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Cyclophosphamide (4 g/m2) and paclitaxel (Taxol) (175, 200 or 250 mg/m2) therapy with subsequent administration of G-CSF (10 micrograms/kg) has been used as intensification and as mobilization therapy for patients with breast cancer. This regimen was used in 19 patients, as part of adjuvant therapy in 14 and as part of therapy of metastatic disease in five. Median number of collected CD34+ cells was 17.5 x 10(6)/kg (2.9-48.1). All patients except one (94.7%) reached minimal required number of CD34+ cells (> or = 3 x 10(6)/kg). Median number of leukapheresis was two. The required number of cells (> or = 3 x 10(6)/kg) was collected in one leukapheresis in 17 out of 19 patients (89.5%) and more than five and 10 x 10(6)/kg CD34+ cells respectively were collected in 14 (73.7%) and 11 (57.9%) patients respectively. No factor significantly influencing the amount of collected cells (except the trend in favour of later year of therapy and large-volume leukapheresis) was identified. Leukopenia gr. 4 was observed in 88.9% of treated patients and febrile neutropenia developed in 46.2% patients. Although the antitumour activity of this chemotherapy was not possible to assess it seems that this intensification could be successfully used as a therapy and as very potent mobilization regimen.

An overview concerning different types of kidney involvement associated with monoclonal gammapathy (MG) is given, focused on light-chain deposition disease (LCDD). Pathophysiologic basis of LCDD remains in the light-chain tissue deposition (resp. in tissue deposition of immunoglobulin's stable domain). This mechanism is typical for monoclonal immunoglobulin's overproduction as found in MG. Clinical picture of LCDD reflects multiorgan character of disorder, while renal lesions rank among the most frequent, serious and best documented ones. Clinical data referring to a group of six patients, treated in our nephrologic department are presented. Diagnosis of LCDD was established on basis of the renal biopsy finding. Renal functions were decreased at the time of diagnosis in all patients, whereas haemodialysis treatment was started in one patient. On conclusion therapeutic possibilities of LCDD are discussed, in which number symptomatic therapy of renal failure is combined with corticosteroids therapy and cytostatic therapy; prognosis of most patients remains serious.

Background: Our study was designed to monitor the presence of the "coronary artery disease (CAD) risk factors" after kidney transplantation.

Methods: 26 kidneys transplant recipients with well-functioning (creatinine clearance > 0.8 mL/s) renal allografts receiving cyclosporine A (CsA) as the basic component of immunosuppressive therapy and 60 healthy age-matched controls were included into the study. As "CAD risk factors" were determined the levels of fibrinogen, acute phase proteins orosomucoid and C-reactive protein, t-PA Ag, PAI-1 Ag and soluble adhesion molecules E-selectin, P-selectin and ICAM-1 in the peripheral blood serum or plasma.

Results: Renal transplant recipients showed higher BMI (p < 0.001) and levels of fibrinogen (p < 0.001), t-PA Ag (p = 0.007) and PAI-1 Ag (p < 0.001), acute phase protein orosomucoid (p < 0.001) and higher level of soluble P-selectin (p = 0.038). The levels of sICAM-1 and sE-selectin did not differ statistically significantly from those in controls.

Conclusion: Our study has demonstrated renal graft recipients with good kidney function already show significantly raised levels of "CAD risk factors" fibrinogen, acute phase reactant orosomucoid, t-PA Ag, PAI-1 Ag and sP-selectin.

The process of apoptosis is genetically regulated form of cell death, which is tightly connected, with maintaining of tissue homeostasis in multicellular organisms. Mitochondria play a key role in this process being involved in ATP synthesis, production of oxygen free radicals, control of Ca2+ ions, extrusion of apoptogenic molecules such as cytochrome c, apoptosis inducing factor, Smac/DIABLO protein and several procaspases. Changes in the flux of ions and water across the inner mitochondrial membrane characterize the early phase of apoptosis, during which an increase in matrix volume may precede a collapse of mitochondrial membrane potential (delta psi m). These changes are suppressed by Bcl-2/Bcl-XL facilitated by Bax, and mediated at least by so-called permeability transition pore complex which is one of possible mechanisms involved in mitochondrial membrane permeabilization (MMP).

Unlabelled: This study observes acute phase response in first time after injury.

