Impairment of Mesenteric Perfusion as a Marker of Major Bleeding in Trauma Patients

The majority of potentially preventable mortality in trauma patients is related to bleeding; therefore, early recognition and effective treatment of hemorrhagic shock impose a cardinal challenge for trauma teams worldwide. The reduction in mesenteric perfusion (MP) is among the first compensatory responses to blood loss; however, there is no adequate tool for splanchnic hemodynamic monitoring in emergency patient care. In this narrative review, (i) methods based on flowmetry, CT imaging, video microscopy (VM), measurement of laboratory markers, spectroscopy, and tissue capnometry were critically analyzed with respect to their accessibility, and applicability, sensitivity, and specificity. (ii) Then, we demonstrated that derangement of MP is a promising diagnostic indicator of blood loss. (iii) Finally, we discussed a new diagnostic method for the evaluation of hemorrhage based on exhaled methane (CH₄) measurement. Conclusions: Monitoring the MP is a feasible option for the evaluation of blood loss. There are a wide range of experimentally used methodologies; however, due to their practical limitations, only a fraction of them could be integrated into routine emergency trauma care. According to our comprehensive review, breath analysis, including exhaled CH₄ measurement, would provide the possibility for continuous, non-invasive monitoring of blood loss.

Therapy of Castleman's disease with siltuximab - case report and review of literature

BACKGROUND

Idiopathic multicentric Castleman disease (iMCD) is characterized by constitutional symptoms, enlarged lymph nodes and laboratory test abnormalities, which are primarily related to the overproduction of interleukin-6 (IL-6). This form (iMCD) was treated earlier with cytostatics used for lymphoma, later with bio-logic therapy as rituximab, immunodulatory drugs and proteasome inhibitors, and in the last years with an anti-IL-6 antibody, siltuximab. Siltuximab is a human-mouse chimeric immunoglobulin G1k monoclonal antibody against human IL-6 approved in the European Union for the treatment of iMCD. In view of the limited treatment options for iMCD, this case report aimed to evaluate the efficacy and safety of siltuximab in the management of this condition.

CASE

We describe a young woman with iMCD diagnosed at the age of 25 years. For first line treatment, rituximab and dexamethasone were used without any cytostatic because the patient wished to give birth to a healthy child in the future. However, the response after this first line therapy was short. In addition, after 3 years from the start of rituximab + dexamethasone therapy, it was necessary to administer treatment for the relapse of iMCD. We decided for siltuximab in this young woman, still aged < 30 years, and started administration of siltuximab in 3-week intervals.

RESULTS

After administration of first two infusions of siltuximab, all inflammatory markers returned to normal value. Moreover, serum hemoglobin and albumin levels as well as C-reactive protein normalized after the first two administrations of siltuximab. The clinical response continue, siltuximab is still administered in 3-week intervals. PET/CT with fluorodeoxyglucose confirmed a very good anatomic and metabolic response to the treatment. Siltuximab demonstrated a favorable safety profile, and the prolonged treatment was well tolerated.

CONCLUSION

This result is encouraging and demonstrates the potential of siltuximab as treatment of CD. As earlier published, this case confirms that significantly elevated inflammatory markers in a patient with CD predict a good response to siltuximab.

Predictive value of tachycardia for mortality in trauma-related haemorrhagic shock: a systematic review and meta-regression

OBJECTIVES

Heart rate (HR) is one of the physiological variables in the early assessment of trauma-related haemorrhagic shock, according to Advanced Trauma Life Support (ATLS). However, its efficiency as predictor of mortality is contradicted by several studies. Furthermore, the linear association between HR and the severity of shock and blood loss presented by ATLS is doubtful. This systematic review aims to update current knowledge on the role of HR in the initial haemodynamic assessment of patients who had a trauma.

DESIGN

This study is a systematic review and meta-regression that follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations.

DATA SOURCES

EMBASE, MEDLINE, CENTRAL and Web of Science databases were systematically searched through on 1 September 2020.

ELIGIBILITY CRITERIA

Papers providing early HR and mortality data on bleeding patients who had a trauma were included. Patient cohorts were considered haemorrhagic if the inclusion criteria of the studies contained transfusion and/or positive focused assessment with sonography for trauma and/or postinjury haemodynamical instability and/or abdominal gunshot injury. Studies on burns, traumatic spinal or brain injuries were excluded. Papers published before January 2010 were not considered.

DATA EXTRACTION AND SYNTHESIS

Data extraction and risk of bias were assessed by two independent investigators. The association between HR and mortality of patients who had a trauma was assessed using meta-regression analysis. As subgroup analysis, meta-regression was performed on patients who received blood products.

RESULTS

From a total of 2017 papers, 19 studies met our eligibility criteria. Our primary meta-regression did not find a significant relation (p=0.847) between HR and mortality in patients who had a trauma with haemorrhage. Our subgroup analysis included 10 studies, and it could not reveal a linear association between HR and mortality rate.

CONCLUSIONS

In accordance with the literature demonstrating the multiphasic response of HR to bleeding, our study presents the lack of linear association between postinjury HR and mortality. Modifying the pattern of HR derangements in the ATLS shock classification may result in a more precise teaching tool for young clinicians.

Mitochondrial Dysfunction Affects the Synovium of Patients with Rheumatoid Arthritis and Osteoarthritis Differently

There is growing evidence regarding the role of mitochondrial dysfunction in osteoarthritis (OA) and rheumatoid arthritis (RA). However, quantitative comparison of synovial mitochondrial derangements in these main arthritis forms is missing. A prospective clinical study was conducted on adult patients undergoing knee surgery. Patients were allocated into RA and OA groups based on disease-specific clinical scores, while patients without arthritis served as controls. Synovial samples were subjected to high-resolution respirometry to analyze mitochondrial functions. From the total of 814 patients, 109 cases were enrolled into the study (24 RA, 47 OA, and 38 control patients) between 1 September 2019 and 31 December 2021. The decrease in complex I-linked respiration and dyscoupling of mitochondria were characteristics of RA patients, while both arthritis groups displayed reduced OxPhos activity compared to the control group. However, no significant difference was found in complex II-related activity between the OA and RA groups. The cytochrome C release and H₂O₂ formation were increased in both arthritis groups. Mitochondrial dysfunction was present in both arthritis groups; however, to a different extent. Consequently, mitochondrial protective agents may have major benefits for arthritis patients. Based on our current study, we recommend focusing on respiratory complex I in rheumatoid arthritis research.

Detection of exhaled methane levels for monitoring trauma-related haemorrhage following blunt trauma: study protocol for a prospective observational study

INTRODUCTION

Early recognition and effective treatment of internal bleeding impose a cardinal challenge for trauma teams. The reduction of the superior mesenteric artery (SMA) blood flow is among the first compensatory responses to blood loss, thus being a promising candidate as a diagnostic tool for occult haemorrhage. Unfortunately, methods for monitoring the SMA flow have not been elaborated to date. Nevertheless, animal experiments suggest that exhaled methane (CH₄) levels correspond to the SMA perfusion. We hypothesise that real-time detection of CH₄ concentrations in the exhaled air is an applicable technique for the early recognition of haemorrhage in severely injured patients. We also hypothesise that exhaled CH₄ levels reflect the volume of blood loss more accurately than conventional markers of blood loss and shock such as shock index, haemoglobin, base deficit, lactate, end-tidal carbon dioxide and sublingual microcirculatory indices.

