Czechoslovak medicine最新文献

Diabetic nephropathy affects half the type 1 diabetics and is the most frequent cause of death there. While in some countries diabetics account for 25-30% of all patients newly admitted in dialysis and transplantation programmes, in Czechoslovakia the number of diabetics treated by dialysis or transplantation is small. From August 1985 to June 1988, 15 isolated kidney transplant operations were performed on 13 diabetics with serious late complications of diabetes. By the time of writing, all recipients had been surviving (for 1 up to 35 months), and only two were receiving artificial kidney treatment. Progressive vascular complications were in two cases the cause of gangrene of the lower extremity, one patient had a central cerebrovascular attack. Despite this, successful transplantation resulted in a marked improvement of the patients' general condition and quality of life. Due to intensified insulin therapy, diabetes, too, was satisfactorily compensated in the majority of the recipients. As experience so far indicates, if the patient is prepared in good time, which includes diabetological, nephrological and ophthalmological treatment, the results of transplantation in diabetics can be comparable to those achieved in non-diabetic patients. Renal transplantation in diabetics should be developed in all transplantation centres in Czechoslovakia, and uraemic diabetics should not be eliminated from the dialysis-transplantation programme except in cases of serious contraindication.

A complex morphological examination of the placentas of the prematurely delivered newborns revealed that in a part of them there was a complex of changes detectable either by a naked eye immediately after delivery or by the use of light and electron microscope, respectively. The changes observed were characteristic of premature maturation of placenta, some changes, however, were similar to those present in the placentas of the term delivered intrauterine growth retarded newborns. The most important were the following changes: underweight of placenta, placental infarctions, capillary haemangioma, increased amount of fibrinoid, small and focal circulatory defects, reduction of the microvillous border and of the pinocytic activity of the syncytiotrophoblast, focal to diffuse thickening of the basal membrane with an increased number of collagen fibrils and fibroblasts in the stroma of terminal villi. These changes resulted in deterioration of the intrauterine state of the foetus and in premature delivery of frequently intrauterine growth retarded newborn. Such changes did not occur in all placentas under study. They indicate, however, the possibility of the occurrence of chronic placental insufficiency in a part of the pregnant women treated for the imminent premature delivery. From this follows the necessity of monitoring the placental functions and the state of the foetus with a subsequent differential approach to the therapy of such patients.

The plasma concentration and renal elimination of phenols was studied in 32 individuals with various renal insufficiency (CRI) and in 30 healthy subjects. In patients with chronic renal insufficiency the increase in P phenols values correlated directly with Per and P urea. Daily urinary excretion of phenols in patients with CRI is only mildly decreased compared with that in healthy controls. Renal clearance (C phenols), 8.52 (+/- 2.69) ml/min on an average, decreases significantly in patients with CRI. While fraction excretion of phenols (FE phenols) was 9.53 (+/- 4.14) % on an average in healthy persons, patients with CRI displayed a significant increase. A significant linear correlation in the values of FE phenols and FEH2O and those of FE phenols and FE urea was documented. Our findings support the assumption that phenols are excreted by the kidney by a mechanism similar to that of urea excretion. Filtration of phenols in the glomeruli is followed, in healthy volunteers, by their significant reabsorption which is a flow-dependent process. In the residual nephrons of patients with CRI, the tubular reabsorption of phenols is decreased, a mechanism largely compensating the effect of decreased filtration of phenols on their total urinary excretion.

During a 24-hour interval, examination was carried out of 5 full-term and 4 preterm newborns in whom no disturbance of postnatal adaptation was found. The newborns received parenteral nutrition using infusates containing 20% Intralipid during 7 hours on the average. The mean daily dose of Intralipid was 1.2 g/kg, infusion rate was 0.17 g/kg/h. The concentration of FFA (n = 9) and ABC/Bi was examined three times in the course of 24 hours, and that prior to Intralipid administration, after one-hour infusion, and approximately 17 hours after the end of infusion. Before infusion and 24 hours after the first collection, blood bilirubin and glucose concentrations, and the values of pH, pCO2 and BE (= 9) were examined. One hour after the start of Intralipid infusion the mean FFA concentration was reduced and decreased again during the following 23 hours. The differences were mostly insignificant. One hour after the start of infusion the mean value of the ABC/Bi ratio decreased insignificantly, but returned to the initial value by the end of the follow-up period (24 hours). The mean concentration of bilirubin and blood glucose and the values of pH, pCO2 and BE did not change significantly. It may be reasonably assumed, that in newborns showing normal postnatal adaptation in the first days of life, the administration of 20% Intralipid (as parenteral nutrition) exerts no substantial effect on the plasma FFA concentration and ABC/Bi ratio in the course of 24 hours. General principles for the indication of parenteral Intralipid administration to the newborn are given.

Using the method of 99mTc-DTPA (diethylenetriaminepentaacetic acid), sequential renal gammagraphy with subsequent glomerular filtration rate determination by means of a gamma-camera and computer, a total of 285 patients with suspected renal and urinary tract diseases, subjects after surgery on these organs or those serving as controls after drug therapy were examined. With the help of a modified computer user's program, a study was designed to perform quantitative evaluation of some functional parameters as well as determination of total and separate glomerular filtration rate values by 99mTc-DTPA according to Gates. The benefits of the method employed in our study are that it is non-invasive, rapid, atraumatic, with low exposure to radiation while offering a broad range of applications in routine diagnostic practice of nephrology, and especially so in paediatric patients.

