[Avoidance of axillary lymph node dissection in breast cancer patients with metastatic sentinel node - a pilot study]. / Vynechání disekce axily u karcinomu prsu pri pozitivní sentinelové uzline - pilotní studie.

INTRODUCTION: Axillary lymph node dissection (ALND) is a standard procedure for locoregional control in metastatic sentinel lymph nodes (SN). A number of studies have provided evidence that avoiding ALND does not worsen the general prognosis. METHODS: A group of 249 female patients with sentinel lymph node biopsy was analysed retrospectively for a 3-year period. The patients were divided into two groups - with non-metastatic SN and with metastatic SN. In the metastatic SN group, the patients were further divided into a group with ALND and a group without ALND, and additional lymph nodes (non-sentinel) in ALND and oncological treatment were evaluated. The goal was to find out whether ALND and oncological treatment affect the disease-free interval (DFI) and overall survival (OS) in the group of patients with metastatic SN and to compare the results with the control group. The histopathology and biology of the primary tumour, its size and the number of metastatic SN were subsequently evaluated as the factors that may be useful for predicting metastatic non-sentinel lymph node positivity. RESULTS: There was a high risk of metastatic non-sentinel lymph nodes in the cases of metastatic SN (63%). Addition of ALND does not prolong either DFI or DFS without post-operative radiotherapy and systemic oncological treatment, both of which can provide a comparable length of DFI as well as DFS without ALND. Patients with metastatic SN with and without ALND had a DFI of 70 and 72 months, respectively, and a 5-year survival of 84% and 80%, respectively. Tumours over 2 cm, tumours with high proliferative activity and a high grade can be regarded as predictors of metastatic non-sentinel lymph nodes. CONCLUSION: In a small patient group it has been demonstrated that the avoidance of ALND in 1 or 2 metastatic SN, regardless of the prognostic factors, does not affect either DFI or DFS if adjuvant oncological treatment is administered. High-grade tumours, tumours with high proliferative activity and tumours larger than 2 cm carry a significantly higher risk of metastatic non-sentinel lymph nodes. Nowadays, the avoidance of ALND in metastatic SN is not a lege artis procedure; further large studies are needed to create scientific guidelines.Key words: metastatic sentinel lymph node - avoidance of axillary dissection - breast cancer.

[The molecular genetic and clinical findings in two probands with Stargardt disease]. / Molekulárne genetická prícina a klinický nález u dvou probandu se Stargardtovou chorobou.

PURPOSE: The aim of our study was to describe the phenotype and to perform molecular genetic investigation in two probands of Czech origin diagnosed with Stargardt disease (STGD). METHODS: Both males underwent ocular examination including assessment by high-resolution spectral domain optical coherence tomography (SD-OCT). DNA was isolated from venous blood. Mutation detection was performed using the ABCA4 genotyping microarray (Asper Ophthalmics, Estonia). RESULTS: The best corrected visual acuity in proband 1 (aged 39 years) was 0.1 bilaterally, and 0.05 in proband 2 (aged 26 years). Fundus examination showed typical multiple yellow-white lesions and macular atrophy. Alterations of retinal pigment epithelium, retinal thinning and disruption of the photoreceptor inner segment ellipsoid band were detected with an SD-OCT. Two known disease-causing mutations in ABCA4 were identified in proband 1; c.4234C>T, p.(Gln1412*) in exon 28; and c.5882G>A, p.(Gly1961Glu) in exon 42. Only one pathogenic change was detected in proband 2; c.1988G>A, p.(Trp663*) in exon 14. A second change, anticipated because of the recessive status of the disease, was not identified. CONCLUSION: The frequency and full spectrum of ABCA4 mutations in Czech patients with inherited retinal disorders is yet to be established. The inability to detect a second pathogenic change in ABCA4 coding sequences in proband 2 warrants further investigation.

Preparation and quality control of [166Ho]-macroaggregates for radiosynoviorthesis.

