Determination of carcinoembryonic antigen and cancer antigen (CA 15-3) in bitches with tumours on mammary gland: preliminary report.

The aim of this work was to determine levels of carcinoembryonic antigen (CEA) and cancer antigen (CA 15-3) in the blood serum of 45 bitches. A modified procedure was used to determine the CEA and CA 15-3 markers with the human kits using the radioimmunoassay method. Samples collected from extirpated tumour of mammary glands were histologically processed and classified as per WHO guidelines. The average age of animals with tumour was 10.00 ± 2.2 years; for healthy bitches average age was 4.2 ± 3.2 years. Values of CEA and CA 15-3 were considered positive, if they exceeded 0.23 ng mL(-1) and 7 IU mL(-1) , respectively. Average levels of CEA in the tumour group were 0.25 ± 0.06 versus 0.20 ± 0.03 in healthy bitches (P = 0.0001). The average CA 15-3 value in bitches with tumour was 8.58 ± 1.27 versus 5.14 ± 1.34 in healthy animals (P < 0.0001).

Prevalence of metabolic syndrome, insulin resistance, and microvascular angina pectoris in 500 consecutive patients referred to coronarography.

OBJECTIVE: This work was aimed to evaluate the prevalence of insulin resistance (IR) and metabolic syndrome in a large cohort of 40-60 years old patients with cardiovascular symptoms. METHODS: A total of 500 consecutive males and females referred to coronarography and coronary catheterization, because of spontaneous or after load precordial pain plus denivelisation of ST segment by electrocardiography, were included. Besides standard clinical examinations, ergometry, echocardiography, fundamental laboratory tests, and several other laboratory examinations were also performed, including oral glucose toleration test (OGTT), total and high-density lipoprotein (HDL) cholesterol, triglycerides, apoprotein A1 and B, apolipoprotein (a), uric acid, fibrinogen, plasminogen activator inhibitor-1 (PAI-1), cytokines (tumor necrosis factor α, TNFα, interleukin-1, IL-1, interleukin-6, IL-6), endothelin-1, as well as hormones (insulin, C peptide, leptin, growth hormone, cortisol). RESULTS: In 81.6% of patients, IR syndrome with compensatory hyperinsulinemia was found in a positive correlation with various symptoms of metabolic syndrome, including abdominal obesity, increased body mass index (BMI), dysglycemia, dyslipoproteinemia, coronary stenosis, decreased HDL level, and hypertension. Hirsutism with polycystic ovarian syndrome was found in 52% of examined women with IR. However, a normal coronary angiogram, called as a microvascular form of the angina pectoris (MIV-AP), was found in 14% of predominantly periclimacteric and benign hirsutic females with long-term disorders of menstrual cycle. Since these patients showed the same symptoms as their gender, age, BMI, and degree of coronary stenoses adjusted pairs with the macrovascular form (such as the same levels of several lipids, hormones and obesity measures), our data strongly support the view that MIV-AP might belong to the IR syndrome. CONCLUSIONS: Hyperinsulinemia and high prevalence of various symptoms of metabolic syndrome (MS) were found in high percentage of patients with after load precordial pain who were referred to coronarography. Similarly, in several women, MIV-AP was detected and its affiliation to MS suggested.

[Diagnosis of thyreopatic diseases by laboratory examinations--possibility for rational economy]. / Laboratórne vysetrovacie metódy v diagnostike tyreopatií--moznosti racionálnej ekonomizácie.

This paper is oriented on the possibility of racional economy of laboratory diagnostical process of thyreopathies. The study was based on analysis of 29,683 examinations made at biochemical department in hospital Trencín. The overuse--mostly of antibodies and also, but less of thyreoidal hormones was discovered, mostly in the group of physicians in general practise and less in hospital and internal practise. The absence of initial algoritmus in thyreoidology is documented. The followed approach was formulated as new proposal: the first step is the examination of TSH (by ultrasensitive method) with possibility for all groups of physicians. Clinical and biochemical department should have responsibility to add fT4 in the case of pathological TSH. The endokerinologist should have responsibility for all other thyreoidal examinations, but in reasonable case also the internists in ambulatory and hospital care, and other relevant hospital physicians could order these examinations. Probability of cost saving was about 34% of expanditures on thyreoidology. To make the recount for Slovak republic the saving cost could be about 42,500,000 Sk.

