effect of ethanol which the patient had consumed before ethylene glycol. The method of extracorporeal haemodialysis was applied for four hours; the membrane surface was 1.3 m2 and blood velocity 200 ml/min. The rate of clearance of ethylene glycol and its metabolites was 110-150 ml/min. The total amount of ethylene glycol eliminated during four hours of haemodialysis came to about 5 g. Four hours from the beginning of the treatment the serum ethylene glycol concentration was not measurable. As the patient developed signs of acute renal failure the haemodialysis method was applied two more times. The patient was dismissed from hospital in good clinical condition, with normal diuresis and repaired renal function on the 13th day from admission.

Angiotensin-converting enzyme gene polymorphism, lipids, and apolipoproteins in menopausal women on hormone replacement therapy.

This study investigated the frequency of angiotensin-converting enzyme (ACE) genotypes, concentrations of total cholesterol (T-C), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), lipoprotein Lp (a), Established Risk Factor (ERF) ratio (total cholesterol/HDL-C), apolipoproteins A-I, A-II, apoBand apoE in 134 menopausal women aged 49.62 +/- 4.83 on oral hormone replacement therapy (HRT) (2 mg 17 beta estradiol plus 1 mg norethisterone acetate/day), during (mean +/- SD) 15.77 +/- 9.94 months. ACE genotypes of 134 menopausal women showed DD genotype in 48 (36%), ID genotype in 59 (44%), and II genotype in 27 (20%) women, with the mean body mass index (BMI) (kg/m2) of 26.34 +/- 4.02, systolic blood pressure (mm Hg) of 145.71 +/- 23.32, diastolic blood pressure of 95.28 +/- 12.88, pulse rate of 77.76 +/- 13.81, positive family history of myocardial infarction (MI) (23%) and stroke (22%); 26% were smokers and 6% consumed alcohol regularly. The mean levels of TC (mmol/l) were 5.72 +/- 1.25, TG (mmol/L) 1.63 +/- 0.82, HDL-C (mmol/L) 1.15 +/- 0.29, LDL-C (mmol/L) 3.98 +/- 1.31, lipoprotein Lp(a) (g/L) 0.16 +/- 0.24, ERF ratio 5.35 +/- 1.90, apolipoproteins (g/L): A-I 1.83 +/- 0.39, A-II 0.57 +/- 0.12, apoB 0.92 +/- 0.31, and apoE 0.08 +/- 0.04. The highest mean levels of T-C 5.89 +/- 1.40, TG 1.67 +/- 0.96, LDL-C 4.15 +/- 1.60, lipoprotein Lp(a) 0.19 +/- 0.25) apoB 0.95 +/- 0.32 and ERF ratio 5.46 +/- 2.24 were found in ID genotype, while in DD genotype HDL-C 1.11 +/- 0.28 and apo A-I 1.78 +/- 0.34 were lowest. In II genotype, the levels of apo A-II 0.56 +/- 0.11 were lowest and of apoE 0.09 +/- 0.05 highest. According to DD, ID and II genotypes and lipid, lipoprotein Lp(a), ERF ratio and apolipoprotein concentrations, there were no statistically significant differences between groups. ERF ratio in DD genotype showed a positive correlation with TG (r = 0.59) and LDL-C (r = 0.57), a slight positive correlation with apoB (r = 0.40), and a strong negative correlation with HDL-C (r = -0.73). ERF in ID genotype showed a strong negative correlation with HDL-C (r = -0.73), strong positive correlation with TG (r = 0.70), and T-C (r = 0.58), and slight positive correlation with LDL-C (r = 0.36) and alcohol abuse (r = 0.34). In II genotype, ERF ratio showed a strong positive correlation with LDL-C (r = 0.73), T-C (r = 0.70) and apoE (r = 0.58), slight positive correlation with apoB (r = 0.46) and TG (r = 0.36), and negative correlation with HDL-C (r = -0.54). Matrix correlation of DD genotypes showed the highest positive correlation between T-C and LDL-C (r = 0.91) and apoE (r = 0.45), and negative correlation between HDL-C and ERF ratio (r = 77), and LDL-C and ERF ratio (r = 0.55). In ID genotype, T-C showed a strong positive correlation between LDL-C (r = 0.75) and ERF ratio (r = 0.63), TG and ERF ratio (r = 0.73), and negative with HDL-C (r = 0.53). In genotype II, T-C showed a strong positive correlation between LDL-C (r = 0.96), ERF ratio (r = 0.71), apoB (r = 0.66) and apoE (r = 0.46). LDL-C correlated positively with ERF ratio (r = 0.72), apoB (r = 0.61) and apoE (r = 0.48). These findings indicated the frequency of ACE genotypes to differ within the group of menopausal women. Analysis of ACE genotypes showed ID genotype to be most common among menopausal women. This result indicated their intermediate risk of coronary heart disease (CHD) and myocardial infarction (MI). It has been well established that an increased risk of MI is associated with high frequency of DD genotype, and a low risk with high frequencies of II genotype. In addition to ACE polymorphism analysis, assessment of lipid, apolipoprotein, and lipoprotein Lp(a) concentrations, and of ERF ratio provides further important parameters for better understanding of the risk factors for CDH in women. In the present study, assessment of the genetic, metabolic and environmental markers pointed to an intermediate risk of CHD in menopausal women on HRT, although the mechanism underlying the disease is not clear and well understood yet.

[Analysis of patulin in apple juice]. / Analiza patulina u jabucnom soku.

A quantitative method for the determination of patulin in apple juice was examined. The procedure involved patulin extraction from apple juice with ethyl acetate, clean-up with column chromatography and preparative thin-layer chromatography. Fluorescent derivatives, obtained by exposure of patulin on chromatographic plates to concentrated ammonia fumes, permitted a convenient quantitative fluorodensitometric assay of patulin by means of the fluorescence quenching method. The detection limits were 200 ng of pure patulin and 100 micrograms of patulin per litre of apple juice. The recoveries of added patulin ranged from 78 to 110.4 percent, with a mean recovery of 97.8 percent.

[Syncope caused by iatrogenic hypercalcemia]. / Sinkopa zbog ijatrogene hiperkalemije.

A course of the disease of a 68-year-old female who had been taking medigoxin, furosemide, verapamil and an unknown amount of spironolactone and potassium salt due to congestive heart failure is presented. She was admitted to emergency department of the University Hospital Rebro after an episode of syncopal attack because of arrhythmia due to hyperkalemia (8.9 nmol/L). She has had a fast idioventricular rhythm, followed by atrial tachycardia after that and with fast ventricular rhythm, S-T segment depression and a tall and peaked T-wave. In the following electrocardiograms left anterior hemiblock appeared, a tall R-wave of the anterolateral location, supraventricular and ventricular premature beats and atrioventricular block of the first degree. The patient had signs of non-oliguric form of acute renal failure at the admission which was a partly explanation for the development of hyperkalemia, together with the use of spironolactone and potassium salt. After the treatment she had normal serum creatinine values. She suffered from combined mitral valve disease: stenosis with a predominant regurgitation of the II/III degree. She was discharged from the hospital in a compensated state with normal serum potassium values.