[The relation between peripheral and autonomic neuropathies in insulin-dependent diabetics]. / Vztah periferní a autonomní neuropatie u inzulíndependentního diabetu.

Eighty-eight type I diabetics were subjected to neurological and myographic examination and tests were performed assessing the condition of the vegetative nervous system. Forty-four patients (50% of the group) suffered from diabetic nephropathy with different expression in the stage of chronic renal failure. The authors revealed significant positive correlation between the results of tests of vegetative neuropathy and all evaluated parameters of the neurological and electromyographic finding. In patients with a S-creatinine level above 125 mumol/l in both tests of vegetative neuropathy and in all examined parameters of peripheral nerves highly significantly lower values were recorded than in diabetic patients with normal renal function. In diabetics without renal insufficiency, however, the correlations between the findings on the autonomous and peripheral nervous system were also statistically significant.

[The effect of pancreas and kidney transplantation on diabetic autonomic neuropathy]. / Vliv transplantace pankreatu a ledviny na prubeh diabetické autonomní neuropatie.

The authors examined, using cardiovascular reflex tests, nine type I diabetics 6-48 months after combined transplantation of the pancreas and kidney with satisfactory function of both grafts. The control group was formed by 10 type 1 diabetics after transplantation of the kidney and 10 subjects free from disease causing damage to the vegetative nervous system. The results of the examination during the pretransplantation period suggested in both groups of diabetics severe affection of the vegetative nervous system. Despite long-term practical normalization of the diabetic metabolic disorder, in the patients after transplantation of the pancreas no detectable improvement of findings was recorded. Changes in the tests used were not found either in the control group of patients after isolated transplantation of the kidney. Damage of the vegetative nervous system in uraemic patients is probably irreversible and intervention studies are therefore indicated in an earlier stage of the disease.

[Variation in the R-R intervals on the electrocardiogram. A new diagnostic method in cardiology]. / Variabilita intervalu R-R elektrokardiogramu. Novejsí pomocná diagnostická metoda v kardiologii.

Periodic heart rate fluctuation depends on the oscillation of sympathetic and vagal activation of the heart. Periodic retardation and acceleration of heart rate related to respiration and to blood pressure changes can be registered on the ECG as the "variability of R-R intervals". Testing procedures of the variability of R-R intervals at rest, during deep breathing, daily activities, during exercise and other stress tests are described in the paper. For the evaluation of the R-R interval's variability, current statistical methods are used (e.g. mean with standard deviation, variation coefficient, mean beat to beat differences in R-R intervals etc.). Power spectral analysis in the variability of 200-600 successive R-R intervals commonly performed today uses either rapid Fourier transformation or the autoregulation model. The analysis shows high- and low frequency peaks corresponding to the rapid and slow oscillations in heart rate. Evaluation of the R-R interval variability, especially using power spectrum analysis, gave good results in testing drugs, e.g., beta blockers, calcium antagonists and antiarrhythmic drugs. Variability of R-R intervals is reduced in conditions affecting the cardiac autonomous nervous system such as diabetes. It is also decreased in patients with ischaemic heart disease and in those with cardiac failure of different aetiology. The decrease is not an expression of the disease itself: it shows an alteration in neurovegetative tonicity in the particular disease condition. The decreased variability of R-R intervals in patients with ischaemic heart disease has an important prognostic value. The predominance of the sympathetic over the depressed vagal activity signalizes an increased risk of sudden coronary death.

Diabetic autonomic neuropathy after pancreas and kidney transplantation.

We have evaluated the effect of successful pancreatic and kidney transplantation on autonomic neuropathy in nine Type 1 (insulin-dependent) diabetic subjects. Cardiovascular reflex tests were performed before and at 6-24 months after transplantation. A control group of ten Type 1 diabetic patients after kidney grafting only was examined at the same time periods. For base-line comparisons results of the tests in ten healthy subjects were used. Advanced autonomic neuropathy was present in both groups of transplant recipients and no significant changes in test results could be found at post-transplant evaluation. Lack of autonomic nerve function improvement was confirmed in seven patients of the pancreatic and kidney transplantation group who were examined again after 2-4 years. Irreversible structural autonomic nerve damage is probably present in uraemic pancreatic transplantation candidates.