Sepsis caused by Chromobacterium violaceum - probably the first case in Europe, or Macbeth read anew

Rare diseases, almost by definition, present us with diagnostic as well as therapeutic difficulties as. They also include infectious diseases outside endemic areas. Without expecting them, we are not preparing to fight them. Like Macbeth, we feel safe, convinced that tropical diseases do not reach us, like Birnam forest towards his castle. Nevertheless, the forest moved according to the prophecy of the three witches, and in a similar way tropical flora is moving towards us according to the predictions of environmentalists. This is illustrated by the history of the presented patient, who was admitted to hospital because of sepsis caused by Chromobacterium violaceum (CV), a Gram-negative facultatively anaerobic, oxidase-positive bacterium producing a dark violet antioxidant pigment called violacein. This is probably the first documented case report of sepsis in this part of the world. To the best of the authors' knowledge, the patient is the first to require dialysis after Chromobacterium violaceum infection.

The Management of Chronic Back Pain in Primary Care Settings: Exploring Perceived Facilitators and Barriers to the Development of Patient-Professional Partnerships

Supporting patients in forming partnerships with health professionals is the key of effective self-management. This study aimed to explore the nature of patient-professional partnerships and its related factors that create facilitators and barriers to patients' self-management ability. A constructivist grounded theory approach was undertaken. Three main themes emerged: interaction and communication, integrated care, and service and system. A theoretical model was generated that posits effective communication, individualized integrated care, and high-quality service as key influences on the successful development of patient-professional partnerships and patients' ability to self-manage. Giving attention to these factors helps understand the development, implementation, mechanisms, and evaluation of building a patient-professional partnership and maximizes the opportunities for patient self-management of chronic pain. Future research and practice are needed to move beyond a simplistic focus on health outcomes to address the complex links between partnerships and treatment delivery processes, and interventions, effects, and patients' context.

Clinicopathologic correlations of renal pathology in the adult population of Poland

Background

This is the first report on the epidemiology of biopsy-proven kidney diseases in Poland.

Methods

The Polish Registry of Renal Biopsies has collected information on all (n = 9394) native renal biopsies performed in Poland from 2009 to 2014. Patients' clinical data collected at the time of biopsy, and histopathological diagnoses were used for epidemiological and clinicopathologic analysis.

Results

There was a gradual increase in the number of native renal biopsies performed per million people (PMP) per year in Poland in 2009-14, starting from 36 PMP in 2009 to 44 PMP in 2014. A considerable variability between provinces in the mean number of biopsies performed in the period covered was found, ranging from 5 to 77 PMP/year. The most common renal biopsy diagnoses in adults were immunoglobulin A nephropathy (IgAN) (20%), focal segmental glomerulosclerosis (FSGS) (15%) and membranous glomerulonephritis (MGN) (11%), whereas in children, minimal change disease (22%), IgAN (20%) and FSGS (10%) were dominant. Due to insufficient data on the paediatric population, the clinicopathologic analysis was limited to patients ≥18 years of age. At the time of renal biopsy, the majority of adult patients presented nephrotic-range proteinuria (45.2%), followed by urinary abnormalities (38.3%), nephritic syndrome (13.8%) and isolated haematuria (1.7%). Among nephrotic patients, primary glomerulopathies dominated (67.6% in those 18-64 years of age and 62.4% in elderly patients) with leading diagnoses being MGN (17.1%), FSGS (16.2%) and IgAN (13.0%) in the younger cohort and MGN (23.5%), amyloidosis (18.8%) and FSGS (16.8%) in the elderly cohort. Among nephritic patients 18-64 years of age, the majority (55.9%) suffered from primary glomerulopathies, with a predominance of IgAN (31.3%), FSGS (12.7%) and crescentic GN (CGN) (11.1%). Among elderly nephritic patients, primary and secondary glomerulopathies were equally common (41.9% each) and pauci-immune GN (24.7%), CGN (20.4%) and IgAN (14.0%) were predominant. In both adult cohorts, urinary abnormalities were mostly related to primary glomerulopathies (66.8% in younger and 50% in elderly patients) and the leading diagnoses were IgAN (31.4%), FSGS (15.9%), lupus nephritis (10.7%) and FSGS (19.2%), MGN (15.1%) and pauci-immune GN (12.3%), respectively. There were significant differences in clinical characteristics and renal biopsy findings between male and female adult patients.

