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Introduction Endothelial dysfunction occurs at the very beginning of hypertension. The primary goal of our study was to determine plasmatic levels of multiple endothelial substances in otherwise healthy patients with primary hypertension and compare them to healthy individuals. Secondary goals were to determine the change in NOx levels after initiation of treatment and to compare the NOx levels in patients with established resistant hypertension. Materials and methods 87 consecutive patients were enrolled. In the exploratory cohort of 22 healthy and 28 hypertensive individuals, plasmatic levels of big endotelin-1, asymmetric dimethylarginin, osteopontin, oxidized LDL, 3-nitro-L-tyrosine, growth/differentiation factor 15, intercellular adhesion molecule, vascular cell adhesion molecule, tumor necrosis factor-α, vascular endothelial growth factor, interleukins -1β, -6 and nitric oxide levels (NO, expressed as NOx) were determined. The remaining 27 individuals were used as a validation cohort. Ten patients with established resistant hypertension were enrolled from our Hypertension Clinic. Results There was a statistically significant difference in NOx levels between healthy controls and hypertensive patients/resistant hypertensive patients: 45.164 µmol/L ± 48.627 vs 17.763 µmol/L ± 10.333 (P=0.00004)/14.36 µmol/L ± 7.194 (P=0.00007). Conclusion We identified a decrease in total NOx plasmatic levels in otherwise healthy patients with primary hypertension that was more profound in patients with resistant hypertension. Plasmatic levels of other determined endothelial substances did not differ among the groups. However, due to the significant variability of plasmatic NOx levels even in healthy controls and many factors that affect it, we cannot recommend it to be used to assess endothelial function routinely.

Presence of left ventricular (LV) hypertrophy significantly increases cardiovascular risk in patients suffering from hypertension. Diagnostics of LV hypertrophy in hypertensive patients is not easy and there is still no method of enabling a simple and sufficiently sensitive dia-gnosis across a large patient population. The golden standard in LV hypertrophy diagnostics is echocardiography, and there are adverse opinions regarding the use of natriuretic peptides BNP and NT proBNP (NP) to diagnose LV hypertrophy.We examined through echocardiography 173 hypertensive patients with signs of metabolic syndrome and a moderate increase in blood pressure (130- 159/ 85- 99 mm Hg) with an average age of 54.8 ± 13.54 years, i.e. 119 men and 54 women, who were divided into 2 groups; 1 with BMI30 (group A with a severe obesity) and the other without obesity, BMI30 (group B). Both groups were examined for BNP and NT proBNP levels.We found a positive correlation between NP and LVMi, both for BNP (r = 0.169; p = 0.033) and for NT proBNP (r = 0.240; p = 0.002). NT proBNP statistically significantly predicts the given LV hypertrophy LK in people with BMI30 but not in obese people (BMI30).Obese patients suffer from a higher occurrence of left ventricular hypertrophy and paradoxically a lower NP value than patients with a metabolic syndrome (MS) who are not obese. Natriuretic peptides have a limited diagnostic value when assessing left ventricular hypertrophy. They are only of value in patients who are not obese and whose kidney function and systolic myocardial function have not been impaired.

Choledocholithiasis is the most common cause of biliary obstruction. Each of the testing methods used in its diagnosis has its advantages and disadvantages.The objective of this prospective study is to compare endoscopic retrograde cholangiopancreatography with magnetic resonance cholangiopancreatography in the diagnosis of choledocholithiasis on the basis of own experience and literature data. Set of patients and methodology: The set was studied from the beginning of 2007 to the end of 2012 (i.e. six years). The study assessed prospectively 45 patients (age range 28- 72 years) with symptoms of biliary obstruction, who first underwent magnetic resonance cholangiopancreatography and subsequently endoscopic retrograde cholangiopancreatography.The sensitivity, specificity and diagnostic accuracy of magnetic resonance cholangiopancreatography was lower, both in our set of patients and according to the literature data, compared to the endoscopic retrograde cholangiopancreatography (92%, 91% or 93 %).Considering the frequency of complications (in some cases serious ones) following endoscopic retrograde cholangiopancreatography, the magnetic resonance cholangiopancreatography is, in spite of its lower sensitivity, the method of choice in the diagnosis of choledocholithiasis by means of noninvasive methods, on the basis of which it is possible to refer the patients subsequently for therapeutic endoscopic retrograde cholangiopancreatography.

