[Recurrent meningitis and inherited complement deficiency]. / Recidivující meningitidy a vrozený deficit komplementového systému.

Complement deficiency represents 5% of primary immunodeficiencies worldwide. A total of seven patients with deficiencies of the classical complement pathway were reported in the Czech Republic by the end of 2015. Typical manifestations of complement deficiency are recurrent meningitis, other bacterial infections, autoimmunity and kidney disease.Two case reports are presented of patients with molecularly confirmed C7 (compound heterozygote, c.663_644del in exon 6 and c.2350+2T:>C in intron 16) and C8 (homozygous c.1282C>T in exon 9) deficiency. The first patient had four attacks of meningococcal meningitis and an episode of pneumonia of unknown aetiology in childhood. The second had six attacks of meningitis. He also suffered from recurrent infections (otitis media, tonsillitis, chronic mucopurulent rhinitis and subsequent pansinusitis complicated by nasal polyposis) since childhood. No autoimmune disease was documented in either patient. They both received meningococcal and pneumococcal vaccines. Antibiotic prophylaxis was used only in the second patient, leading to a decline in the number of ENT infections.Complement deficiency should be suspected in patients with recurrent meningococcal infections, especially if combined with other infections caused by encapsulated bacteria or autoimmunity diseases. Prophylaxis with conjugate polysaccharide vaccines is recommended and antibiotic prophylaxis should be considered in individual cases.

Anti-Outer membrane protein C antibodies in colorectal neoplasia.

Sporadic colorectal cancer (CRC) represents an enormous problem worldwide. Large intestinal microbiota play an important role in the colorectal carcinogenesis. The aim of the study was to investigate anti-Outer membrane protein C (anti-OmpC) antibodies, aimed at porin C, which is embedded in the outer membrane of gram-negative bacteria, in patients with colorectal adenoma (CRA), CRC and controls. The study included 22 patients with CRA (11 men, 11 women, aged 26-79, mean 65 ± 12), 11 patients with CRC (9 men, 2 women, aged 50-83, mean 66 ± 11) and 45 controls, blood donors (24 men, 21 women, aged 20-58, mean 38 ± 10). Serum anti-OmpC antibodies were investigated by means of ELISA. Values of 0-20 U/mL were considered to be negative; values >25 U/mL were assessed as positive. A total of 9/11 (82 %) patients with CRC had positive anti-OmpC antibodies. Anti-OmpC antibodies were negative or grey-zone in 37/45 (82 %) controls. Serum anti-OmpC were found to be significantly higher in patients with CRC (median 42.4, interquartile range (IQR) 22.2) compared to controls (median 18.3, IQR 12.4), p < 0.001. No statistically significant difference in anti-OmpC was found between controls (median 18.3, IQR 12.4) and CRA patients (median 17.7, IQR 16.5), p = 0.326. Anti-OmpC were significantly higher in patients with CRC (median 42.4, IQR 22.2) compared to patients with CRA (median 17.7, IQR 16.5), p = 0.011. Positivity of anti-OmpC antibodies was found in patients with CRC, which supports the contribution of gram-negative large intestinal microbiota to the pathogenesis of CRC.

[Amniotic fluid heat shock protein 70 concentration in preterm premature rupture of membranes]. / Heat shock protein 70 v plodové vode u pacientek s predcasným odtokem plodové vody.

OBJECTIVE: The purpose of this study was to determinate the changes of amniotic fluid HSP 70 concentrations in patiens with preterm premature rupture of the membranes, and in the presence of intraamniotic infection and histological changes of inflammations. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynecology Medical Faculty Charles University Hradec Králové. METHODS: We studied 30 women between 24 and 36 weeks of gestation with preterm premature rupture of the membranes. Samples of amniotic fluid were collected by transabdominal amniocentesis. These patients were divided into 2 groups. In group 1 were patiens with intraamniotic infection. In group 2 were patiens without intraamniotic infection. Among 76% (35/30) patients placenta were collected and assessed for presence or absence acute inflammatory lesions. HSP70 concentration in amniotic fluid were determined using a sensitive and specific diagnostic kit Hsp 70- ELISA kit manufactered Assay Desings, USA. RESULTS: There was no significant difference in the median amniotic fluid HSP70 concentration between patients with preterm rupture of the membranes with IAI and without IAI (patients with IAI: median 5.12 ng/ml, range 3.01-90.37 ng/ml vs. patients without IAI: median 4.68 ng/ml, range 0.58-84.28 ng/ml; p = 0.56). There was no significant difference in the median amniotic fluid HSP70 concentration between patients with preterm rupture of the membranes with presence and absence histological of acute inflammatory lesions in the placenta and membranes (patients with presence: median 6.97 ng/ml, range 2.61-90.37 ng/ml vs. patients with absence: median 4.63 ng/ml, range 0.58-84.28 ng/ml; p = 0.68). CONCLUSION: Intraamniotic levels HSP70 were not associated with intraamniotic infection and acute inflammatory lessions in the placenta and membranes.