METHODS AND ANALYSIS

One hundred and eleven severely injured (Injury Severity Score ≥16), intubated, bleeding patients sustaining blunt trauma will be included in this prospective observational study. Blood loss will be detected with CT and estimated with CT-linked radiologic software. Exhaled CH₄ concentrations will be monitored by attaching a near-infrared laser technique-based photoacoustic spectroscopy apparatus to the exhalation outlet of the ventilator on patient arrival. The primary outcome is the volume of blood loss. Need for massive transfusion and 24-hour mortality will constitute secondary outcomes. The relation of exhaled CH₄ to study outcomes and its performance in predicting blood loss in comparison with conventional shock markers and microcirculatory indices will be tested.

ETHICS AND DISSEMINATION

Our protocol (ID: 5400/2021-SZTE) has been registered on ClinicalTrials.gov (NCT04987411) and complies with the Declaration of Helsinki and has been approved by the medical ethics committee at the University of Szeged (Ref.nr.:121/2021-SZTE RKEB). It is in data collection phase, theresults will be shared with the scientific community through publication in a peer-reviewed journal.

TRIAL REGISTRATION NUMBER

NCT04987411; ClinicalTrials.gov, registered on 27 July 2021.

Mitochondrial dysfunction in trauma-related coagulopathy - Is there causality? - Study protocol for a prospective observational study

Hemorrhage control often poses a great challenge for clinicians due to trauma-induced coagulopathy (TIC). The pathogenesis of TIC is not completely revealed; however, growing evidence attributes a central role to altered platelet biology. The activation of thrombocytes and subsequent clot formation are highly energetic processes being tied to mitochondrial activity, and the inhibition of the electron transport chain (ETC) impedes on thrombogenesis, suggesting the potential role of mitochondria in TIC. Our present study protocol provides a guide to quantitatively characterize the derangements of mitochondrial functions in TIC. One hundred eleven severely injured (Injury Severity Score ≥16), bleeding trauma patients with an age of 18 or greater will be included in this prospective observational study. Patients receiving oral antiplatelet agents including cyclooxygenase-1 or adenosine diphosphate receptor inhibitors (aspirin, clopidogrel, prasugrel, and ticagrelor) will be excluded from the final analysis. Hemorrhage will be confirmed and assessed with computer tomography. Conventional laboratory markers of hemostasis such as prothrombin time and international normalized ratio (INR) will be measured and rotational thromboelastometry (ROTEM) will be performed directly upon patient arrival. Platelets will be isolated from venous blood samples and subjected to high-resolution fluororespirometry (Oxygraph-2k, Oroboros Instruments, Innsbruck, Austria) to evaluate the efficacy of mitochondrial respiration. Oxidative phosphorylation (OxPhos), coupling of the ETC, mitochondrial superoxide formation, mitochondrial membrane potential changes and extramitochondrial Ca2+-movement will be recorded. The association between OxPhos capacity of platelet mitochondria and numerical parameters of ROTEM aggregometry will constitute our primary outcome. The relation between OxPhos capacity and results of viscoelastic assays and conventional markers of hemostasis will serve as secondary outcomes. The association of the OxPhos capacity of platelet mitochondria upon patient arrival to the need for massive blood transfusion (MBT) and 24-hour mortality will constitute our tertiary outcomes. Mitochondrial dysfunction and its importance in TIC in are yet to be assessed for the deeper understanding of this common, life-threatening condition. Disclosure of mitochondria-mediated processes in thrombocytes may reveal new therapeutic targets in the management of hemorrhaging trauma patients, thereby leading to a reduction of potentially preventable mortality. The present protocol was registered to ClinicalTrials.gov on 12 August 2021, under the reference number NCT05004844.

Presence of Titanium and Toxic Effects Observed in Rat Lungs, Kidneys, and Central Nervous System in vivo and in Cultured Astrocytes in vitro on Exposure by Titanium Dioxide Nanorods

Background

Non-spherical titanium dioxide (TiO₂) nanoparticles have been increasingly applied in various biomedical and technological fields. Their toxicological characterization is, however, less complete than that of roundish nanoparticles.

Materials and Methods

Anatase form TiO₂ nanorods, ca. 15x65 nm in size, were applied to cultured astrocytes in vitro and to the airways of young adult Wistar rats in vivo in 5, 10, and 8 mg/kg BW dose for altogether 28 days. Presence of nanorods and cellular damage was investigated in the astrocytes and in rat lungs and kidneys. Functional damage of the nervous system was studied by electrophysiological methods.

Results

The treated astrocytes showed loss of viability without detectable apoptosis. In rats, TiO₂ nanorods applied to the airways reached the blood and various organs including the lungs, kidneys, and the central nervous system. In lung and kidney samples, nanorods were observed within (partly damaged) phagolysosomes and attached to organelles, and apoptotic cell death was also detected. In cortical and peripheral electrophysiological activity, alterations corresponding to energy shortage (resulting possibly from mitochondrial damage) and astrocytic dysfunction were detected. Local titanium levels and relative weight of the investigated organs, apoptotic cell death in the lungs and kidneys, and changes in the central and peripheral nervous activity were mostly proportional to the applied doses, and viability loss of the cultured astrocytes was also dose-dependent, suggesting causal relationship of treatments and effects.

Conclusion

Based on localization of the visualized nanorods, on neuro-functional changes, and on literature data, the toxic mechanism involved mitochondrial damage, oxidative stress, and apoptotic cell death. These indicate potential human toxicity and occupational risk in case of exposure to rod-shaped TiO₂ nanoparticles.

Pre-existing Liver Diseases and On-Admission Liver-Related Laboratory Tests in COVID-19: A Prognostic Accuracy Meta-Analysis With Systematic Review

Background: We aimed to perform a systematic search and meta-analysis to evaluate the prognostic value of on-admission liver function tests and pre-existing liver diseases on the clinical course of coronavirus disease 2019 (COVID-19).

Methods: The study was registered on PROSPERO (CRD42020182902). We searched five databases between 01/01/2020 and 04/23/2020. Studies that reported on liver-related comorbidities and/or laboratory parameters in patients with COVID-19 were included. The main outcomes were COVID-19 severity, intensive care unit (ICU) admission, and in-hospital mortality. Analysis of predictive models hierarchical summary receiver-operating characteristic (HSROC) was conducted with a 95% confidence interval (CI).