Conclusions

The registry data focused new light on the epidemiology of kidney diseases in Poland. These data should be used in future follow-up and prospective studies.

Captopril apparently increase and cisplatin apparently decrease human albumin concentration in artificial urinary solutions

BACKGROUND

Measurement of urinary albumin (HSA) is very important in diagnostic of kidney diseases. Much less is known about the possible impact of substances present in urine together with albumin on the results of measurements.

METHODS

We investigated the effect of the presence of captopril and cisplatin in the solution on the result of the determination of HSA by native polyacrylamide gel electrophoresis. Protein conformation in the absence and presence of the drugs was examined using Fourier Transform Infrared Spectroscopy (FTIR).

RESULTS

The presence of captopril apparently increases HSA concentration while cisplatin causes an apparent decrease in the HSA concentration. The presence of both drugs also influence the secondary structure forms of HSA albumin investigated by FTIR.

CONCLUSION

Both drugs tested in the concentration of human use can have an impact on the results of determination of albumin in urine which can influence clinical decision.

[Expert's opinion on recommendations for water and other beverages consumption in elderly?]

The article encloses definition of water role and its body requirement, review of water balance and management in older persons regarding characteristic of this age group and concomitant disorders. Based on current literature and expert's opinion the recommendations for water consumption were expressed with estimation of insufficient apply and oversupply, evaluation of hydration state, domestic water sources in diet with accent on influence of proper hydration on comfort and good health.

Evaluation of the effectiveness of therapeutic massage in patients with neck pain

BACKGROUND

Neck pain is one of the most common musculoskeletal ailments. The aim of this study was to evaluate the effectiveness and impact of therapeutic massage on the range of motion in patients with neck pain.

MATERIAL AND METHODS

The study involved 60 patients aged 37-82 years (mean age: 62.8 ± 9.86 years) treated for neck pain at the Rehabilitation Department of Zamość University of Management and Administration. The patients were divided into two groups: one (30 persons) received kinesiotherapy and physiotherapy, and the other group (30 persons) additionally received therapeutic massage. The effectiveness of rehabilitation was assessed with a Saunders digital inclinometer, the Neck Disability Index (NDI) and a Visual Analogue Scale (VAS).

RESULTS

Both groups did not differ significantly in terms of NDI and VAS scores at baseline (NDI: p = 0.56, VAS: P = 0.231) and after rehabilitation (NDI: p = 0.203; VAS: P = 0.401). The NDI questionnaire and VAS revealed a significant pain reduction (p <0.001), and improved performance and function (p <0.001) after rehabilitation in both groups. Patients who had received massage demonstrated a statistically significant improvement in the range of flexion (p = 0.022), lateral bend to the right (p = 0.018), and lateral bend to the left (p = 0.003).

CONCLUSIONS

1. Therapeutic massage increases ranges of motion. 2. The effectiveness of therapeutic massage is comparable to the effectiveness of rehabilitation based only on physical therapy and kinesiotherapy.

[Polish physicians'opinions concerning morally controversial medical practices]

OBJECTIVES

Some lawful procedures are morally controversial and this situation can sometimes provoke conflicts between patients and physicians (conscience clause problem). The aim of our survey was to collect opinions about medical procedures that are accepted by Polish law and unaccepted by the Catholic Church--dominating denomination in Poland, and analyzing conditions determining these opinions.

MATERIAL AND METHODS

Cross sectional study. An anonymous survey was distributed among 528 physicians who work in public hospitals in eastern Poland (turn = 61%). The sample consist of: 51% women, 49% men; 52% work AT surgical wards, 48% at non-surgical wards; average work period: 17.03 years (SD = 10.73; min. = 1, max. = 45); 93% Catholics; average religiosity (measured by the Scale of Religious Attitudes): M = 5.47 (SD = 1.01; min. = 1.60, max. = 6.80). The questionnaire contained questions about: hormonal contraceptives, artificial fertilization, abortion in the case of rape and fetus defect.

