Electronic Library of Scientific Literature



Rheumatologia



Volume X / 1996, Number 2



VPLYV BIOMINU-H NA BIOCHEMICKE UKAZOVATELE KOSTNEHO METABOLIZMU U POSTMENOPAUZALNYCH ZIEN S OSTEOPOROZOU

INFLUENCE OF BIOMIN H ON BIOCHEMICAL MARKERS OF BONE METABOLISM IN POSTMENOPAUSAL WOMEN WITH OSTEOPOROSIS

M. STANCIKOVA, P. MASARYK, A. LETKOVSKA, J. ROVENSKY, J. WENDLOVA, E. ORVISKY

Vyskumny ustav reumatickych chorob, Piestany
Riaditel: prof. MUDr. J. Rovensky, DrSc.

Suhrn
Pozadie problemu: Biomin-H je povodnym liekom na liecbu osteoporozy vyvinutym na Slovensku. Je vyrobeny z vajecnych skrupin zdravotne nezavadnych konzumnych vajec. Jeden gram Biominu-H v prasku obsahuje priblizne 370 mg vapnika, male mnozstvo fosforu a stopove prvky zinok, stroncium, horcik, med, selen a ine. V sucasnosti prebiehaju klinicke studie tohto preparatu u zien s postmenopauzalnou osteoporozou, ktorych sucastou je aj predlozena praca.
Ciel: V praci sme sledovali vplyv polrocnej terapie Biominom-H na serovu hladinu vapnika a fosforu, kalciuriu a na vybrane biochemicke markery kostneho metabolizmu (osteokalcin, pyridinolin, deoxypyridinolin) u postmenopauzalnych zien s osteoporozou (21 osob). Liecena skupina dostavala denne 1 vrecko Biominu-H, priblizne 1,1 g vapnika. Hodnoty biochemickych ukazovatelov u postmenopauzalnych zien s osteoporozou sme porovnavali s hodnotami vybranej skupiny preme-nopauzalnych zien (15 osob).
Vysledky: Hodnoty kalcia v sere a v moci u premenopauzalnych a postmenopauzalnych zien sa vyrazne nelisili. Po polrocnej terapii Biominom-H sa hodnoty kalcia v sere zmenili len malo, koncentracia fosforu sa znizila. Kalciuria v 24 h moci sa signifikantne zvysila, hornu hranicu normy vsak prevysila len u troch zien. Koncentracie osteokalcinu v sere, pyridinolinu a deoxypyridinolinu v moci u pacientok s osteoporozou boli vyznamne vyssie v porovnani s premenopauzalnymi zenami. Po polrocnej liecbe Biominom-H osteokalcin signifikantne klesol. Koncentracia pyridinolinu v prepocte na kreatinin sa signifikantne znizila priblizne na polovicu pociatocnej hodnoty. Vyznamny pokles sme zaznamenali aj v koncentracii deoxypyridinolinu.
Zavery: Mozeme konstatovat, ze nase laboratorne vysledky svedcia o signifikantnom inhibicnom ucinku Biominu-H na kostnu resorpciu u postmenopauzalnych zien. Jeho ucinok na kalciuriu je porovnatelny s inymi vapnikovymi preparatmi pouzivanymi v liecbe osteoporozy.
Klucove slova: Biomin-H, postmenopauzalne zeny, osteokalcin, pyridinolin, deoxypyridinolin.

