Branched pedal bypass in the treatment of critical limb ischemia - a single center experience.

INTRODUCTION: Pedal bypass is a therapeutic option for limb salvage in critical limb ischemia. METHOD: Retrospective analysis of 20 patients who underwent either simple (14 patients) or branched (6 patients) pedal bypass in a single center and had at least one postoperative follow-up. In patients with branched pedal bypass, the main trunk was connected to the pedal artery of better quality and the side branch to an artery on the opposite side of the foot. The main trunk was constructed as a reverse saphenous bypass in all patients with branched bypass. From patients with simple bypass, nine had reverse saphenous graft, three had an allograft, one patient had in situ saphenous graft, and one PTFE prosthesis. RESULTS: The difference in the operation time was not significant. One patient with simple bypass required reoperation for wound bleeding and there was one case of perioperative mortality in the same group. The difference between the groups in the primary or secondary patency rates, limb salvage and overall survival was not significant. CONCLUSIONS: We did not find any significant difference in patency rates, limb salvage, or perioperative complications between patients with simple and branched pedal bypass in our cohort. We believe that the anticipated benefits of constructing an additional branch are masked by the disadvantageous presence of an additional anastomosis. Adoption of a branched pedal bypass may therefore require further improvements - perhaps the utilization of a branched saphenous graft. Key words:  critical limb ischemia - peripheral arterial disease - bypass - revascularization - amputation.

[Fetal magnetocardiography: a promising way to diagnose fetal arrhytmia and to study fetal heart rate variability?]. / Fetálna magnetokardiografia: Slubný spôsob diagnostiky fetálnych arytmií a stúdia fetálnej srdcovej variability?

OBJECTIVE: An overwiev of the new diagnostic method of fetal wellbeing - fetal magnetocardiography (fMCG). DESIGN: A review article. SETTING: Department of Gynecology and Obstetrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovak Republic. METHODS: An analysis of the literature using database search engines PubMed, and SCOPE in field of fMCG. RESULTS: Fetal magnetocardiography is a non-invasive technique able to monitor the spontaneous electrophysiological activity of the fetal heart. Compared to cardiotocography and fetal electrocardiography, this is a more effective method with a higher resolution. The signal obtained from the fetal heart is sufficiently precise and the quality allows an assessment of PQRST complex alterations, and to detect fetal arrhythmia. Thanks to early diagnosis of fetal arrhythmia, there is the possibility for appropriate therapeutic intervention and the reduction of unexplained fetal death in late gestation. fMCG with high temporal resolution also increases the level of clinical trials which record fetal heart rate (FHR) variability. According to the latest theories, FHR variability is a possible indicator of fetal status and enables the study of the fetal autonomic nervous system indirectly. fMCG is an experimental method that requires expensive equipment. It is yet to be shown in the future, if this method will get any application in clinical practice.

[Genetic aspects of pelvic floor defects and stress urinary incontinence in women]. / Genetické aspekty defektov panvového dna a stresovej mocovej inkontinencie u zien.

OBJECTIVE: An overwiev of the genetic aspects of pelvic floor defects and stress urinary incontinence in women. DESIGN: A review article. SETTING: Department of Gynecology and Obstetrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovak Republic. METHODS: An analysis of the literature using database search engines PubMed, BLAST and Ensembl in field of POP and SUI. RESULTS: Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) affect a large number of women and often requires surgical correction. Moreover, these diseases are not only individual health but also social and economic burden on patients and society. It is possible to prevent or at least timely intervene these pathologies by screening of risk patients. The incidence of these disorders leads to find possible genetic factors. In ethiopathogenetic studies of pelvic floor defects and stress urinary incontinence it is looking for genes associated with these diseases and optimization of molecular biology methods is necessary to determine the possible gene mutations or polymorphism site. Selection of relevant genetic factors tend to clarify the pathomechanism of SUI and POP that can greatly affect their current diagnostics and therapeutics. KEYWORDS: prolapse, stress urinary incontinence, polymorphism, gene expression.

