An overview of fibrillary glomerulonephritis (GN) is given as well as the description of clinical course in four patients diagnosed and treated in our department. Fibrillary GN and immunotactoid glomerulopathy are entities, characterized by fibrillar and microtubular deposits in mesangium and the glomerular capillary loops. Decisive for diagnosis of fibrillary GN (resp. immunotactoid GN) remains the electron microscopy (EM) of the renal biopsy (RB) specimen. At the nephrologic division of 1st Internal Department of 1st Medical School of Charles University four cases of patients with fibrillary GN were diagnosed from the mid seventies (when both entities were newly described) by the end of the year 2001. In all patients the diagnosis was proven by EM. RB was indicated mainly for proteinuria, hematuria and decrease of renal function. On conclusion: though fibrillary GN/immunotactoid GN are relatively rare disorders, they represent entities, which should not be omitted in the differential diagnosis of nephrotic syndrome/renal insufficiency and which deserve further study.
The results of kidney transplantation from very young paediatric cadaveric donors up to five years, which were transplanted to adult recipients, are evaluated in the first retrospective study of all Czech transplantcentres. In general, 42 of these transplantations were carried out during 1994-2001. In 28 cases single kidney was transplanted, in 14 cases en bloc graft of both children kidneys was transplanted. The reasons of kidney failure by recipients are usual (in 42.9% glomerulonephritis). An average age of the donors was 34.7 months (median 39 months). An average age of the recipients during transplantation was 42.6 years (median 43.5 years). All the kidneys were placed into retroperitoneum. As long as only single kidney was transplanted, the rules, already propagated by Salvatiera in 1970, were respected. At the transplantation of en bloc graft, Kinne's method with possible vessels elongation of the graft and with uretero-uretero anastomoses (in so called Ostrava modification) was used. The higher occurrence of the primary graft non-function (as 50% losses of all grafts) was confirmed in the study. Its reason was an acute thrombosis of vessels or rotation of graft stem. One-, three- and five-years patients and grafts survival were 97.6-90.5-90.5% and 76.2-73.8-73.8% actually. Patients survival are very good while grafts survival are average, momentarily a bit worse than national data published by the Czech Transplant Society, which determines one-, three- and five-years grafts survival with 90.3-82.9-75.5% and 79.1-71.1-65% actually. The kidney transplantation from paediatric cadaveric donors to adult recipients is acceptable under present allocated criteria, in case that some principles are kept. The study confirms the international experiences about rather higher incidence of surgical complications and primary graft non-function. In conclusion, some general references for reduction of complications, as well as for improvement of these transplantation results are introduced.
BACKGROUND:Intima-media thickness of the common carotid artery (IMT ACC) and flow-mediated vasodilatation (FMD) of the brachial artery is considered an early marker of atherosclerosis. This study was undertaken to elucidate whether endothelial dysfunction in the popliteal artery, pronoun to atherosclerosis, is related to IMT ACC.METHODS AND RESULTS:Twenty-nine control subjects, 29 asymptomatic patients with hyperlipoproteinemia (without therapy) and 26 patients with coronary artery disease were examined. Using ultrasound with a linear-array probe (7.5 MHz), we measured IMT ACC and diameter of the popliteal artery (PA) at rest and during reactive hyperaemia after release of 5-minute arterial occlusion. In control subjects we found thicker IMT ACC and greater FMD than did the patients (p<0.001, ANOVA test). A significant negative correlation between the IMT ACC and percent FMD was found in all of the subjects (p<0.001). On multiple regression analysis, percent FMD showed a significant negative correlation with the IMT ACC, total cholesterol, triacylglyceroles, body mass index, age, and diastolic blood pressure.CONCLUSION:We found significant negative correlation between IMT common carotid artery and FMD popliteal artery.
