[Comparison of MRCP a ERCP in diagnosis of choledocholithiasis]. / Srovnání MRCP a ERCP v diagnostice choledocholitiázy.

INTRODUCTION: Choledocholithiasis is the most common cause of biliary obstruction. Each of the testing methods used in its diagnosis has its advantages and disadvantages. OBJECTIVE OF THE STUDY: The objective of this prospective study is to compare endoscopic retrograde cholangiopancreatography with magnetic resonance cholangiopancreatography in the diagnosis of choledocholithiasis on the basis of own experience and literature data. Set of patients and methodology: The set was studied from the beginning of 2007 to the end of 2012 (i.e. six years). The study assessed prospectively 45 patients (age range 28- 72 years) with symptoms of biliary obstruction, who first underwent magnetic resonance cholangiopancreatography and subsequently endoscopic retrograde cholangiopancreatography. RESULTS: The sensitivity, specificity and diagnostic accuracy of magnetic resonance cholangiopancreatography was lower, both in our set of patients and according to the literature data, compared to the endoscopic retrograde cholangiopancreatography (92%, 91% or 93 %). CONCLUSION: Considering the frequency of complications (in some cases serious ones) following endoscopic retrograde cholangiopancreatography, the magnetic resonance cholangiopancreatography is, in spite of its lower sensitivity, the method of choice in the diagnosis of choledocholithiasis by means of noninvasive methods, on the basis of which it is possible to refer the patients subsequently for therapeutic endoscopic retrograde cholangiopancreatography.

[Endoscopic retrograde cholangiography with a single-balloon enteroscope in patients with Roux-en-Y hepatico jejunal anastomosis]. / Endoskopická retrográdní cholangiografie pomocí jednobalónkového enteroskopu u pacientu s Roux-Y hepatikojejunoanastomózou.

AIMS OF THE STUDY: The aim of this retrospective study was to evaluate our experience with using a single-balloon enetroscope for diagnostic and therapeutic endoscopic retrograde cholangiography (ERC) in patients with Roux-en-Y hepatico jejunal anastomosis (HJA). Due to the considerably changed anatomic circumstances after the surgery, ERC is, in comparison to the standard endoscopic retrograde cholangiopancraeaticography (ERCP), significantly more difficult to perform. PATIENT SAMPLE AND METHODOLOGY: The sample was followed up from January 2009 to September 2011. The study retrospectively reviewed 14 patients with Roux-en-Y HJA with symptoms of biliary obstruction. A total of 21 ERCs were performed in these 14 Roux-en-Y HJA patients using the single-balloon videoenetroscope Olympus SIF Q 180. RESULTS: Diagnostic ERC cannulation was successful in 11 of the 14 patients (79% success rate for the diagnostic ERC). One of the 11 patients had a normal finding on the ERC. The remaining 10 patients had a pathological finding on ERC that, in one patient (cystic dilatation of bile duct), was subsequently managed surgically. Endoscopic treatment was initiated in the remaining 9 patients (HJA stenosis in 4, choledocholithiasis in 2 and concurrent HJA stenosis and choledocholithiasis in 3) immediately after the diagnostic ERC; the surgery was successful in 8 of the 9 patients (89% success rate for the therapeutic ERC). The performed endoscopic therapeutic procedures included: balloon dilatation of HJA stenosis 9 times (6 patients), choledocholithiasis extraction - 5 times (5 patients), biliary plastic stent placement - 5 times (3 patients), removal of biliary stents placed by us - 5 times (3 patients). We did not observe any complications in our sample of 14 patients. CONCLUSIONS: ERC using a single-balloon enteroscope in patients with Roux-Y HJA is significantly more difficult than the standard ERCP due to different post-surgical anatomy. In our sample of patients, we achieved 79% success rate for the diagnostic ERC and 89% success rate for the therapeutic ERC. Additional time should be allowed for the individual procedures. Furthermore, the presence of an anaesthesiologist during these operations (deep analgosedation) is essential. This is a technically very demanding technique that, however, is effective and safe and importantly extends the options available for the management of biliary pathologies in these patients.

[The importance of antihypertensive therapy in subclinical brain damage]. / Význam antihypertenzní lécby u subklinického poskození mozku.