[Thallium scintigraphy of the myocardium in evaluation of patients with insulin resistance syndrome and microvascular angina pectoris]. / Táliová spect scintigrafia myokardu v hodnotení pacientov so syndrómom inzulínovej rezistencie a mikrovaskulárnou anginou pectoris.

Insulin resistance syndrom (IR) is often associated with the syndrome of microvascular angina pectoris (MVAP) or with coronary artery disease (CAD). The authors quantified distribution and washout of 201Tl in heart (C), lungs (L) and liver (H) to evaluate the results 201Tl stress (s) and redistribution SPECT in 50 patients. They compared 2 groups of patients with laboratory verified IR (MVAP and CAD) and control group (CG) of patients with normal coronarography without any symptoms of IR. In Patients with IR and MVAP were found significantly more frequent local perfusion abnormalities then in CG. The index sL/C calculated by ROI analysis is significantly lower in controls, then in CAD. The index sC/H is lower in patients with IR (MVAP significantly) then in CG. The washout of 201Tl in CAD myocardium decreased and in MVAP liver increased. 201thalium scintigraphy is useful for separation of patients with MVAP and local perfusion abnormalities. This findings had probably prognostic value in patients with IR.

[Insulin resistance and the coronary syndrome]. / Inzulínová rezistencia a koronárny syndróm.

The different diseases associated with the insulin resistance syndrome--diabetes mellitus or impaired carbohydrate tolerance, atherogenic lipoprotein phenotype, arterial hypertension and central type of obesity are the main risk factors of atherosclerosis. The reduced sensitivity of target tissues to the metabolic action of insulin (insulin resistance) is considered at present a separate risk factor. The authors analyze on the basis of a group of 210 coronarographic patients the influence of insulin resistance and associated etiopathogenetic risk factors on coronary lesions evaluated by the method of quantitative coronarography. From the results of the investigation ensues that insulin resistance is the most frequent metabolic deviation in patients with coronary disease whereby in the macrovascular group it was found in 74.3% and in the group with microvascular angina pectoris in 64.3% of the patients. Changes in the lipoprotein spectrum were a more frequent and earlier manifestation of insulin resistance than impaired carbohydrate metabolism. The change from functional changes of the vascular wall (impaired endothelium-dependent vasodilatation) to the development of an atheromatous plaque depends on the total number of cholesterol conveying lipoproteins assessed by means of the apoprotein B level and on the capacity of the reverse cholesterol transport, whereby both mechanisms are greatly influenced by insulin sensitivity. The degree of coronary affection evaluated by means of a coronary score, is in patients with manifest diabetes comparable with the affection in patients with insulin resistance without manifest diabetes and these two groups differ very significantly as to the extent and degree of affection from patients with a normal sensitivity to the effect of insulin.

[The reflex sympathetic dystrophy syndrome of the lower extremities in patients after kidney transplantation--another complication of cyclosporin A therapy?]. / Syndróm reflexnej sympatikovej dystrofie dolných koncatín u pacientov po transplantácii oblicky--d'alsia komplikácia liecby cyklosporínom A?

The authors describe a new complication observed in patients after transplantation of the kidneys, characterized by intensive periarticular pain of the joints of the lower extremities, mostly with a symmetrical affection of the heels and knees, associated with vasomotor changes in the affected area, X-ray evidence of patchy osteoporosis and an increased periarticular activity of radionuclide on bone scans. The symptoms develop shortly after transplantation and recede within several months. The clinical findings, X-ray and scintigraphic changes are typical for the syndrome of reflex sympathetic dystrophy. The etiology of the syndrome remains obscure, the symptomatology recedes parallel with reduction of the dosage and levels of cyclosporin A.

