Successful revascularisation of a thrombosed renal artery aneurysm in a young man with solitary kidney and history of severe hypertension

Case report of a 18-year-old patient with long lasting hypertension, who developed acute renal failure, in course of an antihypertensive therapy modification, backgrounded by undiagnosed aneurysm of the solitary kidney renal artery. The acute renal function decrease was caused by single dose of ACE inhibitor causing an equivalent drop in serum ACE activity. Aneurysm excision followed by implantation of a venous bypass normalized restored renal function and blood pressure for over 24 months of observation.

[A case of polyostotic fibrous dysplasia]

Fibrous dysplasia (FD) is a benign but slowly progressive disorder of bone in which normal cancellous bone is replaced by immature woven bone and fibrous tissue. Fibrous dysplasia is a very uncommon disorder and the total number of cases is not known. It is usually diagnosed in children and young adults. Some patients have only one bone affected (monostotic), whereas other patients have numerous bones affected (polyostotic). Multiple affected bones are often found on one side of the body. The craniofacial involvement causes very difficult therapeutic problem due to localisation and uncontrolled proliferation followed by compression, both resulting in facial asymmetry, pain, cranial nerve deficiencies, alterations in hearing and loss of vision. Treatment of FD depends on the associated symptoms and may include a range of therapies from observation to complete surgical excision. We describe a rare case of polyostotic fibrous dysplasia with craniofacial localisation associated with the involvement of the humerus in a 65-year-old female patient. The first symptoms in the patient were noted 4 years ago. The diagnosis was based on clinical examination, X-ray, CT and histological examination.

[Usefulness of imaging in the diagnosis of salivary gland diseases]

The aim of this study was to evaluate the value of modern imaging modalities in the diagnosis and management of different salivary gland diseases.

MATERIAL AND METHODS

Material comprised of 135 patients (79 women and 56 men) at the age 14-70 (mean aged 35, 7). Ultrasonography (US) was basic examination in every case. Results of US examinations were compared with sialography, CT and MR imaging. Final diagnosis was established on the basis of histopathologic examination.

RESULTS

The big usefulness of new visualization techniques, especially modem ultrasonography in detecting neoplastic and inflammatory processes of salivary glands was stated.

CONCLUSION

US is the first, precious imaging modality to evaluate a small lesions (in diameter above 5 mm) of the parotid and submandibular gland. CT and MR is better to evaluate large tumors and should be performed whenever a malignancy is strongly suspected or has been assessed.

Oxidative stress and coenzyme Q10supplementation in renal transplant recipients

Recently some reports about the oxidative stress in renal transplant recipients have been published. The role of coenzyme Q10 (CoQ10) as radical scavanger is largely known. The aim of our study was to evaluate the protective role of CoQ10 in renal transplant recipients on lipid peroxidation and lipids parameters, as well as its influence on antioxidant enzymes, neutrophils chemiluminescence and urinary enzymes. The study was performed in 11 long term allograft recipients treated additionally with CoQ10 90 mg/day in three doses, 30 mg each for four weeks. The malonyldialdehyde (MDA) and 4-hydroxynonenal (4-HNE), superoxide dismutase (SOD) and glutathione peroxidase (GPx) and the basic parameters of lipid metabolism such as total cholesterol (TC), high and low density lipoproteins (HDL, LDL), triglycerides (TG), atherogenicity indicators [LDL/HDL; (TC-HDL)/HDL] were evaluated. The chemiluminescence of neutrophils (luminol, fLMP-method) were mesured and the activity of N-acetyl-beta-D-glucosaminidase (NAG), alanylaminopeptidase (AAP), elastase, alpha-1-antitrypsin. All parameters were estimated before and after CoQ10 treatment. Statistically significant changes were noticed with the LDL and atherogenicity indicators (p < 0.01) (decrease) as well as HDL level (p < 0.001) (increase). Also the significant decrease of fMLP stimulated PMNL chemiluminescence (p < 0.05) confirms the antioxidative properties of CoQ10. The significant increase of NAG activity (p < 0.05) can't be the result of nephrotoxic effect, because NAG-B is unchanged. Serum concentration of creatinine and cyclosporine A in renal allograft recipients was unchanged after CoQ10 treatment. The presented date shows that further study with CoQ10 treatment in renal transplant in larger numbers and over longer periods should be considered.

