Lack of renal changes in stainless steel welders exposed to chromium and nickel.

Biochemical markers of kidney damage were examined in 52 male stainless steel welders (manual metal arc welding) exposed to chromium and nickel. No difference was found in the mean urinary excretion of total proteins, albumin, protein 1, transferrin, retinol-binding protein, lactate dehydrogenase, lysozyme, or beta-N-acetylglucosaminidase in a comparison with matched referents. Beta 2-microglobulin was slightly increased in those welders with a urinary chromium concentration of greater than 64.5 nmol.mmol-1 creatinine. The prevalences of abnormal values did not differ from those observed in the reference group. No correlation was found between the concentrations of chromium or nickel in urine and that of proteins or enzymes. No consistent or clinically significant renal impairment was revealed among the stainless steel welders exposed to a chromium air concentration slightly above the current threshold limit value of the American Conference of Governmental Industrial Hygienists for water-soluble hexavalent chromium compounds (50 micrograms.m-3).

Study on kidney function in female workers exposed to perchlorethylene.

1. Biochemical markers of kidney damage were examined in 16 female workers chronically exposed to tetrachlorethylene (TCE) in five dry-cleaning shops. The results were compared with those obtained in 13 females non-occupationally exposed to organic solvents. 2. The intensity of exposure was monitored by personal environmental monitoring. The time-weighed average exposure to TCE amounted to 157 mg m-3 (range 9-799 mg m-3). A satisfactory agreement was found between the concentration of TCE in ambient air sampled with the charcoal tube method and with a passive dosimeter. 3. The urinary excretion of lysozyme was increased in the exposed group. No difference was found in the urinary excretion of albumin, beta 2-microglobulin, lactate dehydrogenase, total proteins or glucose. The prevalence of abnormal values of biochemical parameters in the exposed group did not differ from that observed in the control group. No correlation was found between the level of TCE exposure and biochemical parameters. 4. The present study suggests that chronic exposure to TCE does not lead to renal damage.

Long-term monitoring of the immune reactivity of stainless steel welders.

The immune reactivity of stainless steel welders (n = 22-53) was evaluated in a three year's study. The results (phagocytic activity, cellular and humoral immunity) were statistically compared with those in control group of non-exposed persons from the same plant (n = 14-23) and with long-term laboratory reference values (LRV) (n = 14-311). In welders several changes were found when compared to the LRV: in humoral response there were higher prealbumin, lysozyme, circulating immune complexes and lower IgG. In phagocytic tests there were lower ingestion, bactericidal activity and higher metabolic activity of peripheral mononuclear leucocytes. In cellular immunity the marked lymphocytosis, higher counts of T-lymphocytes, CD4+ and CD8+ lymphocytes were noticed. After lowering the concentrations of metals in the working area there were trends to normal values in some parameters [relative numbers of T-lymphocytes, relative number of CD4+ lymphocytes, phagocytic activity, metabolic activity of leucocytes (INT index), IgA, complement C3, transferrin]. The extent and the length of the exposure to welding fumes, smoking and changed conditions at working place were followed as well.

Summary of the Czech medical resources in the Internet.

The article describes the most important features of the computer network Internet. Various information services are presented such as E-mail, Listserv, Gopher, FTP and World Wide Web. The Internet contribution to medical education, research contacts, and information exchange is particularly emphasized. Medical information sources from the Czech and Slovak Republics are summarized in appendices.

[Assessment of the Costal Hunch by a Scoliosometer to Predict Cobb's Angle in Idiopathic Scoliosis.]. / Merení zeberního hrbu skoliometrem za úcelem predpovedi Cobbova úhlu u idiopatické skoliózy.

