Impaired cerebrovascular reactivity (CVR), an important risk factor for future stroke, is affected by a presence carotid stenosis. However, in some cases CVR can be impaired in the absence of carotid stenosis due to several poorly characterized mechanisms. We hypothesized that arterial stiffening as observed in coronary heart disease (CHD) could be associated with alteration in CVR in CHD patients without carotid stenosis. The study population consisted of patients referred for coronary angiography without significant carotid stenosis (<50 %). CVR was evaluated by breath holding index (BHI) measured with transcranial color code duplex ultrasound. Arterial stiffness was assessed by pulse wave velocity (PWV) measured by the oscillometric method. The extent of coronary atherosclerosis was quantified by Gensini score (GS). Out of 186 subjects, sixty-two patients fulfilled the inclusion and exclusion criteria. BHI decreased with increasing PWV (r = -0.47, p<0.001). Decrease in BHI was significantly inversely associated with GS (r = -0.61, p<0.001). GS was associated with PWV (p<0.001). In conclusion, impaired CVR was associated with increased arterial stiffening in CHD patients in the absence of significant carotid stenosis. Thus, we speculate that increased arterial stiffness may at least partially contribute to the pathophysiology of CVR alteration in coronary artery disease.

• MeSH
• arteriae cerebrales patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mozkový krevní oběh * MeSH
• nemoci koronárních tepen komplikace   patofyziologie   MeSH
• rychlost toku krve * MeSH
• senioři MeSH
• stenóza arteria carotis komplikace   patofyziologie   MeSH
• tuhost cévní stěny * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

The following is a case report of a young man with antiphospholipid syndrome, present with a recurrent iliofemoral venous thrombosis and premature peripheral arterial disease. This case report highlights the high risk of recurrent thrombosis upon discontinuation of anticoagulation therapy, particularly in the presence of persistent spontaneously increased aPTT and a high antiphospholipid antibody titer. The case report also reviews the potential of endovascular treatment of iliac vein thrombosis and points out the good 24-month patency rates of stents implanted into the pelvic vein region.Key words: antiphospholipid syndrome - iliofemoral deep vein thrombosis - recurrent thrombosis - accelerated atherosclerosis - peripheral arterial disease.

• MeSH
• antifosfolipidový syndrom komplikace   MeSH
• dospělí MeSH
• endovaskulární výkony MeSH
• lidé MeSH
• mladý dospělý MeSH
• onemocnění periferních arterií komplikace   MeSH
• recidiva MeSH
• stenty MeSH
• vena femoralis * MeSH
• vena iliaca * MeSH
• žilní trombóza komplikace   terapie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Bilateral leg compartment syndrome due to myonecrosis caused by inappropriate use of statins is a rare but potentially fatal complication of this lipid lowering medication. We report a case of a 39-year-old woman who presented with suspicious critical lower limb ischemia. Subsequently, bilateral leg compartment syndrome and myonecrosis developed. The primary cause of myonecrosis was due to misuse of simvastatin mistaken by the patient for a weight-reducing drug. Urgent fasciotomies were performed and the patient underwent urgent renal replacement therapy with continuous hemodialysis for acute renal failure due to myoglobinuria. After this complex treatment, the patient was discharged. She almost fully recovered with only a residual paresis of the left fibular nerve. According to literature, this is a unique case of bilateral compartment syndrome and myonecrosis with acute renal failure due to statin overdose leading to acute renal failure and bilateral fasciotomy.

• MeSH
• alanintransaminasa krev   MeSH
• aspartátaminotransferasy krev   MeSH
• bérec krevní zásobení   MeSH
• C-reaktivní protein metabolismus   MeSH
• dospělí MeSH
• fibula diagnostické zobrazování   inervace   MeSH
• funkční lateralita MeSH
• ischemie diagnostické zobrazování   etiologie   MeSH
• kosterní svaly diagnostické zobrazování   MeSH
• kreatinin krev   MeSH
• lidé MeSH
• myoglobin krev   MeSH
• myoglobinurie etiologie   MeSH
• nemoci svalů chemicky indukované   komplikace   chirurgie   MeSH
• počítačová rentgenová tomografie MeSH
• simvastatin škodlivé účinky   MeSH
• syndrom předního tibiálního kompartmentu diagnostické zobrazování   etiologie   MeSH
• tibie diagnostické zobrazování   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• alanintransaminasa MeSH
• aspartátaminotransferasy MeSH
• C-reaktivní protein MeSH
• kreatinin MeSH
• myoglobin MeSH
• simvastatin MeSH