(166)Ho is a beta-emitter (E(_max) = 1.84 MeV, T1/2 = 26.7 hours) with a mean penetration in the soft tissue of 2.2 mm and gamma-photons 81keV and 1380keV. In this paper, we present our experiences with preparation of (166)Ho-macroaggregates ((166)Ho-MA) for radiosynoviorhesis. Ho-MA were prepared by reacting the aqueous solution of holmium nitrate pentahydrate with sodium borohydride solution in 0.2 M NaOH. After centrifugation, washing, and drying at 105 degrees C, final fineness of 1-15 microm was attained using a homogenizer working at 70,000 rpm. Neutron activation was carried out in screwed titanium ampules in a nuclear reactor at the neutron flux 10E12-10E14 neutrons.cm-24.s-1. The irradiated samples were allowed to cool 24 hours before further manipulation. (166)Ho-MA were clinically tested on 20 patients suffering from gonarthrosis (15), rheumatoid arthritis (5), psoriatic arthritis (1), and gout arthropathy (1). (166)Ho-MA are currently produced under GMP and production facility allows producing radioactivity for 6 patients within one production run.

[Possibilities and limitations of the surgery of the eye's posterior segment under the outpatient conditions]. / Moznosti a meze chirurgie zadního segmentu oka v ambulantních podmínkách.

The goal of this article was to analyze possibilities of the vitreoretinal surgery under the outpatient conditions and to set its limitations. During the period January 1st-September 30th, 2004, there were performed 95 operations of 78 eyes in 77 patients. Number of men and women was practically equal; the age ranged 17-86 years (average 62.6 years). We operated on mostly the retinal detachment. These as well as other procedures, including also the extreme surgery with relaxing retinectomy, extraction of the subretinal tractions and membranes, silicone oil implantation or extraction, or operations combined with the cataract surgery and intraocular lens implantation. Surgeries were performed under local anesthesia combined with analgesia and sedation introduced by anesthesiologist, who was always present and monitored the patient. Surgeries were performed by means of A.V.I. lens and Biom as well, with the assistance of a doctor, and later on, solely of a theatre nurse. The surgeon performed the operations by herself and long-term followed up the patients. The variety of vitreoretinal procedures did not differ from those performed at the departments of ophthalmology at university hospitals. The retinal detachment surgery was more often performed by means of cryosurgical procedure than pars plana vitrectomy undoubtedly because of early recognition of the beginning detachment. All vitreoretinal procedures may be performed on the outpatient basis. The only limiting factors are the physical condition of the patient and an acute ocular disease demanding urgent surgery in a facility with permanent service. Vitreoretinal surgery in outpatient facility performed under local anesthesia is well tolerated by the patients and the postoperative care under outpatient conditions is of equal quality as in inpatient facilities.

[Transpupillary thermotherapy in exsudative age-related macular degeneration. Two-years results and findings on the other eye]. / Transpupilární termoterapie u exsudativní vekem podmínené makulární degenerace. Výsledky po 2 letech a nálezy na druhém oku.

UNLABELLED: The purpose of the prospective randomized study was to analyze long-term results of transpupillary thermotherapy (TTT) in exsudative age-related macular degeneration (ARMD) after 24 months of follow-up and to compare them with findings on the other, not treated eye. MATERIAL AND METHODS: Seventy-two patients aged 50-93 years (average age 70.6 years) with one eye treated by means of TTT and the other considered as control were in the study. Occult choroidal neovascularization (CNV) was treated in 33 eyes (45.8%), serous ablation of the pigment epithelium (SAPE) in 21 eyes (29.2%), and classical CNV in 18 eyes (25.0%). In all patients, the central visual acuity (VA) on EDTRS chart was specified, the macular findings were observed by means of indirect binocular ophthalmoscope and bio-microscopically with the contact lens on the slit lamp, and fluorescence angiography and optical coherence tomography (OCT) examinations were performed before and 3, 6, 12, 18, and 24 months after the TTT treatment. RESULTS: The final VA improved or remained unchanged in 27 eyes (37.5%), and worsened in 45 eyes (62.5%), by 5 or more lines the VA worsened in 19 eyes (26.4%). The average VA decreased from initial 0.24 to final 0.13, but the decrease in different forms of ARMD varied. In SAPE the highest initial as well as final average VA was found, in occult and classical CNV the initial and final average VA was almost identical. Exsudative changes observed by means of biomicroscopical, fluoroangiographical, and OCT examinations totally disappeared in 59.7%, 63.9%, and 59.7% respectively. At the end of the follow-up period we observed chorioretinal atrophy of different stage in the macula in all eyes (100%) and subretinal fibrosis in 44 eyes (61.7%). Both these findings represented final stages of natural course of exsudative ARMD. On the contrary, differently pronounced areas of chorioretinal atrophy corresponding with applied laser burns represented scars after the coagulation. It developed in 31 eyes (43.0 %) and pointed to the possible destructive consequence of the TTT. In 33 patients (45.8%), late stages of exsudative ARMD, mostly disciform scars with chorioretinal atrophy were found on the other not treated eye. In these eyes the final average VA was 0.05, e.g. more than one half worse than final average VA in treated eyes. CONCLUSIONS: Results of TTT treatment after 24 month of follow-up demonstrated full regression of exsudative changes in the macula in 60% of eyes and improved or stable VA in 37.5 % of eyes. Results in SAPE and classical CNV confirmed the efficacy of TTT treatment in those forms of ARMD. The TTT did not prevent the appearance and progress of the chorioretinal atrophy and subretinal fibrosis, causing the main obstacle of better functional results. Extremely unfavorable course of exsudative ARMD in the other (not treated) eye could indirectly confirm the positive influence of the TTT in theARMD treatment. Despite all positives are the possibilities of the TTT limited and determined by the basis and natural course of exsudative ARMD.

