Association of silicone breast implants and acute renal allograft rejection.

Silicone may, like any other adjuvant, induce an inflammatory reaction and diseases. There is no data about its use in renal transplant recipients. Increased immunogenicity of silicon may manifest by activation of both the innate and the adaptive immune system cells what promotes a chronic pro-inflammatory response. Dendritic cells, macrophages, fibroblasts and T-cells have all been found at the capsule/silicone implant contact zone. Additionally, silicon may induce mononuclear cells to secrete proinflammatory cytokines IL-1ß, IL-6 and TNF-α. Herein, we present two patients who developed acute rejection after breast augmentation and reconstruction with silicone-gel implants. By influencing the immunological and inflammatory response, silicone-gel may be involved in promotion of acute allograft rejection in renal transplant recipients. Further studies are needed to prove our hypothesis.

Development of the National Transplant Program Has Significantly Decreased but Not Ended Transplant Tourism in Montenegro.

Organ transplantation has prolonged and improved the lives of many patients around the world. However, a widespread shortage of donors remains the main factor that has led to organ trafficking and transplant tourism. To stop transplant tourism and to provide optimal treatment for its citizens with end-stage renal disease, Montenegro started performing renal transplantations in September 2012. Thirty-five transplantations have been performed since that time, 34 from living donors and only 1 from a deceased donor. This practice has significantly decreased but not ended transplant tourism in Montenegro.

Epidemiology of end-stage renal disease and current status of hemodialysis in Yugoslavia.

Maintenance hemodialysis (HD) in Yugoslavia started in the sixties and followed the dialysis trends in the Western Europe. However, in the last decade the development of renal replacement therapy (RRT) slowed down. In this report the epidemiology of ESRD from 1997-1999 and the survey of the status of HD treatment in Yugoslavia in 1999 are presented. Epidemiological data are obtained by the annual center questionnaires (response rate: 92.6 -94.2%). The survey of HD status is based on a specific questionnaire and covered 2108 patients (65%). At the end of 1999 there were 56 RRT centers in Yugoslavia treating 3939 patients: 3232 (82%) patients by HD, 248 (6.3%) by peritoneal dialysis, and 459 (11.7%) living with transplanted kidney. In a three year period, incidence of ESRD ranged from 108-128 pmp, point prevalence from 435-463 pmp and mortality rate from 20.7-17.9. Numerous refugee patients were treated over the last 10 years. Main causes of ESRD were glomerulonephritis (30%); Balkan nephropathy represented 11% and diabetic nephropathy 7% of all primary renal diseases. Cardiovascular and cerebrovascular diseases were the most common causes of death of RRT patients. Most centers are overcrowded and HD machines are worn out. Mean Kt/V was 1.19+/-0.08, mean URR% 58.8+/-7.4. The shortage of drugs prevented adequate management: 83% of HD patients had hemoglobin level less than 100 g/L but only 10.3 -17.8% were treated with rHuEpo; 64.5% of patients had phosphate levels higher than 1.7 mmol/L but only 33.5% used phosphate binders; 47% of patients had hypertension despite the antihypertensive therapy. The prevalence of hepatitis B remained unchanged (about 14%) in HD population during the last three years, but the prevalence of anti-HCV positive patients decreased (31-23%). In conclusion, there is a well developed dialysis service in Yugoslavia but insufficient conditions for adequate treatment.

Colonic vasoactive intestinal polypeptide (VIP) in ulcerative colitis--a radioimmunoassay and immunohistochemical study.