RESULTS

The majority of respondents accepts artificial fertilization (70%), about half accepts abortion in case of fetus defect (50%), almost half accepts abortion in case of rape (41%) and contraception for minors (43%). There was statistically significant differences between physicians with different religiosit--the lack of approval for above procedures correlates with increasing religiosity.

CONCLUSIONS

Individual religiosity (regardless of denomination) is the most important condition influencing Polish physician's opinions and attitudes concerning contraception, abortion and artificial fertilization. Physicians with higher religiosity (about 25%) in the situation of divergence between their moral beliefs and patient's demands will choose for their beliefs, which can cause conflicts. Physician-patient relationship's models should take into account physicians'cultural beliefs and not only the cultural beliefs of the patients.

Physicians' religiosity and attitudes towards patients

BACKGROUND

Many religions underline the value of merciful acts, especially the care of the sick. The aim of the survey was to verify the hypothesis that a higher religiosity correlates with a more desirable ethical attitude towards patients.

METHOD

An anonymous questionnaire consisting of standardized tools: Scale of Attitudes towards the Patient (SAtP) (four dimensions: respect for autonomy, altruism, empathy and holistic approach to a patient), the Scale of Religious Attitudes (SReAt) evaluating the religiosity, and some questions related to the role of religious beliefs in respondents' professional lives. The research was carried out on a group of 528 Polish physicians, 324 of whom returned the questionnaire (return = 61%); 51% women, 49% men; average work experience: 17.03 years; 93% Catholics.

RESULTS

Religiosity correlates positively with altruism (r=0.12; p<0.05), holistic approach (r=0.18; p<0.01) and empathy (r=0.20; p<0.01), but not with respect for autonomy. For the majority of physicians, religious faith is an important supportive factor, especially in making difficult decisions. Surgeons are less religious (M=5.32; SD=1.06) than non-surgeons (M=5.61; SD=0.93); (t= -2.59, p<0.05).

CONCLUSION

Physicians' religiosity is an essential factor shaping their attitude towards patients. The majority of physicians declared that their religious faith influences their professional decisions, especially in difficult situations. The religiosity variable explains physicians' moral attitude better than the denomination (religious affiliation) variable. Physician-patient relation frameworks should take into account not only patients' but also physicians' cultural and religious beliefs.

Biobank research and ethics: the problem of informed consent in Polish biobanks

INTRODUCTION

The dynamic development of biobanks causes some ethical, social, and legal problems. The most discussed problems are obtaining informed consent, especially for future research, from minors and from deceased people. The aim of this article is to present the current standards held by Polish biobanks concerning obtaining a participant's informed consent in some aspects.

MATERIAL AND METHODS

Survey was carried out by anonymous questionnaire among 59 institutions which deal with the collecting and storage of human cells and tissues in the year 2008. Twenty four filled-in copies of the questionnaires were sent back (return=41%).

RESULTS

Almost every institution (92%) obtains written consent, but a third of the surveyed institutions (29%) do not obtain consent for the future use of the samples. The majority of the respondents (83%) support the idea of using biological materials for research purposes of a donor who died if he did not leave any written objection to such practices and 46% of respondents stated that biobanks should obtain the consent from the already mature donor who gave their samples as a child.

CONCLUSIONS

The practice and rules for obtaining informed consent for the scientific research require improvement. The possibility to use the human materials in the future, conditions for getting access to the data, the possibility of their withdrawal from the database and using the materials and data after the death of the donor should be clearly determined when the informed consent to collect the material is obtained.