[Transpupillary thermotherapy in age-related serous detachment of retinal pigmented epithelium]. / Transpupilární termoterapie u vekem podmínené serózní ablace pigmentového epitelu sítnice.

UNLABELLED: The goal of this prospective study was to evaluate results of the transpupillary thermotherapy (TTT) in the age related macular degeneration (ARMD) where the serous detachment of the pigment epithelium (SDPE) was the dominant sign. MATERIAL AND METHODS: Thirty eyes of 29 patients were treated by TTT. All patients were examined before and 3, 6, 9, 12, 18, and 24 months after TTT in terms of visual acuity (VA), indirect binocular ophthalmoscopy, and indirect slitlamp biomicroscopy, fluorescein angiography, and optic coherent tomography (OCT) of the macular region. In 25 eyes (83,3%) signs of choroidal neovascularization (CNV) were present (vascular SDPE). TTT was performed with a standard technique by diode laser (wavelength 810 nm). In 14 eyes (46.7%) the TTT procedure was repeated after 3 to 38 weeks. The follow-up period was 7 to 28 month (mean 15.2 months). RESULTS: After TTT, VA improved in 6 eyes (20.0%), remained stable in 8 eyes (26.7%), and deteriorated in 16 eyes (53.3%). Indirect slitlamp biomicroscopy revealed, that the SDPE re-attached in 13 eyes (43.3%), decreased in size in 12 eyes (40.0%); fluorescein leakage disappeared in 16 eyes (53.3%) and was reduced in 10 eyes (33.3%). By OCT, the re-attachment of SDPE was confirmed in 14 eyes (46.7%) and it's reduction in 13 eyes (43.3%). The leading cause of the same or worse VA after diminishing of SDPE was chorioretinal atrophy, with or without subretinal fibrosis. CONCLUSION: In the long term, the TTT led to the decline of SDPE in the majority of eyes and improved or stabilized VA in nearly on half of eyes. In most cases, signs of neovascularization were present. After the SDPE regression, the chorioretinal atrophy prevented the better functional results. TTT is not economically expensive and widens treatment possibilities in exsudative form of ARMD including SDPE.

[Vertebral osteoid osteoma--peroperative detection of its nidus using a surgical gamma probe]. / Vertebrální osteoid osteom--peroperacní detekce nidu pomocí chirurgické gamasondy.

