Serum fibroblast growth factor 21 is predictive of combined cardiovascular morbidity and mortality in patients with type 2 diabetes at a relatively short-term follow-up

AIMS

We hypothesised that serum fibroblast growth factor 21 (FGF-21), a novel adipokine with postulated insulin-sensitizing effects, may be predictive of cardiovascular (CV) events in patients with type 2 diabetes (DM2) at a relatively short-term follow-up.

METHODS

Serum FGF-21 levels were assessed in 87 DM2 patients, aged 57-66 years, with the median duration of diabetes of 10 years, who were referred to the Department of Endocrinology for routine annual metabolic assessment. During a follow-up of 24 months, overall mortality, CV mortality and CV nonfatal events were registered. Cox proportional hazards regression assessed adjusted differences in CV morbidity and mortality risk.

RESULTS

Patients stratified according to serum FGF-21 levels ≤ and > the median value of 240.7 pg/mL showed no significant differences at baseline in gender distribution, diabetes duration, insulin therapy, BMI, biochemical profiles and previous CV events. At 24-month follow-up, 21 (24.1%) patients experienced a nonfatal CV event. A significantly (P=0.0013) higher incidence of the combined end point of CV morbidity and mortality was observed in the FGF-21>240.7 pg/mL group. In the multivariate Cox proportional hazards regression model, the presence of FGF-21>the median value was associated with a significant increase in the risk of the combined end point of CV morbidity and mortality (HR: 4.7, 95% CI 1.67-13.24).

CONCLUSIONS

The obtained results support the prognostic value of FGF-21 in DM2 and may provide a useful tool for stratification of CV prognosis in DM2 patients.

Sensor specific imaging of proteomic Zn2+ with zinquin and TSQ after cellular exposure to N-ethylmaleimide

The impact of the thiol binding reagent N-ethylmaleimide (NEM) on proteomic Zn(2+) availability was investigated in rat glioma cells. Zinquin (ZQ) or TSQ, two related fluorescent sensors, were used to observe reactive Zn(2+). Control cells contained proteomic Zn(2+) but no detectable low molecular weight (LMW) Zn(2+). With either sensor, basal cellular fluorescence emission centered near 470 nm, indicative of sensor-Zn-proteins. ZQ sequestered 13% of proteomic Zn(2+) as Zn(ZQ)(2); TSQ reacted only with the Zn-proteome. NEM (100 μM) abolished LMW thiols, including glutathione (GSH) and lowered proteomic sulfhydryl content about 30%. In ZQ-treated cells, NEM exposure enhanced fluorescent intensity and the formation of Zn(ZQ)(2) (λ(MAX), 492 nm). Cells incubated with TSQ and NEM also displayed increased fluorescence without a spectral shift in wavelength maximum, consistent with increased formation of TSQ-Zn-protein adducts but not Zn(TSQ)(2). In neither experiment was Zn(2+) lost from cells. NEM altered Zn(2+) accessibility to sensors in membrane-nuclear and cytosolic fractions, but Zn(ZQ)(2) was only generated in the cytosol. Similar results were obtained when cell supernatant replaced cells. In contrast, when isolated proteome was reacted with ZQ and 100 μM NEM in the absence of GSH, 70% of the proteomic thiols underwent reaction. As a consequence, most of the ZQ-Zn-protein adducts were converted to Zn(ZQ)(2). Substituting TSQ for ZQ, only increased TSQ-Zn-proteins were observed. Evidently, the results of imaging cells with Zn(2+) sensors are dependent upon the specific chemical properties of the sensors and can only be understood after detailed chemical analysis.