The investigated group comprised 207 patients treated at the spondylologic consulting centre of the orthopaedic clinic where 576 assessment were made with subsequent computer evaluation. Mathematically the correlation between the angle of the costal hunch assessed by a scoliosometer and Cobb's angle on the X-ray picture was calculated. The value of the correlation coefficient was 0.8049. For statistical processing of the results of measurements the authors used the method of robust regression and an equation was calculated according to which the prediced values of Cobb's angle Y were calculated. These results were listed in a table for the extent of measurements from 1 to 16 on the scoliosometer which corresponds to idiopathic scoliosis grade 1 and 2. The scoliosometer is a pendular gravitational instrument which can be replaced by a plummet suspended on a protractor. Assessment of the costal hunch by a scoliosometer can partly reduced check-up examinations of scolioses by X-ray examination of the spine. Key words: scoliosis, scoliosometer, assessment of the costal hunch.

[Systematic Long-term Screening of Scolioses.]. / Systematický dlouhodobý screening skolióz.

The authors implemented in a defined region for a period of 14 years screening of scolioses in children, primary screening using Adams' test and secondary screening using a scoliometer. They selected as criterion for detection 5 degrees of asymmetry of the back, corresponding to 17 degrees according to Cobb on X-ray pictures. In three growth stages a total of 603 children with scoliosis were detected, incl. 382 girls and 221 boys. The detection rate was highest in the adolescent period (71 %), the majority of detected scolioses (77 %) were idiopathic. On examination with a scoliometer comparable results were achieved with the technique moiré (false positivity 5.2 %). Deformities of the spine were detected at a level (mainly grade Ib), where follow up and further treatment can be effective. Screening which was implemented involved small costs per child. A positive outcome of the screening was a reduced incidence of severe scolioses and this reduced among others the expenditure on treatment by orthesis of the trunk or surgery. Key words: scoliosis, screening, mechanical scoliometer.

[Immunologic examination of the synovial fluid in the differential diagnosis of knee joint inflammations. Computer analysis of 275 patients]. / Imunologická vysetrení v synoviální tekutine v diferencní diagnóze zánetu kolenního kloubu. Pocítacová analýza u 275 nemocných.

In the synovial fluid of the knee joint 15 immunological indicators were assessed in 275 patients divided into three groups according to the following diagnoses: rheumatoid arthritis, gonarthritis and synovitis after a blunt injury. The assembled data were evaluated by a stepwise discrimination analysis. This made it possible to select eventually in the compared groups eight characteristics with a differentiating value: IgE, immunocomplexes, beta-2 microglobulin, C3, CRP, alpha-2 macroglobulin, LF-test--reciprocal titre, LF-test--square of reciprocal titre. The classification functions of these characteristics make the correct classification of a random patient with a probability of 78.8-92% possible.

[Immunologic examination of the blood in the differential diagnosis of acute gouty arthritis and rheumatoid arthritis]. / Imunologická vysetrení v séru v diferenciální diagnostice akutní dnavé artritidy a revmatoidní artritidy.

In 16 patients with acute gouty arthritis, 30 IgM RF seropositive cases of rheumatoid arthritis (RA) and 20 IgM RF seronegative cases of RA the values of 14 indicators of antibody and natural immunity were assessed in serum. The assembled data were evaluated by step-wise discrimination analysis. This made it possible to select consecutively signs important for the differentiation of acute gouty arthritis from IgM RF seropositive RA (immunocomplexes, beta-2 microglobulin, C3) and for its differentiation from IgM RF seronegative RA (IgE, C3, transferrin, free SH groups). Thus obtained classification functions make it possible to classify correctly, random subjects with a probability of 76.7-93.7%.

[Prognostic significance of impaired intra-and infra-bundle of His conduction in the heart]. / Prognostický význam poruseného intra-a infrahisálního vedení v srdci.