Results: Fifty studies were included in the meta-analysis. High specificity was reached by acute liver failure associated by COVID-19 (0.94, 95% CI: 0.71–0.99) and platelet count (0.94, 95% CI: 0.71–0.99) in the case of mortality; chronic liver disease (CLD) (0.98, 95% CI: 0.96–0.99) and platelet count (0.82, 95% CI: 0.72–0.89) in the case of ICU requirement; and CLD (0.97, 95% CI: 0.95–0.98), chronic hepatitis B infection (0.97, 95% CI: 0.95–0.98), platelet count (0.86, 95% CI: 0.77–0.91), and alanine aminotransferase (ALT) (0.80, 95% CI: 0.66–0.89) and aspartate aminotransferase (AST) (0.84, 95% CI: 0.77–0.88) activities considering severe COVID-19. High sensitivity was found in the case of C-reactive protein (CRP) for ICU requirement (0.92, 95% CI: 0.80–0.97) and severe COVID-19 (0.91, 95% CI: 0.82–0.96).

Conclusion: On-admission platelet count, ALT and AST activities, CRP concentration, and the presence of acute and CLDs predicted the severe course of COVID-19. To highlight, pre-existing liver diseases or acute liver injury associated by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection plays an important role in the prediction of mortality.

Hydroxyapatite-coated implants provide better fixation in total knee arthroplasty. A meta-analysis of randomized controlled trials

BACKGROUND

The potential advantages of hydroxyapatite (HA)-coated cementless total knee arthroplasty (TKA) implants are bone stock preservation and biological fixation. Studies comparing the outcomes of HA-coated cementless, non HA-coated cementless (uncemented) and cemented TKA implants reported contradictory data. Our aim was to provide a comparison of the effects of HA coating of tibial stem on the stability and functionality of TKA implants.

METHODS

A systematic literature search was performed using MEDLINE, Scopus, EMBASE and the CENTRAL databases up to May 31st, 2019. The primary outcome was Maximum Total Point Motion (MTPM) of the tibial stem. This parameter is determined by radiosterometric analysis and refers to the migration pattern of the prosthesis stems. The clinical outcomes of the implanted joints were evaluated by the Knee Society Knee Score (KSS) and the Knee Society Function Score (KFS). Weighted mean difference (WMD) with 95% confidence interval (CI) were calculated with the random-effects model.

RESULTS

Altogether, 11 randomized controlled trials (RCTs) with 902 patients for primary TKA implants were included. There was a statistically significant difference in the MTPM values with the use of HA-coated and uncoated uncemented implants (WMD = +0.28, CI: +0.01 to +0.56, P<0.001). However, HA-coated stems showed significantly higher migration when compared with the cemented prostheses (WMD = -0.29, CI: -0.41 to -0.16, P<0.001). The KSS values of HA-coated implants were significantly higher than those for the uncemented implants; moreover, KSS and KFS outcome scores were statistically not different between the HA-coated and cemented prosthesis cases.

CONCLUSION

HA-coating yields better stability than other, uncemented prostheses. More importantly, the HA-coating is not outperformed by cemented prosthesis in providing good functional outcome.

[Investigation of the effect of titanium dioxide nanorods on the lungs in a subacute rat model]

INTRODUCTION

The development of nanotechnology increases the risk of occupational and population-level exposure to nanoparticles nowadays. However, scientifically based knowledge relating to the toxicity of heavy metal nanoparticles and potential health damage is insufficient.

AIM

Investigation of lung tissue damage induced by titanium dioxide (TiO₂) nanorods in subacute intratracheal instillation by morphological, chemical and biochemical methods in rat model.

METHOD

General toxicity (changes of body and organ weights), local acute and chronic cellular toxicity (in alveolar spaces and epithelium, in hilar lymph nodes) and oxidative stress were examined using light and electron microscopy, and biochemical methods (reactive oxygen species, lipid peroxidation, expression of pro-inflammatory cytokines).

RESULTS

No dose- and time-dependent alteration was found in the body weight of the treated groups; but the mass and Ti content of lungs increased with dose. Light and electron microscopy of the lung tissue verified the presence of nanoparticles, free in the alveolar space and within phagosomes of macrophages not attached to alveolar epithelium. Chronification of local acute alveolitis was supported by dose-dependent increase of macrophage count in the alveolar region, oedema and thickening of interstitium, and increased expression of certain pro-inflammatory cytokines (interleukin-1a, LIX, L-selectin, vascular endothelial growth factor). Oxidative stress and lipid peroxidation increased substantially in the treated rats' lungs, and correlation was found between Ti content and lipid peroxidation. Insufficiency of the alveolar epithelial and capillary endothelial barrier was indicated by nanoparticle-laden phagocytes in hilar lymph nodes, suggesting nanoparticles reaching systemic circulation and distant organs, inducing systemic acute inflammation.

CONCLUSION

TiO₂ nanoparticles, reaching lower airways, may be etiological factors in the causation or aggravation of pulmonary diseases with acute and chronic airways inflammation and/or progressive fibrosis and obstruction (e.g., chronic obstructive pulmonary disease or asthma). Autophagy and damaged immune response (lymphocytic activity) may have here a role. Orv Hetil. 2019; 160(2): 57-66.

Pulmonary impact of titanium dioxide nanorods: examination of nanorod-exposed rat lungs and human alveolar cells

BACKGROUND

Titanium dioxide nanoparticles have numerous applications, resulting in human exposure. Nonetheless, available toxicological and safety data are insufficient regarding aspherical particles, such as rod-shaped nanoparticles.

METHODS

In a combined in vitro-in vivo approach, cultured A549 lung alveolar adenocarcinoma cells were treated with approximately 15×65 nm TiO2 nanorod-containing medium, while young adult rats received the same substance by intratracheal instillation for 28 days in 5 and 18 mg/kg body-weight doses. Nanoparticle accumulation in the lungs and consequent oxidative stress, cell damage, and inflammation were assessed by biochemical and histopathological methods.

RESULTS

Titanium was detected in tissue samples by single-particle inductively coupled plasma mass spectrometry. Nanoparticles were visualized inside cultured A549 cells, within pulmonary macrophages, and in hilar lymph nodes of the rats. A549 cells showed dose-dependent oxidative stress and lethality, and the observed nanoparticle-laden endosomes suggested deranged lysosomal function and possible autophagy. Strongly elevated Ti levels were measured in the lungs of nanorod-treated rats and moderately elevated levels in the blood of the animals. Numerous cytokines, indicating acute and also chronic inflammation, were identified in the lung samples of TiO2-exposed rodents.

CONCLUSION

Several signs of cell and tissue damage were detected in both the cultured alveolar cells and in treated rats' lungs. Rod-shaped nanoparticulate TiO2 may consequently be more harmful than has generally been supposed. The occupational health risk suggested by the results calls for improved safety measures.

Electrophysiological alterations and general toxic signs obtained by subacute administration of titanium dioxide nanoparticles to the airways of rats

Background and purpose

Particles of titanium dioxide (TiO2) with typical size below 100 nm have gained a broad range of application by now, partly involving direct human exposure. Their known properties - high specific surface, mobility within the organism, induction of oxidative stress, release of inflammation mediators etc. - raise the possibility of nervous system damage but the available data regarding this are scarce and contradictory. Based on that, and the experiences with other metal oxide nanoparticles, the aim of the present study was to investigate certain general end nervous system toxic effects of TiO2 nanoparticles applied in the airways of rats.

