Depression, anxiety in ovarian cancer patient.

OBJECTIVE: A summary article, which is concluding available data about the psychological alterations, especially depression and anxiety, in ovarian cancer patients. DESIGN: Revue article. SETTING: Department of Obstetrics and Gynaecology, University Hospital in Hradec Králove. DISCUSSION: Depressive symptoms could arise as a consequence of the stress, which is the response to oncological diagnosis, treatment or relapse of the oncological disease. This depressive condition is raising concerns in patients, family and health care professionals because it is significantly contributing to morbidity and at the same time is leading to the increase of the health care costs. In general the alteration of the physical and mental functions is reducing the average life expectancy. The patients with serious gynecological cancer diagnosis are requiring psychological support, which is not always satisfactory from their family. It would therefore be desirable to establish professional centers or clinics providing counseling and psychotherapy. CONCLUSION: The summary of the available research data about depression in a women with gynaecological cancer has pointed out not only connection between depression and ovarian cancer, but has also underlined the importance of this problematic for daily praxis and further intensive research.

Strong coincidence between slow wave sleep and low AHI is explainable by the high instability of slow wave sleep to obstructive apnea exposure.

It is well known that in patients with obstructive sleep apnea syndrome (OSAS) the apnea-hypopnea index (AHI) is significantly decreased during slow wave sleep (SWS). It used to be explained by the ability of SWS to stabilize the upper airways against collapse. Another explanation, which is the focus of the current study, is that it is just a result of high instability of SWS to obstructive apnea exposure, i.e. high susceptibility of SWS to transition into lighter sleep stages during exposure to obstructive apneas. A retrospective chart review was performed on 560 males who underwent an overnight polysomnography. Two hundred and eighty-seven patients were eligible for the study. They were divided into 3 groups according to different AHI level. All three groups had a higher SWS occurrence in the lateral position than in the supine position. A special fourth group of patients was created with severe OSAS in the supine position but with very mild OSAS in the lateral position. This group had, in the lateral position, (A) higher AHI in NREM sleep (4.1+/-3.1/h vs. 0.7+/-1.2/h, p<0.001) as well as (B) higher SWS occurrence (27.7+/-15.0 % vs. 21.4+/-16.2 % of NREM sleep, p<0.05), than the group with the lowest AHI in the study, i.e. AHI<5/h in NREM sleep. These data suggest that strong coincidence between SWS and low AHI is the result of the high instability of SWS to obstructive apnea exposure. The data also support the presence of SWS-rebound in OSAS patients in the lateral body position.

Gynecological and urological aspects of pelvic vasculitis.

OBJECTIVE: To review contemporary knowledge of isolated vasculitis in urology and gynaecology. DESIGN: A review. SETTING: Department of Obstetrics and Gynaecology, University Hospital Hradec Kralove. METHODS: To present own experience and an overview of recent literature. CONCLUSION: Vascular system inflammation is a very important and broadly studied medical condition. It can affect either veins or arteries. In pelvic veins it can significantly increase the risk of thromboembolic complications, while in the case of arteries; the clinical significance is still unknown. We still do not know what does the histopathological proven isolated vasculitis in this area mean. Is it just a local finding, or should we look for systemic vasculitis? Unlike most of non-symptomatic gynecological vasculitis, urological cases are often accompanied by severe symptoms depending on the anatomical location of the process. This work presents a basic overview and includes our experience with this issue. Our thesis does not include the vasculitis in pregnancy.

Relationship between dynamic expiratory time constant tau(edyn) and parameters of breathing cycle in pressure support ventilation mode.

Study of the relationship between ventilation parameters: monitored expiratory time constant - tau(edyn) and breathing - trigger frequency (f(trig)) and time of breathing cycle (T(cy)) are main goals of this article. Parameters were analyzed during last 4+/-2 h before weaning from ventilation in 66 patients ventilated in pressure support mode (PSV). We have found out, that there exist mathematical relationships, observed during adequate gas exchange, yet not described. Monitored parameters are represented by tau(edyn), f(trig) and T(cy). The analysis showed close negative correlation between T(cy) and f(trig) (R(2)=0.903). This implies that each increasing of tau(edyn) causes decreasing of f(trig) and vice versa. The calculation of regression equation between tau(edyn) and T(cy) outlined that T(cy) = 5.2625 * tau(edyn) + 0.1242 (R(2)=0.85). Regulation of respiratory cycles by the respiratory center in the brain is probably based on evaluation of tau(edyn) as the tau(edyn) probably represents a regulatory element and T(cy) regulated element. It can be assumed, that respiratory center can optimize the work of breathing in order to minimize energy in system patient + ventilator. The unique relationship, described above could be useful in clinical practice for development of new ventilation modes.

