PROBLEMS OF THE LIMITATION OF MEDICINE
ZIKMUND, V.
Background: Dissatisfaction with the exclusively biomedical
approach to the etiology, manifestations, treatment and
prevention of diseases has manifested itself by the broadening of
the limits of medicine from the inside in the form of
bio-psycho-social model of diseases. From the outside, there has been
an effort to enter medicine by various approaches and
methods of the so-called alternative medicine.
Objectives: Critical evaluation of positives and negatives of the
bio-psycho-social model of diseases as well as of the approaches
of alternative medicine. Particular attention is paid to the
so-called psychotronics and psychotronics-based natural
medicine.
Methods: Analysis of the problems under study using world wide
publications that are cited in the Current Contents in the part
dealing with Life Sciences.
Main results: Multi-factorial bio-psycho-social model of diseases
has stimulated the complex interdisciplinary and
multidisciplinary research of the influence of psychological and
psychosocial factors upon the human health and diseases
respectively. There is, however, a lack of concrete directions
for the application of the model in clinical practice.
The main disadvantage of alternative medicine is that its methods
have no scientifically based conceptions and their effects remain
unproved. The main risk of the use of these methods are faulty
diagnoses and the neglect of the most effective treatment.
Conclusions: Medicine is not merely a science, it is an art as
well. The indispensable part of this art should reside in the most
effective use of the non-specific positive effects of the
interaction between physicians and patients. (Ref. 36.)
Key words: bio-psycho-social relations; psychosomatics;
alternative medicine; psychotronics; natural medicine; placebo.
Bratisl Lek Listy 1995; 96:
Ustav normalnej a patologickej fyziologie Slovenskej akademie
vied v Bratislave
Address for correspondence: V. Zikmund, MD, DSc, Sienkiewiczova
1, 813 71 Bratislava, Slovakia.
Phone: 0042.7.326 271 Fax: E-mail:


PARACRINE MODULATION OF CORONARY VASOMOTOR TONE AND MYOCARDIAL
PERFORMANCE BY VASCULAR AND ENDOCARDIAL ENDOTHELIUM
BARTUNEK, J., MOHAN, P., PAULUS, W.J., CAGAN, S.
Over the last years it has become evident that endothelium is one
of the most active paracrine organs releasing a number of
vasoactive substances. These mediators, by acting on subjacent
vascular smooth muscle, play an important role in control of
vasomotor tone and of platelets aggregation. The relations
between vascular endothelium and cardiovascular risk factors are
complex. Functional abnormalities of vascular endothelium are
probably segmental and may differ in individual cases.
Experimental and clinical study has demonstrated that all cardiac
endothelial cells, coronary vascular and endocardial, modulate
the performance of underlying myocardium. Modulation of the left
ventricular function by endothelial cells constitutes an
important autoregulation of muscle-pump performance of the heart
by altering the duration of contraction and diastolic function.
It is likely that cardiac endothelial cells take part in
extrinsic and intrinsic cardiac compensatory mechanisms and,
although there is still no direct evidence, they may be closely
involved in pathophysiology of heart failure in humans. (Fig. 2,
Ref. 66.)
Key words: endothelium; vasomotor tone; myocardial performance.
Bratisl Lek Listy 1995; 96:
Cardiovascular Center Aalst, Belgium a IV. interna klinika LFUK
v Bratislave
Address for correspondence: J. Bartunek, MD,
Bezrucova 5, 815 26 Bratislava, Slovakia.
Phone: 0042.7.365 501 Fax: E-mail:


ANALYSIS OF SOME RISK FACTORS OF PERIOPERATIVE MYOCARDIAL INFARCTION
IN AORTOCORONARY BY-PASS
HRICAK, V., FRIDRICH, V., FISCHER, V., MARGITFALVI, P., SUMBAL,
P., MIZERA, S.
Background: Perioperative myocardial infarction (PMI) belongs
to the main complications of revascularization surgery of the
heart. Perioperative analysis of PIM risk factors can aid the
cardiosurgeons, anestesiologists and cardiologists to stratify
the group exposed to the risk of PIM origin and to prepare the
most appropriate complex peroperative procedure for this group of
patients.
Aim: The particular aim is to evaluate and analyze some PIM risk
factors prior to and during surgery.
Methods: The paper represents a retrospective study which
analyzes two periods (1984--1986 and 1992). The total number of
patients in the investigated group is 277. The group afflicted
with PIM is constituted of 29 patients. The following clinical,
hemodynamic, angiographic risk factors are analyzed prior to
surgery: age, sex, precedence of infarction of myocardium,
arterial hypertension, instabile angina pectoris, end-diastolic
pressure and left ventricular ejection fraction, affliction of
the main trunk of the left coronary artery and some peroperattive
factors (number of grafts, sequence bypass, endarterectomy,
completion of revascularization, a. mammaria interna graft,
duration of the artificial vascular circuit and clamping of the
aorta.)
Results: Significant relation for the pIM origin was found in
arterial hypertension (p<<0.05), affliction of the main trunk
(p<<0.05), prolonged period of clamping of the aorta (p<<0.05 in
1984-86, p<<0.01 in 1992) and artificial vascular circuit
(p<<0.001).
Conclusion: The basic PIM risk factors include the following:
arterial hypertension prior to surgery, affliction of the main
trunk of the left coronary artery, prolonged duration of the
artificial vascular circuit and clamping of the aorta.
Meaning for practice: 1. The analyzed problem represents
a positive feedback for cardiosurgeons, anestesiologists and
cardiologists. 2. The analysis of the risk factors can be
utilized also by future surgical workplaces in the Slovak
Republic. (Tab. 2, Ref. 42.)
Key words: risk factors; aortocoronary by-pass; perioperative
infarction of myocardium.
Bratisl Lek Listy 1995; 96:
Ustav kardiovaskularnych chorob v Bratislave
Address for correspondence: V. Hricak, MD, PhD,
Partizanska 2, 813 26 Bratislava, Slovakia.
Phone: 0042.7.314 000 Fax: 0042.7.314 250 E-mail:


OUR EXPERIENCE WITH EXAMINATION OF ENDOGENOUS DIGOXIN-LIKE
SUBSTANCES IN PATIENTS WITH MYOCARDIAL INFARCTION AND OTHER
CARDIOPATHIES
KOHN, R., LICHARDUS, B., RUSNAK, M., FRIDRICH, V., ZELENAY, J.,
MIZERA, S., SUMBAL, J., MARGITFALVI, P., HRICAK, V., RIECANSKY,
I., SILVANOVA, E.
A group of 65 patients with acute infarction of myocardium (IM)
who were not treated with digitalis preparations were subdued to
examination to the presence of digitalis-like substances in their
urine by means of radioimmuno-analytic method with the use of
anti-digoxin antibodies. The control group was constituted of 69
healthy subjects. Patients afflicted with IM had significantly
increased concentrations of DLS in serum in comparison with
healthy subjects. No significant relations of DLS to the activity
of creatinkinase, IM localisation, occurrence of dysrhythmias,
heart insufficiency and IM mortality were discovered. An increase
in DLS in the blood of patients with acute IM probably coincides
with a decreased cardiac output, with the activation of the
stress axis and retention of sodium and fluids. The second
examined group of patients was constituted of 20 subjects with
other severe cardiopathies (inborn and acquired heart defects,
chronic ischemic heart disease, inflammatory and degenerative
diseases of the heart, and hypertension), who were subdued to
catheter examinations. The authors discovered no significant
differences of DLS concentrations in the blood during
catheterization of individual compartments of inferior vena cava,
exterior vena cava, and the right ventricle. They were not
successful in defining the particular site of DLS secretion on
the basis of this examination. The authors pay attention to
interaction of DLS during the radioimmuno-analytic examination of
the digoxin serum concentration. (Tab. 2, Ref. 49.)
Key words: digoxin-like substances; infarction of myocardium;,
cardiac catheterization.
Bratisl Lek Listy 1995; 96:
I. interna klinika a Oddelenie hematologie a transfuzie krvi
Dererovej NsP v Bratislave, Katedra vnutorneho lekarstva IVZ
v Bratislave, Ustav experimentalnej endokrinologie SAV
v Bratislave, Narodne centrum podpory zdravia v Bratislave
a Ustav kardiovaskularnych chorob v Bratislave
Address for correspondence: R. Kohn, MD, PhD,
Limbova 5, 833 05 Bratislava, Slovakia.
Phone: 0042.7.374 661 Fax: E-mail:


RADIOFREQUENCY CATHETER ABLATION OF ATRIAL TACHYCARDIA
MALACKY, T., FENELON, G., DøAVILA, A., TSAKONAS, K., ANDRIES, E.,
BRUGADA, P.
Bacground and objective: Radiofrequency catheter ablation has
proved to be highly effective for the treatment of
supraventricular tachycardia originating in the AV node or
related to atrioventricular accessory pathways. However,
experience with ablation of atrial tachycardia is more limited.
The purpose of our study was to analyse the success and safety of
radiofrequency ablation of atrial tachycardias.
Study population: Ten symptomatic patients with drug refractory
atrial tachycardia. Symptoms included palpitations, dizziness,
chest pain, shortness of breath, syncope. Five patients had
reduced left ventricular ejection fraction (tachycardiomyopathy).
Methods: Radiofrequency device - Medtronic ATAKRR with
temperature monitoring. Temperature ranges from 50 ÊC to 70 ÊC
were considered optimal to ablation. Ablation catheter - 7
F CardiorhythmR with a 4 mm2 deflectable tip. Heparin was given
intravenously during the procedure (5000 IU bolus + 1000
IU/hour). Acetylsalicylic acid 160 mg/day for 1 month after the
procedure. Antiarrhythmic drugs were discontinued after the
procedure. The sites for ablation were defined during tachycardia
by the earliest endocardial atrial activation as compared to the
onset of the surface P wave. Criteria of success: Abolition of
the tachycardia followed by inability to reinduce the
tachycardia.
Follow-up: Clinical, ECG and 2D ECHO evaluation in the
outpatientøs clinic. No complications occured during the
procedure. No reccurences of the tachycardia were observed during
follow-up. All 5 patients with reduced ejection fraction before
ablation had normal left ventricular function during follow-up.
Conclusion: Radiofrequency catheter ablation is a safe and
effective treatment for drug refractory atrial tachycardia. (Tab.
2, Ref. 10.)
Key words: radiofrequency ablation; supraventricular tachycardia;
AV node; atrioventricular accessory pathways.
Bratisl Lek Listy 1995; 96:
IV. interna klinika LFUK, NsP Stare Mesto v Bratislave
a Cardiovascular center v Aalste, Belgicko
Address for correspondence: T. Malacky, MD,
Bezrucova 5, 815 26 Bratislava, Slovakia.
Phone: 0042.7.365 501

PRESENT AND FUTURE PROBLEMS OF RESISTANCE OF STREPTOCOCCI,
STAPHYLOCOCCI AND M. TUBERCULOSIS
HUPKOVA, M., KRALIKOVA, K., KRCMERY ST., V.
Mechanisms of resistance of strains of Staphylococcus aureus,
Staphylococcus epidermidis, Streptococcus pneumoniae,
Enterococcus faecalis, Enterococcus faecium, Neisseria
meningitidis and Mycobacterium tuberculosis to antibiotics are
presented and discussed. The resistance to methicillin-oxacillin
in S. aureus and S. epidermidis is chromosomal-mediated by
sequence of DNA, by namely gene mecA. This gene codes altered
PBP-2A protein. Strains of S. pneumoniae contain PBP-1A, PBP-2B
and PBP-2X proteins. It causes resistance to many beta-lactam
antibiotics. Resistance to vankomycin, respectively to
teikoplanin in strains of E. faecalis and E. faecium is coded by
transferable vanA and vanB genes. Strains of N. meningitidis
produce mostly the altered PBP-2 protein. The increase of
resistance in strains of M. tuberculosis is also significant.
(Tab. 2, Ref. 40.)
Key words: methicillin-oxacillin resistance in S. aureus and S.
epidermidis; altered PBP in resistant strains of S. pneumoniae;
transferability of vanA and vanB in strains of E. faecalis and E.
faecium; multidrug resistance of M. tuberculosis.
Bratisl Lek Listy 1995; 96:
Ustav preventivnej a klinickej mediciny v Bratislave
Address for correspondence: M. Hupkova, Ing,
Limbova 14, 833 01 Bratislava, Slovakia.
Phone: 0042.7.373 560 Fax: 0042.7.373 906 E-mail:

THERAPY OF ACUTE INFARCTION OF MYOCARDIUM
MURIN, J.
On the basis of the development of therapeutical procedures in
acute infarction of myocardium (AIM) the author offers the
current standpoint to the standard medicamentous therapy of this
disease. As AIM is caused by thrombotic occlusion of the coronary
artery, the main therapeutical position is ascribed to the
thrombolytic therapy. An important positition is ascribed to
acetylsalicylic acid and betablockators. The optimal application
is intravenous administration at an early stage of the disease.
The ISIS-4 study displayed a beneficial impact on mortality
including ACE inhibitors The symptomatic therapy includes
analgetics administered at an early stage of the disease,
nitrates and magnesium. Antiarrhythmics are not to be applied in
a routine pattern. Cardiogenic shock can be treated exclusively
by invasive therapeutical intervention (e.g. direct PTCA or
emergent by-pass). (Ref. 35.)
Key words: acute infarction of myocardium; acute infarction
therapy; thrombolytic therapy.
Bratisl Lek Listy 1995; 96:
I. interna klinika Lekarskej fakulty Univerzity Komenskeho a
Fakultnej nemocnice v Bratislave
Address for correspondence: J. Murin, MD, PhD,
Mickiewiczova 13, 813 69 Bratislava, Slovakia.
Phone: 0042.7.321 388

