Mapping nursing interventions using the Therapeutic Intervention Scoring System in bloodless liver transplantations

BACKGROUND

The Simplified Therapeutic Intervention Scoring System adapted to liver transplantation by King's College Hospital rank 138 activities to determine the nursing workload, diagnostic, monitoring and therapeutic needs.

OBJECTIVES

To evaluate nursing activities of "King's-TISS" score grouped in organ systems and nurse patient ratio in the perioperative 48 hours of blood product free liver transplantations (LT).

METHODS

The "King's-TISS" score's were analysed by nursing procedures and grouped, scored according to organ systems. The nursing workloads were studied during LT (T1), on arrival on the ICU (T2) and 12-24-48 hours after LT (T3-T4-T5).

RESULTS

The total of "King's-TISS" score points were decreased by ≥20% daily (p = 0.001). The mean score of 104 ± 3.5 points (CI:104-105) during LT decreased to 84.7 ± 12 points (CI:83-86) in 48 hours (T5). The "metabolic" and "haemostasis" points increased (p = ).01), the "immunology" points unchanged (T2-T5) postoperatively. A slight decrease was observed in case of "basic nursing care", "monitoring", "neurologic support", "renal support" and "cardiovascular support" points (T2-T5, p < .01). The "invasive intervention" and "ventilatory support" points strongly decreased (T2-T5, p < .001). One "King's-TISS" point was found to equal 7.4 minutes with a nurse patient ratio of 2:1 intraoperatively and 1:1 postoperatively.

CONCLUSION

Absence of blood product administration in LT decreases the total and organ specific workload, except the metabolic, haemostasis, immunology and basic support requirement. It was not within the scope of the King's-TISS score to analyse the application of viscoelastic haemostasis test and coagulation factor concentrate administration.

How Much Is the Inevitable Loss of Different Coagulation Factors During Blood Product-Free Liver Transplantations?

BACKGROUND

Bloodless liver transplantations (LT) have already been reported, but special characteristics of hemostatic changes remain less defined. The aim of this study was to evaluate the "inevitable" loss of coagulation factors (CF) in blood product-free LT.

METHODS

Blood product and CF concentrate-free LT patient data were analyzed in terms of the first 2 days of perioperative hemostasis kinetics (N = 59). CF levels (FI, II, V, VII, X, and XIII), platelet (PLT) levels, and hemoglobin levels were measured before LT (T1), on arrival at the intensive care unit (T2), and 12, 24, and 48 hours after LT (T3, T4, and T5, respectively). Thromboelastographic (TEG) parameters were determined before and at the end of LT (T1-T2).

RESULTS

Fibrinogen levels decreased by 1.2 ± 0.6 g/L, prothrombin levels by 26% ± 14%, factor V levels by 40% ± 23%, VII levels by 29% ± 19%, and X levels by 39% ± 22% (P < .001). From T2 to T4 fibrinogen increased by 0.9 ± 0.6g/L for 24 hours (P < .001). Factor II, V, and VII levels increased by 20% ± 16%, 31% ± 32%, and 12% ± 27%, respectively, between T3 and T5 (P < .001). However, factor X reached only half of the T1 level (T3-T5, P < .001). Platelet count increased in 34 (58%) patients at T2 (P < .001). The TEG parameters remained in the normal range during LT (T1-T2).

CONCLUSION

The major findings of this study advocate that "inevitable" levels of CF decrease during LT by an average of 1.2 g/L in terms of fibrinogen and 23% to 40% regarding factors II, V, VII, and X. The authors suggest that knowing the "magic numbers" and comparing them against baseline laboratory results might predict the possibility of blood product-free transplant, providing confidence and safety to the surgeon and the anesthetist.

P5485The impact of meteorological parameters on the incidence of myocardial infarction

Introduction

The changing of some meteorological parameters have major burden on the human body. That's why it became necessary to adopt to the altering conditions. The air temperature, atmospheric pressure have a significant influence on the patient's physical shape, blood pressure and response to stress.

The aim of our study was to assess the impact of the fronts and all the factors forming the weather at the same time on the incidence of myocardial infarction and its prognosis.

