[Management of dyslipidaemias -  present and future. Guidelines of the Angiology Section of the Slovak Medical Chamber (2013)]. / Manazment dyslipidémií -  prítomnost a budúcnost. Odporúcania Angiologickej sekcie Slovenskej lekárskej komory (2013).

AIM: The aim of Guidelines of the Angiology Section of the Slovak Medical Chamber is to address a last European guidelines for the management of dyslipidaemias, as well as results in evidencebased medicine (EBM) in order to assess their contribution to our expanding knowledge on reducing of residual organovascular risk. DISCUSSION: Lipid metabolism can be disturbed in different ways, leading to changes in plasma lipoprotein function and/ or levels. This by itself and through interaction with other vascular risk factors and endothelial dysfunction may affect the development of atherosclerosis and other vascular diseases. Therefore, dyslipidaemias cover a broad spectrum of lipid abnormalities, some of which are of great importance in organovascular prevention. Dyslipidaemias may be related to other diseases (secondary dyslipidaemias) or to the interaction between genetic predisposition and environmental factors. Dyslipidaemias may also have a different meaning in certain subgroups of patients which may relate to genetic predisposition and/ or co morbidities. This requires particular attention complementary to the management of the total CV risk. Optimal LDLcholesterol levels are the primary strateging task in the therapeutical preventive approaches. However, at present increasing attention has focused on the role of inflamation, levels of HDLcholesterol and triglycerides in the process of atherosclerosis. Statins represent basic pillar in dyslipidemia treatment. Despite the intensive management of all conventional vascular risk factors and the intensified treatment with statins, residual organovascular risk remains high. Therefore the interest is focused on finding the place of combined antidyslipidemic treatment and the development of new antidyslipidemics. CONCLUSION: Strategies for preventing of organovascular diseases have emphasized vascular risk factors effective modification using treatment approaches supported by evidencebased medicine (EBM).

[Present and future of pharmaco-arteriothromboprophylaxis in clinical practice. Guidelines of Angiology Section of Slovak Medical Chamber]. / Súcasnost a budúcnost farmako-artériotromboprofylaxie v klinickej praxi. Odporúcania Angiologickej sekcie Slovenskej lekárskej komory.

Antiplatelet therapy by acetylsalicylic acid (aspirin) provided pivotal advances in the prevention and treatment of organovascular (cardiovascular, cerebrovascular, extremitovascular, renovascular, genitovascular, mesenteriovascular, bronchopulmovascular, oculovascular, otovascular and other) arterial ischemic diseases. Currently available antiplatelet drugs have some limitations which might be overcomed by improved dosing regimens, use of combination of agents affecting different platelet functions and, in particular, by the new antiplatelet drugs (new arterial antithrombotics) with distinct pharmacodynamic properties offering new advantages, including faster onset of action, greater potency, and reversibility of effects. Document (Guidelines) of the Angiology Section of the Slovak Medical Chamber (AS SMS, 2013).

[Management of superficialis thrombophlebitis. Guidelines of the Angiologiy Section of the Slovak Medical Chamber (2013)]. / Manazment povrchovej tromboflebitídy. Odporúcania Angiologickej sekcie Slovenskej lekárskej komory (2013).

UNLABELLED: The aim of Guidelines of the Angiology Section of the Slovak Medical Chamber (AS SMC) is to address a last european guidelines for the management of thrombophlebitis superficialis, as well as results in evidence based  medicine (EBM) in order to assess their contribution to our expanding knowledge on rational management of thrombophlebitis superficialis. DISCUSSION: Superficial thrombophlebitis is a common disease, usually considered to be benign. However, the practice of systemic duplex ultrasonography has revealed a large number of cases of deep vein thrombosis concomitant with superficial thrombophlebitis. Assessment of clinical probability of deep vein thrombosis and venous tromboembolism and systematic duplex ultrasound investigation has been proposed in the initial management of superficial thrombophlebitis, to detect the presence of any underlying deep vein thrombosis. In contrast with extensive information on the management of deep vein thrombosis, there is little knowledge about the most appropriate treatment of the superficial thrombophlebitis. CONCLUSION: The treatment of superficial thrombophlebitis should improve local symptoms while preventing the development of complications such as venous thromboembolism. The most effective therapeutic approach to superficial thrombophlebitis seems to be represented by fondaparinux (a synthetic selective indirect inhibitor of factor Xa) which have been shown to prevent VTE events and the extension and/ or recurrence of superficial thrombophlebitis.

