Basing on the own experience, the authors discuss causative treatment of sepsis, mainly of unknown etiology. Emphasis is on the depression of immunological system in the acute phase of the disease. Therefore, a combined treatment with 2, often 3 or even 4 bacterial antibiotics is recommended, together with passive immunotherapy, and in certain cases surgical removal of the infection foci.
In the recent years a constant increase of the number of surgical patients with associated diabetes mellitus is observed. Surgical risk is still higher and therapeutic results are worse than in patients without diabetes mellitus. Many years of experience of our department in the surgical treatment of lower limb atherosclerosis (A0) in patients with diabetes, and also the previously published results of studies make possible drawing of conclusions and formulating of a general view. The studies were carried out in 208 patients with A0 and diabetes mellitus. On admission, 65.9% of the patients had IV degrees of limb ischaemia according to Fontaine. Vascular operations in these patients accounted only for 25% of all operations and were performed in 37% of patients. Amputations accounted even for 53.7% of all operations, and among them major amputations accounted for 56.3%. The early and remote results of the operations carried out were subjected to statistical analysis and presented using cumulated indices.
The laser Doppler flowmetry is a new technique for evaluating microcirculation. It is based on the Doppler phenomenon-reflected light changes its frequency when it interacts with moving objects such as red blood cells. The source of light is 2 mW He-Ne laser. The light penetrates into the tissue to the depth of 1 mm, and measures microvascular blood flow throughout it. This technique is objective, harmless even during prolonged exposition, repeatable, and very sensitive even to small changes in the blood flow. Because of difficulties with determination of the perfusion normal values and several factors disturbing microcirculation, the most objective results are obtained with dynamic tests. They measure a response of microcirculation to local ischemia, cooling or given medicines. A disadvantage is its high sensitivity to motion-produced disturbances. Laser Doppler flowmetry may be used not only in scientific investigations. It is of diagnostic value in plastic surgery, vascular surgery, dermatology, internal medicine, dentistry, and neurology.
The activation of polymorphonuclear granulocytes between 2 and 5 hours from the beginning of the pain was examined in patients with myocardial infarction. The efficient neutrophils activated in the first day of illness, take part in recanalization of coronary vessels, thus limiting the extent of myocardial infarction.
Etiopathogenetic, diagnostic, and clinical problems seen in the adult patients with sepsis have been discussed. An emphasis is on the diagnostic problems in an early stage of infection as well as bacteriological findings. The authors stress that sepsis usually develops in patients with depressed immunological system.
In order to analyse anxiety and depression states observed during the treatment of lymphoproliferative diseases, a group of 23 patients were studied. For assessment of the variables the following was used: history taking, psychological observation and psychometric techniques. The obtained results point to various dynamics of anxiety and depression. The intensity of anxiety states decreases during single as well as successive courses of chemotherapy. Depression states intensify during one course with a tendency for mood lowering with prolonged treatment duration. Therapeutic conclusions: 1. It is necessary to minimize anxiety attitudes, particularly during the first phase of the treatment (cognitive psychotherapy). 2. In deep depression it is indicated to use antidepressants and supportive psychotherapy.
Plasma concentrations of interleukines 1, 3, 6, 8 and platelet derived growth factor (PDGF) were estimated in 45 patients with leukaemias. Among patients were 12 with acute myeloblastic leukaemia-AML (type M1 according to FAB classification), 9 with chronic granulocytic leukaemia-CGL, 10 with blastic crisis of CGL (CGL-BC) and 14 with chronic lymphocytic leukaemia-CLL (in 1 and 2 stage according to Rai classification). Additionally the concentration of IL-3 was measured in 10 patients with exacerbation of CLL. Control group consisted of 12 health volunteers. The concentrations of interleukines and PDGF were determined by means of radioimmunoassay or immunoradiometric assay. In the patients with AML, CGL-BC and CLL significant increase of concentrations of IL-1B, IL-6 were found. The patients suffers from CGL and CGL-BC had increase concentrations of IL-3, but patients with CLL-interleukin 8. The concentrations of PDGF were significantly decreased in the patients with AML, CGL-BC, and CGL. The differences of concentrations of studied interleukines can confirm their great significance in proliferation of leukaemic cells. The decrease of concentrations of PDGF in myelocytic leukaemias may reflect thrombopoietic disturbances in these illnesses.