The basic problem of all developed transplant programs is organs deficiency available for transplantation. There is an effort within last 10 years to get each organ for transplantation that it is supposed to be functional for several years. These problems also occur in the program of kidney transplantation. Apart from realizing of kidney transplantations from donors alive, which have an increasing tendency in Czech Republic (in 2001 more than 5%, in 2002 more than 10%), there is the only another possibility to get kidney grafts from non-ideal (suboptimal, marginal) donors. Both short-term and long-term results of kidney transplantation from non-ideal donors are comparable with the transplantation results from ideal donors. The kidneys from very young paediatric cadaveric donors, especially up to five years are the typical example of non-ideal graft. The article introduces the international position of the Czech Republic in organ procurement from cadaveric donors as well as in kidney transplantations. It shortly summarizes the history of kidney transplantations and at the same time it deals with realizing of kidney transplantation from paediatric cadaveric donors to adult recipients. The new division of kidney grafts from paediatric cadaveric donors into four groups according to their age is introduced. All at once the present surgical technique is described and the problems of some post-operative complications are discussed, especially the higher occurrence of primary graft non-function. The principle that kidneys from donor up to three years should be transplanted as a block to the single recipient is emphasized. In conclusion the author recommends, on the basis of his own experiences, the realizing of these transplantations.
UNLABELLED:We present the results of two experiments aimed at the role of IGF-I and NO in the regulation of bone blood flow. In the first experiment A we determined the blood circulation in tibia and distal part of femur and the blood level of IGF-I after oophorectomy (OOX, 4 weeks before the experiment) and/or administration of NG-nitro-L-arginin methyl ester (L-NAME, Sigma, USA, 0.05% in the food for 10 days before the experiment). In the second experiment B we checked up the possibility of correlation between the bone blood flow and IGF-I level in female rats control and after the administration of estradiol (Agofollin Depot, Biotika, Slovak Republic, 1 mg s.c., two times weekly, for 4 weeks before the experiment). The bone blood flow was ascertained by means of 85-Sr microsphere (NEN, USA) technique, IGF level was estimated with Rat IGF-I RIA kit (DSL, USA).RESULTS:Experiment A: group I: controls--sham operation, group II: oophorectomy (OOX), group III: L-NAME + sham operation, group IV: OOX + L-NAME. OOX elevated the 85-Sr microsphere uptake and bone blood flow in tibia and distal femur. The administration of L-NAME to non-castrated females lowered significantly the blood flow in the femur only, whereas in OOX females it inhibited completely the usual OOX-induced increase in circulatory indicators in both bones. IGF-I level was higher after OOX, administration of L-NAME did not exert any effect on it. Experiment B: group I: control females, group II: estradiol. After the administration of estradiol, there was marked decrease in the uptake of 85-Sr microspheres and blood flow in both bones, decrease in body weight, cardiac output, heart rate, blood pressure and also in the blood level of IGF-I. Density and ash weight of the tibia were elevated. Important results found in the group I of experiment B seem to be the correlations between the blood level of IGF-I and 85-Sr microsphere uptake in tibia (r = 0.68, p < 0.01), between IGF-I and blood flow in tibia (r = 0.54, p < 0.05) and between IGF-I and 85-Sr microsphere uptake in distal femur (r = 0.55, p < 0.05). However, in the group II of females after estradiol no significant dependence could be demonstrated. The results support the conception of the role of IGF-I and NO in the regulation of local blood flow also in the bones of rats. The possible sequence of the interrelations could be as follows: OOX--increase in the blood level of IGF-I--increase in the production of NO--vasodilatation and increase in the bone blood flow. Significant correlations between the blood level of IGF-I and bone blood flow represent further evidence of the participation of IGF-I in the regulation of bone blood flow in rats.
UNLABELLEDParathyroid hormone (PTH)--besides its main osteotrophic action--exerts also vascular effect demonstrated formerly also in bones. The aim of the presented work was to verify this effect of PTH using the radioactive microsphere method and to ascertain simultaneously whether NO does participate or not in this effect of PTH. We performed two experiments which were arranged in the same way, as follows: group I--controls, group II--PTH, group III--L-NAME, group IV--L-NAME + PTH. Parathyroid hormone 1.34 fragment (Sigma, USA) was administered to each animal 6-12 minutes before the injection of radioactive microspheres in the dose of 3 micrograms in the experiment A, 10 micrograms in the experiment B. NG-nitro-L-arginin methyl ester (Sigma, USA) was given in the food for ten days before the experiment in the concentration of 0.025% in experiment A, 0.05% in experiment B.RESULTSWe present the results of experiment A in the part "Results" of the paper briefly in percentages--they are similar to the results of experiment B, but without statistical significance. Administration of PTH increased statistically significantly the microsphere uptake in tibia and distal femur and also the blood flow in both bones, increased the cardiac output and lowered blood pressure. Administration of L-NAME alone induced decrease of the heart rate only. After the injection of PTH to the rats fed L-NAME there was--compared to the injection of PTH only--the blood flow through both bones significantly lower. The observed increase in the bone blood flow as well as changes in the general circulation show that i.v. injection of PTH under the experimental conditions used does induce vasodilatation in female rats. Influence of these changes by the administration of L-NAME indicates possible participation of the nitric oxide (NO) in the observed effect of PTH on the vessles.