[Amniotic fluid interleukin 6 levels in preterm premature rupture of membranes]. / Interleukin 6 v plodové vode pacientek s predcasným odtokem plodové vody.

OBJECTIVE: The purpose of this study was to determinate the changes of amniotic fluid interleukin 6 (IL-6) concentrations in patients with preterm premature rupture of the membranes (PPROM), and in the presence of microbial invasion of the amniotic cavity (MIAC) and histological chorioamnionitis (HCA). The aim was to examine amniotic fluid IL-6 in relation to MIAC and HCA. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynecology Medical Faculty Charles University Hradec Králové. METHODS: We studied 37 women between 24 and 36 weeks of gestation with PPROM. Samples of amniotic fluid were collected by transabdominal amniocentesis. Polymerase chain reaction for the genital mycoplasmas and culture for aerobic and anaerobic bacteria were performed. Twenty-eight of 37 patients placentas were collected and assessed for presence or absence HCA. IL-6 concentration in amniotic fluid were determined using a sensitive and specific diagnostic kit Human IL-6 Quantikine ELISA manufactured R&D Systems, USA. RESULTS: There was significant difference in the median amniotic fluid IL-6 concentration between patients with preterm rupture of the membranes with and without MIAC and HCA (patients with MIAC and HCA: median 915 pg/ml, range 651-1854 pg/ml vs. patients without MIAC and HCA: median 780 pg/ml, range 184-1059 pg/ml; p=0.047). There was no significant difference in the median amniotic fluid IL-6 concentration between patients with preterm rupture of the membranes with and without MIAC (patients with MIAC: median 915 pg/ml, range 195-1854 pg/ml vs. patients without MIAC: median 792 pg/ml, range 184-1993 pg/ml; p=0.53). There was no significant difference in the median amniotic fluid IL-6 concentration between patients with preterm rupture of the membranes with and without HCA (patients with HCA: median 829 pg/ml, range 195-1992 pg/ml vs. patients without HCA: median 768 pg/ml, range 184-1890 pg/ml; p = 0.31). CONCLUSION: Amniotic fluid IL-6 concentrations patients with PPROM with presence HCA and MIAC were significantly higher than IL-6 concentration patients without HCA and MIAC.

Antilaminaribioside and antichitobioside antibodies in inflammatory bowel disease.

Testing antilaminaribioside (ALCA) and antichitobioside (ACCA) antibodies in 89 Crohn's disease (CD), 31 ulcerative colitis (UC) and 50 controls, mean values were 38.6 and 53.0 ELISA units for CD, 34.0 and 32.6 for UC, 34.5 and 36.4 for controls, respectively. There was no significant difference of ALCA values between CD and UC (p = 0.401), CD and control subjects (p = 0.698) or UC and controls (p = 0.898). ACCA were significantly higher in CD compared with UC (p = 0.011) but not with the controls (p = 0.095). No significant difference of ACCA values between UC and controls (p = 0.107) was found. ALCA and ACCA values significantly correlated in CD (r = 0.548, p < 10(-4)) and UC (r = 0.885, p < 10(-4)) but not in controls (r = 0.153, p = 0.287). The positive predictive value for CD was only 20 (ALCA) and 8 % (ACCA), the negative ones (to exclude CD) 25 (ALCA) and 86 % (ACCA). Small and/or large bowel involvement or disease type (i.e. stenosing, perforating or inflammatory) of CD did not differ in the two values. The idea that ALCA and ACCA may be useful either to differentiate between CD, UC and healthy subjects or to stratify CD was not confirmed.

[Recurrent vulvovaginal candidiasis--possibility of its treatment]. / Rekurentní vulvovaginální kandidóza--soucasný stav problematiky a lécebné moznosti.