BACKGROUND: So far no final solution was found as regards the relationship of impaired conduction in the His-Purkyne system and the incidence of cardiac and in particular sudden deaths. The objective of the present work was to assess by long-term prospective follow-up of subjects with a normal and pathological prolongation of the intra- and infrahisian conduction in the heart, based on the electrogram of the bundle of His, the importance of these findings for assessment of the patient's prognosis. METHODS AND RESULTS: After elimination of subjects with ventricular preexcitation the authors included in the group 340 patients (243 men, 97 women, aged 16-81 years, mean 49 +/- 16), where they recorded the electrogram of the bundle of His (without cardiac stimulation, during graded and programmed stimulation of the atria, after i.v. administration of ajmaline). In 206 cases they implemented at the same time programmed stimulation of the ventricles. The HV interval or the length of the H wave were in 286 patients normal and in 54 patients protracted. All patients were followed up by the authors for 6 to 144 months (mean follow up period 56.1 months). In the group of subjects with normal intra- and infrahisian conduction, as compared with the group with protracted conduction in the same area, the number of cardiac deaths was lower, i.e. 10.1 %, as compared with 22.2 %, sudden "cardiac" deaths (death within one hour after the onset of symptoms), i.e., 6.6 % as compared with 11.1 %, and sudden bradyarrhythmic" deaths (sudden "cardiac" death except subjects with diagnostic programmed ventricular stimulation), i.e. 2.8 % as compared with 11.1 %. CONCLUSIONS: The results support significantly the prognostic impact of pathological conduction in the His-Purkyne system as regards the occurrence of cardiac deaths and sudden "brady arrhythmic" deaths (p < 0.05). Conversely, the differences as regards the occurrence of sudden "cardiac" deaths were not significant.

[Changes in troponin T levels in patients with acute myocardial infarct treated with fibrinolysis]. / Zmeny hladiny troponinu T u nemocných s akutním infarktem myokardu lécených fibrinolýzou.

The objective of the presentation was to assess changes of the troponin T level--a very sensitive indicator of cardiac muscle damage--in patients with acute myocardial infarction treated by fibrinolysis, and to assess differences in troponin T levels between patients with successful reperfusion and without reperfusion. The troponin T level was examined in 28 patients with acute myocardial infarction (AIM), incl. 22 (78.6%) where probably reperfusion occurred, as concluded from a maximal increase of CPK and CPK MB values within 12 hours. In six patients with a later rise of enzyme values treatment was considered as probably unsuccessful. In both groups of patients troponin T values increased, particularly markedly in the group with probable reperfusion, starting from the 3rd to the 18th hour after the onset of treatment, when the differences in troponin values between the two groups were statistically significant at the 1% and 1% level of significance. An early rise of the troponin T level suggests more rapid release of so-called free cytoplasmic troponin T in patients with successful reperfusion. From the 54th hour there is a statistically insignificant rise of troponin T level in the group of patients without probable reperfusion and it suggests a more marked release of so-called structurally linked troponin T in patients where reperfusion was not achieved. Consistent with these results, the mean maximal value of troponin T during the period of 3-24 hours after the onset of treatment is 2.37 times higher than a corresponding value during the period of 60-108 hours in the group with probable reperfusion and conversely in the group without probable reperfusion the troponin T value is 1.2 times higher during the period 60-108 hours after the onset of treatment.

[Prognostic importance of invasive electrophysiologic findings in the heart]. / Prognostický význam invazivního elektrofyziologického vysetrení srdce.

The objective of the work was the long-term perspective follow-up of subjects with a normal and pathologically delayed intra-, infra-His conduction in the heart based on the electrogram of the bundle of His and subjects with a normal or pathological finding during programmed stimulation of the ventricles, to assess the impact of these findings for the patients' prognosis. The authors included in the group, after elimination of subjects with the syndrome of ventricular preexcitation, 340 patients (243 men, 97 women, 16-81 years, mean age 49 +/- 16) where they made an invasive electrophysiological examination of the heart (electrogram of the bundle of His without cardiac stimulation, during graded and programmed stimulation of the atria, in 206 subjects also programmed stimulation of the ventricles) not before three months after acute cardiac disease. The authors found normal HV intervals or a normal length of H waves in 286 patients and delayed values in 54 patients. They revealed a diagnostic conclusion of programmed ventricular stimulation in 71 subjects and a non-diagnostic conclusion in 135 subjects. All patients were followed up irrespective of implantation of a pacemaker and antiarrhythmic treatment for 6 to 144 months (mean follow-up period 56.1 months). During the mentioned period they described the occurrence of cardiac deaths (deaths from cardiac causes) in 29 subjects with a normal intra-, infra-His conduction (10.1%), in 12 subjects with delayed intra-, infra-His conduction (22.2%), in 7 subjects with undiagnosed programmed ventricular stimulation (5.2%) and in 13 subjects with diagnosed programmed ventricular stimulation (18.3%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Cardiac tamponade as a complication of acute myocardial infarct. (Clinical and pathologico-anatomic analysis of patients with acute myocardial infarct and cardiac tamponade)]. / Srdecní tamponáda jako komplikace akutního srdecního infarktu. (Klinický a patologicko-anatomický rozbor nemocných s akutním srdecním infarktem a srdecni tamponádou.)