The aim of this retrospective study was to evaluate our experience with using a single-balloon enetroscope for diagnostic and therapeutic endoscopic retrograde cholangiography (ERC) in patients with Roux-en-Y hepatico jejunal anastomosis (HJA). Due to the considerably changed anatomic circumstances after the surgery, ERC is, in comparison to the standard endoscopic retrograde cholangiopancraeaticography (ERCP), significantly more difficult to perform.The sample was followed up from January 2009 to September 2011. The study retrospectively reviewed 14 patients with Roux-en-Y HJA with symptoms of biliary obstruction. A total of 21 ERCs were performed in these 14 Roux-en-Y HJA patients using the single-balloon videoenetroscope Olympus SIF Q 180.Diagnostic ERC cannulation was successful in 11 of the 14 patients (79% success rate for the diagnostic ERC). One of the 11 patients had a normal finding on the ERC. The remaining 10 patients had a pathological finding on ERC that, in one patient (cystic dilatation of bile duct), was subsequently managed surgically. Endoscopic treatment was initiated in the remaining 9 patients (HJA stenosis in 4, choledocholithiasis in 2 and concurrent HJA stenosis and choledocholithiasis in 3) immediately after the diagnostic ERC; the surgery was successful in 8 of the 9 patients (89% success rate for the therapeutic ERC). The performed endoscopic therapeutic procedures included: balloon dilatation of HJA stenosis 9 times (6 patients), choledocholithiasis extraction - 5 times (5 patients), biliary plastic stent placement - 5 times (3 patients), removal of biliary stents placed by us - 5 times (3 patients). We did not observe any complications in our sample of 14 patients.ERC using a single-balloon enteroscope in patients with Roux-Y HJA is significantly more difficult than the standard ERCP due to different post-surgical anatomy. In our sample of patients, we achieved 79% success rate for the diagnostic ERC and 89% success rate for the therapeutic ERC. Additional time should be allowed for the individual procedures. Furthermore, the presence of an anaesthesiologist during these operations (deep analgosedation) is essential. This is a technically very demanding technique that, however, is effective and safe and importantly extends the options available for the management of biliary pathologies in these patients.

The authors first provide and overview of the main knowledge on pancreatic pseudocysts. They discuss the individual types of pancreatic pseudocysts, their clinical picture, complications and diagnosis. As part of the differential diagnosis, they emphasise the need to distinguish pancreatic pseudocysts from cystic tumours and benign cysts. Special attention is then paid to various modalities of treatment of pancreatic pseudocysts.The authors present their own results of endoscopic drainage of pancreatic pseudocysts, one of the key options in the treatment of this condition.A total of 33 patients (24 men and 9 women) were treated by endoscopic drainage between September 2007 and March 2009. Endoscopic drainage was performed transduodenally in 4 patients and via the transgastric route in 29 patients; 6 times with endosonographic device and with duodenoscope after endosonographic alignment in 27 patients.The authors conclude that endoscopic drainage is an effective method of treatment of pancreatic pseudocysts.

The incidence of subclinical organ damage is higher in patients with hypertension (HT) and metabolic syndrome (MS). Increased aortic pulse wave velocity (PWV) is one the markers reflecting subclinical arterial damage. Treatment with sartans leads not only to a reduction of blood pressure but may also bring regression of the subclinical damage. Long-acting sartans (telmisartan) may be more effective than sartans with medium duration of action (losartan); the aim of this research was to compare the impact of hypertension therapy with losartan and telmisartan on aortic pulse wave velocity (Ao-PWV).We examined 32 patients with HT and MS, 15 patients were treated with losartan 50 mg (group A) and 17 patients were treated with telmisartan 80 mg (group B). At the beginning and the end of the study, PWV was measured using the Complior method and 24-hour BP monitoring and biochemistry testing were carried out.Treatment with sartans led to a reduction in BP in both groups, daytime BPs/BPd declined by 11.5/9.0 mm Hg in group A and by 13.8/8.1 mm Hg in group B, respectively, and night time BP declined by 5.7/5.1 mm Hg in group A compared to 7.4/3.89 mm Hg in group B. Aortal pulse wave velocity declined by 1.94 m/s in group A (p0.001) and by 0.46 m/s in group B (p0.001), respectively.Treatment with losartan as well as telmisartan resulted in reduced values of BP and Ao-PWV. We did not prove a more significant effect of a long-acting sartan (telmisartan) compared to a sartan with a medium duration of action (losartan) on Ao-PWV reduction after 1 year of treatment.

