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The article deals with peripartum cardiomyopathy, a relatively rare disease, which is very likely in our region underdiagnosed. Increased awareness of the disease should contribute to its detection. The authors describe their own experience with the diverse clinical course of the disease. When properly diagnosed and treated it has a very good prognosis, and vice versa unrecognized or improperly treated can have fatal consequences.

Accelerated atherosclerosis in systemic lupus erythematosus (SLE) is a serious cause of morbidity and mortality. This paper provides a comprehensive overview of the possible etiology of atherosclerosis in patients with SLE. Traditional risks factors (lifestyle, lipid spectrum, hypertension, diabetes), immunology profile, markers of endothelial dysfunction, intima media thickness, medication, disease activity and damage are covered. Subgroups with and without lupus nephritis are compared with a healthy population.

In patients with proven unilateral overproduction of aldosterone, adrenalectomy can cure the hyperaldosteronism with a high probability and a positive effect on hypertension. The main aim of this retrospective study was to determine the effects of unilateral adrenalectomy on blood pressure and laboratory parameters in a cohort of 51 patients. Unilateral adrenalectomy had a positive effect in 82% of the patients and led to either blood pressure normalization or reduction of the antihypertensive medication. This study demonstrated a better effect of surgery on blood pressure in younger patiens.

This is the first study to describe the high prevalence of isolated exercise-only induced heart failure with normal ejection fraction (HFNEF) reaching 58% in a cohort of 81 post-heart transplant patients with normal left ventricular ejection fraction. This finding explains their low exercise tolerance due to exertional dyspnea and/or fatigue. Of the noninvasive parameters obtained at rest, multivariate regression analysis identified left ventricular mass index adjusted for allograft age to be an independent predictor of exercise-induced HFNEF.

Hematopoietic stem cells in combination with portal vein embolization provides new insight into the solution of primary unresectable colorectal liver metastases. The authors present a case report describing successful use of a novel method.

The MEDINA (MEtabolic parameters, DIabetes mellitus and NephropAthy) study compares angiotensin converting enzyme inhibitors (ACE-I) with angiotensin receptor blockers(ARB) in monotherapy and combined therapy with diuretic and/or a calcium-channel blocker (CCB) in 439 hypertensive patients with metabolic syndrome and/or diabetes mellitus. The blood pressure decrease difference between ACE-I and ARB was insignificant. Adding either hydrochlorothiazide or amlodipin was equally effective. There were no significant differences in metabolic parameters. The MEDINA trial has confirmed the equivalence of ACE-I and ARB in hypertension treatment and a combination with diuretics or CCB has an additive effect. Adding statins can further reduce the cardiovascular risk.

This paper evaluates fundamental aspects of electrical skin conductance as an objective parameter of measurements of pain perception in newborns, focusing on all gestational categories of newborns. It also describes the practical use of this method in daily routine practice in neonatal units. Measurement of parameters of electrical skin conductance is quick and non-invasive, does not affect significantly the staff or children and provides results immediately.

Aim: The aim of this study was to assess accuracy of echocardiography in the measurement of left ventricular ejection fraction (LVEF), enddiastolic volume (EDV) and endsystolic volume (ESV) compared with gated SPECT. Methods: A total of 70 patients with left ventricular systolic dysfunction were enrolled to study. Median of the time interval between gated SPECT and echocardiography was 1 hour. Results: Echocardiography was in good agreement with gated SPECT for quantification of LVEF by using Simpson's method in triplane (r=0.88, p<0.001), biplane (r=0.83, p<0.001) and monoplane apical four chamber projections (A4CH) (r=0.71, p<0,001). LVEF measured by SPECT (36.6±11.5%) was non-significantly higher then triplane (35.9±10%, median dif. 0.4%), biplane (35.7±10%, median dif. 0.7%), A4CH monoplane (36.6±12.2%, median dif. 0.1%). Echocardiography correlated with SPECT in quantification of EDV using triplane (r=0.8, p<0.001), biplane (r=0.81, p<0.001) and monoplane echocardiography (r=0.76, p<0.001). EDV measured by SPECT (201.1±72.5 ml) was significantly different and higher then triplane (174.4,5±60.8 ml, median dif. 22.8), biplane (170.9±58.4, median dif. 28 ml) and monoplane echocardiography (173.7±59.3, median dif. 85.7 ml). Echocardiography correlated with SPECT in quantification of ESV by triplane (r=0.87, p<0.001), biplane (r=0.86, p<0.001) and monoplane echocardiography (r=0.83, p<0.001). ESV measured by SPECT (133.1±64.3) was significantly different then triplane (115.1±52.1, median dif. 17 ml), biplane (113.2±51.5, median dif. 15.5 ml) and A4CH monoplane echocardiography (112.5±48.8, median dif. 17.2 ml). Conclusion: Echocardiography is a valid tool for LVEF assessment and systematically underestimates LV volumes compared with gated SPECT in patients with LV systolic dysfunction.