[Principles and limits of clinical methods in the diagnosis of fetal hypoxia]. / Princípy a limity klinických metód diagnostiky fetálnej hypoxie.

OBJECTIVE: An overview of electronic fetal monitoring methods (EFM), and an analysis of their physical and technical limits. DESIGN: A review article. SETTING: Department of Gynecology and Obstetrics Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovak Republic. METHODS: An analysis of the literature using database search engines PubMed, and SCOPE in the years 2000 - 2013 in field of diagnostic methods of fetal status in utero. RESULTS: The essential aim of modern perinatology is the birth of a live and healthy newborn. This aim is strongly related to the abilities of the diagnostic methods to evaluate the intrauterine fetal status and with the professional skills of obstetricians to analyze these methods accurately. Nowadays, EFM is exposed to criticism, in spite of its widespread use. It is associated with some degree of failure in terms of an over-evaluation and under-evaluation. An over-evaluation of results can lead to unnecessary, often surgical, intervention. An under-evaluation of results can lead to an adverse fetal outcome with a neurologic handicap or intrauterine death. The long-term efforts currently underway to improve the reliability of EFM still remain to show any great progress. KEYWORDS: cardiotocography, intermittent auscultation, pulse oximetry, ST analysis, fetal electrocardiography.

Congenital hypothyroidism in one of monozygotic twins: comparison of their long-term psychosomatic development.

Authors present the long-term development of two monozygotic twin sisters. One of them was detected by newborn screening as athyreotic (gemelus A) and healthy gemelus B sister. Therapy in athyreotic girl started at 4 weeks after birth and was monitored in order to maintain serum thyroxine and TSH in normal range. Both sisters spent their chilhood and adolescence together in the same family, school and work together as tailors in the same factory. Their development was very similar. In order to detect subclinical difference of their development, the school achievements were tested using their school certificates. Studies were divided to testing mechanical memory, logical thinking and skills. The evaluation of all classes of school attendance (13 years) reveals subtle differences - deficit of patient at approximately 6-15% level, mainly in studies demanding skills. However, dynamic evaluation after years reveals that the worse results of the patient (gemelus A) occurred during the first years of basic school whereas during adolescence having attended the special school tailor, she attained better results than her healthy sister. It seems that mental deficit in early treated hypothyroid patient is not severe and varies even during the life. Problem of the fetal hypothyroidism is probably more related to the iodine deficiency, which assures necessity of thyroid hormones for athyreotic child from mother's or twin's normally supplemented thyroid glands.

Endocrine activation in tachycardias.

This article reviews the complex character of neuroendocrine response to paroxysmal tachycardia. While the endocrine influences in arrhythmogenesis are well perceived by the cardiologists, less attention has been paid to influence of tachycardia on neuroendocrine activation. However, this may significantly alter the clinical course of tachycardias and its responses to pharmacotherapeutic interventions. Main characteristics of hormones with direct relationship to cardiovascular system (ANP, AVP, catecholamines, angiotensin and others) are listed with description of regulation of their secretion and main biological effects, especially with regard to regulation of circulation. Changes in hemodynamics during tachycardia with accompanying changes in ANP, AVP renin-angiotensin-aldosterone system, sympatho-neural and sympatho-adrenal activation are reviewed. Further research and understanding require more complex approach and concentration on interrelationship of different regulatory hormones in tachycardia. (Fig. 2, Ref. 96.)

[Epidemiology of heart wall rupture in myocardial infarct]. / Epidemiologie der Herzwandruptur bei akutem Myokardinfarkt.