AIM: The injection of bone marrow mononuclear cells (BMMC) into the gastrocnemius muscle has given promising results in patients with critical limb ischemia (CLI). In this article, we have assessed whether a less invasive procedure, i.e. intravascular BMMC infusion, could be effective in this population of patients. METHODS: A total of 28 limbs in 24 patients with CLI were treated. An amount of 276-700 mL of marrow blood was harvested from posterior iliac crests and BMMC were obtained by standard procedure used for bone marrow transplantation. After performance of digital subtraction angiography, BMMC were injected laterally through a 4 Fr sheet. Primary outcome was efficacy of the procedure measured as healing of defects, frequency of high amputations and change of ischemia grade; among secondary outcomes were safety of the procedure, angiographic changes and changes in quality of life. RESULTS: One year after treatment, all patients were alive and only 2 patients have undergone high amputation. Eleven of 14 defects have healed (78%) and Fontaine grade of ischemia has changed from median grade 3.5 to median grade 2 (P<0.0001). Collateral vessel development has improved by mean 1.13 and 1.3 points on a four-point semiquantitative scale in calf and foot, respectively (P<0.0001). There were no grade III-IV adverse events. According to the SF-36 quality of life questionnaire, 1 year after the procedure patients have reported significant improvement in all measured items. CONCLUSION: Intra-arterial infusion of BMMC can lead to significant and long-lasting subjective and objective improvements in patients with CLI. The results merit validation by randomized controlled studies in patients with less critical limb ischemia.

• MeSH
• amputace MeSH
• autologní transplantace MeSH
• bérec krevní zásobení   MeSH
• časové faktory MeSH
• digitální subtrakční angiografie MeSH
• dospělí MeSH
• hojení ran MeSH
• intraarteriální infuze MeSH
• ischemie diagnostické zobrazování   patofyziologie   chirurgie   MeSH
• kolaterální oběh MeSH
• kotník krevní zásobení   MeSH
• krevní tlak MeSH
• kritický stav MeSH
• kvalita života MeSH
• lidé středního věku MeSH
• lidé MeSH
• paže krevní zásobení   MeSH
• pilotní projekty MeSH
• průzkumy a dotazníky MeSH
• regionální krevní průtok MeSH
• reoperace MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• studie proveditelnosti MeSH
• stupeň závažnosti nemoci MeSH
• transkutánní měření krevních plynů MeSH
• transplantace kostní dřeně * škodlivé účinky   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• práce podpořená grantem MeSH

BACKGROUND: Geographic differences of particular species of ticks and variant strains of Borrelias impede the comparison of local and foreign experience. The authors tried to support some literary observations with their own results and designed a study aimed at determination of anti-Borrelia antibodies (AB) in the selected population samples. The goal of the study was to find and statistically evaluate: a) difference in distribution of values of AB in the sample of probands from the risk and non-risk environment (foresters in Sumava and Prague blood donors, respectively) by means of ELISA method, b) tick bite frequency in the risk and non-risk groups, c) to determine and statistically evaluate the prevalence of probands with increased levels of antiborrelial antibodies in the local study population by ELISA method and the prevalence of probands with non-normal values found by Western blot (WB) method. METHODS AND RESULTS: In the group of Prague blood donors (control group), in total 200 probands were examined; in the risk group, 71 probands from Sumava forest were examined. Blood specimens were examined in the National Reference Laboratory for Lyme Borreliosis in Prague. In all specimens, ELISA NRLB KC90 was used. Western blot assay was used for confirmation. CONCLUSIONS: On the basis of literature review from Europe and USA, it is possible to generalize the following, despite some equivocations: 1. regional differences are not significant, with the exception of high-risk territories or "occupational exposure"; 2. there is no significant difference between males and females; 3. considerable caution is necessary in comparing the control and risk groups; prerequisite for such comparison is defining the characteristics of both groups.

