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Abstract Objectives The extent to which sinonasal symptoms impact the likelihood of major depressive disorders in chronic rhinosinusitis patients with nasal polyposis (CRSwNP) remains incompletely characterized. In this study, we sought to determine whether individual symptom clusters differentially impact the likelihood of depression in a cohort of CRSwNP patients. Methods We retrospectively included 77 patients with CRSwNP. The severity of sinonasal symptoms was assessed using the 22‐item Sino‐Nasal Outcome Test (SNOT‐22) and grouped according to a previously validated four‐subdomain structure: nasal, otologic/facial pain, sleep, and emotional subdomains. The likelihood of major depressive disorders was assessed using the Patient Health Questionnaire‐2 (PHQ‐2). The clinical characteristic of symptom severity (nasal polyp size) and disease‐specific information, such as the number of previous sinonasal surgeries, were also collected. Results The sleep subdomain was most strongly associated with the likelihood of major depressive disorders, followed by the otologic/facial pain subdomain, after controlling for demographics and clinical indicators of symptom severity (nasal polyp size). We found a SNOT‐22 score ≥ 30.5 to be an accurate indicator of scoring higher than or equal to 2 on the PHQ‐2 in CRSwNP patients. This had a sensitivity of 83.33% and a specificity of 75.47%. Conclusion Distinct sinonasal symptom clusters differentially impact the likelihood of depression in CRSwNP patients. Raising awareness for those with severe sinonasal symptomatology might help identify more patients with a higher probability of comorbid depression. Level of Evidence: 4.

Central haemodynamics in 23 patients with mitral stenosis and 7 control subjects were compared with the results of regional lung perfusion studied by Xe, pulmonary scintigraphy with mTc-labelled macro-aggregates of albumin, and regional ventilation by Xe. A close correlation was found between both methods assessing regional pulmonary perfusion, i.e. pulmonary scintigraphy and Xe. The results show that lower lung zones, when compared with upper zones, have both worse perfusion and worse ventilation. The changed distribution of perfusion and the changed distribution of ventilation correlated significantly with central haemodynamics in these patients. The ventilation gradient can be a valuable diagnostic tool for evaluating the severity of mitral stenosis, especially in long and repeated studies, due to its simplicity for the patient. [ABSTRACT FROM PUBLISHER]

Background: The CD14 receptor of monocytes is an important mediator for the activation of monocytes/macrophages by endotoxins from the envelope of Gram-negative bacteria (lipopolysaccharides). We identified a polymorphism in the CD14 receptor and examined whether this genetic marker influenced the expression of the CD14 receptor on monocytes and affected the predisposition to myocardial infarction., Methods and Results: We identified a C(-260)-->T nucleotide change, creating a HaeIII polymorphism in the promoter of the CD14 gene. The polymorphism was determined in 178 male patients <65 years old (cases; average age, 55.9+/-6.3 years) at the time of their first myocardial infarction and in 135 representative selected male control subjects (controls; average age, 55.2+/-11.5 years). The frequency of the T allele (absence of the cutting site) was 0.49 in cases and 0.35 in controls (P=0.0005; OR, 1.781; 95% CI, 1.286 to 2.465). Subsequently, we measured the expression of monocyte CD14 by flow cytometry in 18 volunteers with different CD14 genotypes. A significantly higher density of the CD14 receptor was shown in the T/T homozygotes than in the others (P=0.0028)., Conclusions: A higher frequency of allele T(-260) in the promoter of the CD14 receptor gene was found in myocardial infarction survivors than in controls. At the same time, this variation was associated with a higher density of CD14 receptors in healthy volunteers. Therefore, we can conclude that in addition to the well-established risk factors, a genetically determined reaction of monocytes/macrophages to infectious stimuli could play an important role in the process of atherosclerosis.