Background: Two consensus documents have appeared which revised the anatomical nomenclature of the venous system of the lower extremity. They changed and substantially extended the last valid version of the Latin anatomical nomenclature, Terminologia Anatomica, published by the Federative Committee on Anatomical Terminology, with approval of the International Federation of Associations of Anatomists, in 1998. The clinicians felt the need to adjust the terminology in order to better serve their purposes and to serve as a relevant theoretical base for correct diagnostic and appropriate treatment. First a consensus was made to expand and complete the nomenclature of the lower limb venous system during the 14th World Congress of the International Union of Phlebology in 2001. Another consensus was made again three years later, during 21st World Congress of the International Union of Angiology, under the auspices of Federative Committee on Anatomical Terminology and International Federation of Associations of Anatomists. Methods and results: The articles were compiled with the emphasis on the Latin terminology. Review of the original articles concerning the arrangement, variability and different nomenclature was performed thoroughly. The both documents comprise 89 terms of the veins of the lower extremity in both Latin and English. Conclusion: The clinicians, anatomists, and university teachers should follow the new extended anatomical nomenclature of the lower limb veins. The precise anatomical terminology can serve for diagnostic, treatment, and scientific purposes not only in the anatomy and angiology.

Aims: There are currently limited data about whether the effect of spironolactone in patients with resistant arterial hypertension depends on baseline blood pressure and the presence of a secondary cause of hypertension. Methods: Patients with office systolic blood pressure (BP) >140 mmHg or diastolic BP >90 mmHg, despite treatment with at least 3 antihypertensive drugs including a diuretic, were randomly assigned to receive spironolactone or a placebo for 8 weeks in a double-blind, placebo-controlled, multicentre trial (ASPIRANT). Results: Analyses were done with 55 patients treated with spironolactone. The degree of BP reduction after 8 weeks of spironolactone treatment did not differ significantly between the three tertiles of baseline systolic BP and patients with and without a secondary cause of hypertension. The reduction of office systolic, office diastolic BP and office pulse pressure was significantly lower in the highest tertile with baseline diastolic BP > 97 mmHg. Conclusions: Spironolactone treatment is effective to a similar extent both in patients with and without a secondary cause of hypertension and regardless of the baseline value of systolic BP. Less effect of spironolactone was found in patients with the highest baseline diastolic BP.

Aim: We sought to evaluate our experience with endoscopic radial artery harvesting for coronary artery bypass grafting (CABG). Methods: From October 2005 to June 2010, 50 patients who underwent endoscopic radial artery harvesting for an elective CABG were prospectively assessed for harvesting characteristics, complications, postoperative and mid-term outcomes. Results: There were 34 (68%) males and 16 (32%) females, average age 60.8±9.2 years. All but two RA grafts (96%) were successfully harvested endoscopically. Mean harvesting time was 46.2±9.3 min and mean length of harvested grafts was 23.4±2.2 cm. In the post-operative period there were no wound-healing complications; residual forearm edema was recorded in 6 patients (12%) and peripheral neuropathy in 4 patients (8%). At 3 months after the surgery, peripheral neuropathy and residual edema persisted in 2 patients (4%). A significant drop of overall harvesting time (56.2± 18.6 vs. 38.6±8.6 min, P<0.05) and forearm ischemia time (41.8±12.7 vs. 24.2±3.2 min, P<0.01) was found between first and last ten cases in the group. Conclusion: Endoscopic radial artery harvesting was associated with low risk of post-harvesting complications and most of these disappeared within a 3 months follow-up. However, there was a significant learning curve.

