Acta medica (Hradec Kralove). Supplementum最新文献

The authors present a summary of current knowledge on asthma caused by diisocyanates in workers under occupational exposure and introduce basic characteristics of these chemicals widely used in industry. Although they represent one of the main causes of occupational bronchial asthma (AB) in developed industrial countries, the number of reported asthma caused by diisocyanates is still relatively low in the Czech Republic--it represents less than ten percent of all reported occupational asthma. One of the possible reasons is demanding diagnostics and assessment of occupational impact of chemical noxae with combined effect mechanism characteristic of low-molecular diisocyanates. Studies concerned with presented topics support the concept that AB caused by diisocyanates shows clinical features of both atopic and nonatopic asthma. AB caused by DI is presented by mixed type of the TH1/TH2 response, influx and regulatory role of CD4+ and CD8+ T lymphocytes. Mixed immunopathological mechanism and toxic effect are combined. For the present, evaluation of elimination and reexposure tests appear as the most valuable of available diagnostic methods, respectively simulated reexposure test in a health care facility and assesment of serum IgG or IgE antibodies against diisocyanates can be used. Data on occurrence of the disease in the Czech Republic and detailed information on the sample of patients with respiratory allergic disease caused by diisocyanates reported by the Clinic of Occupational Diseases of the Faculty Hospital in Hradec Králové in 1994-2003 are presented. The disease was caused by evaporation of diisocyanates released during the production of polyurethanes and evaporation of adhesives containing toluendiisocyanate (TDI). In most cases, there were milder forms of asthma with significant improvement or elimination of difficulties occuring after occupational exposure was interrupted. Knowledge of the pathogenesis of AB caused by diisocyanates should accelerate the development of diagnostic tests and consequent treatment intervention, as early determination of diagnosis and interruption of occupational exposure are essential for following prognosis of disease.

Occupational asthma is a disease with serious medical, social and economical consequences. Most patients have to change their jobs and very often they lose their professional qualification. This article gives a current review of the problems of occupational bronchial asthma and allergic rhinitis in the region of Eastern Bohemia. The results obtained are compared with the situation in the whole Czech Republic and in the world. The number of new cases of occupational asthma and allergic rhinitis discovered in the contact area of the Department of Occupational Medicine at the University Hospital in Hradec Králové fluctuates around 15-20 cases per year, and 80-100 new cases are reported in the whole republic. The rate of occupational asthma and occupational allergic rhinitis of the total asthma and rhinitis incidence in the Czech population fluctuates between 5-15%. Regarding the number of affected employees, flour is considered the most important allergen. Other important noxas include agricultural allergens, textile dust, diisocyanates and disinfectious preparations. The importance of the alergogenius effect of natural rubber latex and diisocyanates has increased in occupational medicine mainly in the last 20 years. Regarding latex, its harmful effect has been especially demonstrated in health providers who wear protective latex gloves, which results not only in contact eczema-dermatitis, but also in bronchial asthma and allergic rhinitis. Diisocyanates, highly reactive and aggressive substances, originate during polyurethane production which has a wide industrial application (production of polyurethane foam and rubber, paints, adhesives, injected substances, glues, varnishes etc.). The incidence of occupational asthma diseases in workers exposed to diisocyanates is high. Typically, a development of the disease begins after a short time exposure. In this thesis, a diagnostic method in suspected occupational allergic disease of the airways is suggested and possibilities for the application of particular diagnostic methods are given with emphasis on their advantages and limitations and the necessity to determine a proper diagnostic method for the individual patient. In searching for a particular cause of the occupational disease a significant benefit is the determination of a wide range of specific Ig E class serum antigens, in case IgG and standardization of the method provoke tests for its practical application.

Complex therapy of pneumothorax is a multidisciplinary task. The point is: the etiology of pneumothorax is different but the resulting risk for the patient is always the same. Therefore, there is necessity of cooperation of several medical branches in causal therapy. The authors present experience with pneumothorax therapy in Cardiosurgical Department in 5-year interval in 101 patients, where they carried out surgical as well as conservative therapy approaches.

It is known that the subependymal layer (SEL) of the lateral brain ventricles' wall is a source of neural stem cells (NSCs) of adult mammalian brain including the human brain. The NSCs in relation to the striatum differentiate only into glial phenotype. Therefore we focused on proliferative activity of NSCs and precursors in the SEL and on the course of their differentiation into the astrocytes in reaction to the neurodegenerative process in the striatum like in Huntington's disease. Increased gliogenesis, differentiation of newly generated cells and their ability to migrate into the striatum were evaluated in two groups of the rats surviving 1 and 3 months after the application of the neurotoxic (ibotenic) acid into the striatum. For evaluation of the proliferative activity we compared the results obtained using two proliferative markers--Bromodeoxyuridine (BrdU) and Ki-67. Characterization of newly generated cells and of their differentiation was based on the detection using the following antibodies: Nestin (a marker for NSCs and precursors), GFAP (detection of astrocytes), also the double-staining method with BrdU and GFAP.