OBJECTIVE: A review of recurrent vulvovaginal candidiasis and the possibility of its treatment. SUBJECT: Original study. SETTING: Department of Obstetrics and Gynaecology, Medical Faculty Hradec Králové, Charles University, Prague. Department of Clinical Microbiology, Medical Faculty Hradec Králové, Charles University, Prague. Department of Biological and Medical Sciences, Faculty of Pharmacy Hradec Králové, Charles University, Prague. Department of Clinical Imunology and Allergology, Medical Faculty Hradec Králové, Charles University, Prague. Department of Psychiatry, Medical Faculty Olomouc, Palacky University, Olomouc. METHODS: Analysis and discussion focused especially on our results and experience in a long time followup of patients with confirmed recurrent vulvovaginal candidiasis. CONCLUSION: Owing to the multifactorial character of etiopathogenesis, the management of recurrent vulvovaginal candidiasis would be taken into consideration the complexity of the disease, not only the treatment of individual episodes with antimycotics.

[Significance of serum antibodies ANCA, ASCA, ABBA in diagnostics of idiopathic intestinal inflammations]. / Význam sérových protilátek ANCA, ASCA, ABBA u idiopatických strevních zánetu.

BACKGROUND: Crohn's disease and ulcerative colitis still remain a heterogeneous group of diseases with an unclear aetiology. Serologic methods play important role in their diagnosing though there is still not an ideal marker. We tried to determine the importance of serological testing of ASCA IgA, IgG, ANCA, ABBA antibodies in patients with ulcerative colitis and Crohn's disease. METHODS AND RESULTS: ASCA IgG, ASCA IgA; ANCA, ABBA antibodies and C-reactive protein were detected by indirect fluorescence assay. ASCA IgA, ASCA IgG, ABBA, ANCA were examined in 40 patients (28 Crohn's disease, 12 ulcerative colitis, 32 health controls). Specificity of ASCA IgA, IgG in CD patients was high (both 96.2%), specificity ANCA in UC 100%. ABBA antibodies had low sensitivity and specificity in both diseases. Combination of ASCA, ANCA, ABBA makes the specificity higher. CONCLUSIONS: We showed the importance of combination ASCA, ANCA with ABBA antibodies to improve the serological diagnosing of IBD.

[Systemic immunity in patients with recurrent vulvovaginal candidiasis]. / Systémová imunita u pacientek s rekurentní vulvovaginální kandidózou.

OBJECTIVE: This study was undertaken to characterize systemic immunity in the patients with recurrent vulvovaginal candidiasis. SUBJECT: Original prospective study. SETTING: 1. Department of Biological and Medical sciences, Charles University in Prague, Faculty of Pharmacy, Hradec Kralove, 2. Department of Obstetrics and Gynaecology, Medical Faculty, Hradec Kralove, Charles University in Prague, 3. Department of Clinical Immunology and Allergology, University Hospital, Hradec Kralove, 4. Department of Clinical Microbiology, University Hospital, Hradec Kralove, Czech republic. SUBJECT AND METHOD: Basic immunological parameters in 44 patients with recurrent vulvovaginal candidiasis were investigated and analyzed in this longitudinal follow-up study. CONCLUSION: Although there is no fundamental disturbance in systemic immunity in patients with recurrent vulvovaginal candidiasis and the majority of systemic immunological parameters in the patients were within normal range, some subtle changes of a few parameters of humoral and cellular immunity in contrast to the controls were identified.

[Antifungal immunity and its mechanism in female genitalia]. / Protihoubová imunita a její mechanismy ve vztahu k zenskému genitálu.

OBJECTIVE: A review of immunological aspects of fungal infections with focus on vulvovaginal candidiasis. DESIGN: Review. SETTING: Department of Obstetrics and Gynaecology, Medical Faculty, Hradec Kralove, Charles University in Prague, Department of Biological and Medical sciences, Faculty of Pharmacy, Hradec Kralove, Charles University in Prague, Department of Clinical Immunology and Allergology, University Hospital, Hradec Kralove, Department of Clinical Microbiology, University Hospital, Hradec Kralove. SUBJECT AND METHOD: Survey and discussion of current immunological aspects of vulvovaginal candidias based on literature review and personal experience. CONCLUSION: The current knowledge of immunity to Candida vulvovaginitis, particularly from experimental studies on animal models, support a more relevant role of local protection mechanisms than systemic immunity. As a consequence of this compartmentalization of the immune response, the role of innate and adaptive immunity remains unclear. The development of vulvovaginal candidiasis depends on a number of factors, including both the individual predisposition of a macroorganism and the properties of a fungal strain, and the environmental conditions influencing a delicate balance between the host and the yeast.