Methods

Young adult Wistar rats (5 groups of 10 rats each) received, daily for 28 days, intratracheal instillations of titanium dioxide nanoparticles of ca. 10 nm diameter, suspended in 1% hydroxyethyl cellulose dissolved in phosphate-buffered saline, in the doses of 1, 3, and 10 mg/kg b. w. Vehicle controls received the suspension medium and there was also an untreated control group. During treatment, the rats' body weight was measured, and their clinical state observed, daily. After the 28 days, spontaneous cortical activity, sensory evoked potentials and tail nerve action potential was recorded in urethane anesthesia, then the rats were dissected and tissue samples were taken for Ti level determination and biochemical measurements of some oxidative stress indicators.

Results

The two higher doses reduced the rate of body weight gain significantly. Sensory evoked potentials and tail nerve action potential were significantly slowed, but the change in the spectrum of spontaneous cortical activity was not significant. Correlation of moderate strength was found between certain evoked potential parameters and brain Ti level and oxidative stress data.

Conclusion

Our results underlined the possible neurotoxicity of TiO2 NPs but also the need for further investigations.

Functional neurotoxicity and tissue metal levels in rats exposed subacutely to titanium dioxide nanoparticles via the airways

Background and purpose

Nanoparticles of titanium dioxide are suspected neurotoxic agents and have numerous applications possibly resulting in human exposure by several ways including inhalation. In the present work, rats were exposed to spherical TiO2 nanoparticles of two different sizes by the intratracheal route. It was investigated how the neuro-functional alterations, detected by electrophysiological and behavioral methods, were related to the concentration of Ti in the tissue samples and what the influence of the size of the NPs was.

Methods

Rats (young adult Wistar males, 10/group) were exposed to TiO2 nanoparticles of ca. 10 and 100 nm diameter (suspension medium: neutral PBS with 1% hydroxyethyl cellulose) by intratracheal instillation in 5 and 18 mg/kg b.w. dose; 5 days per week for 6 weeks. Controls were instilled with saline, and vehicle controls, with the suspension medium. To see general toxicity, body weight was checked daily, and organ weights were measured at the end of experiment. Grip strength test, to assess motor function damage, was done before and after the 6-week treatment. Finally, the rats were anesthetized with urethane, spontaneous cortical activity and sensory evoked potentials were recorded, then the rats were dissected and tissue samples were taken for Ti level measurement.

Results

Body weight gain indicated no general toxicity, and no significant change in the relative organ weights, except that of the lungs, was seen. However, change of time-to-fall in the grip strength test, and latency of cortical evoked po-tentials, were altered in the treated groups, indicating functional damage. Correlation of these alterations with the cortical Ti level was dissimilar for the two sizes of nanoparticles.

Conclusion

The results provided further support to the functional neurotoxicity of TiO2 nanoparticles. The exact role of particle size, and the mechanisms involved, remain to be elucidated.

ATP-Evoked Intracellular Ca²⁺ Signaling of Different Supporting Cells in the Hearing Mouse Hemicochlea

Hearing and its protection is regulated by ATP-evoked Ca(2+) signaling in the supporting cells of the organ of Corti, however, the unique anatomy of the cochlea hampers observing these mechanisms. For the first time, we have performed functional ratiometric Ca(2+) imaging (fura-2) in three different supporting cell types in the hemicochlea preparation of hearing mice to measure purinergic receptor-mediated Ca(2+) signaling in pillar, Deiters' and Hensen's cells. Their resting [Ca(2+)]i was determined and compared in the same type of preparation. ATP evoked reversible, repeatable and dose-dependent Ca(2+) transients in all three cell types, showing desensitization. Inhibiting the Ca(2+) signaling of the ionotropic P2X (omission of extracellular Ca(2+)) and metabotropic P2Y purinergic receptors (depletion of intracellular Ca(2+) stores) revealed the involvement of both receptor types. Detection of P2X2,3,4,6,7 and P2Y1,2,6,12,14 receptor mRNAs by RT-PCR supported this finding and antagonism by PPADS suggested different functional purinergic receptor population in pillar versus Deiters' and Hensen's cells. The sum of the extra- and intracellular Ca(2+)-dependent components of the response was about equal with the control ATP response (linear additivity) in pillar cells, and showed supralinearity in Deiters' and Hensen's cells. Calcium-induced calcium release might explain this synergistic interaction. The more pronounced Ca(2+) leak from the endoplasmic reticulum in Deiters' and Hensen's cells, unmasked by cyclopiazonic acid, may also suggests the higher activity of the internal stores in Ca(2+) signaling in these cells. Differences in Ca(2+) homeostasis and ATP-induced Ca(2+) signaling might reflect the distinct roles these cells play in cochlear function and pathophysiology.

Protective effect of rasagiline in aminoglycoside ototoxicity

Sensorineural hearing losses (SNHLs; e.g., ototoxicant- and noise-induced hearing loss or presbycusis) are among the most frequent sensory deficits, but they lack effective drug therapies. The majority of recent therapeutic approaches focused on the trials of antioxidants and reactive oxygen species (ROS) scavengers in SNHLs. The rationale for these studies was the prominent role of disturbed redox homeostasis and the consequent ROS elevation. Although the antioxidant therapies in several animal studies seemed to be promising, clinical trials have failed to fulfill expectations. We investigated the potential of rasagiline, an FDA-approved monomanine oxidase type B inhibitor (MAO-B) inhibitor type anti-parkinsonian drug, as an otoprotectant. We showed a dose-dependent alleviation of the kanamycin-induced threshold shifts measured by auditory brainstem response (ABR) in an ototoxicant aminoglycoside antibiotic-based hearing loss model in mice. This effect proved to be statistically significant at a 6-mg/kg (s.c.) dose. The most prominent effect appeared at 16kHz, which is the hearing sensitivity optimum for mice. The neuroprotective, antiapoptotic and antioxidant effects of rasagiline in animal models, all targeting a specific mechanism of aminoglycoside injury, may explain this otoprotection. The dopaminergic neurotransmission enhancer effect of rasagiline might also contribute to the protection. Dopamine (DA), released from lateral olivocochlear (LOC) fibers, was shown to exert a protective action against excitotoxicity, a pathological factor in the aminoglycoside-induced SNHL. We have shown that rasagiline enhanced the electric stimulation-evoked release of DA from an acute mouse cochlea preparation in a dose-dependent manner. Using inhibitors of voltage-gated Na(+)-, Ca(2+) channels and DA transporters, we revealed that rasagiline potentiated the action potential-evoked release of DA by inhibiting the reuptake. The complex, multifactorial pathomechanism of SNHLs most likely requires drugs acting on multiple targets for effective therapy. Rasagiline, with its multi-target action and favorable adverse effects profile, might be a good candidate for a clinical trial testing the otoprotective indication.