• MeSH
• Borrelia burgdorferi komplex imunologie   MeSH
• dárci krve * MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• protilátky bakteriální krev   MeSH
• rizikové faktory MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• Názvy látek
• protilátky bakteriální MeSH

Vascular involvement in thoracic outlet syndrome is beside neurological symptoms one of the possible manifestations of this disease, typically affecting young, otherwise healthy individuals. The most frequent vascular manifestations of the thoracic outlet syndrome include symptoms related to the venous hypertension with possible outfall to the deep vein thrombosis. Arterial involvement is mostly revealed by the presence of ischemic symptoms. Several key points for the correct diagnosis should be stressed out. They include specific events in patient history, especially previous effort or trauma of the affected upper extremity, typically unilateral. Arterial manifestations are characterized by the absence of ischemic symptoms in other localisations. Deep vein thrombosis occurs in the absence of other distinct precipitating factor and/or hypercoagulable state. Some provocative manoeuvres may help in correct diagnosis assessment, especially in the connection with duplex ultrasound examination. Endovascular procedures both in venous and arterial thoracic outlet syndrome became rather a part of therapeutical process while their role in diagnosis decreasing. The treatment of thoracic outlet syndrome patients is currently evolving into an interdisciplinary approach integrating angiologists, interventional angiologists and vascular surgeons. This complex multidisciplinary approach improves long term results and quality of life of these patients.

• MeSH
• ischemie etiologie   MeSH
• lidé MeSH
• paže krevní zásobení   MeSH
• syndrom horní hrudní apertury komplikace   patologie   patofyziologie   MeSH
• žilní trombóza etiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH

The relatively low percent of patients affected with the cardiac form of Lyme borreliosis is difficult to diagnose, especially if the disease manifests itself in ways other than atrio-ventricular blockade. The advanced stage of Lyme carditis manifesting as dilated cardiomyopathy is a special case of this affliction. The authors of this report present clinical experience with an attempt to support the working hypothesis about involvement of Lyme borreliosis infection in the development of dilated cardiomyopathy. The patients were clinically examined thoroughly with special attention to the cardiovascular system. In addition to the basic clinical methods, the following procedures have been employed: dynamic Holter's electrocardiography, exercise ECG test, coronarography, and myocardial biopsy. From laboratory methods pertaining to the detection of Borrelia, ELISA method, Western blot, PCR, electron microscopy and histopathological analysis were used. In all three cases, clinical and laboratory findings provided the evidence of the borreliosis infection involvement in the development of dilated cardiomyopathy.

• MeSH
• dilatační kardiomyopatie diagnóza   etiologie   patologie   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• lymeská nemoc komplikace   diagnóza   patologie   MeSH
• myokard patologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH

A significant part of patients with carotid artery stenosis is operated on without preoperative angiography, to reduce the risks and cost of such examination. Duplex ultrasound often cannot reliable visualise the proximal parts of the aortic arch vessels. We evaluated the ability of duplex ultrasound to identify those types of lesions and ascertain their prevalence. We analysed retrospectively carotid duplex scans and carotid angiography in 448 carotid arteries. 17 significant proximal lesions (3.89%) were identified on the duplex scan and confirmed by angiography. Lesions of the proximal parts of the aortic arch vessels are rare and may be reliably detected by duplex ultrasound.

• MeSH
• arteria carotis communis diagnostické zobrazování   MeSH
• dospělí MeSH
• duplexní dopplerovská ultrasonografie * MeSH
• lidé středního věku MeSH
• lidé MeSH
• rentgendiagnostika MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stenóza arteria carotis diagnostické zobrazování   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

A long-term prospective study of patients with confirmed non-cardiac form of Lyme disease (n=221) over a mean follow-up period of 40.6 months is reported. The study revealed no case of Borrelia-related cardiac involvement developed after several years in patients who had received antibiotic therapy in the early period. Therefore, these patients do not need follow-up by a cardiologist.

• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• lymeská nemoc komplikace   farmakoterapie   MeSH
• mladiství MeSH
• myokarditida diagnóza   mikrobiologie   MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

The article summarizes basic characteristics of Lyme borreliosis, its incidence, epidemiology, pathogenesis and clinical image. Particular attention is given to the review of papers aimed at the cardiac abnormalities--the Lyme carditis. Though they are not very frequent, due to the variability of their clinical course and due to various forms, which are difficult to diagnose, they can represent a specific problem. Major part of the article is given to the authors' own experience with the dilated cardiomyopathy of the Borrelia origin and namely to the perspective study of the patients after the skin form of the disease erythema migrans, who were treated "lege artis" in the early phase of the disease with antibiotics. Authors were interested how many of those patients would develop later the cardiac abnormalities.

• MeSH
• dilatační kardiomyopatie diagnóza   mikrobiologie   MeSH
• lidé MeSH
• lymeská nemoc komplikace   diagnóza   MeSH
• myokarditida diagnóza   mikrobiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH