The importance of clinical and laboratory parameters which have an effect on postoperative mortality and morbidity was evaluated in 124 patients operated on because of obstructive jaundice. The causes of obstructive jaundice were a malign disease in 38 patients (30.6%) and a benign disease in 86 patients (69.4%). Biliary enteric anastomosis in 66 patients (53%), external drainage in 46 patients (37%), and cholecystectomy in 12 patients (10%) were the surgical techniques of choice for correction of obstructive jaundice. There were significantly high mortality rates in patients with weight loss, more than 10 kg during preoperative the month (p < 0.05); jaundice longer than 21 days, (p < 0.001); and malignancy caused jaundice (p < 0.002). Haematocrite less than 30% (p < 0.05), albumin level below 3 g/dl (p < 0.01), blood urea nitrogen level above 30 mg/dl (p < 0.001), and bilirubine above 10 mg/dl (p < 0.01) were determined as risk factors in mortality. Direct relationships between the number of risk factors, complications, and mortality ratios were determined. One or more complications were determined in patients with more than six risk factors. High mortality rate was also determined in patients who had five and more risk factors. The following factors were evaluated: respiratory, circulatory, renal functions, and infection, and metabolic concomitant diseases, and comorbid scores for each patient were calculated. High rate complications in patients with eight and more comorbid scores and high mortality rates in patients with six and more were also determined. Finally, all these parameters were important in demonstrating postoperative mortality in obstructive jaundice patients. We suggest that surgery after treatment of correctable risk factors decreases postoperative morbidity and mortality.
Influence of four epsilon-aminocaproylaminoacids on prothrombin activation and thrombin activity was examined. Only epsilon-aminocaproylnorleucine markedly inhibited the prothrombin activation in an extrinsic system.
Antioxidant defence was investigated in red blood cells (RBC) in 56 patients with 3 different haemoblastoses: polycythemia vera (PV), chronic myelogenous leukaemia (CML), chronic lymphoid leukemia (CLL) with and without anaemia, in 12 iron deficiency anaemia (A) patients and 50 healthy persons. The activities were determined of the following antioxidant enzymes: glucose-6-phosphate dehydrogenase (G6PD), glutathione reductase (GSSG-R), glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), catalase (CAT) and MDA levels. Antioxidant defence is decreased and the level of lipid peroxidation are increased in RBC in all patients (PV, CML, CLL, A). Different changes were detected in the antioxidative defence between normal red blood cells and those formed from leukaemic cells clone. In normal RBC in anaemia (CLL, A) opposite deviation of G6PD and GSSG-R activities was observed. In RBC formed from leukaemic cell clone (PV, CML), a simultaneous significant increase in G6PD and GSSG-R activities was found, which indicated activisation of pentose phosphate pathways (PPP) in these pathologies; in anaemia they function less effectively.
The hepatotoxic effect of 2,4-dichlorophenoxyacetic acid (2,4-D) was investigated. Ultrastructural changes were evaluated under a transmission electron microscope. Certain histoenzymatic reactions were examined (to acid phosphatase according to Gomori (AP) and to succinic dehydrogenase (SD) according to Nachlas) in parenchymal cells of the rat liver in acute intoxication induced by this herbicide. The experiment used 60 male Wistar rats divided into two groups: I-control--18 animals and II--42 animals which received chemically pure 2,4-D acid by gastric gavage in a dose of 200 mg/kg b.w. The animals were sacrificed after 12, 24, 48 hours and 4, 10 and 30 days of the experiment. The results indicate that the administration of 2,4-D acid to rats in a dose inducing acute intoxication leads to histoenzymatic and ultrastructural changes in the liver, which suggest nonspecific reversible adaptive-type damage to parenchymal cells. The changes observed indicate disorders in energetic processes in hepatocytes and are morphological exponents of intense detoxicative processes.
Twenty-three boys and 30 girls with simple obesity aged 12-16 years were investigated. The values of insulin, C-peptide, glycaemia, gastrinaemia and pancreatic polipeptide (PP) were measured in a fasting state and 30 and 60 min. after meal--at the beginning and after 3 weeks of reductive diet and physical exercise. The study of growth hormone and somatomedin C was deemed relevant to the issue in hand. Considerably higher insulinaemia and C-peptidemia values accompanied by impaired metabolic clearance of insulin and lowered glucose utilization in children with significant accumulation of adipose tissue in the abdominal area (waist/hip ratio p > 0.95), may constitute a possible predictor for diet-controlled diabetes mellitus and cardiovascular system diseases in adult age. Evaluation of adipose tissue in obese children makes it easier to indicate subjects exposed to complications at a later age. Low-caloric diet and physical exercise bring about a decrease in insulin secretion and an increase in its metabolic clearance. At the same time, glucose assimilation by cells is intensified.