Introduction: Screening tests for gastrointestinal diseases acceptable for population with a high sensitivity and high specificity can now be offered by clinical laboratories. This paper summarizes major recent advances in this area of laboratory medicine. Methods: Relevant articles published within the last 5 years in the NLM (National Library of Medicine) PubMed - Medline database covering the three gastrointestinal diseases - colorectal cancer, coeliac disease, and atrophic gastritis were included for this overview. Results: In Europe, colorectal cancer (CRCA) is the second most frequent malignant disease. Quantitative immunochemical analysis of the stool for haemoglobin provides the best screening test to date, with both sensitivity and specificity approaching 95%. Even though coeliac disease (CD) affects approximately 1% of the general population, it remains largely unrecognised. Recommended methods for screening currently involve the detection of IgA and IgG antibodies against tissue transglutaminase and deamidated gliadin peptide. Evaluations of screening are now discussed for other diseases of the gastrointestinal tract - such as chronic atrophic gastritis (CAG), and inflammatory bowel disease (IBD). Detection of infection by Helicobacter pylori and stomach-specific plasmatic biomarkers, especially pepsinogen I/II ratio, could help with the prevention of gastric carcinomas. The use of faecal calprotectin as a screening test could substantially reduce the number of invasive methods necessary for the diagnostic work-up of patients with IBD. Conclusions: Screening tests for CRCA and CD have been used worldwide for many years. Screening strategies for gastrointestinal diseases are suggested in the text, based on recent basic science, clinical papers as well as our own experience.

Background: Plasma N-terminal fragment of pro brain natriuretic peptide (NT-proBNP) concentration is elevated in cardiovascular diseases such as congestive heart failure, where increased levels of NT-proBNP indicate cardiac dysfunction, hypervolemia, and higher risk of hospitalization and death. These associations apply also to patients with severe impairment of kidney function. Little is known about diferences in plasma level of NT-proBNP in patients receiving hemodialysis (HD) versus those receiving continuous ambulatory peritoneal dialysis (CAPD). Aim: To evaluate differences in plasma NT-proBNP concentration between HD and CAPD patients. Methods: Plasma NT-proBNP concentration was prospectively measured in consecutive patients receiving either HD or CAPD at our hospital center. All other standard clinical parameters were recorded. The correlation between plasma NT-proBNP concentration and the type of dialysis was then examined. Results: We studied 99 consecutive patients on HD (age 62 ± 15 years, 66% male) and 18 consecutive patients on CAPD (age 56 ± 18 years, 67% male). Both groups had similar baseline characteristics including duration of dialysis, left ventricular function and mass, and cardiothoracic ratio. Significantly more patients on HD had abnormal NT-proBNP levels compared to patients on CAPD (97% vs 44%; P<0.0001), and this difference remained highly significant when using various NT-proBNP cut off values. A subgroup analysis revealed that the lower NT-proBNP levels of CAPD patients are most pronounced in patients with preserved left ventricular ejection function. As expected, NT-proBNP levels correlated negatively with left ventricular function and positively with cardiothoracic ratio, and this applied to both HD and CAPD groups. Conclusion: The lower concentration of NT-proBNP in patients on CAPD compared to those on HD suggests that CAPD produces lesser hemodynamic stress, especially in patients with preserved left ventricular systolic function. Even though increased NT-proBNP levels have been shown to predict increased morbidity and mortality, further studies are necessary to assess the long term benefit of CAPD compared to HD.

Background: The aim was to compare the speckle tracking echocardiography (STE) derived systolic longitudinal strain (SL_Smax) with rest single photon emission computed tomography (SPECT) perfusion imaging (Q_REST), and to define the optimal cut-offs for SL_Smax to discriminate transmural scar on contrast-enhanced magnetic resonance imaging (ceCMR). Methods and Results: In 100 patients with chronic ischemic left ventricular (LV) dysfunction, myocardial viability was assessed using STE and rest SPECT to predict LV segmental relative extent of delayed enhancement (DE) >75% on ceCMR. Correlation was found between regional SL_Smax (r=-0.59, P<0.0001) and DE on ceCMR. The SL_Smax optimal cut-off -5.3% identified segments with DE>75% on ceCMR (sensitivity 83.1%, specificity 84.6%). Optimal cut-offs SL_Smax for segments corresponding to individual perfusion territories (-3.6%, -5.3% and -4.7% for LAD, LCx resp. RCA perfusion territories) were identified. There was a significant difference (AUC 0.866 vs. 0.822 for SL_Smax resp. Q_REST, p=0.036) in the accuracy of predicting non-viable segment due to the greater accuracy of SL_Smax than Q_REST in the RCA perfusion territory (AUC 0.893 vs. 0.75 for SL_Smax resp. Q_REST, P=0.001). Conclusions: STE enabled identification of LV non-viable segments. Cut-off values derived for perfusion territories of individual coronary arteries improve the accuracy of predicting a transmural scar presence. In comparison with rest myocardial SPECT perfusion imaging, STE is more accurate in predicting non-viable myocardium.