Older patients are often affected by impaired cognitive function and high blood pressure. Damage to microcirculation of the brain is closely related to changes in large vessels. High blood pressure and vascular stiffness might lead to a damage in microcirculation of the brain and, consequently, to worsening of the patient's cognitive function and dementia. We discuss early diagnosis of subclinical brain damage using magnetic resonance and its preventive management with antihypertensive therapy.

[The normalized smoothness index and parametric population RDH index of losartan in patients with newly diagnosed hypertension and metabolic syndrome]. / Normalizovaný smoothness index a parametrický populacní RDH index losartanu u pacientu s cerstve zjistenou hypertenzí a metabolickým syndromem.

INTRODUCTION: Ambulatory blood pressure monitoring provides an opportunity to evaluate 24-hour efficacy of once daily preparations. AIMS OF THE STUDY: To evaluate 24-hour efficacy of losartan in patients with newly diagnosed hypertension and metabolic syndrome using the parametric population RDH index and normalized smoothness index. PATIENT SAMPLE AND METHODOLOGY: Twenty seven patients with newly diagnosed hypertension and with metabolic syndrome, sufficiently responding to blood pressure therapy with losartan, assessed using sphygmomanometer. 18 men, 9 women, mean age of 48 years, body mass index of 32.6 kg.m(-2), before and after 1 year of therapy with losartan in the mean dose of 69 mg once a day. Blood pressure measured with sphygmomanometer and 24-hour ambulatory monitoring (SpaceLabs 90207) according to the European Society of Hypertension criteria. Hypertension was defined as sphygmomanometer-measured blood pressure values of more than or equal to 130 and/or 85 mm Hg. Fulfilment of at least 3 criteria of metabolic syndrome according to the definition by The Adult Treatment Panel III. RESULTS: The population normalized smoothness index of losartan (+/- standard error of the mean) was 1.10 +/- 0.13 for systolic pressure, 0.81 +/- 0.11 for diastolic pressure and 1.00 +/- 0.14 for mean arterial blood pressure. The parametric population RDH index of 24, 24, 0 for systolic pressure and 24, 24, 0 for diastolic pressure. CONCLUSION: Losartan at a mean dose of 69 mg once daily showed an adequate 24-hour efficacy in patients with newly diagnosed hypertension and metabolic syndrome responding to treatment when blood pressure was measured using sphygmomanometer and the effect expressed as the parametric population RDH index for systolic as well as diastolic pressure and when evaluating normalized smoothness index based on systolic blood pressure value and mean arterial pressure.

[Our experience with endoscopic drainage of pancreatic pseudocysts]. / Nase zkusenosti s endoskopickou drenázní lécbou pankreatických pseudocyst.

INTRODUCTION: The authors first provide and overview of the main knowledge on pancreatic pseudocysts. They discuss the individual types of pancreatic pseudocysts, their clinical picture, complications and diagnosis. As part of the differential diagnosis, they emphasise the need to distinguish pancreatic pseudocysts from cystic tumours and benign cysts. Special attention is then paid to various modalities of treatment of pancreatic pseudocysts. METHODS: The authors present their own results of endoscopic drainage of pancreatic pseudocysts, one of the key options in the treatment of this condition. RESULTS: A total of 33 patients (24 men and 9 women) were treated by endoscopic drainage between September 2007 and March 2009. Endoscopic drainage was performed transduodenally in 4 patients and via the transgastric route in 29 patients; 6 times with endosonographic device and with duodenoscope after endosonographic alignment in 27 patients. CONCLUSION: The authors conclude that endoscopic drainage is an effective method of treatment of pancreatic pseudocysts.

[Aortic pulse wave velocity in patients with metabolic syndrome and hypertension treated with sartans]. / Rychlost aortální pulzové vlny u nemocných s metabolickým syndromem a hypertenzí lécených sartany.

