[Cytostatic drugs: occupational hazard to health care workers]. / Cytostatyki jako czynnik zagrozenia zawodowego dla personelu sluzby zdrowia.

Cytostatic anticancer drugs are known as carcinogenic, mutagenic, and teratogenic risk factors for health care workers who are occupationally exposed during preparation and management of such drugs. Risk assessment for occupational exposure to antiblastic chemotherapeutic drugs is carried out by means of environmental and biological monitoring. During last twenty years, several researchers have developed and validated methods for monitoring occupational exposure to such agents. The author reviews the literature on possible effects of occupationally exposed hospital workers and occupational exposure.

[Factor VIII inhibitor appearing in women during delivery]. / Inhibitor czynnika VIII pojawiajacy sie u kobiet w okresie okoloporodowym.

Factor VIII inhibitor is rare, but very serious postpartum complication. Bleeding diathesis caused by this inhibitor is called acquired haemophilia. Three women with postpartum inhibitor to factor VIII and life threatening bleeding were described. In two patients bleeding was controlled by treatment with high doses of human and porcine factor VIII concentrates. One patient died presenting uncontrolled haemorrhagic diathesis. This work presents the problems of the diagnosis, treatment and also the elimination of the factor VIII inhibitor.

[The course of acute hepatic porphyria]. / Przebieg ostrych porfirii watrobowych.

Acute hepatic porphyrias are the diseases dependent on the congenital metabolic defects of the hem biosynthesis. The diagnosis of porphyria only on the grounds of clinical picture is extremely difficult as it is presented by the variety of symptoms, often imitating other diseases. In each case the diagnosis must be confirmed by the biochemical and enzymatic investigations. In the paper we described different clinical courses of the acute hepatic porphyrias. The acquaintance with the symptoms of porphyrias enables to decrease the number of complications connected with diagnostic and therapeutic errors what is still a serious economic problem.

[Multiorgan trauma]. / Uraz wielonarzadowy.

A case is presented of a patient with multiorgan trauma. The main diagnostic problem was coexisting haemorrhage. Curable skin defects were healed after several covering them with intermediate thickness mesh grafts. The postoperative course was complicated with sepsis and acute non-inflammatory renal failure with polyuria.

[Propafenone, flecainide, procainamide in the treatment of a fresh attack of atrial fibrillation]. / Propafenon, Flekainid i prokainamid w leczeniu swiezego napadu migotania przedsionków.

The purpose of the present work was an assessment of the effectiveness of intravenously administered propafenone, flecainide and procainamide in restoration of sinus rhythm in patients with atrial fibrillation attack lasting not more than 48 hours, The studies were carried out in 95 patients, including 30 treated with propafenone, 27 with flecainide, and 38 with procainamide. Propafenone turned out to be effective in 23 patients (76.7%), flecainide in 19 patients (70.4%), and procainamide in 14 patients (36.8%). Each of the drugs more effectively restored sinus rhythm in patients with smaller size of the left atrium and with shorter duration of atrial fibrillation attack, and propafenone and flecainide were also more effective in younger patients. The return of sinus rhythm was accompanied a reduction of the size of the left atrium. None of the studied drugs caused any more important adverse effects.

[Splenectomy in adult patients with idiopathic thrombocytopenic purpura after intravenous immunoglobulin treatment]. / Splenektomia u doroslych chorych z samoistna maloplytkowoscia po przygotowaniu dozylnymi preparatami immunoglobulin.

Eight patients with idiopathic thrombocytopenic purpura (ITP) and no response to steroids therapy were prepared for splenectomy, for 5 consecutive days, with intravenous immunoglobulin (IVIG, 0.4 g/kg body weight). Increase of platelet counts and/or remission of haemorrhagic diathesis were observed in 7 patients, in one case IVIG proved ineffective. Splenectomy was performed in 7 cases and the postoperative course was uneventful. IVIG treatment has proved efficient in preparing ITP patients for splenectomy.

[Preliminary experience with achieving immune tolerance in patients with hemophilia A and circulating factor VIII inhibitor]. / Wstepne doswiadczenia w uzyskiwaniu tolerancji immunologicznej u chorych na hemofilie A z krazacym antykoagulantem.

The appearance of antibodies to factor VIII is a serious complication in the treatment of haemophilia A. A protocol is presented aiming at suppression of the anticoagulant using continued treatment with factor VIII (25 u/kg b.w. twice weekly). Ten patients with previous maximal factor VIII antibody titre from 7 to 2900 Bethesda units were treated. So far the inhibitor was eradicated in 3 cases treated continuously for from 5 to 20 months. In two of these three cases successful surgical procedures were performed without anamnestic response.

Surface roughness enhances the osseointegration of titanium headposts in non-human primates.

It is well recognized that micrometer and nanometer sized surface features enhance the skeletal attachment of implants within bone. However, little is known regarding the integration of implants placed outside the bone but in contact with the surface. Loosening of chronic skull anchored headposts in non-human primate based experiments can be a factor. The purpose of this study was to evaluate the effect of a simple and easily applied surface texture on bone apposition to titanium implants fixed to the periosteal surface of the skull. Implants possessed either a polished surface or a textured surface created by grit-basting followed by acid etching. The percent of bone in contact with the implant surface (bone apposition) to three polished and three textured implants was evaluated in one adult female monkey after 14 weeks. Upon harvest, implants were processed for undecalcified histology and regions of bone apposition were quantified using backscatter electron microscopy and digital image analysis. The bone apposition to textured implants was 62±20% and to polished implants was 42±21%. The application of a peak-and-pit like texture to the surface of titanium implants significantly increased bone apposition to titanium implants placed on the periosteal surface of the skull. This study demonstrates that titanium headposts can easily be modified to improve osseointegration using equipment and supplies available to most neurophysiological laboratories. In addition, implant texturing may have utility in areas including skeletal trauma and reconstruction where devices are placed in contact with the bone surface.