Methods

We performed a retrospective analysis on the data of 11820 consecutive patients surviving acute myocardial infarction between 2005 and 2014. We used to scales applied in meteorology to characterise the days (Péczely Scale, Front Scale). We studied the incidence of the values of the different scales 2 days before and after the infarction.

Results

We had a database of 11820 patients, STEMI (n=5183) and NSTEMI (n=6004). We created different subgroups (age, 30-day mortality, occurrence of primary ventricle fibrillation) to make our estimation. Considering non VF patients the effect of Front 3 whereas among VF positive patients Front 5 is more significant. The incidence rates of Front 3 one day before and on the day of the infarction in the non-VF and NSTEMI group is 0.2041 and 0.1735, in the non-VF and STEMI group it is 0.1939 two days before the event. The incidence rate of Front 5 on the 2nd day in the NSTEMI and VF positive group is 0.0357, it is 0.0714 among STEMI and VF positive patients on the day of the event. The influence of the approaching warm front is significant (p<0.05).

Conclusion

The influence of the weather is not irrelevant in the occurrence of MI. The mortality rates are higher in several subgroups on days having a Péczely Scale 3. The different fronts have a major impact on the severity of the infarction. The Front 5 causes higher incidence of VF due to MI. We proved that warm fronts have a significant effect on patients dying within 30 days.

17-β-estradiol Decreases Neutrophil Superoxide Production through Rac1

Neutrophil granulocytes form the biggest free radical producing system of the human body. The importance of this system in atherosclerotic plaque formation and other free radical mediated disorders is confirmed by both in vivo and in vitro studies. Estrogen's effect on free radical production involves multiple estrogen receptors and occurs both on transcriptional and on protein phosphorylational level. Estrogen decreases the superoxide production of neutrophil granulocytes in such a short time frame it is unlikely to be mediated by transcription regulation. We investigated the underlying mechanism through which the mentioned estrogen effect takes place using an immunabsorption-based method. Phosphorylation data of 43 different messenger proteins were used for pathway analysis. The newly identified pathway involved largely second messengers from previously described non-genomic estrogen effects and affected superoxide production via Rac1 - an important regulator of free radical production and chemotaxis. Selective inhibition of the participating second messengers altered superoxide production in the predicted direction confirming that this pathway is at least partly responsible for the effect of 17-β-estradiol on chemoattractant induced superoxide production.

Increased total scavenger capacity in rats fed corticosterone and cortisol on lipid-rich diet

BACKGROUND

In our earlier studies both corticosterone and cortisol had antioxidant effect in vitro.

OBJECTIVES

Our aim was to clarify whether corticosterone and cortisol oral administration results in beneficial antioxidant changes in Sprague-Dawley adult male rats in vivo.

METHODS

Experimental animals were fed a lipid rich diet and treated with corticosterone or cortisol in the drinking fluid. Control group was fed only lipid rich diet with untreated drinking water. The untreated group was feda normal diet with untreated water. Total scavenger capacity (TSC) was measured before and after 4 weeks of treatment in blood samples using a chemiluminometric assay.

RESULTS

Both corticosterone and cortisol treatment caused increased TSC. The control group and the untreated group showed no significant changes in TSC.

CONCLUSION

Our results support the hypothesis that corticosterone and cortisol administration can improve the antioxidant status not only in vitro but also in vivo.

The type 2 diabetes-associated variant in TCF7L2 is associated with latent autoimmune diabetes in adult Europeans and the gene effect is modified by obesity: a meta-analysis and an individual study

AIMS/HYPOTHESIS

The variants of transcription factor 7-like 2 (TCF7L2) gene have been proposed to be associated with latent autoimmune diabetes in adults (LADA). We sought to confirm the possible association in Europeans and to examine the interaction between one gene variant and clinical data.

METHODS

The TCF7L2 rs7903146 C-to-T polymorphism was genotyped in 211 LADA, 1,297 type 2 diabetic, 545 type 1 diabetic and 1,497 control individuals from Hungary. A meta-analysis of our and previously published studies was performed to evaluate the size and the heterogeneity of the gene effect.