Investigation of changes in psycho-physiological parameters evoked by short duration, intensive physical stress

The aim of our study was to investigate changes in psycho-physiological parameters evoked by short duration, intensive physical stress on university students practicing judo at different intensities and timely manner. Stability of posture, muscle strength (hand force exertions), attention concentration (choice reaction time), cardiac parameters, (ECG, heart rate, heart rate variability), and oxygen saturation were measured, cardiac state and stress index were computed before and after the physical stress. The actual psychic state of the subjects was evaluated using the Spielberger's STPI-H Y-1 test which determined anxiety, curiosity, anger and depression level. Analysis of psychometric and physiologic parameters indicated significant correlations, among others, between force and cardiac stress (-), force and depression (-), anxiety and errors in actions (+), cardiac state and errors in action (-), cardiac state and depression (-). Paired samples tests showed the influence of intensive physical stress within groups of students, and independent samples tests made it possible to evaluate the power of medical and sport students, performing physical training at a significantly higher level than it is usual among the medical students. Our results proved that higher level physical training influences the psychic state advantageously, limits increases in cardiac stress level, and decreases susceptibility to anxiety and depression.

[The expected worldwide burden of oesophagus, stomach and colorectal cancers]

According database of Globocan 2008 of total 482 thousand worldwide new esophagel cancers are reported 16.9% cases in more developed and 83.1% in less developed regions, 6.9% in EU, 2.7% in the Eastern Europe; of total 989 thousand new stomach cancers are reported 27.8% in more developed and 72.2% in less developed regions, 8.4% in EU, 7.4% in the Eastern Europe; of total 1.235 milion new colorectal cancers are reported 59% cases in more developed and 41% in less developed regions, 27% in EU, 10.5% in the Eastern Europe. Of total 59,052 all neoplasms (without skin cancers) were reported 10,439 new cases of these three diagnoses in recent Czech Cancer Registry survey, higher by 595 cases than numbers based in Globocan 2008. However, according to these data the Czech males reached the 3rd order and females the 14th order by their cumulative risk of colorectal cancer in the world. The alarming worldwide numbers of new 4.771 milion of these three diagnoses and 3,137 thousands deaths from them, expected in 2030 with a higher risk in population of less developed regions require greater international cooperation and personal responsibility for improving the life-style, which would be failed the expected statistics.

Preserved structural and functional characteristics of common carotid artery in properly treated normoglycemic women with gestational diabetes mellitus

Women with gestational diabetes mellitus (GDM) are at high risk of subsequently developing type 2 diabetes mellitus which is an important cardiovascular risk factor. We have evaluated whether preclinical morphological and functional arterial changes are present in GDM. Diameter, intima-media thickness (IMT), intima-media cross-section area (IMCSA) and elasticity features (compliance, distensibility coefficient, circumferential strain, stiffness index (SI) α and β, incremental elastic modulus) of the common carotid arteries (CCA) were studied in the 3rd trimester in 25 women with GDM, and 17 normal pregnant women matched for age and body mass index using an ultrasonographic vessel wall-movement tracking system and applanation tonometry. Mean IMT, IMCSA and SI α tended to be larger, whereas compliance was smaller in women with GDM but none of these differences were significant. Serum glucose (4.99 ± 0.51 vs. 4.79 ± 0.61 mmol/L, p=0.37) and HbA1c (5.33 ± 0.27 vs. 5.36 ± 0.47 mmol/L, p=0.85) proved normoglycemia in both groups. In conclusion, by the combination of methods we applied in this case control study, neither morphological nor functional characteristics of large elastic arteries differ significantly between well-treated normoglycemic women with GDM and non-diabetic pregnant women in the 3rd trimester.

Effects of genetic vs. environmental factors on cardiovascular autonomic function: a twin study

AIMS

Cardiovascular autonomic function is often assessed in patients with diabetes by measuring heart rate variability and baroreflex sensitivity, the heritability of which is not fully understood. The present study was aimed to determine the effects of genetic and environmental factors on heart rate variability and baroreflex sensitivity in monozygotic and dizygotic adult healthy twin pairs.

METHODS

A total of 101 (63 monozygotic, 38 dizygotic) adult twin pairs (n = 202; mean age 44.3 years) were investigated. Anthropometric variables and serum metabolic markers were measured, while environmental characteristics were evaluated by questionnaires. Linear and spectral indices of heart rate variability and baroreflex sensitivity were determined by non-invasive methods. All measurements were adjusted for age and gender (model 1) and for all significantly relevant covariates (model 2). Heritability A-C-E structural equation models were used for characterizing the proportion of additive genetic, shared and unshared environmental influences.

RESULTS

Genetic influence of different cardiovascular autonomic indices was estimated between 10.3 and 39.4%, common environmental influence was found between 0.0 and 33.2%, while unshared environmental influence was observed between 60.6 and 81.4% in model 1 analysis. In multivariable-adjusted heritability estimates (model 2), the magnitude of the genetic effects decreased to 0.0%, common environmental influence was nearly unchanged (values between 4.4 and 14.5%), while unshared environmental influence slightly increased (values between 85.5 and 96.5%).

CONCLUSIONS

Unshared environmental but not genetic factors have substantial influence on cardiovascular autonomic function, suggesting that appropriate treatment of all modifiable environmental factors is of importance in order to prevent or ameliorate cardiovascular autonomic neuropathy.

[Pneumosurgery in the management of colorectal carcinomas]

OBJECTIVE

Surgically solved lung involvement in patients after surgery of colorectal cancer.

MATERIALS AND METHODS

Altogether 15 patients, 9 men (median age in the time of lung diagnosis 67 years) and 6 women (median age 59 years) underwent classical open pulmonary surgery during 2003-2008 years from the follow-up cohort of 836 persons after operation due to colorectal cancer in the time period of 1996-2008 years. The indication for lung surgery: solitary pulmonary lesion. Procedures distribution: pulmonary lobectomy 7, bilobectomy 2, segmentectomy 4, wedge resection 2. The requirement of the European Society of Thoracic Surgeons (ESTS) guidelines of complete pulmonary resection has been met by 10 operations (66.7%) with lobe specific lymphadenectomy. Histopathology investigation: Formalin fixed, paraffin embedded samples were investigated after hematoxylin-and-eosin staining, supplemented in case of need by immunohistochemistry of CK7, CK20 and TTF1.

RESULTS

Eleven pulmonary metastases were found, in two cases with interlobar lymfatics involvement. Two metachronous primary adenocarcinomas of the lung (ADL) were diagnosed, one of them with metastases into hilar lymphatics. In remaining two patients pulmonary chondrohamartoma was discovered.

CONCLUSION

Solitary pulmonary opacity in patient after colorectal surgery might not represent simple metastasis explicitly. Complete resection is needed.

[Complications in patients undergoing pulmonary oncological surgery]

AIM

A survey evaluating incidence and risk factors of complications in persons underwent complete open lung resection because of primary or secondary lung malignancy.

MATERIAL AND METHODS

Retrospective study of 189 open surgery procedures in 128 males and 61 females, mean age males 61 years (range 21-78), females 64 years (range 33-80) during a five-years period (2003-2007). Data processing and analysis were performed with the statistical software system Statistica and compared by parametres odds ratio a chi2 test.