[Lipids and the size of lipoprotein particles in newly diagnosed and untreated patients with type 2 diabetes mellitus]. / Lipidy a velkost lipoproteínových castíc u pacientov s novozisteným a doposial nelieceným diabetes mellitus 2. typu.

Type 2 diabetes mellitus leads to the typical known form of dyslipidaemia among the patients. This dyslipiademia type re-presents prognostically important type of atherogenic dyslipiadaemia, that significantly increases the risk of atherothrombosis. Estimation of the size of lipoprotein particles with Lipoprint method among newly diagnosed, untreated patients with these patients have not been evaluated yet. Dyslipidaemia among patients with type 2 diabetes mellitus has its course and changes after the treatment. At the beginning i tis characterized by the significant increase of VLDL, large and middle size IDL lipoprotein particles, as well as by lowering of HDL particles. This lipoprotein profile has its own atherogenic potential. The course of the disease later leads to the change of dyslipidaemia, characterized by the increase of LDL levels (small dense particles), triglyceride levels and the persistence of the lower levels of HDLcholesterol. Hypolipidemic treatment leads to the significant lowering of cardiovascular risk, however despite treatment with statin or fibrate residual cardiovascular risk remains still very high.

[Multiple-combination kinezio-phlebothromboemboloprophylaxis, mechano-phlebothromboemboloprophylaxis and pharmaco-phlebothromboemboloprophylaxis of venous thromboembolism in internal medicine]. / Kombinovaná kinezio-flebotromboemboloprofylaxia, mechano-flebotromboemboloprofylaxia a farmako-flebotromboemboloprofylaxia vénovej tromboembólie v internej medicíne.

Parenteral heparin and oral coumarin preparations represent the standard antithrombotics widely used in the prevention and treatment of venous thromboembolism (VTE). Unfractionated heparin, low molecular weight heparins, and fondaparinux have been shown to be effective and safe in reducing VTE risk. Despite high efficacy these medicaments have limitations which become to be more apparent with current widening of the indications for either primary thromboprophylaxis (PTP) or indefinite and even lifelong secondary thromboprophylaxis (STP). There is a need for new effective and safe medicaments with specific antithrombotic action, oral administration and convenient dosing without monitoring. During the last decade new antithrombotics have been developed either blocking selectively one coagulation enzyme or inhibiting particular step in coagulation cascade. Document of the Angiologists Section of the Slovak Medical Chamber (AS SMC).

Contribution of the atherogenic lipoprotein profile to the development of arterial hypertension.

OBJECTIVES: Determination of non-atherogenic and atherogenic plasma lipoproteins, including small dense LDL, in patients with newly diagnosed arterial hypertension and identification of the phenotype of lipoprotein profile: non-atherogenic phenotype A vs. atherogenic lipoprotein phenotype B, in plasma of examined subjects. BACKGROUND: Atherogenic lipoproteins play an important role in the pathogenesis of arterial hypertension. Impaired lipoprotein metabolism results in overproduction of triglyceride-rich particles and LDL 3-7 subfractions - small dense LDL - a strongly atherogenic LDL subpopulation accelerating the development of arterial hypertension. METHODS: Total cholesterol and triglycerides were analyzed by enzymatic CHOD-PAP method, Roche Diagnostics, Germany. Lipoprotein profiles of plasma described as atherogenic lipoprotein phenotype B or a nonaterogenic lipoprotein phenotype A were examined by a new method of lipoprotein separation by means of electrophoresis on polyacrylamide gel (Lipoprint LDL system). Prostacyclin and thromboxane A2 in plasma were analysed by ELISA method. Score of Atherogenic Risk was determined as a ratio of atherogenic and non-atherogenic plasma lipoproteins. RESULTS: 1) High percentage of atherogenic hypertriacylglycerolemia (93%) and atherogenic mixed hyperlipemia (86 %) in subjects with arterial hypertension. 2) Low percentage of atherogenic hypercholesterolemia (52 %) in subjects with arterial hypertension. 3) Atherogenic normolipemia (7%) in control group of healthy subject. CONCLUSION: Contribution of this method lies in benefits as follows: A) Quantification of non-atherogenic and atherogenic plasma lipoproteins. B) Identification of high percentage of atherogenic dyslipoproteinemia (86-93%) in subjects with arterial hypertension. C) Presence of small dense LDL in plasma is decisive for declaring the atherogenic lipoprotein profile in both hyperlipemia and normolipemia (Tab. 5, Ref. 24).

