[Levels of CK MB mass in patients with acute myocardial infarct treatedwith fibrinolysis. Comparison with levels of CK, CKMB, CKMB mass and troponin T in the diagnosis of coronary ischemia]. / Hodnoty CK MB mass u nemocných s akutním infarktem myokardu lécených fibrinolýzou. Srovnání významu hodnot CK, CKMB, CKMB mass a troponinu T pro stanovení diagnózy ischemických srdecních príhod.

In a group of 26 patients with AIM the CKMB value was raised above the discrimination level already on admission--on average 2.7 +/- 1.4 hours after development of ischaemic pain--in 46% patients. The maximal value of CKMB mass was achieved in the group with probable reperfusion 12.1 +/- 3.8 hours after the development of ischaemic pain and this value was elevated in relation to the discrimination value 41.5 +/- 17x and in relation to the so-called basal value 145 +/- 117x. In the group without probable reperfusion the maximal value was achieved significantly later, after 19.8 +/- hours and was elevated in relation to the discrimination value 31 +/- 17x and in relation to the final value 84 +/- 42 times. The value of CKMB mass increased above the discrimination limit from the onset of ischaemic pain after 4.0 +/- 1.5 and after 5.7 +/- 3 hours in the group with probable and without probable reperfusion and declined below the discrimination limit after 00 +/- 60 and 119 +/- 98.0 hours in the same groups. On comparison of CK, CKBM, CKBM mass and troponin T on admission the CKMB mass value was elevated in 46% patients, the value of CK in 23%, of CKMB in 27% and the troponin T value in 96% patients. With regard to the assembled experience that haemolytic serum raises false troponin T values, the percentage of elevated troponin T values on admission declines from the original 96% to 81% when all haemolytic samples are eliminated. The time of reaching maximal values of CKMB mass in patients with AIM and probable reperfusion was significantly shorter than in CK values and is similar as in CKMB values. The time taken to raise the CKBMB mass value above the discrimination value is significantly shorter than the time taken by CK levels, but significantly longer than the time before troponin T levels are raised. The time of total elevation of CKMB mass levels above the discrimination limit does not differ from the time taken to raise CK values, it is however shorter than the increase of troponin T values, although the exact time of persistence of raised levels of troponin T was not assessed in our work. The time of increase above and decrease below the discrimination limit was not assessed in CKMB values. Based on mutual comparison of the impact of indicators for assessment of the diagnosis of ischaemic heart attacks the authors consider it best regardless of financial costs--to assess troponin T, possibly along with levels of CKMB mass.

[Changes in troponin T levels in patients with acute myocardial infarct treated with fibrinolysis]. / Zmeny hladiny troponinu T u nemocných s akutním infarktem myokardu lécených fibrinolýzou.

The objective of the presentation was to assess changes of the troponin T level--a very sensitive indicator of cardiac muscle damage--in patients with acute myocardial infarction treated by fibrinolysis, and to assess differences in troponin T levels between patients with successful reperfusion and without reperfusion. The troponin T level was examined in 28 patients with acute myocardial infarction (AIM), incl. 22 (78.6%) where probably reperfusion occurred, as concluded from a maximal increase of CPK and CPK MB values within 12 hours. In six patients with a later rise of enzyme values treatment was considered as probably unsuccessful. In both groups of patients troponin T values increased, particularly markedly in the group with probable reperfusion, starting from the 3rd to the 18th hour after the onset of treatment, when the differences in troponin values between the two groups were statistically significant at the 1% and 1% level of significance. An early rise of the troponin T level suggests more rapid release of so-called free cytoplasmic troponin T in patients with successful reperfusion. From the 54th hour there is a statistically insignificant rise of troponin T level in the group of patients without probable reperfusion and it suggests a more marked release of so-called structurally linked troponin T in patients where reperfusion was not achieved. Consistent with these results, the mean maximal value of troponin T during the period of 3-24 hours after the onset of treatment is 2.37 times higher than a corresponding value during the period of 60-108 hours in the group with probable reperfusion and conversely in the group without probable reperfusion the troponin T value is 1.2 times higher during the period 60-108 hours after the onset of treatment.

Prevalence of psychopathology in patients suffering from breast and gastrointestinal cancer.