Reaction of metal-binding ligands with the zinc proteome: zinc sensors and N,N,N',N'-tetrakis(2-pyridylmethyl)ethylenediamine

The commonly used Zn(2+) sensors 6-methoxy-8-p-toluenesulfonamidoquinoline (TSQ) and Zinquin have been shown to image zinc proteins as a result of the formation of sensor-zinc-protein ternary adducts not Zn(TSQ)(2) or Zn(Zinquin)(2) complexes. The powerful, cell-permeant chelating agent N,N,N',N'-tetrakis(2-pyridylmethyl)ethylenediamine (TPEN) is also used in conjunction with these and other Zn(2+) sensors to validate that the observed fluorescence enhancement seen with the sensors depends on intracellular interaction with Zn(2+). We demonstrated that the kinetics of the reaction of TPEN with cells pretreated with TSQ or Zinquin was not consistent with its reaction with Zn(TSQ)(2) or Zn(Zinquin)(2). Instead, TPEN and other chelating agents extract between 25 and 35% of the Zn(2+) bound to the proteome, including zinc(2+) from zinc metallothionein, and thereby quench some, but not all, of the sensor-zinc-protein fluorescence. Another mechanism in which TPEN exchanges with TSQ or Zinquin to form TPEN-zinc-protein adducts found support in the reactions of TPEN with Zinquin-zinc-alcohol dehydrogenase. TPEN also removed one of the two Zn(2+) ions per monomer from zinc-alcohol dehydrogenase and zinc-alkaline phosphatase, consistent with its ligand substitution reactivity with the zinc proteome.

TSQ (6-methoxy-8-p-toluenesulfonamido-quinoline), a common fluorescent sensor for cellular zinc, images zinc proteins

Zn(2+) is a necessary cofactor for thousands of mammalian proteins. Research has suggested that transient fluxes of cellular Zn(2+) are also involved in processes such as apoptosis. Observations of Zn(2+) trafficking have been collected using Zn(2+) responsive fluorescent dyes. A commonly used Zn(2+) fluorophore is 6-methoxy-8-p-toluenesulfonamido-quinoline (TSQ). The chemical species responsible for TSQ's observed fluorescence in resting or activated cells have not been characterized. Parallel fluorescence microscopy and spectrofluorometry of LLC-PK(1) cells incubated with TSQ demonstrated punctate staining that concentrated around the nucleus and was characterized by an emission maximum near 470 nm. Addition of cell permeable Zn-pyrithione resulted in greatly increased, diffuse fluorescence that shifted the emission peak to 490 nm, indicative of the formation of Zn(TSQ)(2). TPEN (N,N,N'N'-tetrakis(-)[2-pyridylmethyl]-ethylenediamine), a cell permeant Zn(2+) chelator, largely quenched TSQ fluorescence returning the residual fluorescence to the 470 nm emission maximum. Gel filtration chromatography of cell supernatant from LLC-PK(1) cells treated with TSQ revealed that TSQ fluorescence (470 nm emission) eluted with the proteome fractions. Similarly, addition of TSQ to proteome prior to chromatography resulted in 470 nm fluorescence emission that was not observed in smaller molecular weight fractions. It is hypothesized that Zn-TSQ fluorescence, blue-shifted from the 490 nm emission maximum of Zn(TSQ)(2), results from ternary complex, TSQ-Zn-protein formation. As an example, Zn-carbonic anhydrase formed a ternary adduct with TSQ characterized by a fluorescence emission maximum of 470 nm and a dissociation constant of 1.55 × 10(-7) M. Quantification of TSQ-Zn-proteome fluorescence indicated that approximately 8% of cellular Zn(2+) was imaged by TSQ. These results were generalized to other cell types and model Zn-proteins.

A modified cardiac stabilizer used for recording electrograms

Originally, tissue stabilizer has been developed by Medtronic, Inc. It is used to prevent a certain part of myocardium from moving. For example, such an approach is utilized during Coronary Artery Bypass Grafting (CABG). Moreover, medical procedures during such operations involve blood arrest, thus, potentially may involve ischemia of myocardium. A construction of the modified tissue stabilizer used during surgery on a beating heart is presented in the paper. We have developed a stabilizer that aside preventing part of myocardium from moving enables recording of epicardial electrograms. Four electrograms are recorded simultaneously together with one lead of standard ECG as a reference signal. Time relations between electrograms, recorded at four different points surrounding potentially ischemic area, are strongly modified by processes triggered by myocardium ischemia. Aside a construction of the stabilizer the associated measurement system is also presented. Measurement properties of the developed stabilizer and measurement system have been examined during tank studies. Finally, the waveforms obtained during in vivo study are also presented.