Background: The prevailing recommendation for the elderly is to live in their own homes as long as conditions allow. With this emphasis on the natural living environment, it is imperative to closely monitor both the general health and nutritional needs of the elderly in community settings. Aim: The aim of the study was to compare three nutritional status screening and evaluation tools of the elderly in their homes. Methods: Testing of measuring instruments, MNA, SGA, and MUST took place in the homes of 120 seniors in selected areas of the Czech and Slovak Republics. The study included 120 seniors. For testing of the relationships and dependencies, Pearson's correlation coefficient, t and Fisher tests were used. The level of statistical significance was α = 0.05. Results: All tests were to a large degree correlated (p_MNA = 0.0049; p_MUST = -0.537; p_SGA = -0.578) with the body mass index of the seniors. Simultaneously, it was confirmed that the tools for assessing nutritional status in the study showed significant differences regarding the classification of patients at risk of malnutrition and/or malnourished patients. Conclusions: Based on the findings, we conclude that MNA appeared to be a more appropriate tool for nutritional assessment of the elderly living in their homes. SGA and MUST provided rather subjective evaluation of the nutritional status and did not furnish an in-depth categorization of malnutrition.

Aims: To analyze the paced QRS duration in various septal positions of the right ventricular leads and with different paced QRS vectors. To use the results to assess parameters suggesting the optimal site for right ventricular pacing. Methods and Results: A total of 609 patients with leads implanted in the right ventricular septum were classified using fluoroscopy in the lateral view (the primary pacing site), and in the anteroposterior view (the secondary pacing site), according to the QRS vector in leads I and III. Significantly shortened paced QRS was found in the primary pacing site with the true septal compared with the anteroseptal site, with the vector being negative or isoelectric in lead I plus positive in lead III. In secondary pacing sites, no significant difference in pacing QRS duration was found between RVOT-HS, RVOT-LS, mid-septum and inferior-septum. Conclusions: For optimization of the pacing site in the ventricular septum, the following are significant: the primary site based on the lateral view, and the paced QRS vector in leads I and III.

Aims: To explore the feasibility of subcutaneous continuous glucose monitoring (CGM) in perioperative settings and to evaluate the perioperative development of glycaemia in persons with diabetes mellitus or impaired glucose tolerance by means of CGM. Methods: Monitoring by means of GuardianŸ REAL-Time CGMS (Medtronic, Nortridge, USA) in 20 perioperative periods. Sensor was inserted on the day before surgery and continued for 3 days with some exceptions. Results: Full implementation of the method was successful in the intensive care unit setting only. No electromagnetic interference and no side effects were found. The Wilcoxon signed-rank test revealed no significant difference between sensor and laboratory analyser values. Pearson´s correlation coefficients of the values obtained by sensor and the Wellion Linus glucometer were 0.875 for the whole perioperative period, 0.866 for the intraoperative period and 0.903 for the first perioperative day. A decline in sensor accuracy on the 6^th day was registered in one case. 16 monitored cases (80%) did not meet the criteria for safe plasma glucose range. Hypoglycaemia was found in 4 (20%) cases. There was an association between grade of the perioperative dysglycaemia and need for reoperation within the next 3 months. The most frequent perioperative glycaemic patterns are demonstrated. Conclusion: Subcutaneous CGM is safe offering detailed insight into glucose homeostasis in the dynamic perioperative period. Laboratory confirmation of sensor plasma glucose concentration by approved laboratory analyser is still necessary. The potentional benefits of maintaining patients within a safe glucose range should be comfirmed by future studies.

Introduction: Breast conserving surgery combined with sentinel node biopsy represents currently the gold standard of treatment for early breast cancer. Although breast conserving surgery has been a widely accepted method for many years, there remain some highly controversial unresolved issues. The present analysis focused on the resection margin as one of the key factors for local control of the disease. Methods: Patient disease free survival and overall survival were collected from patients undergoing breast conserving surgery from 2004 to 2009 at the Department of Surgery Atlas hospital Zlin, Czech Republic. All patients with resection margin less then 5 mm were re-resected to achieve this clear resection margin of 5mm or more. Disease free survival (more specifically local relapse free survival, metastasis free survival and regional free survival) and overall survival were assessed. Results: The data on 330 patients were analyzed and 286/330 cases had complete follow-up. After a median follow-up of 70 months, 7 patients with isolated local relapse were identified (2.44%), 13 patients with distant metastasis without local relapse (4.54%) and 2 patients with relapse in the axilla without local relapse in the breast (0.7%). Conclusion: The final decision about the extent of resection margin remains controversial but based on the data on local control presented here it seems reasonable to increase the criteria for a clear resection margin to 5 mm.