Evaluation of the effectiveness of short-term rehabilitation of women with chronic low back pain using the Oswestry and Roland-Morris Disability Scales

BACKGROUND

60-80% of the population experience chronic low back pain at some point in their lives [1], with women suffering more frequently [2]. Low back pain-related ailments lead to long-term or recurrent disability [3, 4]. Rehabilitation based on physiotherapy provides a viable alternative and is rightly regarded as safer for patients. However, finding an effective method of rehabilitation is a difficult task [5, 6]. The aim of this study was to compare the outcomes of rehabilitation in women with chronic low back pain using the Oswestry and Roland-Morris Disability Scales and to identify factors influencing the degree of functional disability in patients with chronic low back pain.

MATERIAL AND METHODS

The study involved 319 women aged 18-75 years (mean age = 45 years, SD ± 16. 3). The participants were undergoing treatment at the Rehabilitation Centre of Zamość University of Management and Administration on account of chronic low back pain, following two or more episodes lasting longer than three months. The outcomes of rehabilitation were assessed with ODI and RMDQ.

RESULTS

We obtained comparable results with the ODI and RMDQ and found statistically significant improvement in functional status after rehabilitation (ODI: p <0.001, RMDQ: p <0.001). In both cases there was a statistically significant relationship between the degree of functional disability and age (ODI: p <0.001, RMDQ: p <0.001), education (ODI: p <0.004, RMDQ: p <0.004), BMI (ODI: p <0.001, RMDQ : p <0.001), WHR (ODI: p <0.001, RMDQ: p <0.001), and hypertension (ODI: p <0.001, RMDQ: p <0.001). There were no statically significant differences between the degree of disability vs. place of residence (ODI: p <0.5, RMDQ: p <0.867) or the presence of type 2 diabetes (ODI: p <0.321, RMDQ: p <0.06).

CONCLUSIONS

1.The programme for rehabilitation of patients with low back pain proved effective in reducing the degree of disability, as demonstrated both by the Oswestry Disability Index and the Roland-Morris Disability Questionnaire. 2. The relationship between the degree of functional disability and age, BMI, WHR, and hypertension was also confirmed by both questionnaires.

First Glass Electrode and its Creators F. Haber and Z. Klemensiewicz – On 100th Anniversary

We celebrate the 100thanniversary of the construction of the first glass electrode, by F. Haber and Z. Klemensiewicz. This electrode was firstly described in the journal Zeitschrift fur physikalische Chemie in 1909. In our paper we present the way how this invention was created.

The analysis of the ethical, organizational and legal aspects of Polish biobanks activity

BACKGROUND

Biobanks create new opportunities for the public health (Public Health Genomics) but need some regulations. Polish biobanks are in the phase of dynamic transformations aiming at integrating their activity and adjusting them to the international standards. The aim of this article is to present the current standards held in the most important Polish institutions collecting biological samples.

METHODS

A survey was conducted by the questionnaire filled by managers and directors of 24 Polish biobanks. Questions concerned obtaining patient informed consent (also a consent to some future researches and access to dates by other organizations), protection of privacy, storage of the samples and the relevant information, the opinion related to the need of establishing Polish national DNA data bank and possibilities of the scientific international cooperation.

RESULTS

The written consent to carry out research on the samples is obtained almost everywhere, but 29% of biabanks does not acquire the consent for the future usage of the samples. Almost all inquired banks (93%, n = 22) declare the willingness to start an international cooperation. Most of respondents support the idea of establishing the Polish national DNA bank by the fusion of the already existing banks.

CONCLUSION

The inquiry findings point that the current biobanks procedures do not differ to any relevant degree from procedures applied in the West European countries. Many of Polish biobanking organizations are willing to cooperate with foreign sites. It may enhance the European biobanking network and gene-environmental research.