Role of IR-Thermal Imaging and Electroimpedance Measurements in Medical Diagnostics

This is a review of the state of the art in two important modalities - thermal and electrical properties of living tissues - that are complementary from the point of view of medical diagnostics. Advantages and limitations of IR thermal imaging and electroimpedance measurements, including tomography procedures are discussed. Properties of both modalities are compared from the point of view of skin burn evaluation, early recognition of breast cancer and some applications in cardiosurgery monitoring.

Reaction of normal and burned tissue to cold excitation

This study is devoted to the question if cold excitation may be effectively used in active dynamic thermal imaging for diagnostics of burn depth. The experiments on animals show quantitatively the reaction of healthy and burned pigskin to forced external cold excitation using cryogenic CO(2) rehabilitation instrumentation. The study allows for comparison of thermal transients at the surface of the pigskin for healthy and burned fields of controlled depths. The results are compared to optical excitation and confirm high value of cold stress in ADT and good correlation of heat flow mechanisms and the state (physiology) of the living skin.

Mild early onset axonal Charcot-Marie-Tooth disease not linked to other axonal Charcot-Marie-Tooth loci

Autosomal dominant axonal Charcot-Marie-Tooth disease type 2 (CMT2) is a heterogeneous group of disorders with seven chromosomal loci mapped in the uncomplicated forms of CMT2. The authors report clinical, electrophysiologic, and genetic analysis of a Polish CMT2 family. Nine known CMT2 gene loci and one MPZ gene locus have been excluded. The authors' findings suggest that this family represents a novel form of CMT2 disease.

A novel MPZ gene mutation in congenital neuropathy with hypomyelination

Congenital hypomyelinating neuropathy (CHN; MIM# 605253) is a severe neuropathy with early infancy onset inherited as an autosomal dominant or recessive trait. Sural nerve biopsy shows a characteristic picture of nonmyelinated and poorly myelinated axons with basal lamina onion bulbs and lack of myelin breakdown products. Several mutations in the MTMR2, PMP22, EGR2, and MPZ genes have been found in patients with CHN. The authors describe the clinical and morphologic features of a patient with CHN and the identification of a novel Thr124Lys mutation in the MPZ gene.

[Dynamic in vitro measurement of pressure and movement with the LCS prosthetic system]

This study measured the femoral inlay pressure and the movement of mobile bearing inlays after implantation of the LCS knee prosthetic system (DePuy,Warsaw, USA). The prostheses were implanted in seven fresh frozen knee specimens. This system offered three different types of inlays [classic (CL), A/P glide (APG), and rotating platform (ROT)] with the same type of femoral component. A pressure-sensitive film (Tekscan,Boston, USA) was attached on the surface of the inlay.T he movement of the inlay was measured by an ultrasonic positioning system (Zebris, Isny,Germany). The specimens were fixed in a hydraulic knee apparatus simulating an isokinetic extension movement from 120 degrees flexion to full extension. The hydraulic cylinder that simulated the musculus quadriceps femoris extended up to 1200 N. The pressure measurement showed a peak pressure of 4.4+/-1.5 MPa (CL),3.6+/-1.0 MPa (APG),and 9.8+/-1.3 MPa (ROT). The mobile bearing inlays moved 1.4+/-2.7 mm (CL) and 2.9+/-5.8 mm (APG) from posterior to anterior during extension of the knee. During the extension the inlays rotated 0.8+/-2.6 degrees (CL), 0.9+/-5.2 degrees (APG), and 3.2+/-6.9 degrees (ROT) internally.

