[Prognostic significance of stress tomographic scintigraphy of myocardial perfusion in diabetic patients]. / Prognostický význam zátezové tomografické scintigrafie myokardiální perfuze u diabetických pacientu.

OBJECTIVE: To assess the prognostic value of SPECT in patients with diabetes (DM) and without DM. METHOD: A total of 366 patients (104 women, 262 men) were examined by T1 +/- 201 or Tc-99m-MIBI SPECT of the myocardium. DM was recorded in 149 patients, 217 patients did not suffer from DM. The SPECT findings were classified as normal and abnormal perfusion (fixed or reversible perfusion defect). A serious cardiac event was defined as sudden cardiac death or non-fatal myocardial infarction. Also angina pectoris requiring revascularization was recorded. RESULTS: During the average investigation period of 24 +/- 7 months we recorded in 147 patients with a normal load perfusion only one non-fatal myocardial infarction and the risk of a serious cardiac event was low: 0.3% per annum in the whole group. A significantly higher incidence of a severe cardiac event, 5.9% per year, was recorded in 219 patients with an abnormal finding on SPECT (10 deaths and 16 non-fatal myocardial infarctions, P < 0.01). On comparison of the frequency of serious cardiac events in groups of patients with and without DM no significant difference was found as regards normal load perfusion of the heart muscle (1.1% vs. 0%, P = NS) even in patients with an abnormal SPECT finding (5.8% vs. 6.1, P = NS). CONCLUSION: SPECT myocardial perfusion makes it possible to stratify the risk in patients with DM similarly as proved previously in non-selected groups. Similarly as in patients without DM normal perfusion in diabetic patients predicts a benign prognosis.

Short-term heart rate variability changes after exercise training in subjects following myocardial infarction.

Heart rate variability reflects the activity of autonomic nervous system. The aim was to evaluate the value of short-term spectral analysis of heart rate for monitoring the effects of exercise training on the autonomic nervous system in subjects following myocardial infarction. Short-term spectral analysis of heart rate variability was performed during standardised supine-standing-supine test in a group of 29 clinically stable patients after myocardial infarction and the same test was repeated after 2 months of exercise training (ergometry or rapid walking). Each subject exercised at 60-80% of his maximal performance for 30 minutes once a day. Short-term spectral analysis of heart rate variability was assessed in the frequency range of 0.02-0.5 Hz involving very low frequency (VLF, 0.02-0.05 Hz), low frequency (LF, 0.05-0.15 Hz) and high frequency (HF, 0.15-0.5 Hz) spectral bands. The influence of exercise training on the autonomic nervous system was registered in the physically active group (n = 16) as a decrease in sympathetic response to standardised orthostatic load. In conclusions the regular exercise influenced an altered neural autonomic regulation of heart rate in post-infarction patients shown by a decrease in sympathetic activity in the short-term heart rate variability. This method enables monitoring of the effects of physical training on the autonomic nervous system in patients following myocardial infarction.

Dynamics of some biochemical indices in myocardial infarction treated with thrombolysis and creatine phosphate.

There was studied the effect of intravenously administered creatin phosphate (Neoton-drug with cardioprotective effect, Alfa Schiapparelli Wassermann) in the group of 98 patients affected by their first attack of myocardial infarction. In the course of the treatment there were observed the serum level of many biochemical indices, including the cardioselective enzyme activity. We concluded that the patients treated with Neoton, compared with the control group, revealed the significantly higher elevation of the CK, AST and LDH activity levels and the shift of the CK peak activity towards to the earlier hours after the onset of anginal pain.

[The effect of creatine phosphate (Neoton) in acute myocardial infarct (a prospective multicenter pilot study]. / Ucinek kreatinfosfátu (Neoton) u akutního srdecního infarktu (pilotní multicentrická prospektivní studie).

The authors investigated in a group of 106 patients with a first myocardial infarction treated by thrombolysis the effect of i.v. administration of creatine phosphate (a new drug with cardioprotective action--Neoton Alfa Schiapparelli Wassermann Co). In the course of treatment electrocardiographic changes were recorded and the presence of arrhythmias examined by the Holter technique. The Neoton group displayed a statistically insignificant but nevertheless obvious trend of electrocardiographically less serious forms of infarction and a lower incidence of infarctions, as compared with the control group.

[Obliterative disease of the carotid and peripheral arteries in hyperlipoproteinemia]. / Obliterující nemoc karotických a koncetinových tepen u hyperlipoproteinémií.

The authors give an account of changes of the carotid and peripheral arteries detected by ultrasonic examination in a group of 133 patients with different forms of primary hyperlipoproteinaemias. Stenoses in the extracranial carotid circulation were found in 31% of the group, stenoses of the peripheral arteries in 37%; in 18% combined changes of the carotid and peripheral system were found. The authors proved a rising trend of the number of risk factors with the rising number of arterial stenoses. The most frequent risk factors were obesity and smoking. In the entire group changes of the peripheral arterial system were found in more than half the patients (in 53%); in clinically asymptomatic subjects they were proved in 39%. The authors emphasize the necessity to introduce ultrasonic screening of the arterial system in all patients with hyperlipoproteinaemia.

Non-surgical synovectomy (basic principles).

Non-surgical synovectomy is an important therapeutical method, the spreading of which is due to intensive research in the ways of treatment, particularly in rheumatoid arthritis. Various procedures have been worked out to settle pathological changes first on the synovial membrane (synoviorthesis) by intraarticular administration of pharmacological substances. From this point of view, we report on cortisonoids, chloroquine, cytostatic drugs, pyrazolone derivates and antiproteolytic substances. Special attention is paid to osmic acid and radioactive colloids as possible. It is a matter of the physician's skill and further research to find the optimal drug for synoviorthesis so as to introduce it into the long-term and systematic therapeutical programme necessarily required by rheumatoid arthritis.

[Development of a moral consciousness in medical schools]. / Formirovanie nravstvennogo soznaniia v usloviiakh meditsinskogo fakul'teta.

In the conditions of developed socialism, changes in social consciousness are also reflected in one of its forms - the morals. The problems of moral education as an inseparable part of communist education is coming to the foreground. It plays its role in all the stages of the education system, having its unsubstitutable place also in the conditions of universities and technical colleges, the faculties of medicine not excluding. It is its task to form the personality of the student and graduate, to make them, among others, acquire the moral codex of a builder of communism (habits of moral behaviour in professional activities - medical ethics). Such crucial situations must be found that are of cardinal importance for the formation of the medical student's moral profile (transition from the secondary school to university, entering the clinic, meeting the patient, running health institutions, positive and negative influences in the health service). The student must live the moral situation, obtain the experience from moral acting on his own self and be an active participant in the events creating his moral qualities, primarily in collective conditions. We stress the necessity of engagement - mobilisation of students to all-round social activities, connection of the theoretical findings of marxist ethics with their particular problems and actual activities. A special accent is laid on the method of personal example, the moral example of the university teacher himself, in the first place his authority based on all the progressive components of his personality.(ABSTRACT TRUNCATED AT 250 WORDS)