Long-course preoperative chemoradiation versus 5 × 5 Gy and consolidation chemotherapy for clinical T4 and fixed clinical T3 rectal cancer: long-term results of the randomized Polish II study.

BACKGROUND: This trial evaluated whether preoperative short-course radiotherapy and consolidation chemotherapy (CCT) were superior to chemoradiation in rectal cancers with clinical (c)T4 or fixed cT3. Previously, we reported early results showing no differences in the radical surgery rate (primary end point). In the short-course/CCT group, we observed lower acute toxicity of preoperative treatment and better overall survival (OS). We updated results to determine whether the benefit in OS was sustained and to evaluate late complications. PATIENTS AND METHODS: Patients with cT4 or fixed cT3 rectal cancer were randomized either to preoperative 5 × 5 Gy and three cycles of FOLFOX4 or to chemoradiation (50.4 Gy with bolus 5-Fu, leucovorin and oxaliplatin). RESULTS: Patients (N = 515) were eligible for analysis, 261 in the short-course/CCT group and 254 in the chemoradiation group. The median follow-up was 7.0 years. The difference in OS was insignificant [hazard ratio (HR) 0.90; 95% confidence interval (CI) 0.70-1.15; P = 0.38). However, the difference in early OS favouring short-course/CCT previously reported was observed again, being 9% at 3 years (95% CI 0.5% to 17%). This difference disappeared later; at 8 years OS was 49% in both groups. There was no difference in disease-free survival (HR 0.95; 95% CI 0.75-1.19; P = 0.65) at 8 years 43% versus 41% in the short-course/CCT group versus the chemoradiation group, respectively. The corresponding values for cumulative incidences of local failure and distant metastases did not differ and were HR = 1.08, 95% CI 0.70-1.23, P = 0.60, 35% versus 32% and HR = 1.10, 95% CI 0.68-1.23, P = 0.54, 36% versus 34%, respectively. The rate of late complications was similar (P = 0.66), grade 3+ being 11% versus 9% in the short-course/CCT group versus the chemoradiation group, respectively. CONCLUSION: The superiority of preoperative short-course/CCT over chemoradiation was not demonstrated. CLINICAL TRIAL NUMBER: The trial is registered as ClinicalTrials.gov number NCT00833131.

Native Nephrectomy in Renal Transplant Recipients With Autosomal Dominant Polycystic Kidney Disease.

INTRODUCTION: Patients with autosomal dominant polycystic kidney disease (ADPKD) represent about 10% of kidney transplant recipients (KTR) and have unique needs regarding acceptance for this procedure. Whether native kidney nephrectomy (NKN) affects kidney transplantation (KT) outcomes remains a matter of debate, and more data is needed to establish a standard approach to KTR with ADPKD. AIM: To analyze the prevalence, timing, and short- and long-term outcomes of NKN in a cohort of ADPKD recipients in a single institution. METHOD: Retrospective, observational study. RESULTS: In the years 1993 to 2016 we identified 162 KTR with ADPKD; of those, 149 had known NKN status. A high proportion of ADPKD KTR (n = 72) underwent NKN, the majority of which (69.4%) were performed before KT. There was no difference in short-term and long-term transplantation outcomes (including death, graft loss, delayed graft function, acute rejection, bacterial and cytomegalovirus [CMV] infection, and post-transplant diabetes mellitus) between NKN and non-NKN groups in a median of 98 months of follow-up. However, we found a significant difference in time on a waiting list, which was longer in the NKN group vs non-NKN. CONCLUSIONS: There is a need for a consensus regarding indications and timing for NKN in recipients with ADPKD. The systematic acquisition, sharing, and analysis of accessible data on NKN between institutions is an important step toward meeting this need. In our cohort, we found no impact of the NKN procedure on KT impact. However, undergoing NKN significantly prolonged the time on the waiting list.

Obesity Risk Factors in Patients After Kidney Transplantation.

