[Renal denervation 2013]. / Renální denervace 2013.

Arterial hypertension is a worldwide serious clinical problem. It affects 30- 40% of the adult population. Resistant hypertension is defined as systolic blood pressure that remains 140mmHg while in the doctors surgery and/ or as average systolic blood pressure during a 24- hour monitoring of an outpatient 130mmHg after a combination of three antihypertensive agents (including a diuretic) has been administered in the maximum tolerated dose amounts. Renal denervation is an invasive method of catheter radio frequency ablation of sympathetic nerves located in the walls of renal arteries. The results of the Symplicity HTN 1 and HTN 2 trials proved that renal denervation can safely decrease blood pressure in patients with resistant hypertension. Further research is necessary in order to verify these data, to clarify the questions which remained unanswered and to evaluate future applications of renal denervation. Current experience and recommendations are included, as well as an overview of existing denervation devices and devices which are in development.

[Pharmacotherapy following myocardial infarction]. / Farmakoterapie po srdecním infarktu.

Early reperfusion is the treatment of choice for acute coronary syndrome. In the Czech Republic, reperfusion therapy is well accessible thanks to the network of 22 catheterization centres. Every year, 28,000 patients are treated using this technique. Successful reperfusion should be followed by life style changes--smoking cessation, maintenance of appropriate body weight etc. These steps than has to be accompanied by effective pharmacotherapy to prevent remodelling of the left ventricle, re-stenosis of the coronary artery, re-thrombosis and arrhythmias. Four drug groups provide the desired effects--renin-angiotensin-aldosterone system blockers, beta-blockers, antiplatelet agents and statins.

[Myocarditis]. / Myokarditidy.

Myocarditis is a disorder with a wide range of symptoms spanning from light breathlessness or chest pain, ceasing without specific treatment, through cardiogenic shock, requiring left ventricular assistance, to sudden death. Dilated cardiomyopathy with chronic cardiac failure might be the very consequence of the precedent myocarditis. Myocarditis is the most frequently caused by viral infections, less frequently by specific infections, toxic or hypersensitivity reactions to medicines, giant cell myocarditis or sarcoidosis. Prognosis and treatment differ according to the cause, clinical or haemodynamic signs inform decision-making on care provided by cardiology centres, including decisions on execution and interpretation of myocardial biopsy. The present overview aims to provide practical guidance on diagnosis and treatment of myocardial inflammation.

Genetics of humoral and cytokine activation in heart failure and its importance for risk stratification of patients.

The study objective is to prove an association among plasma concentration of big endothelin and endothelin-1, other clinical parameters and two frequent polymorphisms - G8002A and -3A/-4A - in the endothelin-1 (EDN-1) coding gene (6p21-23), and among plasma concentration of TNF alpha and gene polymorphisms TNF alpha -308 A/G, -238 A/G, TNF beta Ncol and 3'TACE (tumour necrosis factor alpha converting enzyme) in patients with chronic heart failure (CHF). The second objective is to find an association between polymorphisms G8002A and -3A/4A EDN-1 with diabetes mellitus (DM), peripheral artery disease (PAD) and myocardial infarction (MI) in patients with chronic heart failure (CHF). The study population included 266 patients with symptomatic CHF and proven dysfunction of the left ventricle (LV). Genotyping and plasma concentrations of humoral substances were examined in 224 patients with ejection fraction (EF) below 40%. No associations between plasma concentrations of endothelin-1 and big endothelin and polymorphisms G8002A (p=0.87, p=0.81) and -3A/-4A (p=0.871, p=0.749) in the gene coding endothelin-1 were found. No associations were observed between plasma concentration of TNF alpha and genotypes in four polymorphisms in TNF alpha, beta and TACE genes. A significant correlation was seen between plasma concentration of big endothelin and pulmonary congestion. Patients with ischemic heart disease (IHD) and previous MI showed a difference in the distribution of genotype G8002A for endothelin-1: allele G 0.718 and A 0.282 vs those without MI: allele G 0.882 and A 0.118, (p<0.05). Patients with IHD and DM had allele G in 0.67 and A 0.33, while those without DM had allele G in 0.790 and A in 0.209 (p<0.03). Patients with IHD and concomitant PAD had allele G in 0.718 and A in 0.282 vs those without PAD allele G in 0.882 and A in 0.118 (p<0.0004). Patients with dilative cardiomyopathy (DCMP) showed no differences in genotype G8002A and presence of DM or PAD. It might be speculated that in the case of endothelin-1 and TNF alpha in CHF the genetic determination is not important, and plasma concentrations are influenced more by the disease severity. Ischemics with previous MI, concomitant DM or PAD showed more frequently allele A and less often allele G than those without these diseases. A genotype with allele A is associated with higher risk of concomitant diseases.