Potent neutralization of botulinum neurotoxin by recombinant oligoclonal antibody

The botulinum neurotoxins (BoNTs) cause the paralytic human disease botulism and are one of the highest-risk threat agents for bioterrorism. To generate a pharmaceutical to prevent or treat botulism, monoclonal antibodies (mAbs) were generated by phage display and evaluated for neutralization of BoNT serotype A (BoNT/A) in vivo. Although no single mAb significantly neutralized toxin, a combination of three mAbs (oligoclonal Ab) neutralized 450,000 50% lethal doses of BoNT/A, a potency 90 times greater than human hyperimmune globulin. The potency of oligoclonal Ab was primarily due to a large increase in functional Ab binding affinity. The results indicate that the potency of the polyclonal humoral immune response can be deconvoluted to a few mAbs binding nonoverlapping epitopes, providing a route to drugs for preventing and treating botulism and diseases caused by other pathogens and biologic threat agents.

[Nonsurgical treatment of patients with cervical spine pain--algorithm for proceeding]

Diagnosis and treatment of neck pain still remains a therapeutic challenge. Basing on available literature and their own experience the authors present an algorithm for the management of neck pain in daily orthopaedic practice. It is crucial to correlate correctly the patient's complaints, the physical examination and the laboratory findings (including conventional imaging modes and neurodiagnostic procedures). The chronologically organised algorithm should help the physician in find the optimal therapeutic solution for his patient. The use of this algorithm should also lead to a decrease in the number of unnecessarily performed surgical procedures.

[Early results of short segment internal fixation of the thoracic and lumbo-sacral spine after trauma]

The aim of this paper was to assess the results of short-segment internal fixation of the spine in posttraumatic instability. A group of 53 cases of spinal trauma was analysed using both Magerl's and Frankel's classifications. Spinal instability was assessed according the Sagittal Index (SI). The metaanalysis of the clinical material demonstrated that early decompression of the spinal cord and the spinal roots following trauma allows either total or partial restitution of their physiological functions.

[Diskectomy of the lumbar spine: indication and contraindications]

The authors present an overview of the principles of surgical treatment of lumbar disc herniation which are currently applied at spinal surgery ward by the Orthopedic Department of the Poznan School of Medical Sciences. Most of these principles are valid in spinal surgery centres in USA and most European countries. The authors reviewed surgical technique, indications, contrindications and complications related to discectomy in the lumbar spine. Although the articles deals mainly with "classical" discectomy, other surgical techniques (microdiscectomy, percutaneous discectomy, chemonucleolysis, and endoscopy-assisted discectomy) are also briefly reviewed. Careful selection of patients, meticulous analysis of radiographic findings and proper surgical technique yield good results which allow most patients to improve their life conditions and lead a pain-free existence.

Erythromelalgia--a thrombotic complication in chronic myeloproliferative disorders

Erythromelalgia is a very specific, thrombotic syndrome related with thrombocythemia that may occur during the course of chronic myeloproliferative disorders (MPD), especially polycythemia vera (PV) and essential thrombocythemia (ET). This poorly understood clinical syndrome is characterized by red, congested distal extremities and painful burning sensations, usually confined to the ball of the foot and one or more toes or fingers. If left untreated, it may progress towards acrocyanosis and even peripheral gangrene. Sometimes, it may precede the diagnosis of MPD by months or years. The pathophysiological aspects of erythromelalgia as well as its differentiation with erythermalgia have been reviewed in this study.