Chronic constrictive pericarditis (CP) is a disorder affecting pericardium, that becomes inelastic, rigid and restricts filling of the ventricles. Most commonly CP evolves after acute pericarditis, typical is a long-lasting asymptomatic phase with development of right heart failure and low systemic output. The case report refers CP, which developed in 33 years old patient in a short period after acute idiopatic pericarditis. The patient suffered from severe congestive heart failure with oedema and pleural effusion. At first this diagnosis had not been thought of, the differential diagnosis was focused at primary lung disorder or autoimunne disease. After the true causation had been revealed, pericardectomy was performed with optimal effect and consequential complete recovery. Unfortunately the etiology of CP wasn't discovered. CP is in Europe a relatively rare disease, particularly in such young patients. Determining the correct diagnosis and treatment is vital to be done as soon as possible to prevent increase of surgery risk and probability of post-operative diastolic abnormalities.

The authors evaluated the occurrence of risk factors, mode of therapy and in-patient mortality in 726 patients admitted to 38 Czech and Moravian hospitals for unstable angina pectoris with ECG finding of ischaemia without ST segment elevation, who were indicated to application of anticoagulant treatment with low molecular weight heparin. The duration of the before-hospital phase represented a significant risk factor for the progression of disease up to Q myocardial infarction. The relapse of stenocardia occurred in 19.8% of patients during the hospitalization and myocardical infarction Q occurred in 7.5% patients, while 2.89% patients died during hospitalization. These results were compared with those performed in the registries of GRACE, ENACT and Euro Heart Survey Acute Coronary Syndrome-EHS-ACS. The results of therapy in the Czech Republic may be further improved by a more advanced health education within the framework of secondary prevention of IHD, a risk stratification of patients, more modern drug therapy and a better collaboration of hospitals lacking invasive catchment area workplaces of intervention cardiology.

The objective of the submitted trial was to use combined examination of ECG at rest and after exercise to detect a viable heart muscle in patients with a postinfarction Q wave and ST elevations. The authors found that according to the character of changes of the ST elevation in ECG after exercise it is not possible to detect patients with a viable myocardium. During the combined procedure using analysis of the kinetic disorder at rest and increase of the ST segment in ECG after exercise it is possible in patients with hypokinesia or akinesia at the site of the Q wave to differentiate successfully 66% patients with a viable heart muscle. This combined procedure can serve as a selective test for implementation of further more accurate diagnostic tests for the detection of a viable heart muscle because in common clinical practice the above data are available in these patients before indication of more complicated examinations.

The importance of dipyridamol echocardiography in the diagnosis of ischaemic heart disease (IHD) was described repeatedly. Nevertheless in roughly 20% patients the transthoracic echocardiographic examination at rest is inaccurate or cannot be carried out because the ultrasonic visibility is poor. In these patients transoesophageal dipyridamol echocardiography (TEE Dip) can provide a suitable alternative. This is why the authors evaluated 36 patients examined on account of IHD before and after administration of 0.80 mg/kg dipyridamol. The left ventricle was visualized in the transgastric short axis and from the apical view. Angiography revealed significant stenosis of the coronary arteries in 23 patients. In 18 patients after administration of dipyridamol new motility disorders developed, in 5 patients with motility of the left ventricular wall, impaired at rest, no new disorder of kinetics developed, i.e. the test was falsely negative. Thirteen patients had no signs of stenosis of the coronary arteries and three developed disorders of the motility of the left ventricular wall. The sensitivity of TEE Dip for the diagnosis of left ventricular ischaemia was 78% and the specificity 79%. Dipyridamol load transoesophageal echocardiography is a method suitable for clinical application with a still satisfactory sensitivity and very good specificity and it can be implemented without involving the risk of serious side-effects.

