Disturbance of oxidative balance in the first trimester of spontaneous abortions.

Background/Aim: Pregnancy is defined as a condition of increased oxidative stress. The aim of this research was to determine the intensity of pro-oxidative processes and the content of GSH, as well as antioxidative enzymes: superoxide dismutase (SOD), catalase (CAT), gluthatione peroxidase (GSH-Px), and the total antioxidative status (TAS) in patients with spontaneous abortions. Methods: A total of 120 patients were involved in the research (70 spontaneous abortions and 50 healthy pregnancies). The patients were divided into groups: 35 patients with incomplete and complete spontaneous abortion (group S), 35 patients with missed abortion (group M) and a control group of 50 healthy pregnancies (group N), all of them being in the first trimester of pregnancy. The intensity of lipid proxidation (LPx) was determined with a modified thyobarbituric acid method. The GSH content in erythrocytes was determined by the method ba-sed on the amount of non-protein sulfhydryl residues using the Ellman's reagens. The following antioxidative parameters in the blood were measured: SOD ­ by the method with xanthine oxidase-using commercial RANSOD sets; CAT ­ by the method of Aebi (the enzyme activity was measured by monitoring the decomposition of H2O2 at 240 nm); GSH-Px was determined using hydrogen peroxide as a substrate. The TAS was determined using the ferric reducing autioxidant potential (FRAP) met-hod. Results: The highest average value of LPx was recorded in the spontaneous abortion group (48.03 pmoL/mg Hgb), and the lowest value was recorded in the control group (26.06 pmoL/mg Hgb). A statistically significant positive correlation between LPx and CAT in the group of patients with missed abortion was also noted (p < 0.05, r = 0.37). There was a statistically highly significant difference (p < 0.001) in SOD and in CAT activitices be-tween the examined patients (groups S and N) and the control group (Student's t-test and ANOVA). The highest average value of TAS was recorded in the group S (710.39 µmol/L), while the value in the group M was 277.66 µmol/L. The average value of TAS in the control group was 452.12 µmol/L. Student's t-test showed a statistically highly significant difference in the values of TAS between the examined patients (groups S and M) and the control group. Conclusion: Determination of the value of pro-oxidative and antioxidative parameters in patients with sponta-neous abortion can be the indicator of condition of fetoplacental unit and these analyses can be included in the protocol of the rutine perinatal diagnostics.

The importance of sleep apnea index determination using 24 h ECG analysis in patients with heart rhythm disorders.

BACKGROUND/AIM: A possible cause of malignant heart rhythm disorders is the syndrome of sleep apnea (periodic cessation of breathing during sleep longer than 10 seconds). Recent 24 h ECG software systems have the option of determination ECG apnea index (AI) based on the change in voltage of QRS complexes. The aim of the study was to determine the significance of AI evaluation in routine 24-hour Holter ECG on a group of 12 patients. METHODS: We presented a total of 12 consecutive patients with previously documented arrhythmias and the history of breathing disorders during night. They were analyzed by 24 h ECG (Medilog AR 12 plus Darwin), that is able to determine AI. RESULTS: We presented a case series of 12 patients, 8 men and 4 women, mean age 58.75 years and the average AI 5.78. In the whole group there was a trend of increasing prevalence of complex rhythm disorders with increasing of AI and increased frequency of arrhythmias in the night phase vs. day phase. CONCLUSION: Determination of AI using routine long term (24 h) ECG analysis is important because sleep apnea can be successfully treated as an etiological or contributing factor of arrhythmias.

Rapidly vanishing lung pseudotumor in a patient with acute bilateral bronchopneumonia.

INTRODUCTION: Rapidly vanishing lung pseudotumor (phantom tumor) refers to the transient well-demarcated accumulation of pleural fluid in the interlobar pulmonary fissures. Most frequently their appearance is associated with congestive heart failure, but also other disorders like hypoalbuminemia, renal insufficiency or pleuritis. Its rapid disappearance in response to the treatment of the underlying disorder is a classical feature of this clinical entity. CASE REPORT: A 47-year-old woman, chronic smoker with symptoms of shortness of breath, orthopnea, chills, cough, weakness and the temperature of 39.2 degrees C was admitted to our hospital. A posteroanterior chest X-ray revealed cardiomegaly with the cardiothoracic ratio of > 0.5, blunting of both costophrenic angles and an adjacent 6 x 5 cm well-defined, rounded opacity in the right interlobar fissure. Transthoracic 2-dimensional echocardiography demonstrated left ventricular hyperthrophy with a systolic ejection fraction of 25% and moderate mitral regurgitation. The patient's symptoms resolved rapidly after diuresis, and repeated chest X-ray four days later showed that the right lung opacity and pleural effusions had vanished. CONCLUSION: The presented case underlines the importance of the possibility of vanishing lung tumor in patients with left ventricular failure and a sharp oval lung mass on the chest X-ray. This is the way to avoid incorrect interpretation of this finding causing additional, unnecessary, costly or invasive imaging, interventions and drugs.

[Electrocardiographic specificities in athletes].

