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Diabetes is a frequent metabolic disease which affects also the digestive tract. Functional disorders of the latter have a negative impact on the stabilization of diabetes. An important factor as regards motility is the blood sugar level. Subjective complaints of the patients frequently do not correlate with the objectively assessed functional state of the digestive tract. The authors remind of contemporary available diagnostic and therapeutic possibilities.

The set consisting of 3 patients with esophageal achalasia diagnosed by manometry, pseudoachalasia excluded by esophagoscopy and endosonography, was treated with combined conservative procedure. Botulinum toxin 250u (Dysport) was applied to the area of lower esophageal sphincter and after 7 days balloon dilatation was carried out. Treatment efficacy was evaluated by the data obtained about the subjective condition, manometrically and endoscopically. The spine condition was evaluated in all patients before treatment and functional blockades were released by manual medicine and even by acupuncture. We succeeded in restoring propulsive peristalsis of the esophagus in all of them. It is objectively proven in the longest duration of 44 months in the case of a patient treated with a balloon dilatation.

The authors examined retrospectively the frequency of NSAID use by patients with gastroduodenal ulcer without HP. The objective was to evaluate whether the use of NSAID is the predominating factor in the development of ulceration in subjects with HP negative ulceration. The group comprised 525 patients with confirmed presence of H, incl. 52 who used NSAID. From the results ensues that the incidence of ulcerous lesions with HP negativity and NSAID medication is significantly higher than in subjects who use NSAID and suffer from a confirmed HP infection.

Background: Dynamic esophageal scintigraphy has been proven as an efficient technique of diagnosis of esophageal dysmotility., Methods: The authors monitored the transit velocity, anti-peristalsis and the retention of radioactivity in the esophagus by dynamic esophageal scintigraphy in a group of 50 patients (37 control patients and 13 patients with achalasia)., Results: They found a significantly longer period of radioactivity passage via the esophagus compared to the control group (p < 0.001%)., Conclusions: We observed the statistically significant transit prolongation of radioactivity through the esophagus during dynamic esophageal scintigraphy (41.2 seconds) in our group of patients with achalasia compared to the control group (7.9 seconds). Anti-peristalsis and even the radioactivity retention have occurred statistically more frequently compared to the control group.

The authors investigated a consecutive group of 14 patients treated at the Neurosurgical Clinic on account of traumatic intracranial haemorrhage, admitted with the clinical temporal conus syndrome (GCS 3-5, ipsilateral or bilateral mydriasis, failure of vital functions). All had emergency operations and at the intensive care unit the cerebral perfusion pressure and the saturation in the jugular bulb was monitored continuously. On the first and fifth day after surgery a check-up CT and SPECT examination was made. Only two patients had ischaemia during the first CT check-up, while 11 patients had impaired perfusion on the first SPECT. Improving perfusion on the check-up SPECT was the sign of a favourable prognosis, while ischaemia on the first CT was in both instances fatal. The Glasgow Outcome Score (GOS) six months after the injury was as follows: 9 patients had a good result, 2 patients were moderately disabled 3 patients died. The authors consider the following as basic prerequisites of a favourable outcome: not only early operation but also monitoring and treatment of impaired cerebral perfusion.

We followed up a group of 43 patients suffering from cervical vertebropathy. Dynamic scintigraphy revealed a significant prolongation of oesophageal transit time of 10 ml of labelled liquid (mean transit time, MTT) in comparison with a control group. Patients treated with acupuncture showed a significant reduction in MTT in comparison with patients receiving a placebo needle application. The group of patients treated with manipulative techniques showed in addition to symptom alleviation a significant reduction in MTT. Dynamic scintigraphy facilitates verification of oesophageal dysmotility in patients suffering from vertebropathy and enables the success of therapy to be readily monitored.

24-hour ph-metry of the oesophagus is a standard examination method in patients with reflux complaints. For objective evaluation of the record the following points are most important: 1. calibration of the instrument, 2. precise placement of the pH-probe, preferably under manometric control, 3. elimination of medication (inhibitors of proton pump, H-2 blockers, antacids, prokinetic preparations), 4. cooperation of the patient. A 24-hour record makes it possible to analyze in detail the type of reflux, and when using available software, also its quantity.

Twenty-one patients with a medium severe form of acute pancreatitis were divided into two groups. Eleven were treated with octreotide, 200 micrograms s.c. every 8 hours, combined with standard conservative treatment, 10 patients had the same treatment but without octreotide. In the octreotide-treated group the level of free oxygen radicals and important antioxidants--vitamins A, E and C--was assessed. In the octreotide-treated group the authors found after five days normal levels of originally elevated free oxygen radicals and a significant increase of the vitamin C level. As compared with the control group, in the octreotide group the period of hospitalization was significantly shorter (9.8 +/- 3.2 vs. 13.7 +/- 4.7). The number of complications was not affected.

Eradication regimes with the blocking agent of the proton pump and without it do not influence the activity of cell division after treatment of Helicobacter pylori (H.p.) when using cytoflowmetric evaluation. The non-significant difference in proliferation activity of the gastric mucosa after treatment of H.p. can be also a sign of more rapid repair of the gastric mucosa after elimination of the inflammatory elements.

Colonization of the gastric mucosa with Helicobacter pylori H.p. reduces the vitamin C concentration of gastric juice. Eradication of H.p. within four weeks after completed treatment does not exert a significant effect on changes in the concentration of vitamins A, E and C in gastric juice or serum. Despite this after eradication a rising trend of vitamin E in gastric juice was recorded. Substitution of vitamin C and E in gastritis associated with colonization with H.p. has a favourable effect and may reduce the risk of malignization.