The case of a vertebral osteoid osteoma localized in the arch and pedicle of the fourth lumbar vertebra in a young girl is described. The condition was manifested by the development of scoliosis, which was also the initial diagnosis. Because of painful muscle contractions and persistent pain at night, osteoid osteoma was suspected and then confirmed by scintigraphy. In order to minimize resection of the posterior stabilizing structures and to ensure removal of the complete nidus, surgery was carried out with the use of a surgical gamma probe. The method is based on administration of a radionuclide (99m Techneciumlabeled methylenediphosphonate) 2 to 3 h before the operation and intraoperative detection of the intensity of radiation directly in the operative wound. The values of impulses recorded over the nidus were more than ten-times higher than the background values, i.e., the impulses over the surrounding, unaffected bone. The nidus was exactly localized and removed as a whole. Posterolateral fusion without instrumentation was carried out. The patient was almost immediately free from night pain. After fixation with TLSO for 3 months, the patient started physical therapy. One year later she was without any complaints, fusion was healed and she had no relapse. The aim of this study was to draw attention to this less known and therefore less frequently employed method that may enable the surgeon to detect conditions otherwise difficult to localize. This method can also be used for other body sites if the lesion treated accumulates radionuclides.

[Transpupillary thermotherapy in age-related macular degeneration. Preliminary results]. / Transpupilární termoterapie u vekem podmínené makulární degenerace. Predbezné výsledky.

OBJECTIVE: To evaluate anatomical and functional results of transpupillary thermotherapy (TTT) in age-related macular degeneration (ARMD) with a chorioid neovascular membrane (CNVM). MATERIAL AND METHODS: TTT was performed by means of a diode laser (Iris Medical Oculight Six) in 38 eyes of 35 patients aged 46-93 years, mean 70.6 years. Ocult CNVM was treated in 34 eyes, classical CNVM in 4 eyes. In TTT we applied 1 to 5 points (on average 1.9 spot) and used a laser beam with a diameter of 0.5-3 mm (mean width 1.61 mm). In 10 eyes with occult CNVM (29%) TTT was repeated after 1-6 months. The patients were followed up after TTT for 6-18 months on average for 9.5 months. RESULTS: The final visual acuity (VA) improved after TTT in two eyes (5.3%), remained unchanged in 22 eyes (57.9%) and deteriorated in 14 eyes (36.8%). The mean VA after TTT declined from 0.23 to 0.17. Biomicroscopic manifestations of exudation disappeared or receded in 29 eyes with occult CNVM (85.3%) and in 3 eyes with classical CNVM (75%). Fluoroangiographic examination revealed a reduced or absent extravasation of the dye in 24 eyes with occult CNVM (70.5%) and in 3 eyes with classical CNVM (75%). Optic coherent tomography confirmed regression of exudative changes and the development of a chorioretinal scar in 23 eyes with occult CNVM (67.6%) and 3 eyes with classical CNVM (75%). CONCLUSION: TTT is a new potential therapy of ACMD with CNVM. It is indicated in particular in occult CNVM. It can be however used also in classical CNVM. TTT is not economically pretentious and can be used also in other than large clinical departments. It is important to test the possibilities and limitations of TTT on a large number of patients and assess its position among other therapeutic procedures.

[Results of vitrectomy in cystoid diabetic macular edema detected by optical coherence tomography]. / Výsledky vitrektomie u cystoidního diabetického makulárního edému zjistené optickou koherentní tomografií.

PURPOSE: To evaluate the surgical results of the pars plana vitrectomy (PPV) with separation of the posterior hyaloid (PH) with the cystoid diabetic macular edema (DME) using optical coherence tomography (OCT). METHODS: PPV with removing of the PH was performed in 10 eyes of 10 patients with cystoid DME. The macular structure, the vitreoretinal interface and the foveal thickness before and after PPV was evaluated using OCT and was correlated with a slit lamp biomicroscope. All 10 eyes had undergone panretinal and macular photocoagulation. RESULTS: OCT demonstrated postoperatively in all 10 eyes the regression of cystoid DME and the presence of foveal depression. Visual acuity (VA) has improved by 2 and more Snellen lines in 6 eyes with preoperative decrease of VA not longer than 5 months. CONCLUSIONS: PPV with separation of PH is efficient method in treatment of cystoid DME. Duration of cystoid DME is a significant factor for determination of functional prognosis. OCT facilitates the follow-up of the dynamics of regression of the structure and thickness of the fovea.

[Best's vitelliform dystrophy with complications of a neovascular membrane and hemorrhage]. / Bestova viteliformní dystrofie komplikovaná neovaskulární membránou a krvácením.