INTRODUCTION: The use of electrocardiogram in athletes as a routine screening method for diagnosing potentially dangerous cardiovascular diseases is still an issue of debate. According to the guidelines of the European Society of Cardiology, the recording of electrocardiogram is necessary in all athletes as a screening method, whereas the guidelines of the American Heart Association do not necessitate an electrocardiogram as a screening method and they insist on detailed personal and family history and clinical examination. CLASSIFICATION OF ELECTROCARDIOGRAM CHANGES IN ATHLETES: According to the classification of the European Society of Cardiology, electrocardiogram changes in athletes are divided into two groups: a) usual (physiological) that are connected with training; b) unusual (potentially clinically relevant) that are not connected with training. SUDDEN CARDIAC DEATH IN ATHLETES: The most frequent causes include hypertrophic cardiomyopathy and congenital coronary artery anomalies, while others may be found only sporadically at autopsy. Physiological electrocardiogram changes are frequent in asymptomatic athletes and they do not require further assessment. They include sinus bradycardia, atrioventricular blocks of I and II degree--Wenkebach, isolated increased QRS voltage, incomplete right bundle branch block and early repolarization. Potentially pathological electrocardiogram changes in athletes are not frequent but they are alarming and they urge further assessment to diagnose the underlying cardiovascular disease as well as the prevention of sudden cardiac death. They include: T wave inversion, ST segment depression, complete right or left bundle branch block, atrial pre-excitation syndrome-WPW, long QT interval, short QT interval, Brugada like electrocardiogram finding. CONCLUSION: Introduction of electrocardiogram recording into the screening protocol in athletes increases the sensitivity of evaluation and may help to discover asymptomatic cardiovascular diseases that may cause sudden cardiac death. Special attention and further assessment are required when the above potentially pathological electrocardiogram changes are found in athletes.

[Sudden cardiac death in athletes].

The entity of sudden cardiac death in young athletes has been known since the year 490 B.C. when young Greek soldier Phidipides had run the distance from Marathon to Athens and suddenly fell down dead. In the last twenty years, sudden death of famous athletes have attracted huge attention of medical and social community; afterwards both American and European Cardiology Societies started to publish periodically guidelines for preparticipation screening. These guidelines have focused on both identifying athletes with potential cardiovascular risk for sudden death and eligibility conditions for athletes participating in competitive sports. Structural and functional abnormalities causing sudden cardiac death in young athletes have been identified by autopsy-based studies. Unrecognized congenital cardiovascular abnormalities associated with excessive physical effort create background for electrophysiological instability and occurrence of malignant ventricular tachyarrhythmia and consequent death. The most frequent causes of sudden cardiac death in young athletes include hypertrophic cardiomyopathy, anomalies of the coronary arteries and idiopathic left ventricular hypertrophy. Current ACC/AHA & ESC guidelines should be widely used in order to reduce potential sudden cardiac death in young athletes.

[Percutaneous coronary interventions without on-site cardiac surgical backup]. / Perkutane koronarne intervencije bez "on-site" "kardiohirurske potpore.

Percutaneous coronary interventions are now, three decades after the first balloon angioplasty of the coronary arteries, safe, effective, and most commonly applied method of myocardial revascularization. The first percutaneous coronary intervention without "on-site" cardiac surgery began at the beginning of the nineties of the twentieth century, thanks to the improvement of techniques and materials used for these procedures, as well as the need to make available to citizens in remote areas modern and effective therapy. However, today, after nearly twenty years of application of percutaneous coronary interventions in facilities without cardiac surgery this issue remains controversial and unresolved. So despite the existence of a large number of interventional cardiology centers without "on-site" cardiac surgery in a large number of countries in which they performed a significant number of elective and primary interventions, the official guidelines of the associations for percutaneous coronary interventions still does not recommend implementation of interventions without the existence of "on -site" cardiac surgery. But, recently the focus shifts from the questions about presence of "on-site" cardiac surgery in the direction of defining criteria for performing percutaneous coronary interventions according to the highest standards regardless of the existence of "on-site" cardiac surgical backup. This review article gives the current view on current attitudes about the organization and implementation of percutaneous coronary interventions in facilities without cardiac surgical backup.

[Diastolic dysfunction types in the prediction of viable myocardium functional recovery].

BACKGROUND/AIM: It is well known that patients with coronary artery disease and viable tissue as a guarantee of contractile recovery (CR), despite of decreasing ejection fraction (EF) and systolic dysfunction, could have benefit from surgical revascularization. Therefore, relationship between diastolic filling type and early postoperative recovery and complications need to be established. The aim of this study was to investigate the relation between different left ventricular (LV) diastolic filling types and CR in patients after surgical revascularization with differently preserved systolic function. METHODS: We investigated 60 patients. All of them had CR estimated by stress echocardiography regardless the extent of recovery of the heart systolic function. Echocardiographic evidence of diastolic dysfunction was estimated by Doppler examination of transmitral diastolic flow. According to the derived different diastolic filling types the patients were divided into three groups: I--patients with disorder of LV relaxation, II--with pseudovascularisation, and III--with restrictive filling type, and according to the value of systolic function into two subgroups: (1) relatively recovered systolic function--EF > 40% and (2) pronounced LV dysfunction--EF < 40%. Echocardiographic evaluation was performed before and two week after surgical revascularization. In the preoperative period the medication therapy was optimized. We estimated CR by echocardiografic pare meters but also by detection of cardiovascular events. RESULTS: After CABG the mean value of WMISI LV tended to decrease in any groups: in the group I (n = 12) from 1.64 +/- 0.22 to 1.34 +/- 0.22; in the group II (n = 22) from 1.85 +/- 0.16 to 1.53 +/- 0.42, and in the group III (n=26) from 1.92 +/- 0.29 to 1.81 +/- 0.52. The lowest improvement of systolic function according to EF value expressed by the number of patients was found in the group of patients with restrictive LV filling type (12; 53.8%) as contrasting to the group with pseudonormalisation (15; 78.9%). In the group of patients with restrictive diastolic filling type also was recorded the highest number of lethal outcomes (6; 23.1%), as well as cardiovascular complications (10; 38.5%). CONCLUSIONS: Restrictive LV diastolic filling type was the marker of poor prognosis in the patients with clinical heart failure undergoing surgical revascularization. The patients with heart failure and preserved systolic function were associated with similar prognosis.