BACKGROUND:For comparing of the pathological and normal healthy state it is essential to obtain sufficient amount of the volumetric data. Nevertheless most of the publicized works use only few healthy controls opposite to the patients for the measuring of the basal ganglia volume. Further essential condition is to take into account the effect of age to the basal ganglia volume in such analysis.PURPOSE:The goal of our study was (1) to give the current review of the structure, neurotransmitters, connections and general integration of the basal ganglia in the pathways of the central nervous system, (2) aggregate sufficient amount of volumetric data by virtue of MRI and post-mortem studies, and appoint volumes of the striatum and pallidum, (3) evaluate aging of these structures in adult healthy patients. Another goal was (4) to inspect the correlations between the size of the basal ganglia and volume characteristics of the brain, cranial capacity or frequently measured dimensions within CNS. In the spite of the fact that it is not possible to measure all of these dimensions for clinicians who want to determine if the structure is "normal" or not. Another goal was (5) to find a simple measure, which could serve as the indicator of the real size of structure of the interest.METHODS:By virtue of the classical anatomical methods and MRI examination we appointed volumes of the striatum (furthermore divided into the complex of the caudatum--nucleus accumbens--CD-Acc and putamen) and pallidum in the sample of 108 healthy adults (18-89 years old). From another measurements we calculated the cranial capacity and volume characteristics of each brain.RESULTS:In a general view that does not respect changes due to age neither volumetric difference between two sexes nor interhemispheric difference was significant for absolute volumes of the striatum, CD-Acc complex, putamen and pallidum. In the case of the striatum, significant correlation between size and age was found (p < 0.0001) for absolute volumes in both sexes. In men, striatum showed a decrease about 14.3% in volume in the 20-50-year age range (about 4.8% per decade). In woman, the age related shrinkage is about 16.9% (about 5.6% per decade). Dependence on age was not statistically proven for volume of female complex CD-Acc (p = 0.061). Age related decrease of female putamen was about 23.15% in the 20-50 year age range (7.7% per decade). In men, the seizure decrease of the caudate--accumbens complex amounts 16.2%, in the same age range (5.4% per decade). Similarly, volume of the putamen in men decreases up to 12.3% between 20-50 years of age (4.1% per decade). In men, the pallidum showed a decrease about 21.6% in volume in the 20-50-year age range (7.2% per decade). In women, it amounts only 11.5% (3.8% per decade). Plane of the striatum in the level of the commissura anterior showed high correlation with total striatal volume (p < 0.0001, r = 0.668). The percentual portion of striatal volume at the level of the commissura anterior (1 cm thick slice) does not differ statistically between males and females. In our data it gives 28.56% (SD = 3.05). Correlation between the striatal planes and age was significant in both sexes (in women: p = 0.007, r = 0.348, and in men: p = 0.029, r = 0.349) as in the case of the correlation between striatal volume and age.CONCLUSIONS:Our findings suggest that age mirror differently on separate structures in the brain. We have found unequal volume decrease within both sexes even particular nuclei. Our findings also suggest that decrease of the basal ganglia volume in the dependence on age is not linear but it is composed from periods without changes and periods with reduction of its size. In the case of the striatum, behaviour of changes looks similar (with only 5 years), while in the case of the pallidum this situation is markedly different. Our observations may suggest intersexual singularity in the aging of brain structures. From one MRI, from one frontal slice in the level of the commissura anterior is possible to reduce total volume of the striatum for every examined individual. Simple graph shows interval, where the normal value of this plain should be in dependency on age and sex of the examined patient. Another graph allows reducing from this plane the total volume of the striatum. These findings can be the quick and reliable aid in better diagnostics of different diseases.