[Diagnostic and treatment processes and the requirement of patient's consent in doctors' opinions]

Contemporary medicine, together with the increase in invasiveness into the patient's body, exerts mounting pressure on state institutions and medical chambers aiming at the development of suitable regulations protecting patients against excessive interference with their bodies and psyche, and also allowing for their full autonomy. A gradual shift in the doctors' behaviour from a paternalistic approach towards partnership becomes more apparent. Its purpose is to take shared decisions concerning diagnostic methods and treatment. This process is best noticed when it comes to the issue of taking medical measures after obtaining patient's conscious agreement. The term 'conscious agreement' emerged in the legal terminology fairly late, in 1957, during the lawsuit Salgo vs. Leland Stanford Junior University Board of Trustees. Much later it found its place in the legal regulations concerning everyday medical routines. The fundamental factor of the patient's autonomy and simultaneously a remedy to the risk of patients acting against their own good is the process of obtaining the sick person's conscious agreement prior to anticipated medical measures, both therapeutic and diagnostic. The patient's informed conscious agreement to diagnostic process and treatment is not only the crucial prerequisite of doctor's lawful behaviour but also a significant evaluation criterion with regard to doctor's deeds and intentions. We requested doctors to share their opinion, in the form of an anonymous feedback form, on the issue of obtaining from patients their conscious agreement to diagnostic and therapeutic measures. The survey was carried out among 231 physicians of different specialisations from the Lublin Province and Podkarpackie Province employed both in hospitals, outpatient clinics and in health centres for basic medical care. Almost all the respondents declared the knowledgw of the regulations on the protection of patients' rights; however, only half of the surveyed persons expressed the opinion that the regulations concerning patient's rights refer also to diagnostic examination. Doctors clearly differed with regard to the meaning of the notion of 'giving conscious consent by the patient' and tended to associate such a patient's declaration only with invasive procedures. The survey results allowed us to outline the level of knowledge and the degree of compliance with patient's rights related to the necessity of obtaining conscious consent to medical treatment.

[Anaemia from religious reasons as a distant effect of husband's alcoholism]

Chronic nutrition deficiencies, economic or cultural in their nature are one of the most often reason ofanaemia. From the other hand various diet restrictions may lead to different nutrition deficiencies. The occurrence of anaemia caused by diet restrictions is relatively rare among Catholics in Poland. We present a case of 51 years old woman with severe anaemia (Hgb 2.48 mmol/l), occasionally diagnosed. Anaemia occurred 20 years after she took a pledge never to eat meat. The aim of her oath was the begging for grace and quitting alcoholism by her husband, a habitual alcoholic. The iron and vitamin B12 supplementation led to quick improvement of hematological parameters.

End stage renal disease by patients with malignancy--ethical problems

The problem of co-occurrence of kidney failure, as well as ESRD and malignancy is relatively often and brings a significant therapeutical and moral challenge. The ethical basis of our consideration are "Evangelium Vitae" by John Paul II and "Declaration Jura et Bona". The fundamental choice is whether to start and/or continue the kidney replacement treatment. We present 3 algorithms for the most typical situations. The first ethical postulate in our considerations is that patients with the malignancy of good prognosis should not be denied of any treatment chance and should be dialysed as any other patient. In the situation of patients with neoplastic disease with bad prognosis and ESRD, the question of 'withholding or withdrawing' dialysis is essentially part of a fundamental question, what should be the ultimate goal of medicine? There is no doubt that the person most authorized to take a decision in such a situation is the patient provided it is a conscious decision based on full information. Therefore any decision to cease treatment, even submitted at the public notary, should be verified as long as a conscious contact with a patient is possible. In the situation of continued lack of logical contact with the patient who has not left any clear disposition for such circumstances we must take the decision based on their benefit. It is more than desired that the decision acquires the approval of the patient's family but in the situation when it is not possible the doctor decide. In the doubtful cases we should take decisions "towards life".

[Nephrology of love]

The article presents different aspects of the connection between human heart and kidneys. This connection is evident in the symbolism of the Old Testament of the Bible, organ donation as the manifestation of the love of our neighbor, endocrinological and sexual dysfunction, and finally in searching for biological determinants of finer feelings. In the Old Testament tradition kidneys were thought to be human spirit's dwelling. Moreover, the simultaneous studying of kidneys and heart meant profound understanding of the matter. Nowadays, it is also possible to find the Biblical love of our neighbor, for instance among kidney donors. What is more, every nephrologist should treat his patients with love and dedication, which makes it easier for him to understand their problems, especially these concerning sexual dysfunction. Sexual dysfunction occurs among men and women equally and specialists, apart from using many different methods, have to deal with the consequences of renal failure mainly by means of transplantation.

