The role of melatonin in preventing amiodarone-induced rat liver damage

Long-term exposure to amiodarone, an antiarrhythmic drug, can induce different organ damage, including liver. Cell damage included by amiodarone is a consequence of mitochondrial damage, reactive oxygen species production, and cell energy depletion leading to programmed cell death. In the present study, hepatoprotective potential of neurohormone melatonin (50 mg/kg/day) was evaluated in a chronic experimental model of liver damage induced by a 4-week application of amiodarone (70 mg/kg/day). The obtained results indicate that amiodarone induces an increase in xanthine oxidase activity, as well as the content of the lipid and protein oxidatively modified products and p53 levels. Microscopic analysis further corroborated the biochemical findings revealing hepatocyte degeneration, apoptosis, and occasional necrosis, with the activation of Kupffer cells. Coadministration of melatonin and amiodaron prevented an increase in certain damage associated parameters, due to its multiple targets. In conclusion, the application of melatonin together with amiodarone prevented an increase in tissue oxidative damage parameters and moderately prevented liver cell apoptosis, indicating that the damage of hepatocytes provoked by amiodarone supersedes the protective properties of melatonin in a given dose.

Assessment of the Influence of Asymmetric Triacetate Cellulose Membrane on the Rate of Removal of Middle Molecular Weight Uremic Toxins in Patients Treated with Postdilution Online Hemodiafiltration

BACKGROUND: Postdilution online hemodiafiltration (OL-HDF) effectively removes uremic toxins of middle molecular weight from the blood of patients with end-stage chronic kidney disease. The rate of removal of uremic toxins depends on the type of dialysis membrane, blood flow rate (Qb), net ultrafiltration flow rate (Qnuf), and total convective volume (Vconv). AIM: The aim of this study was to examine the efficacy of asymmetric triacetate cellulose dialysis membrane in patients on post-dilution OL-HDF. METHODS: Thirty-five patients treated with post-dilution OL-HDF hemodiafiltration for at least 3 months were examined. The main parameters for assessing the efficiency of removal of uremic toxins of middle molecular weight are the concentration of β2-microglobulin (β2-M) and interleukin-6 (IL-6) in serum before and after a single session of post-dilution OL-HDF. The followings were used for statistical analysis: Kolmogorov–Smirnov test, Student’s T test for bound samples and Wilcoxon test. RESULTS: The average Vconv was 20.90 ± 3.30 liters/session. The β2-M reduction index during a single session of postdilution OL-HDF was 71.10 ± 6.39%, the IL-6 reduction index was 43.75 ± 15.60%, and the albumin reduction index was 4.55 ± 2.31%. CONCLUSION: The asymmetric triacetate cellulose dialysis membrane effectively removes β2-M and IL-6 during a single session of postdilution OL-HDF. The β2-M reduction index is ∼70%, the IL-6 reduction index is ∼40%, and albumin loss is <4.0 g/4 h. The examined dialysis membrane and dialysis modality prevent the development of amyloidosis associated with dialysis, microinflammation and reduce the risk of developing atherosclerotic cardiovascular diseases in the population of patients treated with regular hemodiafiltration.

Exercise training and inflammatory markers in coronary artery disease patients

Aim. To evaluate the influence of exercise training on inflammatory markers and exercise tolerance in coronary artery disease (CAD) patients. Patients and methods. A total of 54 subjects were enrolled in the present study, including 34 CAD patients (CAD group: 59.2 ± 8.2 years) and 20 healthy controls (C group: 54.2 ± 8.0 years). C reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC), and placental growth factor (PIGF) were determined, and an exercise test was performed in both groups at baseline and once again in CAD group after the supervised 3 weeks of aerobic exercise training. Results. At baseline, CRP, ESR and PIGF were significantly higher in the CAD group compared to the C group (p = 0.038, p = 0.019 and p = 0.002), while exercise capacity was significantly higher in the C group (p ˂ 0.01). After 3 weeks of exercise training, CRP, ESR, WBC count and PIGF significantly decreased (p = 0.048, p ˂ 0.001, p = 0.002 and p ˂ 0.001 respectively), while exercise capacity significantly increased (p ˂ 0.001) in the CAD group. In the CAD group, CRP decrease significantly correlated with WBC and PIGF decrease (r = 0.816, p = 0.002 and r = 0.988, p ˂ 0.001), as well as with exercise capacity increase (r = 0.834, p ˂ 0.001). Also, WBC decrease significantly correlated both with PIGF decrease (r = 0.768, p ˂ 0.001) and exercise capacity increase (r = 0.548, p = 0.012), while PIGF decrease significantly correlated with exercise capacity increase (r = 0.548, p = 0.013). Conclusion. Residential exercise training in CAD patients reduces inflammation, expressed through a significant decrease in CRP, ESR, WBC count and PIGF levels. Those positive changes in inflammatory markers are associated with significant improvement in exercise capacity.

Kinetic Characterization of a Putatively Chitin-Active LPMO Reveals a Preference for Soluble Substrates and Absence of Monooxygenase Activity

Enzymes known as lytic polysaccharide monooxygenases (LPMOs) are recognized as important contributors to aerobic enzymatic degradation of recalcitrant polysaccharides such as chitin and cellulose. LPMOs are remarkably abundant in nature, with some fungal species possessing more than 50 LPMO genes, and the biological implications of this diversity remain enigmatic. For example, chitin-active LPMOs have been encountered in biological niches where chitin conversion does not seem to take place. We have carried out an in-depth kinetic characterization of a putatively chitin-active LPMO from Aspergillus fumigatus (AfAA11B), which, as we show here, has multiple unusual properties, such as a low redox potential and high oxidase activity. Furthermore, AfAA11B is hardly active on chitin, while being very active on soluble oligomers of N-acetylglucosamine. In the presence of chitotetraose, the enzyme can withstand considerable amounts of H₂O₂, which it uses to efficiently and stoichiometrically convert this substrate. The unique properties of AfAA11B allowed experiments showing that it is a strict peroxygenase and does not catalyze a monooxygenase reaction. This study shows that nature uses LPMOs for breaking glycosidic bonds in non-polymeric substrates in reactions that depend on H₂O₂. The quest for the true substrates of these enzymes, possibly carbohydrates in the cell wall of the fungus or its competitors, will be of major interest.

