Zaciskające zapalenie osierdzia (ZZO) jest rzadkim zaburzeniem o roznorodnej etiologii, przebiegającym zwykle z klinicznymi objawami prawokomorowej niewydolności serca. Najcześciej bywa poprzedzone ostrym wysiekowym zapaleniem osierdzia i stanowi jego przewlekle powiklanie. Jest ono powaznym wyzwaniem zarowno w zakresie diagnostyki, jak i leczenia. W diagnostyce pomocne są nastepujące badania: zdjecie radiologiczne klatki piersiowej, elektrokardiogram, echokardiografia, cewnikowanie serca, tomografia komputerowa. W terapii u chorych wydolnych krązeniowo podejmuje sie proby postepowania zachowawczego; u osob z cechami niewydolności krązenia, zwlaszcza ostrej, wybiera sie leczenie chirurgiczne. Zabieg perikardiektomii u wiekszości pacjentow powoduje znaczącą poprawe, lecz obarczony jest 4-18-procentowym ryzykiem zgonu. Autorzy przedstawiają przypadek pacjentki z zaciskającym zapaleniem osierdzia leczonej ciąglą ambulatoryjną dializą otrzewnową, u ktorej z powodu wystąpienia cech ostrej niewydolności krązenia wykonano zabieg perikardiektomii.

Introduction: Mycobacterium tuberculosis is a facultative intracellular pathogen that developes specific T cell response expressed by the production of IL-12, IFN-gamma, and TNF-alpha. The response has been quite well investigated in the experimental models, however, there is little information about certain cytokine levels in patients with extrapulmonary tuberculosis. The shortage of data pertains also to its most common form-kidney tuberculosis, especially when bacilli dissemination into the blood circulation has occurred. Objectives: The aim of our study was to examine simultaneously the frequency of Mycobacterium tuberculosis presence in the blood circulation and the serum cytokine concentration during kidney tuberculosis to approach their relationship in the clinical infection process. It is considered that cytokine levels do not correlate with localisation of tuberculosis (pulmonary vs. extrapulmonary), however, there is little information about the cytokine levels in patients with kidney tuberculosis. Materials and Methods: 30 patients attending the urology clinic with suspicion of kidney tuberculosis were evaluated. Serum concentrations of selected cytokines in patients with urine, urine and blood Mycobacterium tuberculosis presence were quantified by ELISA and compared to PCR negative patient and group of healthy people. Results: Our study demonstrates the increase of TNF-a and IL-12 level in comparison to control group. TNF-alpha concentration was about 2-fold higher in the positive patients than it was in control group; IL-12 concentration was about 4-fold higher and the differences between IL-12 levels were statistically important (p < 0.05). However, no significant differences were found in IFN-gamma level among all groups. Using Spearman correlation rank test, a significant correlation was found between TNF-alpha and IL-12 in the positive patient group. The correlation factor was more significant for the group of patients with Mycobacterium tuberculosis present in blood and urine than it was in urine positive PCR group (r = -0.66 vs. r = -0.51).

Background. Lipoprotein abnormalities characteristic of renal dyslipoproteinemia are significantly associated with different stages of chronic renal insufficiency. The renal dyslipoproteinemia may contribute not only to accelerated development of atherosclerosis but also to progression of human chronic renal insufficiency.Methods. The purpose of the studies was to estimate the lipid and lipoprotein profiles in 52 not dialysed patients with various renal insufficiency advancement. Basing on creatinine level the patients were divided into 3 groups. CR1-A-serum creatinine 2-5 mg/dL (n = 16), CR1-B-serum creatinine 5-10 mg/dL (n = 19), CR1-C-serum creatinine > 10 mg/dL (n = 17).Results. In CR1-A and CR1-B dyslipoproteinemia was found at different stages of renal insufficiency which was manifested by the significant increase of TG, TC, LDL-C, apo B levels and TC/HDL-C, LDL-C/HDL-C ratios and significant decrease of HDL-C level and apo AI/apoB, HDL-C/apoAI ratios in comparison with controls. We also observed decreased TG, TC, LDL-C, apo AI, apo B levels and TC/HDL-C, LDL-C/HDL-C ratios and unchanged HDL-C level and apo AI/apoB, HDL-C/apoAI ratios in cm-c in comparison to CRI-A.The decrease of the lipoprotein parameters in CR1-C might result from malnutrition (statistically decreased albumin level) and metabolism disturbances connected with the renal insufficiency advancement. Negative correlation between IG, HDL-C levels (r = -0.43, p < 0.001) and TG, IIDL-C/apoAI (r = -0.56; p < 0.001) were found, which confirmed the abnormal composition of HDL molecules and indicated a high risk of atherosclerosis.Conclusion: Our results may indicate that of atherosclerosis in CRI patients is connected with dyslipoproteinemia and disturbances in HDL molecular composition and with different stages of chronic renal insufficiency.