[Relation between levels of leptin, insulin and cortisol in persons with the 5H (X) syndrome]. / Vzt'ah hladín leptínu k hladinám inzulínu a kortizolu u l'udí so syndrómom 5H (X).

Leptin levels in subjects with android obesity with the insulin resistance syndrome (syndrome X, 5H) are in general elevated, as compared with non-obese subjects and correlate with the BMI, with the percentage of body fat, WHR, IRI levels and sex (they are higher in women), as it is the case in the general population. In the elevated leptin level in syndrome 5H (association of hyperinsulinism, hyperglycaemia-NIDDM, hyperlipoproteinaemia with android obesity, arterial hypertension and hirsutism in females with the polycystic ovaries syndrome) participate in a significant way also elevated basal IRI and cortisol levels as well as an elevated postprandial IRI response during oGTT despite the fact that leptin and endothelin-1 levels do not rise significantly during oGTT despite hyperinsulinaemia. Leptin levels were however higher in men (liminally significant in women) with an hyperinsulinaemic response during oGTT, as compared with probands with a normal insulin response. Optimal insulin and glucocorticoid levels are the prerequisite for a rise of leptin because proadipocytes in vitro begin to produce leptin as soon as insulin is added to the medium and this effect is trebled, if cortisol is added. It appears that the insulin and leptin resistance in syndrome 5H are parallel phenomena which potentiate each other. Elevated insulin and cortisol levels maintain elevated leptin levels which in turn enhances the insulin resistance in muscles and at the same time has an impact on the IRI response to postprandial hyperglycaemia. In the background of this insulin and leptin resistance in the majority of subjects with the 5H syndrome there is apparently no actual molecular defect of the hormone and its receptors in target tissues but a possible defect in mechanisms of postreceptor transduction of the hormonal signal. In the hormonal resistance participate moreover also two general and non-specific mechanisms such as: 1. increased consumption or uptake of hormonal receptors by elevated levels of the appropriate hormone ("down regulation" phenomenon), 2. disorders of paracrine endothelial mechanisms of the vascular wall which determine via the control of the inflow in the regional microcirculation the availability of insulin, leptin and metabolic substrates to target tissues. Impaired vasodilatation reserves and the development of paradoxical vascular spasms in response to stimuli which normally cause vasodilatation (strain, administration of acetylcholine, histamine, ATP etc.) are constant, associated phenomena in hyperlipoproteinaemias, arterial hypertension and in type 2 diabetics. These phenomena are the syndrome of insulin resistance and syndrome 5H-X resp. Endothelin-1 levels assessed in the systemic circulation are however due to their short biological half-life and the paracrine action of endothelin-1 not sensitive markers of endothelial dysfunction in syndrome X.

Technetium-99m mercaptoacetyltriglycine clearance values in children with minimal renal disease: can a normal range be determined?

Use of technetium-99m labelled mercaptoacetyltriglycine (99mTc-MAG3) simplifies and improves the quantification of renal clearance in children by virtue of its permanent availability, good imaging properties and low radiation exposure. Due to the lack of reference values for 99mTc-MAG3 clearance in children, the Paediatric Task Group of the EANM initiated a multicentre study to evaluate 99mTc-MAG3 clearance values in children with minimal renal disease. One hundred and twenty-five children aged between 12 months and 17 years, classified as renally healthy using defined diagnostic criteria, were included in the study. 99mTc-MAG3 clearance was calculated using an algorithm on the basis of a single blood sample taken at any time between 30 and 40 min after tracer injection. In addition, the absolute 99m-Tc-MAG3 clearance values were normalized to body surface area. For further evaluation the children were classified into several groups according to age. There was a continuous increase in non-corrected 99mTc-MAG3 clearance values from the age of 1 year up to the age of 17 years (mean value <2 years: 98+/-57 ml/min; mean value >8 years: 208+/-66 ml/min). Normal clearance values for adults were achieved by the age of 8 years. Analysis of the relationship between non-corrected clearance and age yielded a correlation coefficient of r=0.7. When these absolute clearance values were normalized to body surface area, we found nearly constant clearance values for all age groups, with a mean clearance value of 315+/-114 ml/minx1.73 m2. The correlation coefficient for the relationship between normalized clearance and age was r=0.28. In conclusion, the clearance of 99mTc-MAG3 increases continuously throughout childhood into adolescence due to the maturation and growth of the kidney. After normalization of the absolute clearance to body surface area, no correlation between clearance and age could be proven.