[Classification of the adolescent idiopathic scoliosis and preoperative strategy]

The authors analysed 841 patients (83% girls and 17% boys) with adolescent idiopathic scoliosis. 678 patients (group I) were treated with the Harrington technique and 163 patients (group II) were treated using multisegmental instrumentation. Follow-up time in group I was on average 14.2 years, and 28 months in group II. Preoperative assessment of patients in group was based on clinical and radiological examination. Assessment of the spine was mainly based on coronal radiogram done in an upright position and lateral side-bending radiograms in a supine position. Traction and lateral X rays were rarely taken into account in this study. The fusion area was decided according to the end vertebrae of the structural curves. The caudal end of the fusion area was identified using Harrington's stable zone. The curves were classified in accordance with the SRS suggestions. Taking into account the apex of the curve, the deformations were classified into: cervico-thoracic, thoracic, thoraco-lumbar, lumbar and lumbo-sacral curves. In group II the triplanar (3D) character of the deformity was taken into account. In the coronal plane the upper and lower stable vertebra of the major structural curves were identified using the CSVL (Central Sacral Vertical Line) based on long films (70 cm x 110 cm) with and without traction. Lumbar curve was classified as mild, moderate, severe according to CSVL. In the axial plane vertebral rotation was assessed according to Nash and Moe method. A careful analysis of lateral radiograms in the upright standing position was performed. Lateral radiograms were performed also in maximal flexion and hyperextension of the spine to obtain a dynamic evaluation of the sagittal plane. Conoral radiograms with maximal rotation of the trunk to assess mobility of the caudad segments of the deformity. Classification of the scoliotic deformity based on its triplanar character included: thoracic curves (King III, IV, V types), double major (thoracic and lumbar), "false" double major curve (thoracic and lumbar) King type II, thoracolumbar/lumbar curves--the main curve is thoracolumbar lumbar/thoracolumbar curves--the main curve is lumbar--10 degrees the thoracolumbar component--King type I triple major curve--all curves have similar structural changes. Correct identification of the type of scoliosis, assessment of structural changes in the frontal, sagittal and axial plane (three dimensional 3D) and analysis of the size and correctiveness of the lumbar curve and all parameters which play a key role in rational preoperative planning. Redefining or at least maintaining lumbar lordosis is far more important than correction of thoracic kyphosis.

[Musculo-skeletal mechanisms of low back pain]

Authors presented in comprehensive form updated knowledge concerning reasons and mechanisms of musculoskeletal back pain nonspecific symptom which in majority of cases, provides only little inside into the nature of the underlying problem. The physician must however find sufficient time to educate the patient as to the nature of this disorder and likely course during treatment. Understanding the source and mechanisms of the patients pain allows the physician and patient to approach the problem rationally with mutual confidence. The basic aim of the physician is exact identification of the anatomic source of pain and exclude the possibility of underlying systemic or malignant process that might threaten the patient's life. The musculoskeletal system consists of the bones and articulations, ligaments, muscles and tendons, that connect and manipulate them within spinal column. All of these tissues are richly innervated and specific biomechanical conditions cause, that lumbar part of the spine and lumbosacral junction are extremely susceptible to direct and indirect affected by a spectrum of reasons causing pain. The pathomechanism of the pain originating within the facet joints, bone and periosteum, paraspinous muscles and tendons, intervertebral disks, posterior longitudinal ligament and dorsal root ganglion was discussed. Although in majority of causes it possible to control localized pain by means of conservative treatment, however in some patients (0.5%-1%) surgery is needed to decompress neurologic structures, restore stability, and eliminate pain.

Impedance mammograph 3D phantom studies

The results obtained using the Technical University of Gdansk Electroimpedance Mammograph (TUGEM) of a 3D phantom study are presented. The TUGEM system is briefly described. The hardware contains the measurement head and DSP-based identification modules controlled by a PC computer. A specially developed reconstruction algorithm, Regulated Correction Frequency Algebraic Reconstruction Technique (RCFART), is used to obtain 3D images. To visualize results, the Advance Visualization System (AVS) is used. It allows a powerful image processing on a fast workstation or on a high-performance computer. Results of three types of 3D conductivity perturbations used in the study (aluminum, Plexiglas, and cucumber) are shown. The relative volumes of perturbations less than 2% of the measurement chamber are easily evidenced.

