Vasoconstriction in patients after heart transplantation.

We have the values of rest and maximal blood flow and of venous compliance in the forearm in three groups of patients: those undergoing orthotopic heart transplantation, those with severe cardiac insufficiency, and a control group. The findings suggest the presence of arteriolo- as well as venoconstriction in transplanted patients. This, however, was less pronounced than in the patients with heart failure. Neither the values of maximal blood flow nor those of minimal peripheral resistance in the forearm obtained after a 5-minute ischaemic insult differed significantly between the patients after heart transplantation and the controls. Thus, arteriolar constriction can be removed by this insult in patients after transplantation.

Chromosomal aberrations and sister-chromatid exchanges (SCEs) in patients undergoing long-term Imuran therapy.

13 patients treated daily for an extended time with Imuran and prednisone and 4 patients treated in the same way with Imuran only were cytogenetically analysed for the induction of structural chromosomal aberrations and SCEs. There was an increase in the number of aberrations and SCEs in nearly all patients analysed. However, we did not find any dose-dependent cumulative effect on chromosomal damage, with the exception of 1 patient tested in a small group of 4 patients involved in a prospective cytogenetic study, who showed a significant time-dependent increase in the number of aberrations.

Aneurysm of the common hepatic artery diagnosed by ultrasonography.

The authors report on their observation of a patient with an aneurysm of the common hepatic artery, the diagnosis of which had been previously established by ultrasonography. Verification of the finding by angiography was followed by timely surgery including aneurysm resection. The potential of ultrasonography in diagnosing this rare vascular abnormality, the CT scan of which had been erroneously interpreted as an inoperable tumour, is pointed out.

Impaired venodilatation due to nitroglycerine in patients after heart transplantation.

The effect of nitroglycerin on forearm peripheral vessels was assessed in three groups of patients: in patients after orthotopic heart transplantation, in patients with severe heart insufficiency and a control group. The effect on arterioles was similar in all investigated groups, the most pronounced arteriodilatation being observed in fifth minute after the application. However, the effect on veins was different. Significant venodilatation was observed only in controls, while in the other groups was not present. Thus impairment in venodilatation was revealed in both the patients after heart transplantation and in patients with severe heart failure.

Peripheral plasma renin activity (PRA) in recipients with allograft artery stenosis; its diagnostic value in acute stage hypertension.

Peripheral PRA was examined in 11 patients with graft artery stenosis after the onset and throughout the course of hypertension. In the acute stage PRA was elevated in 9 patients and decreased to normal in the later stage of hypertension in all but 1 patient with malignant hypertension. The findings suggest that the determination of peripheral PRA is helpful in diagnosing graft artery stenosis only in the acute stage of hypertension, but it has no unequivocal value to the prognosis of hypertension or indication for operation.

[Personal experience with surgical treatment of hyperparathyroidism in chronic kidney failure. I. Etiopathogenesis of secondary hyperparathyroidism, preoperative findings, indications for parathyroidectomy]. / Nase zkusenosti s chirurgickým lécením hyperparatyreoidismu pri chronickém selhání ledvin. I. Etiopatogeneze sekundárního hyperparatyreoidismu, predoperacní nálezy, indikace k paratyreoidektomii.

The authors give an account of the fundamental relations of the calcium-phosphate metabolism in conjunction with the development of secondary HPT in chronic renal failure. The authors analyzed a group of 20 patients operated on account of secondary and tertiary forms of HPT as regards preoperative findings. The analysis comprised the clinical condition, biochemical, radiological and histological findings pertaining to bone, along with evidence of enlarged parathyroid glands by computed tomography and ultrasonography. The mentioned findings supplemented by some findings from the literature are the sum of indications for PTE. From the practical aspect they are indicators of the affection, of a high total ALP blood level and X-ray evidence of subperiostal absorption.