In normotensive patients (pts) with apparently inherited electrolyte disorder characterized by hypokalemia and with metabolic alkalosis the suspicion is usually pronounced on the diagnosis of Bartter syndrome or Gitelman syndrome. During the last two years three pts were admitted to our nephrologic unit of the 1st Internal Department of the 1st Medical School who presented with hypokalemia, metabolic alkalosis and alkalic urine and were followed previously under working diagnosis of (incomplete) renal tubular acidosis. In the article we give the description of the clinical picture in the three pts diagnosed as Bartter/Gitelman syndrome. In conclusion--the problems of differential diagnosis in pts with such a complex disorder of acidobase balance are discussed and new diagnostic approach with mutational studies is suggested.
Impaired wakefulness in machine operators poses a danger not only to themselves but often also to the public at large. While on duty, such persons are expected to be continuously, i.e., without interruption, on the alert. For that purpose, we designed and carried out an experimental model of continuous vigilance monitoring using electroencephalography (EEG) and reaction time measured as the latency of the proband's reaction to sound. If constructed, the set together with other logical elements and an alarm can make for an automatic detection of vigilance and, possibly, also of arousal stimuli in cases of microsleep. We found the following new facts and confirmed the validity of some of the earlier ones: Vigilance is marked by alpha activity in the EEG record (oscillation of 8-13 Hz) and reaction time (RT) of 200-400 ms (milliseconds). Sleep is characterized by theta and delta activities (4-7 and 0.5-3.5 Hz respectively) with no reaction. Between wakefulness and sleep there are at least two stages: relaxation with prolonged RT of 400 to 800 ms and increased EEG alpha, sometimes also beta activities. Then there is the hypnagogic phase with disintegrating alpha and growing theta or even delta activities and an RT of 800 up to 1200 ms. Changes in the EEG and its spectrum and their actual localization on the cranial surface exhibit individual differences; hence, no straightforward categories for the above stages can be established. As for changes in vigilance in the relaxation and hypnagogic phases as well as in the processes of mentation, the most significant are the alpha and delta, less so the theta and beta bands. The most suitable sites for the detection of those changes on the skull surface are temporo-parieto-occipital (TPO) regions, i.e., those over the posterior parts of the skull with the least muscle and oculomotor artifacts and with the most energy for alpha and delta activities. In somnolence, the cortex does not behave as a whole, which means that different areas show different spectra while getting off to sleep, a fact easy to express by means of the alpha/delta ratio, separately for each of the cranial areas. At sleep onset, the alpha/delta ratio undergoes changes; it is greater than one in wakefulness, less than one in sleep, and in the region of one as the person goes to sleep. In the course of sleep with zero reactivity, the cortex already behaves as a whole, i.e., all cranial areas have similar or the same spectrograms, with the alpha/delta coefficient being less than one all over the skull. At times, the spectrogram taken during mentation (e.g., while undergoing psychological tests) resembles that of somnolence, with the alpha/delta coefficient being greater than one. However, there are differences: in somnolence, the delta activity is increased all over its band, i.e., from 0.5 to 3.5 Hz, while during mentation it is increased solely in the slow delta activity band (0.5 to 3.5 Hz). In somnolence, theta is on the increase, but not so in mentation. In the hypnagogic phase, alpha becomes completely extinct--unlike in mentation. As follows from the above listed facts, not everyone applying for an automatic alarm detector of vigilance can be provided with one at random and expect it to go off at the first sign of slumber. Conversely, every applicant ought to be treated as a proband, i.e., tested with simultaneous EEG registration, EEG analysis, determination of the best suitable area on the cranial surface and EEG frequency, separately for vigilance, relaxation, hypnagogic phase and mentation, and--in keeping with the above rules--have individual parameters of the alarm device adjusted accordingly.