The objective of the work was to compare functional indicators of the left ventricle during isometric (HG) and dynamic (Ergo) echocardiographic load examinations in patients with different grades of ischaemic heart disease. In group A they compared results in 34 patients with affection of three coronary arteries and in group B 15 patients with 1-2 coronary arteries affected. They evaluated the systolic, diastolic blood pressure, heart rate (HR), the index of the diastolic end volume EDV/m2, the index of the systolic end volume ESV/m2, Limacher's index for evaluation of left ventricular motility and the left ventricular ejection fraction (EF) at rest and after both types of loads. The EDV/m2 index increased in group A by 5.2 ml during an isometric load and by 10.4 ml during a dynamic load, in group B it increased by 1.6 and 7.0 ml resp. The values of the ESV/m2 index increased in group A by 8.5 ml during the isometric load and by 14.0 ml during the dynamic load, in group B by 4.1 and 10.8 ml resp. EF values at rest were similar in both groups: group A: 51.4%, B: 51.5%. During the isometric load the EF declined to 45.3% in group A and to 47,1% in group B. During the dynamic load the EF declined to 42% in group A and 42.5 in group B. The dynamic load produces, as compared with the isometric one, a statistically more significant drop of Limacher's index and greater volumetric changes of the left ventricular cavity in the group with 1-2 affected coronary arteries, as compared with the isometric load. In patients with three affected coronary arteries the volumetric changes during an isometric load are comparable with changes after a dynamic load.

In 56 patients with ischaemic heart disease the authors evaluated the blood flow in the pulmonary veins, using transoesophageal echocardiography by the pulsed Doppler technique in the left upper pulmonary vein. They assessed the peak systolic velocity (pVS), the systolic integral time-velocity (S-VTI), the peak diastolic velocity (pVD) and the integral time velocity in the diastolic part of the flow (D-VTI). They found a statistically significant correlation between the ratio pVS/pVD and the LVEDP assessed by the invasive method (r = 0.812). In 36 patients the authors evaluated the flow rate and time-velocity integral at rest and after administration of 0.78 mg/kg dipyridamol by the i.v. route. In 17 patients with affections of 2 or 3 coronary arteries (group A) after the administration of dipyridamol an increase of the maximal flow rate occurred in the diastolic portion of the flow (at rest 54.7 +/- 12.5, after dipyridamol 64.9 +/- 14.8 cm/s). The systolic flow velocities did not change in this group of patients (at rest 52.2 +/- 3.0, after dipyridamol 54.3 +/- 14.0 cm/s). In 19 patients with a negative coronarographic finding (group B) or with stenosis of one coronary artery after dipyridamol administration the systolic peak velocity increased (from 58.0 +/- 10 to 70.2 +/- 14.8 cm/s). The pVD values increased slightly after dipyridamol (at rest 42.5 +/- 14.3, after dipyridamol 52.1 +/- 15.6 cm/s).(ABSTRACT TRUNCATED AT 250 WORDS)

The authors investigated 155 patients, mean age 50.6 years, after revascularization of the myocardium. The group was divided at random into a group with a high intensity of physical rehabilitation (A) and a medium and low rehabilitation group (B). The rehabilitation programme comprised physical exercise at least three times per week for at least 30 mins. with a dynamic load up to 80% of the maximum heart rate in group A and up to 40% in group B. The mean initial haemodynamic indicators in both groups were equal (LVEDP 17.5 mm Hg and 16.5 resp. and EF 52.3% and 50.5% resp. in group A and B). Six months after revascularization the mean values of work tolerance increased in group A more than in group B (58.6 kJ, as compared with 44.2 kJ) and this difference is even greater after three years (70.4 kJ as compared with 51.5 kJ). The mean values of the ejection fraction (EF) at rest do not differ in the two groups after 6 months nor after 3 years (51.3% in group A, as compared with 54.6% in group B after 6 months, and 55.2% vs. 53.7% resp. after three years). The EF after a dynamic load after 6 months and 3 years does not differ in the two groups either (57.2% vs. 56.4% after 6 months and 55.1% vs. 54.5% after three years). Similar results were also obtained on evaluation of the mobility index of the walls at rest and after a dynamic load.(ABSTRACT TRUNCATED AT 250 WORDS)

The aim of the submitted study was to evaluate the blood flow in the pulmonary veins by transoesophageal Doppler echocardiography which is the ideal method for recording the blood flow in the pulmonary veins as the ultrasound probe is closely behind the left atrium. In 35 patients with ischaemic heart disease the authors evaluated the blood flow in the pulmonary veins to assess whether the rate of the blood flow in these vessels can serve a non-invasive estimate of the end-diastolic pressure in the left ventricle (LVEDP). It was revealed that venous blood flow has in the majority of cases two anterior peaks during ventricular systole, one anterior peak during diastole and one negative peak during atrial contraction. In patients with normal LVEDP the peak rate and integral time-velocity of the flow curve is greater during systole, while in patients with a higher LVEDP these parameters are higher during diastole. Dopplerian assessment of the flow in the pulmonary veins is safe, relatively non-invasive and simple. This method makes possible rapid visual estimates of the end-diastolic pressure in the left ventricle.