Summary
Background of the problem: Biomin H is an original drug for therapy of osteoporosis developed in Slovakia. It is produced from egg shells of healthy consumer eggs. One gram of Biomin H in powder contains approximalety 370 mg of calcium, a small amount of phosphorus and trace elements zinc, strontium, magnesium, copper, selenium and other. At present clinical trials of this drug in women with postmenopausal osteoporosis are in progress, of which a part is also the presented study.
Aim: In the study the influence of half a year therapy with Biomin H was studied on serum calcium and phosphorus levels, calciuria, and on selected biochemic markers of bone metabolism (osteocalcin, pyridinoline, deoxypyridinoline) in postmenopausal women with osteoporosis (21 persons). The treated group received daily 1 sachet of Biomin H, i.e. 1.1 g of calcium. The values of biochemic markers in postmenopausal women with osteoporosis were compared with the values of a group of selected premenopausal women (15 persons).
Results: The serum and urine calcium values in premenopausal and postmenopausal women did not markedly differ. After half a year of Biomin H therapy the serum calcium values changed only a little, phosphorus concentration decreased. Calciuria in 24-h urine significantly increased, the upper limit of the norm was surpassed, however, only in three women. Serum osteocalcin concentrations, urine pyridinoline and deoxypyridinoline in patients with osteoporosis were significantly higher in comparison with premenopausal women. After half a year of Biomin H therapy osteocalcin significantly decreased. Pyridinoline concentration converted to creatinine significantly decreased, approximately to a half of the original value. A significant decrease was recorded also in the deoxypyridinoline concentration.
Conclusions: It can be concluded that our laboratory results demonstrate a significant inhibitory effect of Biomin H on bone resorption in postmenopausal women. Its effect on calciuria is comparable with other calcium drugs used in the treatment of osteoporosis.
Key words: Biomin H, postmenopausal women, osteocalcin, pyridinoline, deoxypyridinoline.

pp. 61 – 65


PREPARAT DICLOREUM (DICLOFENAC SODIUM) PRI LIECBE ANKYLOZUJUCEJ SPONDYLITIDY

THE DRUG DICLOREUM (DICLOFENAC SODIUM) IN THE TREATMENT OF ANKYLOSING SPONDYLITIS

D. ZLNAY, D. MICEKOVA, J. ROVENSKY, P. MASARYK

Vyskumny ustav reumatickych chorob, Piestany
Riaditel: prof. MUDr. J. Rovensky, DrSc.

Suhrn
Pozadie problemu: V poslednom case sa na nasom trhu rozsirila paleta diklofenakovych pripravkov o novy preparat Dicloreum (diclofenac sodium) talianskej firmy Alfa Schiapparelli Wassermann. Ide o nesteroidne antireumatikum s vyraznymi analgetickymi, antiflogistickymi a antipyretickymi vlastnostami.
Ciel a vychodiska: Autori v otvorenej studii vyhodnotili ucinnost a toleranciu preparatu Dicloreum ako monoterapiu u chorych s ankylozujucou spondylitidou.
Metody: U 30 chorych (26 muzov a 4 zeny) s istou diagnozou ankylozujucej spondylitidy, prevazne so strednou a vyssou aktivitou ochorenia, sa podaval Dicloreum inj. 6 dni 1 amp. 75 mg s naslednou mesacnou peroralnou liecbou 50 mg enterosolventnymi tabletami v dennej davke 150 mg. Vyhodnocoval sa vplyv preparatu na bolest, pocit zdravia, trvanie rannej stuhnutosti, ulava od bolesti hodnotena pacientom, sledoval sa vplyv na pohyblivost chrbtice. Verbalne sa hodnotila tolerancia a ucinnost osobitne lekarom a pacientom. Sucasne sa sledovali neziaduce ucinky preparatu klinicky a laboratorne.
Hlavne vysledky: Autori zistili, ze preparat Dicloreum dobre ovplyvnuje pokojovu a pohybovu bolest ako v injekcnej, tak aj v tabletovej forme. Pri korelacii s aktivitou ochorenia vyznamnejsie posobi pri strednej a nizsej aktivite. Dobra a kompletna ulava od bolesti sa zistila u viac ako 70 % chorych. Statisticky vyznamne doslo k zlepseniu hybnosti chrbtice do dlhsom podavani preparatu vo forme tabliet. U 90 % chorych bola vyborna a velmi dobra tolerancia, pricom podobne velmi dobre a dobre hodnotil ucinnost pacient a lekar. Len u jedneho choreho bola liecba prerusena pre alergicku koznu reakciu, u ostatnych chorych sa nevyskytli zavaznejsie klinicke a laboratorne komplikacie liecby.
Zavery: Preparat Dicloreum je pomerne bezpecne antireumatikum s dobrou ucinnostou a toleranciou, ktore rozsiruje paletu medikamentoznej liecby ankylozujucej spondylitidy.
Klucove slova: ankylozujuca spondylitida, liecba nesteroidnymi antireumatikami, Diclofenac, tolerancia, ucinnost.