INTRODUCTION: The incidence of subclinical organ damage is higher in patients with hypertension (HT) and metabolic syndrome (MS). Increased aortic pulse wave velocity (PWV) is one the markers reflecting subclinical arterial damage. Treatment with sartans leads not only to a reduction of blood pressure but may also bring regression of the subclinical damage. Long-acting sartans (telmisartan) may be more effective than sartans with medium duration of action (losartan); the aim of this research was to compare the impact of hypertension therapy with losartan and telmisartan on aortic pulse wave velocity (Ao-PWV). METHODS: We examined 32 patients with HT and MS, 15 patients were treated with losartan 50 mg (group A) and 17 patients were treated with telmisartan 80 mg (group B). At the beginning and the end of the study, PWV was measured using the Complior method and 24-hour BP monitoring and biochemistry testing were carried out. RESULTS: Treatment with sartans led to a reduction in BP in both groups, daytime BPs/BPd declined by 11.5/9.0 mm Hg in group A and by 13.8/8.1 mm Hg in group B, respectively, and night time BP declined by 5.7/5.1 mm Hg in group A compared to 7.4/3.89 mm Hg in group B. Aortal pulse wave velocity declined by 1.94 m/s in group A (p < 0.001) and by 0.46 m/s in group B (p < 0.001), respectively. CONCLUSION: Treatment with losartan as well as telmisartan resulted in reduced values of BP and Ao-PWV. We did not prove a more significant effect of a long-acting sartan (telmisartan) compared to a sartan with a medium duration of action (losartan) on Ao-PWV reduction after 1 year of treatment.

[The normalized smoothness index and parametric population RDH index of telmisartane in patients with newly diagnosed hypertension and metabolic syndrome]. / Normalizovaný smoothness index a parametrický populacní RDH index telmisartanu u pacientu cerstve zjistenou hypertenzí a metabolickým syndromem.

INTRODUCTION: Ambulatory blood pressure monitoring provides an opportunity to evaluate 24-hour efficacy of once daily preparations. AIMS OF THE STUDY: To evaluate 24-hour efficacy of telmisartane in patients with newly diagnosed hypertension and metabolic syndrome using the parametric population RDH index and normalized smoothness index. PATIENT SAMPLE AND METHODOLOGY: Thirty newly diagnosed hypertonics with metabolic syndrome, sufficiently responding to blood pressure therapy with telmisartane, assessed using sphygmomanometer. Twenty six men, 4 women, mean age of 44 years, body mass index of 31.4 kg. m2, before and after 1 year of therapy. Blood pressure measured with sphygmomanometer and 24-hour ambulatory monitoring (SpaceLabs 90207) according to the criteria of the European Society of Hypertension. Hypertension was defined as sphygmomanometer-measured blood pressure values of more or equal to 130 and/or 85 mm Hg. Fulfilment of at least 3 criteria of metabolic syndrome according to the definition by The Adult Treatment Panel III. RESULTS: The population normalized smoothness index oftelmisartane (+/- standard error of the mean) of 1.00 +/- 0.11 for systolic pressure and 0.84 +/- 0.10 for diastolic pressure. The parametric population RDH index of 24, 24, 0 for systolic pressure and 22, 15, 1 for diastolic pressure. CONCLUSION: Telmisartane at a mean dose of 60 mg once daily showed an adequate 24-hour efficacy in patients with newly diagnosed hypertension and metabolic syndrome responding to treatment, when blood pressure was measured using sphygmomanometer and the effect expressed as the parametric population RDH index and normalized smoothness index based on systolic blood pressure value. We did not prove the full 24-hour efficacy when diastolic blood pressure was used to calculate both indexes.

[The diurnal variability of blood pressure in patients with hypertension and rheumatoid arthritis]. / Diurnální variabilita krevního tlaku u pacientu s hypertenzí a revmatoidní artritidou.