BACKGROUND/AIMS: In this study, we present radioimmunoassay data describing the concentration of Vasoactive Intestinal Polypeptide (VIP) in both plasma and colonic biopsies, as well as immunostaining of VIPergic innervation in mucosal biopsies of normal subjects and patients with ulcerative colitis (UC). PATIENTS AND METHODS: Thirty three patients with UC and 17 healthy subjects were investigated. All UC patients suffered from active disease. Fasting circulating levels of VIP in plasma as well as tissue concentrations were measured by radioimmunoassay. For the immunohistochemistry, polyclonal antibody against VIP and the streptavidin-biotin peroxidase complex technique were carried out. RESULTS: Overall plasma VIP concentrations in the UC patients were similar to those in the controls. Significantly decreased concentrations of VIP were found in UC of rectum compared to the normal tissue. However, both plasma VIP values and tissue concentrations were found to be significantly lower in patients expressing minimal or mild active disease according to clinical activity index (AI) and histological activity index (HAI), but marked increase of plasma VIP was clear in UC patients with moderate or severe AI and HAI. There was a trend towards increased tissue concentrations of VIP in the group of patients with moderate or severe AI and HAI. Our immunohistochemical analysis of VIP fibers and nerve cell bodies revealed consistently weaker VIP-immunoreactivity in the rectum in UC patients with minimal or mild HAI. Simultaneously, in the rectal biopsies from UC patients with moderate and severe disease, the fibers in the lamina propria and ganglion cells in the submucous plexus were markedly increased in density and in degree of immunostaining. Very strong immunoreactivity was also found in inflammatory cells of the lamina propria as well as in the epithelial layer of the biopsies from UC patients with obvious disease. CONCLUSIONS: Our study shows clearly the heterogeneity in the response of VIP plasma level as well as rectum concentration and distribution in UC patients at different stages of the active disease. The possible role of VIP in the colon suggests that further studies of the alterations of this gut peptide may be useful in the understanding of UC pathophysiology.

Changes in neuropeptide levels after brain damage in rats.

The physiological and pathophysiological roles of neuropeptides are still not clear. The aim of our study was to detect long lasting changes of vasoactive-intestinal peptide (VIP), somatostatin (SOM) and substance P (SP) contents in the rat cerebral cortex and hippocampus after brain lesion. The experiments were performed on groups of adult male Wistar rats. The first group consisted of animals with unilateral ablation of the sensorimotor cortex performed at the age of 60 days. The second group was a control one (rats of the same age but with an intact brain). Both groups of animals were sacrificed at the age of 90-105 days and radioimmunoassay was used to determine amounts of VIP, SOM and SP. The mean values of VIP levels were decreased significantly only in contralateral cortical areas, while there was an increase of SP in lesioned animals. Our results suggest that descrete changes in neuropeptide levels occur during restorative processes after brain lesion.

[Relation between pyloric dysmotility and serum levels of gastrin, somatostatin and vasoactive intestinal polypeptide in patients with non-insulin dependent diabetes mellitus]. / Odonos pilorusnog dismotiliteta i serumskih vrednosti gastrina, somatostatina i vazoaktivnog intestinalnog polipeptida u bolesnika s insulinnezavinim dijabetes melitusom.

Serum levels of gastrin, somatostatin and vasoactive intestinal polypeptide were evaluated in 105 noninsulin dependent diabetics (25 of them had a pyloric dysfunction). The serum levels were determined by RIA and blood was taken before and after the test meal. The basal gastrin level was significantly higher in patients with the pyloric dysfunction (p < 0.001). 45 minutes later the serum levels of vasoactive intestinal polypeptide and somatostatin were significantly higher in diabetics with the pyloric dysfunction (p < 0.001). The serum levels of gastrin, somatostatin and vasoactive intestinal polypeptide were impaired in diabetics with the pyloric dysfunction and might be associated with its pathogenesis.

[Association of autonomic neuropathies and gastrointestinal peptides in non-insulin dependent diabetics]. / Ispitivanje povezanosti autonomne neuropatije i gastrointestinalnih peptida u insulinnezavisnih dijabeticara.

Basal and postprandial levels of gastrin, somatostatin, vasoactive intestinal polypeptide (VIP) and pancreatic polypeptide (PP) were followed up in 105 patients with non insulin dependent diabetes mellitus (20 with autonomic neuropathy only, 35 with peripheric neuropathy only, 30 with autonomic and peripheric neuropathy simultaneously and 20 without any sign of neuropathy) and in the control group of 40 individuals. Serum levels of gastrin, somatostatin, VIP and PP are determined by a RIA (used kits of Prof. SR Bloom, Hammersmith Hospital, London). The results of investigation showed significantly higher basal and postprandial levels of gastrin and VIP in patients with autonomic neuropathy in comparison with the group without neuropathy and with the control group (p < 0.001). The serum levels of somatostatin did not differ significantly between the groups of diabetics with and without neuropathy. Basal level of PP was significantly lower and postprandial PP levels remained low in patients with autonomic neuropathy in comparison with the group without neuropathy (p < 0.001). We postulate that basal and postprandial gastrin and VIP levels raised secondary to partial vagotomy in diabetics with autonomic neuropathy. Measuring PP serum levels in diabetics after a protein rich meal can be useful to check vagus nerve function in the gastrointestinal tract in order to detect autonomic neuropathy.