UNLABELLED: The objective of the paper is to draw attention to an uncommon picture of Best s vitelliform dystrophy of the macula (BVD) complicated by a choroidal neovascular membrane (CNVM) and haemorrhage. In an 8-year-old boy where incidentally at the age of 5 years cystic changes in both maculars were found and a reduced central visual acuity (CVA) of the left eye, the CVA of the so far asymptomatic right eye suddenly deteriorated. In the right macula a vitelliform focus was present the lower half of which was formed by a vascularized scar with subretinal haemorrhage on the margin. In the left macula was a round chorioretinal scar with hyperplasia of the pigmented epithelium (RPE) and remnants of macular yellow. Fluoroangiographic examination (FAG) visualized classical CNVM, optical coherence tomography (OCT) ablation of the RPE. The electrooculogram (EOG) was bilaterally reduced, CVA of the right eye was 6/60, of the left eye 6/36. Examination of the mother revealed though the ophthalmological finding was normal, a significantly reduced EOG and in an older brother there was a small vitelliform focus in both maculae and reduced EOG with CVA of 6/6. CONCLUSION: CNVM with haemorrhage is a rare complication of BVD. This complication markedly extends the polymorphism of findings, is a risk of the CVA and makes the diagnosis more difficult. EOG examination is decisive for the diagnosis of less common forms of BVD.

[Eye injury from a paintball projectile]. / Poranení oka paintballovým projektilem.

A fourteen-year-old adolescent suffered after a direct hit with a plastic projective (paintball) a severe injury of the anterior and posterior segment of the eye manifested by intraocular haemorrhage, cyclodialysis, detachment of the retina with two giant tears and oedema and haemorrhages of the retina. After cerclage, pars plana vitrectomy and transient four-month tamponade with silicone oil the retina reattached. Late complications, cataract, broad anterior adherence with scars of the chamber angle and ciliary body, a lamellar defect of the macula and partial atrophy of the optic disc determined the subsequent development and were an indication for cataract surgery, implantation of an artificial lens into the lenticular capsule and reconstruction of the pupil. The final result was from the cosmetic and functional aspect (visual acuity 0.3) very satisfactory. Plastic projectiles (paintballs) are a new cause of severe eye injuries. At risk are in particular participants of games who do not protect their eyes with spectacles or masks. To save the function of the eye in unnecessary injuries frequently several operations are needed and close collaboration of surgeons for the anterior and posterior segment.

[Optical coherence tomography in age-related macular degeneration]. / Optická koherentní tomografie u vekem podmínené makulární degenerace.

INTRODUCTION: Optic coherent tomography (OCT) is a new non-contact and non-invasive diagnostic method which visualizes biological tissues in their transverse section, similarly as ultrasound examination. It uses however infrared radiation and during examination of the posterior pole of the eye it has a greater differentiating capacity. THE OBJECTIVE: Of the paper is to compare biomicroscopic OCT and angiographic findings in different forms and developmental stages of age-related macular degeneration (ARMD), to evaluate the asset of OCT for classification and therapy of ARMD. PATIENTS AND METHODS: The authors examined 183 patients (266 eyes) with ARMD in different developmental stages. The clinical diagnosis of ARMD was established by biomicroscopic and/or angiographic examination with fluorescein. RESULTS: In the majority of patients the different manifestations of ARMD were associated, and the OCT findings were polymorphous. OCT defined more accurately the site and character of changes in the retina and adjacent structures, made it possible to assess objectively the thickness of the retina and surrounding structures and to detect the presence of fluid and/or newly formed intra- and subretinal tissue and tissue benewath the RPE. The CNVM classification, introduced by fluorescent angiography differentiating classical and occult forms did not have an accurate correlate in the OCT image in our group of patients. CONCLUSION: OCT is in the diagnosis and follow up of the development of ARMD a suitable supplement of commonly used methods. It provides information on spatial relations of pathologically altered tissues. Visualization of the retina on the section is particularly valuable when evaluating the results of laser or surgical treatment.

[Relation between cardiovascular and gastrointestinal neuropathy in diabetics]. / Vztah kardiovaskulární a gastrointestinální neuropatie u diabetiku.