Serum levels of lipids, lipoprotein(a) Lp(a) and other apolipoproteins were determined in 47 predialysis patients, 40 hemodialysis (HD) patients, 39 chronic ambulatory peritoneal dialysis (CAPD) patients, 11 patients after kidney transplantation and 47 healthy subjects as reference group.The predialysis, HD, and CAPD patients had disturbances in the concentration of serum triglyceride (TG), high density lipoprotein (HDL)-cholesterol, apolipoprotein Al (apoAI), total apoCIII, apoCIII present in the particles without apoB (apoCIII non B), and Lp(a) and HDL-cholesterol, low density lipoprotein (LDL)-cholesterol/HDL-cholesterol, HDL-cholesterol/apoAI, apoAI/apoB, and apoAI/apoCIII ratios. Predialysis patients had significantly lower concentrations of HDL-cholesterol and total apoE levels than CAPD patients and total apoE level than HD patients.Moreover, both HD and CAPD patients had significantly increased levels of apoB containing apoE (apoB:E) and apoB containing apoCIII (apoB:CIII). The concentrations of serum TG, total cholesterol, LDL-cholesterol, apoB, Lp(a) in CAPD patients were statistically higher than in HD patients. The patients after transplantation demonstrated normalization of lipid and lipoprotein parameters and lipoprotein ratios except serum levels of TG, total apoCIII, apoCIII non B and the apoAI/apoCIII ratio.We concluded that abnormal lipid and lipoprotein concentrations in patients with uremia may be the cause of their high risk of atherosclerosis, but posttransplant patients exhibited improved levels of serum lipids, Lp(a) and other lipoprotein parameters and lipoprotein composition, which could be an index of decreased atherogenic status.

The serum levels of lipids, apolipoproteins and lipoprotein ratios in 19 healthy persons and 20 patients with uraemia not dialyzed were determined. Based on creatinine level the patients were divided into two groups: L (serum creatinine 2–5 mg/dl) and H (serum creatinine 5–10 mg/dl).

The subjects of the studies were 31 haemodialysed (HD) patients with chronic renal insufficiency (CRI).

We present our results on the efficacy and safety of low dose r-HuEPO given subcutaneously in the treatment of anaemia in CAPD. We have studied 10 stable patients (5 males, 5 females) on CAPD. In our study subcutaneous r-HuEPO was administered twice a week for 6 months. Mean initial dose of r-HuEPO was 67.3±21.7 U/kg/week, and maintenance dose was 35.8±12.1 U/kg/week. The target Hb concentration was 10–12 g/dl.

The bleeding tendency is a common feature of chronic uremia. Abnormalities of platelet function play a role in the pathogenesis of this disorder. A direct contact between platelets and an artificial dialysis membrane results in strong activation of thrombolysis. The aim of our study was to investigate platelets activation in vivo during haemodialysis. We used monoclonal antibodies specific against platelet activation markers--selectin P (CD62) and glycoprotein CD63. The expression of those antigens was analyzed by flow cytometry. Blood samples were obtained from 20 long-term haemodialysed patients with end-stage renal disease. After 15 minutes of haemodialysis the expression of CD62 and CD63 was significantly higher (p < 0.001) as compared CD63 glycoprotein. Our results show that haemodialysis has a significant influence on platelet activation and can favour co-existence of the bleeding tendency and the prothrombotic status in long-term hemodialyzed patients.

In respect to the immune deficiency state of long-term haemodialysed patients, both cytokines and their receptor disturbances have been taken into consideration. The purpose of our study was to evaluate the effect of uraemic and haemodialysis factors on the interleukin-6 and interleukin-2 soluble receptor levels and the reactivity after influenza vaccination. We have found that IL-6 and IL-2 receptor levels were statistically significantly elevated (98.8±39 pg/ml and 1557±544 U/ml, respectively) in serum of haemodialysed patients.