[Multivessel coronary angioplasty in chronically haemodialysed patient]

Unstable angina in chronically haemodialysed patients has poor clinical outcome. Surgical treatment of these patients is a procedure of high risk. According to guidelines left main coronary artery stenosis is the indication for by-pass grafting. In some cases the alternative to surgical treatment could become percutaneous coronary intervention. We present the case of the patient in which we have perform multivessel percutaneous coronary angioplasties including left main coronary artery.

[Caroli's disease--if so rare clinical problem?]

Jacques Caroli for the first time described in the year 1958, cavernous dilatation of the hepatic bile ducts. It's the rare abnormality; there have been reported less than 200 cases until now. The disease is caused by defects in the genetic program which are transmitted in an autosomal recessive way. There are two basic types of the disease: focal (so called. "simple type") and diffuse, embracing entire bile tree. Both types maybe associated with congenital hepatic fibrosis and then the abnormality is usually called "Grumbach disease". There is an excessive risk of cancer (cholangiocarcinoma) in patients with Caroli's disease. Dominant symptoms are due to recurrent cholangitis, sometimes with signs of portal hypertension. Basic treatment is hepatic resection (focal form) and internal bypass of the biliary tree (diffuse form). The prognosis of the disease is reserved one.

[Discitis caused by Kingella kingae--case report]

The patient with acute infection and the presence of bacterium Kingella kingae cultured from cerebrospinal fluid is presented. The analysis of clinical picture and the results of all performed tests did not allow to diagnose cerebrospinal meningitis. Despite of being not sure if Kingella kingae was an etiopathogenetic factor in the described subject, we decided to discuss this interesting case.

[Is dehydration an ethical problem?]

In the paper, issues connected with chronic dehydration were discussed from the point of view of medical ethics. Rudimentary definitions concerning the issues were mentioned. An attempt was made at analysing critically the views on chronic voluntary dehydration as a possible form of causing death. Some pathophysiological and psychopathological aspects were discussed. "The pyramid" of physician doubts were presented.

[Some ethical and historical aspects concerning placental blood transfusion]

Recently, a greater interest is observed concerning the taking of placental blood in order to use it in future. This article pays attention to some ethical aspects like the ownership of the placenta or the possible commercial problems. We reminded the very first study on placental blood transfusion which took place before the World War II and also other abandoned methods used in transfusion in the past.

[About the beginnings of otolaryngology in Poland in commemoration of the 150th anniversary of Teodor Heryng's birthday and the 100th anniversary of the founding of the first Laryngology Ward in Warsaw]

In this study was remain biography of two pioneers of polish laryngology--Teodor Heryng and Leopold Lubliner. The first laryngological subdivision in Warsaw was localised in St. Roch hospital. The first full equipment laryngological division where was open in Jewish hospital.

Does moxonidine increase cytotoxic activity of ethanol in rats? Preliminary report on the base of the ultrastructural study

Combined effects of moxonidine and ethanol on ultrastructure of selected Wistar-Kyoto rat organs (kidney, liver, heart) were investigated. In cells of the animals, which received moxonidine alone, no morphological changes were found. In the group of rats which received alcohol, several typical submicroscopical changes were found, especially related to the mitochondria. After the combined administration of ethanol and moxonidine the pathological changes were bigger than those found in animals which received alcohol alone. Those changes were particularly significant in kidney and liver. The results might indicate that moxonidine increased cytotoxic activity of ethanol on several organs in rats.