Administration of cisapride, 3 x 5 mg in a suspension one day before surgery and 30 mg 3 and 8 hours after abdominal surgery with subsequent administration of 2 x 30 mg in suppositories up to the time when oral ingestion is possible, hastens significantly the restoration of GIT motility as compared with placebo. It can be therefore recommended as effective medication in the prevention of complications caused by impaired motility of the digestive tract.

Extremely effective drugs used in the therapy of diseases etiologically associated with excessive HCl secretion by the gastric mucosa include proton pump blockers. Their obvious advantage, as compared with commonly used drugs, is that they cause a marked drop of HCl production by the gastric mucosa regardless of the type of stimulus, i.e. whether parietal cell receptors are influenced. Their therapeutic action is extremely effective, while side-effects are minimal. The publication gives the basic indications of administration of proton pump blockers, compares their therapeutic efficiency with H2 blockers and draws attention to possible pitfalls of therapy.

Impaired motility of the oesophagus is relatively frequent in patients with functional blocks of the cervical spine. The patient does not always realize oesophageal dysmotility. Auricular acupuncture focused on reflex relations seems to be a useful therapeutic procedure.

The authors give an account of functional disorders of the digestive tract. They deal briefly with possibilities of their medicamentous treatment with regard to the pharmacological action of prokinetics. Finally they review indications for Prepulside.

The results of 3061 laparoscopic cholecystectomies made by 58 surgeons in nine departments--feasibility 88.9%, low morbidity rate (n = 2071) 11.8%, high morbidity rate 2.48%, mortality rate 0.22%, residual choledocholithiasis 1.36%, preoperative use of endoscopic methods 1.0%, revision in a total of 1.8%--are as a rule less favourable than summarized statistical data from abroad. Similarly as in data abroad the incidence of biliary lesions is not satisfactory--0.65%. The incidence of fistulas (0.13%) revisions on account of haemorrhage (0.29%) and surgical preoperative accidents (0.24%) was lower. Departments which use thermocoagulation have a significantly lower incidence of lesions (0.14% - p < 0.06) than teams working with electrocoagulation.

Atenolol and bisoprolol, two beta-1-selective blockers, were compared in patients with mild and medium severe hypertension. Forty patients with a diastolic blood pressure of 95-115 mm Hg were two weeks after discontinuation of treatment divided at random into two groups treated with 50 mg atenolol and 5 mg bisoprolol. If the blood pressure was not affected by this dosage, the dose was raised to 100 mg atenolol and 10 mg bisoprolol. The blood pressure readings, heart rate, side effects of the drugs, laboratory and echocardiographic values were followed up for a period of three months. The authors recorded a marked decline of pressure and heart rate after the first week of therapy, the pressure readings in an upright position did not differ statistically from values in a sitting position, orthostatic hypotension was not recorded. The rate of success of bisoprolol was 85%, of atenolol 75%. During treatment no serious side-effects were observed. The biochemical parameters and echocardiographic values were not altered significantly by treatment. Atenolol and bisoprolol are two effective beta-1-selective blockers with a comparable effect in the treatment of mild and medium severe hypertension. They are useful in monotherapy as well as in combination with other antihypertensive drugs. In hypertension associated with diabetes mellitus, incipient bronchopulmonary disease and pregnancy they are also indicated. They are well tolerated also by elderly patients, an advantage of bisoprolol may be that it has a smaller impact on pressure and heart rate during the night.

A total of nine patients with diabetes type I and II and with claudications due to macro- and microangiopathies of the lower extremities took sulodexide (Vessel Due F) by the i.m. route for a period of 20 days and then as capsules for 90 days. In all a favourable therapeutic effect was recorded, in particular as regards delay of claudications. The authors recorded lower blood sugar values, lower levels of cholesterol, triglycerides, fibrinogen and plasma viscosity. In the authors' view sulodexide is an important advance in the treatment of diabetics with claudications.

The authors describe infection with the Epstein-Barr virus (EBV) which is associated with the formation of various types of antibodies--heterophil (HP) antibodies as well as antibodies against individual EBV antigens. They evaluate the contribution of a recently elaborated and introduced method used for detection of antibodies against the capsid antigen of the EBV class IgA (anti-VCA IgA) by indirect immunofluorescence to the diagnosis of acute and chronic EBV infections. Anti-VCA IgA are useful in the diagnosis of EBV infections if the patient has no longer HP and anti-VCA IgM, but only anti-VCA IgG. If, however, in addition to anti-VCA IgA also anti-VCA IgA are present, their presence can be the only detectable sign of a recent EBV infection and also a sign of reactivation of chronic EBV infection.

The majority of nodes of iliosacral lymphocenter are attached to the wall of a. iliaca communis dextra et sinistra from its origin to the rise of a. circumflexa ilium profunda. The total number of nodes of the lymphocenter ranges from 5 to 11, without any marked dextro-sinistral asymmetry. The size of nodes, as expressed by their length, showed a wide range from 1.5 to 20 mm and in more than one half of nodes it was 5 to 10 mm. The mass of individual nodes ranged from 1.7 to 98.9 mg and in one half of them was up to 20 mg. The total mass of all nodes of lymphocenter fluctuated individually from 131 to 340 mg with a slight asymmetry in favour of the right-hand side. Regarding a considerable positional variability of nodes the authors do not hold a further particularization of iliosacral lymphocenter for reliable and they consider the nodes under study to be a uniform topical group.