Peritonitis is a major complication of intermittent peritoneal dialysis (IPD); over 70% of the infections are caused by Gram-positive bacteria. Vancomycin (V) is the antibiotic of choice in the treatment of peritonitis caused by G(+). The influence of vancomycin on peritoneal transport in IPD patients has not been described before. We have investigated the effect of intraperitoneal vancomycin on dialysis efficiency in 8 IPD patients using dialysis solutions containing either lactate or acetate. The following parameters were measured: net ultrafiltration (UF), concentration ratios (D/P) of urea, creatinine, potassium, peritoneal clearances (ml/min) of urea, creatinine, potassium, mass transfer of sodium (MTNa), sodium sieving index (SCNa). It has been found that vancomycin significantly decreases D/P urea (p < 0.05) and creatinine (p < 0.05). We found also a significant decrease of mean clearance of urea (p < 0.05) and creatinine (p < 0.05). The mean clearance of potassium did not change significantly. There was no significant change in UF, MTNa, and SCNa. Our preliminary data suggest that vancomycin decreases the permeability of peritoneum for certain low molecules in IPD patients which may have a negative impact on dialysis efficiency.

The clinical picture in chronic renal failure (CRF) shows great variability depending on age, sex, aetiology of disease, grades of renal injury and type of treatment.

Objective and Design: Secretion of IL-2 and sIL-2R in the peritoneal dialysis fluid and in the peripheral blood during peritonitis with reference to the process of IL-6 and IL-8 release were investigated.Subjects: 17 patients with end-stage renal disease, treated with continuous ambulatory peritoneal dialysis.Methods: ELISA method using commercial kits, Genzyme Corp Boston and DAKO.Results: Markedly increased IL-6 (mean; 2895 ± 1360 pg/ml) and IL-8 concentration (1459 ± 966 pg/ml) in drain dialysate fluid at the onset of peritonitis, started to drop rapidly in the successive samples after antibiotics had been administered. Statistically significant increase of IL-2 (197 ± 92 pg/ml) and sIL-2R (287 ± 79 pg/ml) was observed 16 h later and kept increasing until reaching the peak after 24 h.Conclusion: Secretion of IL-6 and IL-8 pro-inflammatory cytokines which are mainly synthesized in mesothelium cells is followed by the activation of lymphocytes, their infiltration and the production of T lymphocyte derived IL-2 and sIL-2R.

Thrombotic complications constitute a significant problem connected with maintaining arteriovenous fistulas (A-V) for a long time. It has been established that platelets play an important role in the development of thrombosis in high flow systems. Aspirin and dipyridamole do not decrease the frequency of shunt thrombosis. Some of the more recently synthetised antiplatelet drugs (i.e. indobufen, 2-p-oxo-isoindolinyl-phenyl-butyric acid) could be promising in the prevention of such complications. The study group consisted of 40 patients in the terminal stage of renal failure treated with intermittent peritoneal dialysis (IPD). The A-V fistulas were formed by the same surgeon anesthetist team and this allowed for the elimination of technical errors. All patients were divided into two groups. Group I received indobufen at the dose of 2 x 100 mg/24 h orally. Group II received no antiplatelet treatment. The therapy started 24 h before A-V formation. The treatment was continued for 3 weeks. The following tests of platelet function were performed before indobufen therapy, after 9 h and 3 weeks of treatment: ADP and adrenaline induced platelet aggregation, platelet circulating aggregates, MDA level, platelet factor 3 and 4 and bleeding time. During indobufen treatment only a significant decrease in ADP induced aggregation was observed. No prolongation of the bleeding time was noted. No case of fistula thrombosis in indobufen group was observed. This complication, however, appeared in 3 patients (15%) of the control group (without antiplatelet therapy).

We have investigated the effect of intraperitoneal gentamicin on dialysis efficiency in 10 intermittent peritoneal dialysis (IPD) patients.

In 16 patients on chronic haemodialysis treatment the platelet activation and function were studied during 2 weeks antiplatelet therapy with indobufen. Followings tests were made: platelet count, platelet aggregation, platelet factor 3 and 4. Indobufen inhibited platelet function, mainly release of platelet factor 4 and improved dialyser regeneration.