Prognostic value of the right ventricle diameter, pulmonary arterial pressure and biomarkers in patients with acute heart failure

The aim of the paper was to examine the echocardiographic parameters of the right ventricle (RV), its diameter and pulmonary arterial pressure (PAP); to determine their relationship to B-type natriuretic peptide (BNP), troponin and (TnI) and high-sensititity C-raective protein (hsCRP), and to evaluate their prognostic significance to one-year mortality in patients with acute heart failure (AHF). The study included a total of 225 patients (pts) (70.29 ± 9.74 years) who were admitted to Intensive care unit due to the signs and symptoms of AHF. The values of standard biochemical parameters, BNP, TnI and hsCRP were determined during the first 24 hours after admission. All patients underwent echocardiographic examination. During a one-year follow-up, 78 (34.70%) patients died. As compared with the group of survivors (n = 147), the group of non-survivors had higher values of BNP (853.10 ± 384.92 vs. 1399.68 ± 464.44 pg/mL, p < 0.001), TnI (0.59 ± 2.04 vs. 2.00 ± 8.29 ng/ml, p < 0.05), right ventricular diameter and PAP (p < 0.001). BNP was positively correlated with TnI (r = 0.311), PAP (r = 0.255) and right ventricular diameter (r = 0.304, p < 0.001 for all correlations). The cut-off value of BNP ≥ 1062.04 pg/ml, PAP ≥ 44.5 mmHg and TnI ≥ 0.04 ng/ml were associated with a higher risk of mortality. Our results have shown that BNP, PAP and TnI are strong and independent predictors of one-year mortality in hospitalized patients with acute heart failure.

Treatment fracture of the diaphisis humerus with functional plaster

Treatment of humerus fractures is divided into operative and non-operative treatment Fractures of the diaphysis of the humerus heal well. Surgeons today have many opportunities to treat them. The decision on the type of treatment to be applied depends on the location of the fracture, the existence of associated injuries, the age and the general condition of the patient. Non-operative treatment is most often applied, although there are fractures in which surgical intervention is necessary in order to perform healing and prevent complications. Non-operative treatment of fractures of the diaphysis of the humerus gives good results, with little angulation and minimal or no shortening of the arm. Adequate repositioning, appropriate plaster immobilization and regular X-rays heal the fracture within the allotted time. Disciplined early physical therapy in terms of circular movements prevents shoulder contracture and allows later physical therapy to last significantly shorter. Non-operative treatment lasts from 7-11,5 weeks.

Analysis of fatal injuries in Serbian underground coal mines - 50 years review

The study presented here analyzes mining accidents and fatal injuries in Serbian underground coal mines over a period of 50 years, in order to assess the effectiveness of legislation changes in the overall safety of work environment. Two distinct periods, prior to 2000 and after 2000 were compared. The data from the period after 2000 were further analyzed to provide better understanding of the results. In order to assess the overall state of safety in Serbian mines, the data on fatal injuries were also compared to the international data. It was found that the legislative changes are more easily accepted by the common workers than by the mine management. Consequently, the key recommendation for the safety of coal mine companies in Serbia is the investment in the new technology. Additionally, mine management should be in the focus of the mining inspection with a stronger penal policy regarding mine safety neglect.

Correlation between oxidative stress parameters and left ventricular geometry in patients with chronic heart failure

Oxidative stress, as one of the pathophysiological mechanisms involved in the reduction of myocardial contractility, stimulates the proliferation of cardiac fibroblasts and the activation of matrix metalloproteinases, which leads to extracellular matrix remodeling. Left ventricular hypertrophy (LVH) is a well-known independent risk factor for cardiovascular events. The aim of this research was to determine the connection between the parameters of oxidative stress and left ventricular geometry indicators in patients with chronic heart failure. The study included 81 subjects diagnosed with heart failure and 68 subjects in the control group. Parameters of myocardial morphology and left ventricular function were measured by echocardiography. Thiobarbituric acid reactive substances (TBARS) content, advanced oxidation protein products (AOPP), total serum SH groups and catalase activity were performed in both groups. The results showed that there were significantly higher concentrations of TBARS, AOPP, and SH groups in patients compared to controls (p < 0.01) and higher concentration of TBARS in patients with concentric hypertrophy compared to patients with normal geometry (p < 0.05). Correlation analysis showed a strong positive correlation between geometry parameters and myocardial function and TBARS and negative correlation between the right ventricule diameter and catalase activity. The results of this study show that oxidative stress parameters are significantly elevated in patients with heart failure, and that concentrations of TBARS and AOPP - the markers of lipid and protein oxidation, strongly correlate with left ventricular geometry parameters.

Case Report of the Patient with Acute Myocardial Infarction: “From Flatline to Stent Implantation”

Asystole is a rare primary manifestation in the development of sudden cardiac death (SCD), and survival during cardiac arrest as the consequence of asystole is extremely low. The aim of our paper is to illustrate successful cardiopulmonary resuscitation (CPR) in patients with acute myocardial infarction (AMI) and rare and severe form of cardiac arrest - asystole. A very short time between cardiac arrest in acute myocardial infarction, which was manifested by asystole, and the adequate CPR measures that have been taken are of great importance for the survival of our patient.

After successful reanimation, the diagnosis of anterior wall AMI with ST segment elevation was established. The right therapeutic strategy is certainly the early primary percutaneous coronary intervention (PPCI). In less than two hours, after recording the “flatline” and successful reanimation, the patient was in the catheterization laboratory, where a successful PPCI of LAD was performed, after emergency coronary angiography. In the further treatment course of the patient, the majority of risk factors were corrected, except for smoking, which may be the reason for newly discovered lung tumor disease. Early recognition and properly applied treatment of CPR can produce higher rates of survival.

Pulmonary Valve Insufficiency as a Complication of Radical Surgical Treatment of Tetralogy of Fallot

Tetralogy of Fallot is the most common cyanogenic congenital heart defect. The diagnosis is based on clinical signs, ECG examination, ultrasound examination of the heart, additional imaging methods and invasive testing. The therapeutic approach to the patient with tetralogy is complex and based on conservative and radical methods. Patients who have not undergone a radical surgical intervention have a poor prognosis, whereas the prognosis is much better for patients who have been operated. The most common complication of the surgical treatment is the pulmonary valve insufficiency which usually requires reintervention, as was the case with our patient.

Repair of Bone Tissue Affected by Osteoporosis with Hydroxyapatite-Poly-L-lactide (HAp-PLLA) With and Without Blood Plasma

The aim of this study is to examine the reparatory ability of the synthetic biomaterial hydroxyapatite-poly-L-lactide (HAp-PLLA), the replacement of alveolar ridge, and rehabilitation of bone defects caused by osteoporosis, in an experimental group of animals. The experiments are performed on syngeneic Sprague Dawley rats. Osteoporosis is induced by glucocorticoids in rats during a 12-week period. After this, the experimental group of animals is divided into five subgroups. An artificial defect is made in the alveolar bone on the left side of the mandible. In one group of animals, the defect is left to heal by itself, while in other groups, pure HAp-PLLA or one mixed with plasma is implanted. The best results are achieved by the implantation of the HAp-PLLA composite biomaterial mixed with autologous plasma. Formation of a new mandibular bone is seen, growing intensely, leading to rapid osteogenesis.