BACKGROUND: The patients with rheumatoid arthritis have high prevalence of hypertension and increased risk of cardiovascular morbidity and mortality. OBJECTIVE: To determine the level of clinical blood pressure (BP) and 24h ambulatory BP in patients with rheumatoid arthritis and hypertension. Analyze the diurnal variability of BP depending on chronic treatment with prednisone, nonsteroidal anti-inflammatory drugs and methotrexate. GROUP OF PATIENTS: 60 patients with clinically stable rheumatoid arthritis and treated or newly diagnosed hypertension. 15 male and 45 female, mean age 58 +/- 11.3 years. RESULTS: Mean clinical systolic BP 139.0 +/- 14.7 mm Hg, diastolic BP 85.7 +/- 6.5 mm Hg and heart rate 74.9 +/- 7.3 beat.min(-1). Mean 24h systolic BP 127.7 +/- 12.6 mm Hg, diastolic BP 77.7 +/- 7.4 mm Hg and heart rate 73.9 +/- 8.7 beat.min(-1). Mean clinical pulse pressure 54.7 +/- 15.6 mm Hg, mean 24h pulse pressure 50.1 +/- 11.6 mm Hg. In the whole group of patients the number of systolic dippers was 28 (47%), nondippers 17 (28%), excesive dippers 11 (18%) and risers 4 (7%), diastolic dippers 27 (45%), nondippers 9 (15%), excesive dippers 22 (37%) and risers 2 (3%). The patients treated with prednisone and nonsteroidal anti-inflammatory drugs were nondippers in 34% both for systolic BP, in 19% and 20% respectively for diastolic BP. They were excessive dippers for systolic BP in 22% and 20% respectively, for diastolic BP in 37% and 38% respectively. In the course of the treatment with methotrexate were 22% patients nondippers for systolic BP and 8% for diastolic BP, 28% was excessive dippers for systolic BP, 47% for diastolic BP. CONCLUSION: Patients with rheumatoid arthritis and hypertension have a slightly increased pulse pressure (55 mm Hg for clinical BP and 50 mm Hg for 24h ambulatory BP) in comparison to arbitrary limits in generally population. Patients treated with prednison and nonsteroidal anti-inflammatory drugs were more often nondippers (34%) in systolic BP than hypertensive control. The patients treated with methotrexate (47%), prednisone (37%) and nonsteroidal anti-inflammatory drugs (38%) were more often excessive dippers in diastolic BP than hypertensive control.

[Definition of 24 hour ambulatory blood pressure values corresponding to office blood pressure values of 130/80 mm Hg]. / Stanovení hodnot 24hodinového ambulantního monitorování krevního tlaku odpovídajících kazuálnímu tlaku 130/80 mm Hg.

BACKGROUND: Ambulatory blood pressure monitoring (ABPM) provides a profile of blood pressure (BP) away from the medical environment and has been shown to be a stronger predictor of cardiovascular morbidity and mortality than office BP measurement. There are known the normal BP values for ABPM in general population with office BP value 140/90 mm Hg, but don't are known normal values for ABPM of patients with high risk hypertension which needs to have office BP below 130/80 mm Hg. AIM OF STUDY: Definition of normal BP value of ABPM in patients with office BP130 and/or 80 mm Hg. METHODS: BP measurement in 241 healthy subjects by ABPM and mercury sphygmomanometer according to European Hypertension Society criteria. Subject selection with following criteria: mean office systolic blood pressure 128-132 mm Hg or diastolic blood pressure 78-82 mm Hg. Exclusion ABPM curves with white-coat hypertension and masked hypertension. All office and ABPM inclusion criteria fulfill 37 subjects for systolic blood pressure, mean age 44 years and 48 subjects for diastolic blood pressure, mean age 45 years. RESULTS: Mean office systolic BP 129.9 +/- 1.6 mm Hg, diastolic BP 80.2 +/- 1.5 mm Hg. Mean 24hour systolic BP 119.1 +/- 12.3 (95% CI, 119.0-119.3) mm Hg, diastolic BP 71.4 +/- 10.2 (95% CI, 71.3-71.5) mm Hg, day time systolic BP 123.7 +/- 9.0 (95% CI, 123.6-123.8) mm Hg, diastolic BP 75.4 +/- 7.0 (95% CI, 75.3-75.5) mm Hg, night time systolic BP 105.8 +/- 10.4 (95% CI, 105.7-105.9) mm Hg and diastolic BP 59.8 +/- 9.0 (95% CI, 59.7-59.8) mm Hg. CONCLUSION: The normal BP value ofABPM in patients with office BP 130/80 mm Hg is for 24hour BP 119/71 mm Hg, day time BP 124/75 mm Hg and night time BP 106/60 mm Hg.

[Increased activity of the sympathetic nervous system and the possibilities for therapeutic influence]. / Zvýsená aktivita sympatiku a moznosti terapeutického ovlivnení.

Breakdown in the function of the autonomic nervous system (ANS) due to chronic stress is very probably one of the main pathophysiological mechanisms in the onset and development of essential hypertension, especially in younger hypertonic patients. The degree of dysfunction can be assessed by means of simple tests such as measurement of resting heart rate. Betablockers are the most effective group for chronic treatment of excessive activity of the sympathetic nervous system.

[The smoothness index of betaxolol hydrochloride in patients with newly diagnosed hypertension]. / Smoothness index betaxolol hydrochloridu u pacientu s terstve zjitenou hypertenzí.