The authors submit their initial experience with the work protocol of transoesophageal loading echocardiography, which they used in 148 patients. The method is meant in the first place for individuals where the records of classical transthoracic echocardiography in 10-25% are difficult to visualize by echocardiography or patients who for any reasons cannot be subjected to common loading examinations. The informative capacity of this method is almost 100%. It makes it possible to evaluate every accurately filling and ejection indicators as well as changes in the motility of cardiac walls.

The authors submit findings of haemodynamic changes during long-term treatment of mild hypertension by physical training. Using this method, blood pressure was normalized in all subjects. The authors conclude that physical activity has a similar impact on the haemodynamics of mild hypertension as drugs which reduce the tension of the sympathetic nerve. A surprising finding was the diminution or complete disappearance of cardiac hypertrophy in this treatment.

The authors introduced and evaluated the clinical importance of the echocardiographic positional test for the detection of left ventricular insufficiency after exercise. They found that in decompensated ischaemic patients, contrary to healthy subjects, left ventricular ejection indicators deteriorate. Latent left ventricular weakness in ischaemic patients without clinical signs of heart failure is revealed by positional reduction of the rate of shortening of the circumferential fibre. The authors conclude that this test does not fully replace the work load examination. The change of position is, however, a simple, preliminary functional test which may be useful in patients with ischaemic heart disease for checking treatment, rehabilitation and the selection of subjects for further aimed examinations.

The authors provide evidence that changes of diastolic indicators precede in incipient hypertension the impaired left ventricular function. In marginal hypertonics and in particular in stage 1 hypertonics they found by echocardiography that, as compared with healthy normotonic subjects, sings of impaired relaxation in the early diastole. This is apparent from the significant prolongation of the time constant of relaxation at rest and the maximal speed of relaxation which are due to the early filling of the left ventricle. To increase the sensitivity of the echocardiographic examination of left ventricular functions the isometric loading test proved useful.

The authors submit the results of a long-term study of the treatment of mild hypertension by physical training. Its advantage, as compared with medicamentous treatment, is the physiological effect on the organism, its financially unpretentious character, and if the population is seriously informed, its wide application. The authors found in general a poor approach to physical activity, in particular among young people due to lack of information on the importance of physical activity. They conclude that physical training is the method of choice in the treatment of mild forms of hypertension. The blood pressure attained normal levels after this treatment in liminal hypertonics as well as hypertonics stage I.

The authors report on their experience with the transdermal spray, TD spray Iso Mack. Using a graded ergometric test, the authors examined 11 patients with angina on exertion before and 60 minutes after administration of 60 mg of the effective substance by the transdermal route. The average threshold of ischaemia and work tolerance increased significantly and the ECG depression of segment S-T receded. In an open trial six patients were investigated with angina on exertion during three-week treatment with the spray--twice a day 60 mg by the transdermal route--as compared with standard treatment. The number of attacks and consumption of sublingual nitroglycerin decreased significantly. Five patients were subjected to haemodynamic examination before and repeatedly after application of 60 mg of the spray. A significant drop of the filling pressures occurred which persisted for 6 to 8 hours.

The authors discuss the possibility to make use of a simple echocardiographic indicator of left ventricular function--the angle formed by the anterior cusp of the mitral valve and the line of the interventricular septum, assessed from a four-chamber tracing (angle M). Based on echocardiographic examination of 87 subjects they established their own standards. They consider values above 30 degrees as pathological, suggesting impaired left ventricular function. The M angle correlates significantly with invasive (final diastolic pressure in the left ventricle, ejection fraction) and with non-invasive (top speed of shortening of the circumferential fibre) indicators of left ventricular function. The authors assume that this simple, quick screening of left ventricular function will prove helpful, in particular in subjects where visualization by one-dimensional echocardiography from a parasternal approach is difficult. In practice it can be also applied for evaluation of left ventricular function during loads, in particular in dynamic echocardiography.