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Insulin lispro was compared with regular human insulin with respect to glycaemic control in patients with diabetes mellitus on intensive insulin treatment. Sixty-two patients (55 type 1; 7 type 2) from eight study centres in the Czech Republic, Slovenia and the Slovak Republic participated in a 4-month, open-label, randomized, crossover study. Patients administered insulin lispro immediately before meals or regular human insulin 30 min before meals. A test meal (220-400 kcal), based on local and individual dietary habits and consistent for each patient throughout the study was given at baseline and at the end of each treatment. At each test meal visit HbA1c, fasting blood glucose, 1-hour and 2-hour postprandial blood glucose levels were measured. The level of HbA1c (7.6% +/- 1.5% versus 7.4% +/- 1.5%), incidence of hypoglycaemia (41-66% of patients--versus 39-63%) and daily insulin dose (0.67 +/- 0.11 U/kg versus 0.65 +/- 0.11 U/kg) did not differ between treatment groups at endpoint (insulin lispro versus regular human insulin, respectively). Mean 2-hour postprandial blood glucose excursion for the insulin lispro group (0.0 +/- 3.7 mmol/L) was significantly lower (p = 0.035) when compared with the regular human insulin group (1.3 +/- 3.7 mmol/L) at endpoint. Therapy with insulin lispro was therefore associated with a significant improvement in postprandial blood glucose excursion control when compared with regular human insulin, without an increase in rate of hypoglycaemia.

Reports maintaining that sperm concentration in male ejaculates had decreased markedly over the past decades captured mind-share all over the world. However, literary data diverge about such a lasting trend. Our objective has been to contribute to the ongoing debate by presenting results of our own research. We have studied semen analyses of 5,363 men who had been tested at an outpatient care unit of the Prague Institute of Sexology between 1950 and 1984. These semen analyses measured volume of the ejaculate, sperm concentration, sperm motility, and a share of sperms with morphological abnormalities. None of these values showed statistically significant deterioration among seven groups of patients, each spanning five years. Therefore, our data did not confirm the above-mentioned lasting trend in semen analysis values. Research teams from all over the world have recently attracted a lot of attention by reporting a no-table decrease over the past decades in sperm concentration in the male ejaculates. However, literary data diverge about such a lasting trend. Our objective has been to contribute to the ongoing debate by presenting results of our own research. We have analysed semen tests filed in the archives of the Institute of Sexology at the 1st Faculty of Medicine of Charles University. We have studied a set of 5,363 men who had undergone their first sperm analysis between 1950 and 1984. We have gathered our data from medical records, using a uniform pattern of investigation. The set was divided into seven five-year groups based on the year of the first analysis. Volume of the ejaculate: The groups showed the following average volume of the ejaculate: 3.9-3.8-3.8-3.8-3.8-3.7-3.7 (ml). Neither the distribution nor the mean value of this variable has changed much over time. Sperm concentration: The groups showed the following mean sperm concentration: 32.9-42.3-56.2-57.9-72.2-70.8-72.3 (million per ml). It is obvious from these results that the mean sperm concentration increased over time in our set. Sperm motility: The groups showed the following mean sperm motility: 34.7-46.4-53.3-57.7-59.6-58.5-58.2 (per cent). Sperm morphology: The share of ejaculates with a high percentage of morphologically abnormal sperm cells has not grown much. Our data did not confirm the hypothesis that sperm analysis results have been gradually worsening. We have not found deteriorating trends in any of the sperm quality measures in the five-year intervals between 1950 and 1984. Although our results cannot close the debate about purported deterioration of sperm analysis results, they seem to indicate that we should take reports of universal decrease in sperm concentration in the seminal fluid with a grain of salt.

The occurrence of cardiac dysrhythmias have been analysed in 16 adult patients suffering from obstructive sleep apnea syndrome of various severity randomly selected from more than 300 persons examined in our sleep laboratory from 1996 with a complex polysomnography Alice 3 (Healthdyne). The number of apneic episodes emerging in the first, second and third part of sleep was practically the same although their duration prolonged during the night culminating with an average of 25 sec (p < 0.02). OSA episodes caused a decrease of oxyhaemoglobin saturation to lower values during REM compared to NREM sleep (76.1% versus 81.7%, p < 0.05). Cardiac dysrhythmias occurred more frequently during and immediately after, than before OSA episodes demonstrating their causal relations.

