Xanthine oxidase activity in patients with age-related cataract associated with hypertension.

Reactive oxygen species and lipid peroxidation are important factors that contribute to the development of age-related cataract. The study included 130 patients with age-related cataract, 69 of whom were diagnosed with hypertension (HT), 20 with hypertension and type 2 diabetes mellitus (DM), and 41 had no accompanying condition. The following parameters were measured in the serum of the examinees: products of lipid peroxidation malondialdehyde (MDA) and lipofuscin-like fluorophores (LLF), activity of prooxidative enzymes xanthine oxidase (XO) and myeloperoxidase (MPO), antioxidant enzymes superoxide dismutase (SOD) and glutathione peroxidase (GPx), the concentration of thiol groups, and the ferric reducing activity of plasma. The activity of prooxidative enzymes XO and MPO was higher in the plasma of patients with HT (XO=9.0±1.2 U/L; MPO=77.3±8.4 U/L) and with HT and DM (XO=11.9±0.9 U/L; MPO=89.5±5.0 U/L) compared to patients with age-related cataract (XO=6.2±0.9 U/L; MPO=52.4±6.3 U/L; P<0.01). Our research has shown that patients with age-related cataract and hypertension were exposed to increased oxidative damage of biomolecules, based on the increased plasma LLF and MDA content and decreased levels of thiol groups. Oxidative changes of biomolecules in these patients were associated with increased activity of the XO, MPO, and GPx enzymes and a lower extracellular SOD activity and total ferric reductive ability of plasma.

Xanthine oxidase activity in patients with age-related cataract associated with hypertension

Reactive oxygen species and lipid peroxidation are important factors that contribute to the development of age-related cataract. The study included 130 patients with age-related cataract, 69 of whom were diagnosed with hypertension (HT), 20 with hypertension and type 2 diabetes mellitus (DM), and 41 had no accompanying condition. The following parameters were measured in the serum of the examinees: products of lipid peroxidation malondialdehyde (MDA) and lipofuscin-like fluorophores (LLF), activity of prooxidative enzymes xanthine oxidase (XO) and myeloperoxidase (MPO), antioxidant enzymes superoxide dismutase (SOD) and glutathione peroxidase (GPx), the concentration of thiol groups, and the ferric reducing activity of plasma. The activity of prooxidative enzymes XO and MPO was higher in the plasma of patients with HT (XO=9.0±1.2 U/L; MPO=77.3±8.4 U/L) and with HT and DM (XO=11.9±0.9 U/L; MPO=89.5±5.0 U/L) compared to patients with age-related cataract (XO=6.2±0.9 U/L; MPO=52.4±6.3 U/L; P<0.01). Our research has shown that patients with age-related cataract and hypertension were exposed to increased oxidative damage of biomolecules, based on the increased plasma LLF and MDA content and decreased levels of thiol groups. Oxidative changes of biomolecules in these patients were associated with increased activity of the XO, MPO, and GPx enzymes and a lower extracellular SOD activity and total ferric reductive ability of plasma.

Dynamic changes of carotid artery intima-media thickness and mortality in hemodialysis patients.

INTRODUCTION: Intima-media thickness (IMT) of the carotid artery is a widely accepted parameter for detection and quantification of atherosclerosis. The aim of the study was the evaluation of the impact of changes of IMT on the mortality of patients on hemodialysis. METHODS: The study was organized as a prospective and observational one. Intima-media thickness was determined by ultrasound in 194 patients who were evaluated every year during a three-year period. We analyzed the mortality rate of patients on hemodialysis in relation to their biochemical parameters, demographic and anthropometric characteristics, type of dialysis, smoking habits and statin therapy. RESULTS: Female gender and hemodiafiltration emerged as good predictors of long-term survival. Baseline IMT values were significantly lower than those at the end of the second (p <0.001) and third years of the study (p <0.001). The baseline values positively correlated with uric acid levels (p =0.027) and body mass index (p =0.024), while at the end of the second year, IMT positively correlated with LDL-cholesterol (p =0.037) and triglyceride levels (p =0.018) and body mass index (p =0.045). Patients on hemodiafiltration had significantly higher values for erythrocytes (p =0.047), hemoglobin (p =0.005), creatinine (p =0.048), Kt/V (p =0.026), albumin (p =0.012), LDL-cholesterol (p <0.001), body mass index (p <0.001),and lower IMT values at the end of the first year (p =0.039), compared to patients on bicarbonate hemodialysis. Predictors of death were the duration of hemodialysis (p <0.001), and IMT at the end of the first (p =0.008) and second years of the study (p =0.005). CONCLUSION: Dynamic changes of IMT of the carotid arteries during the first two years were found in our study to be predictors of mortality in patients on hemodialysis. Hippokratia 2015; 19 (2):158-163.