Hypothesis: Injured patients are already in first timepiece up severe injury in worse general state developed acute phase response than control group before planed surgery. Levels of indicators acute phase response and haemostasis from venous blood samples collected in an injury day and at patients control group before planned surgery were compared. We compare findings of traumatized in admission day and of patients at 6th-7th day after planned surgery, when is the biggest handicap. Plasma levels of orosomukoid, C reactive protein, prealbumin, transferin, alpha-2-macroglobulin, PAI-1, tPA, sE-Selectin, SICAM, sP-Selectin, antithrombin III, fibrinogen, haemoglobin, time of Quick test, TT, APTT, number of leukocytes, erythrocytes and thrombocytes were determined.

Results: Tested group severe injured admitted in I. Surgical Department of First Medical School of Charles University and General Faculty Hospital in Prague in years 1995-1998 (n = 105) be characterized by average value ISS--19.182 +/- 3.315, PTS--28.284 +/- 2.362, AIS--6.739 +/- 0.829 and GCS--11.449 +/- 0.974 and average age 56.89 +/- 4.84 year. Average time hospitalization was 70 days. Between 7th-21st day of hospitalization 23 patients dead on multiorgan failure or sepsis. Control patient file before planned surgery (n = 50) and after planned surgery (n = 33) was comparable in age characteristics.

Conclusions: Adaptation reserve of injured is already in first time-piece since injury significantly lower to patients without trauma. Starting position traumatized patients before acute surgery is comparable with state of patients at 6th-7th day after planned surgery, when culminates postoperative acute phase response.

The authors demonstrate analgetic effect on a group of 32 patients operated for pancreatic cancer pain after videothoracoscopic splanchnikectomy. The authors define adequate criteria for selection of splanchnikectomy.

The author explain the importance of the early diagnosis of breast cancer and introduce the surgery treatment of early stages of breast carcinoma, especially of DCIS (ductal carcinoma in situ) in the last years on the 1st Surgery Department of First Medical Faculty, Charles University and General Faculty Hospital in Prague.

Four basic control mechanisms of breathing (brainstem respiratory centre, peripheral and central chemoreceptors, intero- and exteroceptive reflexes and suprapontine influences), as well as their sleep-related disorders are analysed. A decrease in central chemoreceptor sensitivity to CO2 and an increase in upper airway resistance during sleep result in hypoventilation and mild hypoxaemia already in physiological conditions. Compensatory increase in ventilatory effort with synchronous inhibition of pharyngeal dilators during sleep reduces the upper airway lumen manifesting with snoring, upper airway resistance syndrome, and OSA. The resulting hypoxaemia may cause marked cardiovascular, neuro-psychic, endocrine-metabolic and behavioural disorders. The augmented ventilatory effort and hypoxaemia evoke reflex dilation of airways and arousal from sleep, stimulating the sympatho-adrenal system, which provokes autoresuscitation by gasping preventing fatal asphyxia. Failure of this autoresuscitation mechanism seems to cause SIDS. Elimination of voluntary breathing by sleep either in Ondine's curse induced by lesions of respiratory centre, or in congenital central hypoventilation syndrome caused by insufficient central chemoreceptors result in respiratory failure and death. Nocturnal attacks of bronchial and cardiac asthma, lung oedema and other consequences of pulmonary congestion are also discussed. The pathomechanism of extreme daytime sleepiness, chronic fatigue, and disorders of memory, cognitive and other brain functions, are also analysed. Severe cardiovascular consequences of SAS may manifest acutely as angina pectoris, myocardial infarction. dysrhythmias, transient ischaemic attacks and even stroke or sudden cardiac death. OSAS may result also in development of hypertension, central obesity, diabetes mellitus, erectile dysfunction, depression, and various behavioural disorders.

Authenticity, in psychological sense of the word, is connected with human identity and it belongs among the effective factors of psychotherapy. We can define it as a complex psychological variable and relatively constant characterization of a personality. Authenticity expresses the degree of a person's self-identity and, at the same time, it shows how much is his behaviour towards his surrounding connected with his self-concept. In the researches, for authenticity we can use the term congruence. In the psychotherapy therapist's authentic behaviour leads to release of the patient's spontaneity and to the increase of his own authentic behaviour. Mentally healthy person is authentic and independent, he leads a meaningful life and his decisions mainly depends on his own experience. Authenticity we can detect directly with the help of the clinical methods [interview] and indirectly through the self-concept and incongruences. One of the main instruments used to measure authenticity are rating scales.

A case story of a patient with renal biopsy (RB) proven infiltration with lymphoma is given. RB in patient with known malignancy and onset of renal failure was indicated with regard to an atypical picture of kidney involvement (non-enlarged kidneys, without any structural changes typical for tumour mass presence). Though spread of the primary tumour to the kidney is not uncommon, involvement severe enough to impair renal function is unusual and occurs primarily with rapidly growing haematologic malignancies; diagnosis is being established by renal biopsy only rarely.