In the Institute of Clinical and Experimental Medicine in Prague 101 orthotopic allotransplantations of the heart were performed in 100 patients (87 men and 13 women). The reason for transplantation were terminal stages in the first place dilated cardiomyopathies and ischaemic heart disease. 58% of the patients survive after transplantation, the mortality rate is 42%. The highest mortality is in the early postoperative period (within two weeks after operation)--21 cases (50%). The longest survival period is nine years and six months. All patients have cyclosporin immunosuppressive treatment (in combination with another drug, later with another two drugs). In the authors' group in particular incipient acute rejections are encountered, "mild" rejections are less frequent and "moderate" rejections least frequent. The patients do not reach the stage of advanced acute rejection, i.e. "severe" rejection. Acute rejections are treated as a rule with 3 g Urbason. After this treatment acute rejection improves as a rule completely after one or two weeks therapy.

The authors summarize their hitherto assembled experience with pericardiocentesis under echocardiographic control. From May 1986 to December 1991 they made these punctures 55 times in 49 patients. In the majority therapeutic puncture was involved, only seven times puncture was used for diagnostic purposes. Echocardiography can evaluate not only the presence of an exudate and assess its haemodynamic impact but it is the optimal method for finding an optimal site for puncture and it is very suitable for checking the course of the operation. In smaller operations and in biopsies of pathological pericardial tissue it is advisable to use special instruments which make the procedure safe. The authors recorded a total of three failures, in one instance the exudate was removed with the assistance of a surgeon, in one instance the situation was coped with by repeated puncture and in one instance by a conservative procedure. None of the patients developed complications. A list of the latter is discussed. The method is nowadays part of therapeutic procedures of the cardiologist.

The incidence of infectious complications was monitored in a group of the first 100 patients undergoing orthotopic heart transplantation at the Institute for Clinical and Experimental Medicine from January 1984 through May 1993. The definition of an infectious complication was a clinically manifest infection requiring treatment. Cytomegalovirus infection and Epstein-Barr virus infection were evaluated by the development of antibody against IgM. A total of 168 infectious complications were detected in 80 patients. The infectious complications were fatal in 11 patients; hence, infections were implicated in 26% of all deaths following heart transplantation. The spectrum of infections markedly varies depending on the interval since the procedure. The most frequent infections within the 30 postoperative days are bacterial (often nosocomial) infections. In the later period (30 days onward), viral infections account for 72% of cases. Of the rarer types of infections, the pulmonary form of aspergillosis was identified in 3 cases, nocardiosis and legionellosis in one case each. Infectious complications were the main cause of deaths in the period of 1 to 4 months post-transplantation, and the spectrum and rate of complications were not different from data reported by other centres.

After ten years of experience, the authors present an overview of the possible clinical uses of precordial isopotential electrocardiographic mapping in patients with ischaemic heart disease. The resting Q wave and ST segment maps have most often been found useful in the early phases of myocardial infarction. They are a helpful tool for monitoring progression of the disease, the effect of drugs, or the therapeutic effect of fibrinolytic therapy, etc. R wave mapping provides an excellent opportunity for following up patients after orthotopic heart transplantation and monitoring cardiac rejection. Stress tests are usually performed under a workload; alternative loads may be mental, pharmacological, stimulation-induced or under hypoxaemic stress. To evaluate a test, resting values are compared with those obtained during exercise. It is mainly exercise ST segment maps which have proved to be most informative; their use in the chronic phase of ischaemic heart disease helps to make the diagnosis of coronary insufficiency more accurate. In clinical practice, stress tests are recommended mostly in the follow-up of drug therapy, monitoring of the therapeutic effect of cardiac surgery or coronary angioplasty.

Hypoxaemic precordial ST mapping was compared with precordial exercise mapping in a group of 64 patients. During hypoxaemia, IHD patients show ischaemic changes in ST maps similar to those found in exercise maps, and a significant increase in the sums of ST depressions. The test can be recommended to detect coronary insufficiency in cases where the exercise ECG test is not feasible or available, and to expand the arsenal of non-invasive diagnostic procedures. The physical exercise test, however, remains the strongest test for ECG detection of myocardial ischaemia.