Cellulose is one of the hemostyptic biomaterials, which are able to initiate or accelerate blood coagulation at the site of their application. It belongs to surgical sealants. The mechanism of its action is not clearly understood. We studied the participation of blood platelets in this mechanism. As a marker of platelet activation we used serotonin release reaction. Serotonin release in platelet rich plasma incubated with various concentrations of oxidized cellulose (0.5%-2.0%) started in about 20 min. Washed platelets were not directly activated by oxidized cellulose within one hour. Washed platelets reconstituted in plasma obtained from two patients with coagulation factor XII deficiency were activated by oxidized cellulose with a prolonged lag phase. Our results demonstrate the significant influence of factor XII on blood platelets activation by oxidized cellulose.
Systemic inflammatory response syndrome and the resulting complications continue to be important causes of morbidity in surgical patients. A favourable prognosis of patients with postoperative inflammatory intraabdominal complications is limited by forwardness if diagnosis of this severe complication. Cytokines play a significant role not only in regulating pathogenic mechanisms, during the rising of SIRS, but can themselves directly lead to tissue damage. Increased concentrations of inflammatory cytokines observed in the initial phase of postoperative complications have great significance in the early diagnosis of systemic complications. Procalcitonin, alongside to cytokines, appears as a significant parameter. Despite lots of its pathophysiological points are unclear it is a highly selective and specific indicator of systemic bacterial inflammation. Leptin is not only a hormone of adipocytes but also a member of inflammatory network of cytokines and acute phase reactants. Leptin is possibly a necessary factor for adequate course of acute phase reaction. Proinflammatory cytokines as interleukin-1 or tumour necrosis factor-alpha are the main regulatory factors of leptin in this period.
UNLABELLED Recently used antenatal steroids for induction of fetus lung maturity remain as standard procedure in the treatment of premature labour. However, the effect of antenatal steroids to the fetus may not be only the positive one. OBJECTIVE Investigate the role of antenatal steroids on total mortality and severe morbidity in extremely low birth weight newborns under 1000 grams. DESIGN Comparative case-control study. SETTING Institute for the Care of Mother and Child, Prague, Czech Republic. METHODS Antenatal steroids were used in 55 cases (group ANS+) and no steroids were used in 65 control newborns (group ANS-). Both study groups were comparable in birth weight, gestational age, gender, mode of delivery and presence of intrauterine growth retardation. Statistical significant difference was in time of premature rupture of membrane (ANS+ 108+/-228 hrs versus ANS- 27+/-56 hrs, p<0.007). The Epi Info 6 (CDC, U.S.) software package and ANOVA was used for statistical analysis. RESULTS We have found statistical significant differences in total mortality (ANS+ 22%, ANS- 45%, p<0.008), in severity of respiratory distress syndrome (ANS+ median 2, ANS- median 3, p<0.0008), in total cumulative dose of surfactant (ANS+ 73 mg, ANS- 111 mg, p<0.0003), in the incidence of periventricular-intraventricular haemorrhage (ANS+ median 1, ANS- median 2, p<0.005) and posthaemorrhagic hydrocephalus (ANS+ 6%, ANS- 23%, p<0.008). Statistical significant differences were also in CRIB value (ANS+ median 7, ANS- median 11, p<0.007) and NEOMOD value (ANS+ median 5, ANS- median 7, p<0.002). In the other parameters (pneumothorax, sepsis, patent ductus arteriosus, necrotizing enterocolitis, periventricular leukomalacia) no statistical differences were found. CONCLUSIONS Our study confirmed positive effect of antenatal steroids on mortality, severe respiratory morbidity and incidence of intraventricular haemorrhage. No negative effect of antenatal steroids to higher frequency of infection complications and/or periventricular leukomalacia was observed.