Cardiac tamponade is a frequent cause of death in acute myocardial infarction--in as many 23%. It is encountered in particular in the 7th and 8th decade, in patients with a first infarction which is frequently situated in the anterior wall of the left ventricle. 93% of the patients have obvious ECG manifestations of Q infarction. The diagnosis of cardiac tamponade is easy when during an acute terminal attack slow activity on the ECG tracing is found without a haemodynamic response and the pulse on the great arteries is not palpable even after external cardiac massage. In 80% the onset of cardiac tamponade is very sudden. The presence of shock or cardiac failure makes the diagnosis of cardiac tamponade more difficult. As to investigated indicators, in the development of cardiac tamponade the systemic pressure--systolic as well as diastolic--on admission or during hospitalization, may play a part. The patients have a less marked coronary sclerosis, fibrosis of the cardiac muscle is less frequently present. Previous necroses of the heart muscle may have probably a certain protective effect on the development of cardiac tamponade. Anticoagulants obviously do not influence the development of cardiac tamponade.

[Levels of CK MB mass in patients with acute myocardial infarct treatedwith fibrinolysis. Comparison with levels of CK, CKMB, CKMB mass and troponin T in the diagnosis of coronary ischemia]. / Hodnoty CK MB mass u nemocných s akutním infarktem myokardu lécených fibrinolýzou. Srovnání významu hodnot CK, CKMB, CKMB mass a troponinu T pro stanovení diagnózy ischemických srdecních príhod.

In a group of 26 patients with AIM the CKMB value was raised above the discrimination level already on admission--on average 2.7 +/- 1.4 hours after development of ischaemic pain--in 46% patients. The maximal value of CKMB mass was achieved in the group with probable reperfusion 12.1 +/- 3.8 hours after the development of ischaemic pain and this value was elevated in relation to the discrimination value 41.5 +/- 17x and in relation to the so-called basal value 145 +/- 117x. In the group without probable reperfusion the maximal value was achieved significantly later, after 19.8 +/- hours and was elevated in relation to the discrimination value 31 +/- 17x and in relation to the final value 84 +/- 42 times. The value of CKMB mass increased above the discrimination limit from the onset of ischaemic pain after 4.0 +/- 1.5 and after 5.7 +/- 3 hours in the group with probable and without probable reperfusion and declined below the discrimination limit after 00 +/- 60 and 119 +/- 98.0 hours in the same groups. On comparison of CK, CKBM, CKBM mass and troponin T on admission the CKMB mass value was elevated in 46% patients, the value of CK in 23%, of CKMB in 27% and the troponin T value in 96% patients. With regard to the assembled experience that haemolytic serum raises false troponin T values, the percentage of elevated troponin T values on admission declines from the original 96% to 81% when all haemolytic samples are eliminated. The time of reaching maximal values of CKMB mass in patients with AIM and probable reperfusion was significantly shorter than in CK values and is similar as in CKMB values. The time taken to raise the CKBMB mass value above the discrimination value is significantly shorter than the time taken by CK levels, but significantly longer than the time before troponin T levels are raised. The time of total elevation of CKMB mass levels above the discrimination limit does not differ from the time taken to raise CK values, it is however shorter than the increase of troponin T values, although the exact time of persistence of raised levels of troponin T was not assessed in our work. The time of increase above and decrease below the discrimination limit was not assessed in CKMB values. Based on mutual comparison of the impact of indicators for assessment of the diagnosis of ischaemic heart attacks the authors consider it best regardless of financial costs--to assess troponin T, possibly along with levels of CKMB mass.