The diagnosis of congenital dyserythropioetic anemia-type II (CDA-II) was established in 1974 in three siblings aged 20, 18 and 5 years, respectively. Liver biopsy performed in two elder siblings on admission revealed liver siderosis. Anemia showing haemolytic component with destruction of erythrocytes in the spleen was corrected after splenectomy. Increased number of erythrocytes showing "the double membrane phenomenon" was found in the peripheral blood after splenectomy. All three siblings developed cholecystolithiasis with choledocholithiasis and obstructive jaundice in two of them. Two patients at the age of 49 and 34 years (the third died in an accident at the age of 40 years) developed 29 years after the diagnosis of CDA-II had been established signs of iron overload with transferin saturation 99%, serum ferritin 1450.4 microg/l and 1131.7 microg/l respectively, and hepatic iron concentration (dry weight) 14,843 microg/g and 15,415 microg/g (norm 70-1400 microg/g) respectively. No mutations of HFE gene (C282Y and H63D) were found. Liver biopsy showed heavy accumulation of hemosiderin in hepatocytes and reticuloendothelial cells. The structure of the liver tissue was not changed, only mild fibrosis in portal area was present in the older patient. Because of iron overload therapy with phlebotomy once monthly (400 ml) has been started in both patients. In peripheral blood films excess of Pappenheimer bodies was found.

This work deals with analysis of technical and legal aspects of qualified electronic signature implementation in the area of electronic medical information systems with respect to real usability of such a signature as an equivalent to a manual signature on paper medical documents.

This article is aimed at developing of multimedia teaching programs. Authoring tool Authorware Professional for Windows is briefly described as a suited system for the developing of didactic applications. Author presents own application based on Authorware--Biophysics of perception of sound and light. At the end are also disscused benefits of multimedia teaching tools.

The paper summarizes the principal information on the properties and effects of asbestos and a survey of diseases which can be recognized in the Czech Republic as occupational diseases according to the List of Occupational Diseases (Government Order 290/1995 Coll.). The paper lists possible diagnostic means and criteria for evaluation and presents a survey of developmental trends of the disease in exposed workers of the plant under study. In the period of years 1951-2003, 87 cases of occupational diseases were reported. The first asbestosis occurred in 1955, the first lung cancer in a patient with a previously reported asbestosis in 1962, the first pleural mesothelioma in 1976, the first asbestosis of the lung with concurrent lung cancer in 1981, and the first pleural hyalinosis in 1999. A very serious fact is that 56, i.e. 64.4% of diseases, particularly lung cancer and mesothelioma, were diagnosed after the termination of working in risk and many years of latency. A long-term folow-up of workers, even of those with a short exposure, is therefore necessary.

Aging is accompanied by a natural decrease of the hard dental tissues. Occlusal and incisal tooth abrasion occurs during the normal mastication. In the study, the collection of 717 adult and child skulls without mandibles, and 518 isolated adult and child mandibles from the "Broumov Ossuary" (13th-18th century)--the Czech Republic was examined for the study of tooth abrasion. In the skulls and mandibles of the adult individuals high prevalence of both tooth abrasion and its high degree was ascertained. The established pattern of dental abrasion suggests an abrasive composition of diet at the historical Broumov populations and concurrently indicates that tooth age-abrasion can be used for the age-at-death determination solely in the context with the given particular historic epoch.

Introduction: Endoscopy, a golden standard with its high diagnostic value, is an invasive and unpleasant method as far as patients are concerned. So far there has been no available non-invasive test in the Czech Republic capable of distinguishing between heavy (i.e. peptic ulcer) and light (i.e. portal gastropathy) lesions of upper gastrointestinal mucosa.

Aims: In this pilot study we decided to test our modification of sucrose permeability test (SaLM test) on upper dyspepsia patients in our conditions. We first needed to compare the results of intestinal permeability obtained from the studied test (containing sucrose, a so called SaLM test) with a formerly established intestinal permeability test (containing glucose, a so called LaMa test) to know, if the new test could replace the old one. Then we wanted to find normal values of sucrose permeability, find a relationship between sucrose permeability and endoscopically verified damage to upper gastrointestinal mucosa and calculate sensitivity and specificity of SaLM test using results of gastroduodenoscopy. After that we tried to suggest possible future benefits of the test for clinical praxis.

Materials and methods: A group of 10 young healthy volunteers underwent both SaLM and LaMa tests, which were made methodically indentical to compare the tests as to the results of intestinal permeability. The probands ingested SaLM solution with the following composition: sucrose (25.0 g), lactulose (10.0 g), mannitol (2.0 g), xylose (2.0 g) and water (up to 100 ml). Urine was collected for five hours and the samples were analysed using gas chromatography. From the results normal value of sucrose permeability was calculated, too. After that, 28 patients with upper dyspepsia were included in the study. They were divided into two groups (a group of light lesions with 9 patients and a group of heavy lesions counting 19 patients) according to gastroscopical findings. We compared the results among the three groups.

Results: In our volunteers, the intestinal permeability values using LaMa and SaLM tests showed normal distributions. No statistically significant difference (p < 0.05) was found between the tests in regard to the intestinal permeability. The normal value of sucrose permeability was found to be up to 0.10% of the amount taken orally. The permeability for sucrose was significantly higher (p < 0.01) in patients with heavy lesions (0.527 +/- 0.414) versus those with light ones (0.178 +/- 0.090). Moreover, the latter had their sucrose permeability values significantly higher than healthy volunteers (0.088 +/- 0.067), (p < 0.05). Sensitivity and specificity of the test for heavy upper gastrointestinal mucosal damage was 0.95 and 0.33, respectively.

Conclusion: SaLM test could replace LaMa test without having a significant effect on the intestinal permeability results. It is feasible to study SaL