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Development of amino acid solutions for i.v. use proceeds worldwide, the main stimulus being the expanding physiological and pathophysiological findings of specific effects of some amino acids and their metabolism and the need to improve intensive metabolic care. New Czech preparations in this respect are the series of NEONUTRINS 5%, 10% and 15% (Infusia Ltd. Horátev). They are modern preparations which meet the pretentious criteria of contemporary amino acid solutions (balanced ratio of all essential, semiessential and assisting amino acids, a high content of essential and branched-chain amino acids, amino acids with specific pharmacodynamic effects). In a multicentre open clinical study the authors assessed the tolerance, safety and efficacy of NEONUTRIN 15% in 82 patients requiring total parenteral nutrition on account of catabolic states of different etiology. The preparation was administered repeatedly in an all-in-one mixture (together with glucose and lipid emulsions) by means of a central venous catheter. A total of 801 doses was administered. The trial provided evidence of very good tolerance and safety of the preparation with a practically zero incidence of undesirable effects. The follow-up of basic indicators of nitrogen metabolism confirmed also the efficacy of NEONUTRIN 15% in comprehensive treatment of patients (stabilization of nitrogen balance in the acute stage of a disease, normalization of the plasmatic aminogram).

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BACKGROUND: The use of hypertonic-hyperoncotic solutions (HHS) is a modern method of volume restoration in hypovolaemias of different etiology. The objective of the present work was to evaluate the effectiveness and safety of the hypertonic-hyperoncotic plasma expander Tensitone (7.5% NaCl in 6% dextran 70, Infusia a.s., CR) in patients with a massive acute blood loss. METHODS AND RESULTS: In a multicentre clinical study the authors investigated the effect of a rapid infusion of a small volume of tensitone (4 ml/kg) on the restoration of basic haemodynamic parameters, diuresis and the general condition of 81 patients with massive traumatic or peroperative haemorrhage. As compared with the effect of standard volume expanders (N = 34), Tensitone had a markedly more rapid and more pronounced effect on the normalization of the blood pressure (p < 0.01), heart rate (p < 0.05), central venous pressure and diuresis (p < 0.01). The haemodynamic effects of Tensitone are almost immediate (rise of blood pressure within 10 minutes) while they are at the same time sufficiently protracted (for at least 2 hours). The tolerance and safety of treatment were very good, more serious undesirable effects (thrombophlebitis) were recorded only in 3.6% of the patients. CONCLUSIONS: Tensitone is an effective and safe preparation for rapid small volume resuscitation. Its use is consistent with modern trends in intensive care and acute medicine.

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BACKGROUND: Postsynaptic alpha 1 adrenoceptor blockers are considered suitable drugs for modern vasodilatatory treatment of chronic heart failure. Therefore new analogues of these substances with more favourable characteristics than those of their main representative, prazosin are sought. The objective of the present work was to evaluate the therapeutic effect and tolerance of the original alpha 1-adrenoceptor blocker metazosin developed in the Research Institute for Pharmacy and Biochemistry (VUFB). METHODS AND RESULTS: In a multicentre clinical trial metazosin (tablets à 10 mg), 10-20 mg/day, were added to standard treatment of 56 patients of both sexes suffering from chronic congestive heart failure, for a period of eight weeks. The administration of metazosin led to rapid improvement of subjective complaints (in particular dyspnoea) as well as objective symptoms of peripheral congestion, to a significant (p < 0.05) regression of X-ray signs of pulmonary congestion and a slight (but statistically significant--p < 0.05) increase of the ejection fraction and cardiac output. After two months treatment the functional degree of severity of insufficiency according to the NYHA classification decreased from 2.7 to 2.2. Metazosin did not induce tachycardia and was well tolerated by the patients. CONCLUSIONS: Metazosin (Kenosin) tablets is a suitable supporting drug in the comprehensive treatment of chronic cardiac failure, in particular if refractory to treatment.

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The authors evaluated after 4-year interval the results of coronarographic and spiroergometric examination after a work load on a bicycle ergometer up to the limiting work syndrome in 51 all patients with the aim to reveal "risk factors" of sudden death in CHD patients. The following parameters were recorded: age, duration of treatment number of cigarettes smoked, systolic blood pressure at rest and the daily dose of the most frequently used drugs. After the work load the limiting values of pulse rate, systolic blood pressure, oxygen consumption, blood lactate level and the work ECG were evaluated. In the group of 7 sudden deaths of CHD patients the authors found statistically significant (p less than 0.001) a lower mean limiting value of oxygen consumption/kg and a deeper (p less than 0.0001) mean depression of the S-T segment in the work ECG when compared with 35 CHD patients surviving for 4 years. Both indicators are considered the main "risk factors" for sudden death.