Objective: The aim of the survey was to identify the needs of mothers to infants hospitalized in intensive care units (ICUs) and second, to assess the level of parental support provided by the health personnel. Methods: The sample consisted of 147 mothers to infants hospitalized in ICUs. The research was conducted over six months in ICUs for newborns at two hospitals in Ostrava. The study used two standardized questionnaires: The parental stressor questionnaire scale: Neonatal Intensive Care Unit which measures the degree of stress in parents of hospitalized infants and the questionnaire The Nurse Parent Support Tool which evaluates the level of parental support provided by nursing staff. Results: The highest level of stress was identified in the parental role. Specifically, the inability to help the child remain separate from the mother, a feeling of helplessness and inability to protect the child from painful procedures and the inability to feed her baby. Mothers evaluated the support of nursing staff in most of these areas as high. Top were rated the ability of the caring staff to respond well to the questions of parents and the mother's willingness to engage in childcare. Conclusion: Intensive care units for the newborn obviously need to be family-centered care and at the same time they must be aware of all the factors that can be sources of stress for the parents.Only in this way can stress be eliminated with positive impact on the relationship between mother and child.

Aim: The purpose of this study was to evaluate whether there are gender differences in total cholesterol levels in patients with acute heart failure and if there is an association of this parameter with short and long time mortality. Methods: The AHEAD MAIN registry is a database conducted in 7 university hospitals, all with 24 h cath lab service, in 4 cities in the Czech Republic. The database included 4 153 patients hospitalised for acute heart failure in the period 2006-2009. 2 384 patients had a complete record of their total cholesterol levels. 946 females and 1437 males were included in this analysis. According to the admission total cholesterol levels, patients were divided into 5 groups: < 4.50 mmol/l (group A), 4.50-4.99 mmol/l (group B), 5.0-5.49 mmol/l (group C), 5.50-5.99 mmol/l (group D) and > 6.0 mmol/l (group E). The median total cholesterol levels were 4.24 in males and 4.60 in females (P<0.001). There were differences in the distribution of total cholesterol levels between men and women: group A 57.6 vs 45.0%, group B 13.8 vs 16.3%, group C 9.8 vs 12.5%, group D 7.7 vs 11.4%, group E 11.1 vs 14.8% respectively (all P<0.001). The median age of men was 68.7 vs 77.3 years in women (P<0.001). In all total cholesterol categories women were older than men: group A 77.7 vs 69.5 years, group B 78.6 vs 69.1 years, group C 77.3 vs 68.8 years, group D 76.8 vs 64.2 years, group E 75.6 vs 64.4 years (all P<0.001). For the calculation of long term mortality, the cohort was divided into three groups: total cholesterol levels below 4.50 mmol/l, 4.50-5.49 mmol/l and above 5.50 mmol/l. The log rank test was used for the analysis. Results: There were no differences in hospital mortality between male and female in general (9.2 vs 10.8%, P<0.202), or in total cholesterol levels in subgroups. Total cholesterol levels were associated with in-hospital mortality (P<0.002). In the long-term follow up (78 months) patients with total cholesterol levels below 4.5 mmol/l had the worst prognosis (P<0.001). An independent influence of total cholesterol level on mortality and survival was confirmed in the multivariate model as well. Conclusions: Women with acute heart failure had higher total cholesterol levels than men in all ages. There was a higher percentage of women with total cholesterol levels above 6 mmol/l and lower percentage in the group below 4.5 mmol/l than in men. In all, total cholesterol categories women were older than men. Total cholesterol levels are important for in- hospital mortality and long term survival of patients admitted for acute heart failure.

Introduction: Severe forms of psoriasis are indicated for systemic treatment with conventional and biological preparations. The former includes methotrexate, cyclosporin, acitretin and narrow-band ultraviolet B phototherapy but toxicity may limit the dose and duration of treatment. Currently used less toxic biological preparations include inhibitors of TNF-alpha (etanercept, adalimumab, infliximab) and the monoclonal antibody against IL 12/23 ustekinumab. We present our own more than five-year experience with the systemic treatment of severe forms of psoriasis using these preparations. Methods: A total of 66 patients treated with systemic therapy (except for phototherapy) were divided into groups based on treatment. Therapeutic doses were administered according to the recommendations of the manufacturer and dermatological societies. Standard PASI and BSA indexes were used to evaluate clinical condition at weeks 0, 12 and 24. Results: Differences in PASI score reduction and BSA index between patient groups treated with different preparations were statistically significant at monitored intervals. At week 12, PASI score was reduced by 75% or more in a significantly greater number of patients treated with infliximab + methotrexate than those treated with acitretin. At week 24, identical comparison showed a significantly greater number of patients treated with etanercept or adalimumab than those receiving methotrexate. For BSA index reduction by 50% or more, no statistically significant differences were found between patient groups during the follow-up period. Conclusion: Systemic therapy provides a significant benefit to patients with severe psoriasis. Biological preparations are more effective than conventional medications which are often limited by severe side-effects and generally less tolerated than biological treatments.