ARE THE CLINICAL FEATURES OF NON SPECIFIC INFLAMMATORY BOWEL
DISEASE USEFUL IN DIAGNOSE?
PRIKAZSKA, M., PECHAN, J.
Due to controversial evaluation of the contribution of clinical
signs for the diagnosing of non-specific inflammatory bowel
disease, as well as due to the lack of similar data, we tried to
find our own answer to the question as to whether the clinical
signs of ulcerative colitis (UC) and Crohn's disese (MC) are
helpful, unhelpful, or even confusing for the diagnosis.
A group of patients with MC and UC was analyzed from this aspect.
Individuals in their twenties and thirties prevailed in the
sample, mostly intelectual workers, the number of males and
females was equal.
Our attempt to analyze all the available diagnostic methods
originated in an observation that a long period of health
problems preceeds the diagnosis of MC, namely 1.5 y in males and
as long as 4 y in females. Other striking information was that
surgery represented the initial treatment in 66 % of cases and
the correct diagnosis was made peroperatively only in 56 % of
cases.
We compared our results with those of the OMGE study, one of the
largest projects which evaluated positively the contribution of
clinical signs to the diagnosing of MC an UC. We found that the
main signs of CU have not changed in the last century, and some
additional signs occur rather due to complications than due to
the disease per se. Frequency of pain increased by 25 % in our
patients, and approximately 1/3 of it represented intermittent
pain caused by tenesms. Pain in MC must be properly analyzed in
order to discriminate accute appendicitis. Other indicators did
not differ from the OMGE study. In accordance with its results,
we confirmed the importance of correct evaluation of clinical
signs for the diagnosis and differential diagnosis of UC and MC.
The number of diagnostic methods still increases. Their validity
must be continuously re-evaluated, however the clinical
examination in this dynamic process stays to be of crucial value.
(Tab. 8, Ref. 9.)
Key words: Crohn's disease; ulcerative colitis; clinical picture;
diagnosis.
Bratisl Lek Listy 1995; 96:
Vyskumny ustav vyzivy v Bratislave a II. chirurgicka klinika
Lekarskej fakulty Univerzity Komenskeho v Bratislave
Address for correspondence: M. Prikazska, MD, PhD, Limbova
l4, 833 37 Bratislava, Slovakia.
Phone: 0042.7.373 968 Fax: 0042.7.373 968

ONCE-PERTAINED THERAPY OF THE LOWER URINARY DUCT
KRCMERY, S., HROMEC, J.
The authors analyze two clinical studies in the frame of
once-pertained treatment of uncomplicated infection of the lower
urinary duct. The first study deals with comparison of the effect
of netilmycin, ciprofloxacine and aztreonam. The second study
deals with pefloxacine and cefuroxim-axetil. As the results
implied, both long-term and short-term effectiveness of therapy
comparable with other verified regimes was accomplished in female
patients who were not pregnant and irrespective of their age. It
is necessary to respect the contraindications of therapy.
Chemotherapeutics which are appropriate for once-pertained
therapy of uncomplicated infections of the lower urinary duct
include quinolones (pefloxacine, ciprofloxacine),
phosphomycin-trometamol, co-trimaxozole a netilmycin. The
majority of oral beta-lactam antibiotics cannot be recommended
for a once- pertained therapy of uroinfections. The authors
summarize the advantages of a once-pertained therapy of
uroinfections and analyze the criteria of significant
bacteriuria. (Tab. 2, Ref. 19.)
Key words: uroinfection; antibiotics; once-pertained therapy;
significant bacteriuria.
Bratisl Lek Listy 1995; 96:
IV. interna klinika NsP Stare Mesto v Bratislave
Address for correspondence: S. Krcmery, MD, PhD,
Bezrucova 5, 815 26 Bratislava, Slovakia.
Phone: 0042.7.365 501
Phone: 0042.7.365 501