[The incidence of dyslipidemia in a sample of asymptomatic probands established by the means of Lipoprint system]. / Výskyt aterogénnej dyslipidémie vo vzorke asymptomatických probandov vysetrením pomocou metódy Lipoprint.

Method of lipoprotein determination on polyamideacryl gel Lipoprint enables an exact quantification nonatherogenic and atherogenic plasma lipoproteins. For its use in human medicine this method was recently approved by FDA. According to majority of nonatherogenic, or atherogenic lipoproteins in their spectrum this method can distinguish nonatherogenic type A vs atherogenic type B. After their identification, there is the possibility for exact means of interventions among patients with higher cardiovascular risk. Also in the group of clinically healthy asymptomatic controls with normolipemia it is possible using this method to estimate the certain group of risk of development of premature atherothrombosis.

Management of pituitary macroprolactinoma in a 27-year-old male patient from Taiwan.

OBJECTIVES: The aim is to document the success of bromocriptine pharmacotherapy in a patient with gigantoprolactinoma. RESULT: The management of the patient was not appropriate at the beginning, because he underwent an operative therapy after the ophthalmological examination and MR without previous internal--endocrinological examination and pharmacotherapy. The endocrinologist participated in the patient management later, after the unsuccessful operative and when the patient's status was characterized by hyperprolactinaemia 15,000 ug/l and by hypopituitarism. Bromocriptine therapy immediately at the beginning would enable the patient to avoid several surgical interventions and subsequent complications with a high probability. CONCLUSION: The case report presents the failures at the beginning of diagnostic and therapeutic management of the patient with hyperprolactinaemia due to macroprolactinoma. It is both the example and the proof of irretrievability of general internal medicine, endocrinology and other internal disciplines in clinical practice. It confirms the integrating and coordinating function of the internal medicine specialist in clinical medicine (Tab. 1, Ref. 13).

[Epidemiology of vascular disease]. / Epidemiológia cievnych chorôb.

In the European Union are vascular diseases the main cause of death, causing 1.9 millions of deaths per year. The highest mortality rates for cardiovascular diseases are found in Slovakia (data provided by National center health information, 2006). In 2007 died 29,289 (54.1%) persons from cardiovascular diseases, which means more than half of all deaths. From all men 47.8% died from cardiovascular diseases and from all women died 61.6% for cardiovascular disease. Coronary heart disease (55%) presents more than half causes of these deaths. Despite that mortality from cardiovascular disease has been continuously decreasing, in Central and East European countries it is still kept in high rates.

[Serum lipoprotein profile in newly recognized arterial hypertension. The role of atherogenic lipoproteins in the pathogenesis of disease]. / Lipoproteínový profil séra pri novozistenej artériovej hypertenzii. Uloha aterogénnych lipoproteínov v patogenéze ochorenia.

New examination approaches in biochemical analysis of lipoproteins can identify and quantify atherogenic plasma lipoproteins, including small dense LDL and characterise a lipoprotein spectrum as a non-atherogenic lipoprotein profile phenotype A, respectively as an atherogenic lipoprotein profile phenotype B. Identification of a non-aterogenic hypercholesterolemia (48%), atherogenic hypertriglyceridemia (93%), atherogenic normolipemia (13%) in patients with arterial hypertension and an atherogenic normolipemia in control group of healthy subjects (7%), is an essential contribution of this new laboratory diagnostics.

[Changes in lipoprotein spectrum in patients with the diagnosis of extremity vascular ischemic disease]. / Zmeny v lipoproteínovom spektre pri koncatinovo-cievnej isthemickej chorobe.