Aims: To determine the effectiveness of second line treatments in patients with neovascular AMD who did not respond adequately to primary treatment. Methods: Retrospective, multicentre assessment. The frequency of primary treatment failure and outcomes of subsequent secondary treatment were assessed according to the type of primary treatment, type of CNV and change in BCVA over a 12 month period. Results: At the time of assessment 750 entries (750 treated eyes, 725 treated patients) had follow-up longer than 12 months. A treatment change required 7.7% subjects treated with ranibizumab, 20.5% with pegaptanib and 22% with PDT and verteporfin. Average BCVA of all patients at the beginning of primary treatment was 50.7 ± 3 letters and 43 ± 3.5 letters in 12^th month (P<0.001). The mean decrease in BCVA was 7.7 ± 0.6 letters during the first 6 months of observation. During the next 6 months, no significant change occurred. The change of primary therapy was required on average after 6.5 ± 2.1 months. Conclusion: BCVA loss was the most significantly decelerated in patients who received ranibizumab as a secondary therapy following unsuccessful treatment with pegaptanib sodium.

Aim: Provide an overview of how bipolar disorder affects cognitive function in patients. Methods: MEDLINE and PsycInfo data bases were searched for articles indexed by the combinations of MESH term or key word "bipolar disorder" with the following terms: "cognition", "memory", "neuropsychology", "neuropsychological tests", "lithium", "anticonvulsants", "antipsychotics", and "schizophrenia". Constraints limiting time period of publications or their language were not applied. Reference lists of publications identified by these procedures were hand-searched for additional relevant citations. Results: There is evidence of stable and lasting cognitive impairment in all phases of bipolar disorder, including the remission phase, particularly in the following domains: sustained attention, memory and executive functions. But research on the cognitive functions has yielded inconsistent results over recent years. There is a growing need for clarification regarding the magnitude, clinical relevance and confounding variables of cognitive impairment in bipolar patients. The impact of bipolar illness on cognition can be influenced by age of onset, pharmacological treatments, individual response, familial risk factors, and clinical features. In addition to the mood state, cognitive performance in bipolar patients is influenced by seasonality. Conclusion: Previous optimistic assumptions about the prognosis of bipolar disorder were based on the success of the control of mood symptoms by pharmacotherapy. However, it is now clear that the "remitted" euthymic bipolar patients have distinct impairments of executive function, verbal memory, psychomotor speed, and sustained attention. Mood stabilizers and atypical antipsychotics may reduce cognitive deficits in certain domains and may have a positive effect on quality of life and social functioning.

Aim: We evaluated the effects of botulinum toxin type A (BTA) - abobotulinumtoxinA on passive motion resistance (PMR) values of lower limbs affected muscles and on the functional motor status in children with spastic cerebral palsy (CP). Methods: In Group I (28 lower limbs with spastic muscles), and in Group II (14 lower limbs with dynamic spastic equinus) BTA was administered. Physical therapy was prescribed for 16 weeks. We estimated PMR using the Modified Ashworth Scale. Achieved functional motor level was evaluated by Gross Motor Function Classification System (GMFCS) and Gross Motor Function Measure (GMFM). Parameters were assessed before treatment and after 3,8,16 weeks and 6 months respectively. Results: In Group I, PMR was significantly lower for hip adductors and knee extensors over 3-16 weeks, and for ankle joint extensors in both groups. There were significant differences for both groups in frequencies of GMFCS values after 16 weeks from BTA application. There was a significant increase in GMFM scores after 8 and 16 weeks from BTA application in both groups of patients. Conclusions: BTA treatment in CP children is followed by reduction in PMR values and improvement in functional motor status.