RESULTS

Complications were divided into five groups. First group was defined as complications in perioperative period and was composed of three events 1.5%: endotracheal tube dysfunction (i.e. 0.5%), heavy cardiac arrhytmia 0.5% and serious haemorrhage, that occurred immediately after operation 0.5%. Second group includes complications within period of 7 days after surgery: prolonged air leak (PAL > 7 days) 7.4%, bronchopneumonia 6.9%, cardiac arrhythmia 6.9%, postoperative delirium 4.2%, atelectasis 2.6%, wound infection 1.1%, bleeding 1.1% and chylothorax 0.5%. Third group contains events between 8th and 30th postoperative days: thoracic empyema 2.1%, dysphonia 2.1%, painfull shoulder 1.1%, alimentary tract infection 0.5% and bronchial closure insufficiency 0.5%. Fourth group contains patients with severe complications, that led to death during 30 days after operation: ischemic stroke 0.5% and pulmonary embolism 0.5%. Patients without any complication formed the fifth group of 60.5%.

CONCLUSION

Main risk factors for complications in postoperative period after lung resection due to primary or secondary lung malignancy in our group of patients are COPD, corticotherapy, time of operation over 3 hours, BMI over 25, left side tumor localization and bronchoplastic procedure. For cardiac arrhytmia seems to be risk factor pneumonectomy and previous neoadjuvant radiochemotherapy.

[Pulmonary segmentectomy for tumour]

BACKGROUND

An analysis of outcome data of pulmonary segmentectomy focused on local efficacy in primary non small cell lung cancer and true or seeming lung metastasis.

PATIENTS AND METHODS

Miscellaneous series of twenty patients treated with classical open procedure involving individuals with primary or metachronous non small cell lung cancer, solitary pulmonary metastasis of extrapulmonary cancer and/or benign pulmonary lesions, lung metastasis mimicing. Thirteen patients after segmentectomy because of malignancy are separated into a group of 7 cases with NSCLC up to 20 mm in diameter, and a group of 6 persons with solitary pulmonary opacity up to 38 mm treated previously surgically for extrapulmonary cancer. Both without enlargement of hilar and/or mediastinal lymphatics proven on preoperative CT imaging. Third part of the group collects benign pulmonary lesions: chondrohamartoma, pneumonitis and pulmonary infarct. Persons involved through a ten years period are followed up at 3 (4)-months intervals.

RESULTS

No perioperative and thirty day mortality was registered. Six cases of distant recurrence were recorded, three in NSCLC and three in extrapulmonary cancer patients. Five patients died within the follow-up period, three of them through the general progression of the oncological disease. Two deaths were non-cancer related. One R1 disease was discovered in a patient with primary lung adenocarcinoma. No local recurrence was recorded in both cancer series with median age of 63 yrs (range 45-79 yrs) and median duration of follow up 35 months.

CONCLUSION

Lung segmentectomy seems to accomplish local control of early stage non small cell lung cancer and pulmonary metastasis of extrapulmonary cancer in selected patients.

Improvement of insulin sensitivity by a novel drug, BGP-15, in insulin-resistant patients: a proof of concept randomized double-blind clinical trial

The efficacy and safety of the new drug, BGP-15, were compared with placebo in insulin-resistant patients in a 28-day dose-ranging study. Forty-seven nondiabetic patients with impaired glucose tolerance were randomly assigned to 4 weeks of treatment with 200 or 400 mg of BGP-15 or placebo. Insulin resistance was determined by hyperinsulinemic euglycemic clamp technique and homeostasis model assessment method, and beta-cell function was measured by intravenous glucose tolerance test. Each BGP-15 dose significantly increased whole body insulin sensitivity (M-1, p=0.032), total body glucose utilization (M-2, p=0.035), muscle tissue glucose utilization (M-3, p=0.040), and fat-free body mass glucose utilization (M-4, p=0.038) compared to baseline and placebo. No adverse drug effects were observed during treatment. BGP-15 at 200 or 400 mg significantly improved insulin sensitivity in insulin-resistant, nondiabetic patients during treatment compared to placebo and was safe and well-tolerated. This was the first clinical study demonstrating the insulin-sensitizing effect of a molecule, which is considered as a co-inducer of heat shock proteins.

Bacteriological recovery after intramuscular or intracisternal spiramycin-based drying-off therapy

Systemic (intramuscular, i.m.) vs. local (intracisternal, IC) routes of spiramycin-based drying-off therapy were compared for efficacy on 65 Staphylococcus aureus infected udder quarters of 38 dairy cows. Single-dose (30,000 IU/kg) i.m. treatment (single i.m. group) resulted in a similarly low bacteriological recovery rate (14%) as seen in the untreated controls (18%). I.m. treatment (30,000 IU/kg) on 4 consecutive days (4 i.m. group) resulted in significantly higher quarter-based recovery rates than that in the single i.m. group. The bacteriological recovery rates obtained in the intracisternal and 4 i.m. groups were quite similar but remained below 50%. Based on these findings as well as on the high cost of the repeated intramuscular treatment regime there is no reason to give extra preference to the systemic application of spiramycin at drying off in the practice.

Epidemiology of congenital coronary artery anomalies: a coronary arteriography study on a central European population

The anatomical patterns and frequency of occurrence of congenital coronary anomalies (CCA) in a Central European cohort has not yet been studied. The angiographic data of 7,694 consecutive patients undergoing coronary arteriography at the Albert Szent-Györgyi Medical University, Szeged, Hungary, from 1984 to 1994 were analyzed. CCA were found in 103 patients (1.34% incidence). Ninety-eight of them (95.2%) had anomalies of origin and distribution, and five (4.8%) had coronary artery fistulae. The incidence was the highest for the separate origin of left descending artery and left circumflex from the left sinus of Valsalva (52.42%). Anomalous origin of the left circumflex coronary artery from the right coronary was 8.7% while from the right sinus of Valsalva 18.4%. CCA, which may be associated with potentially serious events, such as ectopic coronary origin from the opposite aortic sinus (1.9%) and single coronary arteries (3.88%), were not frequent. The incidence of CCA in the Central European cohort under study was similar to that of the largest North American study. The anatomic classification presented can be useful from both clinical and surgical standpoints.

Epidemiology of congenital coronary artery anomalies: a coronary arteriography study on a central European population

The anatomical patterns and frequency of occurrence of congenital coronary anomalies (CCA) in a Central European cohort has not yet been studied. The angiographic data of 7,694 consecutive patients undergoing coronary arteriography at the Albert Szent-Györgyi Medical University, Szeged, Hungary, from 1984 to 1994 were analyzed. CCA were found in 103 patients (1.34% incidence). Ninety-eight of them (95.2%) had anomalies of origin and distribution, and five (4.8%) had coronary artery fistulae. The incidence was the highest for the separate origin of left descending artery and left circumflex from the left sinus of Valsalva (52.42%). Anomalous origin of the left circumflex coronary artery from the right coronary was 8.7% while from the right sinus of Valsalva 18.4%. CCA, which may be associated with potentially serious events, such as ectopic coronary origin from the opposite aortic sinus (1.9%) and single coronary arteries (3.88%), were not frequent. The incidence of CCA in the Central European cohort under study was similar to that of the largest North American study. The anatomic classification presented can be useful from both clinical and surgical standpoints.