Reflex sympathetic dystrophy of the lower limbs after kidney transplantation.

Reflex sympathetic dystrophy syndrome (RSDS) is a rarely described complication after different types of organ transplants. Three out of 147 kidney recipients treated at our center during the last 6 years developed severe bilateral symmetrical pain in the ankles and knees, with great difficulties in walking 2-3 months after kidney transplantation. Clinical examination revealed periarticular soft tissue swelling and vasomotor changes with no effusion. Patchy osteoporotic patterns were seen radiographically in clinically affected areas. Scintigraphy showed increased epiphyseal uptake of 99mTc with a periarticular distribution. Clinical symptoms, radiographic, and scintigraphic signs were compatible with so-called RSDS. The exact cause of the syndrome remained obscure. All patients received standard immunosuppression with cyclosporine A (CyA), azathioprine, and prednisone. Symptoms of RSDS improved when doses of CyA were reduced and blood levels declined; patients were treated with calcitonin and calcium channel blockers simultaneously. Non-steroidal antiinflammatory drugs were not effective in symptom relief. In all three cases, most probably spontaneous complete recovery was achieved over the course of 2-8 months; no one patient progressed to aseptic osteonecrosis.

[The effects of nicotine on leptin levels in patients with android obesity]. / Vplyv nikotínu na hladiny leptínu u androidne obéznych jedincov.

In insulin resistant subjects with android obesity the leptin levels are, as compared with non-obese subjects, elevated in proportion to their BMI, WHR and their percentage of body fat. Generally independent on obesity, leptin levels are significantly higher in women than in men as in women the percentage of adipose tissue is higher. After administration of 2 mg nicotine in Nicorette chewing gum to 36 android obese non-smokers the elevated baseline values of leptin did not change and thus the observation that cigarettes suppress hunger or that smoking promotes weight reduction is untrue or else this effect is not mediated by nicotine stimulation of leptin secretion or formation in adipose tissue, leptin being the adipose tissue hormone which controls food intake, the sensation of satiety and via neuropeptide Y also other hypothalamic functions such as muscular and sexual activity, gonadoliberin output, thermoregulation etc. Leptin thus offers no alibi to smokers. Conversely smoking in android obese hyperinsulinaemic hyperleptinaemic subjects with syndrome X (5H) potentiates significantly the risk of cardiovascular death.

[The importance of studying the renin-angiotensin-aldosterone system in essential arterial hypertension in clinical practice. Activity of the renin-angiotensin-aldosterone system during treatment of hypertension with ACE-inhibitors and beta blockers]. / Význam vysetrovania renín-angiotenzín-aldosterónového systému u esenciálnej artériovej hypertenzie v klinickej praxi. Chovanie sa renín-angiotenzín-aldoesterónového systému v priebehu liecby hypertenzie ACE--inhibitormi a betablokátormi.

The authors assessed in 20 subjects with mild or medium severe arterial hypertension basal and stimulated values of plasma renin activity (PRA) and aldosterone before onset of treatment and after 6-week therapy with enalapril (ENAP KRKA) or metoprolol (Vasocardin Slovakofarma). PRA and aldosterone secretion was stimulated by a vertical position and by administration of 40 mg furosemide by the i.v. This test proved suitable for assessment of secondary arterial hypertension in different forms of primary hyperaldosteronism and for expressing suspicion of renovascular hypertension and hypertension with affection of the renal arteries resp. Based on PRA levels, arterial hypertension can be divided into normorenin, high-renin and low-renin hypertension. This classification is, however, of no value for selection of treatment and the prognosis of hypertension. Each level of PRA can be associated with three different aldosterone levels. PRA and aldosterone did not correlate with urinary K, Na excretion nor with blood pressure. During treatment with ACE inhibitor PRA rose while basal as well as stimulated aldosterone levels declined. After administration of betablockers basal as well as stimulated PRA and aldosterone levels declined.