INTRODUCTION: 24-hour ambulatory blood pressure monitoring (ABPM) has a higher predictive value for cardiovascular diseases than occasional blood pressure (BP) measurement with sphygmomanometer. ABPM allows for the assessment of 24-hour effect of drugs administered once a day using the smoothness index (SI) method. OBJECTIVE OF WORK: Find out the 24-hour effect of betaxolol hydrochloride administered once a day by determining the smoothness index. Cohort and methodology: Examination of 30 newly diagnosed hypertonics prior to and after 3-month treatment with betaxolol hydrochloride at an average dose of 15 mg once a day. BP measurement using sphygmomanometer and ABPM (SpaceLabs 90207) according to European Society for Hypertension criteria. Determining the smoothness index from individual average hourly changes in BP after treatment by dividing the hourly values average by standard deviation. Calculation of average SI from individual patient data with standard deviation and 95% confidence interval (95% CI). RESULT: The calculated SI value of betaxolol hydrochloride was 1.03 +/- 0.65 (95% CI, 0.80 to 1.26) and 1.27 +/- 0.89 (95% CI, 0.95 to 1.59) for systolic and diastolic BP, respectively. CONCLUSION: Average SI of betaxolol hydrochloride is higher than 1 when both systolic and diastolic BP is measured. Based on the above parameter, the monitored drug has a sufficient 24-hour effect and can be administered once a day.

[Primary pulmonary hypertension--aspects of diagnosis and therapy]. / Primární plicní hypertenze--aktuální pohled na diagnostiku a lécbu.

Primary Lung Hypertension is a serious disease of unknown cause. Various genetic, vasoconstriction, proliferation and procoagulation factor participate in etiology and pathogenesis. In establishing the diagnosis it is necessary to exclude secondary, particularly embolic cause of pulmonary hypertension. There are diseases with associated primary pulmonary hypertension. Present therapy improves symptoms of the disease, three years after the diagnosis is established, 75% of patients survive. In the therapy of primary pulmonary hypertension, the recommended drugs are calcium channel blockers, epoprostenol, oxygen therapy and anticoagulant drugs. The new, clinically tested drugs include inhalation and oral analogs of prostacyclins, endothelin receptor antagonists and phosphodiesterase blockers.

Heart rate and increased intravascular volume.

The objective was to establish whether an intravascular volume increase leads to a heart rate (HR) increase without increased sympathetic tonus. HR changes at rest and at deep breathing (6/min - simulated increase of atrial filling pressure) were measured in patients after heart transplantation. Evaluation of dependency of HR changes on breathing depth was done through a new time series methodology. The data was evaluated through graphs displaying a significant increase in the graph area at deep breathing, when compared with breathing at rest (p<0.01). We presume that an increase in HR corresponds to increased intravascular volume and malfunctioning kidneys.

Angiotensin I-converting enzyme and angiotensinogen gene interaction and prediction of essential hypertension.

To prove whether the interaction between insertion/deletion (I/D) angiotensin I converting enzyme (ACE) and M235T angiotensinogen (AGT) gene polymorphic alleles could contribute to causing essential hypertension, we examined subjects from the Czech Republic (365 Caucasians total; 202 normotensives and 163 hypertensives). Subjects were genotyped for insertion/deletion polymorphism of ACE (I/D ACE, intron 16) and for M235T polymorphism of angiotensinogen gene (AGT, exon 2) by means of the polymerase chain reaction (PCR) method. The case-control approach was used. Fisher's exact test followed by Holmes's test to overcome the problem of multiple comparisons were used for the statistical analysis of data. No association of single gene allelic variants with essential hypertension was found in our population. Having compared only double homozygote combinations, the association of the DDMM genotype with essential hypertension was proven (P = 0.0081). To the contrary, IITT (P = 0.0086) was found more frequently in normotensive subjects. We conclude that the interaction of the I/D ACE and M235T AGT polymorphic alleles can contribute to essential hypertension, despite the absence of single gene associations with the condition.

[Betaxolol hydrochloride in the treatment of mild and medium hypertension--long-term effects]. / Betaxolol hydrochlorid v lécbe mírné a stredne tezké hypertenze--jeho dlouhodobý úcinek.