BACKGROUND: The presence of autonomic neuropathy impairs the quality of life (orthostatic hypotension, impotence, gastroparesis) or endangers the life of diabetics (sudden death, unawareness of hypoglycemia). The purpose of the investigation was: 1. To assess the presence of the autonomic neuropathy of the cardiovascular and the gastrointestinal systems and their mutual relationship. 2. To assess the relationship of found autonomic neuropathy and the subjective symptoms which are typical to affected particular systems (cardiovascular, gastrointestinal, genitourinary, sudomotor systems and the syndrome of unawareness of hypoglycemia). METHODS AND RESULTS: The group comprised of 25 type 1 diabetic patients (12 women and 13 men) mean age 40.5 +/- 11.6 (range 21-57 years) with a mean duration of diabetes of 17.8 +/- 7.9 (range 4-35 years), treated with intensified insulin regimens. The cardiovascular autonomic neuropathy was automatically examined by the VariaPulse TF 3 computer system. Scintigraphy was used to investigate the gastric emptying time of 99mTc labelled rice. The information about the subjective symptoms we collected from the questionnaire. For statistic analysis we used Spearmen correlations and ANOVA. RESULTS: 1. A statistically significant correlation was found between the presence of the autonomic neuropathy of cardiovascular and gastrointestinal systems (r = 0.634, p < 0.0007). 2. We didn't find any relation among the cardiovascular autonomic neuropathy and the subjective symptoms of cardiovascular system, respectively the gastrointestinal neuropathy (impair gastric emptying) and the subjective symptoms of gastrointestinal system. We found a significant correlation between cardiovascular and gastrointestinal neuropathy and erectile dysfunction (r = 0.48, p < 0.0078), (r = 0.42, p < 0.0388) and with the syndrome of hypoglycemia unawareness (r = 0.49, p < 0.0057), (r = 0.52, p < 0.0075). CONCLUSIONS: The evidence of the cardiovascular autonomic neuropathy is warning signal for the affected autonomic neuropathy in other systems which are more complicated for diagnostic. The subjective symptoms don't correlate with the presence of the visceral neuropathy.

[Gastric emptying in diabetics]. / Zaludecní vyprazdnování u diabetiku.

UNLABELLED: The authors evaluate gastric emptying in diabetic patients and follow up selected factors which may influence it. METHOD: In a group of 25 type 1 diabetics selected at random (12 women and 13 men), mean age 40.5 years +/- 11.6 SD (range 21 to 57 years) with a duration of diabetes of 17.8 +/- 7.9 years (minimum 4, maximum 35 years) with a mean value of glycosylated haemoglobin of 8.71% +/- 1.82 (minimum 7.2, maximum 12.2%) the authors assessed: the time of gastric emptying by scintigraphic follow up of the progress of solid food (rice labelled with 99mTc). 2. The correlation of gastric emptying and time factors (age, duration of diabetes) and metabolic factors (blood sugar level, glycosylated haemoglobin). 3. Relations of impaired gastric emptying and the presence of gastrointestinal symptoms. RESULTS: Only 9 patients had normal gastric emptying (36%). In 16 patients (64%) the time was pathologically altered, incl. 5 (20%) where the period was reduced, while in 11 (44%) the time was prolonged. After classifying the diabetics into three groups according to the period of gastric emptying in minutes (group I < 40, group II 40-90, group III > 90) by means of the statistical method ANOVA a significant correlation was found between the time of gastric emptying and age (p < 0.036) and the duration of diabetes (p < 0.0044). No significant relationship was found between metabolic parameters (blood glucose level, glycosylated haemoglobin) and the time of gastric emptying. The authors did not find any significant relationship between impaired gastric emptying and subjective symptoms. CONCLUSION: Impaired gastric emptying is frequently encountered in diabetics. In the authors group there was only a correlation between the time of gastric emptying and age and the duration of diabetes. The authors did not find a relationship with the blood glucose level or glycosylated haemoglobin. Impaired gastric emptying was not correlated with subjective gastrointestinal symptoms.

Interactions between nitric oxide and dopamine in inhibitory learning and memory in newborn rats.