PURPOSE:Suprapubic or endoscopic Burch colposuspension is a preferred technique for the treatment of stress urinaly incontinence in selective cases. We have attempted to investigate the early and long term results of suprapubic surgery for the treatment of stress incontinence and cystocele.PATIENTS AND METHOD:98 patients with grade 1-2 stress urinary incontinence and grade 1-2 cystocele were included in this study. Preoperative testing include the Boney test, pad test, cystography, cystometry, leak point pressure, and urethral pressure profile studies.RESULTS:Our success rate was 93% three months after surgery for stress incontinence, 81% after twelve months (range 11 to 14) and 67% after 48 months (range 44-55). Grade 1 cystocele was corrected with a 76% success rate and Grade 2 cystocele was corrected with a 70% success rate 3 months after surgery. Twelve months later, these rates were 68% and 56% respectively. At the time of the last control these rates were 59% and 37% for cystocele, respectively.CONCLUSION:Burch colposuspension is an effective method for the treatment of Grade 1-2 stress incontinence and grade 1 cystocele in the early and late control examinations, but is not effective in patients with grade 2 cystocele in the long-term follow up examinations.
Monocytes may contribute to a coagulation process by expression of the tissue factor and by synthesizing factors V, VII, X and XIII. Cultured blood monocytes also express both the tissue plasminogen activator and the plasminogen activator inhibitor I. The present study assesses the ability of human monocytes to secrete protein C and its cofactor protein S, which are potent inhibitors of the clotting cascade. Monocytes derived from the blood of healthy volunteers and prepared according to Boyum were cultured for up to 36 hours with or without lipopolisaccharide from Escherichia coli. After different times of incubation, the concentrations of proteins C and S in the supernatants were measured in order to determine synthesis of proteins, monocytes were cultured in the presence or absence of cycloheximide, the protein synthesis inhibitor. The concentration of protein C was estimated by means of the ELISA Protein C test (Boehringer Mannheim). Protein S concentrations were measured by rocket immunoelectrophoresis according to Laurell, using monospecific antisera (American Diagnostica Inc., N.Y.). The study showed that human monocytes, when stimulated by lipopolisaccharide, release proteins C and S in vitro. The concentration of these proteins in the culture supernatants markedly increased with time during the 36-hour observation. The supernatants obtained from the culture of unstimulated monocytes did not contain detectable quantities of the investigated proteins. The exposure of the cells to cycloheximide did not suppress the release of proteins C and S. In conclusion, our results suggest that monocytes are not able to synthesize proteins C and S. They can only release these factors. Furthermore, monocytes may be responsible for coagulation due to the inactivation of factors Va and VIIIa by protein C.
A case of voiding difficulties was investigated. Other than usual prostatic obstruction or urethral stricture, a small mass at the anterior region of the bulbous urethra was present. Detailed investigation by urethroscopy, biopsy, CT imaging and ultrasonography revealed epidermoid carcinoma of the urethra.
The concentrations of fibrinogen (Fb) and the activities of factor VII (F VIIC) and antithrombin III (AT III) both in men less than 55 years old with a history of myocardial infarction (MI) and with normolipemia (MI-NLP) or hyperlipoproteinemia (MI-HLP) and in their sons have been measured. A significantly higher levels of Fb were found in both MI groups. Significantly higher levels of F VIIC and AT III were found only in the MI-NLP group. No lipid or haemostatic disorders were noted in sons. Furthermore, a positive correlation between the level of F VIIC and triglycerides (TG) or total cholesterol (TCh) in the patients and sons was revealed. A positive correlation was found between: (a) Fb levels in MI-HLP patients and in their sons; (b) TG levels in MI-HLP patients and in their sons; and (c) AT III activity in MI patients and in their sons. Fibrinogen appears to be associated with ischemic heart disease more closely than factor VII, the latter being strongly linked with hypertriglyceridemia. Elevated activities of AT III may reflect the haemostatic response to the prothrombotic state in IHD on the one hand whereas they may contribute to the development of IHD on the other.