BACKGROUND: Kidney transplantation is currently the best approach for renal replacement therapy. Compared with dialysis, it provides a better quality of life and improves patient prognosis. However, some evidence suggests that body composition could play a role in the complications observed in kidney transplant recipients (KTRs), and may influence survival. The purpose of this study was to assess the eating habits and body composition of KTRs. METHODS: Seventy KTRs were included in this study. Anthropometry and body composition were performed using electronic-scale, dynamometer, and bioimpedance analyses. Dietary habits were investigated using the Food Frequency Questionnaire (FFQ6). Biochemical parameters were also determined. RESULTS: Overweight and obesity were found in 33.8% and 21.1% of KTRs, respectively. High body mass index (BMI, >25) correlated positively with high body fat (r = 0.8, P < .05) and waist circumference (r = 0.7, P < .05). The mean percentage of body fat was 30.8 ± 9.3% (range, 13%-52%), fat tissue index was 12.4 ± 4.9, and lean tissue index (LTI) was 13.2 ± 2.2. Sarcopenia was recognized based on decreased LTI and decreased handgrip strength in 33.3% of KTRs with excess body weight. Patients with excess body mass consumed significantly (P < .05) more sugar and fruits. CONCLUSION: A significant percentage of KTRs present with sarcopenic obesity. Excess body weight is associated with many factors, such as immunosuppressive therapy, low physical activity, and abnormal diet. Results based on the FFQ6 indicate a relationship between carbohydrate intake and excess body weight among those in the study group.

Dietary Intake of Vitamins in Different Options of Treatment in Chronic Kidney Disease: Is There a Deficiency?

BACKGROUND: The importance of diet in the management of kidney transplantation (KT), as well as other treatment options of chronic kidney disease (CKD), is generally acknowledged. However, data regarding vitamin intake are very limited. Vitamins are essential in maintaining good nutritional status and preventing many chronic complications. It is still not clear which treatment modality imposes the highest risk of dietary vitamin deficiency and whether successful KT reverses such a threat. METHODS: We performed this observational study to assess dietary intake of vitamins in CKD patients: after successful KT, not yet dialyzed (ND), treated with hemodialysis (HD), and with peritoneal dialysis (PD). A total of 202 patients were recruited (45 KT, 50 ND, 45 HD, and 62 PD). Vitamin intakes were evaluated through the use of a 24-hour dietary recall and processed with the use of a computerized database. Each record was evaluated by a skilled dietitian. In general, vitamin intakes in all study groups were comparable, with KT and ND groups manifesting lower risk of deficiency than HD and PD groups. RESULTS: The content of fat-soluble vitamins in diet was insufficient, with remarkably high prevalence of vitamin D deficiency. Mean intakes of water-soluble vitamins were close to recommended, with the exception of folic acid, which was profoundly deficient in all groups. CONCLUSIONS: CKD patients are at risk of inadequate vitamin intake. Vitamin D and folic acid are universally deficient in diet. KT patients have the most satisfactory content of vitamins in their diet, whereas HD individuals are at highest risk of deficiency.

Tissue Doppler Imaging and Intima-Media Thickness as Noninvasive Methods of Cardiovascular Risk Stratification in Patients After Kidney Transplantation.