TSH-receptors and prognostic value of their analysis.

TSH receptors were analyzed by equilibrium binding method of Scatchard in nodular and perinodular specimens surgically obtained from nine patients suffering from thyroid nodular goiter, which were clinically euthyroid. Among these patients, the group of those at "real risk" for reappearance of postoperative thyroid nodule in follow-up period was formed. The obtained results showed that there were no significant differences in specific 125I-bTSH binding between perinodular (assumed to be normal by PH analysis) and nodular tissues. The level of high affinity receptors was higher in perinodular than nodular specimens, while low affinity binding sites were increased in nodular tissue. Decreased level of high affinity and increased content of low affinity binding sites were observed in perinodular compared to nodular specimens obtained from patients of "real risk" group. These results give evidences for real risk of postoperative compensatory hypertrophy and thyroid goiter relapse in follow-up during long-term period.

Thyrotropin receptors, thyroid hormones and thyroglobulin in patients with Hashimoto's thyroiditis.

TSH receptors in plasma membranes of thyroid nodular and perinodular tissue and the concentration of thyroid hormones and thyroglobulin in serum were estimated in patients with Hashimoto's thyroiditis (HT) and in six persons with scintigraphically cold thyroid nodules (AFN). In perinodular tissue of HT patients specific binding of 125I-bTSH was found to be significantly decreased (1.50 +/- 0.13%; mean +/- S.E.) as compared with AFN patients (2.79 +/- 0.53%), whereas any significant difference in hormone binding to nodular tissues between both examined groups was not detected. Scatchard analysis of TSH binding revealed two kinds of binding sites for both thyroid tissues of all examined patients. The capacity of high affinity binding sites in both thyroid tissues of HT patients was found to be decreased (3.92 +/- 0.86 fmol/mg protein in nodular tissue and 5.93 +/- 1.16 fmol/mg protein in perinodular tissue) in comparison with these tissues of AFN patients (18.80 +/- 18.36 and 32.24 +/- 33.38, respectively). Any differences in dissociation constant and capacity of low affinity binding sites between analysed groups were not observed. Serum TSH levels of HT patients were higher than these in AFN patients and were not significantly changed after surgical treatment. Any difference in triiodothyronine (T3) levels between analysed groups was not detected, while the concentration of thyroxine (T4) was lower in HT than in AFN and significantly decreased after the excision of thyroid gland. Thyroglobulin levels were significantly changed after surgical treatment in both analysed groups.

Thyroid functional status and TSH receptors of cold nodular tissue.

TSH receptors of plasma membrane fractions of human cold thyroid adenoma and perinodular thyroid tissues (PTT), assumed by pathohistological analysis to be normal, were examined. In perinodular thyroid tissues (PTT) obtained by partial thyroidectomy from twelve euthyroid female patients 125I-TSH binding (as determined by equilibrium binding analysis on particulate plasma membrane preparations) was found to be significantly increased as compared with scintigraphically cold thyroid nodular tissues (CTN). In all examined thyroid tissues Scatchard analysis of TSH binding revealed two kinds of binding sites: these with high affinity showed a significantly increased dissociation constant (Kd1), while these with low affinity showed a decreased dissociation constant (Kd2) in PTT as compared with CTN. The capacity of low affinity binding sites in PTT was found to be decreased in comparison with CTN tissues. These results suggest that the changes in affinity of TSH receptors sites as well as iodine deficiency of thyroid tissues may be an important events in functional status of analysed perinodular and cold nodular thyroid tissues.

Effect of prostaglandin PGE2alpha on the synthesis of placental proteins and human placental lactogen (HPL).

The biosynthesis of placental proteins and placental lactogen (HPL) was studied in vitro in 10-12 week, 16-18 week and term human placenta in the presence and absence of PGF2alpha. The highest 14C-leucine incorporation was detected in 10 to 12 weeks old placentas of PGF2alpha to the incubation medium depressed the rate of incorporation of 14C-leucine into placental proteins in a dose dependent manner. Placentas most sensitive to this action of PGF2alpha were those obtained at 18 weeks of gestation followed by placentas at term. In vivo application of PGF2alpha for therapeutic induction of abortions resulted in the marked inhibition of placental protein synthesis in vitro.