Czechoslovak medicine最新文献

Using the Western blot method, the authors analyzed 85 sera obtained from patients with rheumatic diseases, focused on the presence of antihistones and antiactin autoantibodies. The authors detected a 32% incidence of the two investigated autoantibody specificities. In a group of 42 patients with systemic lupus erythematosus in 22 sera (52%) positive antihistone antibodies were present, whereby autoantibodies anti-H1 and anti-H2B were most frequent. In 15 sera in this group of patients (36%) antiactin autoantibodies were present.

The author analyzes retrospectively a group of 11 casualties who had treatment during 1985-1990 in VUTSCH Brno on account of a Monteggia fractures. The low frequency of these fractures is compared with the overall activity of the Institute. The fractures were caused most frequently by traffic injuries, less frequently by a fall. The author presents an account of associated injuries in the investigated group of patients. Classification into different types based on X-ray examination was possible only in a general way, the majority of dislocations was not typical, mainly fractures caused by considerable force were involved. The author describes treatment (with the exception of one patient who died from associated surgical injuries) and the results achieved: two subjects died during the early postoperative period from sequelae not associated with the Monteggi fracture, two patients could not be traced. In the remainder excellent results were recorded three times, good results twice and poor results once; one female patient is still being treated and it is assumed that the results will be excellent. From the discussion the following conclusions ensued: 1. Monteggia fractures should be considered important for the function of the affected extremity and should be treated as such without delay and perfectly. 2. The basis of treatment is anatomical reconstruction of the ulna by stable osteosynthesis. 3. Surgical reposition of the head of the radius is reserved for those cases where spontaneous reposition failed. Fractures of the head of the radius must be treated, however, primary resection and extirpation must be avoided. 4. Additional external fixation must not be excessive.

In 10 patient-sibling pairs (sibling perspective bone marrow donor) the author typed HLA-A, B, DR and specific monocyte antigens MoP-1 to 6. Concurrent HLA-A, B and MoP identity was revealed in 80% of the cases, concurrent HLA-A, B, DR and MoP agreement in 60%. The author discusses the importance of this observation for the solution of the relationship between HLA and specific monocyte antigens. He recommends typing of specific monocyte antigens before transplantation of bone marrow as another way of donor selection.

The submitted prognosis of need of personnel to ensure specialist diabetological care in the Czech Republic is based on an analysis of the development of the number of diabetic patients and on analysis of activities which must be provided to diabetics in order to maintain the selected standard of health care. The estimate of the future number of diabetics is assessed by the method of demographic projection for one-year age groups, separately for men and women. The analysis of activities in diabetological care was elaborated from the results of an anonymous survey among diabetologists in the South Moravian region. Reflections on different variants of the standard of provided care respect also the analysis of the hitherto recorded trend in the number of health workers in diabetology and their available time. The estimate of needs is objective and can be applied in specialized diabetological services as well as in a different organization of care of diabetics, e.g. by the general practitioner. The contemporary organization of care of diabetics cannot ensure the required standard of care. The prognosis submits several possible ways how to achieve this standard. The prognosis deals in particular with the number of working hours of doctors but does not omit other categories of health workers.

The authors report on tuberculosis situation in the Czech Republic (CR) in 1989 and compare the data with 1988. The incidence of all cases of respiratory TB was 15.5 and that of bacteriologically confirmed cases 11.1/100,000. The mortality from TB was also low (1/100,000). Two-thirds of the patients were detected because of the patients' complaints. This passive case - finding was, however, inadequate in subjects with a poor health consciousness. Active screening was restricted to subjects with a high risk of TB (in contact with tuberculosis, with different diseases, with socio-economic factors, migrating subjects, non-cooperating subjects). In 1989 for the first time in the CR stagnation of the incidence of bacteriologically confirmed TB of the respiratory organs was recorded. The number of patients (5.7/100,000) with TB with a microscopically positive bacteriological finding in sputum was also the same. A slowing down of the hitherto recorded favourable trend of TB must be foreseen. It will be important to maintain the contemporary system of TB surveillance.