Enzymuria and beta2-mikroglobulinuria in the assessment of the influence of proteinuria on the progression of glomerulopathies

The important role of the tubulo-interstitial system for the progression of glomerulonephritis (GN), is the cause of a continuous search for the proper markers of kidney tubules damage, which can be applied in clinical diagnosis. In the present work the activity of N-acetyl-beta-D-glucosamidase (NAG), its isoenzyme NAG-B, alanylaminopeptidase (AAP), gamma-glutamyltransferase (GGT), concentration of beta2-microglobulin (beta2M) and daily protein excretion in the urine of 37 patients with morphologically different glomerulopathies were measured. The serum creatinine was also controlled. The obtained results suggest that activity of NAG in the patients with GN has an intermediate connection with proteinuria and could be a cause of the inflammatory process of the kidney, but the activity of AAP is directly dependent on urine protein concentration. Systemic analysis of both partial and multiple correlation coefficients of the examined indicators creates new, additional possibilities in the estimation of activity and progress of GN.

[A case of Wegener's granulomatosis]

We present a case of Wegener's granulomatosis in which otitis media symptoms masked the disease in first phases. Progressive, unilateral hearing loss, almost deafness, together with facial nerve paresis allowed us to make proper diagnosis and apply therapy.

Enzymatic markers of cyclosporine nephrotoxicity in patients after renal transplantation

Toxicity of cyclosporine (CsA), an immunosuppressive drug widely used in transplantation, to the transplanted kidney creates a serious side effect. Therefore, searching for sensitive indicators of nephrotoxic action is well worth the effort. In this work we describe the results of estimation of urine concentration of lysosomal enzymes widely present in the kidney: N-acetyl-beta-D-glucosaminidase (NAG), its isoenzyme NAG-B and beta-glucuronidase (beta-Gr). The studies were conducted in various periods after transplantation of kidneys, on patients under various treatments and receiving different doses of CsA. The results indicate a substantial dependence of the activity of NAG and NAG-B on CsA doses and the period after transplantation. The enzyme proved to be also a sensitive indicator of graft rejection. No such dependence was observed in the case of beta-Gr.

[A case of cylindroma of the parapharyngeal space]

The authors show a case of parapharyngeal space cylindroma paying attention to large diagnostic difficulties. This tumor has been characterized by a slow local growth but after five years disease involved many organs with metastases.

Enzymuria in antibiotic therapy of acute infections

Activities of N-acetyl-beta-D-glucosaminidase (NAG), its isoenzyme NAG-B, alanylaminopeptidase (AAP), elastase and trypsin inhibitor (alpha 1 PI) were evaluated as markers of nephrotoxicity and inflammation in acute infections treated with various antibiotics (vancomycin, netilmicin, pefloxacine, cefoperazone and imipenem).

Diagnostic application of AAP isoenzyme separation

We describe the separation of alanylaminopeptidase (AAP) from urine into two isoenzymes: a particulate and a soluble form. The separation was accomplished using ion-exchange column chromatography on DEAE-52 cellulose. The purity of the isolated forms was confirmed electrophoretically. We attempted to create a method allowing the quantitative assessment of AAP isoenzymes in urine based on electrophoretic separation in 7.5% polyacrylamide gel with subsequent densitometric analysis. The content of AAP isoenzymes in examined urine was estimated using ultracentrifugation. The differences in the content of cytosolic and microsomal forms were observed suggesting the possibilities of using AAP isoenzymes in diagnostics. Furthermore, the effect of temperature on the activity of AAP separated on DEAE-52 cellulose was studied.

[Influence of vapours of paint and toxic dusts on mucous membranes of the upper airways in paint and varnish factory workers]

Macroscopic, cytologic and bacteriologic conditions of mucous membranes of the upper airways in workers (n = 146) of the Polifarb Factory, Wrocław, exposed to dusts and solvent vapours used in the paint and varnish production was estimated. In 89% of the workers, pathologic changes in throat mucous membranes were observed. Three types of macroscopic changes were distinguished. In workers with the shortest period of employment, laryngeal oedema congestion alteration was diagnosed, and atrophic changes with medium intensity were observed in workers employed for a long period. It was found that cytologic changes in the nose mucous membrane depended on the duration of exposure. Inflammation cytograms appeared during the first period of exposure to the substances discussed. The longer period of exposure, the more clear features of metaplasia squamous epithelium. The composition of the nose and throat bacterial flora changed according to the length of employment. An increased growth of G(-) genera Enterobacter, Klebsiella, Proteus, Escherichia and Candida fungi was found in workers with long period of employment.