In this study the effect of hypoxia on thrombocytes was investigated in patients with a chronic obstructive pulmonary disease (COPD). 15 Hypoxic (group 1), 15 nonhypoxic (group 2) patients with COPD and 10 healthy persons (group 3) were included in the study. The differences in haemoglobin, hematocrit and PaCO2 values of group 1 and group 2 were insignificant, but there was a significant difference between group 3 and the other two groups. The differences in blood pH values in the above groups were insignificant, but the differences in FEV1, FVC and PaO2 values were significant. We found that thrombocyte aggregation increased significantly in group 1 and group 2. Also the platelet count decreased and mean platelet volume increased significantly in group 1. As a result, we think that in hypoxic patients with COPD, thrombocyte count decreases, volume and aggregation formation increases and oxygen plus antiaggregation therapy may have positive effects on the survival and life quality of these patients.
Quinolinic acid was administered intraperitoneally to male Wistar rats in a dose of 60 mmol, once daily for 8 days. The neuronal cell bodies in the paraventricular nucleus of the hypothalamus of quinolinic acid-treated rats exhibited electron microscopic features of increased cellular activity but some damage of neuronal cell bodies was also present. After quinolinic acid treatment, damaged cells predominated within the parvocellular division of the nucleus. The cells varied with respect to the degree of their damage. Besides, the cells exhibiting an increased activity, as well as those looking normally, were also present. In the magnocellular division of the nucleus, the cells exhibiting an increased activity predominated, although some forms of damage could also be distinguished.
In 30 patients with Parkinson's disease (PD) CT scan, isotopic cisternography and neuropsychological examination were performed to test possible relationship between cerebrospinal fluid (CSF) turnover, intellectual impairment and brain atrophy. Pathological cisternography was found in one third of the patients and it was positively correlated with the Columbia Rating Scale. Cerebral atrophy on CT was found more frequently in patients with earlier onset of PD. Combined pathological pattern on CT scan and on cisternography was correlated with intellectual decline. We conclude from this study, that in PD intellectual deterioration and brain atrophy separately are not connected with abnormal CSF turnover.
Examinations were performed in 20 adult male and female patients (pts) suffering from acute back pain due to vertebral compression fracture secondary to osteoporosis proved by lateral X-rays of the dorso-lumbar spine (Th3-L5), and bone mineral density with the method of dual energy X-ray absorptiometry. The synthetic human calcitonin (SUC) (0.5 mg) was injected I.M. every day during 28 days. Analgesic effect was evaluated on 0, 3, 7, 14, 21 and 28th day by patient's assessment of functional capacity, and physician's assessment of pain and mobility. On the same days biochemical variables of Ca-P homeostasis were determined. Treatment with calcitonin resulted in a positive analgesic effect. The functional capacity and mobility of pts increased with diminution of pain. No significant alterations of Ca-P homeostasis was observed. Mild and transient side effects as nausea and tachycardia were negligible. SHC appears to have a significant analgesic effect in treatment of primary osteoporosis.
A 10-day open trial with Tropisetron, the selective serotonin type 3 receptor antagonist, in a dose of 5 mg daily was undertaken in 19 patients with the primary fibromyalgia syndrome (FB). Before and after the therapy, pain was assessed using a visual analogue scale and a pain score. All the patients were asked about the presence and intensity of vegetative and functional symptoms. Moreover, the tenderness at the 24 typical tender points at baseline and at the end of the therapy was evaluated. A statistically significant improvement of all examined parameters was observed after the therapy. The efficacy of Tropisetron in a dose of 5 mg daily was comparable with the results obtained in a previously reported trial with a dose of 10 or 15 mg per day, but the frequency of gastric troubles decreased (21% vs. 60%). The hypothesis about the existence of two subgroups of patients with FB is also discussed.
In 180 men with BPH, aged 50-84 (mean 65) yrs. PSA levels were determined before and at 6 mo. after either transvesical removal of the adenoma (TRA, Group 1, n = 65), TURP (Group 2, n = 51) or after 6 mo. Doxazosin therapy (Group 3, n = 64). Fine-needle biopsy, performed when the baseline PSA exceeded 10 ng/ml, as well as pathologic examination of specimens taken during TRA and TURP confirmed BPH in all cases. After all modes of treatment the decrease in PSA values was largest in Group 1 and smallest in Group 3. This probably reflects the degree of completeness of adenoma removal. However, all therapeutic modalities including Doxazosin pharmacotherapy ensured PSA normalization, despite the persistence of the adenoma.