RESULTS

The meta-analysis yielded a significant effect of TCF7L2 T allele (OR 1.28; p < 0.0001) on LADA risk without heterogeneity among Europeans. The T allele conferred equally strong susceptibility to LADA and type 2 diabetes. In the Hungarian dataset, the T allele was associated with LADA and type 2 diabetes, but not with type 1 diabetes. T allele carriers had significantly lower BMI than patients with the CC genotype in the LADA and type 2 diabetes groups (p = 0.0021 and p = 0.0013, respectively). In both diseases, the diabetes risk was significantly higher in the non-overweight than in the overweight BMI category (p = 0.0013 and p < 0.0001, respectively); susceptibility to LADA was increased by 2.84-fold in non-overweight individuals compared with overweight ones.

CONCLUSIONS/INTERPRETATION

The meta-analysis demonstrates that TCF7L2 rs7903146 polymorphism is a population-independent susceptibility locus for LADA in Europeans. The effect size is similar for LADA and type 2 diabetes. The gene effect on diabetes risk may be modulated by BMI, such that the lower the BMI, the higher the gene effect.

Smoking following renal transplantation in Hungary and its possible deleterious effect on renal graft function

Smoking is a known risk factor for kidney damage and also influences graft function following renal transplantation. Because smoking habits following kidney transplantation are not systematically evaluated, we analyzed them in a single center in Hungary. The survey was conducted among 402 randomly selected kidney graft recipients. We assessed smoking-related questions as well as clinical kidney disease and transplantation data. Posttransplantation renal function was analyzed based on serum creatinine values at 1 month and at 3 years after transplantation. In our study 25% (n = 102) of patients continued to smoke after transplantation. Smokers who received grafts displayed a significantly younger age compared with nonsmokers (40.1 +/- 13.4 vs 47.1 +/- 12.7 years; P < .001) independent of underlying kidney disease. Posttransplantation kidney function in smokers did not differ at 1 month after engraftment, but was significantly impaired at 3 years as assessed based on serum creatinine levels: 138.9 +/- 42.4 versus 128.4 +/- 48.5 micromol/L (P < .05). Decrease of renal function correlated with smoking intensity defined in pack-years (r(2) = 0.102; P < .05). Smoking is common following kidney transplantation in Hungary and might represent a risk factor for kidney damage following renal transplantation. Therefore, effective tobacco-dependence treatment is necessary in this patient population.

Hepatitis C infected hemodialysis and renal transplant patients with elevated α-glutathione S-transferase have increased risk for liver damage

Patients on hemodialysis (HD) and renal transplant recipients (RT) have a high prevalence of HCV infection. Theaimof our study was to determine the prevalence of HCV-RNA in the anti-HCV positive patients and to compare the biochemical parameters of PCR(+) and PCR(−) subgroups.Methods:The 525 sera were screened for anti-HCV. HCV-RNA was detected by polymerase chain reaction (PCR) and liver enzymes [SGOT, SGPT, GGT,α-glutathione S-transferase (GST)] were measured.Results:Active viraemia was found only in 187 of 289 (65%) seropositive HD patients in contrast to 53 of 53 (100%) of seropositive RT patients. Significantly increased (p<0.05) GST values (9.9 μg/l) were found in the PCR(+) subgroups compared to GST levels (2.7 μg/l) of the PCR(−) subgroups. Elevated GST concentration was found in 80% (208/251) of PCR(+) patients. The measured enzymes were not elevated in HCV infected patients. Six percent of HD and 11% of RT patients were screened before seroconversion. Diagnostic sensitivity (80%) and specificity (79%) of GST were calculated as good for early liver damage caused by HCV. In contrast, the sensitivity of the measurement of other liver enzymes were very weak (SGOT: 8%; SGPT: 10%; GGT: 42%).Conclusion:The significantly higher viraemia of the RT subgroup could be related to the immunosuppressive therapy. Increased GST level may be a useful indicator of tissue damage during HCV infection. If HCV infection is suspected, PCR and GST measurement should be performed, even if anti-HCV result is negative.