[Pancreatogenic panniculitis based on 2 cases]

The rarest and hardly known complication of pancreas diseases is the subcutaneous nodular fat necrosis, a special type of panniculitides. It is mostly associated with pancreatitis and adenocarcinoma of pancreas. Its diagnostic criteria are (1) red painless or occasionally painful nodules showing a tendency of coalescence, emolition and fistulation on the lower extremities and later anywhere on the body, (2) alcoholic case-history, (3) tense, painful joints, (4) elevated pancreatic enzyme levels in the blood and urine. Since the underlying pancreas diseases may be asymptomatic, the pancreatogen panniculitis should be considered as a noteworthy marker of them. The histologic findings are pathognomic. In pancreatogen panniculitis in all likelihood the remote foci of adiponecrosis are due to the local action of pancreatic lipolytic enzymes carried by the blood. The question has not been settled yet. In this article there are presented two cases of pancreatogen panniculitis, recognized by the consultant dermatologist. Referral diagnoses of both cases were misleading: "erythema nodosum" in the first case and "drug eruption" in the second one. The determinant underlying pancreas disease in both cases was pancreatitis with pseudocyst resulted from alcoholic toxicomany.

[Correlations between clinical picture and coronary angiography in unstable angina]

In a one year period (from 01.07. 1993 to 30. 06. 1994) 103 patients were admitted to the Central Intensive Care Unit of the Albert Szent-Györgyi Medical University with the diagnosis of unstable angina. In this cohort of patients the authors assessed the correlation of clinical and angiographic data. Significant coronary artery disease was found in 84% (85 patients), single-vessel disease in 23% (24 patients), double-vessel disease in 38% (29 patients), triple-vessel disease in 20% (21 patients), left main stenosis in 8% (8 patients). The culprit lesion was determined in 73 cases. The distribution of the culprit lesion severity was the following: 50-70% in 17% (12 cases), 70-90% in 27% (20 cases), greater than 90% in 44% (32 cases), 100% in 12% (9 cases). Simplex lesions were seen in 43 cases, complex lesions in 9 cases, diffuse irregularities in 5 cases and total occlusions in 9 cases. Abnormalities indicating intracoronary thrombin-us were seen on 5 coronarograms. No correlation could be demonstrated between the clinical classes according to Braunwald and the angiographic morphology.

[Non-traumatic intrahepatic bile-duct perforation in an adult]

Authors report a case of a patient suffered from intrahepatic bile duct perforation caused by stenosis of the papilla of Vater. With the help of data of medical literature there are analysed the etiological factors of bile duct perforations and the pathological process that leads to perforation. There is emphasized that the only way to avoid the sepsis and other postoperative complications on operation carried out in an early time and the supplemented intensive care. Authors call attention for the importance of carefully carried out intraoperative revision of bile system in cases of biliary peritonitis.

[The place of percutaneous transluminal angioplasty in the management of obliterative vascular diseases of the lower extremities. Femoro-popliteal arterial angioplasty]

Authors treated 331 patients having symptoms of femoropopliteal stenoses or occlusions with transluminal angioplasty from 1983. They performed 186 dilatations and 189 recanalizations. Procedures were preceded by medicinal preparation. The primary technical success rate was 94.6% after dilatation, and 79.9% after recanalisation. In case of stenosis the success rate did not show significant connection with the length of the dilated segment but in case of occlusion longer than 6 cm the success rate decreased. After procedure 87.2% of the patients became asymptomatic, or improved. 21 (5.6%) complications (7 inguinal hematomas, 6 emboles, 6 thromboses, one perforation of arterial wall) occurred and twelve of them required surgical intervention. One patient died after angioplasty due to cardiac failure. Authors are of the opinion that femoropopliteal occlusions and stenoses shorter than 6 cm should be treated by angioplasty. They suggest making balloon catheter dilatation for multiple stenoses even they are longer than 6 cm.

[Functional treatment of humeral diaphyseal fractures using a Hungarian-manufactured brace]

Authors suggest, in their paper, a new method in this country, the so called brace treatment for the functional treatment of the diaphyseal fractures of the humerus. A 2-4 fifth of the diaphyseal fractures of the humerus can be treated in the majority with this method. An other novelty of this treatment is the humerus brace developed and manufactured in Hungary. This fracture treatment has unequivocal advantages both for the health service and the patient for its shorter duration of healing and treatment.

[The place of percutaneous transluminal angioplasty in the treatment of obliterative vascular diseases of the lower limbs. Angioplasty of of the iliac system]

Between 1983-91 386 patients with hemodinamically significant stenosis or short-segment occlusion of iliac arteries were treated by transluminal angioplasty. 487 dilatations and 13 recanalizations were performed. In 353 (70.2%) of these cases were carried out without medicinal preparation continuously after the diagnostic angiography. The technical success rate was 93.4%. The technical success rate did not depend on medicinal preparation. 93% of their patients became symptomless or improved. 28 complications were noted (7 thrombosis, 4 embolisms, 14 inguinal haematomas, 2 false aneurysms, 1 bleeding), 11 of them required surgical intervention. One patient died because of cardiac failure due to retroperitoneal haematoma. Authors' opinion isolated short uni- and bilateral iliacal stenosis can be treated by transluminal angioplasty. Longer or multifocal stenosis required individual consideration.

[Treatment of pancreatic pseudocysts with ultrasound-guided percutaneous puncture and drainage]

The authors have treated 37 pancreatic pseudocysts in 36 patients by ultrasonically guided percutaneous puncture and drainage. The indication for intervention was rapid enlargement or threatening rupture of the acute (younger than 6-8 weeks) pseudocysts with recurring fever in 5 cases and chronic pseudocysts causing abdominal symptoms in 32 cases. After puncture six of seven patients were recuperated, but later in three of them the pseudocysts recurred. In one case as a complication of the puncture the pancreatitis exacerbated and led to death of the patient. The outcome of percutaneous drainage was successful in 26 of 32 pseudocysts. During the follow-up (6-54 months) recurrence were observed without symptoms in three cases. In four patients the treatment was ineffective, therefore cystogastrostomy was performed. During the time of the percutaneous drainage two pseudocysts had been infected and abscesses developed, which were treated by oncotomy. On the basis of their favourable experiences the authors recommend the US-guided percutaneous durable drainage as primer intervention for treatment of the pancreatic pseudocysts causing symptoms.