[Personal experience with surgical treatment of hyperparathyroidism in chronic kidney failure. II. Surgical technic, postoperative course and the state of bone metabolism after parathyroidectomy]. / Nase zkusenosti s chirurgickým lécením hyperparatyreoidismu pri chronickém selhání ledvin. II. Technika operacního výkonu, pooperacní prubeh a stav kostního metabolismu po paratyreoidektomii.

In 20 haemodialyzed patients operated on account of HPT, in 12 instances total PTE was performed with autotransplantation of portions of the parathyroid gland and in 8 patients so-called partial PTE was performed, leaving one parathyroid gland (in one instance two). Histomorphological examination revealed diffuse to nodular hyperplasia and twice an adenoma of the parathyroid; the mean weight of the excised tissue was 4000 mg. The follow-up period after operation varied from two months to 36 months. After total PTE the regression of HPT is more marked and more rapid. Possible relapses are more probable after partial PTE, also the possible development of hyperplasia of the implanted tissue cannot be ruled out. A new rise of C-HPT levels precedes changes of the clinical picture and a rise of indicators of bone metabolism. From linear correlations between serum levels of the ALP bone fraction, total ACP, free OH-P and values of C-PTH (p less than 0.01-0.001) conclusions can be drawn on regression or progress of the osseous finding after PTE. Data on the possible participation of aluminum osteopathy are essential, as in the florid stage it is a contraindication of PTE. The positive effect of operation recorded in 17 patients comprised not only restoration of a satisfactory mobility but also an improved mental condition. Surgical treatment of advanced forms of HPT in dialyzed patients is therefore still considered an indicated operation, provided these patients receive subsequently further aimed care.

[Change from treatment with cyclosporin A to conventional treatment in kidney transplantation]. / Prevod z lécby cyklosporinem A na konvencní lécbu u transplantací ledvin.

Patients after a first transplantation of the kidney from a dead donor treated with cyclosporin A in combination with one, two or three drugs were switched to conventional treatment with azathioprine and prednisone. Fifty-two patients were switched to the new treatment 11-15 months after transplantation (group I), 9 patients after 6-10 months (groups II), 17 patients after 16-30 months (groups III). Group I was compared with 21 patients where no switched was made after 11-15 months (group IV). The authors did not reveal any change in the survival of grafts nor in the number of rejections during the three-month period following the switch. Survival of grafts in patients with rejection was after two years following the switch significantly lower than in patients without rejection, the loss of grafts, however, did not differ as compared with patients who suffered a rejection during a comparable period but were not switched to conventional therapy. The interval of the switch after transplantation did not influence the incidence of rejections. Rejections after the switch cannot be reliably foreseen from the level of cytotoxic anti-HLA antibodies or previous repections before the switch.

[Cyclosporin A in preventive therapy after kidney transplantation: a double combination versus a triple combination. I. Therapeutic effectiveness]. / Cyklosporin A v profylaktické lécbe po transplantaci ledviny: dvojkombinace versus trojkombinace. I. Ucinnost lécby.

Two groups of patient after a first renal transplantation from a dead donor were treated by a double combination of cyclosporin A and prednisone (group A) and triple combination cyclosporin A and azathioprin and prednisone (group B). The groups were similar as regards effectiveness of treatment (evaluated with regard to the survival of recipients and grafts and the number of rejection episodes); they did not differ as to the losses of grafts for other than immunity reasons, which predominated in both groups over losses caused by rejection. Discontinuation of prednisone after four months in group A was complicated by rejection in 54%. Discontinuation of cyclosporin A after one year's treatment and a change to azothioprin and prednisone treatment was in both groups complicated by rejection in cca one fifth of the patients.

[Cyclosporin A in preventive therapy after kidney transplantation: a double combination versus a triple combination. II. Adverse effects of cyclosporin A and therapeutic complications]. / Cyklosporin A v profylaktické lécbe po transplantaci ledviny: dvojkombinace versus trojkombinace. II. Nezádoucí úcinky cyklosporinu A a komplikace lécby.