[Acute renal failure in patients with tumour lysis sindrome]

`Hematologic malignancies (leukemia, lymphoma, multiple myeloma, et al.), as well as solid tumours (renal, liver, lung, ovarian, etc.), can lead to acute or chronic renal failure.The most common clinical manifestation is acute renal failure within the tumour lysis syndrome (TLS). It is characterized by specific laboratory and clinical criteria in order to prove that kidney disorders result from cytolysis of tumour cells after chemotherapy regimen given, although on significantly fewer occasions it is likely to occur spontaneously or after radiotherapy. Essentially, failure is the disorder of functionally conserved kidney or of kidney with varying degrees of renal insufficiency, which render the kidney impaired and unable to effectively eliminate the end products of massive cytolysis and to correct the resulting disorders: hyperuricemia, hyperkalemia, hypocalcaemia, hyperphosphatemia, and others. The risk of TLS depends on tumour size, proliferative potential of malignant cells, renal function and the presence of accompanying diseases and disorders. Hydration providing adequate diuresis and administration of urinary suppressants (allopurinol, febuxostat) significantly reduce the risk of developing TLS. If prevention of renal impairment isn't possible, the treatment should be supplemented with hemodynamic monitoring and pharmacological support, with the possible application of recombinant urate-oxidase enzyme (rasburicase). Depending on the severity of azotemia and hydroelectrolytic disorders, application of some of the methods of renal replacement therapy may be considered.

Work-Related Factors as Predictors of Burnout in Serbian Nurses Working in Hemodialysis

Nurses who work in hemodialysis (HD) are considered highly susceptible to burnout due to their close relationship with incurable patients and handling sophisticated machinery. A total of 210 nurses from 12 state-owned HD centers in the Republic of Serbia anonymously completed a background information questionnaire providingfactual data on nurses' sociodemographic characteristics and working conditions using the Maslach Burnout Inventory--Health Services Survey. Almost half of the nurses (42.9%) were experiencing burnout High emotional exhaustion, high depersonalization, and low level of personal accomplishment were present in 40.9%, 8.6%, and 31.3% of nurses, respectively. The number of children, involuntary choice of current position, and unwillingness to choose the same type of job again were significant predictors of burnout. Our population of nurses working in HD was more affected by emotional exhaustion than their colleagues in other countries, but maintained high level of empathy and feeling ofpersonal accomplishment.

A computational study of circulating large tumor cells traversing microvessels

Circulating tumor cells (CTCs) are known to be a harbinger of cancer metastasis. The CTCs are known to circulate as individual cells or as a group of interconnected cells called CTC clusters. Since both single CTCs and CTC clusters have been detected in venous blood samples of cancer patients, they needed to traverse at least one capillary bed when crossing from arterial to venous circulation. The diameter of a typical capillary is about 7µm, whereas the size of an individual CTC or CTC clusters can be greater than 20µm and thus size exclusion is believed to be an important factor in the capillary arrest of CTCs - a key early event in metastasis. To examine the biophysical conditions needed for capillary arrest, we have developed a custom-built viscoelastic solid-fluid 3D computational model that enables us to calculate, under physiological conditions, the maximal CTC diameter that will pass through the capillary. We show that large CTCs and CTC clusters can successfully cross capillaries if their stiffness is relatively small. Specifically, under physiological conditions, a 13µm diameter CTC passes through a 7µm capillary only if its stiffness is less than 500Pa and conversely, for a stiffness of 10Pa the maximal passing diameter can be as high as 140µm, such as for a cluster of CTCs. By exploring the parameter space, a relationship between the capillary blood pressure gradient and the CTC mechanical properties (size and stiffness) was determined. The presented computational platform and the resulting pressure-size-stiffness relationship can be employed as a tool to help study the biomechanical conditions needed for capillary arrest of CTCs and CTC clusters, provide predictive capabilities in disease progression based on biophysical CTC parameters, and aid in the rational design of size-based CTC isolation technologies where CTCs can experience large deformations due to high pressure gradients.

Granulomatosis with polyangitis (Wegener's) and central nervous system involvement: case report

INTRODUCTION

Granulomatosis with polyangitis (Wegener's) is an antineutrophil cytoplasmic antibody (PR3-ANCA)-associated vasculitis, which commonly involves the upper and lower respiratory tracts and kidneys. Central nervous system involvement is reported in less than 11%, and rarely present at onset.

CASE OUTLINE

We report the case of a 41-year-old male patient with a high disease activity, large organ involvement, as well as central nervous system manifestations presented at onset.Treatment with intravenous pulse methylprednisolone, followed by the pulsed doses of cyclophosphamide was induced. After 6 months of cyclophosphamide pulse therapy a remission was achieved. Next, azathioprine was used for maintenance during the next 18 months.There were no disease flares during 24-month follow-up.

CONCLUSION

Granulomatosis with polyangitis (Wegener's) with large organ involvement, affecting the central nervous system structures require a rapid diagnosis and intensive medication treatment in order to prevent or reduce irreversible damage. Our experience confirms the findings reported in the literature that the severe forms of the disease are associated with increased probability of achieving remission, which reflects increased responsiveness of such patients to immunosuppressant therapy.

[Prosthetic rehabilitation in patient with forced class III malocclusion]

The paper presents clinical case of 63 years old edentulous patient with slight class III malocclusion. For 15 years he was using inadequately fabricated dentures causing forced severe class III malocclusion. Forced progeny was corrected by newly fabricated dentures which restored normal orofacial function and facial harmony.

Assessment of patient eligibility for kidney transplant procedure

Kidney transplantation offers better quality of life in comparison to patient dialysis. Patients with endogenous creatinine clearance 30 mL/min/1.73m2 are introduced into the kidney transplant program. Every patient should be assessed for a degree of eligibility for the kidney transplant procedure. Basic principles of eligibility assessment include: patient education, assessment of patient's motivation level, medical risk assessment, as well as evaluation of psychosocial status and the level of family support. Medical risk assessment involves establishing the etiology of the primary kidney disease, cardiovascular status assessment, viral status assessment, risk assessment for renal graft thrombosis, screening for early malignancy detection, assessment of mineral metabolism and bone tissue disorders, and immunological risk assessment. Identification of patients with highest degree of kidney transplant eligibility shall decrease morbidity and mortality, reduce medical costs and improve the quality of life for these patients.