Prevalence and pathogenicity of Cryptosporidium andersoni in one herd of beef cattle.

Over a 35-week period from January to July 2002, a breed of Hereford beef cattle (H) and their hybrids were monitored. Five hundred and ninety-nine individual fecal samples from calves and 96 samples from their mothers were examined. First excretion of Cryptosporidium andersoni oocysts in calves was found in the 9th week after the start of calving (a calf 63-day old). The prevalence of C. andersoni in calves ranged from 11.1 to 92.9% depending on age. The mean prevalence in their mothers was found to be 43.8%. The size of oocysts was 8.48 +/- 0.78 x 6.41 +/- 0.59 microm. Infection intensity in calves ranged from 32 000 to 4 375 000 oocysts per gram (OPG) and in mothers from 78 000 to 2 552 000 OPG. Three cases of abomasal cryptosporidiosis slaughtered at the age of 81, 157 and 236 days were examined histologically and ultrastructurally [transmission electron microscopy (TEM) and scanning electron microscopy (SEM)]. Cryptosporidium infection of the abomasum was located in the upper half of the mucosal glands in the plicae spirales of the fundus, corpus and near the ostium omasoabomasicum. Cryptosporidia were not located in the glandular epithelium of the pars pylorica in the abomasum minimally 10 cm from pylorus. Histopathological changes in the site of cryptosporidial infection in the abomasum had a non-inflammatory character and included distinctive dilatation of infected parts of the glands with atrophy and metaplasia of the glandular epithelial cells, goblet cell activation and mucus hyperproduction. The TEM revealed a relatively small number of Cryptosporidium life cycle stages attached to glandular epithelial cells. In SEM the inner mucosal abomasal surface appeared swollen but was never infected by cryptosporidia.

[Disorders of laminins in diseases of myocardial and skeletal muscles]. / Poruchy laminu u postizení srdce a kosterního svalstva.

UNLABELLED: The Emery-Dreifuss muscular dystrophy is caused by muscular lesions and disorders of cardial rhythm and/or by cardiomyopathy. An autosomal dominant form is related to mutations of genes, which are coding for lamins A/C. GROUP AND METHODS: In the group A the authors examined 37 patients with the diagnosis of dilatation cardiomyopathy (DKMP) and the mean ejection fraction 28.4; 8.8%. In the group B of 13 patients a cardiac stimulator was implanted for a rhythm disorder. Both groups were subjected to cardiological, neurological, clinical and electromyographic (EMG) examinations. A muscle biopsy from m. vastus lateralis was made and the sample was evaluated by histology, histochemistry and immunohistochemistry. The coding sequences of genes for lamins were amplified by polymerase chain reaction and the products were analyzed by the DHPLC method (denaturing higher performance liquid chromatography). RESULTS: In the group A there was a clinically myopathic picture in three patients, while EMG examination revealed a myogenic finding in 12 patients and a marginally myogenic one in five patients. The histological finding in 12 patients was evaluated as myogenic and marginally myogenic in six. In one patient the mutation analysis revealed mutation in the gene for lamin A/C. A myogenic finding in this patient was determined by EMG as well as by histological examination and the autosomal dominant form of the Emery-Dreifuss muscular dystrophy was therefore diagnosed. In the group B one patient displayed a myopathic neurological finding and a myogenic finding during EMG. A subsequent mutation analysis revealed a mutation in the gene for lamin A/C. The case was therefore the autosomal dominant form of the Emery-Dreifuss muscular dystrophy. In the other patients the clinically marginal myopathic finding was observed once, a marginally myogenic finding during EMG was seen five times, histology and immunochemistry revealed a myogenic finding once and a marginally myogenic finding also once. The other findings were within normal range. CONCLUSIONS: A careful neurological examination including EMG determined symptoms of skeletal muscle myopathies in a surprisingly high percentage of our cardiological patients. This observation draws attention to the need of neurological examination in patients with DKMP in order to discovered disorder in this area in time. In two patients mutations in genes coding lamins A/C were detected. It would be useful to analyze also genes coding for other cytoskeletal proteins in the future.