In a retrospective study including 1888 consecutive patients (pts) with acute myocardial infarction (AMI) admitted in the years 1989-1993 to the CCU, the relationship between sex, age, history of angina, location of infarction and heart wall rupture has been studied in a multivariate regression model. Female sex (p = 0.0013), older age (p = 0.0001), first angina during the AMI (p = 0.001) were indicative for significantly higher risk of rupture. Women are at higher risk only with anterior wall AMI (p = 0.0393). This risk increases continually with age, more in pts with inferior wall AMI than anterior wall AMI (p = 0.339). Females over the age of 75 with anterior wall AMI and first AP, and males and females over 83 with inferior wall AMI and first AP are at the highest risk of rupture (48.6% of deaths). We conclude that the defined high risk pts should be carefully monitored concerning the signs of impending heart wall rupture.

[Problems in children with growth hormone deficiency in Slovakia]. / Problematika detí s deficitom rastového hormónu na Slovensku.

The authors give an account of 71 patients treated on account of complete growth hormone deficiency in Slovakia. Before the age of five the diagnosis was established in 24 children, after the age of 10 in 17 patients. Nine patients suffer from panhypopituitarism, while isolated deficiency of growth hormone was recorded in 34 patients. Perinatal pathology plays an important role in the aetiology. A tumour caused the disorder in five children. Treatment of the majority of patients was not systematic and was inadequate because of shortage of growth hormone. When regular substitution treatment was started before the age of 8 years, the therapeutic results were very satisfactory. The authors draw attention to the danger of further deterioration of care of children with growth hormone deficiency for economic reasons.

Effect of human growth hormone and somatomedin on the recovery of sheep red blood cell receptor in peripheral T-lymphocytes.

The effect of growth hormone (GH) and somatomedin (SM) on the recovery of sheep red blood cell (SRBC) receptor in trypsinized human T-lymphocytes was studied either with the use of sera from patients with acromegaly or pituitary dwarfism or after the addition of exogenous GH, SM or thymosin to human sera. It was found that GH does not show any effect on the recovery of SRBC receptor, but it may act through the increase of SM level. It was concluded that the regulation of cellular immunity may be influenced by GH through its stimulatory action on the synthesis and release of somatomedins.

Effect of growth hormone on the activity of some lysosomal enzymes in neutrophilic polymorphonuclear leukocytes of hypopituitary dwarfs.

Elevated activities of beta-D-glucuronidase, myeloperoxidase, and lysozyme were found in polymorphonuclear leukocytes (PMNs) of both hypopituitary dwarfs and normal subjects after the administration of growth hormone (GH), as compared to the activities in PMNs from blood drawn immediately before the administration of GH. During in vitro incubation, GH was able to inhibit the release of lysosomal enzymes from resting PMNs. This inhibition may be one of the reasons for the elevated lysosomal enzyme activities observed in PMNs after the administration of GH. GH can also affect hexose monophosphate shunt (HMPS) activity and superoxide production by PMNs. The activity of HMPS is stimulated by GH in resting PMNs, while in PMNs incubated with zymosan the GH inhibits both HMPS and superoxide production.

Effect of growth hormone on the metabolic activity of phagocytes of peripheral blood in pituitary dwarfs and acromegaly.

The increase of metabolic activity pf phagocytes estimated by nitrozolium reductase activity is often employed to distinguish between bacterial and non-bacterial febrile disorders. However, false responses has been also observed. The possible role of serum growth hormone in the activation of tetrazolium reductase activity in patients with pituitary nanism or acromegaly was studied. In isolated peripheral granulocytes of pituitary dwarfs the reductase activity was low at resting conditions as well as after starch stimulation of phagocytosis. Two hours after i. m. administration of human growth hormone the resting and stimulated tetrazolium reductase activity was significantly increased (P less than 0.05, and P less than 0.01, resp.). The increase of both activities was found also in patients with active acromegaly. A moderate increase of tetrazolium reductase activity was observed after adding of growth hormone to isolated granulocytes in vitro (P less than 0.01). These results suggest the stimulatory role of growth hormone in regulation of respiratory burst activity of peripheral granulocytes.