BACKGROUND: Cardiovascular complications, including coronary artery disease and chronic heart failure, are the leading causes of death in patients with chronic kidney disease. New echocardiographic techniques, such as tissue Doppler imaging (TDI) with strain and strain rate, are noninvasive, easy-to-perform methods of the estimation of left ventricular (LV) systolic and diastolic function. The aim of the study was to analyze the utility of new noninvasive methods of cardiovascular risk stratification in patients after kidney transplantation. METHODS: We included 43 consecutive kidney transplant (KT) recipients, with 30 healthy subjects constituting the control group in the study. We evaluated LV morphology and LV systolic and diastolic function by means of echocardiography with TDI and intima-media thickness by ultrasonography of the carotid arteries. RESULTS: LV mass index was significantly higher in transplanted patients, and both mitral inflow E/A and Em/Am ratios from pulsed myocardial imaging were significantly lower in the KT group as compared with the control group. The systolic wave of TDI at the basal segments was much lower in KT patients than in the control patients (P < .05). The mean value of strain rate was reduced in KT recipients as compared with the control patients. IMT was significantly higher in KT recipients. CONCLUSIONS: Echocardiography with TDI provided more accurate information about systolic and diastolic LV function. KT recipients showed significant alterations in LV longitudinal myocardial function parameters estimated by strain and strain rate. Strain and strain rate are noninvasive methods, easy to repeat, and valuable for detecting myocardial LV dysfunction in asymptomatic KT recipients.

Toxicological studies for adults and children of insecticide residues with common mode of action (MoA) in pome, stone, berries and other small fruit.

The presence of pesticide residues in fruit is a serious health concern. This paper for the first time demonstrated the Hazard Index (HI) method to carry out acute, chronic and cumulative health risk assessment to the 14 groups of insecticides for three subpopulations. The challenge of this study was to present results from a long period of research (years 2005-2014) with toxicological aspects, especially in multiresidue samples. Near 1000 fresh pome, stone, berries and small fruit were prepared by two accredited MSPD and QuEChERS methods followed by liquid and gas chromatography analyses with various systems of detection ECD/NPD/MS/MS. Twenty percent of the fruit samples contained 16 insecticide residues in the range of 0.01-0.81mg/kg and 3% over MRL. The class of pesticide with the highest contribution to the ADI was found to be OPPs: dimethoate and diazinon for adults 48% and 66% of the ADI whereas for infants 144% and 294% of the ADI. The highest contributions of the cHQ to common MoA pesticides were AChE inhibitors: 135% for adults and 528% for infants, sodium channel modulators 4.9% and 20%, nicotic acetylocholine receptor <2.9% and <10.6% for adults and infants, respectively. The fruit with the highest contribution to the ADI were found to be apples (316%, 58%), cherries (96%, 37%) and pears (129%, 33%) for infants and adults. The study findings indicated that dietary exposures to insecticide residues in fruit would be unlikely to pose unacceptable health risks for the infants, toddlers and adults.

Long-course oxaliplatin-based preoperative chemoradiation versus 5 × 5 Gy and consolidation chemotherapy for cT4 or fixed cT3 rectal cancer: results of a randomized phase III study.

BACKGROUND: Improvements in local control are required when using preoperative chemoradiation for cT4 or advanced cT3 rectal cancer. There is therefore a need to explore more effective schedules. PATIENTS AND METHODS: Patients with fixed cT3 or cT4 cancer were randomized either to 5 × 5 Gy and three cycles of FOLFOX4 (group A) or to 50.4 Gy in 28 fractions combined with two 5-day cycles of bolus 5-Fu 325 mg/m(2)/day and leucovorin 20 mg/m(2)/day during the first and fifth week of irradiation along with five infusions of oxaliplatin 50 mg/m(2) once weekly (group B). The protocol was amended in 2012 to allow oxaliplatin to be then foregone in both groups. RESULTS: Of 541 entered patients, 515 were eligible for analysis; 261 in group A and 254 in group B. Preoperative treatment acute toxicity was lower in group A than group B, P = 0.006; any toxicity being, respectively, 75% versus 83%, grade III-IV 23% versus 21% and toxic deaths 1% versus 3%. R0 resection rates (primary end point) and pathological complete response rates in groups A and B were, respectively, 77% versus 71%, P = 0.07, and 16% versus 12%, P = 0.17. The median follow-up was 35 months. At 3 years, the rates of overall survival and disease-free survival in groups A and B were, respectively, 73% versus 65%, P = 0.046, and 53% versus 52%, P = 0.85, together with the cumulative incidence of local failure and distant metastases being, respectively, 22% versus 21%, P = 0.82, and 30% versus 27%, P = 0.26. Postoperative and late complications rates in group A and group B were, respectively, 29% versus 25%, P = 0.18, and 20% versus 22%, P = 0.54. CONCLUSIONS: No differences were observed in local efficacy between 5 × 5 Gy with consolidation chemotherapy and long-course chemoradiation. Nevertheless, an improved overall survival and lower acute toxicity favours the 5 × 5 Gy schedule with consolidation chemotherapy. CLINICAL TRIAL NUMBER: The trial is registered as ClinicalTrials.gov number NCT00833131.