[Doppler-duplex ultrasonography in the diagnosis of cavernous portal vein]. / Ultrasonografija dupleks-dopler u dijagnostici kavernozne vene porte.

UNLABELLED: Prehepatic portal hypertension caused by cavernous transformation of the portal vein has been more and more considered as a multiorgan disease with circulatory changes in numerous organs related to systemic and splanchnic vascular network [1]. Honeycomb-like, spongy, cavernous portal vein is a rare clinical and pathoanatomical entity which usually results from portal vein thrombosis. Recanalization and neovascularization processes lead to cavernomatous transformation of the portal vein lumen and formation of periportal collateral hepatopetal venous varices (Petren's veins) [5, 6]. Recently, with Doppler ultrasonography and angiography cavernous portal vein has been identified as the cause of prehepatic portal hypertension. Usage of color Doppler and duplex Doppler ultrasonography has greatly contributed to diagnostic efficiency, while therapeutically, the disease remains a serious and controversial problem. METHODS: At the Institute of Digestive Diseases, Clinical Centre of Serbia, 8 patients with cavernous portal vein were studied in the period 1995-1997. Real-time duplex and color Doppler ultrasonography (Toshiba-SSA 100A with sector duplex probe 3.75 MHz, and 9 ATL with color Doppler convex duplex probe 3.5 MHz) were used. Indirect (arterial) portography was used for imaging of lienoportal system in the venous phase of angiography as follows: catheterization (Seldinger's technique) of the coeliac trunk or lienal artery, and catheterization of the superior mesenteric artery. Indirect portography was performed by injection of 60-80 ml of the contrast medium by an automatic pump, at 10-14 ml/sec, i.e. 8-10 ml/sec by the digital technique [7]. Peroral fiberendoscopy was performed in all patients by Olympus GIF-XQ 10 endoscope. RESULTS: In our study the conventional ultrasonographic examination failed to provide an appropriate image of the normal portal vein. In hepatoduodenal ligament multiple tubular and round structures were seen, revealing an atypical honeycomb or spongycavernous shape of the venous lumen (Figs. 1 and 2). Doppler ultrasonography of the lumen of these venous collateral structures revealed a continuous, hypokinetic flow, mid-rate 7.4 cm/sec, which was always hepatopetally directed (to the liver). Color Doppler ultrasonography detected extensive portosystemic collateralls in all patients, and varices in the gallbladder wall in 1 patient. The results of indirect portography correlated well with Doppler ultrasonographic findings. In all patients hepatopetal flow was found (Figs. 3 and 4). The aetiology was diverse: idiopathic, liver cirrhosis, haematological diseases, Crohn's disease and Marfan's syndrome. Two patients had IV degree varices in the distal third of the oesophagus, and 4 patients had II/III degree varices. Patients with posthepatic liver cirrhosis and Crohn's disease had no varices in the distal third of the oesophagus and gastric fornix. DISCUSSION: Since Pick (1909) described this malformation as the hepatopetal collateral, the haemodynamic concept of this entity has not been changed. Doppler ultrasonography and angiography confirm that the blood flow in cavernomas is hepatopetal, i.e. compensated and functional. Cavernous transformation of the portal vein is clinically manifested by bleeding from oesophagogastric varices. Haemathemesis is the most alarming complication and may be the first clinical sign. The haemorrhage is usually recurrent and profuse, but in most cases it is tolerated well owing to preserved hepatic function in patients without liver cirrhosis [19]. Portosystemic collateral circulation may take place via retroperitoneal and other spontaneous venous shunts, not involving the left gastric vein or vv. gastricae breves, when oesophagogastric varices are absent (our patient with Crohn's disease and posthepatitic B cirrhosis). Splenomegaly with hypersplenism is always present with cavernous transformation of the portal vein, and usually precedes the occurrence of gastrointestinal hae

[Echohistograms of circumscribed liver lesions]. / Ehohistogrami cirkumskriptnih lezija jetre.