The incidence of irreversibly afunctional grafts, late functional development and period of the initial temporary lack of function did not differ in the two groups. The total number of nephrotoxic episodes was significantly (p less than 0.05) lower in the triple combination, chronic nephrotoxicity developed with equal frequency. Infectious complications were present in 54% of the patients in group A and in 60% in group B, viral complications in 15% patients in group A and in 16% in group B. Serious bacterial infections were the cause of death in one of three patients in group A and in five of six patients in group B.

[Heart surgery in Czechoslovakia]. / Ceskoslovenská kardiochirurgie.

In 1985, the cardiovascular Section of the Society of Surgery decided to start a registry of cardiac surgery procedures. Since then, basic data on surgical treatment of patients with heart disease have been collected each year. The following conclusions have been drawn from the data available: 1. The situation in cardiac surgery in Czechoslovakia is catastrophic. Czechoslovakia ranks among nations with the lowest numbers of operations per population in Europe. The most critical situation exists in IHD. 2. The standard of care provided to patients in individual areas of Czechoslovakia is about the same. 3. The critical lack of funds led to a decrease in the number of operations performed in 1990. 4. Organization of health care is poor, as indicated by length of hospital stay longer than that in the industrialized nations. 5. It is crucial to allocate more money to departments of cardiac surgery.

[Initial clinical experience with Consupren, a new preparation manufactured in Czechoslovakia (Galena), in patients after liver transplantation]. / První klinické zkusenosti s novým cs. prípravkem Consupren (Galena) u nemocných po transplantaci ledviny.

Fourteen patients on average 10 months after transplantation of the kidney treated with Sandimmune were changed to a new Czechoslovak preparation Consupren, Galena (Cyclosporine A), while maintaining the other components of immunosuppressive treatment (azathioprine, prednisone). The patients were followed up for 6-12 months on the new drug. The tolerance of Consupren was in all patients satisfactory. Two weeks after the change the mean cyclosporine A level was significantly higher and called for a reduced dosage. No significant changes in the clinical condition and laboratory indicators were observed, the serum creatinine values did not change during the investigation and within 6 months after the change no rejection was recorded, despite the fact that during the first six weeks after the change an insignificant rise of mean absolute number of lymphocytes, CD4 lymphocytes and the regulatory index and a significant rise of CD3 lymphocytes was observed.

[Precordial mapping of the R wave in the diagnosis of rejection after orthotopic heart transplantation]. / Prekordiální mapování kmitu R v diagnostice rejekce po ortotopické transplantaci srdce.

In 15 patients after orthotopic transplantation of the heart the authors made repeated examinations of electromaps of the R wave and endomyocardial biopsies (TMB) during a long-term, at least one-year, investigation. In the detection of rejection EMB plays a dominating role. In three patients the authors found at the time of rejection a significant reduction of the R waves on maps, which correlated closely with the bioptic findings. It was revealed that maps of R waves are a good indicator of rejection of the transplanted heart. The examination may prove helpful when checking treatment of rejection but does not lead so far to a restriction of the number of endomyocardial biopsies of the heart.

[Changes in plasma renin and aldosterone after parathyroidectomy in patients with hyperparathyroidism]. / Zmeny plazmatického reninu a aldosteronu po paratyroidektomii u nemocných s hyperparatyrózou.

The plasma renin activity and its changes after parathyroidectomy indicate a preserved internal secretory renal function in dialyzed patients. The PRA values before parathyroidectomy are not unequivocally related to the blood pressure reading. After parathyroidectomy during the initial months the renin and aldosterone plasma levels decline in patients with secondary and primary HPT (p < 0.001), the urinary Na/K quotient rises in primary HPT (p < 0.05) and the systemic blood pressure declines in dialyzed patients with secondary HPT (p < 0.001). The findings suggest relations between the two hormonal systems during hyperparathyroidism and in the early stage after parathyroidectomy. Parathormone probably stimulates renin secretion. After a prolonged time interval following operation the parathormone levels in the blood steam reach normal levels and the same probably applies to intracellular calcium in cells of the iuxtaglomerular apparatus along with PRA.