Selection and electrophoretic characterization of Salmonella enterica subsp. enterica biocide variants resistant to antibiotics.

The proposed research outlines a serious common concern of Salmonella resistance to antimicrobials following prolonged exposure to the disinfectants (biocides). These phenotypes of bacteria could potentially result in hard to treat infections. Typical for avian sources, biocide sensitive S. enterica subsp. enterica serovars: Typhimurium, Enteritidis, Virchow and Zanzibar and their isogenic biocide-tolerant variants were studied in order to investigate bacteriostatic effect of two commercially available biocide formulations: potassium peroxymonosulfate (P) and dodecylamine based structure (triamine, D). We found that cultivating of the bacteria in the medium supplemented with a blend containing P did not influence their antibiotic susceptibility pattern. In contrast, tolerance of bacteria to D compound resulted in resistance to co-trimoxazole, cefotaxime and ciprofloxacin of which two cefotaxime and ciprofloxacin are used commonly for the treatment of invasive Salmonella infections in humans. The dependency between OMP patterns and the level of Salmonella survival in media containing the biocides was observed merely in serovar Typhimurium. In conclusion, these results suggest that Salmonella strains challenged by prolonged treatment with the disinfectants become resistant to antibiotics, however it depends on Salmonella serovar and the chemical used. This paper also highlights the loop-mediated isothermal amplification (LAMP) as a technique that offers great benefits to microbiological detecting of Salmonella species in the samples.

Kidney transplantation does not increase the level of basic hope or life satisfaction compared with hemodialysis in patients with chronic kidney disease.

INTRODUCTION: Although renal replacement therapy can lead to improved health, it also can cause emotional disturbances in patients. It is believed that the success of renal replacement therapy hinges not only on medical parameters, but also on psychosocial factors, which is why modern medicine provides an ever-increasing role in the improvement of patients' quality of life. PURPOSE: The purpose of this study was to compare the level of life satisfaction, purpose in life, and basic hope in patients who had received renal replacement due to chronic kidney disease. We also tested whether the specific type of renal replacement therapy and kidney function parameters were influential factors on the above variables. PATIENTS AND METHODS: Sixty-one adult patients treated via renal replacement for chronic kidney disease took part in the study. Patients were divided into two groups: 31 hemodialysis patients (15 women and 16 men, ages 23-77 years, mean 51.19 years, SD 14.53 years) and 30 patients who had undergone kidney transplantation (14 women and 16 men, ages 22-69 years, mean 48.40 years, SD 12.64 years). The following research tools were used for analysis: Satisfaction With Life Scale (SWLS), Purpose in Life Test (PIL), and Basic Hope Inventory (BHI-12). RESULTS: There were no statistical differences in the level of satisfaction with life between hemodialysis patients and postkidney transplant patients. The results for the SWLS obtained from both groups fell within the normal range. The average SWLS for hemodialysis patients remained 20.61, SD = 5.79; for postkidney transplant patients, it was 22.57, SD = 5.16. The PIL level in the group of hemodialysis patients (101.5, SD = 15.64) was significantly lower than in the group of postkidney transplant patients (109.7, SD = 15.54). The average BHI-12 level was similar in both groups. The average BHI-12 result for hemodialysis patients was 29.00 (SD = 5.06), and for postkidney transplant patients 29.93 (SD = 3.55). The correlations between the psychological variables and selected biochemical parameters are worthy of particular attention. Among hemodialysis patients, there was an additional correlation between SWLS and hematocrit; whereas for postkidney transplant patients, there was an additional correlation of PIL and eGFR. CONCLUSIONS: Our data show that satisfaction with life and basic hope do not increase in patients after renal replacement therapy. The form of renal replacement therapy (hemodialysis or kidney transplantation) does not change the above variables. Patients treated via renal replacement require specialized psychological support to improve the efficacy of renal replacement therapy.