Aim: Obstructive sleep apnea (OSA) can be associated with the metabolic syndrome. Adipocyte fatty acid-binding protein (A-FABP) may play a role in OSA. The aim of this study was to determine whether cont i nuous positive airway pressure (CPAP) treatment results in decreased serum A-FABP levels. Subjects and methods: 81 patients (70 males, a mean age of 53.9±10.3 years) were evaluated by polysomnography, diagnosed with OSA and indicated for CPAP treatment. Anthropometric, clinical and laboratory investigations were carried out and repeated after 1 month/ 1 year of CPAP treatment. The data were analyzed using the SPSS Statistics 15 software (SPSS Inc., Chicago, USA). Results: Patients had significantly decreased A-FABP levels (34.4 ng/ml, 31.2 ng/ml, 24.8 ng/ml, P=0.048, P=0.001) and improved OSA parameters: AHI (53.9, 5.0, 5.6, P<0.0001), mean nocturnal oxygen saturation (91%, 93%, 94%, P<0.0001), ODI (55, 9, 8, P<0.0001), and percentage of sleep time with oxygen saturation below 90% (28.2, 0.2, 0, P<0.0001). BMI, waist, neck circumference, and blood pressure did not statistically significantly change. Conclusion: CPAP therapy in OSA patients has a positive effect on A-FABP levels. Decreased A-FABP levels play an important role in regulating glucose metabolism and affect the regulation of lipid metabolism and thus may contribute to decrease in the cardiovascular complications of OSA.

Aim: The aim of this study was to assess coagulation markers of endothelial damage and examine new markers of endothelial activation such as matrix metalloproteinases (MMPs) in a group of healthy pregnant women. Matrix metalloproteinase (MMP)-2, in particular, plays a major role in the degradation of the extracellular matrix confirming its essential function in both the survival (angiogenesis) and death of endothelial cells. Detection of specific coagulation factors, mainly released from the vascular endothelium such as vWF, sTM (soluble thrombomodulin) and ePCR (endothelial protein C receptor) and factors dependent on endothelial activation such as t-PA and PAI-1, could provide information on possible endothelial dysfunction and help differentiate pregnant patients with an altered thrombotic state. Methods: Healthy pregnant women underwent complete assessment for endothelial damage (as vWF, vWF activity, sTM, ePCR, EMP, MMP-2, MMP-9 and TIMP-2) using the ELISA and other methods. Results and Conclusions: The results show that endothelial activation during pregnancy is different from that in other pathological conditions involving endothelial damage and typically characterized by higher levels of both coagulation endothelial markers and MMPs. In pregnancy, changes in extracellular matrix composition and matrix metalloproteinase activity also occur and promote vascular remodeling but, only in the uterus. Predisposing risk factors for epithelial dysfunction, and vascular mediators associated with vascular remodeling must be assessed from concentrations in whole blood. The levels of MMPs are not increased in the circulation and the local situation in the uterus cannot be monitored this way. However, MMP-2 processes and modulates the functions of many other vasoactive and pro-inflammatory molecules including adrenomedullin, big endothelin-1, calcitonin gene-related peptide, CCL7/MCP-3, CXCL12/SDF-1, galectin-3, IGFBP-3, IL-1 Beta, S100A8, and S100A9. These molecules represent new potential molecular markers of endothelial damage during pregnancy.

Backround. The treatment of personality disorder is repeatedly reported as less successful than the treatment of patients without personality disorder. Most clinicians believe that anxiety disorder in tandem with a personality disorder often leads to longer treatment, worsens the prognosis, and thus increases treatment costs. Our study was designed to compare the short-term effectiveness of therapy in patients suffering from social phobia with and without personality disorder. Method: The specific aim of the study was to assess the efficacy of a 6 week therapeutic program designed for social phobia (SSRIs and CBT) in patients suffering from social phobia with comorbid personality disorder (17 patients) and social phobia without comorbid personality disorder (18 patients). The patients were regularly assessed in weeks 0, 2, 4 and 6 using the CGI (Clinical Global Improvement) for severity, LSAS (Liebowitz Social Anxiety Scale), and in self-assessments BAI (Beck Anxiety Inventory) and BDI (Beck Depression Inventory). Results: Patients in both groups improved their scores in most of the assessment instruments used. A combination of CBT and pharmacotherapy proved to be the most effective treatment for patients suffering with social phobia with or without comorbid personality disorder. Treatment efficacy in patients with social phobia without personality disorder was significantly better than in the group with social phobia comorbid with personality disorder for CGI and specific inventory for social phobia - LSAS. The scores on the subjective depression inventory (BDI) also showed significantly greater decrease over the treatment in the group without personality disorder. The treatment effect between groups did not differ in subjective general anxiety scales BAI. Conclusion: Our study showed that patients suffering from social phobia and comorbid personality disorder showed a smaller decrease in specific social phobia symptomatology during treatment compared than patients with social phobia without personality disorders. However, a significant decrease in symptomatology occurred in personality disorder patients as well.