[Algorithm in low back pain management in adults]

Currently recommended management for low back pain in adults is presented. The algorithm consists of two phases. In a patient presenting acute low back pain with no previous history thorough clinical evaluation (phase I) should aim at exclusion of cauda equina syndrome, fracture, neoplasm, infection, progressive neurological deficit, or chronic pain syndrome. If none of these condition is responsible for low back pain 4-6 weeks therapy depending on the severity of symptoms should be commenced. Then clinical reevaluation is indicated and if pain persists patient should be referred to a specialist (phase II). Previous diagnosis and treatment should be reviewed critically; if found appropriate the treatment might be repeated during phase II. Primary sources of low back pain as herniated nucleus pulposus, unremitting low back pain (segmental instability), spondylolysis, isthmic spondylolisthesis degenerative spondylolisthesis with spinal stenosis should be identified and appropriate treatment (surgical or conservative) undertaken. Patient education is an important component of phase II. In general, phase II of the algorithm aims at returning the patient to full psychophysical activity and at prevention of low back pain recurrence.

[Idiopathic scoliosis: epidemiology and etiology]

Authors present current knowledge about incidence and etiologic factors in idiopathic scoliosis (IS). Most data about incidence are based on screening examination in school children. Amount of patient with IS is related to the method of evaluation and experience of examiner. There is 1.9% to 3% cases in whole population if scoliosis is assumed as much as 10 degrees of Cobb angle (SRS). Etiology of IS is still in doubt despite of many investigations. There are many abnormalities in tissues but most of them probably secondary to this process. Etiology is multifactorial with dominance of inheritance. There are many genes responsible for occurrence of IS but genetic trait is still unknown.

Cell for measurements of biological tissue complex conductivity

The construction of the cell for measurement of complex electric conductivity is described. Two-chamber and four-electrode system with temperature stabilisation is developed. Guarding chamber and electrodes are used to minimise the leakage of current from the measurement chamber. The cell construction is examined by use of Finite Element Method. The model of the measurement cell is examined in order to improve the accuracy of measurements. The calibration procedure based on measurement of reference materials is presented. The frequency range of the cell is extended to 10 MHz with acceptable level of error. The examples of results from measurement breast normal and cancerous tissues are presented.

[Surgical treatment of idiopathic scoliosis with multisegmental posterior instrumentation and its influence on postoperative spinal balance]

Causes of postoperative spinal imbalance in patients with idiopathic scoliosis treated with multisegmental posterior instrumentation CD or TSRH and posterior fusion are presented. Investigation included 88 patients (77 girls, 11 boys) aged 11.4-17.1 (mean 13.8). Primary curve Cobb angle ranged from 52 (to 133 mean 75), secondary curve 16 (to 88 mean 47). Follow-up ranged from 12 to 19 months (mean 18.2 months). In 31 patients (35.2%) postoperative decompensation of the spine occurred. Six of them regained spinal balance within 12 to 19 months postoperatively. As the magnitude of correction increased in relation to preoperative correctiveness and/or preoperative rotation of the spine the imbalance of the spine was more pronounced. It was worsened also in cases where spontaneous correction within the secondary curve (not instrumented) was lesser than expected. Thoracic curve overcorrection in type II scoliosis with instrumentation inclusive of 1 or 2 vertebrae beyond neutral one resulted in decompensation to the left. To short a fusion (in relation to neutral and stable vertebrae) caused in this type as well as in type II and IV right sided decompensation. Overcorrection of lower (right sided) curve or omission of upper (left sided) curve in type V scoliosis caused shoulder girdle decompensation. In type I lumbar fusion done proximally to neutral and stable vertebrae caused left side decompensation of the spine.

[Ethics in tutorial publications]

On basis of scientific literature authors discuss general rules of ethics as the whole of moral rules and behaviour. They point out that compliance with ethical rules in scientific publications should be an integral part of scientific progress. They present the frequent breaches of ethical principles which include: changes or trickery in stating own study results to a priori accepted assumptions, their incorrect presentation or in a more positive mode, taking advantages from other authors publications not revealing its source, lack of sufficient knowledge of scientific literature, theft of foreign scientific ideas, plagiarism and auto plagiarism, unfair presentation of authors sequence in publication, omitting of some co-workers, not in conformity with Helsinki Declaration during human investigations, not in conformity with basic care concerning animals subjected to medical experiments.