Laparoscopic body-tail pancreatic resection for insulinoma

INTRODUCTION

Insulinomas are the most common endocrine tumours of the pancreas. They are more frequent in females, and they are commonly less than 2 cm in diameter. If conservative treatment of typical clinical symptoms fails, detailed diagnostic procedures are necessary and surgical treatment is indicated.The aim of this report was to emphasize the need of pancreatic resection when insulinoma is poorly visualized during surgery and when it is not possible to perform intraoperative ultrasonography.

CASE OUTLINE

A 27-year-old female patient suffered from hypoglycaemic episodes during physical efforts and fasting periods. After examination, diagnostic procedures and preoperative preparation, laparoscopic surgery was performed. The tumour was less than 10 mm in diameter, and it could not be visualized during laparoscopic exploration. The body and the tail of the pancreas were mobilized using ultrasound scissors and the resection was performed by two Endo GIA staplers. The surgical specimen was removed in an endo-bag. The postoperative course was without complications and the glycemic level was normalized. Macroscopic examination of the resected specimen showed a solitary, poorly demarcated, dark grey lesion, 0.8 cm in diameter, with a solid consistence in comparison with the surrounding gland tissue. Histological examination showed a poorly demarcated, subcapsular tissue in this area, consisting of uniform, irregular, cubic and short cylindrical cells, organized in clusters with pseudoglandular and "zellballen" formations.

CONCLUSION

In case when the insulinoma is so small in size that it cannot be visualized during operation, pancreas resection is a surgical procedure of choice. Laparoscopic surgery is preferred because of less postoperative complications and faster recovery.

Characteristics of radiological changes in lungs during varicella zoster viral infection

The objective of this research was to analyse the varicella patients' data in order to determine the following: general frequency of pneumopathies and types of lung changes according to X-ray presentation and the changes on the computed tomography. It examined 101 patients with the clinical presentation of varicella and some of the X-ray entities of varicella pneumopathies. Radiological techniques included chest X-ray and CT scans. Familiarity with clinical, laboratory and radiological characteristics of the disease may be of utmost importance for early recognition.

Equilibrium studies of the reactions of palladium(II) bis(imidazolin-2-imine) complexes with biologically relevant nucleophiles. The crystal structures of [(TLtBu)PdCl]ClO4 and [(BLiPr)PdCl2]

The kinetics and the mechanism of the substitution reactions of the complex [(TL(tBu))PdCl](+), where TL(tBu) is 2,6-bis[(1,3-di-tert-butylimidazolin-2-imino)methyl]pyridine, with nucleophiles (guanosine-5'-monophosphate (5'-GMP), l-Methionine (l-Met) and l-Histidine (l-His)) were studied using variable-temperature stopped-flow techniques in aqueous 0.1 M NaClO(4) with 10 mM NaCl at 298 K. The order of reactivity is: l-Met > 5'-GMP > l-His. The formation equilibria of [(BL(iPr))Pd(H(2)O)(2)](2+), where BL(iPr) is 1,2-bis(1,3diisopropyl-4,5-dimethylimidazolin-2-imino)ethane, and [(TL(tBu))Pd(H(2)O)](2+) with some biologically relevant ligands (l-Met, 5'-GMP and l-His) were also studied. The stoichiometry and stability constants of the newly formed complexes are reported, and the concentration distribution of the various complex species has been evaluated as a function of pH. Comparing the values of logβ(1,1,0) for 5'-GMP, l-His and l-Met complexes, the most stable complex is with 5'-GMP followed by l-His and l-Met for both complexes, [(BL(iPr))Pd(H(2)O)(2)](2+) and [(TL(tBu))Pd(H(2)O)](2+). The crystal structures of [(TL(tBu))PdCl]ClO(4) and [(BL(iPr))PdCl(2)] were determined by X-ray diffraction. The coordination geometries around the palladium atoms are distorted square-planar, with the Pd-N1 distance to the central nitrogen atom of the TL(tBu) ligand, 1.944(2) Å, being shorter than those to the other two nitrogen atoms of TL(tBu), viz. 2.034(3) and 2.038(2) Å. The BL(iPr) complex displays similar Pd-N distances of 2.031(2) and 2.047(2) Å.

[Rare congenital heart disease as a cause of tuberculosis activation]

INTRODUCTION

Patients with congenital cyanotic heart defects and the left-to-right shunt are at a three times higher risk of getting tuberculosis than acyanotic ones. No TB cases have been recorded in adult patients with the right-to-left shunt having cyanosis since their birth.

CASE REPORT

A 34-year-old man was referred to our Clinic with the discomforts such as chronic cough, hemoptysis and insomnia. At the admission he was pale, cyanotic, with a partial manifest respiratory insufficiency and characteristic TB pulmonary lesions detected by x-rays and tomography. After the sputum positive TB recidivism had been diagnosed, the antituberculotics treatment was introduced resulting in the successful smear and culture conversion and radiological regression of pulmonary lesions, but associated with non-explicable deterioration of cyanosis and chronic respiratory insufficiency until Doppler-echocardiographic examination verified the presence of tetralogy of Fallot.

CONCLUSION

Congenital cyanotic heart defects are extremely rare in adults. Nevertheless, it is necessary to maintain a very high level of clinical suspicion regarding TB activation even in the cases of defects with the right-to-left shunt.

Risk factors for aortic valve calcification in patients on regular hemodialysis

INTRODUCTION

Aortic valve calcification (AVC) accelerates development of aortic valve stenosis and cardiovascular complications. Hyperphosphatemia is one of the key risk factors for aortic valve calcification.

AIM

The aim of this study was to evaluate the prevalence of AVC in patients on regular hemodialysis and to assess the impact of different factors on its appearance.

METHOD

The study investigated a total of 115 patients treated in the Hemodialysis Department of the Urology and Nephrology Clinic at the Kragujevac Clinical Center in Serbia. The variables investigated were: serum albumin, C-reactive protein (CRP), homocysteine, total cholesterol, LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), triglycerides (TG), Apolipoprotein A-I (Apo A-I), Apolipoprotein B (Apo B) and lipoprotein (a), calcium, phosphate and parathormone, and calcium-phosphorus product (Ca x P). Patients were evaluated by echocardiography for AVC. Statistical analysis included univariate and multivariate logistic regression analysis.

RESULTS

Univariate regression analysis showed that serum phosphate levels and Ca x P are the most important risk factors for AVC (p<0.001). Multivariate logistic regression analysis revealed that hyperphosphatemia is an independent risk factor for AVC (p<0.001).

CONCLUSION

Hyperphosphatemia is an independent risk factor for aortic valve calcification.

