[The syndrome of inappropriate secretion of antidiuretic hormone in hypophyseal tumors]. / Syndróm neprimeranej sekrécie antidiuretického hormónu pri nádore hypofýzy.

70-year old man was admitted to the hospital due to the sudden change in his behaviour with the production of unusual echolalic word connections. Arginin-vasopressin (AVP) level (1.16 pg/ml) was found inappropriately higher in relation to the severe serum hypoosmolality (261 mmol/kg) and hyponatraemia (117 mmol/l) with relatively high urinary osmolality (590 mmol/kg) and natriuria (684 mmol/24 h). Diagnosis of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH-type C) was confirmed during the water load test. Magnetic resonance imaging and CT scans revealed in the region of hypophysis intrasellar tumour (diameter of 16 mm) and the stabilized finding of temporal cyst. Substitution of sodium losses with the restricted fluid intake resulted in the correction of water-electrolyte balance and the restoration of normal clinical state.

[The heart and the brain. Aspects of their interrelations]. / Srdce a mozog. Niektoré aspekty vzájomných vzt'ahov.

The objective of the investigation was an attempt to analyze some aspects of the heart-brain relationship. The group was formed by 626 patients with the diagnosis of focal cerebral ischaemia (CI) and 191 patients with the diagnosis of subarachnoidal haemorrhage (SAH). It was revealed that the CI group comprised 77.3% patients with a pathological finding on the heart. Analysis revealed moreover that in the group of patients with "congestive heart failure" there was a significantly higher percentage of patients with a severe neurological deficit as compared to the group with a "normal" ECG (p < 0.001). Atrial fibrillation causes a fivefold increase of the risk of cerebral infarction. The incidence of ECG abnormalities of various types was significantly higher in the group of patients with CI during long-term ECG monitoring, as compared to the results of conventional ECG examination (p < 0.001). The value of long-term ECG monitoring was confirmed also in an investigation of these changes in a group of patients with arterial hypertension, quari potential candidates of cerebral infarction. The relationship between cardiac and cerebral function was tested also in an investigation focused on the incidence of ectopic activity and changes of the QT interval. It was revealed that while the percentage rate of ectopic activity assessed by conventional ECG examination was in the group of "improved" patients 18.0%, long-term monitoring revealed a rate as high as 48.0%, the difference being statistically significant. Similar significant differences were observed also on analysis of the QT interval: in the group of patients with neurological "improvement" the QT interval was significantly shorter, as compared with the group with neurological "deterioration". It was assumed that the prolonged QT interval could be the cause of sudden death. A cardio-cerebral relationship was found also on analysis of changes of the cerebral circulation (CBF) in different forms of cardiac insufficiency. It was revealed that isolated ventricular extrasystoles reduced the CBF by 8.0%, isolated atrial extrasystoles by 12% and in atrio-ventricular tachyarrhythmia the CBF is reduced by as much as 25.0%. The cerebro-cardiac relationship was tested in a group of patients with SAH. ECG abnormalities of a varying type were found in 30.7% of the patients with SAH. They are described in as many as 100% of patients and were detected also other in cerebral disorders, such as contusion of the brain, intraoerebral haemorrhage and cerebral tumours.