New safety assurance for biological skin covers.

The described system of safety assurance of cryopreserved allogeneic and xenogeneic dermoepidermal transplants comprises serological examination of deceased tissue donors, long-term storage of sera of all donors, microbiological control of prepared allogeneic and xenogeneic dermoepidermal grafts, labelling of released tissue grafts and monitoring of temperatures inside the mechanical freezer (-80 degrees C). From a total number of 76 donors from whom tissues were collected for transplantation during 1999-2001, tissues were discarded in two instances. One because of a positive HBsAg test, the others second one because of presence of anti-HTLV antibodies. In xenogeneic dermoepidermal grafts, out of a total number of 1,203 grafts prepared during the same period, 84 (6.9%) were discarded because of the presence of pathogeneic or potentially pathogeneic microbes. The system of labelling released grafts makes unequivocal identification of the pathway from recipient to donor possible, while at the same time respecting the anonymous character of the donor's data. In xenogeneic grafts it ensures the identification of the appropriate batch. Storage of cryopreserved biological skin covers at a temperature of -80 degrees C in low temperature cabinets with emergency back-up cooling with liquid nitrogen and a supplementary source of electric power, proved very useful. The system responds to the gradual implementation of the principles of Quality Management System ISO 9000 and Good Manufacturing Practice into the activities of tissue banks. Further tightening of the demands for the safety of allo- and xeno-transplantation is foreseen in conjunction with the occurrence of transmissible spongiform encephalopathy and porcine retroviruses.

The effect of trimetazidine on C-reactive protein, cytokines and adhesion molecules in the course of acute myocardial infarction.

The aim of this randomised, double-blind, placebo controlled, parallel group study was to assess the effect of trimetazidine (TMZ), a potent antiischaemic drug, on plasma C-reactive protein (C-RP), cytokine and adhesion molecule levels. The study population consists of 18 patients (16 males, 2 females, average age 56.45 +/- 10.97 years) with acute myocardial infarction admitted within 6 hours after onset of symptoms and treated with streptokinase. Blood samples were taken at 3-hour intervals during the time of treatment. All patients were randomised blindly using a centralised randomisation process, between trimetazidine (40 mg bolus i.v. then 60 mg per day for 48 hours intravenously in glucose infusion) or placebo group. Plasma C-RP level was significantly lower in TMZ group (39.5 mg/ml +/- 9.7 mg/ml) as compared to placebo (75.7 +/- 29.4 mg/ml, p < or = 0.001) and peaked 28 hours later in TMZ group. Plasma interleukin 6 (IL 6) level showed a sharp peak 9 hours after the onset of the symptoms in TMZ group (116.9 +/- 180.2 pg/ml vs. 45.4 +/- 37.9 pg/ml) and was increased up to 30 hours after the onset of the symptoms. Plasma interleukin 1 beta (IL 1 beta) was also higher in TMZ group notably 21 hours after the onset of symptoms (26.4 +/- 9.3 pg/ml vs. 16.2 +/- 2.4 pg/ml). TMZ group showed lower plasma E-selectin levels. Plasma IL 8, TNF alpha and ICAM 1 levels were without statistical significant differences. The present study demonstrates a significant reduction of plasma C-reactive protein level in the course of acute myocardial infarction treated with streptokinase and intravenous trimetazidine infusion compared with the group of patients without trimetazidine treatment.

Serum soluble adhesion molecules (sICAM-1, sVCAM-1 and sE-selectin) in healthy school aged children and adults.

The aim of this study was to map normal levels of serum soluble isoforms of adhesion molecules in relation to age and sex in the group of school-aged children. sICAM-1, sVCAM-1 and sE-selectin were determined in the group of 158 normal children subdivided into two subgroups; 6-10 years (68 children, median age 8 years) and 11-15 years (90 children, median age 12 years) and in 70 normal adult blood donors (25 females and 45 males, median age 46 years). The levels of sICAM-1 and sE-selectin fell down significantly over the age range 6-15 years, while the level of sVCAM-1 was remained. Age-related normal ranges were established using correlation analysis and were expressed as the 5%-95% percentiles intervals: sICAM-1 206.8-486.8 ng/ml, sE-selectin 36.7-153.2 ng/ml in the group of 6-10 years old children, sICAM-1 184.1-354.0 ng/ml, sE-selectin 29.9-114.1 ng/ml in group of 11-15 years old children. The levels of sVCAM-1 were 359.6-822.0 ng/ml and were constant within the examined age interval from 6 to 15 years. The influence of sex was also assayed and it was not statistically significant in any age category tested. Normal ranges of sICAM-1 (60.2-218.4 ng/ml), sE-selectin (8.3-116.9 ng/ml) and sVCAM-1 (338.0-1148.0 ng/ml) were established for adult population of healthy blood donors using the same methods.

