[The ankle brachial index in type 2 diabetes]. / Kotníko-pazni index u nemocných s diabetes mellitus 2. typu.

INTRODUCTION: The ankle brachial index (ABI), i.e. the ratio of systolic blood pressure (SBP) on the ankle and on the arm, is diagnostic for peripheral occlusive artery disease and a marker of cardiovascular (CV) risk. The association between the low ABI < 0.9 and the CV risk in type 2 diabetes (T2DM) subjects was investigated. METHODS: We examined 253 T2DM subjects (135 males, 118 females, aged 66 +/- 9 years). The blood pressures were measured in the supine position with the 2 mm Hg accuracy; Doppler ultrasound was used for the ankle SBP and the mercury sphygnomanometer for the arm SBP. The high CV risk was defined as manifest CV diseases, elevated coronary calcium score (CAC) by Agatston (> 101) or according to the global CV Risk Score > or = 5% (SCORE). STATISTICAL METHOD: Wilcoxon's unpaired test, chi2 test, multiple logistic regression. RESULTS: The ABI < 0.9 was found unilateral in 23 T2DM (8%), bilateral in 24 (9%), in older males (71 +/- 8 years) with higher CAC (600 +/- 707) (p < 0.01), higher total cholesterol (5.4 +/- 1.3 mmol/L) and total homocystein (17.2 +/- 7.1 micromol/L) (p <0.05) in comparison to those with the ABI > or = 0.9 (age 66 +/- 9 years, CAC 234 +/- 458, total cholesterol 5.0 +/- 0.9, total homocystein 14.3 +/- 78). Many CV risk factors correlated positively with the low ABI < 0.9; it was significantly independently associated with age (p < 0.001), smoking (p < 0.01), LDL-cholesterol, total homocystein and CAC (p < 0.05). Low ABI < 0.9 predicted ischemic stroke in subjects with T2DM and manifest CV diseases in the further 3 years. There was no correlation between the ABI and the ultrasensitive C-reactive protein. CONCLUSION: Low ABI < 0.9 was in a strong association with the CV risk. The ABI measurement is a simple, noninvasive, time-nonconsuming and inexpensive method for subclinical atherosclerosis detection; the ABI can supply standard methods for the CV risk prediction.

[Analysis of mortality trends in the West Bohemian Region in comparison with the entire Czech Republic 1988-1995]. / Analýza trendu mortality v západoceském regionu v letech 1988-1995 ve srovnání s celou Ceskou republikou.

BACKGROUND: Unfavourable trends in Czech republic (CR) started in the sixties and peaked in the late eighties i.e. in years when a dramatic mortality fall was observed in most western european countries. So, CR belonged among those Eastern European countries in that total and cardiovascular mortality showed increasing and alarming trends. West Bohemia Region (WB) was characterised by the concentration of heavy industry and high environmental pollution. Because of its geographical position on the western frontier, it was generally restricted in capital investment in the past. We wondered whether these phenomenon were reflected in higher mortality rates than in the rest of CR and which changes occurred after the year 1989. METHODS AND RESULTS: We compared the age standardized mortality data from 1988, 91, 93 and 95 in CR and WB for total mortality, cardiovascular mortality, coronary heart disease, strokes, malignancies and respiratory diseases. Data were age-adjusted for "World Population Standards" and rates were given for 100,000 inhabitants. In the whole CR a significant decrease of total, cardiovascular and cancer mortality was observed from 1988 to 1995. In WB these trends were similar, however in comparison to the whole CR the mortality rates remained in each respective period higher for total, cancer (mainly lung cancer) mortality and for non specific respiratory disease. In contrast, the coronary mortality rates in CR and WB were similar, however in WB after a temporary decrease in 1993 a significant increase in 1995 was observed. On the other hand the stroke mortality rates which were until 1993 in WB higher, significantly decreased in 1995 below the rates for CR. The cause of higher mortality rates in WB are far from being clear. To elucidate this observation epidemiologic studies of environmental pollution, life style of the population and socioeconomic factors are necessary, even as a further monitoring of regional mortality rates and trends.

[Compartment syndrome]. / Compartment syndrom.