[Diuretic scintigraphy with 131I-hippurate and 99mTC-MAG3 in children with dilatation of the upper urinary tract]. / Diuretická scintigrafia s 131I-hipuranom a 99mTc-MAG3 u detí s dilatáciou horných mocových ciest.

The method of diuretic scintigraphy was used to examine 27 children, aged 2-15 years, with excretion urography findings of dilatation of the upper urinary tract. Vesicorenal reflux was excluded in all the children of the series by classical radiologic cystography. The radionuclide 131I-hippurate was used in 15 children and 99mTc-MAG3 in 12 children. In both groups the parameter T 1/2 was determined as the time of 50% decrease of activity above the kidney after administration of the diuretic. With both radionuclides the same borderline time of T 1/2 was established. In cases with T 1/2 < 10 minutes and preserved kidney function, dilatation of obstructive origin can be excluded with both substances. 99mTc-MAG3, however, has a markedly better imaging capacity and a significantly lower radiation load than 131I-hippurate. (Tab. 4, Fig. 3, Ref. 12.)

[Advantages of the new radiopharmaceutic agent, 99mTC-mercaptoacetyltriglycine (99mTc-MAG3), in the diagnosis of kidneydiseases. A comparative study with 131I-OIH, 99mTc-DTPA and 99mTc-DMSA]. / Prednosti nového rádiofarmaka 99mTc-merkaptoacetyltriglycínu (99mTc-MAG3) v diagnostike ochorení obliciek. Porovnávacia stúdia s 131I-OIH, 99mTc-DTPA a 99mTc-DMSA.

The properties of 99mTc-mercaptoacetyltriglycine (MAG3), a new radiopharmaceutic for dynamic renal scintigraphy, were assessed in a series of 138 patients with different diseases of the uropoietic system. The physiological values of renographic curves were determined as well as the characteristics of MAG3 excretion, which closely resembled the values for 131I-OIH. On comparing the values of separate MAG3 clearance with standard radiopharmaceutics in 26 subjects examined, very good correlation coefficients (r) were obtained: 0.98, 0.96, and 0.92 for 131I-OIH, 99mTc-DMSA, and 99mTc-DTPA, respectively. Global MAG3 clearance reached 0.64 of the OIH value. The higher quality of scinfigraphic imaging than seen with the substances used so far, the favorable pharmacokinetic properties and the low radiation load (H(E) = 0.51 mSv in adults) of MAG3 determine the indication spheres in which it can best be used to advantage. Of the radiopharmaceutics used to date, MAG3 yields the best results. It can well substitute 123I-OIH, which is not readily available in our conditions, and can thus be expected to be widely used in clinical practice.

A new approach in radionuclide imaging to ureteric peristalsis using 99Tcm-MAG 3 and condensed images.

A new method for the evaluation of ureteric peristalsis is described. Standard, dynamic renal scintigraphy was carried out using 99Tcm-MAG 3 in 59 patients. Time-activity curves and condensed images over the ureter area were created simultaneously. A six-grade scale (O-V) was chosen for the classification of ureteral function. The results obtained were compared with parameters of renographic curves and other clinical findings. In a group of 13 patients, two different renal radiopharmaceuticals were used: 131I-OIH and 99Tcm-DTPA. The results show that the new method is suitable for the assessment of ureteral disorders, and has some advantages compared with previously described methods. 99Tcm-MAG 3, with a better target-to-background ratio compared to 131I-OIH and 99Tcm-DTPA, is the most suitable radiopharmaceutical for this purpose.

[Clinical evaluation of a new radiopharmaceutical agent 99mTc-mercaptoacetyltriglycine (MAG3)]. / Klinické hodnotenie nového rádiofarmaka 99mTc-merkaptoacetyltriglycínu (MAG3).