The Institute of Human Studies in Medicine (UHSL) was initiated at the First Medical Faculty of Charles University (1. LF UK) in Prague in 1989. At the beginning, the Institute drew upon the ideas and work of a number of medical professionals who were dealing with the issues of their discipline in a wider context. Thus, they created a foundation for current disciplines such as medical ethics, the philosophy of medicine, psychology, psychotherapy and others. These scholars included, for example: prof. Mihajlo Rostohar, prof. MUDr. Vladimír Vondrácek, prof. MUDr. Zdenek Myslivecek, doc. MUDr. Jaroslav Dobrý, CSc., doc. Nikolaj Jevgrafovic Osipov, prof. MUDr. Bohuslav Boucek, and prof. MUDr. Ferdinand Knobloch, CSc. UHSL was first listed in the Curriculum of the 1. LF UK (Karolinka) in the school year 1991-1992. In the following years, the Institute underwent rapid changes such as personnel structure, areas of specification, and educational programs. The structure of UHSL was divided into the following departments: the Department of Medical Ethics and Anthropology, the Department of Psychology, Psychotherapy, and Psychosomatics, the Department of Public Health and Social Medicine, since the school year 1996-1997 the Department of Psychotherapy and Psychology and Psychotherapy Counselling Office. In 1998, UHSL was assigned the project "Goals of Medicine: Quality of Life", which required the participation of doctors, philosophers, psychologists, theologians, historians, mathematicians and others. The decisive factor for UHSL was the appointiment of the dean of the 1. LF UK on January 24, 2002, and thus establishing UHSL as a separate institution with its own organizational structure and fields of study. Later, UHSL was divided into two independent institutions: UHSL, and the Institute for Social Medicine and Public Health (USMVZ). The history of UHSL is documented by the facts about its directors, professors and doctors, visits of foreign specialists, international cooperation, study guidelines and library information, available to UHSL scholars.
Nowadays a theoretical psychotherapeutical thinking develops from the eclectic practice and uses particularly the research of the effective factors of the therapy. Best they can be characterized as differentiate, synthetic, integrative and exceeding other approaches. The development in question goes on with attempts of creating a general model of the psychotherapy that could be a basis for models of special psychotherapies. The aim of such a model is to describe all that is present as important factor for inducing a desirable change of a human in all psychotherapeutical approaches. Among general models we can mention the generic model of D. E. Orlinski and K. I. Howard, Grawe's cube (the author is K. Grawe) and the equation of the psychotherapy.
By the means of the research of the psychotherapy we can obtain objective and reliable informations that help us to decrease the risk of the subjective distortion, to control the influence of the chance events and to find the connections otherwise not observed. We use several types of research strategies: a qualitative or quantitative strategy, intensive, extensive, multi-variational strategy etc. The contemporary research deals with the effectiveness of the therapy, the indication and the psychotherapeutical process. It was found out that the therapy by the psychological means is demonstrably more effective than the placebo therapy or no therapy, and using various methods we induce qualitatively different changes. That is why the differential approach is necessary; this approach leads in the theory towards progressive integration and towards forming the general model of the psychotherapy.
Professor Frantisek Pór, MD, was one of the most important physicians in Czechoslovakia. He graduated in German Medical Faculty of Charles University in Prague in 1926. He was a founder of the first Internal Clinic of Medical Faculty of P. J. Safárik University and of Faculty Hospital in Kosice. Professor F. Pór, MD, was the head of the 1st Internal Clinic from 1948 until 1971. During his active professional life he educated eleven assistant professors and three full professors. He was also a founder of Eastern Slovakian Medical Meetings in Nový Smokovec, High Tatras in 1961. Medical Society in Kosice organized "Memorial of Professor F. Pór, MD" from 1994 every year and the last was held in April 28, 2003 in Faculty Hospital of L. Pasteur in Kosice.
BACKGROUND Kinesiologic assessment is included in the neurological examination and the kinesiologic findings may be used as a valuable criterion in assessment of the motor development dynamics. METHODS The experimental group consisted of twenty-one preterm children (11 boys and 10 girls) born between 28th and 36th week of gestational age. All children were examined every two weeks till the expected term of delivery. Examinations included neurological-kinesiological assessment based on selected parameters of spontaneous or forced movement, muscle tonus, primitive reflexology and postural reactivity and screening scores according to Touwen and Salokorpi. RESULTS When comparing the results obtained in the examined sample of children, using examination records and screening scores according to Touwen and Salokorpi, the neurological-kinesiological appeared as the best to be applied to the clinical practice. The criteria of rehabilitation applied, proved to be very effective. CONCLUSIONS Despite the diagnosis based on the kinesiological assessment cannot be determined, further precision of the specific features of the kinesiological picture in these children, as a parameter of the motor development dynamics, is needed, as it will allow for subsequent evaluation of the therapy applied.