The data of the first 100 patients undergoing heart transplantation in the period between January 1984 and May 1993 were analyzed. Of this group, 57 patients are alive. Out of the total of 43 deaths, 14 patients died from graft failure within the first postoperative days, 6 died from surgical complications, 11 from infection, 10 deaths were due to accelerated coronary atherosclerosis, and 2 patients died from tumours. Early mortality rates (within 30 days since surgery) were 37% and 17% in patients operated on between 1984-88 and between 1989-93, respectively. The health condition of heart transplant recipients is affected by side effects of immunosuppressive therapy. Forty per cent of patients re-develop systemic hypertension within the first post-transplantation year. Five years after transplantation, hypertension is detected in 60% of patients. Elevated serum creatinine levels are present in 70% of patients by the end of the first post-transplantation year. In the ensuing period, there is no progression in renal function impairment, which does not require cyclosporin withdrawal and is not associated with the development of hypertension. In the first post-transplantation year, 45% of patients are markedly obese. All patients with overweight and obesity show markedly raised levels of serum cholesterol. Another undesirable effect (mainly due to corticosteroid therapy) is the development of ulcers in 16% of patients. Heart transplantation has become an established method at the Institute for Clinical and Experimental Medicine in Prague. Despite the above pitfalls, heart transplantation substantially prolongs the life of patients and dramatically alters the quality of their life.

The potential of echocardiography in evaluating myocardial rejection was determined in 56 patients (8 females) following orthotopic heart transplantation. The patients' average age was 42.3 (range 18-67) years. Endomyocardial biopsy was used as the reference method. The study included a total of 254 results of biopsy: 137 specimens were free of any signs of rejection while 51 showed incipient rejection and mild rejection was found in 54 specimens. Moderate rejection was detected in 12 specimens; severe rejection was not present in any case. Echocardiography was used to determine ventricular size, wall thickness, left ventricular function, pericardial effusion, mitral and tricuspid flow and isovolumic relaxation time. Rejection has been found to be associated with ventricular wall thickening; the appearance of or an increase in pericardial effusion seems to be a relatively specific feature (a very low-sensitivity marker though); change in isovolumic relaxation time is believed to be the most sensitive marker. No relation between rejection and mitral and tricuspid flow was demonstrated. Echocardiography may alert the cardiologist to a rejection episode; isovolumic relaxation time and its alterations are the most informative features in this respect. The method may help postpone the intervals of biopsy which, however, must be performed on the slightest suspicion of rejection. Still, it cannot be regarded as a replacement for endomyocardial biopsy at the moment.

The article examines the history of heart transplantation in experiment and in clinical practice. The part focusing on experimental transplantation covers the period from the very first attempts in 1905 up to the introduction of the current technique. The second part provides an outline of the history of transplantation in clinical practice including immunosuppressive therapy and rejection control. The first heart transplantation in the Czech Republic was performed in 1984.

Coronary artery lesions are evaluated in a group of 43 patients surviving for more than 3 months after heart transplantation. An angiographic finding was obtained from 35 patients, autopsy findings were available in eight cases. Angiography demonstrated coronary artery lesions in 12 out of the 35 patients whereas autopsy findings were positive in five out of the eight post mortem examinations. Overall, lesions were found in 40% of patients at a mean follow-up interval of 3.5 years. While the finding of a coronary artery lesion was not related to the classic risk factors for atherosclerosis, an association to a previous cytomegalovirus or Epstein-Barr virus infection was demonstrated. The data suggest that infection caused by the two above viruses is an important factor in the development of vascular lesions in the heart transplant.

