[The "Short Physical Performance Battery" in the Czech Republic -  the pilot and validation study in older persons]. / "Krátká baterie pro testování fyzické zdatnosti senioru" -  pilotní studie a validizace testu u starsích osob v Ceské republice.

INTRODUCTION: Population ageing increases number of seniors with decline of physical capabilities and functional deficits. Targeted interventions to maintain or increase physical performance are most effective before the development of full frailty, in so-called "prefrail" period. One of the assessment tools for evaluation of the physical performance and/ or frailty in older persons is the "Short Physical Performance Battery" -  SPPB. The aim of the study was to introduce the assessment battery to clinical practice in the CR and to evaluate its selected psychometric properties. METHOD: Original English SPPB was translated into Czech language and back translated to ensure linguistic accuracy. SPPB was applied in the selected sample of older persons and validated against other performance tools for cognition, self- care and nutrition status used in CR and selected psychometric properties evaluated. RESULTS: We examined 145 older persons (108 women, i.e. 74.48 % and 37 men, i.e. 25.52 %) mean age 80.38 years (54- 101 years, SD ± 8,47). We found good physical performance in 35 (24.1 %) older persons (SPPB 10- 12 points), 21 (14.5 %) were identified as prefrail (SPPB 7- 9 points) and 89 (61.4 %) as frail in high risk of future disability or already disabled (SPPB 6 points). We found statistically significant correlation of global SPPB score with nutritional status (MNA- Short Form), activities of daily living performance (ADL) and cognitive performance (MMSE) -  (Spearman correlation ρ = 0.51; 0.53 and 0.38 respectively). The Cronbachs a for SPPB variables scored 0.821, which is consistent with good internal consistency of SPPB battery. When evaluating 3 age groups [ 75 years (n = 41), 76- 85 (n = 62) and 86- 101 years (n = 42)] the most significant correlations were found between SPPB and MNA, ADL and MMSE in the young elderly (ρ = 0.74, 0.79 and 0.64 respectively) and they diminished with increasing age. CONCLUSION: We confirmed significant correlations between SPPB and self care activities, cognitive performance and nutritional status and good internal consistency of the battery. SPPB test is simple, easy to perform, with low time and cost requirements. It could be recommended for clinical practice in both community and hospitalized older patients to evaluate their overall physical performance and identify persons at risk of frailty and disability who may profit from targeted interventions.

[Obesity, body mass index, waist circumference and mortality]. / Obezita, body mass index, obvod pasu a mortalita.

Obesity belongs to civilization diseases with its incidence and prevalence increasing all over the world. Complications of obesity represent a serious socioeconomic problem. Obesity is a part of the metabolic syndrome and an independent mortality risk factor in all age categories, however, this relation is twice as strong in individuals under fifty years of age. Slight overweight in old age is associated with reduced total mortality risk. Simple evaluation of obesity via calculation of body mass index and measurement of waist circumference can be carried out in every medical consulting room.

[Turner's syndrome requires multidisciplinary approach]. / Turneruv syndrom vyzaduje multidisciplinární prístup.

Turner syndrome is one of the most frequent genetic disorders, the result of complete or partial monosomy of the X chromosome. It affects 1 : 2,500 live female births. The principal features of Turner syndrome are short stature and ovarian dysgenesis accompanied by estrogen deficit. Turner syndrome is associated with further numerous, more or less serious abnormalities and high risk of cardiovascular mortality. The article concisely summarizes the most frequent problems in Turner syndrome and emphasizes the need of multidisciplinary care for affected patients.

[Turner syndrome is associated with increased cardiovascular morbidity and mortality]. / Infarkt myokardu--prícina predcasné smrti u Turnerova syndromu.

The authors present a case of an acute myocardial infarction in a patient with Turner syndrome, leading to the death of the patient. An emphasis is put on the need of a thorough examination of cardiovascular system, specialized on congenital heart disease including aortic dilatation with the risk of dissection, and early development of ischemic heart disease. Regular monitoring as well as adequate therapy in patients suffering from this genetically determined disorder is recommended.

[Correction of morphology and indicators of atrial function using long-term physiologic cardiac pacing in patients with prior chronic atrioventricular dissociation or VVI pacing]. / Uprava morfologických a funkcních ukazatelu srdecních predsíní vlivem dlouhodobé fyziologické kardiostimulace u pacientu s predchozí chronickou atrioventrikulární disociací nebo VVI stimulací.