Vitamin B6 status, immune response and inflammation markers in kidney transplant recipients treated with polyclonal anti-thymocyte globulin.

BACKGROUND/OBJECTIVES: Vitamin B6 status has an impact on the body's inflammatory and immune responses. Immunosuppressive therapy may influence vitamin B6 metabolism in kidney transplant recipients. Treatment with polyclonal anti-thymocyte globulin (ATG) is associated with long-term changes in inflammatory and immune parameters. It is not known if ATG therapy also may have an impact on vitamin B6 status in kidney transplant recipients. We aimed to analyze the impact of therapy with ATG on vitamin B6 status, immune response, and the profile of inflammatory cytokines. SUBJECT/METHODS: This was a retrospective, observational study that included 44 kidney allograft recipients. Twenty patients received induction therapy with ATG (6 to 24 months before enrollment). Twenty-four patients constituted the control group, matched with respect to time since transplantation. The B6 vitamers, total lymphocyte count, CD3 percentage, interleukin (IL)-6, -7, and -10, transforming growth factor ß, interferon γ, and chemokine ligand 21 were analyzed in a study group. RESULTS: All indicators of vitamin B6 status were lower in the ATG group than in the control group. There were also significant differences with respect to immune response (significantly lower total lymphocyte count and CD3 in the ATG group) and inflammatory status (significantly higher IL-6 and IL-10 in the ATG group). Vitamin B6 vitamers and derivatives were not related to lymphocyte count and cytokine levels or to estimated glomerular filtration rate and age of the study population. CONCLUSIONS: Vitamin B6 stores and active forms are lower in kidney transplant recipients treated with ATG. ATG therapy promotes CD3 and total lymphocyte depletion and increases indicators of inflammation. We found no associations between vitamers of B6, immune response cells, and inflammatory cytokines in study population.

Epidemiology of posttransplantation chronic kidney disease can be altered by choice of formula estimating glomerular filtration rate.

BACKGROUND: Epidemiology of posttransplantation chronic kidney disease (CKDPT) has different characteristics than in the general population. Precise determination of glomerular filtration rate (GFR) is essential in the clinical decision making process as well as in management of a population that is based on epidemiological data. The aim of our study was to analyze the impact of an applied GFR estimation method on the epidemiology of CKDPT during the first year after transplantation. METHODS: We estimated GFR (eGFR) using the 4-variable Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula in 215 renal transplant recipients. We also measured and estimated creatinine clearance using the Cockroft-Gault (C-G) formula. Based on these data, we analyzed the influence of these formulas on the epidemiology of CKDPT. RESULTS: The largest fraction of patients is in stage 3 of CKDPT (40% to 62%). Application of the CKD-EPI formula instead of MDRD results in a decrease of prevalence of stage 3 by 3.9% at the early period (weeks 2 to 8) and by 13.8% at the late period (weeks 9 to 52) after transplantation. This is coexistent with reclassification from stage 3B to 3A and 3A to stage 2. Use of a measured or C-G-based creatinine clearance instead of the MDRD formula results in decrease of prevalace of stage 3 by 16.5% and 13%, respectively, in the early period and by 32.5% or 27%, respectively, in the late period. CONCLUSIONS: Epidemiology of CKDPT depends on the method of calculation of eGFR. Application of creatinine clearance or the C-G formula results in an increase of prevalence of patients with better graft function.

