Serum bilirubin concentration as a marker of severity of acute appendicitis.

INTRODUCTION: Acute appendicitis (AA) is one of the most common causes of urgent admission to the hospital. Clinically applicable classification distinguishes simple and complex inflammation. Among commonly used inflammation markers of AA, bilirubin concentration is not well studied and thus is rarely applied. AIM: To examine the association between increased serum total bilirubin concentration and the severity of AA. MATERIAL AND METHODS: This retrospective study included 169 patients with a presumptive diagnosis of AA who were operated upon between 2015 and 2017. The determined study endpoints were simple complex inflammation and a different diagnosis after surgery. The Mann-Whitney U, Kruskal-Wallis, Fisher's exact, Spearman correlation coefficient and logistic regression tests and receiver-operating characteristics (ROC) were used in analyses. The area under the curve (AUC) was presented with 95% confidence intervals (95% CIs). Statistical significance was set at 0.05. RESULTS: In total, 84 (49.7%) patients underwent laparotomy and 85 (50.3%) laparoscopy. After surgery, 45 (26.6%) patients had a diagnosis other than AA. Furthermore, 83 (49.1%) and 41 (24.3%) patients had simple and complex AA, respectively. The median bilirubin concentration was 0.56, 0.69, and 1.08 mg/dl in patients without AA, with simple, and complex AA, respectively (p < 0.01). The optimal cut-off for serum bilirubin concentration to predict AA severity was ≥ 0.94 mg/dl (AUC = 0.652; 95% CI: 0.543-0.761) with a 44.9% positive and 83.9% negative predictive value (p = 0.006). CONCLUSIONS: The serum bilirubin concentration should be considered as one of the possible markers of AA. Moreover, it can be used to predict the severity of AA.

Bone marrow harvest from unrelated donors-up-to-date methodology.

OBJECTIVES: Bone marrow harvesting is one of the essential sources of stem cells for hematopoietic stem cell transplantation. We describe here the current "up-to-date" standard of the bone marrow harvest in unrelated stem cell donors. METHODS: We analyzed medical data of 187 unrelated hematopoietic stem cell donors who underwent bone marrow harvest without previous peripheral blood stem collection at the center between 2011 and 2015. The methodology of marrow collection includes multiple cells aimed at safety of the procedure, for example, educational movie, modified skin disinfection protocol, cell enumeration during the procedure, reduction of the contamination surfaces, and ongoing monitoring of the quality of work of the doctors. RESULTS: The total nucleated cell count over 2×108 per kg of recipient has been reached in 93.6% of harvests. All of the donors harvested more than 1×108 per kg of the recipient. There were no donors who required transfusions or had serious adverse events during and after the harvest. CONCLUSION: We describe here the current up-to-date standard of bone marrow harvest, which leads to excellent results in majority of donors without causing significant complications during the donation.

ApaI polymorphism of vitamin D receptor affects health-related quality of life in patients with primary sclerosing cholangitis.

BACKGROUND: Polymorphisms of vitamin D receptor (VDR) contribute to the pathogenesis of multiple autoimmune conditions. METHODS: We investigated the incidence of VDR polymorphisms (rs1544410-BsmI; rs7975232-ApaI; rs731236-TaqI) in a group of patients with primary sclerosing cholangitis (PSC, n = 275) and in healthy controls (n = 376). Additionally, correlations of the VDR polymorphisms with clinical and biochemical factors of the disease were analysed. RESULTS: The genotype and allele distributions of these polymorphisms in PSC patients were similar to those observed in controls. However, the ApaI polymorphism was associated with an impaired health-related quality of life (HRQoL). The generic SF-36 questionnaire showed that the Role-Physical (p = 0.01), Role-Emotional (p = 0.01), Physical Component Summary (p = 0.01) and Mental Component Summary (p = 0.003) scores were significantly affected. Similarly, the disease-specific questionnaires, PBC-40 and PBC-27, demonstrated that carriers of the C allele suffered from more severe Itch (p = 0.03 assessed by PBC-40 and PBC-27), more Fatigue (p = 0.02 assessed by PBC-40 and PBC-27) and Impaired Cognitive Capacity (p = 0.04 and p = 0.03). Correspondingly, individuals who were AA homozygotes (non-carriers of the C allele of ApaI) had higher summary scores for the Physical (p = 0.01) and Mental Components (p = 0.006) measured with SF-36. Moreover, they experienced less itch (p = 0.03) and less Fatigue (p = 0.03) and had better Cognitive Abilities (p = 0.04) as assessed by the PBC-40 and PBC-27 questionnaires. No associations between other VDR polymorphisms and clinical or laboratory findings were made. CONCLUSION: In summary, this study is the first to show that the ApaI polymorphisms in VDR may exert an effect on disease-related symptoms and quality of life in patients with PSC.

The comparison of usefulness prosthetic rehabilitation with removable and fixed suprastructures on endosseous implants.