Systematic investigation of different steroid precursors with respect to their effect on superoxide anion production by human neutrophil granulocytes

Free radicals are involved in several pathological processes in living organisms, for example in athero- and oncogenesis. Some steroids are known to be effective antioxidants, while others do not play any such role. The aim of our study was to examine the antioxidant capability of different metabolites in the synthesis of steroid hormones. As a model, we chose human neutrophils producing superoxide anion, which is the source of many other radicals. Neutrophils were separated from healthy volunteers. Isolated cells were incubated with varying concentrations of steroid compounds and stimulated with N-formyl-Met-Leu-Phe. Superoxide anion production was determined by photometry. Neutrophils incubated with corticosterone and 18-hydroxy-deoxycorticosterone showed a significant reduction in superoxide production, whereas we found a significant enhancement in the presence of 11beta-hydroxyprogesterone. Furthermore, we observed a non-significant decreasing trend after incubation with cholesterol 3-sulphate and an increasing tendency using 11-hydroxyandrostenedione. We were also able to produce newer morphological and functional evidence of the role of myeloperoxidase enzyme in the steroidal antioxidant effect by electronic microscopy and use of sodium hypochlorite in our incubation model. Based on these results, we conclude that not only steroid end products but also their intermediate metabolites, most of which are also present in human plasma, partly influence free radical metabolism. Thus, this study provides further argument for the search for the molecular basis responsible for the antioxidant effect of steroid structures. This may lead to new opportunities for finding really efficient antioxidants, which might perhaps be used in a combined manner with other agents in the fight against certain life-threatening diseases.

Comparative study between the free radicals and tumor markers in patients with gastrointestinal tumors

The tumorous processes, increased level of tumor markers and the change of free radical status are associated in patents with gastrointestinal tumors. The aim of this study was to examine free radical status and tumor markers in patients with gastrointestinal tumors. Two hundered and thirteen patients with gastrointestinal tumor were examined. In the control group 44 non-tumorous patients were examined. The tumor markers (CEA, CA 19-9, CA 72-4, AFP, TPA, AGP) and free radical status (total scavenger capacity) were diagnosed using venal blood (obtained by LIA-kits and chemiluminescent methods, LIA-mAT and the Lumat Berthold instrument). It has been found that: (1) The results showed that the tumor markers, TPA and AGP are the best indicators for the tumorous process; (2) The AGP serum level was in the operable case 91.56+/-38.29 mg/dl meanwhile its value was, 128.46+/-47.62 mg/dl (P<0.001) in the inoperable case; and (3) The TPA value was 118.37+/-155.47 mg/dl in the operable case, (P<0.001) while its value was 227.32+/-244.39 mg/dl in inoperable cases. The significantly high levels of the plasma Chemiluminescent Light Intensity (CLI)=28.12+/-25.96; was obtained in patients with rectal tumors vs. in the control cases CLI= 4.27+/-5.12 RLU% (Relative Light Unit; mean+S.D.; P<0.005). In six of these cases, the free radical status examination indicated the presence of the tumor, even though the level of tumor markers was normal. It has been concluded that the testing of both regular tumor markers and free radical status has an important role in the diagnosis and monitoring of the patients with gastrointestinal tumors.

[Increase in prevalence of childhood asthma in Budapest in relation to the air pollution data and the total pollen count]

The authors surveyed the prevalence of bronchial asthma in childhood in Budapest in 1995 and in February 1999, via questionnaires directed to paediatricians. In 1995, replies were received from 118 paediatricians in 11 districts, who were responsible for the supervision of 104,087 children, of these, 1.88 +/- 0.87% had been diagnosed as having asthma. In 1999, replies were sent by 153 physicians in 22 of the 23 districts, who had a total of 142,684 children under their care. These included 3228 asthmatics, i.e. a prevalence of 2.26 +/- 0.95%. The difference between the two data was highly significant (p = 0.0001). The prevalence increased by 20% in 4 years. The dust, CO, NO2 and SO2 concentrations in the air were measured constantly at 8 points in Budapest, while ozone level measurements were also made at 2 stations. The counts of pollens and of fungal elements in the air were calculated separately for Buda and for Pest. These data overall revealed that the level of air pollution in Budapest did not deteriorate in the period in question, and the pollen counts from allergizing plants did not rise relative to earlier years. An interesting question (though it is far from certain that this is a causal correlation) can be upposed whether the 13% drop in the number of live births in Hungary during this 4-year period can be connected with the 20% rise in prevalence of childhood asthma.