A study was made of changes in the ratio of CD4+/CD8+ in patients who had received cadaverous kidneys and who were under treatment with a combination of cyclosporin A + azathioprine + cor ticosteroids. The results showed that one month after the transparent there was a significant drop (P less than 0.05) in the immunoregulation index compared with the pretransplantation values. Throughout the whole period a correlation (r = -0.65, P less than 0.05) was found between the CD4+/CD8+ ratio and serum, creatinine. In recipients with acute rejection episode no significant difference was found between the CD4+/CD8+ values before the rejection episode (7 +/- 1 days and 3 +/- 1 days) and after it was diagnosed. The introduction of monoclonal antibodies specific for determinants in T-lymphocyte transplantation. Many authors have investigated changes in the CD4+ (helper inducer) to subpopulations (1) made possible immunological monitoring following the organ CDB+ (cytotoxic suppressor) ratio following the organ transplant (2, 3, 4, 5). Some reports (6, 7) have indicated that during rejection of a transplanted kidney there is a rise in the immunoregulation index (CD4+/CD8+), while other works (8, 9) failed to confirm this. Our work presents the dynamics of changes in the CD4+/CD8+ ratio in peripheral blood of recipients of cadaverous kidney transplants, and points to changes in the immunoregulation index before and during acute rejection episodes.

The following results were obtained in an experimental study in the dogs in general pentobarbital anaesthesia: Lidocaine type antiarrhythmics (lidocaine, Xylocaine ASTRA, Ethmozin USSR) administered shortly before artery ligation have a pro-fibrillation effect. This effect is indirectly proportional to the ischaemic focus development. A 3rd-generation beta blocker with intrinsic sympathetic activity (celiprolol, Selectol Chemie-Linz) had the same electrostabilizing effect on the ventricles in the acute phase of ischaemia as a 1st-generation beta blocker (metipranolol, Trimepranol SPOFA). The 3rd-generation blocker, however, stopped short of provoking a drop in the heart rate invariably associated with the 1st-generation beta blocker. The analgesic fentanyl (G. Richter) in combination with benzodiazepine (m,idazolam, Dormicum Hoffmann-La Roche) inducs analgosedation. In this way the dose of the analgetic can be reduced and yet the analgesia and electrostability of the heart remain the same. Due to the lower dose of the analgesic there is a lesser decrease in the heart rate and blood pressure. Analgosedation can be discontinued by administering an antagonist-agonist of benzodiazepines (flumazenil, Anexate Hoffmann-La Roche) or an antagonist of potent analgesics (butorphanol, Beforal SPOFA) without the risk of eliminating, at the same time, the electrostabilizing effect of analgosedation on the ischaemically damaged ventricles of the heart. For the prevention of sudden coronary death due to ventricular fibrillation in the acute phase of local myocardial ischaemia we can, on the basis of our experimental results, recommend analgosedation and the use of beta blockers with intristic sympathetic action. The use of lidocaine antiarrhythmics may lead to a reduction in the electric stability of the heart ventricles the ischaemic focus is developing under a certain "critical" blood level of the antiarrhythmics.

The rapid weight decrease at the beginning of strict slimming regimens leads often to an inconsiderate shortening of these cures. Our long-term experience with a slimming regimen lasting 13 days based on diet (3.7 MJ) and 4 hours of supervised exercise of low to moderate intensity was omitted by the organizers. They shortened the cure to 8 days. We checked therefore a group of obese women on the first, eight and twelfth day in the course of this regimen. A statistically significant decrease of serum insulin, growth hormone, triiodothyronine and cholesterol was observed on the twelfth day. These trends were not significant on the eighth day. On the other hand, the step-test revealed on the eighth day a reduction of the heart rate during recovery. Nevertheless, a higher level of significance was obtained after 12 days. No significant response to the regimen was obtained in the case of blood glucose, thyroxine, cortisol, uric acid, AST and ALT. The advantages of the 12-day regimen are discussed--especially the decrease of insulinemia, because hyperinsulinemia is responsible for several complications of obesity. The importance of the decrease of cholesterolaemia and the modification of heart rate after a load was also stressed. These favourable effects are not depreciated by a smaller weight loss in the second week due to an enhanced protein synthesis, stimulated by exercise and supported by a decrease of T3 which protects the organism against energy deficit.