Advanced atrophy bone in edentulous jaws is a serious problem for conventional prosthodontics. The advent of implantology, as well as guided reconstruction of bones, has opened new possibilities for conventional prosthodontic suprastructures. The turning point in implantology occurred in the sixties and was promoted by a Swedish orthopaedist Brånemark. Nowadays, implants are inserted routinely without creating any significant problems to a skillful maxillofacial surgeon. This study was performed in 73 patients who had 77 prosthodontic suprastructures (fixed suprastructures in 58 and removable in 15 patients) placed on a total of 331 implants. Three types--blade, cylindrical and screw implants, were used. Patients with both total and partial defects had typical removable and fixed suprastructures installed. All patients were followed radiologically and clinically. Pantomographic images taken at different stages of the study served to measure bone atrophy near the implants. The atrophy of bones near implants supported by removable prosthodontic suprastructures was compared with fixed suprastructures. Dental bridges were made and supported by implants and by the patient's own teeth at the same time. Removable suprastructures, however, were supported mainly by implants connected with bars or implants with ball attachments. The prothesis saddle rested on the epithelium of the oral cavity. Following location of the implants, lower and upper jaws were divided into four regions. Statistical data served to determine in which of the four regions atrophy of bones was most and least advanced taking into consideration the type of implant and type of prosthodontic suprastructure. Record was made of the region, stage and implant which underwent explantation. Radiographs taken before and after implantoprosthetic rehabilitation demonstrated that atrophy of bones did not occur in 106 cases. Six patients underwent reconstruction of bones near the implants. Statistics showed that fixed prosthodontic suprastructures are superior to removable as far as jaw rehabilitation is concerned. Atrophy of bones near implants supported by fixed suprastructures was smaller. Nevertheless, usefulness of the removable suprastructures cannot be questioned. Not only do they represent an effective solution, but are far less expensive than fixed. Statistics revealed that the best regions to install implants include the presinusal (I) and interforaminal regions (II). The least advanced atrophy of bones occurred near screw implants (0.8 mm in region I, 0.7 mm in region II, 0.3 mm in subantal region (III) and 1.3 mm in postforaminal region (IV)). On the other hand, the most advanced atrophy occurred near blade implants (1.7 mm in region III and 3.3 mm in region IV). Twelve out of 331 implants were lost (3.6%)--seven during the healing process and five after placement of suprastructures (all cylindrical), contributing to successful implantoprosthetic therapy in 96.4% of cases. One out of twelve implants was lost in the mandible and eleven in the maxilla indicating that the mandible is more suitable for implantation. On the basis of this prospective study it can be concluded that further progress in implantoprosthetics, a relatively new branch of dentistry, will open new possibilities for prosthetic therapy.

[Comparison of interleukin-6 and C-reactive protein serum concentrations assessment in diagnosis of infective endocarditis]. / Porównanie przydatnosci oznaczania stezenia interleukiny-6 i bialka C-reaktywnego w diagnostyce infekcyjnego zapalenia wsierdzia.

UNLABELLED: Serum interleukin-6 (IL-6) level might be used to aid in diagnosis of infective endocarditis (IE), especially when blood cultures are negative. One of typical acute phase proteins is C-reactive protein (CRP), often served as an additional inflammation maker. The aim of the study was to compare serum IL-6 and CRP concentrations assessment in diagnosis and monitoring of IE. The study group consisted of 40 patients with ongoing IE and valvular heart diseases. Two control groups consisted of patients with valvular heart diseases: 15 without infection and another 15 with urinary tract infection. The diagnosis of IE was established according to the Duke University criteria; in 34 patients positive blood cultures were found. Serum IL-6 and CRP were measured on three occasions after diagnosis of IE was established and during antimicrobial treatment (mean period 14 +/- 7 days) by ELISA. Usefulness of both parameters for IE diagnosis were described. Reference values were defined as 0-12.5 pg/ml for IL-6, and 0-10 mg/l for CRP. Mean concentrations of IL-6 and CRP in patients with IE (37 +/- 44.3 pg/ml and 27.1 +/- 23.9 mg/l) were significantly higher than in controls: with urinary tract infection (9.1 +/- 4.42 pg/ml and 6.95 +/- 4.39 mg/l) and without infection (3.95 +/- 1.4 pg/ml and 2.21 +/- 0.96 mg/l). CRP concentration was not significantly correlated with IL-6 (r = 0.51, p = 0.07). The significant tendency of consecutive IL-6 concentrations to decrease (from 37 +/- 44.3 to 8.7 +/- 5.7 pg/ml), without decrease of CRP (from 27.1 +/- 23.9 mg/l to 22 +/- 18.3 mg/l) was found. CONCLUSIONS: 1. Elevated serum IL-6 and CRP levels may suggest ongoing IE. 2. Sensitivity, specificity, positive and negative predictive value are nonsignificantly higher for IL-6 than CRP. 3. Combined assessment of serum IL-6 and CRP concentration has no higher value in diagnosis of IE. 4, IL-6 level decrease is faster than CRP during antimicrobial treatment, and it helps better and faster monitoring of treatment.