UNLABELLED: In patients with atrioventricular dissociation associated with complete atrioventricular block or reverse synchronization and preservation of the sinus rhythm the atria are mechanically over-burdened by contraction in an inept stage of the cardiac cycle (against a closed atrioventricular valve). Prolonged overburdening leads to dilatation of the atria and a higher incidence of supraventricular arrhythmias incl. atrial fibrillation. The objective of the trial was to assess whether these changes are reversible. METHOD: In 26 patients where atrioventricular dyssynchronization as the only detectable reason of atrial dilatation was eliminated by implantation of sequential atrioventricular stimulation, the authors investigated by echocardiography the dimensions, volumes and ejection fractions of the atria and left ventricle at baseline (A), after 24 hours following implantation (B), after 8 weeks (C), after one year (D). RESULTS: Left atrium: during the first 24 hours diminution in the long axis occurred (AxB: -4.28, p = 0.023), the difference remained significant even after eight weeks (AxC: -6.1, p = 0.050). The ejection fraction was after eight weeks also significantly greater (BxC: +8.29, p = 0.039). Right atrium: within 24 hours the long axis was reduced (AxB: -4.70 p = 0.033), the difference was apparent also after 8 weeks (AxC: -5.60 p = 0.028). Within 8 weeks (AxC) the mean enddiastolic pressure diminished significantly (-11.01, p = 0.032) as well as the endsystolic volume (-9.01, p = 0.018, while the ejection fraction increased (+7.50, p = 0.031). The right ventricular volume during diastole increased between the 8th week and the check-up after one year (+6, -1, +17.77, p = 0.046). Left ventricle: the ejection fraction had a rising trend, after one year a significant difference was found as compared with the baseline value (AxD: +10.20%, p = 0.007) and as compared with the value assessed 8 weeks after implantation (CxD: +9.44%, p = 0.018). The change of the ejection fraction was inversely proportional to the value of the ejection fraction immediately after implantation (r -0.83, p < 0.01). CONCLUSION: The authors provided evidence of the reversibility of the morphological and functional atrial damage and the favourable effect of atrioventricular synchronization on left ventricular function.

[Dual-cavity pacing for maximal work capacity in patients with a chronic high-grade atrioventricular block]. / Prínos dvoudutinové stimulace pro maximální pracovní kapacitu nemocných s chronickou sínokomorovou blokádou vyssího stupne.

Twenty-eight patients with a grade 2 and 3 atrioventricular block and an implanted DDD pacemaker were repeatedly subjected to a bicycle ergometric test with a maximum load of the AV block (VV30), ventricular stimulation (VVI70) and DDD stimulation. The maximum work capacity and maximum heart rate achieved on VVI30 were 92 + xi 38 W and 61 +/- 27/min. The maximum work capacity increased on DDD by 49% while on VVI70 only by 22% (p < 0.00001) and the maximum heart rate increased on DDD by 185%, while on VVI70 only by 41% (p < 0.00001). The authors found a significant correlation between the increment of the maximum work capacity on DDD, as compared with that on VVI70 (d maximum work capacity) and maximum work capacity at VVI70 (r = -0.53, p < 0.01), maximum work capacity on VVI30 (r = -0.437, p > 0.03), maximum heart rate at VVI70 (r = -0.415, p < 0.004) and age (r = 0.56, p < 0.005). The d maximum work capacity was significantly higher in patients without their own ventricular activity during the load on VVI70 (28 +/- 24% vs. 13 +/- 8%, p < 0.05 (in patients who did not attain the upper frequency limit of DDD stimulation (30 +/- 25% vs. 14 +/- 9%, p < 0.004) and in patients above 60 years of age (37 +/- 26% vs. 14 +/- 10%, p < 0.002).

Retroperitoneal embryonal carcinoma/yolk sac tumor. A case report and a review of the histogenesis.

A case of 26-year old man, with a large primary retroperitoneal tumor which showed the pattern of embryonal carcinoma as well as yolk sac tumor, is reported. The disease ran an aggressive course and led to death within 8 months from the onset of clinical symptoms. Characteristic histological and ultrastructural patterns with Schiller-Duval bodies and adenocarcinomatous differentiation were accompanied by diffuse expression of alpha-fetoprotein and human chorionic gonadotropin expression in isolated cells, as well. The histogenesis of the tumor may be interpreted in terms of the reflection of the very early stages of the embryonal development rather than by the totipotent-neoplastic-germ-cell approach.