Prevalence of psychopathology in 107 in- and outpatients suffering from cancer was assessed by means of self-rating inventory (Symptom Check List (SCL-90)) and an interview. There were 86 women with breast cancer and 21 patients with gastrointestinal cancer (9 women and 12 men). Inventory was administered once after surgery. Psychopathology exceeding so called mean borderline values derived from control samples ranged from 2% to 33% of the patients in particular dimensions of the inventory. Maximal mean values of the psychopathology were found in the dimensions of somatisation, depression, anxiety, phobic anxiety, hostility and of items not included, reflecting mostly sleep and eating distortions. Mean values of the psychopathology were insignificantly lower in patients after mastectomy, compared with gastrointestinal cancer patients. No significant differences between initial (I and II) and advanced (III and IV) stages of the illness were achieved in the patients from both investigated samples. Screened patients are suitable for psychiatric or psychologic therapeutic intervention.

[Methylphenidate (Ritalin) in the treatment of acute drug poisoning (discussion)]. / Metylfenidát (RITALIN) v lécení akutních otrav léky. (Diskusní príspevek).

Based on data in the literature and his own clinical experience the author submits a historical reminiscence of the nowadays already obsolete indication of methylfenidat in the treatment of acute drug intoxications. Methylfenidat, being a central stimulant, reduces and alleviates quantitative disorders of consciousness or prevents a relapse of unconsciousness in acute drug intoxications. Even when large doses are administered by the parenteral route, it is very safe. The author recommends therefore to workers in anaesthesiology and resuscitation departments to test methylfenidate in this indication and include it again in the comprehensive treatment of acute drug intoxications. A prerequisite is the registration of RITALIN amp. à 20 mg of Ciba Geigy (British branch) in Czech Republic.

[Subacute thrombosis of the abdominal aorta with suprarenal involvement and successful treatment with pharmacomechanical fibrinolysis]. / Subakutní trombóza brisní aorty suprarenálne zasahující, úspesne lécená farmakomechanickou fibrinolýzou.

In a 43-year-old patient with Ebstein's anomaly and a history of acute myocardial infarction by means of duplex ultrasonography and aortography the diagnosis of thrombotic occlusion of the a aorta was established, starting above the insertion of the renal arteries and reaching as far as the bifurcation of the aorta and the common iliac arteries. In the clinical picture dominated complete anuria with uraemia and marked hyperkaliaemia as a result of ischaemic affection of the extremities due to thrombosis of the aorta; at the onset of hospitalization also left ventricular failure with hyperhydration and later also signs of the hyperviscous syndrome. The latter developed after repeated haemofiltrations which led to a rise of the originally high haemoglobin and haemotocrit values a result of a righ-left shunt in Ebstein's anomaly. After improvement of the clinical condition local fibrinolytic treatment of the aortal thrombosis with urokinase (total dose 2,160,000 u. administered within 24 hours) was provided. The thrombus with a total length of 13.5 cm was dissolved except for a residual portion of 10 mm located in the area of insertion of the right renal artery. After dissolution of the thrombus it proved possible to restore the blood flow into the left kidney a and lower extremities, but not into the right kidney because of the residual thrombus. Seventy-two hours after terminated fibrinolysis - and after 31 days of anuria - the diuresis was restored and after a polyuric stage normalization of mineral, urea levels was restored and the creatinine value was slightly above the upper normal range. Concurrently with fibrinolytic therapy angioplasty of the aorta was carried out and a stent was placed on the left iliac artery. The clinical condition of the patient was improving, the patient started to mount stairs. Death occurred suddenly and the cause was cardiac failure due to very serious congenital heart disease.

[Arrhythmogenic right ventricle]. / Arytmogenní pravá komora.