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A number of important differences can be found between the left ventricle (LV) and right ventricle (RV) of the heart under physiological conditions. In anatomy, the most important is probably the architecture of the atrioventricular valve and its annulus. The LV has a mitral valve (with two cusps) and a firm annulus, while the RV has a tricuspid valve with a greater total area, but relatively small cuspid areas, and an elastic annulus. The difference in the blood supply is important. Owing to high intramural pressure, the coronary flow in the wall of the LV occurs only during the diastole; in the RV it is limited only in the presence of a significant increase in intracavitary pressure. The LV myocardium is functionally "accustomed" to short-term marked changes in the systolic load (in extreme static exercise the arterial pressure rises for a short time to three times the normal value), while the RV is adapted to changes in the diastolic load (marked filling changes associated with deep breathing, for instance). The difference in the response to a long-term volume load is difficult to evaluate: between a defect of the interatrial septum and aortic insufficiency there are too many differences. A long-term pressure load seems to be tolerated better by the right ventricle: patients with severe pulmonary stenosis and a pressure six times higher than the physiological value have lived 25 years and patients with isolated corrected L-transposition of the great arteries can reach 35 years without any signs of impaired RV function.(ABSTRACT TRUNCATED AT 250 WORDS)

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Mechanocardiographic investigations were carried out in a group of eight patients with hypertrophic obstructive cardiomyopathy (HOCM) who had been implanted a DDD pacemaker which allowed efficient therapy to be administered in the combination of metoprolol in the dose of 300 mg/day and verapamil in doses of 240-480 mg/day. The investigation was repeated one week after temporary withdrawal of verapamil. The control group consisted of six patients with idiopathic third-degree-complete AV block with implanted DDD pacemakers. Over the period of 24 hours before investigation, these patients received 300 mg of metoprolol. All the patients had the same heart rate (70 bpm) and a constant PQ interval (0.18 s). Statistical analysis of the obtained data revealed the following findings: 1. There was no difference between the control group and the group of HOCM patients treated with verapamil. 2. Withdrawal of verapamil in HOCM patients resulted in a significant prolongation of the 2-0 interval and shortening of the O-c interval recorded on apexcardiogram compared to the control group. In conclusion, verapamil affects LV diastolic parameters in patients with HOCM and the changes are compatible with the beneficial effects of verapamil. These changes may however result partly from increased left atrial pressure due to atrial poisoning with verapamil.

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The importance of noninvasive methods in cardiology has continuously been increasing; beside electrocardiography, phonocardiology, bicycle ergometry, echocardiography, radioisotopic examination and nuclear magnetic resonance, mechanocardiography preserves its significance, too. There are several reasons for it: modern apparatus technique has brought a pronounced increase in examination accuracy, comparison with invasive methods showed a number of mechanocardiographic data to be of value for left ventricular function evaluation, mechanocardiography is especially useful in repeated and long-term functional observation of the left ventricle, evaluation of treatment effects, revealing the onset of left ventricular dysfunction, the method is relatively economical and applicable even in peripheral workplaces. The literature survey of the study sums up the present knowledge of mechanocardiographic techniques, the genesis of curves and the manner of their evaluation, the physiological and other influences on the mechanocardiographic data and their clinical utilization. An analysis of experience gathered in a number of laboratories all over the world demonstrates the need of further improvement and development of the method. The present dissertation is aimed at this goal. I has set itself a task to contribute to the solution of some methodological problems of mechanocardiography and to evaluate critically its importance for the clinical practice. Polygraphy and apexcardiography (including 1st derivatives of curves) performed both at rest and during isometric handgrip exercise were used. From the obtained curves a wide spectrum of parameters was determined and several indices were calculated, some of them being introduced originally. The mechanocardiographic data were correlated in some studies with the results of echocardiography and bicycle ergometry and with invasive examination (heart catheterization, coronarography). The following results were obtained in the research into mechanocardiographic methodology problems: the suitability of a LPA 100 transducer of Czechoslovak production (Tesla VUST) was demonstrated; some physiological influences on the obtained values were determined (effects of age, respiration, body weight). The author's own method of cardiac cycle intervals correction to comparable values at unified cycle duration was elaborated; the effects of isometric handgrip exercise were studied in detail. The work was focused on verifying the importance of mechanocardiography for clinical cardiology. Therefore the method was used in a number of diseases and pathological conditions to get more complex experience. On the basis of the results obtained the value of mechanocardiography application in coronary artery disease has been demonstrated. The method provides a certain possibility in CAD diagnosis by means of combined evaluation of three sensitive parameters (pulse transmission time and two parameters of alpha wave amplitude). This type of valuation has been proposed by our laboratory.(ABSTRACT TRUNCATED AT 400 WORDS)