The term focal liver changes usually applies to benign and malignant primary and secondary tumours. However, according to echotomographic findings, tumour-like diseases, such as focal nodular hyperplasia and diseases caused by bacteria, fungi, protozoa and parasites may also be included. Improvement in echotomographic technique and use of echohistogram have recently enabled provision of data determining the aetiology, i.e. pathohistological structure of changes with computerized analysis. The study included 178 patients with circumscribed liver lesions: thirty patients had primary carcinoma, 39 had secondary carcinoma, 41 had cystic disease, 35 hemangioma, 10 focal steatosis, 23 had other circumscribed lesions, as well as 175 subjects with healthy liver. The examinations were performed using the real-time ulstrasound apparatus (Toshiba SA 100 A). Echohistograms were obtained by placing certain amount of liver tissue onto X and Y axes, to be processed and graphically presented by the apparatus. X axis showed the number of particles (N) of liver tissue on certain surface, while Y axis showed the average value (M) and maximal value (Max) of particles. Analysis of echohistographic parameters evidenced the following: mean distribution values of M, Max and N differed in different pathological conditions (Tables 1 and 2). Correlation analysis of the studied parameters revealed different values among the studied groups of patients (Table 3, Figure 1). Analysis of echohistograms and their parameters revealed differences between the tissues of the "healthy" and "affected" liver which may be significant in diagnosis of circumscribed liver changes. N/Max:N/M ratio was higher in normal liver when compared to the studied groups of patients (except for N/M subration in focal changes). Our study, as well as the studies performed by aforementioned authors, evidenced close correlation of the appearance of echohistograms and parameter ratio with density, homogenicity and greatly with vascularization of the studied tissue. It has also been evidenced that the interrelations between the echosistographic parameters are in a complexly interwoven, and partly in aetiology, or it is better to say in relations between the healthy tissue and pathological liver changes. However, it must be concluded that the series of the described cases is small to enable establishment of diagnostic criteria exclusively based on echohistograms. Similar analysis of echohistograms in circumscribed liver diseases was not evidenced in the referential literature published so far. We consider the method useful and believe that the future development of computerized ultrasound extensions will enable differentiation of lesions.

The value of ultrasound in staging the severity of acute pancreatitis.

The authors asses the accuracy and role of early ultrasound examination in staging the severity of acute pancreatitis. A total of 110 consecutive patients with acute pancreatitis were included into the study. The ultrasound findings were categorized into six categories and compared with a modification of multiple prognostic criteria, computerized tomography, operative findings (when available) and clinical outcome. The probability of a positive ultrasound finding in a patient with clinically severe acute pancreatitis was 89.6% (sensitivity). In comparison to computerized tomography the sensitivity of ultrasound in discovering CT diagnosed moderate and severe forms of acute pancreatitis was 86.6%. The sensitivity of ultrasound in discovering moderate and severe forms of acute pancreatitis as defined at laparotomy was 77.8%. The specificity of ultrasound was low (44.0%) in comparison with modified prognostic criteria, but high in comparison with computerized tomography (87.5%) and staging at laparotomy (85.7%). There was a good correlation between US defined moderate and severe forms of acute pancreatitis and clinical outcome (average number of hospital days and case fatality). The authors conclude that early ultrasound examination in acute pancreatitis is indicated and can help stage the severity of the disease and affect decision making.

[Renal size as an ultrasonographic parameter in the differential diagnosis of primary and secondary glomerulopathy]. / Velicina bubrega kao ultrasonografski parametar u diferencijalnoj dijagnozi primarne i sekundarne glomerulopatije.

Between October 1987. and October 1992. 289 biopsies of the kidney in patients with glomerular diseases were performed. Pathohistologic analysis showed 218 cases with primary and 71 cases with secondary glomerular diseases. In all patients kidneys were measured by ultrasound examinations. The results showed significant difference in longitudinal diameter of kidneys in patients with primary from those with secondary glomerular diseases. These results can help a nephrologist to diagnose glomerular disease.

[The effect of propranolol on portal hypertension]. / Uticaj propranolola na pritisak u sistemu portne vene.

The review of literature on propranolol (Inderal) pharmacological action on the portal vein pressure is reported in this article. The patients with liver cirrhosis and esophagogastric varices have 25-33% risk of initial bleeding, risk more than 70% of variceal re-bleeding and associated mortality over 50% in each episode. The use of nonselective beta adrenergic blockers according to previous data, descreases portal vein pressure and mostly prevents the initial bleeding. In the prevention of esophageal re-bleeding, nonselective beta adrenergic blockers (Inderal) are recommended in patients with relatively good liver function (Child's A and Child's B), while in liver failure with great ascites (Child's C) no beneficial effect is expected.

[Echotomography of malignant tumors of the liver]. / Ehotomografska slika malignih tumora u jetri.

The echotomographic primary liver carcinoma can be hyperechogenic and hypoechogenic, or both. In metastasis, in addition to the pattern of primary carcinoma end-lesion changes are also visible, or liver parenchyma can be diffusely heterogeneous. The echotomographic findings of primary and secondary liver tumours cannot be differentiated. The origin of metastasis in the liver cannot be established by echotomography. However, a typical echotomographic picture can be obtained in some carcinoma (colon carcinoma).