Cytokines and adhesion molecules in the course of acute myocardial infarction.

The plasma levels of interleukin 1 beta (IL 1beta), interleukin 6 (IL 6), interleukin 8 (IL 8), tumor necrosis factor alpha (TNF-alpha), E-selectin, ICAM 1 and C-reactive protein (CRP) have been studied in 24 patients with acute myocardial infarction in the course of 96 h. The plasma IL 1beta and IL 6 levels were continually elevated during the 96 h study period (the peak of plasma IL 1beta level was 22.2 pg/ml, S.D. 8.6, P < 0.001, normal values of IL 1beta are less than 10 pg/ml, the mean peak plasma concentration of IL 6 was 184.9 pg/ml, S.D. 134.7, vs. normal values of 15.57 pg/ml, S.D. 2.4, P < 0.001). The mean plasma IL 8 level was increased for the duration of the study, the mean plasma IL 8 level was 103.0 pg/ml, S.D. 23.4 (normal value was below 30 pg/l, S.D. 8.0) P < 0.001. The plasma TNF-alpha level was elevated throughout the time of observation without any significant peak. The mean plasma TNF-alpha concentration was 46.8 pg/ml, S.D. 2.13, vs. normal value 4.35 pg/ml, S.D. 1.23, P < 0.001. The plasma E-selectin level reached the mean level of 145.1 ng/ml, S.D. 75.4, vs. normal value 29.1-63.4 ng/ml, P < 0.001 at an interval of 15-42 h after the onset of the symptoms. The plasma ICAM 1 level showed only a slight significant increase during the first 36 h. The plasma CRP concentration increased later than IL 6, and reached a peak at 42 h after the onset of the symptoms (69.2 mg/l, S.D. 29.9, vs. 1.2 mg/l, S.D. 4.7, P < 0.0001). We conclude that cytokines and adhesion molecules can play an important role in the mechanisms of tissue injury in the process of ischemia and reperfusion.

Serum soluble adhesion molecules (sICAM-1, sVCAM-1, sE-selectin) and neopterin in patients with Sjögren's syndrome.

Sjögren's syndrome is a systemic autoimmune disease characterized by focal lymphocytic infiltration of the salivary and lacrimal glands. Expression and up-regulation of adhesion molecules and activation of cellular immune system is essential for the migration of inflammatory cells into tissues. Soluble forms of adhesion molecules sICAM-1, sVCAM-1, sE-selectin and neopterin were analyzed in serum of 17 patients with primary Sjögren's syndrome and 11 patients with secondary Sjögren's syndrome together with 26 age-matched healthy blood donors. There were significantly higher serum concentrations (mean +/- 1SD) of sICAM-1 (362.0 +/- 67.9 ng/ml, p < 0.001), sE-selectin (78.7 +/- 28.1 ng/ml, p < 0.001) and neopterin (17.9 +/- 6.4 nmol/l, p < 0.001) in primary Sjögren's syndrome patients in comparison to control group (sICAM-1: 128.3 +/- 46.9 ng/ml, sE-selectin: 46.3 +/- 39.5 ng/ml, and neopterin: 7.6 +/- 2.3 nmol/l). Sera from patients with secondary Sjögren's disease contained significantly higher levels of sICAM-1 (356.0 +/- 62.4 ng/ml, p < 0.001), sE-selectin (65.5 +/- 27.0 ng/ml, p < 0.05), and neopterin (18.8 +/- 9.8 nmol/l, p < 0.001) in comparison with control group. There were no significant differences between patients with primary and secondary Sjögren's syndrome in any parameters tested. No statistically significant differences in serum levels of sVCAM-1 were found either in patients with primary or secondary SS compared to control group.

Mitogen-induced lymphocyte proliferation and systemic immune activation in cancer patients.