Summary
Background of the problem: In the recent time the offer of diclofenac drugs on our market has been enriched by a new drug Dicloreum (diclofenac sodium) of the Italian firm Alfa Schiapparelli Wassermann. It is a non-steroidal antirheumatic drug with marked analgesic, antiphlogistic and antipyretic properties.
The aim and the starting points: The authors in an open trial evaluated the efficacy and tolerance of Dicloreum as a monotherapy in patients with ankylosing spondylitis.
Methods: In 30 patients (26 men and 4 women) with certain diagnosis of ankylosing spondylitis, predominantly with middle and high activity of the disease, Dicloreum inj. were administered 6 days in the dosage 1 amp. of 75 mg, with a subsequent one month peroral treatment with 50 mg enterosolvent tablets in the daily dosage of 150 mg. We have evaluated the influence of the drug on pain, feeling of well-bein, duration of morning stiffness, relief from pain evaluated by patients, and the influence on spine mobility. Verbally, the tolerance and efficacy was evaluated by physician and the patient separately. At the same time the undesirable effects of the drug were studied clinically and by laboratory examinations.
Main results: The authors found out that Dicloreum influences favourably the pain at rest and in motion in both injection and tablets form. In correlation with activity of the disease, it has a more significant effect in the middle and low activity. A good and complete relief from pain was found in more than 70 % of patients. There was a statistically significant improvement of spine mobility after a longer administration of the drug in tablets. In 90 % of patients, there was a good and/or very good tolerance and good and very good evaluation of its efficacy by both the physician and the patient. In a single case the treatment was discontinued due to an alergic reaction, in the remaining patients there were no more severe clinical or laboratory complications of the treatment.
Conclusions: Dicloreum is a relatively safe antirheumatic drug with a good efficacy and tolerance, widening the scale of drug therapy of ankylosing spondylitis.
Key words: ankylosing spondylitis, therapy with non-steroidal antirheumatic drugs, Diclofenac, tolerance, efficacy.

pp. 67 –73


CHRONOBIOLOGIA DNAVEHO ZACHVATU II.
MESACNE A SOLARNE ROTACNE CYKLY

CHRONOBIOLOGY OF ACUTE GOUT ARTHRITIS II.
MOON AND SOLAR ROTATION CYCLES

M. MIKULECKY, A. VALACHOVA, J. ROVENSKY, K. BOSMANSKY, F. MALIS

Ustav preventivnej a klinickej mediciny, Bratislava
Riaditel: prof. MUDr. T. Trnovec, DrSc.
I. interna klinika LFUK a FN, Bratislava
Prednosta: prof. MUDr. I. Duris, DrSc.
Vyskumny ustav reumatickych chorob, Piestany
Riaditel: prof. MUDr. J. Rovensky, DrSc.

Suhrn
Casove udaje o 126 zachvatoch dny registrovanych v priebehu viac ako 22 rokov vo Vyskumnom ustave reumatickych chorob v Piestanoch sa posudili z hladiska ich pripadnej zavislosti od faz solarne rotacneho, tropickeho lunarneho, anomalistickeho lunarneho a synodickeho lunarneho cyklu. Na testovanie prislusnych hypotez sa pouzila periodogramova a kosinorova analyza s hladinou vyznamnosti alpha=0,05. Statisticky vyznamna periodicita s dlzkou celeho cyklu sa nasla pre vsetky styri cykly, s polovicnou dlzkou cyklu pri anomalistickom, s tretinovou pri vsetkych lunarnych, so stvrtinovou a patinovou pri vsetkych okrem anomalistickeho a so sestinovou pri solarnom a synodickom cykle. Najtesnejsia zavislost (s 97 % celkoveho rozptylu vysvetleneho pouzitou regresiou) sa ukazala pri synodickom, najmenej tesna (78 %) pri solarne rotacnom cykle. Najnapadnejsie je nakopenie pripadov (s rozdielmi az o viac ako o 100 %) okolo splnu a novu v synodickom a okolo perigea v anomalistickom mesacnom cykle. Podla toho by mechanizmus vplyvu mesacnych faz, aspon v pripade dny, mohol spocivat v zmenach lunisolarnej gravitacie. Vo vsetkych plexogramoch okrem anomalistickeho mesacneho je zrejmy priblizne tyzdnovy rytmus. To potvrdzuje predstavu o kozmickom prapovode cirkaseptanov — rytmov s priblizne tyzdnovou periodou, a teda aj socialneho tyzdna kodifikovaneho v mnohych kulturach ludskej spolocnosti. Zmeny v priebehu synodickeho cyklu a scasti aj inych mesacnych cyklov sa porovnavaju s podobnymi zmenami pozorovanymi pri urgentnych stavoch v kardiologii, infektologii, psychiatrii, neurologii, gastroenterologii. Vysledky bude pravdepodobne mozne zuzitkovat nielen pri patogenetickych uvahach, ale aj pri prevencii.
Klucove slova: zachvaty dny, chronobiologia, solarne rotacny cyklus, tropicky lunarny cyklus, anomalisticky lunarny cyklus, synodicky lunarny cyklus, analyza casovych radov.

