Czechoslovak medicine最新文献

20 healthy full-term infants have been studied in their 2nd, 10th, 18th and 26th weeks of life in three standard situations: before feeding, in the course of milk drinking and after feeding. A polygraphic record of sucking, breathing, swallowing, the oculomotor activity, the EEG and vocalization has been taken simultaneously with a video-recording of the infant's behaviour. Physiological patterns and developmental changes of sucking, breathing and swallowing are described. These activities are considered as fine motor activity of the earliest age. The possibility of using polygraphic recordings of these variables for the diagnosis of the neurological syndrome called feeding problems is discussed. Further, behavioural activities in above mentioned three situations and their developmental changes, are described. None of the infants, not even the smallest ones, were asleep in the beginning of feeding. On the contrary, their eyes were open and there were more eye movements during feeding than in other situations. In the authors' opinions, the situation of feeding has, especially in the first days and weeks of life, a special significance for the development of social interactions between the infant and the person taking care of him. The behaviour of a regularly fed infant in the second quarter of his first year seems to be no longer influenced in the periods proceeding and following the feeding act by the prandial cycle but rather by cognitive needs. The influences involved in the regulation of the behaviour of the youngest infants are discussed.

The authors present partial results of a prospective study conducted in 65 insulin-dependent diabetics with varying duration of disease in whom development of micro-angiopathic organ alterations is followed in relation to diabetes compensation and development of clinically manifest proteinuria or to albumin excretion (microalbuminuria). The results suggest that the increase in albumin excretion in recent-onset and non-recent-onset patients is in most cases only an expression of changes in renal function due to metabolism and therapy and apparently of little value in predicting the risk of developing diabetic nephropathy. The situation is not so unambiguous in patients with long duration of diabetes and, in case increased albumin excretion remains unchanged or further increases despite intensive insulin therapy, it may serve most likely as a marker of high risk of developing diabetic nephropathy.

The authors offer their experience with the use of the ileocoecal segment for orthotopic bladder replacement (in 7 patients) or augmentation (in 2 patients) in contracted bladders after multilpe trauma. The group of patients was followed up for 6-35 months. In no case did replacement result in adverse metabolic changes, and it was invariably instrumental in normalization of the upper urinary tract, if dilated. By virtue of its hypotonic nature, replacement was not associated with incontinence, with urge incontinence persisting only in patients undergoing augmentation, probably in view of the remaining spacious lower urinary bladder segment with inadequate neurogenic signalization. As both intervention provided patients with a sufficiently long intermicturition intervals thus giving them relative comfort, the response by patients was most favourable.

The first part of the study gives data on the FFA concentrations, glycaemia and energy quotient in newborns with uncomplicated postnatal adaptation in the first 2 weeks of life. The study was carried out in a group of 69 full-term and 69 pre-term infants at the age of 24, 48, 72, 96 hours and 7 and 14 days. Although it is not the case of consecutive values of FFA concentrations in plasma, a certain developmental trend can be suggested. This is analogous in both groups with the only difference that in pre-term infants FFA culminate and decrease earlier (pre-term 48-72 hours, full-term infants 72-96 hours). The study shows that, in pre-term and full-term infants with satisfactory postnatal adaptation and above nutrition, stabilization of glucose-lipid metabolism occurs on the 3rd and 4th day after birth, respectively. In pre-term infants supplementary nutrition by the glucose system (glucose and amino acids) had a favourable effect. The second part of the study assesses the potential risk of increasing plasma FFA concentration for the separation of bilirubin from albumin binding. The means plasma FFA concentrations reached 25-48 and 49-72 hours after birth had no significant effect on the BCA/Bi ratio and, therefore, they are not dangerous as regards the possibility of displacing bilirubin from albumin binding.