A 26-year-old patient with an irrelevant personal and family-history was treated on account of attacks of relapsing ventricular tachycardia and cardiac failure, mostly dextrolateral. After ruling out other possible causes of the disease--such as embolism of the lungs, ischaemic heart disease, out other possible causes of the disease--such as embolism of the lungs, ischaemic heart disease, Ebstein's anomaly, the diagnosis of an arrhythmogenic right ventricle was established. This disease is suggested by negative T waves in the thoracic leads V1-V3 during sinus rhythm and by the shape of the QRS complex which was the type found in block of the Tawara branch with an axis of + 100 degrees during attacks of ventricular tachycardia. Moreover, ventricular tachycardia of the same type was produced during electrocardiographic examination. On angiographic examination ARVD is suggested by marked trabeculization and impaired kinetics of the outflow tract of the right ventricle. In the prevention of relapses of ventricular tachycardia beta-blockers and Cordarone were successful when used simultaneously with cardiac stimulation type AAI applied on account of a confirmed sinoatrial block.

[Problems of admission and detention of citizens in health care institutions in the Czech Republic]. / K problematice prevzetí a drzení obcana v ústavu zdravotnické péce v Ceské republice.

The author explains in detail new legal regulations on admission to and detention in health institutions of citizens of the Czech Republic, as applied to people with mental disorders. The author describes three stages of implementation as regards admission of a person to a psychiatric in-patient department, i.e. prerequisites for involuntary psychiatric hospitalization, the stage of the intervention and the stage of admission to and detention in a psychiatric in-patient department. Attention is drawn to the fact that in the legal regulations are some inaccuracies and that practical implementation of involuntary hospitalization of the mentally sick is associated with some difficulties. It is recommended that after evaluation of experience with the implementation of the new regulations which are valid since Jan. 1, 1992 some of the regulations should be amended.

[Actilyse (a recombinant tissue-type plasminogen activator] in the treatment of acute myocardial infarct. Comparison of the effects of Actilyse and streptokinase]. / Preparát Actilyse (rekombinacní tkánový typ aktivátoru plazminogenu) v lécbe akutního infarktu myokardu. Srovnání úcinku Actilysy a Streptokinázy.

The preparation Actilyse--a tissue plasminogen activator prepared by recombination--is an effective fibrinolytic drug. The authors recorded in a group of 33 patients reperfusion in 91%, evaluated on the basis of indirect criteria. In a group of 18 patients treated with streptokinase reperfusion was achieved in 74%. Based on changes of CK and CK-MB values--an earlier rise of values following Actilyse administration and conversely their more marked increase during subsequent sampling after streptokinase administration--it may be assumed that earlier dissolution of the thrombus in the coronary artery occurs after Actilyse administration, as compared with streptokinase. It may be thus assumed that there is also a smaller necrotic focus after Actilyse treatment, as compared with streptokinase. Early re-occlusion--according to indirect indicators--occurred in 8.6% in the Actilyse treated groups, as compared with 5.9% in the streptokinase treated group. The fibrinogen values decline in the Actilyse group to 40% and in the streptokinase group to 28%. Later enhanced new formation of fibrinogen occurs and the fibrinogen values rise to 160% in the Actilyse treated group and to 250% of the initial value in the streptokinase treated group. The elevated fibrinogen value, as compared with the baseline value, persists for the 12 days of the follow-up. No severe spontaneous haemorrhage was recorded, haemorrhagic manifestations were associated with blood sampling and i.v. administration of drugs only. The necessity to administer blood was due to a complication during puncture of the subclavian vein in one patient.(ABSTRACT TRUNCATED AT 250 WORDS)

[15 years' activity of the Psychosomatic Disorders Section within the Psychiatric Association in the Czech Medical Society]. / Patnáct let cinnosti sekce pro studium psychosomatiky psychiatrické spolecnosti CLS.

The author describes in detail the activities of the psychosomatic section of the Psychiatric Society of the Czech Medical Society since its foundation in 1975 from the theoretical, organizational, research and teaching aspects. The aim of this section is above all to enforce the psychosomatic approach and bio-psychosocial model of disease in the Czechoslovak health services. The society developed its activities according to interdisciplinary principles. The perspectives of development of psychosomatic care in Czechoslovakia in the next future are in particular: 1. further enforcement of the psychosomatic approach to patients and the bio-psychosocial model of disease in clinical practice and theory; 2. development of so-called consultation-liaison psychiatry according to the concept of Z. J. Lipowski on the basis of nonpsychiatric disciplines and creation of further psychosomatic in- and out-patient units and departments, in particularly at the primary health care level; 3. further development of postgraduate and initiation of undergraduate teaching of psychosomatic and behavioural medicine; 4. development of research, in particular by the method of controlled clinical trials and prospective studies; 5. extension of possibilities to publish work and of international collaboration.