The modification of diet in renal disease and chronic kidney disease epidemiology collaboration formulas versus measured or estimated creatinine clearance in kidney transplant recipients.

BACKGROUND: Estimation of glomerular filtration rate (eGFR) after renal transplantation is performed with the use of methods that are standardized for a population of nontransplantation patients with chronic kidney disease. The aim of the study was to compare the performance of GFR estimation formulas in renal transplant recipients. METHODS: The Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas were compared with measured creatinine clearance or clearance estimated by the Cockroft-Gault (C-G) formula. The influence of age, body mass index, and eGFR on the relative performance of these formulas also was studied by subgroups analysis. RESULTS: Mean measured or estimated creatinine clearance overestimates the values of GFR calculated using the MDRD or CKD-EPI equation. This was statistically significant (P < .05) in whole-study population and in subgroups of patients at age above 25 years, with body mass index above 25, and in a subgroup with eGFR-MDRD <50 mL/min/m(2). The mean bias from creatinine clearance was 7.46 mL/min for MDRD, 4.4 mL/min for CKD-EPI and -1.65 mL/min for C-G formula. There was a statistically significant (P < .05) negative correlation between eGFR value and bias from creatinine clearance for all 3 methods of estimation. The correlation coefficient was -0.4 for MDRD, -0.36 for CKD-EPI, and -0.46 for C-G clearance. CONCLUSIONS: Measured and estimated creatinine clearance overestimate values of eGFR calculated by the MDRD or CKD-EPI formula in a population of kidney transplant recipients, especially in subjects with obesity and worse renal function. Accuracy of analyzed GFR estimation formulas decreases with deterioration of renal graft function.

Management and results of treatment of breast cancer patients having sentinel lymph node micrometastases.

According to current therapeutic guidelines, finding micrometastases in the sentinel node (SLN) of a patient with non-advanced breast cancer is not an absolute indication for adjuvant axillary lymph node dissection (ALND). This work presents our experiences regarding this clinical problem. 1071 breast cancer patients were referred for sentinel node biopsy between January 2004 and December 2011. Metastases were found in 245 of the removed lymph nodes. In 49 patients lymph node changes turned out to be micrometastases or isolated tumor cells (ITC). ALND was performed in 38 cases of sentinel node micrometastases or ICTs. In three patients involvement of other axillary lymph nodes was found in the studied tissue material (7.9% vs. 37.9% for metastases >2mm). The remaining patients with micrometastases in the SLN (11/49) were treated conservatively. No local axillary recurrences or neoplastic metastases were found in this group of patients with SLN micrometastases. Mean follow-up period in patients who had undergone ALND was 18.0 months (4 to 60 months) and 21.4 months (9-40 months) in patients without ALND. Non-radical surgical treatment in the presence of SLN micrometastases in patients with non-advanced breast cancer does not lead to therapeutic failure (local axillary recurrences, distant metastases). Obtaining favorable outcomes of conservative treatment in the analyzed group of patients does not require additional modification of the adjuvant therapy.

The loop-mediated isothermal amplification assay for rapid diagnosis of Babesia canis canis infections in dogs.

The aim of this study was to use a rapid and easy DNA-based test, the loop-mediated isothermal amplification (LAMP), for diagnosis of Babesia canis canis infections in dogs. 10 DNA samples of 18S RNA-A and 10 DNA samples of 18S RNA-B of B. canis canis were used in the study. LAMP method could successfully detect DNA in all examined samples down to 0.1 pg dilution. Obtained results suggest that this method has high specificity and sensitivity and can be applied in analytical laboratories in diagnosis of canine babesiosis.

Pesticide residues in raspberries (Rubus idaeus L.) and dietary risk assessment.