[Kidney transplantation in diabetics]. / Transplantace ledvin u diabetiku.

Diabetic nephropathy affects half the type I diabetics and is their most frequent cause of death. While in some countries diabetics account for 25-30% of all newly admitted patients in dialyzation-transplantation programmes, in the CSSR the number of diabetic patients treated by dialyzation or transplantation is small. From August 1985 to June 1988 in the Institute of Clinical and Experimental Medicine a total of 15 isolated transplantations of the kidneys were made in 13 diabetics with serious late complications of diabetes. At present all recipients survive (1-35 months) and only two are treated by an artificial kidney. Progressing vascular complications were in two instances the cause of gangrene of the lower extremity, one recipient had a central cerebrovascular attack. Despite this, successful transplantation caused a marked improvement of the general condition and quality of life. The compensation of diabetes was also, due to intensified insulin therapy, satisfactory in the majority of recipients. Hitherto assembled experience indicates that when the patient is prepared in time, which includes diabetological, nephrological and opthalmological treatment, the results of transplantation treatment in diabetic patients can be comparable with results in should be developed in all transplantation centres in the CSSR and uraemic diabetics should be eliminated from the dialyzation transplantation programme only in case of fundamental contraindications.

[Dynamic bone scintigraphy in the diagnosis of renal osteopathy]. / Pouzití dynamické kostiní scintigrafie v diagnostice renální osteopatie.

UNLABELLED: A study was undertaken to assess types of RO by a dynamic modification of osteoscintigraphy 53 pts dialyzed for 27-75 mths, 19-52 yrs old were divided, according to histological bone pictures, into 4 groups: I) 11 pts with hyperparathyroidism, II) 12 pts with osteomalacia, III) 11 pts with mixed RO, IV) 11 pts were after parathyroidectomy (PTE) and 13 controls. INVESTIGATIONS: the rate of 99mTc-Sn-HEDP accumulation in the skeleton, skeletal/background radioactivity index both registered for 60 min. (parameters K and P), serum levels of C-PTH, bone isoenzyme of alkaline phosphatase (bALP), acid phosphatase (ACP), free hydroxyproline (S-Hypro). RESULTS: 1. compared to controls: elevations of K and all biochemical parameters, P in groups I and III (p < 0.01 - < 0.001) were found. 2. Group 1 was characterized by the highest values of all parameters compared to groups II and IV (p < 0.01). 3. Linear relationships were found between K and bALP (p < 0.01), P and bALP, ACP, S-Hypro (p < 0.01) in pts of groups I, II, III. 4. PTE in group IV was followed by a decrease in all parameters (p < 0.01) compared to values of the same pts in group I. Aluminum osteopathy was present in 2/3 of cases in group II showing the lowest values of all parameters. CONCLUSION: DBS is a sensitive method for assessing bone turnover rate according to the degree of skeletal uptake of radionuclide. In this manner it is possible to determine both the type of RO and it's further development in repeated measurements.

[Electrolyte disorders in brain dead organ donors and early functional development of the transplanted kidney]. / Elektrolytové poruchy dárcu orgánu s mozkovou smrtí a casný rozvoj funkce transplantované ledviny.