[Serum level of retinol-binding protein 4 in obese patients with insulin resistance and in patients with type 2 diabetes treated with metformin]. / Sérová hladina retinol-binding proteinu 4 u obéznytch s inzulínovou rezistenciou a jedincov s diabetom 2. typu liecených metformínom.

OBJECTIVE: Is there a difference between the retinol-binding protein 4 (RBP4) levels in obese patients with insulin resistance (IR) without diabetes, in obese patients with type 2 diabetes mellitus (DM2T) treated with metformin and in nonobese healthy individuals? METHOD: 28 obese individuals with insulin resistance, 11 type 2 diabetes patients treated with metformin and 17 control individuals were examined for serum level of retinol-binding protein 4 using the RIA method. The results were compared within the groups and RBP4 was correlated with insulin in the IR group and the control group. OUTCOME: The highest and the lowest RBP4 levels (561.6 +/- 209 ng/ml) were recorded, respectively, for obese individuals with IR (IR HOMA 3.9) and for obese type 2 diabetics treated with metformin (391.1 +/- 133,5 ng/ml) (P < 0.01). The RBP4 level of the control group was significantly lower as compared with the obese individuals with IR (452.8 +/- 104.6 ng/ml) (P < 0.05), but insignificantly higher as compared with the obese individuals with DM2T treated with metformin (391,1 +/- 133.5 ng/ml). RBP4 in the monitored group correlated with insulin r = 0.46 (p < 0.03). CONCLUSION: The increase in RBP4 in obese individuals by GLUT4 regulation in adipocytes contributes to the development and aggravation of systemic IR. Through its effect on RBP4 expression in adipocytes, metformin may improve total insulin sensitivity in obese individuals including those with MS and delay the onset of manifest DM. RBP4 could by used as a marker of deteriorating glucose tolerance in obese individuals.

[Blood pressure and heart rate monitoring as a method of detection of sleep apnea]. / Monitorovanie TK a frekvencie srdca ako metóda zistovania výskytu spánkového apnoe.

UNLABELLED: Ambulatory blood pressure monitoring (ABPM) and heart rate variability measurement are frequently used by general practitioners for diagnostic of various cardiovascular diseases. Coincidence of hypertension, heart failure and sleep related breathing disorders are very common. Therefore we proposed to use ambulatory blood pressure monitoring device (ABPM), as a tool, for selection of proper patients for polysomnographic examination in sleep laboratory. METHODS: Power spectral analysis of heart rate (HR) monitored together with blood pressure (BP), was performed using a ABPM device (Cardiotens 01, Meditech Budapest) in 24 adults patients. Low frequency/high frequency ratio (LF/HF), which reflects the sympatho-vagal balance, was calculated for the period of sleep versus wakefulness (S/W). Our aim was to detect changes in sympatho-vagal tone during sleep in the following groups of patients: obstructive sleep apnea syndrome (OSAS, respiratory disturbance index RDI = 43.8, arousal index ArI = 17.1), upper airway resistance syndrome (UARS-RDI = 7.4, ArI = 18.3), CPAP treated group (RDI = 6.4, ArI = 8.1) and controls. RESULTS: S/W ratio reflecting sympathetic activation, was lower in controls (0.59), than in patients with OSAS (0.9; p < 0.025) or UARS (2.16, p < 0.01). S/W ratio in patients treated with CPAP (0.68) was similar to controls (p = 0.38). S/W ratio correlated moderately with arousal index (r = 0.94 in group of patients with OSAS). CONCLUSION: S/W ratio reflecting sympathetic activation upon arousal can be used for screening of patient with sleep related breathing disorders, as well as for assessment of CPAP treatment. ABPM with measurement of heart rate variability can detect also effectiveness of antihypertensive treatment with drugs influencing the autonomous nervous system.