[Beta-blockers in the treatment of chronic heart failure. How should results of clinical studies be introduced into clinical practice]. / Betablokátory v lécbe chronického srdecního selhání. Jak prevést výsledky klinických studií do lékarské praxe.

The long-term action of elevated catecholamine concentrations on the heart muscle causes a number of adverse effects from apoptosis to malignant arrhythmia or terminal failure of the cardiac pump. Recently completed mortality studies with beta-blockers (BB) in chronic heart failure CIBIS II and MERIT HF confirmed the conclusions of pilot studies with carvedilol that in stabilized chronic heart failure BB reduces the mortality rate as well as the need of hospital admission on account of deteriorating heart failure. Proper selection of patients for administration of BB is necessary, assessment of absolute and relative contraindications. It is also necessary to define the initiation and increase of dosage and the target dose of the beta-blocker. The sooner treatment with beta-blockers is started, the greater the foreseen benefit for the patient.

Congenital fibropapillomatosis in a piglet.

We report a case of congenital fibropapillomatosis in the head and neck of a piglet from a swine breeding farm where sporadic cutaneous papillomas of the prepuce and scrotum had previously occurred in several boars. Histologically, the tumor consisted of multiple exophytic, papillary projections composed of branching, densely cellular, fibrovascular stalks covered by hyperplastic keratizing squamous epithelium. Ultrastructural examination failed to reveal viral particles. Cutaneous papillomatosis is rare in swine. To the best of our knowledge, this is the second report of congenital fibropapillomatosis in pigs.

Experimental giardiasis in goat kids.

The clinical, pathological and parasitological features of giardiasis resulting from experimental inoculation with 3 x 10(6) Giardia cysts were studied in goat kids. All experimentally inoculated goat kids given Giardia cysts became infected. Three of the eight inoculated kids had decreased appetite, formless feces and become slightly depressed beginning 7 or 8 days post inoculation. The mean duration of the appearance of abnormal feces was 6 days. Irregular and intermitted cysts shedding started after prepatent periods of 6-10 days and lasted throughout this study (10 weeks). The evidence of high infectivity and fast transmission of Giardia were observed under standard zoohygienic conditions. The characteristics of intestinal lesions were similar to those found in other hosts infected with Giardia. The most severe lesions were seen in the duodenum and proximal jejunum, and consisted of moderate villus atrophy, villus blunting, crypt hyperplasia and inflammatory infiltration in the lamina propria. Scanning electron microscopy revealed ultrastructural alterations in the microvillus border of enterocytes. Mucosal smears and histological sections of the gall bladder displayed Giardia trophozoites and gall bladder epithelium hyperplasia together with bile ductular proliferation in the liver tissue in two kids.

Pathogenicity of experimental caryosporosis.

Pathogenicity of the coccidia C. bigenetica and C. simplex was studied in experimentally inoculated pigs, goat kids (untreated and immunosuppressed) and severe combined immunodeficient (SCID) mice. The major pathological changes of caryosporosis were similar in all inoculated animals. In pigs and goat kids, caryosporosis was self-limiting, with clinical responses that included focal swelling and erythema of the muzzle, snout, jaws, cheeks, eyelids, bases of the ears, backs of the necks, scrotum, external genitalia of females, legs and footpads. Histopathological changes were characterized by involvement of the cutaneous mononuclear phagocyte system with an inflammatory exudate containing numerous macrophages, especially around the root sheaths, sensory nervous corpuscles of the hair follicles and surrounding dermal free nerve endings. The tactile hair follicles in the muzzle, snout and upper jaw were most severely changed. In SCID mice, inoculation with C. bigenetica or C. simplex caused a severe, fatal, systemic disease characterized by dissemination of numerous caryosporan developmental stages into the host mononuclear phagocyte system. This study presents evidence that both caryosporan species tested caused similar clinical signs and lesions of dermal coccidiosis in the mammalian secondary hosts.