Day/night ratio of microproteinuria and blood pressure rhythm in type II diabetes

The paper discusses the results of the studies conducted with a group of patients with type II diabetes without clinical nephropathy. The aim of the study was to attempt to determine the markers for early stages of diabetic nephropathy in NIDDM patients. The following examinations were carried out: the level of selected microproteinuric components, 24 h monitoring of arterial blood pressure, and electrocardiogram (ECG). Among the patients examined, the level of alfa-1-microglobulin, albumin and immunoglobulin G (IgG) in diabetic patients was higher than in the control group, and the increased activity of beta NAG was observed. The 24 h profile of blood pressure and the ratio afternoon/night of albumin excretion flattened in the majority of diabetic patients. The results of the study suggest that the proximal tubules and the membranes of renal glomeruli are damaged as early as during the period of subclinical diabetic nephropathy.

[Microproteinuria and circadian rhythm of blood pressure in patients with arterial hypertension]

Microproteinuria is a recognized sign of early nephropathy in the course of arterial hypertension. There is few data concerning the excretion of proteins other than albumin in this group of patients. The aim of the study was to examine circadian rhythm of alfa-l-microglobulin (AlMG), albumin (ALB), immunoglobulin G (IgG) excretion and N-acetyl-beta-glukosaminidase (beta NAG)-activity, then to compare the results with the results of 24 hour ambulatory monitoring of arterial blood pressure in patients with arterial hypertension. The study comprised 28 patients. The control group included 27 healthy volunteers. Albumin concentration was determined by Beckman ICS2 nephelometer, using Beckman and Dako reagents. Blood pressure and ECG were monitored by analysis with ABP-system (AMP-USA). In patients with arterial hypertension significantly higher levels of ALB, AlMG, IgG and increased beta NAG activity were observed in morning urine samples. Despite hypotensive treatment blood pressure values were slightly, though significantly higher than in the control group. Among patients in the study circadian BP rhythm was disturbed. The results obtained suggest that in this group of patients subclinical nephropathy develops involving renal glomeruli and proximal tubules--probably resulting from vascular and humoral disorders, with accompanied hypertension.

[Evaluation of the accuracy of arterial pressure measurements with different types of devices used for self-monitoring]

The self-control is the important item in hypertension treatment. The results of blood pressure measurements were received by using various types using different of oscillometric equipment (thumb, wrist and arm manket) and compared with the outcomes of mercury sphygmomanometer which was used in the same trial. The satisfactory correlation of results from different types of equipment was confirmed with the exception of the thumb oscillometric apparatus results.

Human erythropoietin improves the blood platelet phospholipid composition in chronically hemodialyzed patients

Phospholipids play an essential role in platelet structure and function. In uremic patients an abnormal platelet phospholipid pattern is observed. We examined the influence of recombinant human erythropoietin (rhuEPO) on platelet phospholipid composition in hemodialyzed patients. Before rhuEPO therapy, phosphatidylethanolamine, phosphatidylinositol, and phosphatidylcholine were significantly reduced as compared with a healthy control group. After rhuEPO treatment, the phosphatidylethanolamine, phosphatidylinositol, and phosphatidylcholine concentrations showed a significant increase. We conclude that rhuEPO partially normalizes the platelet phospholipid composition in uremia.

[The effect of human recombinant erythropoietin on levels of plasma phospholipids in patients chronically treated with hemodialysis]

In uremic patients a disturbed lipid metabolism is observed. In our former works a positive effect of erythropoietin (EPO) on blood platelet phospholipids composition in uremic patients was indicated. In this study we examined the EPO influence on blood plasma phospholipids in chronically hemodialyzed patients. Phospholipids were measured by thin layer chromatography method before and 3 months after the beginning of EPO treatment. EPO was administered subcutaneously, 2000 U twice a week. Decreased phosphatidylethanolamine, phosphatidylinositol and phosphatidylcholine levels were shown in patients before EPO treatment, compares with the control group. During EPO therapy the phospholipid levels approached to normal values. Conclusion is that EPO administration has a positive influence on blood plasma phospholipids in hemodialyzed patients. The detailed importance of this event has been not known yet, but our observations suggest that EPO profoundly interferes with lipid metabolism.