[Range of distal spondylodesis in surgical treatment of idiopathic scoliosis using multisegmental instrumentation]

This presentation aim was to provide correct answer in question of range of spondylodesis (both proximal and distal levels) in surgical treatment of idiopathic scoliosis with multisegmental instrumentation. The postoperative evaluation o 88 patients (77 girls and 11 boys) was done according to King and Moe classification. Average patients age was 13.8 years (11.4-17.1) with 18.2 months (12-29) follow-up. In 53 cases it was longer than 2 years. The identification of the curve pattern in both the coronal and sagittal planes will allow you to decide which curves to fuse. In the choice of upper fusion level one should keep attention to shoulder balance and presence of superior junctional kyphosis, extending than range of the fusion up to T2. In the lower level there is important to keep distal fusion mass in vertical alignment transsected by CSL (just like in the upper end in thoracic spine) to preserve spine compensation and remaining as many sa possible mobile spine segments below the fusion.

[The most frequent errors during use of the surgical techniques of Cotrela-Dubousset (C-D) and Texas Scottish Rite Hospital (TSRH) for surgical treatment of idiopathic scoliosis]

Results of operative treatment of idiopathic scoliosis in 88 patients (77 girls and 11 boys) with an average follow-up of 18 months have been presented. Basic principles of surgical procedure and most commonly made errors are demonstrated on the basis of authors' experience and data from the literature. The method of strategic vertebrae selection for hook implantation depending on scoliosis type are discussed. Differences in surgical technique in respect to idiopathic lordoscoliosis or kyphoscoliosis have been highlighted.

[Professor Franciszek Raszeja--a centenary of his birthday]

The authors present a concise biography of professor Franciszek Raszeja on the centenary of his birthday. Special attention is given to his scientific and organizational achievements, particularly in regard to the formation of the Orthopaedic Department at the University of Poznań.

[Autologous blood-derived stem cell transplantation in the treatment of hematopoietic malignant diseases (Part II)]

Autologous transplantation of circulating stem cells is potentially capable of creating a chance of normal hematopoietic reconstitution in the patients in which both allogeneic and autologous bone marrow transplantation was impossible. The authors have reviewed the possibilities for collection of adequate and sufficient numbers of peripheral blood stem cells as well as up-to-date results of their autografting especially in relation to hematopoietic malignant diseases. The advantages resulting from autologous transplantation of circulating stem cells depends on: 1. The lack of risk of GvH--disease. 2. early and rapid hematopoietic and lymphoid recovery, 3. probably, the low risk of graft contamination by tumor cells in early remission.

[Autologous blood-derived stem cell transplantation in the treatment of proliferative disorders of the hematopoietic system (I)]

Peripheral blood can be an alternative source of hematopoietic stem cells which after autografting are capable of sustaining or completely recovering of lymphopoiesis without the necessity of bone marrow harvesting. Theoretical assumptions conditioning the clinical application of circulating stem cells autotransplantation have been described. The results of experimental studies performed in animals and humans have allowed for closer characterization of these cells. However, the physiological significance of their presence in the peripheral blood still remains unknown.

[Torsion and rotation of apical vertebrae and thoracic deformity in idiopathic thoracic scoliosis in computer tomography]

CT examination of 9 patients with primary thoracic right sided scoliosis aged from 13 to 19 years (15 years and 4 months on an average) was carried out. The angle of curvature (Cobb method) ranged from 38 degrees to 99 degrees (68 degrees on an average). Rotation of the apical vertebra was measured and torsion evaluated. Rotation ranged from 5 degrees to 28 degrees (17 degrees on an average). No relation among rotation, angle of curvature and size of the hump was found. The directions of rotation and torsion were opposite. At the apex of curvature due to torsion the end of spinous process was deviated towards the hump but the vertebrae into opposite direction.