Aims: We report a case of multi-recurrent herpes zoster in a 53-year-old Caucasian woman treated repeatedly at the Faculty Hospital Hradec Kralove, Czech Republic over the years 2009 - 2011. Methods: Specific PCR methods targeting single nucleotide polymorphisms (SNPs) in open reading frames (ORF) 38, 54 and 62 were utilized to determine vaccine or wild type varicella-zoster (VZV) strains followed by SNPs analysis using two amplicons in ORF 22 and/or ORF 21/ORF 50. Additional genotyping in ORF 1, 6, 9 and 28 was subsequently performed due to the unusual results. Results: Three sets of clinical specimens from one patient (from hospital visits 2, 3 and 4) were analyzed and the presence of an unusual wild-type strain of VZV was discovered. The VZV strain isolated from the lesions bears a combination of markers characteristic both for Mosaic 2 (M2) and European 1 (E1) wild-type VZV strains. Conclusion: This is the first report of atypical wild-type VZV strain circulating currently in Czech Republic.

Aims: The i-gel^TM and the AuraOnce^TM laryngeal mask are supraglottic airway devices used for airway management during general anaesthesia. Both devices are cheap, disposable and widely used. They may be used with both spontaneous and controlled ventilation. This study compared differences in the seal and peak pressures, and postoperative complications in these devices when used in paralyzed patients under controlled ventilation. Methods: A prospective randomized trial was designed to compare the i-gel^TM and the AuraOnce^TM in paralyzed adult patients under conditions of controlled ventilation. Two hundred and four patients (ASA class 1-3, age 18-89, weight 46-115 kg) were enrolled in the study. Standardized anaesthesia (fentanyl, propofol and sevoflurane in air-oxygen) was administered including neuromuscular blockade. The primary outcome measure was the difference in seal airway pressures between the two devices. Secondary outcome measures included peak airway pressures, insertion data and postoperative profiles - the incidence of sore throat, swallowing difficulties, numb tongue, hearing difficulties, neck pain, nausea and vomiting. Results: First time insertions were 85.6% (i-gel) and 82% (AuraOnce) with overall success rates 96.3% (i-gel) and 94.2% (AuraOnce) (p=0.54). Average insertion times were 11.0 s (i-gel) and 11.6 s (AuraOnce) (p=0.19). Seal pressures were 30.4 cmH₂O (i-gel) and 27.8 cmH₂O (AuraOnce) (p=0.007). Peak pressures were 15.3 cmH₂O (i-gel) and 15.6 cmH₂O (AuraOnce) (p=0.57). Traumatic insertion occurred in 5.8% of i-gel^TM and 2% of AuraOnce^TM insertions. The overall incidence of postoperative complications was low, with the i-gel^TM causing less sore throat and difficulty swallowing at 24h. Conclusion: Both devices provided effective seals for ventilation under positive pressure. I-gel^TM may be a better alternative for the procedures with controlled ventilation because of higher seal pressures and lower incidence of sore throat postoperatively.

Background: In the past, the first goal of schizophrenia treatment was to reduce psychotic symptoms, mainly positive symptoms. Recently, as a result of an emphasis on patient needs, the concept of quality of life (QoL) has been brought into the treatment. The goal has therefore changed from the alleviation of symptoms to improvement of the patient's satisfaction with social activities. Self-evaluations by people with schizophrenia were previously thought to lack reliability because of the presence of psychopathological symptoms and poor awareness of the disease. Recently the importance of evaluating the satisfaction of patients themselves, however, has been recognized in schizophrenia. Studies on this field showed us, that QoL data from patients with chronic mental illness were reliable and concluded that subjective QoL evaluation was applicable to such patients. Aims: The purpose of the present study was to compare the QoL in patients suffering from schizophrenia in clinical remission with healthy controls and examine the extent of the effects of subjective cognitive functioning on QoL in these patients. Methods: Data were obtained using the quality of life questionnaire (Quality of Life Enjoyment and Satisfaction - Q-LES-Q), and subjective questionnaire for cognitive dysfunction (Cognitive Failures Questionnaire - CFQ) for 40 schizophrenia patients in clinical remission and 40 healthy controls. Results: Cognitive function correlates negatively with subjective QoL in patients with schizophrenia.