[Change of platelet function after the beginning of repeated hemodialysis treatment in patients with uremia]

The disturbances of platelet function in end-stage renal failure varies in dialysed and non-dialysed patients. We examined some platelet function in 11 uremic patients treated conservatively (TC) and, again in the same patients, 3-month after the beginning of repeated hemodialysis treatment (HD). The blood samples were taken before hemodialysis. In TC patients normal platelet count, prolonged bleeding time, normal platelet aggregation, unchanged PF4 activity and decreased PF3 availability were shown, compared with control group. In HD patients also normal platelet count and prolonged bleeding time were noted, but increased platelet aggregation, increased PF4 activity and PF3 availability were observed, compared with control group and with TC patients. We conclude that in TC patients rather decreased platelet function was observed; after the beginning of hemodialysis treatment some platelet function became significantly enhanced, which suggests platelet activation. Moreover, in HD patients the disturbances of platelet function before dialysis were shown, then it is possible that platelet activation persists in interdialytic period.

[Distribution of platelet membrane phospholipids in patients chronically hemodialyzed using cuprophane and cellulose acetate membranes]

The hemodialysis treatment is associated with a number of untoward events due to the blood-membrane contact. The severity of these reactions depends greatly on the kind of membrane. One of such effects is platelet activation with platelet membrane phospholipid translocation. The aim of this study was to assess the platelet membrane phospholipids distribution during hemodialysis through cuprophane (group I--12 patients) and cellulose acetate (group II--13 patients) membranes. Samples were taken before hemodialysis 14 days after treatment with the same dialyzer type. Phospholipids distribution was determined using a non penetrating tracer (TNBS) and by highly purified phospholipases hydrolysis. In patients of the group I a significant increase of phosphatidylserine and phosphatidylethanolamine at the outer platelet membrane surface was noted, as well as decrease in the other phospholipid classes, compared with control group. In patients of the group II the disturbances of phospholipid distribution were markedly smaller, and concerned only phosphatidylserine and sphingomyelin. Our data indicate that in patients dialyzed with the use of cuprophane membrane the disturbances of platelet membrane phospholipid distribution persist during the dialysis period. The milder intensity of these disturbances in patients treated using cellulose acetate suggests a better biocompatibility of this membrane.

The effect of pilocarpine on electrodermal resistance in chronic hemodialyzed patients

Electric resistance of forearm skin was examined in 40 hemodialyzed (HD) patients under resting conditions and after subjecting the skin to the action of a 10% pilocarpine gel. The results were compared with a control group of a 100 healthy volunteers. An increased skin resistance was observed before dialysis and then a significant post-dialysis fall to the normal level followed. The response to the applied pharmacological stimulus in the HD group was similar to that in the control group. The results suggest that the rise in skin resistance in patients with renal failure and the so-called uremic dry skin, are not connected with the dysfunction of the glands themselves but rather with their insufficient stimulation.

[Arrhythmia in patients on dialysis treatment for chronic renal failure]

In 6 patients treated with repeated peritoneal dialyses 48-hour ECG monitoring was carried out. In no patient significant heart rhythm disturbances were demonstrated during the dialysis and 24 hours after its completion. On the ground of pathological results of Valsalva's manoeuvre function disturbances of the autonomic nervous system were disclosed but these showed no correlation with premature ventricular and supraventricular++ ectopic beats appearing periodically in some patients. The study showed that under conditions of sufficient control of electrolyte balance (especially potassium) the patients treated with peritoneal dialyses are not a group at risk for arrhythmia development.

Leukopenia with different regenerated haemodialysis membranes

The white blood cell count (WBC) decreases during haemodialysis and it was investigated as a function of different dialysis membranes. Each of them was used four times, applying different sterilization methods. Twelve chronic haemodialysis patients were studied and dialysed with cuprophan and polyacrylonitrile (PAN) membranes. Cuprophan was studied by a dry sterilization method and after perchloric acid and formalin treatment. PAN was studied with dry sterilization and after perchloric acid. As it has been shown, cuprophan membranes cause significantly more marked neutropenia than PAN. No significant difference was seen in pO2, pH, pCO2 and bicarbonate between dialysers used four times. The results indicate differences in biocompatibility between cuprophan and PAN membranes, independent of the sterilization method employed.