Parathyroid hormone response to vitamin D insufficiency in elderly males with chronic heart failure.

Secondary hyperparathyroidism (SHPT) may contribute to the systemic illness that accompanies chronic heart failure (CHF). Healthy elderly with vitamin D deficiency who did not develop hyperparathyroidism (functional hypoparathyroidism, FHPT) had lower mortality than those who did. This study was designed to examine determinants of the PTH response in the vitamin D insufficient CHF patients. Sixty five vitamin D insufficient males with NYHA class II and III and 20 control subjects age >/=55 years were recruited. Echocardiography, physical performance, NT-pro-BNP, PTH, 25-hydroxyvitamin D (25(OH)D), adiponectin and bone activity surrogate markers (OPG, RANKL, OC, beta-CTx) were assessed. Increased NYHA class was associated with SHPT, while physical performance was inferior compared to FHPT. SHPT was associated with lower left ventricular ejection fraction (LVEF) and flow mediated dilatation, but with higher left heart dimensions, left ventricular mass index and right ventricular systolic pressure. CHF patients with SHPT had increased NT-pro-BNP, adiponectin and bone markers, but decreased 25(OH)D compared to those with FHPT. Independent determinants for SHPT in CHF patients with vitamin D insufficiency were LVEF, adiponectin and beta-CTx, irrespective of renal function and serum vitamin D levels. In conclusion, increased PTH levels, but not low vitamin D, demonstrated close relation to CHF severity.

[Diagnosis of cerebrovascular diseases in the elderly]. / Dijagnostika cerebrovascularnih bolesti kod starnih osoba.

Modern diagnostical methods and treatment of geriatric patients depend on the course and nature of cerebrovascular diseases. They require special individual therapy. The incidence of stroke increases with the age of a patient. This fact can be explained by the effect of risk factors associated with the statistically significant frequency of cardiac arrhythmias and heart decompensation. The loss of consciousness, convulsions and metabolic disorders predominate in the clinical picture of old people. The evolution of flexion contractions on paretic and non-paretic sides is usually faster and easier in this population. Taking into account the general condition of old people and frequent existence of other diseases in them, the diagnostic procedure should give priority to the treatment with non-invasive methods.

Cerebral infarction vs. intracranial hemorrhage--validity of clinical diagnosis.

In aim to improve the validity of clinical diagnosis of acute supratentorial ischemic cerebral infarction vs. intracranial hemorrhage, two different scoring systems were analyzed, each separately and combined, on one hundred eighty-eight patients sample. Results suggested higher sensitivity and positive predictive value for Guy's Hospital score, giving it higher importance in detection of hemorrhage, while combined application of both systems, in cases with identical findings, provided sensitivity 0.95 and 0.92 negative predictive value, in certain diagnosis category. A review of complete results disclosed that application of both systems separately didn't provide satisfactory diagnostic gain in differential diagnosis of that syndrome on our sample, while combined application provided high level of accuracy, eliminating simultaneously a significant proportion of patients (43.62%), as a category of uncertain diagnosis.