Taking into account our previous results on dopamine and nitric oxide effects on neonatal inhibitory learning and memory in rats, the mutual interactions of the two molecules were studied in this experimental paradigm. Both increased dopamine content and nitric oxide bioavailability in the brain after application of dopamine and L-arginine as substrate for nitric oxide synthase solutions into lateral cerebral ventricles improved learning and 24 h memory. Joint application of dopamine and L-arginine yielded still more improvement. Learning and memory processing were dose dependently enhanced by D1 receptor agonists as well, whereas D1 receptor antagonists had an opposite and also dose-dependent effect. Dopamine or D1 receptor agonists administered together with nitro-L-arginine, a nitric oxide synthase inhibitor that impaired learning and memory due to a decreased nitric oxide availability, antagonized the effect of nitro-L-arginine, as did L-arginine. D1 receptor antagonists impaired both learning and memory, and L-arginine rendered learning values normal. The dopamine and D1 receptor-agonist effect on 24 h memory was concentration dependent, and their higher concentrations substantially increased the retention indexes. The intimate mechanisms of these interactions are to be identified in further experiments.

[Radionuclide venography in occlusions of the inferior vena cava]. / Radionuklidová venografie pri uzáverech dolní duté zíly.

Based on 1234 examinations made by radionuclide venography the authors evaluated a group of 11 patients, where an occlusion of the vena cava was proved. In five instances ascension of thrombosis from the area of the pelvic veins was involved. in three instances compression by a tumour, twice the cause of occlusion was surgical ligature of the vena cava inferior. In one instance suppurative thrombosis developed as a result of spread of the infection from an intraabdominal abscess. Radionuclide venography provided evidence of a collateral circulation, as a rule a combination of several collateral routes was involved. Most frequently parietal collaterals in the abdominal aorta were present (9X), 4X paravertebral venous routes and only once anastomoses into the system of the azygos vein. In six patients anastomoses via the portal vein were found (cavoportal anastomoses). Based on their own experience, the authors evaluated the importance of radionuclide venography. Its advantage is the possible administration of the radiopharmaceutical preparation into the peripheral vein on the leg, the simple, safe procedure, the reproducibility and diagnostic yield during detection of high occlusions in the area of the vena cava inferior.

Use of radionuclides in the diagnosis of thromboembolism of venous origin: its potential and limitations. A review.

The review discusses the potential and limitations of radionuclide (RN) techniques of examination in diagnosing thromboembolic disease of venous origin. The advantages and drawbacks of perfusion pulmonary scintigraphy as the most commonly used method are weighed especially with a view to the diagnosis of pulmonary embolism (PE). The need for a combined examination including inhalation scintigraphy and chest X-ray is underlined. The criteria for interpreting results of RN techniques of examination in assessing the presence of PE are defined. Of the methods used in the diagnosis of venous thrombosis, the benefits and limitations of the fibrinogen uptake test (FUT) and radionuclide venography (RNV) are pointed out. When comparing RNV with X-ray phlebography, the authors found a low sensitivity in the crural area (54%) and, on the contrary, a 100% agreement in the areas of iliac veins and the vena cava inferior.

[Comparison of radionuclide venography with roentgen phlebography]. / Srovnání radionuklidové venografie s rtg-flebografií.

The authors evaluated a group of 78 patients where in addition to radionuclide venography (RNV) also X-ray phlebography was used (RTGF) within a time interval of not more than 72 hours. The results of 102 examinations were compared, 276 areas were correlated at six different sites. Agreement was recorded in 249 instances (90%), a false negative finding in 23 (8%) and a false positive finding in 4 (2%). Sensitivity was low in the area of the calf (55%), high in the femoral area, iliac area and in the area of the inferior vena cava (92-100%). The specificity was in all areas, incl. the calf, relatively high (94-100%). The investigation revealed the disadvantages of RNV--a low reliability in the area of the calf, the impossibility to detect small and parietal thrombi, the inability to assess the "activity and age" of the thrombus, the more difficult interpretation in insufficiency of venous perforators, and advantages of RNV--a great reliability at higher parts of the venous system and after administration of radiopharmaceutical preparations (RF) into peripheral veins, the possibility of simultaneous examination of pulmonary perfusion without further administration of RF, a low failure rate of intravenous administration of RF (less than 2%); RF do not irritate the venous endothelium and therefore thrombosis cannot develop; in case of paravenous escape of RF local inflammations do not develop, the radiation load is low, there is a small probability of allergic reactions, the method is non-invasive, it can be frequently repeated and used for the follow-up of treatment.