[Effect of vitamin E on the function of blood platelets in patients with diabetes mellitus]

An effect of vitamin E on blood platelets functioning was studied in 39 patients with diabetes mellitus type 1. Control group included 20 healthy blood donors. Vitamin E in a daily dose of 1000 mg produced statistically significant decrease in platelets aggregation, number of circulating platelet aggregates and release of the platelet factory 4 in diabetics after 7 days of treatment. No adverse reactions were seen in any patient treated with vitamin E. The obtained results indicate that vitamin E inhibits increased platelets activity in the patients with diabetes mellitus type 1 and does not exert toxic reactions during the treatment.

Ultrastructural aspects of leukaemic cells in acute myeloblastic leukaemia

Ultrastructural aspects of leukaemic cells in a case of myeloblastic leukaemia are described. Changes concerning of mitochondrial ultrastructure, but primarily the presence of vast numbers of fibrillar structures in the cytoplasm of the examined cells were observed. These structures were spreading through their gradual widening to cover almost the whole cell cytoplasm, damaging its organellae and internal architecture. The nature of the observed changes remains unknown.

Transcatheter embolization in a haemophiliac with post-traumatic renal haemorrhage. Report of a case

Percutaneous transcatheter arterial embolization was performed in a case of severe haemophilia A to control haemorrhage secondary to renal trauma. The treatment proved to be life-saving. Eighteen months follow-up revealed no evidence of hypertension, renal failure or infection.

Nonrandom chromosome rearrangements in 27 cases of human myeloid leukemia

The R-banding pattern of the chromosomes of 31 patients hospitalized in the Hematologic Clinic for myeloid leukemia were studied before chemotherapy. This analysis permitted identification of one unusual 3-chromosome rearrangement t(3;9;22) in addition to 25 classic forms of (22q-;9q+) translocation accompanied by the specific Ph' chromosome in chronic granulocytic leukemia patients, independent of the blastic course of the disease. During blastic crisis observed in 6 patients, extra 8 and 10 chromosomes, monosomy for chromosome 17, isochromosomes 17q, translocation (12q;13q), and additional Ph' were noted. The nonrandomness of these findings is determined from results published by other authors. Their significance for the cellular phenotype is presently unknown.

[Cytochemical studies of primary granules in rat neutrophils: an electron microscope study]

Cytochemical investigations were carried out on primary granules in neutrophils in rats. For this purpose reaction for acid phosphatase and then using the same preparations of bone marrow peroxidase activity was determined. Peroxidase activity was demonstrated in all granules of first order (primary), but only in a part of them the activity of acid phosphatase was present. These granules are, most probably, lysosomes containing peroxidases apart from hydrolases.

[Ultrastructure and cytochemistry of neutrophil granulocyte series in the bone marrow of white rats]

Ultrastructure of the neutrophil granulocyte series of rat was studied. Besides morphological investigations of maturating cells activity changes of two selected enzymes were determined: acid phosphatase and peroxidase. It was observed that the activity of acid phosphatase is connected with appearance of primary granules and peroxidase activity is connected with these granules as well but shows different location at different developmental levels of these cells.

[Value of determination of mononuclear blood cell proliferation in vitro in the diagnosis of lymphosarcoma]

The authors describe mitotic activity in non-stimulated cultures of mononuclear cells obtained from the peripheral blood of patients with lymphosarcoma. The investigations were carried out on 3 patients in stage 3rd and 4th of this disease and 5 patients in the stage of sarcomatous-cell leukaemia. During a period of 24-48 hours after setting up of culture a rise was observed in the number of blast cells and appearance of up to 10% of mitotic figures. This observation may be useful for differentiation of sarcomatous-cell leukaemia from chronic lymphocytic leukaemia in which cells obtained from the peripheral blood and cultured in vitro without addition of mitogen do not demonstrate mitotic activity.