A total of 150 offspring of diabetic mothers, born and followed up at the institute of Care for Mother and Child, were examined at a mean age of 20 years. A control group consisted of 34 age-matched subjects without a family history of diabetes. Diabetes mellitus was diagnosed in 7.3% (in (children of seven mothers) of the followed up offspring of female diabetics. While normal glucose tolerance was found in 82%, impaired glucose tolerance was present in 6.7% and borderline values in 4%. However, compared with control group levels, mean glycaemic values following glucose load were increased even in the offspring of diabetic mothers with normal glucose tolerance. Mean insulin levels were likewise increased, and were highest in the group of children with impaired glucose tolerance. Nineteen percent of the children on follow-up lost their mothers already during adolescence, at a mean age of 15 years, when their mothers were 41 years old. Thirty-seven percent of mothers were recipients of disability pensions due to diabetic complications. Children of diabetic mothers represent a group at high risk requiring follow-up also in adulthood.

75 healthy men and women, aged from 20 to 45 years, were divided into five groups of 15 persons each. Na131I resorption halftime values from the examined area of the gingiva, pulse frequency as well as systolic and diastolic blood pressure were examined. Tests were carried out twice. One group served as a control group. During the second test emotional, light, sound or tactile impulses were applied to the other groups. The control group that was not exposed to any of the impulses investigated during the second examination showed no significant differences in values with any of the observed indices. Under the influence of emotional, sound or light impulses, a significant increase in pulse frequency as well as in systolic and diastolic blood pressure was noted. This suggested that both the one-minute volume and the peripheral resistance of the circulation system increased. Na131I resorption half-time values from the examined area of the gingiva significantly increased under the influence of emotional and sound impulse by 64%, of light impulse by 84% and of tactile impulse by 93%. This meant that the blood flow through the capillary gingival bed had significantly reduced due to the influence of these impulses. It is to assume that their long-term influence could contribute to the development of parodontopathies.

The kinetics of mixed lymphocyte reaction (MLR) was studied in an unrelated pair of potential kidney graft donor and recipient. The recipient immunological reactivity to donor cells was specifically modulated by donor blood transfusions. Prior to transfusions, recipient MLR to donor lymphocytes expressed as per cent of the relative response (% RR) was 85.73. It dropped to 43.75 on the 21st posttransfusion day, and was as low as 19.16 on the 151st day (5th month). Next, a gradual increase in MLR occurred. The % RR increased to 46.15 in the 9th month and returned close to the pretransfusion level, to 78.30, in the 12th month. Transplantation of the kidney from the potential donor was not performed.

Methods of post-transfusion hepatitis (PTH) prevention including voluntary donorship, search for the carriers of specific HBV markers, for donors having impaired liver function tests, i. e. AST screening, ALT quantitation, and AST + bilirubin screening are discussed on the basis of twenty years' development of their effect on regional PTH incidence. A combination of AST + bilirubin screening has been found to prevent 66% of PTH incidence in the year 1984 and on average 49% during the five years through 1988, disqualifying only 1-3% of donors, and avoiding wastage of blood through its performance before blood unit collection. A comparison with the data of Hollinger et al. about ALT quantitation suggests that the sources of PTH removed by either of the two preventive methods are different and that an improved effect could be therefore obtained by their combination.

The response of T-helper and T-suppressor cells to various immunosuppressive regimens was studied in long surviving cadaveric renal allograft recipients. Eight patients were immunosuppressed with Azathioprine and corticosteroids, 12 recipients were treated with a combination of Cyclosporin A, corticosteroids and Azathioprine for 1 year. Both regimens decreased the Th/Ts ratio significantly as compared with healthy controls (p less than 0.05). No correlation between the Th/Ts ratio and the serum creatinine concentration was found. Likewise, the Th/Ts ratio did not correlate with Cyclosporin A blood levels.

Unlabelled: beta 2-microglobulin (beta 2-m) serum levels were significantly elevated in patients waiting for kidney transplantation. The levels decreased after successful transplantation, even when they were never as low as in a control group of healthy blood donors. A higher amount of serum (s-) beta 2-m was observed also in heart transplant recipients. A significant reincrease in s-beta 2-m occurred during rejection of renal allograft and during CMV and EBV infection. The levels of s-beta 2-m were higher in patients infected with CMV than in those infected with EBV.

Abbreviations: beta 2-m = beta 2-microglobulin, s-beta 2-m = serum beta 2-microglobulin, CMV = cytomegalovirus, EBV = Epstein-Barr virus.