New method of lipoprotein determination on polyacrylamid gel with Lipoprint LDL system quantifies non atherogenic and atherogenic plasma lipoproteins, including small dense LDL, the potent atherogenic lipoprotein subpopulations. According to majority of non atherogenic versus atherogenic lipoprotein in the whole lipoprotein spectrum, this method distinguishes a non atherogenic lipoprotein profile phenotype A from an atherogenic lipoprotein profile phenotype B. Definitely, the contribution of this method is focusing on the atherogenic lipoprotein profile phenotype B in 80% of patients with an extremito-vascular ischemic disease and on the existence of control subgroup ofnormolipemic subjects with an atherogenic lipoprotein profile (7% ofprobands of control group). These persons represent a risk population. Till now, the facilities for identifying of these "normolipemic persons at risk" are limited.

[Prevention and treatment of extremity vascular ischemic disease]. / Preventia a liecba koncatinovocievnej ischemickei choroby.

Extremitovascular ischemic disease (peripheral arterial disease of extremities - PAD) is an important manifestation of systemic atherosclerosis and other arterial diseases of vascular system. The lower the anklebrachial pressure index, the greater the risk of serious cardiovascular events (e.g., acute myocardial infarction, stroke). Prevention and treatment ofextremitovascular disease is discussed in this article.

[Venous thromboembolism in an oncology patient]. / Vénová tromboembólia u onkologického pacienta.

Venous thromboembolism is a common complication in many patients with different types of malignant tumors. In this paper we describe a case of a patient with cancer in remission, who developed pulmonary embolism.

Reccurent erythema migrans as a persistent infection.

BACKGROUND: Effective antibiotic therapy administered early in the course of the clinical presentation of erythema migrans (EM) prevents further progression of infection and dissemination of the agent to internal organs. CASE REPORT: A 73-year old woman was referred with a history of five episodes of recurrent EM after repeated adequate antibiotic treatment. The patient who had visited an endemic area only once before the disease recalled no tick bite either prior to the first episode or later. After the first episode, the serological examination was negative (IFA, ELISA, Western blot). In the second episode, not preceded by her visit to any endemic area, the patient showed borderline positivity. Western blot confirmed Borrelia burgdorferi sensu lato. The following episodes were observed again without a prior visit to any endemic area. The most recent EM episode was accompanied by nonspecific moderate symptoms such as fatigue and malaise without involvement of internal organs, with the same serological result as found previously. Peripheral blood PCR assay detected Borrelia burgdorferi specific DNA. Intravenous cephalosporin was effective in treating both the skin and extracutaneous signs of the disease. CONCLUSION: Recurrent episodes of appropriately treated EM may occur as a result of either reinfection due to contact with another vector tick or persistent infection. Intravenous cephalosporin is likely to be appropriate therapy for recurrent borrelial infection in the skin, in particular when accompanied by general extracutaneous signs and symptoms that might indicate dissemination of the spirochetes.

[Genetic factors and the risk of cardiovascular diseases]. / Genetické faktory a riziko kardiovaskulárnytch ochorení.

The objective of the study is to summarise the hereditary factors of cardiovascular diseases based on current knowledge, focus will be applied to genetic markers of multifactorial forms of cardiovascular diseases based on atherosclerosis, including their interaction with traditional risk factors.

[Diabetic angiopathy--etiopathogenesis and clinical manifestations (hypersyndrome X)]. / Diabetická angiopatia--etiopatogenéza a klinické prejavy (hypersyndróm X).

Diabetic angiopathy is a generalised systemic disease of the vascular system which afflicts both distribution vessels (diabetic macroangiopathy) and microcirculation (diabetic microangiopathy). The diabetic angiopathy, as well as other angiostenotic diseases (obliterations, obstructions, occlusions) result in one common consequence--ischaemia. This study is based on an analysis of a large group of patients (71,662 angiologic consultant examinations which took place during the 25-year period of the existence of the Comenius University Faculty Hospital). The author indicates that the clinical course of angio-organic ischaemic syndromes determined by diabetic angiopathy is multiform, remarkably severe and unfavourable. The author has suggested the term "X hypersyndrome" referring to cases with simultaneous occurrence of various pathophysiologic abnormalities and clinical units which finally increase the risk of origin and development of diabetic angiopathy. (Tab. 7, Ref. 47.)