Prediction of early renal graft function by the measurement of donor urinary glutathione S-transferases

BACKGROUND

We have investigated the possibility of urinary alpha- and pi class glutathione S-transferases (GST-a; GST-pi) serving as a valuable parameter to predict early graft function after transplantation.

METHOD

Urinary GST concentrations of 61 donors (DON) and recipients (REC) were analyzed at preoperative, intraoperative, and postoperative periods. We grouped recipients according to the early postoperative graft recovery days.

RESULTS

The donor graft function, represented by the donor urinary GST concentration (GST-pi:17,1+/-12 microg/l mmol creatinine (crea); GST-a:14,3+/-10 microg/mmol crea), sustained a loss in comparison to the healthy controls (GST-a; pi< or =1 microg/mmol crea). According to statistical analysis, the donor GST-pi level showed a strong correlation with graft recovery days-pi (r = 0.84; P<0.001). The early graft function cannot be predicted by means of cold ischemia time (22.8+/-3.4 hr), nor handling time (42.4+/-11.1 min), nor even the intraoperative enzyme concentrations. The GST-pi cut off level (12.55 microg/mmol crea) might predict the possible posttransplant graft dysfunction. The discriminative analysis showed that using only DON GST-pi alone could discriminate well between the groups among all grafts in 68%.

CONCLUSION

Prognosis is poorer if the donor GST-pi concentration is above 12.55 microg/mmol crea. On the basis of the determination of GST-pi concentration in the donor urine, we can predict graft viability before the surgical procedure with a reliability of 68%.

[Biometry: data scales]

In this paper the author shows the basic concepts of the different data scales, which are important from statistical investigations points of view. He summarizes the characteristics of each scale and presents their sample data.

[Biometric bases: basic concepts of probability calculation]

The author gives or outline of the basic concepts of probability theory. The bases of the event algebra, definition of the probability, the classical probability model and the random variable are presented.

[Biometric concepts and function theory]

r shows the basic concepts of function theory, which ones are necessary in biometrical works. The concept of the function, the different mapping methods and some often used function types are presented.

[Basic concepts of biometric bases of the set theory]

In this paper the author shows the basic concepts of set theory, which ones are necessary to understand biometric methods. The sets, the most important operations, the power of sets and the types of the used variables are presented.

[Analysis of normality of data on the basis of the mean and standard deviations]

In this study the author shows a method for the supervision of normal distribution on the basis of the mean and the standard deviation. The given method can be used to control the data of the scientific articles and the clinical data from normal distribution point of view.

[Prospective epidemiologic study for the determination of lung cancer risk groups (1975-19940]

Authors make known the comprehensive results of a longitudinal epidemiological examination which commenced in the 10th District of Budapest with nearly 100,000 inhabitants in 1975. The observation period is 15-20 years. Its aim was the determination of the risk factors of lung cancer. They followed up the lot of 30,561 persons, 92% of the population over 40 years of age 14,191 patients took part in a control examination supplemented with respiratory test. They analysed the connection between the supposed external risk factors and parenchyma functional damages caused by them and the development of lung cancer by detailed mathematical statistical arithmetic. 571 patients fell ill with lung cancer. The cured lung tuberculosis also proved to be a leading risk factor besides smoking. From the not endangered group 43, the highly super highly endangered groups 458 people fell ill with lung cancer. There was no difference between men and women in the lung cancer risk of the risk free population. According to their supposition the connection between the parenchyma functional damages caused by external risk factors and the development of lung cancer is determined by the different immunological status of people. (During the 20 years observation period 4% of heavy smokers and 3% of cured lung tuberculous patients fell ill with lung cancer). They urge the organization of wide ranging international prospective examination for the testing of this supposition.