Authors describe a case of 100 kg weight loss of 20 years aged old patient with the incipient body weight 174 kg (BMI = 64 kg/m2) during four years using combination of dietary intervention (2; 5; 6.7; 7.6 MJ), increased physical activity and repeated surgical resection of cutaneous lobes. Development of laboratory parameters, resting energy expenditure, correction of hypertension and hyperuricaemia are documented.

Background: B-chronic lymphocytic leukemia (B-CLL) is the most common adult leukemia in the Western countries. Any routinely used staging system does not distinguish exactly the probable course of the disease at the time of diagnosis. Therefore the new prognostic factors, which help to assess the optimal therapeutic plan of patients, are searched intensively.

Methods and results: We evaluated 154 patients with the B-CLL at the time of diagnosis--133 of them were retrospectively divided into two groups--one with stable form and the other with progressive form of the disease. We compared these two groups of patients with some of the prognostic factors (absolute lymphocyte count, the level of C-reactive protein, lactatdehydrogenase, beta-2-microglobulin, tumour necrosis factor, the immunoglobulin levels, the expression of CD38, FMC7, surface immunoglobulins, the type of bone marrow infiltration, and the cytogenetic abnormalities (trisomy 12, del(13)(q14), del(17)(p13) a del(11)(q23)). We found higher absolute lymphocyte count, level of beta-2-mikroglobulin, tumour necrosis factor, expression of CD38, light chains lambda, lower expression of FMC7 and less frequent nodular type of bone marrow infiltration by the patients with progressive disease. The correlation of the cytogenetic abnormalities and the course of the disease or stage according to the RAI et al. [27] staging system were not significant may be due to the small number of evaluated patients and short period of follow up.

Conclusion: The routine evaluation of some risk factors in patients with B-chronic lymphocytic leukemia at the time of diagnosis helps to distinguish those with the probable more aggressive course of the disease and have the implication for the design of risk-adapted treatment strategies. The prognostic impact of the cytogenetic abnormalities and other risk factors has to be evaluated on larger group of patients during longer follow up period and repeated evaluations.

Unlabelled: Multiple myeloma plasma cells are actively dividing cells with the long surviving ability in the ex-vivo culture. In the effort for better understanding of the proliferative potential of malignant myeloma cells and establishment of permanent myeloma cell lines we performed long term cultures of human myeloma cells ex-vivo. During the last two years we cultured 41 bone marrow samples from 39 patients with multiple myeloma. Cells were cultured in the RPMI 1640 culture medium with 15% fetal calf serum at 37 degrees C in 5% CO2 and approximately one third of the culture medium was changed regularly twice a week. Most of the marrows cultures died by apoptosis within 30 days. Four bone marrow samples were cultured for more than 11 months, however, no culture can be qualified as an established cell line. In three cases permanent B-lymphoblastoid cell lines were established (UHKT-55, UHKT-56 a UHKT-57) but secondary immortalization by Epstein-Barr virus was suggested.

Conclusions: Presented results suggest that myeloma plasma cells can survive and are able to proliferate in the ex-vivo culture for several months up to one year independently on the addition of any external growth factor without spontaneous apoptosis or necrosis. The probability of the establishment of a permanent cell line of plasma cell origin is, however, low. Presence of accessory bone marrow cells was the most important factor for the long-term survival of myeloma cells.

Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary disease of kidney. The renal function is impaired by the development of the cysts. Patients with ADPKD have often affected other organs. Nowadays there is established linkage analysis of ADPKD using microsatellites in Czech Republic. Molecular analysis allows presymptomatic diagnosis in risk-individuals and prenatal diagnosis in affected families. The detection of mutations is performed supporting by the grant in Czech Republic. The detection of mutation will contribute to more precise diagnosis in controversial cases.