AIMS AND BACKGROUND: Proliferative response of lymphocytes to mitogens is known to be decreased in cancer patients. Depressed proliferation of lymphocytes in other disorders has been linked to systemic inflammatory response. METHODS: Lymphocyte proliferation in response to phytohemagglutinin (PHA) and concanavalin A, as well as urinary neopterin, plasma interferon-gamma and interleukin-4, were investigated in 41 patients with solid tumors. RESULTS: The proliferative response to PHA was significantly depressed in cancer patients at most of the concentrations examined. Urinary neopterin and plasma interferon-gamma were significantly elevated in cancer patients, whereas interleukin-4 was undetectable in all the subjects. A negative correlation was observed between urine neopterin and lymphocyte proliferative response to mitogens. CONCLUSIONS: Lymphocyte proliferative response to PHA is significantly diminished in cancer patients, and this depression appears to be partly linked to systemic inflammatory response. Plasma interferon-gamma was significantly increased in cancer patients, whereas interleukin-4 was undetectable.

The effect of reperfusion on plasma tumor necrosis factor alpha and C reactive protein levels in the course of acute myocardial infarction.

Severe acute response, the synthesis of human acute-phase proteins and the increase of plasma cytokines and adhesion molecules occur in patients in the course of acute myocardial infarction. We examined the plasma tumor necrosis factor alpha (TNF alpha), plasma creatinkinase (CK) and C-reactive protein (C-RP) levels in patients with acute myocardial infarction (AMI) in the course of 96 hours. Venous blood samples were taken at 3-hour intervals during the first 48 hours, and at 6-hour intervals during the next 48 hours. All patients were treated using thrombolytic therapy (streptokinase). Detection of the reperfusion was based on the method of measuring the time to achieve peak serum creatinkinase activity. The study was done on a group of 24 patients. Plasma levels of the parameters were compared between the group of patients with expected reperfusion versus the group of patients in which reperfusion is not suggested. The plasma TNF alpha level was elevated constantly without any significant peak. The mean plasma TNF alpha concentration was 46.8 pg/ml, SD 2.13, vs. normal level 4.35 pg/ml, p < 0.001. The plasma TNF alpha level in the group of patients with reperfused coronary artery showed a significant decrease especially during the 3rd and 4th day (the mean peak plasma TNF alpha concentration was 35.2 pg/ml, SD 15.8, vs. 66.9 pg/ml, SD 38.3 pg/ml, p < 0.005). The plasma C-RP levels were elevated throughout the time of observation in the both groups. The elevation of the plasma C-RP levels was more significant in the group of patients without successful reperfusion (80.6 mg/ml, SD 31.2, the mean plasma C-RP level of the group of the patients with successful reperfusion was 45.7 mg/ml, SD 18.1, p < 0.005). We conclude, that TNF alpha can play a role in the mechanisms of tissue injury. The successful reperfusion of coronary artery leads to significant decrease of plasma TNF alpha and C-RP levels.

[Evaluation of patients after heart surgery in the 20-year period of the 2d rehabilitation phase (1967-1986) in Sliac]. / Vyhodnotenie chorých po chirurgických výkonoch na srdci za dvadsatrocné obdobie II. rehabilitacnej fázy (1967-1986) v Sliaci.

In the 1967-1986 in the Czechoslovak State spa Sliac 961 (48.15%) men and 1035 (51.85%) women after surgical operations on the heart were followed up during the second rehabilitation stage. The operations were made because of the following indications: acquired rheumatic valvular defects 1208 (60.52%), congenital heart disease 461 (23.10%), ischaemic heart disease 260 (13.03%), myxomas and thrombi of the left atrium 31 (1.55%), pericardiectomy was performed in 36 (1.80%). As to surgical operations, commissurotomy and commissurolysis were performed in 724 (36.27%) an artificial prosthesis was implanted in 330 (16.53%), homotransplants in 151 (7.57%) autotransplants in 3 (0.15%), aortocoronary by-pass/revascularization in 260 (13.03), surgical operations on account of congenital heart disease, thrombi and myxomas of the left atrium were performed in 492 (24.65%) of the patients. Rehabilitation care comprised in addition to remedial exercise a therapeutic regime, clinical and laboratory examinations, dietotherapy, medicamentous and physical therapy and carbon dioxide baths. After rehabilitation care objective improvement was recorded in 850 (42.59%), subjective improvement in 953 (47.74%) no change in 143 (7.16%), deterioration in 47 (2.35%), and three patients (0.15%) died.