Apolipoprotein E and complement C3 polymorphism and their role in the response to gemfibrozil and low fat low cholesterol therapy

Three different allelic variants of apolipoprotein E determine, in concert with other gene products, the levels of plasma lipoproteins. Recently, cleavage products of the complement C3 molecule have also been implicated in determining plasma triacylglycerol concentrations. This study presents data of an ongoing study to dissect the role of the apolipoprotein E gene locus in the response to low fat/low cholesterol diet combined with gemfibrozil treatment. In addition, for the first time, the significance of C3 allelic variants to such hypolipidaemic therapy response was analysed. To this end data from 81 obese hyperlipoproteinaemic patients (Fredrickson type II/A and B and type IV and V) confirmed the usefulness of the combined gemfibrozil/diet treatment and unveiled apolipoprotein E allele group specific therapy responses. The mean changes of lipid properties due to combined treatment was 15% for total cholesterol, 48% for triacylglycerols and 28% for atherogenic index. Division into hyperlipidaemia types according to Fredrickson and subgrouping into E2, E3 and E4 groups (apolipoprotein E2/2 and 2/3, apolipoprotein E3/3 and apolipoprotein E4/2 and 4/3 phenotype groups respectively) exposed pronounced differences from these mean changes, suggesting substantial influence of apolipoprotein E variants on this therapy. We observed triacylglycerol reductions of from 17% in type IIA-apolipoprotein E3 group patients up to 78% in the type IV and V-apolipoprotein E2 group. Thus it might be concluded the apolipoprotein E genotyping aides therapy success prediction. Although, low sample number in some subgroups obscures significance in this pilot study, significant therapy success emerges for the E3 and E4 group in type IV and V hyperlipidaemia and type IIB-apolipoprotein E3 homozygous patients can be predicted to respond better than apolipoprotein E2 carriers. Finally, we present evidence that positive changes of lipid properties are also determined by the "fast" complement C3 allel (C3-F). Patients with complement factor C3-FS pattern respond better to treatment than patients with C3-SS configuration. In summary these data endorse the genotyping of apolipoprotein E alleles to predict maximal success of "fibrate" treatment. In addition they argue strongly for further assessment of the involvement of complement C3 allelic variations in lipid homeostasis.

[Molecular genetic markers of Alzheimer dementia]

Alzheimer's dementia (AD) is a progressive neurodegenerative disease which is one of the most common forms of dementia in the above 65 years old age group. Diagnosis is based upon evaluation of cognitive skills, elimination of other dementia associated diseases and on cranial CT examination. However, definitive diagnosis is proved only by neurohistological findings. The etiology of the disease is unknown and effective treatment is not available. Intensive research into the pathomechanism of the disease revealed a connection between increased frequency of apolipoprotein E4 allele and later onset of AD. The aim of the author's research was to characterize apolipoprotein E polymorphisms in AD patients and to examine immunological factors which could play an important role in the development of the disease such as the polymorphism of complement and lipoprotein(a) [Lp(a)] alleles previously had not been investigated. 35 AD patients (26 female, 9 male) were examined (mean age 66.4 years +/- 8.7 SD). 18 of these patients showed late onset of the disease. The E4 allele was significantly more frequent in both early and late onset groups compared to controls (0.29 vs. 0.14 and 0.33 vs 0.09). The high frequency of apo E4 found in the early onset group in this study differs from other international data. Serum lipid, lipoproteins, Lp(a) concentrations and Lp(a) phenotype distribution showed no significant difference compared to controls. Furthermore, it was found that the frequency of complement C4AQ0 (null) and Bf F alleles was higher in the late onset AD group compared to controls (0.35 vs 0.139 and 0.305 vs. 0.225) suggesting an active involvement of the complement system in the pathogenesis of this disease.