[Unstable atherosclerotic plaque and acute coronary syndromes]. / Nestabilný aterosklerotický plát a akútne koronárne syndrómy.

Acute coronary syndromes (unstable angina pectoris, acute myocardial infarction, sudden cardiac death) participate significantly in cardiovascular and general morbidities and mortalities. Their common pathogenetic mechanism resides in the disturbance of the integrity of atherosclerotic plaque by a fissure, rupture, or ulceration and the origin of unstable atherosclerotic plaque by the formation of thrombi, which together with vasoconstriction, causes a varying degree of the dynamic obstruction of the coronary artery. Thrombogenesis takes place in coincidence with the factors of vascular wall, rheologic, thrombotic (proaggregatory and procoagulatory), and antithrombotic (antiaggregatory and anticoagulatory-fibrinolytic) factors. The formation of unstable atherosclerotic plaque is a critical point of the dissociation of both stable and unstable myocardial ischaemiae. The prevention and therapy of atherosclerosis must be complex, namely antiatherogenic, however most of all endothelium-protective, or cellulo-protective, antilipidogenic and antithrombogenic. They cannot be alternative; one therapy will not substitute another. Regarding the importance of even residual thrombosis and thrombin, new antithrombotic substances are being intensively investigated.

Clinical picture of arteriolosclerosis.

Arteriolosclerosis is a generalised systemic vascular disease which is characterised by hyalinisation of intima (hyalinosis) as well as proliferation and hypertrophy of the media in the arteriolar part of the arterial system (so-called benign arteriolosclerosis). However, the patients suffering from accelerated and malign hypertension develop also fibrinoid necrosis (so-called malign arteriolosclerosis, arteriolonecrosis). Arteriolosclerosis as well as other similar stenotic (obliterating, obstructive, occlusive) diseases of the arterial system, have one single common consequence--ischemia. Currently, angio-organic ischemic syndromes in the whole world most frequently result from atherosclerosis which, however, is not the only nosologic unit of the group of arterial diseases having the tendency to develop arterial wall sclerosis. The latter group is briefly referred to as arteriosclerosis. In addition to atherosclerosis, this group includes also Mönckeberg's medial arteriosclerosis, diabetic angiopathy and arteriolosclerosis. The authors of this study, on the basis of their analysis of their own large set of patients (71,662 angiologic consultant examinations performed during the period of 25 years of the existence of the Angiologic Department of the Medical Faculty Hospital of Comenius University in Bratislava) attract attention to the fact that the clinical picture of this disease is multiform, and that it occurs frequently in clinical practice. Therefore, angiology is a separate specialisation which is above the structure of internal medicine.

[Angiology as a most important specialty and an integral part of internal medicine]. / Angiológia ako najvýznamnejsí specializovaný (nadstavbový) odbor, ale aj integrálna súcast' internej medicíny.

The author wishes to remind the broad medical public, in particular specialists in internal medicine, that vascular diseases are the most widespread, most serious and most urgent medical, social and economic problems of all countries in the present world. They cause a high morbidity, associated with work incapacity, disability and about half of all deaths in the population, i.e. twice as many as the second most frequent cause of death--oncological diseases (angioepidemy). Vascular diseases and their risk factors are internal diseases which usually effect several organs and tissues of the human organism. The author refutes disintegration of internal medicine and explains the integral relationship of angiology and internal medicine.

[Differential diagnosis of mushroom poisoning]. / Diferenciálna diagnostika otráv hubami.

Mushroom poisoning is a very urgent problem of internal medicine. Mushroom picking is one of the most popular hobbies in the Czech and Slovak Republic. This is one of the main reasons of the rising incidence of mushroom poisoning, incl. fatal cases. Mushroom poisoning is characterized by a very varied clinical picture which is reflected also in recent classification systems. The main objective of the present work is to draw attention to cardinal symptoms and signs of different types of mushroom poisoning which respect new findings in the diagnosis and differential diagnosis of mushroom poisoning.