DNASK--a new image analysis module for TV image cytometry

The DNASK is a PC-based image analysis module for quantitative cytological and histological examinations on Feulgen-Schiff preparations. The module consists of a frame grabber, a CCD black and white video camera and the DNASK software package which can be incorporated in an IBM compatible PC-AT joining to a standard pathological research photo microscope. The use of 386 IBM AT systems leads to significant decrease of the measurement's time. Mono- or color VGA graphics card should be used. The resolution of the images is 512 x 512 pixels and 256 gray values. The image caption is made in less than 0.5 second, the measurement of a cell nuclei (18 parameters) takes less, than 5 seconds (IBM AT 286). The camera is a standard CCD one. The microscope should be a good quality, modern microscope with built-in light source, however, the application of voltage stabiliser is strongly recommended. The software is able to measure the parameters mostly used and suggested in the international literature: 15 morpho- and densitometric parameters of the cell nuclei 6 DNA histogram parameters of the measured case, like DNA Index, 2c deviation Index, 5c exceeding rate, G1-S-G2 phase fraction ratio. The system supports the grouping of the measured cases and at the end of a study results of the single measurements can be collected and summarized in an ASCII file, which is readable by major statistical programpackages. The DNASK has a special graphical user interface for the control of the program.

Endogenous scavenger levels (vitamin E and A) of patients with chronic alcoholic liver disease under different environmental conditions

Serum level of endogenous scavengers (E and A vitamin) was studied in groups of patients with various chronic alcoholic liver diseases and in a healthy control group on polluted and non-polluted areas. Vitamin levels in patients with chronic liver disease are diminished in comparison to the healthy in general, but mainly in the cirrhotic group. Diminution of vitamin E levels was observed in earlier phase of liver disease than that of vitamin A levels. Patients and healthy control on polluted area showed more expressed diminution of vitamin levels than the same groups on non-polluted area. Free radical parameter (RBC diene conjugate content) and characteristic alcoholic parameters (serum GOT, gamma-GT, cholesterol level and liver GOT, gamma-GT content in biopsy specimen) were used to explain the differences between the same investigated groups on polluted and non-polluted areas. As conclusion can be supposed that industrial pollution of environment has a worsening effect in diseases with free radical mechanism.

[Successful intraoperative angioplasty in bilateral fibromuscular dysplasia of the internal carotid arteries]

The authors report the clinical history of a 55-years old woman suffering from the multiplex stenosis of both internal carotid arteries caused by fibromuscular dysplasia. Successful intraoperative angioplasty was performed. In connection with their case the authors review briefly the clinical feature, diagnosis and therapy of fibromuscular dysplasia of the internal carotid artery.

[Typhlitis as a complication of acute leukemia]

The authors describe the clinical history of two adult patients with acute myeloid leukemia, who had severe neutropenia and thrombocytopenia. After chemotherapy in both patients had developed typhlitis with fatal outcome caused by sepsis. They discuss the etiopathogenesis and clinical features of necrotizing typhlitis as a complication of treated acute leukemia and point out the difficulty of the differential diagnosis and management.

[The role of intraoperative angioplasty performed simultaneously with reconstructive vascular surgery]

21 arterial lesions were dilated intraoperatively in conjunction with primary vascular reconstructive procedures. Of these, five involved the iliac vessels, fourteen the femoropopliteal segment, one the subclavian artery and one the common carotid artery. 19 intraoperative balloon dilatations were successful and two were unsuccessful. Only one catheter-related complication were noted, it was a perforation of the wall of the artery caused by guidewire. No deaths occurred as a result of the combined procedure. Attention is drawn to the advantage of the intraoperative balloon dilatation and the authors recommend it on adequate conditions and correct indication.

[Reconstruction possibilities in obliterative arterial diseases in diabetics]

Authors treated 144 diabetic patients with arterial angiopathy localised to the lower extremities. 114 cases belonged to III. and IV. stages. There was a possibility in 55 (38.2 per cent) for reconstructive surgery, 80 per cent of the reconstructive procedures localised to the femoro-popliteal region. In 20 cases a so-called "high", in 61 a "low" (minor) amputation was performed, 14 patients died. In 113 cases (78.47 per cent) an improvement or a cure could have been achieved, of whom 52 with the complete preservation of the extremity, and in the others after necrectomy or minor amputation. Authors emphasize that, in more than a half of the cases the obstruction localised to the femoropopliteal and iliacal region, so the possibilities of the vascular surgery are given in a considerable number of diabetic patients.

[Experience with the surgical treatment of superficial thrombophlebitis (varicophlebitis)]

107 patients with acute varicophlebitis of the lower limbs have been treated. In 101 cases operation were performed. These patients were treated by surgical excision of the thrombosed segments, with excision or stripping of the remaining varicosities and high saphena ligature. There were no postoperative deaths. One male patient experienced nonfatal minor pulmonary embolism. Wound-healing disturbances were observed in only 11 patients. Attention is drawn to the advantage of the surgical management. Regarding the good experiences, the authors recommend the performance of the "acute" varicectomy.

[Management of malignant pleural effusion by tetracycline pleurodesis]

Eleven patients were treated with chest tube drainage and intrapleural instillation of tetracycline for malignant pleural effusion. In ten cases this procedure for 6-10 days achieved complete resolution of pleural fluid and produced pleurodesis. Only one patient needed longer treatment, but it was also successful. Fluid recurrence was not recognised during the follow-up period. This method is very effective and simple, so the authors recommend the tetracycline pleurodesis for the palliative management of malignant pleural effusions.

Sulfadimidine kinetics in patients with various chronic liver diseases

Biotransformation and elimination of sulfonamides in healthy volunteers and patients with five various groups of chronic liver diseases was investigated with administration of sulfadimidine as testmaterial. Metabolic and kinetic parameters were estimated after intravenous and oral administration of the testmaterial in the same patients. The aim of study was to get an indirect information about the detoxication and elimination of drugs with elimination by acetylating reaction. Distribution of slow and fast acetylators showed an other ratio in patients than in the normal control; acetylating ability progressively decreased with the severity of liver diseases. Connection of kinetic and metabolic parameters seems to be the same in the patients as in the normal controls, however, kinetics of sulfonamides will be influenced in patients with liver diseases by the changed hemodynamic factors and by the elevated serum bilirubin level too. The mean conclusion is that dosage of drugs with elimination by acetylating reaction needs precaution in patients with liver diseases.

Effects of allopurinol, (+)-cyanidanol-3 and dihydroquinoline-type antioxidants on rat hepatic microsomal cytochrome P-450 and monooxygenases

The cytochrome P-450 system is a sensitive indicator in different forms of experimental liver diseases in the rat. Both CCl4 and ethanol produce a liver damage by free radical mechanisms causing a lesion of liver cell endoplasmic reticulum. Protective effects of antioxidants on CCl4 or ethanol induced liver damage were investigated on this basis in adult Wistar rats. The strongest protective effect in CCl4 treated animals was shown to be exerted by allopurinol. The other three antioxidants (cyanidanol, MTDQ monomer and MTDQ dimer) could not prevent the CCl4 induced changes, measured by liver/body mass quotient, P-450 concentration, ethylmorphine N-demethylation and ethoxycoumarin O-deethylation. Ethanol in the given doses did not produce any distinct effect on the test parameters. The most sensitive parameter was the ethylmorphine N-demethylation. In conclusion CCl4 intoxication is a suitable model for studying radical initiated liver injuries. The mechanisms of the hepatoprotective effects of the four substances are different.