Summary
The data defined in time concerning 126 attacks of gout, registered during more than 22 years in The Research Institute of Rheumatic Diseases in Piestany were analyzed from the point of view of their possible dependence upon the phases of the solar rotation, tropical lunar, anomalistic lunar and synodic lunar cycles. To test the corresponding hypothe-ses, the periodogram and cosinor analysis has been applied with the significance level of alpha=0.05. A statistically significant periodicity with the length of the whole cycle was found for all four cycles, with half length in the anomalistic, with one third length in all lunar, with one fourth and one fifth in all excluding the anomalistic, and with one sixth in the solar and synodic cycles. The most pronounced dependence (with 97 % of the total variance explained by the regression applied) appeared for the synodic, a least pronounced (78 %) for the solar rotation cycle. The most conspicuous phenomenon is an accumulation of cases (with differences by more than by 100 %) around the full and new moon within the synodic, and around the perigee in the anomalistic lunar cycle. Accordingly, the mechanism of the influence of moon phases could be explained, at least for the case of gout, by changes in the lunisolar gravitation. In all plexograms, excluding the anomalistic lunar one, an approximately weekly rhythm is apparent. This confirms the idea about a cosmic ancient origin of circaseptans — rhythms with roughly weekly period, and therefore also about that of social week, codified in many cultures of human society. The changes during synodic, and partly other lunar cycles are compared with similar ones, observed earlier for urgent situations in cardiology, infectology, psychiatry, neurology, gastroenterology and other fields. The results can probably be used for pathogenetic considerations, for organization of work and for prevention.
Key words: gout attacks, chronobiology, solar rotation cycle, tropic lunar cycle, anomalistic lunar cycle, synodic lunar cycle, time series analysis.

pp. 75 – 82


REUMATOIDNA ARTRITIDA A PROJEKT EUROPSKY VYSKUM INVALIDIZUJUCICH CHOROB A SOCIALNA PODPORA

RHEUMATOID ARTHRITIS AND EUROPEAN RESEARCH ON INCAPACITATING DISEASES AND SOCIAL SUPPORT

A. SZILASIOVA, M. KOVAROVA, Z. MACEJOVA, D. ZAHORSKA, D. TREJBAL, A. BERESOVA, K. KOHLER, K. GOMBOSOVA, A. SCHLOSEROVA

II. interna klinika FNsP, Kosice
Prednosta: doc. MUDr. D. Trejbal, CSc.
Ustav socialnej mediciny LF UPJS, Kosice
Prednosta: MUDr. M. Kovarova, CSc.