A case of hepatic and intestinal secondary amyloidosis in 43 years old patient with Hodgkin's disease is presented. Diagnostic difficulties due to atypical localization of Hodgkin's disease were discussed. Therapeutic problems were caused by severe hepatic insufficiency.
Chemotaxis, spontaneous migration, phagocytosis, expression of the receptors of Fc Ig fragments and of C3 component of complement has been examined in blood of 51 patients with obesity divided into 3 groups with: 1. disturbances in carbohydrate and lipid metabolism, 2. disturbance in lipid metabolism, 3. no symptoms of metabolic diseases and 20 healthy controls. A comparison of the characteristics of neutral granulocytes in the blood of the healthy controls before and after fat rich meal has been performed. Obtained results indicate that high concentration of lipids, decrease granulocyte activity therefore could be the cause of the decrease of immunological defence.
Six patients with myelodysplastic syndromes (MDS) and two patients with chronic lymphocytic leukemia, all with severe anemia entered the study. Before treatment reasons of secondary anemia were excluded. Concentration of erythropoietin, iron, transferrin, ferritin were measured before, and in the second and the third month of the trial. A r-HuEpo dosage of 80 U/kg was administered intravenously three times weekly for a minimum of three months. Four patients finished the study. The increase in hemoglobin concentration by 6 g% was observed in one patient with MDS subtype RA. In three other patients who apart from r-HuEpo received chemotherapy transfusion requirements decreased by 90%. Together with increase in hemoglobin decrease in ferritin was observed. The correlation between r-HuEpo and endogenous erythropoietin and ferritin was defined.
The authors describe a 9 year-old girl with homozygous deficiency of C2 component, causing null activity of the classical pathway of complement. The girl suffered from several recurrent infections since birth, later developed signs of the Henoch-Schönlein disease. At the age of 1 1/2 years she was hospitalized due-to bacterial meningitis, most probably of Neisseria meningitis etiology.
In 1981-1990, 584 patients with non-Hodgkin malignant lymphoma, 209 women and 375 men, aged between 17 and 75 years, were treated at the I Department of Medicine and Department of Hematology, Silesian Medical Academy in Katowice. In this group the primary localization outside lymph nodes was seen in 26 patients (9 women and 17 men), i.e. 4.6% of all patients with malignant non-Hodgkin lymphomas. Most frequently digestive tract was involved-19 patients (73.1%). Twenty three patients were treated surgically followed by chemotherapy and/or irradiation. Not operated patients were treated with either chemotherapy or both radio- and chemotherapy. Complete remission was achieved in 17 patients (65.4%), partial remission in 4 (15.4%) patients. Five patients did not respond to therapy (19.2%). A mean survival time was 49.4, 14.3, and 6.4 months, respectively.
The aim of the study was to evaluate bone mineralization in the patients with multiple myeloma. The examinations were performed in 49 patients (25 men and 24 women). Seven patients were before chemotherapy and 42 patients were treated with chemotherapy. All of them received prednisone. The bone mineral density was measured by dual-energy X-ray absorptiometry with Lunar spine (L2-L4) in AP projection, femoral neck and total body were examined. There was a decrease of bone mineral density in 35 patients in at least one place (T-score more than 2 SD below normal of young healthy persons). There was no correlation between densitometric results and the duration of multiple myeloma, or chemotherapy. The decrease of bone mineral density (expressed es T-score) of lumbar spine (for the patients without spinal degenerative changes) was higher than that of femoral neck (p < 0.05). The decrease of bone mineral density (expressed as T-score) of lumbar spine and femoral neck was more pronounced than that of total body (p < 0.001). Bone densitometry, especially of lumbar spine and femoral neck and less of total body is indicated in the patients with multiple myeloma. The result of this examination may be considered as an independent parameter of disease intensity.