Experimental schistosomiasis mansoni: modulation of granulomas by inhibition of collagen cross-link formation. Preliminary report.

beta-Aminopropionitrile (BAPN) is an inhibitor of the lysyl oxidase required for cross-link formation in collagen maturation. The efficacy of BAPN, alone or in association with the anti-schistosomal drug, praziquantel (PZQ), was primarily assessed by measuring the reduction in liver and intestinal egg loads in murine schistosomiasis mansoni. Depending on the treatment group (PZQ, BAPN, BAPN + PZQ), organ-specific effects were observed using microscope image analysis. Most notable was the relatively small size of granulomas in the livers of BAPN-treated mice, which contrasted with the relatively large size and irregular shape of the granulomas in the intestinal tissues of these mice. Mice treated with the combination of BAPN and PZQ had decreased liver and spleen weights, and a significant reduction in the number of eggs trapped in both the liver (86%) and the intestine (99.1%), compared with untreated mice and those given PZQ alone. The lowest number of living eggs/g of tissue in both the liver and intestine was recorded in the combined BAPN + PZQ-treated group. These results suggest that the concurren treatment of infected mice with PZQ and BAPN enhances the release of eggs trapped in the intestine and also results in a significant reduction of liver egg load. The mechanism by which BAPN reduces the number of liver granulomas in PZQ-treated mice is currently being investigated.

Efficacy of praziquantel treatment of schistosomiasis in a non-endemic country: a follow-up of parasitological, clinical and immunological parameters.

Schistosomiasis patients were immigrants to Czechoslovakia from Angola and Yemen. Most of them had light or moderate infections and felt subjectively healthy. They received treatment with praziquantel (two doses with a total of 40 mg/kg) and were followed up for several years. In nine of 13 patients, Schistosoma haematobium or S. mansoni eggs with undamaged miracidia were detected in biopsies from the bladder or the rectum one year or later after treatment. Granulomatous reactions in the rectum and bladder lesions of stage 1 including thickened bladder walls persisted in most of the patients. Antibody levels against adult S. mansoni worm antigen remained elevated for at least two years after therapy in some patients and declined in others. Among the nine patients, for whom pre- and post-treatment sera were available, the changes in relative levels of antibodies did not strictly correlate with the continued presence of schistosome eggs in, or their absence from, biopsies. We discuss the results obtained with sensitive diagnostic techniques in the absence of subjectively perceived disease.

The pathogenicity of rabbit coccidium Eimeria coecicola Cheissin, 1947.

The pathogenicity of Eimeria coecicola for rabbits has been demonstrated in our experiments. The animals suffered from prolonged affection of appendix lasting at least 20 days. Pathological changes appeared with the development of merogony since day 4 post infection (DPI) and were characterized by an inflammatory infiltration and abundant pyogenic component in lamina propria, swelling and coalescence of upper parts of appendix mucosa above atrophied domes, where spaces filled with stagnating inflammatory exudate, endogenic stages of coccidia, and desquamated epithelia are formed. The alteration of the epithelium and exposure of the appendix lamina propria occur in relation with the gametogony in the period of about 10 DPI. Since 8 DPI, the epithelium of the infected endogenic stages of coccidia becomes hyperplastic, proliferates into lamina propria and is subjected to necrosis. Groups of immature oocysts and their fragments remain in lamina propria and are resorbed, at least for 10 days, by granulomatous inflammatory structures with abundant multinucleate cells of the type of foreign body cells.

A new method for selective diagnostic staining of hooks of echinococci, cysticerci and tapeworms in histological sections.

This paper describes a new method for selective staining of hooks of echinococci, cysticerci and tapeworms in histological sections. The method is based on pre-staining in hematoxylin, then the preparations are stained overnight in dilute polychrome blue and differentiated with tartrazine in Cellosolve (Ethylene glycol monoethyl ether or Ethylene glycol monomethyl ether). The hooks stain blue, nuclei brown to brown-green, and cell plasma is yellow. The hooks stain very brightly, which enables the identification of parasite remnants in granulomas and scars. The intensity of staining depends on the grade of maturity and sclerotization of hooks and these are readily observed, even in lower magnifications. The staining was successfully used in a variety of parasites.

Pathology of natural isosporosis in nursing piglets.