[The role of the exercise test in patients with ischemic heart disease in estimating the risk of sudden death]. / Prínos pracovního testu u nemocných s ischemickou chorobou srdecní k odhadu rizika náhlé smrti.

The authors evaluated after 4-year interval the results of coronarographic and spiroergometric examination after a work load on a bicycle ergometer up to the limiting work syndrome in 51 all patients with the aim to reveal "risk factors" of sudden death in CHD patients. The following parameters were recorded: age, duration of treatment number of cigarettes smoked, systolic blood pressure at rest and the daily dose of the most frequently used drugs. After the work load the limiting values of pulse rate, systolic blood pressure, oxygen consumption, blood lactate level and the work ECG were evaluated. In the group of 7 sudden deaths of CHD patients the authors found statistically significant (p less than 0.001) a lower mean limiting value of oxygen consumption/kg and a deeper (p less than 0.0001) mean depression of the S-T segment in the work ECG when compared with 35 CHD patients surviving for 4 years. Both indicators are considered the main "risk factors" for sudden death.

[Actilyse (a recombinant tissue-type plasminogen activator] in the treatment of acute myocardial infarct. Comparison of the effects of Actilyse and streptokinase]. / Preparát Actilyse (rekombinacní tkánový typ aktivátoru plazminogenu) v lécbe akutního infarktu myokardu. Srovnání úcinku Actilysy a Streptokinázy.

The preparation Actilyse--a tissue plasminogen activator prepared by recombination--is an effective fibrinolytic drug. The authors recorded in a group of 33 patients reperfusion in 91%, evaluated on the basis of indirect criteria. In a group of 18 patients treated with streptokinase reperfusion was achieved in 74%. Based on changes of CK and CK-MB values--an earlier rise of values following Actilyse administration and conversely their more marked increase during subsequent sampling after streptokinase administration--it may be assumed that earlier dissolution of the thrombus in the coronary artery occurs after Actilyse administration, as compared with streptokinase. It may be thus assumed that there is also a smaller necrotic focus after Actilyse treatment, as compared with streptokinase. Early re-occlusion--according to indirect indicators--occurred in 8.6% in the Actilyse treated groups, as compared with 5.9% in the streptokinase treated group. The fibrinogen values decline in the Actilyse group to 40% and in the streptokinase group to 28%. Later enhanced new formation of fibrinogen occurs and the fibrinogen values rise to 160% in the Actilyse treated group and to 250% of the initial value in the streptokinase treated group. The elevated fibrinogen value, as compared with the baseline value, persists for the 12 days of the follow-up. No severe spontaneous haemorrhage was recorded, haemorrhagic manifestations were associated with blood sampling and i.v. administration of drugs only. The necessity to administer blood was due to a complication during puncture of the subclavian vein in one patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of chronic lead exposure on hormone levels in developing rats.

The effect of five months' exposure to 0.5% lead acetate in drinking water on hormone levels of developing rats was studied. The hypothalamic and striatic concentrations of noradrenaline (NA) were decreased in both sexes. In female but not in male rats, blood and adrenal catecholamines and serum corticosterone concentrations were also increased. No changes were observed in serum thyroxine and 3,5,3'-triiodothyronine levels. Our results indicate that female developing rats are more susceptible to lead than male rats. In female rats, both the hypothalamo-pituitary-adrenal and sympatho-adrenal systems seem to be affected by this lead exposure; in male rats, only the latter system is affected.

Influence of chronic lead exposure on hormone levels and organ weights in developing rats.