Compartment syndrome most commonly occurs following revascularization of an acutely ischemic extremity. It is not only a danger for patient's extremity but also for his or her life if it is not detected and treated in time. The authors present 37 patients treated during 10-years period at the Department of Surgery, University Hospital in Pilsen for compartment syndrome after acute extremity ischemia due to arterial occlusion or trauma. Twenty-five (67.6%) patients healed without complication. Amputation and mortality rate was 16.2%. The main cause of patient's death was reperfusion injury. The length of ischemia and time of fasciotomy were statistically significant factors for the result of treatment. The authors emphasize the significance of early diagnosis and treatment of compartment syndrome.

[Effectiveness of conservative and surgical treatment of lumboischiadic syndrome]. / Efektivita konzervativní a operacní lécby lumboischiadického syndromu.

BACKGROUND: Hitherto performed retrospective studies of conservative and surgical treatment of compressive radicular lumboischiadic syndrome did not provide a clear answer to the question which procedure cures the disease more effectively. The reason is that severe types of the disease treated by surgery were compared with therapeutic results of milder forms treated conservatively. The authors compared therefore the effectiveness of both therapeutic procedures in a prospective study with a random selection of patients as regards the therapeutic procedure. METHODS AND RESULTS: In two groups--first group comprising 100 patients with the global syndrome and second group comprising 64 patients with the pure syndrome--the authors enlisted the patients by random selection for conservative or surgical treatment. Early results were assessed three months after treatment. Satisfactory results (cure) were achieved in 50% of the operated patients with the global syndrome, compared with 23.81% treated conservatively (p < 0.01), and improvement was recorded in 77.77% operated patients as compared with 58.69% conservatively treated patients (p < 0.05). In the group with the pure syndrome satisfactory results were achieved in 68.75% operated patients as compared with 21.87% conservatively treated patients (p < 0.001) and improvement in 81.25% patients as compared with 53.12% conservatively treated patients (p < 0.01). CONCLUSIONS: The investigation proved a statistically significantly greater effectiveness of the surgical method of treatment of compressive radicular lumboischiadic syndrome as compared with conservative treatment. The second finding was that both methods have a relatively low effectiveness as regards, complete recovery. It is necessary to seek methods to increase the effectiveness of both therapeutic procedures, in particular clearly more effective surgical treatment.

Impact of cardiovascular risk factors on morbidity and mortality in Czech middle-aged men: Pilsen Longitudinal Study.

The impact of biological and life-style characteristics measured during baseline examination on 12-year morbidity and mortality of coronary heart disease (CHD), stroke (STR), and malignancies was investigated in an urban population of 3,540 middle-aged men initially free of clinical disease. The following factors enhanced significantly (at the 5% level) the adjusted relative risk ratios: for total mortality age, smoking, and elevated systolic blood pressure; for CHD age, smoking, elevated systolic blood pressure, serum cholesterol levels, and body mass index, and family history (father or mother). Myocardial infarction was positively associated with age, smoking and elevated serum cholesterol levels. For STR age and elevation of both systolic and diastolic blood pressure were risk factors. The relative risk for all malignancies was enhanced by age and smoking. Regular alcohol consumption was associated with a significantly lower risk for all CHD; however, with only marginal significance for myocardial infarction. Higher education was associated with a significantly lower risk of total mortality, all CHD, and myocardial infarction and a marginally lower risk of STR. A high leisure physical activity was negatively (but not significantly) associated with the risk of all end points.

[Carcinoma of the lung in patients with pneumoconiosis]. / Karcinom plic u nemocných s pneumokoniózou.

From 614 patients with notified pneumoconiosis who died in 1964-1992 on necropsy carcinoma of the lungs was found in 87, i.e. 14.1% (in 48 it was the cause of death). The incidence in individual years did not differ significantly; on evaluation in relation to the diagnosis of pneumoconiosis an insignificantly more frequent incidence was found in complicated pneumoconiosis of miners. On evaluation by work places miners in black coal mines and workers in quarries were affected more frequently, the difference being at the borderline of statistical significance. As to the histological aspect, most frequently squamous cell carcinoma was involved, the site was most frequently in both upper lobes. The carcinoma was seven times associated with silicotic lesions, with anthracofibrotic lesions six times (a total of 14.9%). In lifetime carcinoma was detected in 55 of the patients who died, i.e. in 63.2%. As to aetiopathogenetic influences, the relationship with smoking is significant. The aetiopathogenesis of carcinoma of the lungs in patients with pneumoconiosis is most probably not uniform-the influence of smoking is beyond doubt, the carcinogenic effect of silica should be considered in patients with carcinoma in the scar. With regard to the repeatedly proved more frequent incidence of carcinoma of the lungs in patients with pneumoconiosis, frequent check-ups of patients with pneumoconiosis focused on possible detection of lung cancer are essential.