N-acetyl-B-D-glucosaminidase isoenzymes in the diagnosis of poisoning and kidney diseases

Damaged lysosomes from renal tubular cells are, to the greatest degree, the source of activity of NAG in urine. Besides this, the enzyme can appear as a result of degranulation of granulocytes (PMN), active infection of the urinary system as also from serum as a result of glomerular filtration during damage to the glomerular basement membrane. For the purpose of explaining the source of origin of the enzyme in urine, NAG was separated into isoenzymes from the kidneys, granulocytes and serum for comparison with isoenzymes in physiological and pathological urines after ethylene glycol poisoning, and glomerulonephritis, respectively. The separation was made by column ion-exchange chromatography on DEAE-52 cellulose and by electrophoresis in 7% polyacrylamide gel. In addition, the thermostability of isolated isoenzymes was compared.

The variety of clinical and histopathologic presentations of glomerulonephritis associated with latent syphilis

Glomerulonephritis is a well established but rather uncommon complication of latent secondary syphilis. We present three cases of glomerulopathies associated with luetic infection, observed and managed in our institutions in the past three years. They illustrate a variety of clinicopathologic presentations of this nephropathy, from acute nephrotic syndrome through membranous glomerulopathy up to rapidly progressive glomerulonephritis. Regardless of the clinical course and histologic type, they were all characterized by strongly positive results of serologic tests for syphilis. Our observations suggest the necessity of eliminating luetic infection in aetiologic considerations of each newly diagnosed case of nephrotic syndrome.

Spontaneous platelet aggregation, tourniquet ischaemia, and aspirin in survivors of myocardial infarction

Platelet number, plasma beta-thromboglobulin (beta-TG), spontaneous platelet aggregation (SPA), serum thromboxane B(2) (TXB(2)), and 6-keto-PGF(101) were assessed in 9 males with proven atherosclerosis (survivors of myocardial infarction, (MI) in a stable condition) and compared with values for 9 young, healthy controls. Results were obtained before and after 3-day treatment with aspirin. In addition, SPA was assessed before and after a tourniquet test. MI survivors had higher beta-TG (p < 0.01) and SPA values (p < 0.05), and a lower platelet count (p < 0.05) than controls. Aspirin significantly attentuated all these changes. These data suggest that platelet function is increased in survivors of MI. Tourniquet-induced ischaemia significantly (p < 0.05) enhanced SPA in MI survivors but not in controls. Aspirin did not inhibit SPA following ischaemia in contrast to its effect under pre-ischaemic conditions or in controls. It seems that the proaggregatory threshold is decreased in MI survivors. The results challenge the assumption that an acute coronary event with underlying atherosclerosis is due to an interaction between atherosclerosis plaque and normal platelets.

[Sudden relief of symptoms in a patient with mesangiocapillary glomerulonephritis during treatment of hematuria with epsilon aminocaproic acid]

A case of not expected turn in the course of mesangiocapillary glomerulonephritis in a 30-year old patient is presented. The patient has been treated with EACA. It confirms possible efficiency of EACA inhibitory effect on various immunological reactions. This new, unknown property of EACA justify some new concepts in pathogenetic mechanisms of glomerulopathy.

Chemiluminescence of neutrophils in patients with glomerulonephritis treated with methylprednisolone

The effect of high dose methylprednisolone (Solu-Medrol, Up John) (1000 mg) on chemiluminescence (CL) of peripheral blood neutrophils in patients with various primary glomerulopathies was determined. Contrary to the well-established influence of corticosteroids on in vitro suppression of leukocytic chemiluminescence, our studies disclose a remarkable enhancement of neutrophil chemiluminescent activity in patients receiving pulse methylprednisolone infusion. Subsequent administrations of the drug did not result in any significant change of the analysed parameters. Increased chemiluminescence returned to the pretreatment values within approximately seven days. A possible explanation for the observed phenomenon is discussed.

[Certain aspects of clinically mild, non-tropical chyluria]

Chyluria despite pseudo- banality may pose several diagnostic and therapeutical problems. Its etiopathogenesis is unclear, too. Prolonged loss of the lymph observed in patients with chyluria due to inherited anomalies of lymphatic system may lead to serious deficits and homeostasis disorders. Basing on these thesis, the authors present two patients with chyluria due to inherited anomaly of extraperitoneal lymphatic system and review available literature. Particular role in the clinical follow-up of these patients plays their immunologic status. The authors did note deficiency of cell-mediated immunity measured with skin tests and lymphocyte T blastic transformation test, and increasing IgG deficit, and particularly annoying IgA deficit in the patient with long-lasting, massive chyluria.

[Is local antiproteolytic failure the cause of a prolonged course in various forms of glomerulonephritis?]