All available beta-blockers are effective in the treatment of high blood pressure. Differences in the pharmacokinetics are important as they can have an impact on their clinical use. Betaxolol, a beta-1-selective blocker has a long biological half-life which can control the blood pressure and pulse rate for 24 hours. The authors investigated 20 patients with mild and medium severe hypertension by out-patient monitoring of the blood pressure. Treatment was focused on influencing the morning rise of blood pressure and pulse rate. The results confirm the effectiveness of betaxolol (Lokren) in the administered dose of 10-20 mg once per day. A favourable response was obtained in 75% when checked by a sphygmomanometer. The morning readings of blood pressure at 5, 6 and 7 o'clock following treatment did not exceed 90 mmHg diastolic pressure. It was also found that there is a statistically significant difference in the effect exerted on pressure and pulse rate in daytime, while the difference at nighttime is not significant. This mild reduction on blood pressure and pulse rate during the night is an advantage in particular in elderly patients. Lokren treatment did not have any serious side-effects it did not affect laboratory values or ECG with the exception of the pulse rate.

Variability of changes in Doppler transmitral filling pattern during stress echocardiography in patients with stable angina pectoris.

Stress electrocardiography and echocardiography using atrial pacing together with the right-sided heart catheterization were performed in 21 patients with stable angina pectoris. Peak velocity of transmitral flow in early diastole (E) and in atrial contraction (A), deceleration time of early filling, and pulmonary artery wedge pressure were measured simultaneously at rest and immediately after each pacing frequency. Patients were divided according to their stress pulmonary artery wedge pressure changes into Group A (14 patients with an increase in pulmonary artery wedge pressure > or = 3 mmHg during stress) and into Group B (6 patients with a change in pulmonary artery wedge pressure < or = 2 mmHg during stress). One patient, T.L., with an increase in pulmonary artery wedge pressure > or = 5 mmHg after each pacing frequency was evaluated separately. In Group A patients, the non-linear course of the E/A ratio changes (from 0.78 +/- 0.06 to 0.66 +/- 0.05, P < 0.01; to 0.72 +/- 0.05, P = NS; and to 0.93 +/- 0.06, P < 0.01) and deceleration time changes (from 188.9 +/- 7.2 ms to 195.3 +/- 8.9 ms, P = NS; to 188.8 +/- 9.9 ms, P = NS; and to 154.2 +/- 6.7 ms, P < 0.01) was seen.(ABSTRACT TRUNCATED AT 250 WORDS)

Transmitral flow velocities and times during stress transthoracic echocardiography in patients with myocardial ischaemia.

Twenty-nine men with chronic stable angina pectoris were investigated using stress electrocardiography (ECG) and stress transthoracic echocardiography by means of transoesophageal stimulation of the left atrium. At rest and after each stimulated frequency, ECG and 2-dimensional echocardiography combined with Doppler were performed simultaneously. Fourteen patients without ischaemia at stress ECG and two patients who were subjected only to two different frequencies of stimulation were excluded from our study. Thirteen patients with ischaemic electrocardiographic response at stress, who were subjected to at least three stimulated frequencies, were evaluated. Their deceleration time of early transmitral filling was prolonged from 171 +/- 15.4 ms to 178.1 +/- 14.4 ms (P = ns) after the first stimulated frequency, to 172.8 +/- 15.1 ms after the second stimulated frequency (P = ns) and was shortened to 143.6 +/- 7.9 ms (P < 0.05) after the fastest stimulated frequency. The ratio of peak transmitral flow velocity in early diastole (E) to that during atrial contraction (A) decreased from 0.93 +/- 0.07 at rest to 0.85 +/- 0.07 (P < 0.05) after the first stimulated frequency, to 0.87 +/- 0.07 (P = ns) after the second stimulated frequency and increased to 1.13 +/- 0.08 (P < 0.05) after the fastest stimulated frequency. In patients with angina pectoris and myocardial ischaemia, the changes in the E/A ratio and deceleration time during stress are not linear and their direction depends on the moment of their evaluation. Their use for the quantitative evaluation of the diastolic function of the left ventricle is problematic.

[Primary pulmonary hypertension]. / Primární plicní hypertenze.

The authors describe a case of primary pulmonary hypertension from the onset of subjective complaints to terminal dextrolateral cardiac failure. They give an account of an unsuccessful attempt to influence the haemodynamics in this female patient by calcium channel blockers. In the discussion they deal briefly with contemporary knowledge and treatment of primary pulmonary hypertension.