[Tumor microembolization in the lungs--a cause of marked dyspnea, syncope, hemolytic syndrome and disorders of hemocoagulation]. / Nádorová mikroembolizace do plic--prícina výrazné dusnosti, synkop, hemolytického syndromu a poruchy hemokoagulace.

The authors describe the course of the disease in a 28-year-old woman who suffered two years following surgery of breast cancer from rapidly deteriorating dyspnoea, syncopes and laboratory manifestations of global respiratory insufficiency. The finding on auscultation of the lungs was normal, pulmonary angiography did not reveal signs of serious pulmonary embolization. The patient died after ten days in hospital despite comprehensive therapy and artificial ventilation. Necropsy revealed multiple microembolizations of tumourous cells into the pulmonary vessels as the main causes of the disease. Concurrently infiltration of the bone marrow by tumourous cells was revealed. The course of the disease was complicated by impaired haemocoagulation as a result of microangiopathic haemolytic anaemia and disseminated intravascular coagulation during the passage of erythrocytes through the pathologically altered pulmonary capillaries and impaired liver function.

Psychosomatic medicine in Czechoslovakia: history, present state and perspectives.

The history and present state of psychosomatic medicine in Czechoslovakia are described in detail. At the present time, a concept of Z.J. Lipowski is spreading. Since the formation of the Section for Study of Psychosomatic Medicine, a part of the Czech Psychiatric Association in 1975, several teams of physicians and clinical psychologists have started work in various fields of psychosomatic medicine. Some inpatient and outpatient psychosomatic wards and units were opened. Pre- and postgraduate training in psychosomatics and behavioral medicine have started. Future developments of psychosomatic health care in Czechoslovakia will require the integration of the psychosomatic approach and the bio-psychosocial model of disease into primary health care and other bio-medical disciplines. Psychosocial theory must be incorporated into prevention, diagnosis, treatment and rehabilitation of all diseases using the method of liaison psychiatry, along with the further institutionalization of psychosomatic care.

[Successful treatment of the superior vena cava syndrome caused by thrombosis and a fibrous septum in a patient with a permanent cardiac pacemaker]. / Uspesne lécený syndrom horní duté zíly zpusobený trombózou a vazivovým septem u nemocného s trvalou kardiostimulací.

A patient with a ten-year permanent implantation of a pacemaker was admitted on account of a clinically serious syndrome of the vena cava superior. The cause of the syndrome was an angiographically confirmed extensive thrombosis and after its dissolution a fibrous septum in the area of the orifice of the vena cava superior into the right atrium. The septum caused by a fibrous strip at the orifice of the vena cava superior into the right atrium was removed by surgical operation during thoracotomy by dilatation of the original opening in the fibrous septum by a Broca dilator and digitally. The authors recommend, based on their own experience and data in the literature, to use fibrinolytic therapy in clinically severe thrombosis in the area of the vena cava superior or the right atrium caused by an electrode--during temporary or permanent pacing--or by a catheter used for parenteral nutrition.

[Suicidal ingestion of thioridazine as a cause of severe impairment of heart rhythm--polymorphic ventricular tachycardia]. / Sebevrazedné pozití thioridazinu jako prícina závazné poruchy srdecního rytmu--polymorfní komorové tachykardie.

A 35-year-old female alcohol addicted ingested with suicidal intentions a single dose of 500 mg thioridazine. The course of intoxication was complicated by the development of polymorphous ventricular tachycardia of the torsade de pointes type, about six hours after ingestion. The dysrhythmia was immediately suppressed by stimulation from the right atrium. After 36 hours the stimulation could be abolished. Because of delirium tremens the patient with a normal ECG tracing was returned to the psychiatric clinic.

[Sulpiride (Eglonyl Alkaloid) in the treatment of functional disorders of the digestive tract]. / Sulpirid (Eglonyl Alkaloid) v lécení funkcních poruch zazívacího ústrojí.