Suhrn
Pozadie problemu: Projekt Europsky vyskum invalidizujucich chorob a socialna podpora — EURIDISS, ktory vznikol roku 1990, je zame-rany na dlhodobe sledovanie chorych s reumatoidnou artritidou. Lekarska fakulta UPJS v Kosiciach bola zaradena od 1.10.1994 do tohto projektu, ktory potrva 4 roky.
Ciel: Zhodnotit prvu cast suboru chorych z hladiska osobnych a demografickych udajov, zistit ich socialno-ekonomicke postavenie a zdravotno-funkcny stav.
Material a metody: Autori vysetrili 62 chorych s priemernym vekom 47 rokov trvanim choroby od 4 do 48 mesiacov od 1.10.1994 do 31.12.1994. Pouzili niektore metody z projetku EURIDISS ako Groningensku skalu na hodnotenie obmedzenia aktivity, hodnotenie zdravia indexom neschopnosti, Karnofskeho skalu na hodnotenie vykonnostneho stavu choreho, hodnotenie vlastnej osoby, vlastnu definiciu reumatickej choroby a dotaznik na zistenie stavu socialnej podpory pri dennych cinnostiach.
Vysledky: Autori zistili, ze 54,8 % chorych je stale ekonomicky aktivnych, pricom iba 34 % chorych z celeho suboru ma plnu schopnost pre beznu dennu aktivitu s malymi alebo so ziadnymi znamkami ochorenia. Stav funkcnej schopnosti chorych vyznamne koreluje s aktivitou ochorenia. Prevazna cast pacientov si doveruje a ma pozitivny vztah k svojej osobe. 92 % chorych povazuje reumatizmus za zavazne ochorenie. Napriek znacnemu prisposobeniu sa tejto chorobe 82 % chorych vyzaduje pomoc blizkeho okolia a spolocnosti.
Zaver: Socialna podpora a pomoc u vacsiny pacientov je nedostatocna v oblasti citovej, ako aj v oblasti technickej pomoci.
Klucove slova: reumatoidna artritida, Europsky vyskum invalidizujucich chorob a socialna podpora (EURIDISS projekt).

Summary
Objectives: The objective of the follow-up European Research on Incapacitating Diseases and Social Support project is to study patients suffering from rheumatoid arthritis. Faculty of Medicine and the University Hospital of P.J. Safarik University in Kosice joined this international project since the 1st of October 1994.
Aim: The aim of this paper is to introduce the preliminary results evaluated in a pilot sample of patients with regard to demographic and personal data, social and economic background and medical-functional status.
Material and methods: In the time span since 1 October 1994 to 31 December 1994 the authors followed a sample of 62 patients with the mean age of 47 years. The duration of the rheumatoid arthritis ranged since 4 to 48 months. The following selected measures of the project were administered and assessed: The Groningen Activity Restriction Scale, Health Assessment Questionnaire, Self Esteem, Subjective Definition of the Rheumatoid Condition, The Karnofsky Perfomance Status Scale, Social Support Questionnaire for Transactions for assessment of received and needed amount of interactions to support patients in their daily activities.
Results: The authors found 54.8 % patients still being economically active. 34 % patients have preserved full capacity for common daily activities showing moderate sings or no signs of the disease. The patient s functional status strongly correlates with the disease activity level. The majority of the patients reports selfconfidency and development of positive attitude toward his/her own person. Rheumatism is considered to be a serious disease in 92 % of the study samples. Though our patients showed a great extent of the adaptation to the restrictions caused by the disease, at least 82 % of them require a social help and support of their close relatives or wider society.
Conclusions: Patients showed dissatisfaction with social support and network, especially in terms of lack in emotional and technical type of support.
Key words: rheumatoid arthrithis, European research on incapacitating disease and social support (EURIDISS project).

pp. 83 – 87


LUMBALNA TRAKCIA V KOMPLEXNEJ LIECBE ANKYLOZUJUCEJ SPONDYLITIDY

LUMBAR TRACTION IN COMPREHENSIVE TREATMENT OF ANKYLOSING SPONDYLITIS

V. DRLICKOVA, D. ZLNAY, P. MASARYK, P. SCHULTZ

Vyskumny ustav reumatickych chorob, Piestany
Riaditel: prof. MUDr. J. Rovensky, DrSc.