The aim of this study was to evaluate the residues of 140 pesticides in raspberries from north-eastern Poland (2005-2010). Gas chromatography with electron capture detector (GC-ECD) and nitrogen phosphorous detector (GC-NPD) was used. Among the 128 samples, 66 (51.6%) were found to detect residues: 14.1% contained one pesticide and around 38% multiple pesticide residues. The most frequently detected were pyrimethanil residues (36.0%). Twenty-seven (21.1%) raspberry samples exceeded the maximum residue limits. The estimated daily intakes ranged from 0.003% to 3.183% of the acceptable daily intake (ADI) for adults 0.008% and 9.7% for toddlers, respectively. The most critical case is procymidone, the acute risk was 180.9% of acute reference dose (ARfD) for toddlers and for adults (83% of ARfD) which is high.

HLA-B27 is a potential risk factor for posttransplantation diabetes mellitus in autosomal dominant polycystic kidney disease patients.

The aim of this work was to investigate HLA phenotype predisposition to posttransplantation diabetes mellitus (PTDM) in kidney transplant recipients stratified according to kidney failure etiology. Ninety-eight transplant recipient pairs with kidney grafts from the same cadaveric donor were qualified for the study. In each pair, 1 kidney was grafted to an individual with autosomal dominant polycystic kidney disease (ADPKD group) and 1 to recipient with a different cause of kidney failure (non-ADPKD group). All class II HLA antigens were determined with the PCR-SSP molecular method. To identify class I HLA molecules we used both molecular and serologic methods. Diabetes was diagnosed according to the American Diabetes Association criteria. The posttransplantation observation period was 12 months. In the ADPKD group, HLA-B27 was more common in PTDM than non-PTDM patients; 31.6% versus 11.4% (P = .069). The difference achieved significance when comparing insulin-treated with non-insulin-treated patients (44.4% vs 12.4%; P = .029). In the non-ADPKD group, HLA-A28 and HLA-B13 were observed more frequently in patients with PTDM than in recipients without diabetes (22.2% vs 2.5% [P = .0099] and 22.2% vs 3.8% [P = .020]). All of these associations were significant upon multivariate analysis. HLA-B27 allele is a factor predisposing ADPKD patients to insulin-dependent PTDM. Antigens predisposing to PTDM among kidney graft recipients without ADPKD include HLA-A28 and B13.

[Opportunistic infections in HIV-positive patients hospitalized in the Clinic of Infectious Diseases AMG]. / Infekcje oportunistyczne wystepujace u pacjentów zakazonych HIV hospitalizowanych w Klinice Chorób Zakaznych AMG.

UNLABELLED: Opportunistic infections are one of the major problem among HIV infected patients still connected with high mortality. The aim of the investigation is to evaluate the incidence and mortality from opportunistic infections in HIV infected population in Pomeranian region of Poland. The paper presents analysis of incidence of opportunistic infections among 141 AIDS patients hospitalised in Clinic for Infectious Diseases in Gdansk from 1988 to 2001/June/. In examined group 179 opportunistic infections were diagnosed. Most frequent was oesophageal candidiasis 58%, tuberculosis 29%, pneumocystis carinii pneumonia 21% and central nervous system toxoplasmosis 13%. The occurrence of opportunistic infections depends on CD4 count and rises with CD4 decline. Opportunistic infections were the reason of death in 33 from 74 cases/45%/. CONCLUSIONS: In examined group 28% of patients did not know about HIV infection when first opportunistic infection was diagnosed. Most frequent opportunistic infections in AIDS patients were oesophageal candidiasis, tuberculosis, pneumocystis carinii pneumonia and toxoplasmosis. In 98% of cases opportunistic infection developed when no HAART nor infection prophylaxis was administered. Opportunistic infection was the reason of death in 45% of cases, the most frequent were PCP and CNS toxoplasmosis.

[Sepsis in HIV-positive patients--own observation]. / Posocznice u HIV--dodatnich pacjentów w materiale wlasnym.