The gastric bandage is reliable method for long time control of weight loss in failed conservative cure of morbid obese patients. Since 1983 we have been concerned with bariatric surgery at the First Surgical Department of General Faculty Hospital of Charles University. 691 morbid obese patients (BMI 49.7 kg/m2, mean age of 38.1) underwent gastric banding (GB)--by laparotomy 58 obese patients and since 1993 by laparoscopy 633 obese patients. After 12 months the mean weight loss was 21.1 kg (14-32 kg) and after 24 month the mean weight loss was 38.7 kg (27-73 kg). In period of 1993-1998 the most frequent late complication in the group of 517 obese patients after laparoscopic nonadjustable gastric banding (LNGB) was in 5.1% dilatation of upper gastric pouch or slippage of anterior stomach wall above the band with vomiting and failure of gastric evacuation. In majority we removed GB laparoscopically. To prevent this complication we modified GB with fixing band with a cuff made from the anterior gastric wall. To test the effectiveness of this method we implemented in 1998-1999 a prospective randomized study. In the group of 80 morbid obese patients we created in 40 patients (n1-GB+C) LNGB with the cuff fixation and in 40 patients (n2-GB-C) without fixation. We followed-up of this patients after LNGB was in 6 weeks, 6 months and 12 months with measurement of pouch volume by endoscopy with calibrate endocannula. One year after GB in the group n1-GB+C the mean increase of the pouch volume was 14.6 ml, i.e. 124% of the original size, while in group n2-GB-C the mean increase of the pouch volume was 33.6 ml, i.e. 154.1% of the original size. The slippage or dilatation of the pouch was in group nl in one case while in group n2 in three cases (p < 0.001).

Percutaneous electrogastrography (EGG) is a non-invasive measuring method of gastric myoelectrical activity. We measured myoelectrical activity patients after laparoscopic cholecystectomy (16 patients), after laparotomic cholecystectomy (9 patients) and after gastric bandage (14 patients). We used a Microdigitrapper (Medtronic) and data were analysed with a spectral analysis and Fournier's transformation. We measured 24 hours and 5 hours before operation procedure and 24 and 48 hours after operation. After operative procedure we compared results with healthy voluntaries. Bradygastria was found in most frequent cases in early postoperative period. Physiologic conditions were renewed in laparoscopic operative procedure in first day, after laparotomic operation in second day after operation.

Abdominal and gluteal (waist and hip) circumferences are accepted as indicators of central fat distribution and abdominal (waist) circumference is generally regarded as a simple anthropometric measure of visceral fat distribution. In the years 1987-88 there was carried out an anthropometric survey on the whole region of former Czechoslovakia, which was done in 16,400 of adult men and women, aged 20 to more than 70 years on the basis of the three grade statistical choice. Except for many other anthropometric measures, abdominal and gluteal (waist and hip) circumferences were estimated according to Martin and Saller [1957] (M62/1; M64/1). The results show that gluteal (hip) circumference is longer than abdominal (waist) circumference in adulthood similarly as in childhood. Abdominal circumference is longer in men than in women in agreement with sexual dimorphism. Abdominal circumference is not significantly different in Czech and Slovak men and Czech and Slovak women. Nevertheless, in Slovak women increases their abdominal circumference to maximum at the beginning their fifth decade and then decreases concurrently with lowering of BMI while in Czech women increase in abdominal circumference lasts till seventh decade. Maximal intersexual difference is found in the third decade (21-25 years) and at the end of follow-up in both populations. Gluteal (hip) circumference is not significantly different in men and women to the half of the forth decade in both Czech and Slovak populations. Afterwards it is markedly longer in women probably due to the higher accumulation of subcutaneous fat. In the second part of seventh decade in Czech population and about five years earlier in the Slovak group the circumference is getting shorter on the average value in men. This change can be caused by the age involution of adipose tissue. The examined data were constructed into percentile nets of the abdominal and gluteal circumferences for both men and women and Czech and Slovak populations.