In 70 cadaverous donors the authors examined 2 hours before collection of organs the serum and urinary electrolyte levels and the creatinine and urea levels. Serious hypokaliaemia (less than 3.0 mmol/l) was found in 24.5% of the donors, hyperkaliaemia (more than 6.0 mmol/l) in 11.4%. Hyponatraemia (less than 125 mmol/l) was present in 11.4%, hypernatraemia (above 160 mmol/l) in 18.6% of the donors. Hyperchloraemia (above 130 mmol/l) was recorded in 22.8 percentage of the donors. In cases where SK less than or equal to 3.0 mmol/l, early functional development of the graft did not occur in 82.3% (p less than 0.001), in cases where SNa less than or equal to 125 mmol/l in 75% (p less than 0.01). When the value of FENa greater than or equal to 5%, early restoration of the graft did not occur in 81.3% of the cases (p less than 0.01). Conversely when FENa less than or equal to 1%, functional development of the graft was highly probable (p less than 0.001). Diuresis above 400 ml/h had an adverse (p less than 0.01) effect on the early functional development of the graft.

[Repeat kidney transplantation]. / Opakované transplantace ledviny.

BACKGROUND: The objective of the study was an analysis of results of repeated kidney transplantations (Tx2, Tx3) implemented during the first 29 years of activities of the Transplantation Centre of the Institute of the Clinical and Experimental Medicine in subjects with a different maintenance immunosuppression. METHODS AND RESULTS: The retrospective study pertains to 134 Tx2 and 17 Tx3 in 134 non-diabetic subjects: 43 of them had during Tx1 and Tx2 (1966-1981 and 1966-1985 resp.) immunosuppression on the basis of azathioprin (Aza, sub-group AA), 42 during Tx1 (1972-85), Aza, while during Tx2 (1984-85) immunosuppression on the basis of cyclosporin (CyA, subgroup AC) and 49 both during Tx1 and Tx2 (1985-93 and 1986-95 resp.) CyA (subgroup CC). Compared was survival of grafts by the actuarial method (with regard to all losses regardless of cause) by the end of the 4th year inside the subgroups (Tx2, vs. Tx1 and Tx3 vs. Tx2 in the same subjects) and between subgroups (Tx1 vs. Tx1 and Tx2 vs. Tx2 in different subjects). Moreover in paired investigations the survival of recipients and grafts after Tx2 was compared after immunosuppression on the basis of CyA with the same parameters after Tx1 in different subjects with the same immunosuppression, operated at approximately the same time (n = 81) and survival of subjects with Tx1 + Tx2 on the CC regime regardless whether the second grafts functioned at the time of the last examination, with survival of subjects after Tx1 where after graft failure Tx2 was not performed (n = 34). Prophylaxis with antilymphocyte globulins was not used. Survival of second and first grafts did not differ in any of the subgroups, third grafts survived at the end of the third year more frequently than second grafts (66 vs. 18%, p < 0.01). Second grafts in CC survived more than in AA (55 vs. 28%, p < 0.01). In the paired study Tx2 vs. Tx1 the survival of grafts and recipients was the same (88 vs. 89%, N.S. and 47 vs. 62% resp.), in the paired study Tx1 + Tx2 vs. Tx1 more subjects with Tx1 + Tx2 survived 10 years after Tx1 than subjects who did not have Tx2 (82 vs. 49%, p < 0.05). CONCLUSIONS: A further transplantation of the kidney after functional loss of the first graft is the method of choice: the mortality is low, the probability of several years' function is considerable and the prognosis as regards quality and length of life better than with regular dialysis treatment.

[Significance of endomyocardial biopsy for heart transplantation]. / Význam endomyokardiálních biopsií pro transplantaci srdce.

The development and retreat of acute rejection was studied by repeated right-side endomyocardial biopsy in a patient after orthotopic heart transplantation. Endomyocardial biopsy was a sensitive detector of acute rejection.

[Endomyocardial biopsy and acute rejection in heart transplantation]. / Endomyokardiální biopsie a akutní rejekce transplantovaného srdce.

Nearly 6-year experience with EMB in patients with transplanted heart concerned especially problems of acute rejection. EMB proved to be a sensitive and for the time being unique method for the detection of acute rejection in patients treated by Cyclosporine immunosuppression. EMB were also criterion of correctness of immunosuppression because they reflected changes in treatment.