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The purpose of this study was to examine morphometric changes of myelinated fibers in early stages of experimental diabetes mellitus. Adult male Wistar rats aged 17 wk were used in this study. Diabetes mellitus was induced by streptozotocin. Samples of common peroneal nerve from diabetic rats (4 and 8 wk after induction of diabetes mellitus) and age-matched control animals were removed and processed. The semithin cross sections were stained with toluidine blue and used for myelinated fiber computer-aided morphometric analysis. There were no significant changes in diabetic animals after 4 wk duration of the disease. There was significant reduction in myelinated nerve fiber caliber in diabetic rats 8 wk after induction of diabetes as compared to age-matched controls. There was no significant reduction of axonal area in this group of diabetic rats, so diminution of fiber area was caused predominantly by reduction of myelin sheath area. The study demonstrates that the induction of diabetes mellitus in rat by streptozotocin is accompanied by early changes of the morphometric indices of myelinated nerve fibers of peripheral nerve.

Aims: Incidence of early myocardial changes in asymptomatic diabetic individuals is not clearly documented. In the present study, we examined diabetic patients without a history of cardiovascular disease with negative treadmill test and no signs of systolic dysfunction for presence of cardiac autonomic neuropathy established by measurement of heart rate variability (HRV) and 99m Tc -Myoview gated-SPET. Materials and methods: 47 type I and type II diabetic patients were subjected to prospective study including echocardiography and HRV measurement using the combination of Ewing´s testing and spectral analysis. Subsequently, patients underwent treadmill test and stress myocardial perfusion scintigraphy. Additionally, vascular and metabolic parameters were collected. Results: Treadmill test was negative in all patients. Diastolic dysfunction was found in 10 % of T1DM and 11 % of T2DM patients by echocardiography, whereas none of the patients had systolic dysfunction. SPET confi rmed hypoperfusion in 35 % T1DM (p=0.01) and in 60 % T2DM (p=0.001). Diagnosis of cardiac autonomic neuropathy based on Ewing´s testing and HRV examination was established in 60 % of T1DM patients (p=0.001) and 77 % of T2DM patients (p=0.001). In T1DM group, signifi cant association was found between cardiac autonomic neuropathy (CAN) and frequency of hypoglycaemia (p=0.04). No such correlations were found in patients with T2DM. Conclusion:The results of the present study show high incidence of myocardial hypoperfusion and cardiac autonomic neuropathy among asymptomatic diabetic patients, whereas the standard diagnostic approaches including treadmill test and echocardiography failed to show any changes. Therefore, we conclude that diabetic heart disease remains underdiagnosed by standard approaches, but could be detected in asymptomatic patients by more sensitive methods, such as HRV measurement and myocardial scintigraphy (Tab. 2, Fig. 2, Ref. 26). Text in PDF www.elis.sk.

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I. interná klinika, Univerzitná nemocnica a JLF UK v Martine Akútna disekcia aorty typu A je život ohrozujúci stav a významnou príčinou morbidity a mortality. Jej typickým symptómom je náhle vzniknutá bolesť na hrudníku, ktorá sa vyskytuje u viac ako 85% pacientov. Akútna bolesť na hrudníku vedie k podozreniu na akútny koronárny syndróm a ak zmeny na elektrokardiograme naznačujú možnú ischémiu, pacientom je podaná antitrombotická liečba. U niektorých pacientov bolesť na hrudníku nemusí byť prítomná, môže byť prítomný ložiskový neurologický deficit, ktorý sa objavuje ako jedna z komplikácií šírenia dissekcie na veľké artérie. Autori v práci popisujú troch pacientov s akútnou disekciou aorty typu A. Dvaja z nich nemali akútne bolesti na hrudniku, dominoval u nich ložiskový neurologický deficit. Tretí pacient mal typické akútne bolesti na hrudníku, na elektrokardiograme suspektné ischemické zmeny, čo viedlo k podozreniu na akútny koronárny syndróm. Autori prezentujú, že akútna disekcia aorty typu A môže byť ľahko prehliadnutá, preto je potrebné na túto diagnózu myslieť, aby sa včas diagnostikovala a bola zahájená okamžitá adekvátna liečba.Kľúčové slová: aorta, akútny koronárny syndróm, cievna mozgová príhoda, disekcia aorty typu A. Dissection of ascending aorta, a diagnosis needs to remember about itAcute type A aortic dissection is a life-threating condition, and is associated with significant morbidity and mortality. Patients typically present with the acute onset of chest pain, which occurs in up to 85% of cases. Acute chest pain may lead to the suspicion of acute coronary syndrome, and as the electrocardiogram may indicate ischaemia, patients are given anti-thrombotic treatment. Some patients can present without chest pain, but with focal neurological deficits, which can occur with involvement of the great vessel. The authors described three patients with acute type A aortic dissection. Two of them did not present with the acute onset of chest pain, but with focal neurological deficits. Third patient presented with the acute onset of chest pain and the electrocardiogram indicated suspected ischaemia, which led to the suspicion of acute coronary syndrome. The authors presented, that diagnosis of acute type A aortic dissection can be easily overlooked and a high index of suspicion is needed to obtain a timely diagnosis such that appropriate initial therapy can be instituted promptly.