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The authors compared two groups of men: the group with minimal sclerotic wall changes (n = 18) and the group with a normal coronary angiographic finding (n = 32). All the examinations were repeated after 5 to 10 years (mean 8.4 years). The two groups did not differ in the occurrence of the main IHD risk factors, complaints, kind and amount of principal drugs and working history. No statistically significant differences were found between the groups in the reasons for discontinuing bicycle ergometric test or in the exercise ECG finding. The two groups studied did not differ in the mean values of limiting metabolic and cardiologic parameters (oxygen consumption, lactate, pulse rate, RPP index) either. The conclusion can be made that in the functional and clinical prognosis the group of symptomatic men with minor sclerotic wall changes does not differ practically from individuals with completely normal coronary angiography.

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The aim of this study was to investigate whether the rapid improvement of the clinical condition of patients after administration of nitroglycerin can be documented objectively using the apexcardiogram. The study was performed on 28 male patients with coronary heart disease whose clinical condition allowed us to perform the initial polygraphic examination during an attack of angina pectoris. The heart rate and three apexcardiographic indexes were determined from non-invasive polygraphic tracings. The first index was the a/H (ratio: amplitude of apexcardiographic "a" wave to total amplitude of apexcardiogram). The second and third were the velocity of the anterior left ventricular wall motion during both isovolumic contraction (VwmC) and isovolumic relaxation (VwmR) of the left ventricle. The mean differences from initial values were calculated after 2, 4, 6 and 10 min following administration of nitroglycerin. Significant changes already occurred during the second minute after administration of nitroglycerin. All parameters remained significantly changed up to the 10th minute after this treatment. According to our results, the cardiovascular response to sublingual administration of nitroglycerin can be objectively evaluated by apexcardiography.

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Noninvasive polygraphic tracings obtained at rest and during isometric hand-grip exercise were analysed in 67 healthy subjects. The purpose of the study was to determine the response of noninvasive polygraphic parameters to isometric exercise. During the third minute of sustained squeezing of a balloon dynamometer (30% of maximal voluntary contraction) a significant increase occurred in heart rate (+16.8 +/- 10.7 beats/min) an increase in both systolic and diastolic blood pressure (+3.4 +/- 1.6 kPa and 2.6 +/- 1.7 kPa respectively), increase in apexcardiographic index 100.a/D (+14.5 +/- 15.0% "D" amplitude), decrease of diastolic amplitude time index square root 2-c/(2-0) X (a/D) (-20.1 +/- 26.5), shortening of pulse transmission time (-0.006 +/- 0.005 s) and prolongation of cardiac cycle length corrected for left ventricular ejection time (+0.011 +/- 0.010 s) discussed. All these changes were statistically significant.

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The authors examined systolic time intervals, apexcardiograms and left ventricular echocardiograms in 151 patients with chronic disease of the airways. Their study showed that unlike apexcardiograms and echocardiograms, which can be performed in 33.8% and 56.7% of patients respectively, systolic time intervals can be assessed in 90.1% of patients. Pathological values of left ventricular function parameters were a comparatively common finding: 49.2% in systolic time intervals, 35.1% in apexcardiograms and 23.5 % in echocardiograms. There was no relation between the parameters of pulmonary function and those of left ventricular function. The authors hold that non-invasive examination of the left ventricular function in pulmonary disease is most valuable in long-term follow-up studies of the changes of the above parameters.

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The article describes poly- and echocardiographic examination of the ejection fraction, the mean contraction rate of the perimetric fiber of the left ventricle, the total tension period, the period of left ventricular ejection, and the tension period to ejection period ratio. The results obtained in a group of 17 healthy individuals were compared with the findings in patients with angina pectoris who were divided into 2 groups, one without any serious changes in the coronarogram (19) and the other with pathological changes in the coronary arteries (18). In patients with an abnormal coronarogram, the ejection fraction, the rate of contraction of the perimetric fiber, and the ejection period were considerably reduced. These values showed no significant changes in patients with a normal coronarogram. The ECG data correlated well with the systolic phase structure.

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