In the period of 1988-2001 (June) 24 HIV-positive patients with symptoms of sepsis were observed. Most of them (17 persons) were intravenous drug addicts, six patients were infected HIV trough sexual contact and one person-via blood transfusion. There were 26 cases analyzed (one of the patients went trough three episodes of sepsis). Bacterial sepsis dominated (22 cases). In three patients fungoid etiology was diagnosed, and one case was of mixed character. The highest risk factors of sepsis were: intravenous drug addiction and advanced stage of HIV infection.

Value of magnetic resonance cholangiography (MRC) in primary sclerosing cholangitis (PSC).

BACKGROUND: Magnetic resonance cholangiography is a relatively new method, hence it has not gained a proper status yet in the diagnostic algorithm in patients with bile duct diseases. Many authors believe that MRC is an effective method for the visualisation of bile ducts. The aim of the study is to evaluate MRC usefulness in patients with PSC. MATERIAL AND METHODS: The study material consisted of 4 patients with PSC (3 men and 1 woman) aged 23-50 years. Patients were subjected to liver MRI in transverse plane, and T1 and T2-weighted images were obtained. Additionally, magnetic resonance cholangiography was performed with Gyroscan 0.5 T unit and Magnevist contrast medium. RESULTS: The patients manifested cholestasis and hepatitis of different duration (range: 2-14 years). The biochemical analyses revealed FA ranging from 563 to 1114 IU/l, GGTP 157-1270 IU/L, AlAT 56-295 IU/L, AspAT 80-190 IU/L. Three out of four patients displayed significant increase in the level of ANCA antibodies. Histopathological investigation of the liver, conducted in 3 out of 4 patients, showed cholangitis et pericholangitis. ERCP was attempted in all the patients. In one case, irregular, overlapping and narrowed bile ducts were found, while in two cases it was impossible to fill intrahepatic ducts. ERCP was not performed due to technical obstacles encountered in one patient. All the subjects underwent MRC. In three cases, the segmental irregular dilatation of intrahepatic ducts was observed, while in one case intrahepatic ducts were poorly marked. The defect in the filling of initial segment of common bile duct was diagnosed in one patient. Another patient had a lesion adjacent to common bile duct--low signal intensity in T1 and the intensification after the administration of contrast medium indicate the presence of expansive process. CONCLUSIONS: 1. MRC is an accurate examination enabling the visualisation of all bile ducts in their natural size. 2. Simultaneous MRI of the liver allows for the diagnosis of focal lesions. 3. MRC may be used in those cases, where ERCP cannot be performed for technical reasons or when it is objected by the patient.

Isolation in cell culture of nodavirus from farmed Atlantic halibut Hippoglossus hippoglossus in Norway.

Isolation in cell culture of nodavirus from Atlantic halibut Hippoglossus hippoglossus suffering from viral encephalopathy and retinopathy (VER) is described. The cell line SSN-1 was inoculated with tissue material from affected juveniles (60 d after first feeding). Extensive cytopathic effects (CPE) developed approximately 5 d after inoculation, and were also observed after several passages in the same cell line. Cells from infected cultures showed reactivity with an antiserum against sea bass Dicentrarchus labrax nodavirus in an indirect immunofluorescence test. Analysis of infected cells with reverse transcriptase-polymerase chain reaction (RT-PCR) resulted in a product of the predicted size using primers specific for striped jack Pseudocaranx dentex nodavirus. Electron micrographs of infected SSN-1 cells demonstrated virus particles that were approximately less than 30 nm. Challenge of Atlantic halibut larvae (4 d post-hatching) with supernatants from infected SSN-1 cells resulted in development of VER as verified by immunohistochemistry performed on larvae sampled from Day 9 after challenge. The present results show that a nodavirus from Atlantic halibut has been isolated using the SSN-1 cell line and that virus propagated in cell culture retained virulence.