Penile self-mutilation - two cases in one family

Male genital self-mutilation is an infrequently reported event in the general medical literature. The majority of cases deal with a single episode of self-mutilation. These cases are usually focused on surgical repair. We present an extremely rare situation of two cases of male genital self-mutilation occurring in the same family. Both patients were treated for schizophrenia. Both patients had religious psychotic experiences and guilt feelings associated with sexual conflicts. Both patients had an experience of setting fire. Although they were close relatives, the younger did not imitate the older one when he mutilated his genitals. The possible causes of such behavior have been analyzed in the light of the recent literature.

[Left ventricular hypertrophy in patients treated with regular hemodialyses]

Left ventricular hypertrophy is the main risk factor for development of cardiovascular morbidity and mortality in patients on hemodialysis. Left ventricular hypertrophy is found in 75% of the patients treated with hemodialysis. Risk factors for left ventricular hypertrophy in patients on hemodialysis include: blood flow through arterial-venous fistula, anemia, hypertension, increased extracellular fluid volume, oxidative stress, microinflammation, hyperhomocysteinemia, secondary hyperparathyroidism, and disturbed calcium and phosphate homeostasis. Left ventricular pressure overload leads to parallel placement of new sarcomeres and development of concentric hypertrophy of left ventricle. Left ventricular hypertrophy advances in two stages. In the stage of adaptation, left ventricular hypertrophy occurs as a response to increased tension stress of the left ventricular wall and its action is protective. When volume and pressure overload the left ventricle chronically and without control, adaptive hypertrophy becomes maladaptive hypertrophy of the left ventricle, where myocytes are lost, systolic function is deranged and heart insufficiency is developed. Left ventricular mass index-LVMi greater than 131 g/m2 in men and greater than 100 g/m2 in women, and relative wall thickness of the left ventricle above 0.45 indicate concentric hypertrophy of the left ventricle. Eccentric hypertrophy of the left ventricle is defined echocardiographically as LVMi above 131 g/m2 in men and greater than 100 g/m2 in women, with RWT ?0.45. Identification of patients with increased risk for development of left ventricular hypertrophy and application of appropriate therapy to attain target values of risk factors lead to regression of left ventricular hypertrophy, reduced cardiovascular morbidity and mortality rates and improved quality of life in patients treated with regular hemodialyses.

Cardiac troponins and left ventricular hypertrophy in hemodialysis patients

BACKGROUND

Cardiovascular diseases are the leading cause of death in hemodialysis patients. Left ventricular (LV) hypertrophy is an important predictor of cardiovascular morbidity and mortality in these patients. Cardiac troponins (cTnT and cTnI) are indicators of myocardial cell damage.

AIM

The aim of this study was to determine prevalence of LV hypertrophy, prevalence of elevated serum cTnT and cTnI in hemodialysis patients, and identify the correlation between cardiac troponins and LV hypertrophy.

METHODS

The study included 115 hemodialysis patients (71 men and 44 women), mean age 53.30 +/- 12.17 years, mean time on dialysis 4.51 +/- 4.01 years and average Kt/Vsp 1.17 +/- 0.23. Mean serum cTnT was 0.14 +/- 0.23 ng/ml, mean serum troponin I 0.20 +/- 0.48 ng/ml. Mean LV posterior wall thickness in diastole (LVPWd) was 11.44 +/- 2.09 mm, mean LV interventricular septal wall thickness in diastole (IVSd) 11.21 +/- 2.12 mm, mean LV end diastolic volume index (iLVEDV) 100.80 +/- 34.62 mL/m2 and mean LV mass index (LVMi) 143.85 +/- 41.21 g/m2.

RESULTS

We found statistically significant positive correlations (p <0.05) between serum troponin T concentration, IVSd, LVPWd and iLVEDV. A highly significant positive correlation (p < 0.01) was found between serum troponin T and LVMi. One-year follow-up showed that patients with cardiac troponin T > 0.10 ng/ml and cardiac troponin I > 0.15 ng/ml had significantly lower (p < 0.01) survival rate than patients with troponin T < or = 0.10 ng/ml and troponin I < or = 0.15 ng/ml.

CONCLUSION

A significant positive correlation exists between serum troponin T concentration and echocardiographic indicators of LV hypertrophy in hemodialysis patients. Patients with higher serum levels of cardiac troponins have lower survival rates during one year follow up.

Studies of interactions between platinum(II) complexes and some biologically relevant molecules

The reactions of Pt(II) complexes, cis-[Pt(NH3)2Cl2], [Pt(terpy)Cl]+, [Pt(terpy)(S-cys)]2+, and [Pt(terpy)(N7-guo)]2+, where terpy=2,2':6',2''-terpyridine, S-cys=L-cysteine, and N7-guo=guanosine, with some biologically relevant ligands such as guanosine-5'-monophosphate (5'-GMP), L-cysteine, glutathione (GSH) and some strong sulfur-containing nucleophiles such as diethyldithiocarbamate (dedtc), thiosulfate (sts), and thiourea (tu), were studied in aqueous 0.1 M Hepes at pH of 7.4 using UV-vis, stopped-flow spectrophotometry, and 1H NMR spectroscopy.

[Restless legs syndrome prevalence in patients on chronic hemodialysis in central Serbia]

BACKGROUND/AIM

Restless legs syndrome (RLS) is a sensorymotor disorder and the core feature of this syndrome is a distressing, irresistible need or urge to move the legs. RLS is one of the most troublesome conditions experienced by endstage renal disease patients treated with regular hemodialysis, and is significantly associated with their increased mortality. The aim of this study was to assess the prevalence of RLS in the patients with end-stage renal failure in the three dialysis centers in central Serbia, and to investigate the association of the syndrome with clinical characteristics and biochemical variables.

METHODS

A cross-sectional multicentric study in which 166 consecutive hemodialysis patients were evaluated using a standard questionnaire based on diagnostic criteria elaborated by the International Restless Legs Syndrome Study Group was performed. All patients were reinterviewed and clinically examined by a qualified neurologist. The data on the patients with and without RLS were compared.

RESULTS

The prevalence of RLS was 22.96% (95% CI, 16.57% to 29.35%). There was no significant difference in duration of hemodialysis and clinical characteristics when we compared the patients with RLS with those without RLS. We found significantly higher levels of blood urea nitrogen and creatinine and lower level of Kt/V index in the patients with RLS, which might point to inadequate dialysis in these patients.

CONCLUSION

In our study the prevalence of RLS in the patients on the regular hemodialysis was 22.96%. The obtained results are similar to those of other studies using the same methodology in the white population on the regular hemodialysis.