Suhrn
Trakcia chrbtice sa doteraz odporucala najcastejsie pri lumboischialgickom syndrome. Pri jej posobeni sa dosiahla relaxacia paravertebralneho svalstva, zvacsenie medzistavcoveho priestoru a distrakcia intervertebralnych klbov. Takyto ucinok sme chceli vyuzit aj u chorych s ankylozujucou spondylitidou.
Nasou ulohou bolo sledovanie vplyvu lumbalnej trakcie na pohyblivost a bolestivost chrbtice v oblasti L[_5]—S[_1]. Do suboru sme zaradili chorych bez osifikacii v sledovanej oblasti.
U 70 hospitalizovanych pacientov (48 muzov a 22 zien) sme hodnotili ucinok intermitentnej lumbalnej trakcie, pricom sme porovnavali vysledky u 28 chorych s intermitentnou lumbalnou trakciou a 42 chorych bez trakcie ako kontrolnej skupiny. Sucasne vsetci pacienti dostavali standardnu balneorehabilitacnu liecbu. Lumbalna trakcia sa podavala v leziacej polohe, 10 dni pomocou elektronickej trakcnej aparatury firmy Enraf Nonius. Intermitentny tah bol standardny, trakcna sila 2/3 hmotnosti tela pacienta posobila periodicky 10 sekund s naslednym poklesom tahu o 50—100 N pocas 6 sekund a s celkovym trvanim 10 minut. Objektivizacia rozsahu pohybu v LS chrbtici sa vykonavala pomocou pocitacovej dynamometrie Isostation B-200.
Pri hodnoteni pohyblivosti LS chrbtice sa zistilo statisticky vyznamne zlepsenie v rotaciach, v ostatnych rovinach bolo zlepsenie len percentualne. Pri hodnoteni trakcie vo vztahu k aktivite z hladiska bezpecnosti je vyhodnejsia indikacia u chorych s nizkou, pripadne strednou aktivitou ochorenia, pri vysokej aktivite je potrebne individualne zvazenie. Z hladiska bolestivosti nedoslo k statisticky vyznamnemu zmierneniu oproti kontrolnej skupine, ani v jednom pripade sa vsak nemusela trakcia prerusit.
Intermitentnu lumbalnu trakciu v individualnych pripadoch mozno povazovat za vhodnu doplnkovu metodu ku komplexnej rehabilitacnej liecbe pre chorych s ankylozujucou spondylitidou.
Klucove slova: intermitentna lumbalna trakcia, ankylozujuca spondylitida, rozsah pohyblivosti LS chrbtice, rehabilitacia.

Summary
Traction of the spine has been so far most often recommended in lumboischialgic syndrome. During its action relaxation of paravertebral muscles is achieved, as well as an increase of intervertebral space and distraction of intervertebral joints. The presented study describes its use in patients with ankylosing spondylitis.
Our aim was to study the influence of the lumbar traction on mobility and painfulness of the spine in the region of L[_5]—S[_1]. The group were included the patients without ossifications in the studied region.
In 70 inpatients (48 men and 22 women) the effect of intermittent lumbar traction was evaluated, comparing the results in 28 patients with intermittent lumbar traction and 42 patients without traction as a control group. At the same time, all the patients received standard balneorehabilitation. Lumbar traction was administered in lying position for 10 days by means of electronic traction equipment of the firm Enraf Nonius. The intermittent traction was standard, traction strenght of 2/3 patient’s body weight was acting periodically 10 seconds with a subsequent decrease of the traction of 50—100 N for 6 seconds and the total duration 10 minutes. The objectification of the range of motion in the LS spine was performed by means of computer dynamometrics Isostation B-200.
The evaluation of the LS spine mobility revealed a statistically signi-ficant improvement in rotations, in the other planes the improvement was only percentual. Evaluating the traction from the point of view of its safety in relation to the disease activity, a more advantageous is the indication in patients with low and/or middle activity of the disease, in the high activity an individual consideration is necessary. In painfulness, no statistically significant improvement was achieved in comparison with the control group, but there was not a single case when the traction had to be interrupted.
Intermittent lumbar traction can be considered in individual cases as a suitable complementary method in comprehensive rehabilitation treatment of patients with ankylosing spondylitis.
Key words: intermittent lumbar traction, ankylosing spondylitis, range of motion of the LS spine, rehabilitation.

pp. 89 – 93


NEUROHUMORALNI REGULACE ZANETLIVEHO PROCESU

NEUROHUMORAL REGULATION OF INFLAMMATORY PROCESS

K. TRNAVSKY

Arthrocentrum, Praha
Reditel: prof. MUDr. K. Trnavsky, DrSc.

Souhrn
V prehlednem referatu jsou uvedeny nektere novejsi poznatky o ucasti periferniho neuronu a neuropeptidu na rozvoji zanetliveho procesu. Jsou uvedeny moznosti regulace zanetu interakci mezi strukturami centralniho nervoveho systemu, osou hypofyza—nadledvinka a imunitnimi procesy. Je diskutovana revmatodini artritida jako onemocneni s poruchou osy hypotalamus—hypofyza—nadledvinka.
Klicova slova: periferni neuron, centralni nervovy system, osa hypotalamus, hypofyza, nadledvinka.