[Could tuberculosis again be an endemic disease in Hungary? (Model study 1968-1993)]

The aim of this examination started in an industrial district of Budapest with 100,000 inhabitants in 1968, was the determination of risk groups of pulmonary tuberculosis and the organisation of X-ray screening. The initial decrease in the incidence of pulmonary tuberculosis stopped (between 1981 and 1993) and, a minimal increase could be even demonstrated in the last years. The cause of the increase is explained by sociological factors (the influx of refugees, growth in the number of homeless people and of chronic alcoholics). The authors propose the modernization of the preventive and exploratory medical work: the use of computers in the lung-screening center and the institutionalisation of screening aimed at risk groups of pulmonary tuberculosis. In the population over forty years of age 92% of 408 new pulmonary tuberculosis patients, emerged from risk groups between 1981 and 1993, and only 8% from people who did not belong to the risk groups. The effectiveness of screening in the risk groups was 3 to 4 times higher than that of indiscriminate screening.

[Effect of Gevilon therapy and its relation to E polymorphism]

Our clinical trial was set out to estimate the apoE allele frequency by way of polymerase chain reaction and restriction enzyme isoform genotyping amongst 81 obese, hyperlipoproteinemic patients (treated with gemfibrozil + diet). The relative frequencies of the E2, E3, E4 alleles were 0.28, 0.61, 0.11 respectively (according to the Hardy-Weinberg equilibrium). Phenotypes with increased triglycerides levels were dominant in both sexes: IV + V > II/B > II/A (44.4%, 39.5%, 16.0%). Therapy significantly decreased the atherogen lipid values with differing efficacy among each genotype group: E3 > E4 > E2. Our findings demonstrate that in the II/A group there was no great change using the gemfibrozil + diet combination: whereas in IV + V group this combination was effective in each apoE isoform. In the case of II/B it is highly important to determine the apoE genotypes, because the therapy is only efficacious in the E33 group taking all lipid parameters into consideration.

[Relation of angiographic changes to clinical data and risk factors in patients with arteriosclerosis obliterans]

The arteriographical changes of 66 patients with peripheral arterial obliterative disease and the relationship between the observed alterations and certain clinical and laboratory data as well as some risk factors were analysed. A score system was used to quantify the arteriosclerotic lesions. The arterial alterations of the examined 90 extremities were studied in the pelvic (common and external iliac arteries), femoral (common, superficial, deep femoral and popliteal arteries) and crural (anterior and posterior tibial arteries) regions. Pathomorphological changes in 433 of the investigated 720 arteries were shown, from among them plaque in 11.8%, stenosis in 22.3%, total occlusion in 26% were proved. Most frequently (89%) the superficial femoral artery was affected. As to the single vessels, the superficial femoral and posterior tibial arteries, while among the zones the femoral region proved to be most serious radiologically. The degree and extent of vessel lesions were related to age. The morphological severity was basically concordant with the results of clinical investigations (walking distance, ergometry, Doppler index). The separately examined risk factors (smoking, hypertension, diabetes, hypercholesterolemia, hypertriglyceridemia) were not related consequently to the radiological changes, but in certain combinations, as heavy smoking with hypertension and heavy smoking with diabetes, the relationship proved to be statistically significant.

[Smoking and mortality: longitudinal epidemiologic study (1975-1991)]

The authors have started a basic screening examination in one of the industrial districts of Budapest in 1975. The district has nearly 100,000 inhabitants. The aim of the examination was to determine the risk factors of lung cancer. 30,566 persons have participated. The health of all patients has been followed up between 1975-1991. During this period 3,573 patients have moved out of the district. On 26,993 patients they have examined the death ratio, the prospective life-span, in the various age groups divided into subgroups according to their smoking habits. They have studied the formation of death rate in the four risk groups determined by them on the basis of the simultaneous examination of more lung cancer risk-factors (risk-free, moderate, high and superhigh risk groups). During these 16 years the death rate both among the heavy smokers and among patients in the high and superhigh risk groups has been two, three, even almost five times higher than that in the non-smoking and in the risk-free group of the relatively younger age groups of the population (born between 1921-1930 and 1931-1938). The knowledge of these connections makes economic calculations possible in respect of life and health insurance.