Vascular access blood flow for hemodialysis: A risk factor for development of cardiovascular complications in hemodialysis patients

Introduction. Vascular access blood flow rate of 100-350 cm/s and between 500 and 1000 ml/min, points to normal vascular access function and adequate hemodialysis. High blood flow through the arteriovenus fistula overloads the left ventricle inducing left ventricular remodeling. Material and methods. The aim of the study was to establish the degree of correlation between blood flow through the vascular access for hemodialysis and echocardiographic parameters for the assessment of left ventricular hypertrophy and left ventricular dilatation and left ventricular function. The research included 115 patients (M:F 71:44), average age 53.30?12.17 years, average length of dialysis 4.51 ? 4.01 years and average Kt/Vsp index 1.17?0.23. Results. The average blood flow through the vascular access for hemodialysis was 662.27?301.59 ml/min, EDDLV 54.52?6.42 mm, and EDVi 100.80?34.62 ml/m2. There is a statistically significant positive correlation between blood flow through vascular access for hemodialysis and EDDLV and EDVi. Conclusion. High blood flow through the vascular access for hemodialysis is an independent risk factor for the development of cardiovascular complications in patients on hemodialysis. .

[Cardiac troponins and left ventricular hypertrophy in hemodialysis patients]

INTRODUCTION

Cardiovascular diseases are the most frequent cause of death among hemodialysis patients. Left ventricular hypertrophy is a potent predictor of cardiovascular morbidity and mortality in those patients. Cardiac troponins (cTnT and cTnI) are indices of myocardial cell damage. The study was aimed to investigate the impact of left ventricular hypertrophy on serum cardiac troponin concentrations.

MATERIAL AND METHODS

The study included 115 patients (71 men and 44 women) at the mean age of 53.30+/-12.17 years, treated with regular hemodialyses for 4.51+/-4.01 years, with mean left ventricle mass index LVMi 143.85+/-41.21 g/m2 and mean Kt/Vsp 1.17+/-0.23. According to echocardiographic findings of the left ventricle the patients were divided into four groups: the first group included patients with concentric left ventricular hypertrophy, the second group were the patients with eccentric left ventricular hypertrophy, the third group consisted of patients with left ventricular dilatation, and the fourth group were patients with normal left ventricular morphology. The mean serum troponin T value in the first group was 0.13+/-0.16 ng/ml, in the second group 0.20+/-0.32 ng/ml, in the third group 0.07+/-0.09, and in the fourth group 0.03+/-0.03 ng/ml.

RESULTS

Patients with concentric left ventricular hypertrophy showed significantly greater (p<0.05) and patients with eccentric left ventricular hypertrophy showed highly significantly greater (p<0.01) serum troponin T concentrations in comparasion to patients with normal left ventricular morphology.

CONCLUSION

Serum cardiac troponin T concentration can also be used to estimate left ventricular hypertrophy in clinically stable patients on hemodialysis, in the absence of acute coronary syndrome.

[Correlation of C-reactive protein with echocardiographic parameters of hypertrophic and ischemic heart disease in patients on regular hemodialyses]

INTRODUCTION

Cardiovascular diseases are the most frequent cause of morbidity and mortality in patients on hemodialysis. The reason for this is a high prevailance of risk factors for the development of cardiovascular complications with these patients. Microinflammation is one of the risk factors for the development of atherosclerosis of coronary arteries in patients on hemodialysis. The study was aimed at investigating correlation between microinflammation parameter C-reactive protein (CRP) and echocardiographic parameters of left ventricular hypertrophy and left ventricular dilatation (left ventricular mass index-LVMi, left ventricular end-diastolic volume index-EDVi) and echocardiographic parameters of ischemic heart disease and systolic function (systolic thickness of interventricular septum-StIVS, systolic thickness of left ventricular posterior wall-StPWLV, amplitude of motion of interventricular septum-AmmIVS, amplitude of motion of left ventricular posterior wall-AmmPWLV, left ventricular fractional shortening-LVFS, left ventricular ejectional fraction-LVEF).

MATERIAL AND METHODS

The research was conducted on 115 patients (M:F 7/:44) regularly treated by hemodialysis, average age 53.30+/-12.17 years, average length of dialysis 4.51+/-4.01 years and average Kt/Vsp index 1.17+/-0.23.

RESULTS

Average CRP was 7.50+/-9.34 mg/l, EDVi 100.80+/-34.62 ml/m2, StPWLV 54.17+/-14.03%, and AmmPWLV 6.09+/-1.58 mm. Statistically significant positive correlation between serum concentration CRP and EDVi (p=0.221) was found. Highly statistically important significant negative correlation was proved between the serum CRP concentration and StPWLV (p=-0.249) and AmmPWLV (p=-0.289).

CONCLUSION

Microinflammation is a possible risk factor for the development of atherosclerosis of coronary artheries in patients on hemodialysis.

[Left ventricular hypertrophy in patients on hemodialysis: importance of anemia]

INTRODUCTION

Cardiovascular diseases are the most frequent cause of mortality in hemodialysis patients. Left ventricular hypertrophy is the main risk factor for development of cardiovascular morbidity and mortality in patients on hemodialysis. Anemia is the only main risk factor for the development of left ventricular hypertrophy in patients on hemodialysis. The aim of this study was to examine the impact of anemia in the development of left ventricular hypertrophy, and correlation between anemia and echocardiographic parameters for the assessment of left ventricular hypertrophy.

MATERIAL AND METHODS

The research was conducted on 115 patients (M:F 71:44) regularly treated by hemodialysis, average age 53.30+/-1.2.17 years, average length of dialysis 4.51+/-4.01 years and average Kt/Vsp index 1.17+/-0.23. Depending on the level of hemoglobin, the patients were divided into three groups. The basic parameters investigated were the following: hemoglobin, hematocrite, serum concentrations of albumin, CRP, total cholesterol, HDL cholesterol, LDL cholesterol, and triglyceride serum concentrations, parathormon, diastolic thickness of interventricular septu-mIVSd, diastolic thickness of left ventricular posterior wall, relative wall thickness-RWT, left ventricular mass index-LVMi, index of left ventricular end-diastolic volume-iLVEDV. The results were statistically analyzed using ANOVA, Kruskal-Wallis test, Student t-test, Mann-Whitney U test, Univariate logistic regression analysis test, and Multivariate logistic regression analysis test.

RESULTS

The patients with hemoglobin <80 g/l had a very significantly higher (p<0.01), while the patients with hemoglobin 80-100 g/l had a significantly higher (p<0.05) left ventricular mass index than patients with hemoglobin >100 g/l. The univariate logistic regression analysis has showed that lower HDL cholesterol, anemia, higher systolic arterial pressure and higher mean arterial pressure cumulatively lead to the development of left ventricular hypertrophy. Multivariate logistic regression analysis established anemia as an independent risk factor for the development of left ventricular hypertrophy.