In 22 patients with a first myocardial infarction the authors assessed the relationship between morphological changes of the QRS complex and systolic left ventricular function. Using a 56-lead computer-assisted electrocardiogram from the precordium in the form of a map (apparatus Cardiomap-1), the authors prepared a record during the first days after initiating treatment with a thrombolytic agent and again after a period of three weeks. They found only one correlation between the decrement of Q waves and the increase of the left ventricular ejection fraction (p less than 0.05). This correlation, however, is of no practical importance due to the low correlation coefficient. The relationship is moreover markedly influenced by the time of the first record. After the third day of thrombolytic treatment it is not expedient to make the initial record. No relationship between the change of R waves, ST segments and left ventricular function was found. Similarly, due to the great dispersal of values it is not possible to differentiate between patients with inferior infarctions of the heart muscle and anterior myocardial infarctions.

Between 1 January, 1989, and 28 April, 1990, a total of 888 selective coronary arteriographies were performed at the Institute for Clinical and Experimental Medicine in Prague. Of that number, 58 findings were assessed as at least 50% stenosis of the left main coronary artery (LCA). Having applied exclusion criteria, 50 patients (i.e., 5.63% of all those examined) were entered into a retrospective study. They were 45 men (90.0%) and 5 women (10.0%) with significant cumulation of risk factors for IHD; more than half on them had a history of coronary event. The patients had marked symptomatology--NYHA Class III and higher angina pectoris was present in 96%, a low tolerance of exercise was found in 26 patients undergoing ergometry (average workload of 13 kJ and heart rate of 111/min); exercise testing was invariably evaluated as positive. Coronary angiography regularly revealed multiple coronary artery lesions; the right coronary artery was also involved in 90%; a collateral circulation was present in as little as 34%. The localization of coronary stenoses and the mostly preserved left ventricular mechanical function allowed operative management of IHD in 84% of cases. In the group of patients undergoing surgery, hospital mortality was 4.8%. On long-term follow-up (mean 6.2 months) of the group of patients operated on, 59.9% were free of problem, 31% had NYHA Class II angina pectoris, and there was no improvement at all in one patient only (2.4%). In the group provided conservative therapy (not operated on primarily for severe left ventricular dysfunction), one patient died of recurrent myocardial infarction and cardiogenic shock, 2 have NYHA Class IV angina pectoris, and the remaining subjects continue experiencing NYHA Class III problems.

The morphological impact of percutaneous transluminal angioplasty (PTCA) on the treated artery is closely checked by coronary arteriography. Indirect non-invasive evaluations are made possible by electrocardiography, isotope methods and echocardiography which are the commonest visualization methods. The authors used a precordial S-T load map. After complete revascularization following PTCA there was a significant drop of the sum of S-T depressions and in some members of the group it reached normal values. The S-T load map is a suitable non-invasive procedure for monitoring the effect of PTCA.

The authors evaluated retrospectively the course of the early stage of symptomatic myocardial infarction (IM) with regard to the incidence and character of infarction pain and the clinical course of IM during hospitalization at the coronary unit (CU) in a group of diabetic patients (D, n = 67) and a group of non-diabetic controls (ND, n = 63). In the group D there was a higher incidence of painless IM (D 7.5%, ND 0%, p less than 0.05). The interval between the development of the first symptoms of IM and admission to the CU was significantly longer in diabetics (D 20 +/- 35 hours, ND 9 +/- 16 hours, p less than 0.05). IM in diabetics was more frequently complicated by left-sided cardiac failure (D 48%, ND 27%, p less than 0.05). As to other investigated complications the two groups did not differ significantly. Nor did they differ in the mortality during hospitalization at the CU.

The authors evaluate the incidence of pulmonary embolism (PE) and its impact in patients who died in the cardiological department of the Institute of Clinical and Experimental Medicine during two five-year periods (1979-1983 and 1984-1988). These two periods are compared with the period 1974-1978 in the same department. The purpose was to assess the trend of fundamental findings (number of post-mortem examinations, number of PE, number of fatal PE, source of thrombosis in PE etc.). Based on the assembled findings it may be said that the number of p.m. examinations is increasing and thus also the number of PE. There was an obvious rise of the number of women with embolic, attacks in the cardiological department. Correct clinical diagnoses are equal in all periods.