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HYPOGLYCEMIA UNAWARENESS - DEFINITION, FREQUENCY, PATHOGENESIS, CLINICAL TYPES
MOKAN, M.
Failure to recognize autonomic warning symptoms or failure for them to occur before the development of neuroglycopenia is defined as hypoglycemia unawareness. Incidence of this phenomenon among patients with insulin-dependent diabetes mellitus is frequent. Using a standardized insulin infusion test it has been found that one out of four patients (26 %) with insulin-dependent diabetes mellitus has present hypoglycemia unawareness. Various mechanisms and predisposing factors have been implicated in the pathogenesis of the phenomenon of hypoglycemia unawareness. This defect is probably at the central nervous system level and could be due to: 1. lack of appropriate recognition by the central nervous system of a decreasing glycemia (altered hypothalamic glucostat function or altered blood-brain glucose transport); 2. diminished release of neurotransmitters; 3. diminished target tissue responses on appropriate neurotranmitters secretion. Theory of pathogenesis of hypoglycemia unawareness must be able to explain and define its association with duration of diabetes, strict glycemic control, autonomic neuropathy and repetitive episodes of hypoglycemia. The present hypothesis of hypoglycemia unawareness is that the repetitive frequent hypoglycemia leads to generalized central nervous system adaptation by means of increased transport of glucose through the blood-brain barrier which results in diminished counterregulatory hormone responses and symptoms. A dangerous vicious circle develops whereby hypoglycemia induces unawareness, which in itself increases the risk for development of new hypoglycemia. This state is at least partially reversible. The presence of hypoglycemia unawareness should influence the physician's decision before using intensive insulin therapy regimen in diabetic patients. (Tab. 2, Fig. 1, Ref. 39.)
Key words: hypoglycemia unawareness; frequency; pathogenesis.
Bratisl Lek Listy 1995; 96: 413-419
ANALYSIS OF ARRHYTHMIAS IN HOLTER ELECTROCARDIOGRAM MONITORING IN PATIENTS WITH VENTRICULAR PREEXCITATION
JURKOVICOVA, O., HLUCHY, J., SCHEIDOVA, L., CAGAN, S.
Background.
It is known that patients with preexcitiation of ventricles
(PE) have a predisposition to paroxysmal supraventricular tachyarrhythmias
(PSVT). There is a relatively small amount of knowledge concerning
the occurrence and clinical significance of other disturbances
of the cardiac rhythm in these patients.
Objectives. 1. To consider the possibility of utilization
of Holter monitoring (HM) of electrocardiograms (ECG) in the detection
of PSVT; 2. To find out the occurrence and evaluate the significance
of other than paroxysmal tachycardias; 3. By means of correlation
of subjective complaints with objectively documented arrhythmias
to consider the extent, to which the subjective complaints are
determined by disturbances of cardiac rhythm.
Methods. 24-hour HM ECG was performed under clinical conditions
in 50 patients, 23 male and 27 female patients at the average
age of 35±13 (ranging 15-17) years, with manifestant PE on
ECG. 21 (42 %) patients with documented PSVT and/or atrial paroxysmal
fibrillation (APF) constituted a group with Wolff-Parkinson-White
(WPW) syndrome. 29 (58 %) patients without these arrhythmias were
ranked among the group with WPW pattern. 22 (44 %) patients had
concommitant organic heart disease (OHD). Each long-term electrocardiographic
ECG recording was judged in order to specify the occurence of
individual types of arrhythmias and to perform their quantitative
analysis per 24 hours. Subjective complaints presented by patients
during HM were correlated with the objectively documented arrhythmias.
Results. Arrhythmias were recorded in HM in 35 (70 %) of
patients with PE. Supraventricular premature beats (SVPBs) occurred
in 32 (64 %) and ventricular premature beats (VPBs) in 15 (32
%) patients with PE. When comparing the patients with PE and OHD
with subjects with PE but without OHD, no statistical differences
in the occurrence of SVPBs and VPBs as well as in numbers per
24 hours were discovered. PSVT were recorded by HM only in 2 patients,
and AV reciprocating echoes in another patient with WPW syndrome.
Short runs of atrial tachycardia occurred in 2 patients with WPW
syndrome. One patient with WPW pattern yielded in sleep 8 asymptomatic
episodes of pauses in the length of 2-2.2 seconds. No other disturbances
of the cardiac rhythm were found in patients with PE during HM.
Subjective complaints as markers of arrhythmia ocurrence yielded
a sensitivity of 31 % and specificity of 73 %. Evaluation of long-term
ECG recordings brought about several problems and obstacles.
Conclusions. 1. HM is not an appropriate method in detection
of PSVT in patients with PE. 2. The occurrence of SVPBs and VPBs
in patients with PE does not significantly differ from the occurrence
presented by healthy individuals. Significant differences are
not even among groups with WPW syndrome and WPW pattern. 3. There
are no typical arrhythmias (besides PSVT and PFP) in patients
with PE. 4. Presence or absence of subjective complaints in patients
with PE is not a reliable indicator for orientation in real occurrence
of arrhythmias. 5. Evaluation of long-term ECG recordings according
to Holter is in patients with PE more complex and time consuming.
Besides a computer it requires also a physician with sufficient
knowledge on arrhythmology. (Tab. 4, Fig. 6, Ref. 17.)
Key words: ventricular preexcitation; Holter ECG monitoring; arrhythmias.
Bratisl Lek Listy 1995; 96: 420-429
SERUM LEVELS OF VITAMINS A, C AND E IN SLOVAK POPULATION
BABINSKA, K., BEDEROVA, A., GRANCICOVA, E., MAGALOVA, T., BRTKOVA, A.
Background: Significant forms of vitamin deficiencies
are rare in Slovak Republic, however mild hypovitaminoses are
still relatively frequent and they have negative consequences
on the functional status. Vitamins A, C and E represent an important
part of the antioxidant defense system acting against free-radical
damage. Imbalance between oxidative stress and antioxidant capacity
which leads to free radical damage is considered to be an aetiological
factor of ischaemic heart disease and cancer.
Objectives: The study was focused on assessment of serum
levels of vitamins A, C and E in the Slovak population older than
35 y and frequency of decreased levels. Relationship between high
prevalence of chronic non-communicable diseases and high frequency
of suboptimal levels of antioxidant vitamins is discussed.
Methods: Serum levels of vitamin A and E were assessed
by the HPLC method, the levels of vitamin C by the colorimetric
method.
Results: Mean levels of vitamin A were 1.85 micromol/l
in both sexes (95 % c.i. 1.75-1.89 in males, 1.77-1.92 in females).
Mean level of vitamin C was 31.36 micromol/l in males (95 % c.i.
30.06-32.72), the value observed in females was significantly
higher (43.05 micromol/l, 95% c.i. 41.75-44.40). Mean level of
vitamin E observed in males (29.2 micromol/l, 95 % c.i. 27.62-30.87)
was only slightly, not significantly higher than in females (28.11
micromol/l, 95 % c.i. 26.45-29.87). Decreased levels of vitamin
E were observed only in a small proportion of the sample, however
almost one third of males had decreased level of vitamin C and
more than 20 % had low level of vitamin A. We observed high prevalence
of serum levels of vitamins A, C and E suboptimal from the aspect
of risk of coronary heart disease and cancer (vitamin A: males
78 %, females 75.5 %, vitamin E: 41.9 and 49.6 %, respectively,
vitamin C: 61.8 % and 41.1 %).
Conclusion: Results indicate that sizeable proportion of
population has decreased serum levels of vitamins, males especially
of vitamin C and females of vitamin A. According to serum levels
of vitamin A, C and E high percentage of population can be ranked
into the group with increased risk of CHD and cancer. (Tab.
6, Ref. 29.)
Key words: vitamin A, C and E; adults; hyposaturation; risk of CHD and cancer.
Bratisl Lek Listy 1995; 96: 430-434
LAPAROSCOPIC PEROPERATION CHOLANGIOGRAPHY - INDICATION AND SIGNIFICANCE
BOBER, J., BLAZEJ, I., VRZGULA, A., ROSAK, M., HARBULAK, P., MARTINCEK, M., JELINEK, V.
The authors have performed 35 peroperative laparoscopic
cholangiographies by means of transcystic cannylation of the choledochus
in 410 patients subdued to laparoscopic cholecstectomy. Choledocholelithiasis
was found in 8 patients (22.85 %).
The authors advocate for the application of peroperative cholangiography
in indicated cases since the method is simple, safe and sufficiently
successful. (Tab. 5, Ref. 9.)
Key words: laparoscopic peroperative cholangiography; indication; procedure description; measures of improvisation.
Bratisl Lek Listy 1995; 96: 435-438
VISUAL EVOKED POTENTIAL AFTER MOTION STIMULATION - BASIC CHARACTERISTIC
SOTH, J., LIPOVSKY, L., SCHINGLER, F.
The study presents a methodical analysis and results of examinations of visual evoked potentials after stimulation by pattern reversion and motion in the visual field. The stimulus is generated on a PC monitor. In this manner selective stimulation of X and Y ganglionic cells is enabled by reversion, motion and their mutual combination. (Tab. 1, Fig. 2, Ref. 14.)
Key words: visual evoked potentials; stimulation by pattern reversion; stimulation by motion in visual field.
Bratisl Lek Listy 1995; 96: 439-441
THE DIVERTICULOSIS OF SMALL BOWEL
MAZUCH, J., BRUNCAK, P., KUNIK, Z., MACHAN, L., MISANIK, L.
Small
bowel diverticulosis is a rare disease of gastrointestinal tract
that occurs most frequently in older patients. Since this disease
can be asymptomatic, for a long time, the diagnosis rarely is
made in the preoperative period. In 40 % of cases there are acute
or chronic complications, most frequently diverticulitis either
with or without perforation, bowel obstruction and massive haemorrhage
clinically manifested as bleeding from the lower part of the gastrointestinal
tract. Abdominal pain, pseudoobstructive and malabsorption syndrome,
expressive weightloss, steatorrhea and anemia are common chronic
complications. In these cases a surgical treatment is necessary.
Resection of the affected part of the small bowel is usually performed
with end-to-end anastomosis.
The authors present 4 cases with diverticulosis of the small bowel,
two cases of which were manifested by diverticulitis and one of
them was perforated. Pseudoobstructive syndrome, malabsorption
and expressive weightloss were presented in other two cases. All
four cases were dominated by severe abdominal pain. The surgical
treatment was based upon radical resection of the small bowel
with end-to-end anastomosis. (Fig. 4, Ref. 28.)
Key words: diverticulosis; jejunun; ileum; clinical findings; diagnosis; surgery.
Bratisl Lek Listy 1995; 96: 442-446
PREVENTION AND TREATMENT OF THE GROIN LMYPHATIC FISTULA AFTER ARTERIAL RECONSTRUCTIVE PROCEDURES
LEHOTSKY, L., HUTAN, M.
Lymphatic fistula is a complication of
2 % of surgical vascular reconstruction in the groin especially
in the critically ischaemic limb.
We investigated the incidence of lymphatic fistula, its prevention
and treatment in patients at the Department of Surgery of the
Ruzinov Hospital in Bratislava during the period of 5 years.
7 patients out of 162 (4,44 %) had lymphatic fistula in the groin.
The patients underwent 172 operation involving 209 groin incisions.
Lymphatic fistula developed in 7 groin incisions - 3,34 %. Operations
included 36 aortobifemoral bypass procedures, 2 unilateral bypass
procedures, 76 femoropopliteal bypass procedures or profundoplastic
surgeries, 48 embolectomies.
The diagnosis was based upon the clinical findings of the characteristic
persistant watery discharge in the groin after vascular operation.
Conservative treatment was successful in all patients, the average
duration of lymphatic fistula was 27.2 days.
Lymphatic fistula may be complicated in 25 % of patients by wound
infection but it shouldn't be regarded as the first degree of
infection in vascular surgery. (Ref. 12.)
Key words: lymphorrhea; lymphatic fistula; arterial reconstruction of the groin.
Bratisl Lek Listy 1995; 96: 447-449