Occurrence of oral leukoplakia and lichen planus in diabetes mellitus

The occurrence of oral leukoplakia and lichen planus in 1600 patients with diabetes mellitus (815 type 1: insulin-dependent, 761 type 2: non-insulin-dependent)-under care at the International Medicine Department-was studied. Precancerous lesions and conditions were diagnosed and grouped according to internationally accepted criteria. The prevalence of oral leukoplakia in diabetic patients was 6.2%, as compared to 2.2% in the healthy controls, that of oral lichen was 1.0% in the test-, and 0.0% in the control group. Leukoplakia and lichen both showed the highest occurrence in the second year of established diabetes, and their prevalence was higher among insulin-treated diabetics. Smokers were more often affected, by both kind of lesions, oral lichen showed a more frequent association with candidiasis. The prevalence of oral leukoplakia and lichen in diabetes mellitus patients was higher, than average ratios in population samples from the same country.

[Relationship between the caries status and metabolic imbalance in diabetics]

The dental clinical examination of 1600 (815 insulin dependent of type 1 and 761 non-insulin dependent of type 2 respectively) patients cared of because of diabetes mellitus was carried out and an answer to the question was sought for whether the condition of the teeth does change according to he type of the metabolic disturbance of the diabetic, the time of its manifestation, its setting, the manner of therapy, the family occurrence of the illness and the mouth hygiene, respectively. According to examination results, greater edentulousness with diabetes over 30 years showed a positive interdependence according to the confirmance time of diabetes. On the other hand, with diabetic of better setting there were less teeth with caries or removed ones and the DMF-T average was lower than with patients with worse diabetes setting. No independence was found in the development of the DMF-T average and the caries conditions, respectively, if diabetes occurred in the family history and according to the type of diabetes.

[Possible cause of the increased incidence of lung cancer in 1987 in the 10th District of Budapest (1975-1989)]

In 1975 in one of the major industrial districts of Budapest some longitudinal epidemiological examinations were carried out with the aim of, among others, determination of connection between environmental injuries and lung cancer incidence in connection with determination of lung cancer risk groups. Between 1975-1989 out of the environmental injuries the most important was the radioactive contamination observed due to the atomic power station catastrophe in Chernobil (1986). In 1987 the incidence of lung cancer increased. The increase was significant among the 50-69-year-old women, and expressly among the heavy smokers. In 1987, especially among women, but also in both sexes, the ratio among the major cell types of lung cancer shifted towards micro-cellular ones. In 1988 and 1989 lung cancer incidence has decreased. In view of the above a hypothesis was raised: patients who have previously suffered immunobiological hurt, could not prevent the increased radioactive burden and got ill with lung cancer earlier, than it should have been happened without this increased burden. For clarification this question further examinations are considered to be necessary.

[The role of risk factors in the development of lung cancer of various cell types]

Between 1975 and 1978 in 10th district of Budapest a basis examination was carried out with the aim of determination of lung cancer risk factors. Out of the 30,566 inhabitants 403 persons got ill with lung cancer during the above mentioned period. In case of 321 patients the cell type was determined in detail. As to the connection between the main risk factors and the various cell types it was found that planocellular lung cancer can be regarded as the cell type of men, but exclusively of smokers, while the microcellular type lung cancer can be considered as cancer of not only the younger age-groups, but that of expressly women, especially heavy smokers. With elimination of the two main risk factors (smoking, pulmonal lesions) not only the number of patients with lung cancer could be decreased to one third, but the ratio of adenocarcinomic diseases would also increase. These diseases are more favourable in respect of operability and survival.

[Limitations and possibilities of detecting lung cancer by fluoroscopic screening of the population]

In 10th district of Budapest a longitudinal, epidemiological examination was started in 1975 with the aim of analysis of the objective factors influencing the population screening and determination of possibilities of screening effectiveness. It was found that effectiveness of lung cancer detection with screening depends on the tumour cell-type, as well as on the localization being in connection with same. By computer method based on mathematical modelling the population can be divided into the following groups: risk-free, moderate-risk, high-risk and superhigh risk groups. The screening was said to be absolutely unnecessary in risk free groups and in case of persons over the age of 70 irrespective of their risk factor status. The material savings resulting from the reduction of screenings can be assigned to introduction of complex methods. The switch-over from quantitative screening to the qualitative one can increase the effectiveness of lung cancer detection.