Summary
In the review some recent findings are presented about the role of peripheral neuron and neuropeptides in the development of the inflammatory process. Possibilities of the inflammation regulation by interaction between the structures of central nervous system, the hypophysis—adrenal gland axis and immune processes are presented. Rheumatoid arthritis as a disease with the disorder of the hypothalamus—hypophysis—adrenal gland axis is discussed.
Key words: inflammation, peripheral neuron, central nervous system, hypothalamus, hypophysis, adrenal gland axis.

pp. 95 – 97


USPESNE TEHOTENSTVI U SYSTEMOVE SKLEROZY S BIOPTICKY PROKAZANOU SKLERODERMICKOU NEFROPATII

SUCCESSFUL GRAVIDITY WITH DIFFUSE SYSTEMIC SCLEROSIS AND SCLERODERMA NEFROPATHY PROVEN WITH BIOPSY

Z. DVORAK, L. KUBES, E. PINTEROVA, Z. HRNCIR

II. interni klinika FN, Hradec Kralove
Prednosta: prof. MUDr. V. Pidrman, DrSc.
Ustav patologicke anatomie FN, Hradec Kralove
Prednosta: doc. MUDr. I. Steiner, DrSc.

Souhrn
Popsano 10 let trvajici pozorovani nemocne se systemovou sklerozou (SS) a biopticky overenou sklerodermickou nefropatii. Nemocna si prala otehotnet, prestoze jiz mela jedno zdrave dite narozene pred manifestaci SS a byla poucena o riziku dalsi gravidity. Tymova spoluprace revmatologa, nefrologa a porodnika zabezpecila fyziologicke druhe tehotenstvi zakoncene porodem zdraveho chlapce, a to bez nasledku pro nemocnou. Popsany priklad doklada, ze planovana, soustavna a individualne specifikovana lekarska pece v nekterych pripadech umoznuje uspesne tehotenstvi bez nasledku pro matku a dite u zen se SS a sklerodermickou nefropatii.
Klicova slova: systemova skleroza, sklerodermicka nefropatie, tehotenstvi.

Summary
This case report describes ten years long observation of a women-patient with systemic sclerosis (SS) and scleroderma nefropathy proven with biopsy. This women wanted to be pregnant although she already had one healthy child who was born before the manifestation of SS and she was told about possible risks of another gravidity. Team cooperation of rheumatologist, nefrologist and obstetrician secured physiologic second pregnancy that was finished by delivery of a healthy boy without side effects for the patient and her child. Shown case suggested, that planned, systematic and individually designed medical care provides in some cases successful gravidity harmless for the mother and the child also in women with SS and scleroderma nefropathy.
Key words: systemic sclerosis, scleroderma nefropathy, pregnancy.

pp. 99 – 102


ARTROPATIA PRI HEMOCHROMATOZE — MOZNOSTI SKRININGU V REUMATOLOGICKEJ PRAXI

ARTHROPATHY WITH HEMOCHROMATOSIS — SCREENING IN A RHEUMATOLOGICAL CLINIC

P. HNILICA Jr., M.R. PIJAK, J. SIDLO, S. MAHROVA

2. interna klinika LFUK, Bratislava
Prednosta: prof. MUDr. I. Balazovjech, DrSc.
Ustav patologickej anatomie LFUK, Bratislava
Prednosta: prof. MUDr. M. Zaviacic, DrSc.
Farmakologicky ustav LFUK, Bratislava
Prednosta: prof. MUDr. M. Kriska, DrSc.

Suhrn
Na priklade kazuistiky autori poukazuju na reumatologicke prejavy genetickej (idiopatickej, primarnej) hemochromatozy (GH) a na skriningove diagnosticke postupy, ktore umoznuju vcasnu diagnostiku GH uz v klinicky asymptomatickom stadiu.
Klucove slova: hemochromatoza, artropatia, feritin, skrining.

Summary
In the case report of a patient with genetic (idiopathic, primary) hemochromatosis (GH) the authors concentrate on rheumatological signs of GH. The authors point out on the screening diagnostic methods for early establishment of the diagnosis already in the asymptomatic stage of disease.
Key words: hemochromatosis, arthropathy, ferritin, screening.

pp. 103 – 105