CONCLUSION

Anemia is an independent risk factor for the development left ventricular hypertrophy. Identification of patients with increased risk for development of left ventricular hypertrophy and application of appropriate therapy to attain target values of risk factors, result in the regression of left ventricular hypertrophy, reduced cardiovascular morbidity and mortality rates and improved quality of life in patients treated with regular hemodialyses.

Apoptosis of cardiomyocytes in myocarditis

Apoptosis of cardiomyocytes has been reported to be involved in the pathogenesis of heart failure of different aetiologies. The purpose of this study is to assess the role and extent of apoptosis of cardiomyocytes in active myocarditis. Endomyocardial samples from the right ventricle of 22 patients with active myocarditis were compared with 25 traffic accident victims without a history of cardiovascular disease. Twenty-two patients fulfilled the histopathologic Dallas criteria for myocarditis. The TUNEL method and immunostaining for active caspase 3 were used for the detection of apoptosis. Immunohistochemical methods were used for the evaluation of regulators of apoptosis (p53, Bcl-2) and evaluation of interstitial cells (macrophages, T and B lymphocytes). Apoptosis of cardiomyocytes (TUNEL-positive and anti-caspase 3-positive cardiomyocytes), which was not p53-dependent, was present in 0.3 to 0.4% (0.3% by TUNEL method and 0.4% by immunostaining for active caspase 3) of cardiomyocytes in active myocarditis, whereas only few apoptotic cardiomyocytes (0.0006 +/- 0.002% TUNEL-positive cardiomyocytes and 0.001 +/- 0.002% active caspase 3-positive cardiomyocytes) were found in the control group (P = 0.001). Apoptotic (TUNEL-positive and active caspase 3-positive) cardiomyocytes were found in small clusters. An increased expression of Bcl-2 was found in active myocarditis compared to the controls (P < 0.01), yet Bcl-2 failed to protect myocytes from apoptosis. We provide evidence of apoptosis of cardiomyocytes in active myocarditis, which may be involved in the development of heart failure.

Influence of proteinuria on the lipoprotein (a) metabolism disorder

Background/Aim. Proteinuria causes lipid metabolism abnormalities. The aim of the present study was to examine the influence of proteinuria on the lipoprotein (a) metabolism disorder. Methods. The study included 60 patients of the male-famele ratio (M : F = 32 : 28), mean age 37.15?9.85 years with, the average endogenous creatinine clearance 86.27?19.81 ml/min, and the average body mass index (BMI) 24.18?2.23 kg/m2. Regarding the level of glomerular proteinuria, the patients were divided into four groups. The first (control) group, with proteinuria levels less than 0.25 g/24h, included 15 patients (M : F = 6 : 9), mean age 34.66?4.82 years, the mean clearance of endogenous creatinine 99.70?12.94 ml/min, and mean BMI 23.28?3.50 kg/m2. The second group, with proteinuria between 0.25 and 1.0 g/24 h, includ 15 patients (M : F = 9 : 6) with primary glomerulonephritis, mean age 37.87?9.65 years, the mean clearance of endogenous creatinine 82.85?18.48 ml/min, and mean BMI 23.83?1.57 kg/m2. The third group include 15 patients (M : F = 8 : 7) with primary glomerulonephritis, with proteinuria between 1.0 and 3.0 g/24 h, mean age 35.67?13.29 years, the mean clearance of endogenous creatinine 82.85?18.48 ml/min, and mean BMI 23.83?1.57 kg/m2. The fourth group, with proteinuria higher than 3.0 g/24 h, included 15 patients (M : F = 9 : 6) with primary glomerulonephritis, mean age 40.40?9.75 years, the mean clearance of endogenous creatinine 80.16?20.80 ml/min, and mean BMI 24.83?1.44 kg/m2. In order to assess the influence of proteinuria on the lipoprotein (a) metabolism abnormalities we investigated 24-hour proteinuria, the colloid osmotic pressure (COP) of plasma, and the serum concentration of lipoprotein (a). The results were statistically analyzed using ANOVA, Kruscal-Wallis test, Mann-Whitney U test, ?2 test and Spearman test. Results. Statistically, the patients with proteinuria over 3.0 g/24 h had the significantly higher values of lipoprotein (a) in serum as compared to the control group, and the patients with proteinuria about 0.25-1.0 g/24 h. The patients with proteinuria between 1.0-3.0 g/24 h had the statistically significantly higher values of lipoprotein (a) in serum than the control group (proteinuria < 0.25 g/24 h). There was a highly statistically significant negative correlation between serum albumin concentration, COP and the concentration of lipoprotein (a) in serum. There was a highly statistically significant positive correlation between 24-hour proteinuria and the concentration of lipoprotein (a) in serum. Conclusion. Proteinuria leads to the deterioration of lipoprotein (a) abnormalities.

Effects of proteinuria on apolipoprotein metabolism disorders

Introduction Proteinuria causes lipid metabolism abnormalities. Material and methods The study included 60 patients (M:F 32:28), mean age 37.15? 9.85 years, with average glomerular filtration rate (GFR) 86.27? 19.81 mL/min, and average BMI 24.18?2.23 kg/m2. Regarding the level of glomerular proteinuria, patients were divided into four groups. The first group, with proteinuria levels less than 0.25 g/24h, included 15 patients (M:F 6:9) (control group), average age 34.66?4.82 years, with mean GFR 99.70? 12.94 mL/min, and mean BMI 23.28?3.50 kg/nr. The second group, with proteinuria between 0.26 and 1.0 g/24h, comprised 15 patients (M:F 9:6) with primary glomerulonephritis, mean age 37.87?9.65 years, with mean GFR 82.85?18.48 mL/min and mean BMI 23.83?1.57 kg/m2. The third group consisted of 15 patients (M:F 8:7) with primary glomerulonephritis, with proteinuria between 1.1 and 3.0 g/24h, average age 35.67? 13.29 years, mean GFR 82.85?I8.48 mL/min, and mean BMI 23.83?1.57 kg/m2. The fourth group, with proteinuria over 3.0 g/24h, included 15 patients (M:F 9:6) with primary' glomerulonephritis, mean age 40.40?9.75 years, with mean GFR 80.16?20.80 mL/min, and mean BMI 24.83?1.44 kg/m2. In order to assess the influence of proteinuria on apoprotein metabolism abnormalities we investigated apo A-l apo B, apo E and the apo A-I/apo B ratio. Results Results were statistically analyzed using Student's t-test, and the Mann-Whitney U test. Statistically, patients with proteinuria over 3.0 g/24h have significantly higher apoprotein B and apoprotein E values in the serum, as well as apo B/apo A-l compared to control subjects, and patients with proteinuria around 0.26-1.0 g/24h and proteinuria around 1.1-3.0 g/24h. Proteinuria leads to deterioration of apoprotein abnormalities. .