In the present clinically oriented study the authors checked the properties of 99mTc-mercaptoacetyltriglycine (MAG3), the new radiopharmaceutical for dynamic scintigraphy of the kidneys, in a group of 30 patients. They positively value particularly the high quality of visualization of the parenchyma and the urinary tract, the pharmacokinetic properties similar to those of 131I-orthoiodhippurate and the capability of representation of the kidneys with their markedly decreased function. They examined the take-up of the pharmaceutical in the liver, which is slightly more marked with the worsening tubular function and partly depends also on the length of the time interval between the preparation and administration of MAG3. No significant changes were found in the clinical and principal laboratory parameters after its administration. In conclusion, the authors point out to advantageous properties of the novel radiopharmaceutical for clinical use in our conditions.

[Mercaptoacetyltriglycine (MAG 3) 99mTc--a new radiopharmaceutic for uropoietic diagnoses]. / Merkaptoacetyltriglycín (MAG 3) 99mTc--nové rádiofarmakum v diagnostike uropoetického systému.

The present authors show mercaptoacetyltrigylcine (MAG 3), labelled with 99mTc technetium, as a novel prospective diagnostic agent of the uropoietic system, replacing the injections of sodium iodohippurate labelled with 131I. The paper reports the procedure of labelling of this novel radiopharmaceutical with technetium 99mTc, evaluation of its quality by chromatographic methods, and biological distribution of MAG 3 in laboratory animals in comparison with the biodistribution of injections of sodium iodohippurate labelled with 131I.

[Thallium scintigraphy of the myocardium. I. Principles and methods]. / Táliová scintigrafia myokardu. I. Princíp a metodika.

Thallium scintigraphy of myocardium is a diagnostic method of nuclear medicine which enables visualization of well perfused and vital tissue of myocardium by means of 201thallium absorbed by its cells. In the first part of the review the authors present various radiopharmaceuticals having been used in this area. Physical properties are described in greater detail as well as preparation and pharmacokinetics of 201thallium. The method of examination is described in its basic form, but also some special cases of detection and evaluation are presented, such as ECG-synchronised thallium scintigraphy of myocardium and one-photon transaxial tomography.

[Thallium scintigraphy of the myocardium. II. Evaluation of the results]. / Táliová scintigrafia myokardu. II. Hodnotenie výsledkov.

In the first part of the review the authors define general principles of evaluating thallium scintigraphy of myocardium. A standard evaluation protocol is proposed. A normal picture is described and the evaluation procedure of pathological findings is outlined. A particular attention is paid to the importance of mathematical processing of data by means of a computer for increasing sensitivity of the method and reproducibility of the results. In the conclusion the authors present table with examples of normal values of quantitative analysis of thallium scintigraphy of myocardium.

[The significance of a new radiopharmaceutic agent, 99mTc-mercaptoacetyltriglycine (MAG 3), in the diagnosis of diseases of the kidneys and urinary tract in children]. / Význam nového rádiofarmaka 99mTc-merkaptoacetyltriglycínu (MAG 3) v diagnostike ochorení obliciek a mocových ciest u detí.

Using the method of dynamic scintigraphy of the kidneys by means of a new radiopharmaceutical preparation, 99mTc--mercaptoacetyltriglicide [MAG 3], the authors examined 35 children with various urological and nephrological diseases. In indicated cases the examination was supplemented by administration of a diuretic, further projections or indirect mictional cystography. The authors assessed normal parameters of functional curves and their normal extent in a group of 18 healthy kidneys. They did not find a significant difference, as compared with results obtained by means of 131I-OIH. The assessed values of global clearance attained 66% of the 131I-OIH clearance values. In 60% of the patients the visualization of the parenchyma and in 80% the visualization of the efferent urinary pathways was better than when 99mTc-DTPA was used. In all instances the scintigrams were better than when 131I-OIH was used. The new radiopharmaceutical preparation combines the advantages of technetium-labelled preparations and the favourable pharmacokinetic properties of hippuran. It is suitable for quantification of tubular secretion. It is superior to hitherto used substances as regard the quality of visualization and in particular the lower radiation load. Therefore it is particularly suited for paediatric practice.