Immunoglobulin A-alpha-1-antitrypsin complex (IgA-AT) is a nonimmune complex formed by disulphide bonding between an active thiol group available on the cysteine residue of alpha heavy chains of IgA and a cysteine in position 232 of alpha l-antitrypsin in single polypeptide chain. The level of the complex can easy be determined using the ELISA method and findings are expressed in arbitrary units. In the healthy adults' sera the IgA-AT complex level is lower than 0.4 arbitrary unit. The elevated levels of the complex were found in a number of rheumatic diseases. In 50% of SLE patients, its levels are increased, particularly in those with current central nervous system involvement. Similarly, in approximately 50% sera derived from RA patients they are also found to be higher. Their presence correlates with anatomical progression of the disease. IGA-AT complex is found in RA (in 90% of cases) but not in the osteoarthritis synovial fluid. Our findings can be applied in clinical praxis in differential diagnosis of early rheumatoid arthritis and osteoarthritis. The IGA-AT complex can be also found in ankylosing spondylitis. The complex has been determined in a relatively large number of IgA myeloma sera. In 30% of the cases its levels were 10-fold higher than the upper limit for healthy adults.
Tachycardia-dependent right bundle branch block (RBBB) with atrial fibrillation in a patient under digitalis therapy is presented, in which supernormal phase of intraventricular conduction was well-documented. The development of long intervals terminated by a normally conducted beat was attributed to the occurrence of concealed atrio-ventricular (A-V) conduction of the atrial fibrillation impulse during the supernormal phase. The ventricular interval caused by a normally conducted beat (xs) in the interval of 1.01-1.63 s was transformable into a vector differential equation dy/dx = In (x + a) + 1, where parameter a = 0, 0.04, 0.08, 0.16, and 0.24. This is piecewise continuous and integrable. The function in (x + 0.04) + 1 was considered to give the solution of the problem of optimal control, which is equivalent to the problem of finding Green's function of the region, i.e. to solving the Dirichlet problem. The solution curves, given by y = (x + a) in (x + a) + 1, can be interpreted as distributions. There were structurally stable vector field points on a differentiable manifold, i.e, attractors. In general, the modelling may be applicable to tachycardia-dependent RBBB.
Prospective studies on 347 children under treatment due to seizures which appeared in the first 10 years of life helped to evaluate and define the incidence of epilepsy resistant to treatment. With regard to each patient the following aspects were analysed: the kind of seizures, their etiology, accompanying neurological disorders and a type of epileptic syndrome, kind of treatment applied before admission to the clinical department as well as socioeconomic conditions of the families. Patients under study were divided into four age groups to evaluate the results. Epilepsy, which was completely resistant to treatment, was observed in 10% of the patients, partially resistant in 20%. Resistance is the outcome of the following factors: onset of epilepsy in early childhood, symptomatic etiology coexisting symptoms of CNS damage, occurrence of unfavourable epileptic syndromes such as Lennox-Gastaut, wrong selection and low dosage of drugs, inappropriate polytherapy and adverse social conditions. On the basis of the results obtained, the authors suggested point evaluation as a kind of screening in prediction of failures in treatment.
Hypothetical, therapeutic effects of ozone were investigated in an animal model. One ml of oxygen or mixture of 40 micrograms ozone with oxygen were injected intraperitoneally to male rats for 10 days. Previously, rats had been poisoned with 50 ppm Cd2+ in drinking water for 12 weeks. Exhaustive treadmill running was applied to some animals before sacrification. Ozone injections increased iron-ascorbate-stimulated lipid peroxidation (LPO) in the liver and kidney, catalase (CAT) activity in the heart and glutathione S-transferase (GST) activity in the heart, kidney and liver. Oxygen increased GST activity in the brain and reduced glutathione peroxidase (GPX) activity in the kidney. Cadmium enhanced LPO in the liver and GST activity in the brain, heart, kidney and liver. In contrast to ozone, cadmium inhibited GPX activity in the brain, kidney and liver. Cadmium combined with ozone enhanced the changes of GPX activity in the kidney and liver, that of GST activity in the heart, kidney and liver as well as of CAT activity and LPO in kidney. The results suggest that ozone injections combined with tested factors may provoke an oxidative stress. The effects of ozone therapy can not be explained as the results of ozone action on the antioxidative enzymes in rat.
The influence of treatment in health resorts on the behaviour of C-peptide and insulin concentrations was evaluated in serum and urine of diabetics. The group examined comprised 68 girls with insulin-dependent diabetes estimated by radioimmunological methods. The study was carried out during and after health resort treatment. C-peptide initial concentrations constituted the basis for the examined and comparative group division into the following sub-groups: A--C-peptide secretion within standard limits, B--C-peptide trace secretion, and C--patients whose C-peptide concentrations were not determined. After health resort treatment a statistically significant difference of C-peptide secretion was found in serum in the groups with the well preserved secretion and that with only traces of C-peptides. A statistically significant difference in insulin concentrations was also found. Summing up, after health resort treatment of insulin-dependent diabetics with preserved only insignificant secretion of endogenous C-peptide, the secretion of this hormone increased.