What are the causes of unsatisfactory control of arterial hypertension in the population?

A cross-sectional epidemiological study was conducted in the late 1980's in 660 men and 440 women, aged 35-60 years to assess the level of control of arterial hypertension (AH) in an industrial population. A relatively high rate of blood pressure (BP) assessment was found; only 2% of those screened had never their BP measured. Despite this, 44% of men and 40% of women with a high BP were unaware of their AH and conversely 15% of women and 12% of men with a positive history of AH were found to have BP less than 140/90 mmHg. Sufficient AH control was provided only in one fifth of the total amount of 300 hypertensive subjects. The paper evaluates the detection rate of our epidemiological study designed to assess the current status of control of AH and the causes of the unsatisfactory level of detection and control of a high BP are discussed.

Serum cholesterol increase in a middle-aged male industrial population during ten years (1976-1986) and general food consumption changes in Czechoslovakia.

The authors evaluate the coronary risk factor changes in middle-aged men from the point of view of changed nutritional habits of the whole population (yearly per capita consumption of different food). They compared 3,754 men aged 40-50 years when screened in 1976-77 (Skoda I Study) and 568 men aged 40-50 years when screened in 1986-88 (Skoda II Study). During the 10-year period, a significant decrease of smoking habits was observed, hypertension prevalence remained unchanged and hypercholesterolaemia prevalence increased significantly. The estimated yearly per capita consumption of meat and fat remained unchanged in the years 1975-1985, however, the structure of consumption revealed a gradual change towards food containing high amounts of animal fat. Education efforts during the 10-year period (1976-1986) led to a decrease in smoking habits in middle-aged men leaving hypertension control unchanged. The observed increase of cholesterol levels may be attributed to inappropriate nutritional habits gradually worsening in the whole population probably due to a socio-economic depression.

[Adjuvant therapy of lung cancer]. / Adjuvantní lécba rakoviny plic.

The authors evaluated in a retrospective investigation the effectiveness of adjuvant postoperative chemotherapy (ChT) and radiotherapy (RT), as compared with surgery alone, according to morphological types and stages of cancer lung (CaP). In a group of 321 patients 143 were treated by operation alone, 36 by operation and RT and 53 by operation and ChT. ChT involved administration of Cyclophosphamide, 30 mg/kg, at three-week intervals, some of the patients were also given vincaalkaloids. Therapy was repeated after 6-month intervals. According to the gross mortality data the probability of survival (PP) was compared by Kaplan-Meier's method. Improved PP was proved in patients with small cell lung cancer (MbCa) treated by operation and ChT and in third-stage disease treated by adjuvant ChT. In stage I of CaP adjuvant ChT and RT cause deterioration of the perspective of survival, as compared with operation alone and in stage II adjuvant ChT and RT are no advantage. The authors recommend adjuvant ChT in patients with surgically treated small-cell carcinoma and in stage III of operated CaP. They draw attention to the different response of tumours to adjuvant ChT and RT according to types and stages of CaP, to the fact that RT does not prolong the survival and to the possibility of preoperative ChT and RT in some types and stages of CaP.

[Effectiveness and reliability of preoperative studies in patients with lung cancer]. / Effektivität und Zuverlässigkeit präoperativer Untersuchungen bei Patienten mit Lungenkrebs.

The data of documentation of 267 operatively treated patients with lung cancer are shown in a retrospective study. The patients were treated in the clinic for tuberculosis and respiratory diseases of the faculty hospital Plzen. In 50% of the cases the results of histological and cytological examinations correspond with the surgical observations. Results of the pneumomediastinography and the computed tomography of the lung and mediastinum correspond with findings through the operation in 71% and 73% respectively. Through out the last three years the reliability of the cytological diagnosis was increased significantly (p less than 0.01).