In piglets suffering from natural coccidiosis, post-mortem examination showed that pathological changes induced by Isospora suis were evident from day 7 to day 14 of life, and particularly, by days 9 and 10. Macroscopically, the changes were manifest as enteritis varying from catarrhal to pseudomembraneous form. Microscopically, they consisted of more or less extensive atrophy of villi whose apical parts were necrotic, of metaplasia and erosion of epithelium. With the exception of duodenum and the adjoining sector of jejunum, the alterations were manifest along the entire small gut though intensity of lesions and incidence of endogenous stages of Isospora suis varied from sector to sector of the intestine. Predilected was a portion limited approximately by 50 and 140 cm cranially from ostium ileocecale, viz. the caudal sector of central jejunum and the cranial sector of the caudal jejunum. Within this area, lesions were more severe and frequent than in sectors situated cranially and caudally of it. The predilection persisted even in case of concurrent adenovirosis. The lesions contained meronts and gamonts at the same time though gamonts predominated. Advanced merogony and gametogony resulted in distinct displacement of cell nuclei and in cell walls bulging into the inner diameter of the gut. We assume that endogenous stages of Isospora penetrate the submucosis via the narrow opening at the orifice of lymph follicle; such was the case with gamonts and oocysts detected in activated lymph tissue of Peyer's patches.

[The first occurrence of demodicosis in cattle in Czechoslovakia]. / První nálezy demodikózy skotu v Ceskoslovensku.

Demodectic lesions were found in 37 per cent out of the total number of seventy-five cows examined by palpation in a large cow-house in South Bohemia, Czechoslovakia. These lesions were intradermal nodules, mostly 2 to 6 mm in diameter, located in the corium in the anterior parts of the body. The animals had 1 to 75 lesions (on the average 11.6). Their age was three to seven years. Their overall health condition was good and their behaviour was not affected. Microscopic examination revealed large numbers of Demodex bovis Stiles, 1892, causative agent of demodicosis, in the contents of nodules in five out of six examined animals. Histopathological changes in two nodules were characterized by inflammatory granulomatous structures containing large numbers of mites, epithelioid cells with rich, pale cytoplasm, giant cells of the foreign body type, and inflammatory infiltrates consisting mostly of lymphocytes. Fibroproduction in the contents of granulomas and along their periphery was markedly low.

[Adenovirus inclusions in the ileum in coccidiosis in suckling piglets]. / Adenovirové inkluze v ileu pri kokcidióze sajících selat.

Numerous intranuclear inclusion bodies in enterocytes were detected exclusively in the ileum of two nine-day piglets coming from a litter infected with diarrhea. The inclusion bodies were homogeneous in hematoxylin and eosine (HE), their staining was not clear enough, was amphophilic and they filled nearly the whole nucleus. They were eosinophil less often and had a halo on the periphery. Their staining was clearly orange-red in Feulgen's nuclear reaction after re-staining with G orange and bright green. Intranuclear inclusions were located exclusively on shortened villi and pseudovilli of ileum above the follicles of activated Peyer's patches. The findings of intranuclear inclusions in ileum demonstrate adenovirus enteral infections in suckling piglets.

[Enterocolitis in spontaneous cryptosporidiosis infections in calves]. / Enterokolitida pri spontánních kryptosporidiových infekcích telat.

The pathology of lesions in the intestines of 48 calves with spontaneous cryptosporidiosis was studied by histological examination and by scanning electron-microscopy (SEM). The animals were 7 to 21 days old, emergency-slaughtered mostly for dehydration and diarrhoea. Identical lesions were observed in the jejunum and ileum. The villi, often infected by cryptosporidia on a mass scale, were shortened, atrophic, markedly curved and shrunk in their ultrastructure, often as a result of the regression of groups of enterocytes with cryptosporidia, the adjacent tissue being affected, at the same time, by nodular hyperplasia. The enterocytes harbouring the protozoans exhibited cuboidal up to squamous metaplasia; in ultrastructure they had not hexagonal shape and showed signs of microvillus regression. The cryptosporidiosis of the small intestine was always accompanied by hyperaemia and inflammatory reactions in lamina propria, mostly non-purulent, with numerous eosinophils. Signs of typhlitis in the caecum--more frequent and intensive than in other parts of the large intestine infected by cryptosporidia--were characterized, in most cases, by lesions in the covering epithelium and by mostly non-purulent inflammatory infiltration with a large admixture of eosinophils in lamina propria. No inflammatory lesions were found in the colon and rectum. Severe cryptosporidial infections of large parts of intestine and the nature of pathological lesions lead to a considerable reduction in the total absorption surface of the intestine and are potential causes of diarrhoea from malabsorption.