Sulpirid was administered in an open clinical trial--150 mg/day for 4 weeks--to 31 patients (15 man and 16 women, mean age 31.5 years, mean duration of complaints 1 month to 6 years) suffering from functional disorders of the digestive system. Their health status was evaluated by a specialist in internal medicine, by a psychiatrist and a self-administered SCL-90 questionnaire before the onset of treatment and after four weeks. In 29 patients the complaints disappeared or improved markedly and this improvement persisted also after discontinuation of the drugs. In the entire group a significant drop of the mean initial intensity of psychopathological feature in all dimensions of the questionnaire occurred; the improvement was more marked in men where the mean baseline values of psychopathology were higher. There was also a significant decline of the mean numbers of positively evaluated items in 9 of 10 dimensions of the questionnaire. The drug was well tolerated by the patients with the exception of one transient allergic skin reaction. So far the exact ratio of improvement of psychopathology as a therapeutic response to sulpirid administration and the placebo effect on the patient's complaints cannot be exactly evaluated. Sulpirid has some advantages, as compared with other psychopharmaceutic preparations used in this indication (e.g. amitriptyline, dosulepine).

[News in psychopharmacotherapy]. / Novinky v psychofarmakoterapii.

The author deals with new findings in research and clinical application of atypical neuroleptic drugs, MAO inhibitors, in particular and second generation, and non-diazepine anxiolytics, in particular serotonergic ones. He summarizes the possibilities of psychopharmacotherapy of clinical units which will be included in the 10th revision of the International statistical classification of diseases, injuries and causes of death, i.e. panic anxiety, obsessive compulsive disorder, agoraphobia with panic attacks and generalized disorder of anxiety.

[Hospitalization of the mentally ill without their consent in the USSR]. / Hospitalizace dusevne nemocných bez souhlasu v SSSR.

The author gives a detailed account of recent Soviet instruction of urgent hospitalization which is an important step in this area of psychiatric institutionalism. The new Soviet set-up is compared with analogous Czechoslovak regulations and the practice of admitting a patient without his consent. The author assumes that consequential adherence to the new Soviet instructions in practice should contribute to a reduction of the possible risk of abuse of psychiatry.

[Severe antihistamine poisoning complicated by ventricular tachycardia]. / Závazná intoxikace antihistaminiky komplikovaná komorovou tachykardií.

A 26-year-old female clerk without previous heart disease ingested with suicidal intensions antihistaminic drugs--H1 blockers, astemizole (a total of 700 mg) and terfenadine (a total of 900-1200 mg). The main sign of intoxication was repeated polymorphous ventricular tachycardia type torsade de pointes, which at the onset of hospitalization changed into ventricular fibrillation. Therapeutically the impaired rhythm was controlled by electric cardioversion and atrial stimulation with a frequency of 120/min. On the third day it was possible to discontinue atrial stimulation and later the patient was discharged without any permanent sequelae.

[Cardiac tamponade as a complication of acute myocardial infarct. (Clinical and pathologico-anatomic analysis of patients with acute myocardial infarct and cardiac tamponade)]. / Srdecní tamponáda jako komplikace akutního srdecního infarktu. (Klinický a patologicko-anatomický rozbor nemocných s akutním srdecním infarktem a srdecni tamponádou.)

Cardiac tamponade is a frequent cause of death in acute myocardial infarction--in as many 23%. It is encountered in particular in the 7th and 8th decade, in patients with a first infarction which is frequently situated in the anterior wall of the left ventricle. 93% of the patients have obvious ECG manifestations of Q infarction. The diagnosis of cardiac tamponade is easy when during an acute terminal attack slow activity on the ECG tracing is found without a haemodynamic response and the pulse on the great arteries is not palpable even after external cardiac massage. In 80% the onset of cardiac tamponade is very sudden. The presence of shock or cardiac failure makes the diagnosis of cardiac tamponade more difficult. As to investigated indicators, in the development of cardiac tamponade the systemic pressure--systolic as well as diastolic--on admission or during hospitalization, may play a part. The patients have a less marked coronary sclerosis, fibrosis of the cardiac muscle is less frequently present. Previous necroses of the heart muscle may have probably a certain protective effect on the development of cardiac tamponade. Anticoagulants obviously do not influence the development of cardiac tamponade.