The effect of 5 months' exposure to 0.5% lead acetate in drinking water on the hypothalamo-pituitary-thyroid-adrenal system was evaluated by measuring hypothalamic and striatic noradrenaline (NA), serum thyroxine (T4), 3,5,3'-triiodothyronine (T3) and corticosterone (CS) and blood and adrenal catecholamines (CA) levels in developing rats of both sexes. Blood CA were increased and hypothalamic and striatic NA was decreased by exposure in male rats. In female rats, blood and adrenal CA and serum CS were increased and hypothalamic and striatic NA was decreased by exposure. No changes in the two sexes were observed in serum T3 and T4. Exposure induced an increase in spleen and kidney weights in both sexes; the weight of liver was increased only in female rats. Weights of hypothalamus, striatum, adrenals and thyroid glands were not changed. Female but not male rats exposed to lead gained less weight than controls. The results suggest a non-specific stress response in female rats. In male rats only the sympatho-adrenal system seems to be affected by this lead exposure.

Lack of nephrotoxicity of styrene at current TLV level (50 ppm).

Biochemical markers of kidney damage were examined in 37 female workers exposed to an average concentration of 225 mg/m3 of styrene. The concentration of mandelic acid in urine was on the average 759 mg/g creatinine. The mean duration of employment of the exposed subjects was 11 years. The results were compared to those obtained in 35 control female workers matched for age and a number of demographic and lifestyle factors and with no history of exposure to organic solvents. No difference was found in the urinary excretion of albumin, beta 2-microglobulin, retinol-binding protein, total proteins, glucose, lysozyme, lactate dehydrogenase and beta-N-acetyl-D-glucosaminidase. The present study provides thus further evidence that exposure to styrene at the current TLV (215 mg/m3) does not entail any detectable risk for the renal function.

Effect of supplementation of University of Wisconsin solution with glycoproteins from psychrophilic strains of yeast on hypothermic liver storage of rats.

Extracellular yeast glycoproteins (YG) produced by Rhodosporidium toruloides have been shown to increase the survival rate of different yeast species after storage in liquid nitrogen. The purpose of this study was to investigate the effect of YG on cold-stored rat livers. Water-soluble YG produced either by Phaffia rhodozyma (G3) or by Leucosporidium antarcticum (G4) were added to a modified University of Wisconsin solution (mUW) and used for cold storage (1 degree C) of isolated livers. The functional status of each liver was then assessed under conditions of 90-min normothermic reperfusion. The 46-h cold storage in mUW without G3 and G4 resulted in serious preservation-reperfusion injury of the liver. The addition of G3 to mUW for 46-h preservation of the liver resulted in significantly higher bile flow (4.32 +/- 0.35 vs 2.35 +/- 0.49 microliters/min/10 g at 75-90 min), higher portal blood flow (10.99 +/- 0.2 vs 4.78 +/- 1.07 ml/min/g at 90 min), lower liver weight after reperfusion (102.4 +/- 1.5 vs 116.7 +/- 6.6% of weight before preservation), and lower total tissue water after reperfusion (2.49 +/- 0.05 vs 2.92 +/- 0.13 g water/g dry weight). However, the activity of ALT, AST, and LDH in perfusate was not changed. The beneficial effect of G4 was less pronounced. The 24-h storage in mUW resulted in a significant increase of AST and LDH activity in perfusate; the addition of G3 to mUW for 24-h preservation did not affect these parameters. In conclusion, the addition of 0.05% G3 or G4 to mUW was only partially beneficial in improving rat liver preservation.

Elastin content in human fibrotic and cirrhotic liver.

Human liver tissue obtained at autopsy was extracted with hot 0.1 M NaOH. Determination of amino acids desmosine and isodesmosine was used to quantify elastin in the insoluble residue. Hydroxyproline content was used as an index of collagen content in the liver. Hydroxyproline content was twofold in fibrotic liver and threefold in cirrhotic liver when compared to normal liver, while the sum of desmosine and isodesmosine increased threefold and sixfold, respectively. Elastin content is low in normal liver when compared to collagen but appears to grow much faster in diseased liver.