Just as in other inflammatory processes in glomerulonephritis also a great role has been ascribed recently to proteases released from phagocytes and mesangial cells. On the basis of original observation (clinical and experimental) of glomerulopathy inhibition by EACA, the authors present the concept of local antiproteolytic failure as the cause of protracted course of certain forms of glomerulonephritis.

Plasma beta-thromboglobulin in acute myocardial infarction with ventricular arrhythmias

Patients with myocardial infarction, complicated by ventricular arrhythmias (Lown grade greater than or equal to 2), had higher (p less than 0.05) plasma beta-thromboglobulin level than that found in patients with uncomplicated infarction. This indicates higher platelet activation in the former group than in the latter. Such data provide rationale for clinical trial of antiplatelet drugs in cases of myocardial infarction complicated by severe arrhythmias.

Isoenzymes of N-acetyl-beta-D-glucosaminidase in urine of patients with acute renal failure after intoxication

Activity of urinary N-acetyl-beta-D-glucosaminidase (NAG) was determined and basic clinical studies were carried out in oliguric, polyuric phases and restoration to health in patients with acute renal failure due to intoxication. At the same time, enzyme separation into isoenzymes A and B was achieved by column ion-exchange chromatography and by electrophoresis. This was done in urines from 9 patients and a control group of 10 persons who had no contact with toxic substances. The contribution of particular isoenzymes in total activity was determined by the "batch-wise" method with DEAE-52 cellulose. Significant differences were discovered in thermostability of NAG isoenzymes which may be utilized in nephrological diagnosis.

Captopril in temporary, non-dialytic management of pulmonary edema in end-stage renal disease

The only effective management of life-threatening hypervolemia in course of terminal renal failure is dialysis or hemofiltration. Nonetheless we succeeded in attenuating hypervolemic pulmonary edema utilizing low doses of Captopril in three patients awaiting entry into the maintenance hemodialysis program. The drug added to diuretic and, in two cases, digitalis therapy enabled pharmacologic management of patients volume overload for 12-25 days before the dialysis treatment could be started. No further decline in renal function or other side effects of Captopril were encountered. We conclude that Captopril may be life-saving in settings requiring pharmacologic relief of uremic pulmonary edema.

Left ventricular function in preeclamptic patients: an echocardiographic study

To examine left ventricular function in pregnancy complicated by preeclampsia, echocardiographic dimensions and left ventricular performance indices were determined in 42 preeclamptic patients, 25 normotensive third-trimester patients, and 25 nonpregnant patients. The performance of the left ventricle in normal third-trimester pregnant patients was unchanged as compared to that in nonpregnant patients. Three patients (7%) in the preeclamptic group had diminished values of echocardiographic contractility indices. However, in only one of these patients were there clinical signs of left heart failure; two other patients had latent myocardial dysfunction. Our conclusion is that left ventricular function in most preeclamptic patients is well preserved despite significant volume and pressure overload.

Echocardiographic estimation of hemodynamics in hypertensive pregnancy

M-mode echocardiography and indirect blood pressure measurements were used to examine hemodynamics in three groups of pregnant patients: 19 who were preeclamptic, nine who had essential hypertension, and 19 who were normotensive. The preeclamptic patients had significantly lower heart rate (68.4 versus 74.7 beats/min, p less than 0.05), stroke volume (89 versus 101 ml; p less than 0.02), and cardiac index (5.9 versus 7.5 L/min/sq m; p less than 0.001) than those of control patients matched for age, parity, and gestational age. The mean values for heart rate, stroke volume, and cardiac index in patients with essential hypertension were not significantly different from those in the control group; however, the former had widely varying individual hemodynamic patterns. The significant inverse correlation was found between cardiac index and mean blood pressure (r = -0.602) in preeclamptic patients. There was a positive correlation between maternal cardiac index and infant birth weight (r = 0.813) and also inverse relationship between systemic vascular resistance and infant birth weight (r = -0.890) in this group. Possible explanations for these findings are discussed.

[Neural conduction velocity in patients on hemodialysis]

Fourteen patients with chronic glomerulonephritis and with Alport's syndrome were treated. Haemodialysis was performed 2--3 times weekly. The duration of treatment was from 10 months to 9 years. Serum levels of electrolytes, urea and creatinine were determined, the neurological condition was examined and nerve conduction velocity was measured in the lower and upper extremities. The determinations were done before and after haemodialysis. Subclinical manifestations of polyneuropathy were demonstrated with reduced motor-nerve conduction velocity in the lower extremities. A direct effect of single haemodialysis was far from uniform: usually the conduction velocity increased after haemodialysis and in some cases it decreased. There was no correlation between the serum levels of electrolytes, urea and creatinine and motor-nerve conduction velocity.