Proteinuria: The diagnostic strategy based on urine proteins differentiation

Basal glomerular membrane represents mechanical and electrical barrier for passing of the plasma proteins. Mechanical barrier is composed of cylindrical pores and filtration fissure, and negative layer charge in exterior and interior side of basal glomerular membrane, made of heparan sulphate and sialoglicoproteine, provides certain electrical barrier. Diagnostic strategy based on different serum and urine proteins enables the differentiation of various types of proteinuria. Depending on etiology of proteinuria it can be prerenal, renal and postrenal. By analyzing albumin, armicroglobulin, immunoglobulin G and armacroglobulin, together with total protein in urine, it is possible to detect and differentiate causes of prerenal, renal (glomerular, tubular, glomerulo-tubular) and postrenal proteinuria. The adequate and early differentiation of proteinuria type is of an immense diagnostic and therapeutic importance.

Proteinuria inducing tubulointerstitial damage

Introduction Glomerular basal membrane represents a mechanical and electric barrier for plasma proteins. In physiological conditions only plasma proteins of low molecular weight are completely filtered through basal membrane. Due to damages of glomerular basal membrane there is an increase in filtration of plasma proteins of moderate and high molecular weight. Proteinuria In regard to its etiology proteinuria can be prerenal, renal and postrenal. By analyzing albumin, 1-microglobulin, immunoglobulin G and 2-macroglobulin, together with total protein in urine, it is possible to detect and differentiate causes of prerenal, glomerular, tubular and postrenal proteinuria. Abnormal glomerular permeability to macromolecules results in excessive protein delivery and reabsorption in proximal tubules. Excessive reabsorption in turn may cause congestion of intracellular endocytic and biosynthetic compartments leading to NFkB-dependent and -independent gene upregulation. Among those genes, monocyte chemoattractant protein-1 (MCP-1), cytokines, osteopontin and endothelin stimulate processes of interstitial inflammation and fibroblast proliferation and are ultimately responsible for enhanced extracellular matrix deposition and renal scarring. Human tubular cells exposed to albumin and HDL increase production of endothelin-1. Endothelin-1 affects microcirculation and fibroblasts and is a monocyte chemoattractant. Specific proteins that are cytotoxic are transferrin/iron, low-density lipoprotein, and complement components, all of which appear in urine in proteinuric states. Adequate and early diagnosis and differentiation of proteinuria are of immense therapeutic importance.

Concentrating ability of the kidneys in proteinuric patients

Proteinuria causes damage to renal tubulointerstitum. The study included 50 patients (24 males and 26 females), mean age 46.50 +/- 13.08 years, with average endogenous creatinine clearance 87.29 +/- 31.17 ml/min. Regarding level of glomerular proteinuria patients were divided into three groups. The first group, with proteinuria less than 0.3 g/24 h, included 19 patients (7 male and 12 female), average age 45.12 +/- 13.28 years and mean clearance of endogenous creatinine 94.27 +/- 34.70 ml/min. The second group, with proteinuria between 0.3 and 3.0 g/24 h, comprised 18 patients (8 male and 10 female), mean age 45.39 +/- 12.64 years, and with mean clearance of endogenous creatinine 90.07 +/- 31.89 ml/min. The third group consisted of 13 patients (9 male and 4 female) with proteinuria values higher than 3.0 g/24 h, average age 50.08 +/- 13.73 years and mean endogenous creatinine clearance 73.25 +/- 20.44 ml/min. In order to assess the concentrating ability of the kidneys we investigated: urine osmolality, osmolar concentration index, fractional osmolar excretion, fractional urea excretion and free water clearance. Results were statistically analyzed using Student t test, Mann-Whitney U test and chi 2 test. Proteinuria leads to deterioration of concentrating ability of the kidneys.

[Effect of proteinuria on transport of sodium, potassium and chloride ions in renal tubules]

Functional and structural damages of tubulointerstitium are caused by proteinuria. The aim of this study was to assess the influence of different proteinuria levels on Na+, K+, Cl- tubular transport. We examined 50 patients (24 males, 26 females), mean age 46.50 +/- 13.08 years, with mean creatinine clearance of 87.29 +/- 31.17 mL/min. They were separated in three groups, depending on proteinuria value. The first group with proteinuria less than 0.3 g/24 h included 19 persons (7 males, 12 females), mean age 45.12 +/- 13.28 years, with mean creatinine clearance of 94.27 +/- 34.70 mL/min. The second group of 18 patients (8 males, 10 females), mean age 45.39 +/- 12.64 years, had proteinuria of 0.3-3.0 g/24 h and mean creatinine clearance of 90.07 +/- 31.89 mL/min. The third group had proteinuria level higher than 3.0 g/24 h and mean creatinine clearance of 73.25 +/- 20.44 mL/min. It included 13 patients (9 males, 4 females), mean age 50.08 +/- 13.73 years. As a parameter of proteinuria influence on tubular transport of Na+, K+ and Cl-, fractional excretion of these electrolytes, was studied. Student's T test, Mann Whitney U test and c2 test were used for statistical analysis. No statistically significant influence of proteinuria was found on Na+, K+ and Cl tubular transport.

[Results of IVF treatment methods in Germany in 1998--the German IVF Registry]

We used data in Germany IVF registar 1998 from 86 (94.6%) centers which take upon IVF procedures. The total documentary were treated 46730. The cultivated data were 45459. The visible is increase number of group which use IVF procedures and growth IVF/ICSI centers with options KRYO preservations. In Germany 1998, IVF ICSI, KRYO and GIFT procedures were treated 30,009 women, on an average 1,515 cycles per year. The endurance leaning of children was amoung 2 and 8 years for both procedures. In stimulated cycles on an average were taken 9.04 eggs (follicule punction). During IVF procedures it was 22.64% clinical pregnancy and ICSI procedures 23.53% clinical pregnancy. In most of the cases cycles were stimulated with long gonadotropine protocol, with GnRH-agonists, after suppression adenohypophysis. Considering pregnancies and abortions in addiction to chosen gonadothropine it was not possible to confirm significant difference neither for IVF of ICSI procedures. Results of therapy showed clear addiction to age of women and become worse after 39 the year of life and distintcly less after 49th year for both procedures. During transvaginal ultrasonography follicule punction reported is 253 (0.67%) complications. Severe cases such as ovarial hyperstimulation syndroms (OHSS III) were reported in 1.12% cases.