In this article, the authors present their experience with the diagnosis of bone metastases in patients with breast cancer using bone scintigraphy with 99mTc phosphonate and radioimmunological determination of carcinoembryonic antigen (CEA) and tissue polypeptic antigen (TPA). In a group of 395 patients, there was agreement between tumour markers (CEA, TPA) and the results of bone scintigraphy in 331 cases (84%)--negative in 193 cases (49%) and positive (i.e. in terms of bone scintigraphy results and the presence of at least one tumour marker) in 138 cases (35%). On the basis of this good agreement of the results between bone scintigraphy and CEA and TPA levels, the authors recommend the following algorithm in monitoring patients with breast cancer: follow-up of tumour markers at several-month intervals and, any increase in their levels will refer the patient to further examination using imaging techniques including bone scintigraphy.

Atrial natriuretic factor (ANF) is a humoral agent isolated in recent years from cardiac atrial tissue, and produced by atrial cardiocytes as a peptide precursor containing 152 amino acids. In secretory atrial granules, it is stored in reserve form as a prohormone and released into circulation as a 28-amino acid peptide from the C-terminal portion of the peptide precursor representing the active circulating hormone. ANF possesses potent natriuretic, myorelaxant, vasodilatory and blood pressure-lowering properties. Besides, it inhibits renin, aldosterone and vasopressin secretion. It is present also in the CNS and its function is closely related to the sympathetics nerves. By its direct renal and vascular effect, renin-angiotensin-aldosterone system and vasopressin inhibition and, by its neuromodulatory action on the central and sympathetic nerves, ANF plays an important role in electrolyte, volume and pressure homeostasis. The development of a radioimmunoassay for ANF determination in the plasma of rats and man enabled us to follow up its changes under various experimental conditions (water deprivation, increased or decreased salt intake, effect of anaesthetics, ontogenetic changes in ANF concentration during development of hypertension in the spontaneously hypertensive rat) and in clinical studies (effect of ECV expansion in controls, arterial hypertension, liver cirrhosis as well as ANF changes in congestive heart failure or chronic renal failure). These findings of ours have supported the concept that ANF represents an important adaptive and corrective mechanism mobilized during intravascular volume and blood pressure changes in an effort to normalize these. ANF is expected to find use also in the treatment of oedema, arterial hypertension and acute renal failure.

Periapical granulomas have been investigated histologically, immunohistologically using polyclonal and monoclonal antibodies, as well as electronmicroscopically. Lesions were formed by inflammatory granulation tissue frequently with foci of purulent exudation and fibrosis. Most numerous were plasma cells usually in cellular regions of the granulation tissue where they were tightly pressed. Of other cellular types were numerous lymphocytes, fibroblasts, less frequent were macrophages, scattered granulocytes and mast cells. More than a half of the plasma cells were IgG positive, about 20% IgA positive, up to 10% IgM, rarely IgE and sporadically IgD positive cells. In the vascular walls and their surrounding as well as in the phagocytes fine granular to granular positivities of C3 and C4 components of the complement were present. The majority of lymphocytes beared markers of T lymphocytes of which the T-suppressor markedly prevailed over the T-helper lymphocytes. In electron microscopy the plasma cells were most frequent. They were usually close to each other, sometimes with a disintegrated cytoplasmic membrane and non-damaged organelles being free around the nucleus. Mast cells were numerous and did not show any signs of marked degranulation. Rich production of immunoglobulins as well as the presence of IgG and IgM positive material in phagocytes, and the presence of positivities of the C3 and C4 components of the complement in the surrounding of the vessels and in phagocytes on the other hand supported the presumption that immune complexes participate in the pathogenesis of periapical granulomas. In spite of the presence of the IgE producing cells the morphological picture of mast cells did not suggest the presence of anaphylactic reaction in periapical lesions. Diffuse distribution of T lymphocytes, moreover with the prevalence of T-suppressor/cytotoxic over T-helper lymphocytes and not numerous macrophages in the inflammatory infiltrates did not suggest the participation of a typical cell-mediated immunity reaction in the development of periapical granulomas. Numerous T-suppressor/cytotoxic lymphocytes and low numbers of macrophages can be important factors of the chronicity of periapical inflammatory diseases.

In our group of newborns we have observed that the rate of occurrence of incompatibility states between blood group 0 mothers and their blood group A or B offspring amounted to 14%. It was in every tenth newborn that this incompatibility became manifest as a haemolytic disease requiring treatment. There were no significant differences between blood group A or B newborn infants, either in the frequency rates of hyperbilirubinaemia or in the uniformly indicated therapeutical measures. Among the neonates treated successfully by phototherapy boys prevailed significantly. In contrast, among the most severe forms of the ABO haemolytic disease, requiring blood exchange transfusion, there was a significantly higher prevalence of girls. In relationship to the time of institution of phototherapy as a method of treatment, there occurred a significant decrease of the rates of newborns treated by exchange transfusion. This was due specially to a significant decrease of the necessity of performing this procedure in blood group A boys.