[Mechanisms in the development of cardiovascular complications in obstructive sleep apnea]. / Mechanizmy rozvoja kardiovaskulárnych následkov obstrukcného spánkového apnoe.

Obstructive sleep apnoea may be accompanied by various cardiovascular consequences resulting from alteration of the activity of the autonomous nervous system. These changes are mediated by: a--hypoxemia developing during the apnoea, b--severe hypoxemia, hypercapnia and acidosis in postapnoea, c--powerful but ineffective ventilatory efforts causing arousal and stimulation of the cardioexcitatory and vasomotor centres. There are four main pathogenetic mechanisms implementing the cardiovascular changes: 1--Functional alteration in the conduction system and the myocardium resulting in nocturnal cardiac dysrhythmias. 2--Vasoconstriction manifesting as angina pectoris, myocardial infarction, brain attacks and pulmonary or systemic hypertension. 3--Pulmonary congestion leading to cardiac or bronchial asthma or even lung oedema. 4--Neuroendocrine activation, including the sympathetic nervous system, renin-angiotensin-aldosterone system, atrial natriuretic peptide and erythropoietin, which may result in nycturia, nocturnal hypotension and diurnal hypertension.

[Interesting cases of ventilatory therapy of sleep apnea in a group of our patients]. / Niektoré zaujímavé prípady ventilacnej liecby spánkového apnoe zo súboru nasich pacientov.

UNLABELLED: In the group of patients investigated in our sleep laboratory and successfully treated by positive pressure applied in to the upper airways through nasal mask (nCPAP) some interesting cases appeared. These cases show beneficial effect of nCPAP therapy, unfortunately not widely spread and recognized in our country. These patients were unsuccessfully treated before by conventional methods, which did not improve their situation for a longer time. Only after polysomnography carried out in our sleep laboratory and after home treatment with nCPAP or BiPAP machine, the situation radically improved. FIRST CASE: In a director of important enterprise after unrelated car accident atrial fibrillation caused by dilation was discovered, which did not respond even on Electro cardioversion. After recognition of severe obstructive sleep apnoea syndrome (OSAS) this patient was treated successfully by BiPAP. The second case: a bus driver, who falls asleep on the traffic light with full buss of passengers. A diagnose OSAS with a multiple sleep latency test result below 2.5 minutes. The nCPAP treatment allowed him to continue to work, but transiently on different position. The third: 40-year-old patient with a body mass index (BMI) 38 and with dysrhythmias IIIb-IVb according to Lown. The respiratory disturbance index (RDI) was 40 and oxygen desaturation bellow 77%. There was bigeminia on ECG. During four hour with nCPAP treatment there was only two randomly ventricular extrasystols appeared, confirming the beneficial effect of treatment. These cases demonstrate a wide spectrum of cardiac dysrhythmias, which have only functional character, but are important for the practice. The demonstrated cases highlighted the importance of home nCPAP therapy in OSAS patients.

Power spectral analysis of respiratory responses to pharyngeal stimulation in cats: comparisons with eupnoea and gasping.

1. Based on similarities between properties of gasping and the aspiration reflex, we hypothesized that this reflex activates the central pattern generator for gasping. To evaluate this hypothesis, we have analysed high-frequency oscillations in phrenic and hypoglossal neural activities. These oscillations, analysed by power and coherence spectra, are considered as signatures of the central pattern generators for automatic ventilatory activity. 2. In decerebrate, vagotomized, paralysed and ventilated cats, the aspiration reflex was elicited in eupnoea and gasping by mechanical stimulation of the pharynx and electrical stimulation of the glossopharyngeal nerve. 3. Compared with eupnoeic values, the peaks in the power spectra occurred at higher frequencies in spontaneous gasping. Peaks in the coherence spectra showed identical changes. 4. Power and coherence spectra of inspiratory neural activities during the aspiration reflex differed markedly from those of eupnoea, but were similar to those in gasping. 5. We conclude that mechanical stimulation of the pharynx or electrical stimulation of the glossopharyngeal nerve activates a reflex by which the central pattern generator for eupnoea is depressed, and that for gasping is activated. Our results also support the concept that separate brainstem mechanisms generate ventilatory activity in eupnoea and gasping.