[Tests concerning the usefulness of serum myoglobin levels for the diagnosis of reperfusion in patients with imminent myocardial infarction]. / Badania nad przydatnoscia oznaczen stezenia mioglobiny w surowicy w rozpoznawaniu reperfuzji u chorych na zagrazajacy zawal serca.

Blood myoglobin, CPK and CK-MB activities were assayed in 32 patients with the acute myocardial infarction up to 360 minutes following the start of thrombolytic therapy. Plasma myoglobin, CPK and CK-MB activities increased significantly less in 18 patients in whom reperfusion of the coronary artery has been noted. Maximum increase in myoglobin levels preceded an increase in CPK and CK-MB activities and it may be an early marker of reperfusion.

[Influence of magnesium on rate of sodium transport through lymphocyte membranes in patients with hypertension]. / Wplyw magnezu na wskazniki szybkosci przeplywu sodu przez blony komórkowe limfocytów u chorych na nadcisnienie tetnicze.

Clinical and experimental investigations indicate that one of the causes of primary hypertension may be diminished membrane sodium efflux. Magnesium is thought to be one of necessary factors that influence normal sodium membrane efflux and thereby maintains correct membrane gradient and potential. The aim of the study was to determinate the influence of intravenous 25% magnesium sulphate infusion on arterial pressure and sodium leukocyte membrane efflux in subjects suffering from primary arterial hypertension. The measurements were performed in 43 hypertensive patients. All patients have been divided into two groups: first-23 subjects with mild hypertension (5 women aged 32 to 50 years and 18 men aged 22 to 58 years), second-20 subjects with moderate hypertension (7 women aged 41 to 60 years and 13 men aged 28 to 65 years). The control group consisted of 31 healthy volunteers (9 women aged 37 to 55 years and 22 men aged 21 to 60 years). After venous catheter has been placed in cephalic vein standard supine arterial pressure measurements and venous blood were obtained in every person. Infusion of 20 ml 25% magnesium sulphate dissolved in 500 ml 5% dextrose was administered during 60 minutes. Again measurements were obtained after the infusion all. Arterial blood pressure was also measured 6 hours after infusion. In our investigation we proved that infusion of 20.3 mmol. of magnesium in patients with primary hypertensive disease enhanced total and furosemide-dependent but not oubain-dependent sodium membrane efflux. It did not also influence neither systolic nor diastolic arterial pressure. The greatest enhancement of total and furosemide-dependent sodium membrane efflux was observed in persons who had the greatest enhancement of magnesium blood concentration.

Immune tolerance induction in haemophiliacs with inhibitor to FVIII: high- or low-dose programme.

In 1993-94, 15 high responders were treated in our centre according to the Malmo protocol which was modified as follows: serial plasmapheresis was performed instead of extracorporeal adsorbtion to protein A for reducing inhibitor levels and, after the bolus dose to neutralize the inhibitor, factor VIII concentrate was administered by a continuous infusion. Thus, this regimen included continuous infusion of factor VIII(FVIII) for 1-4 weeks, iv cyclophosphamide for 2 days and orally for 8-10 days, and intravenous immunoglobulin (IVIG) from the fourth day for 5 days. All patients had been qualified for the treatment when the antibody level was < 15 BU mL(-1) . Tolerance was induced in 10 patients (66.6% very good and good results). The treatment failed in five cases in which, due to a high inhibitor level, it was not possible to maintain a measurable factor VIII:C concentration throughout the whole period of infusion. We compared these results with results of our low-dose regimen: 25 IU FVIII kg(-1) b.w. twice a week (1985-89, 11 high responders). The modified Malmo Protocol is much shorter than the low-dose programme and this is a method of first choice in patients undergoing surgery in the near future.

Surgery in hemophilia A patients with factor VIII inhibitor: 10-year experience.

Patients with hemophilia A and circulating anticoagulant (factor VIII inhibitor) present a difficult, even unsolvable problem, particularly if they require surgical treatment and the inhibitor titer is high. During the 1986-1995 period 29 surgical procedures on inhibitor hemophilia A patients were performed in our center. Each of the cases had an individual character, and all demanded special clinical treatment. Based on this experience we present the possibilities of hemostasis maintenance during the perioperative period with high doses of human or porcine factor VIII, aPCC, plasmapheresis, and extracorporeal antibody adsorption to protein A-Sepharose. In some patients hemostasis maintenance requires combined treatment. To induce immunotolerance in patients with inhibitor is the gold standard treatment because it is then possible to achieve proper hemostasis after factor VIII infusion. Various methods of immunotolerance induction have been discussed and compared with our experience with immunotolerance induction in 11 patients with small factor VIII doses (25 IU/kg twice a week) and the modified Malmö protocol in 15 patients.

A study on financial viability of clinics and physician practices in under-served areas of Wisconsin: summary of results with recommendations.

A survey of 21 physicians and clinic managers located in Health Professional Shortage Areas (HPSAs) and other under-served areas in Wisconsin found that to combat increasing costs, low reimbursement rates, and increasing charity care demands, several practices rely on outside sources of funding to remain financially viable. Also, the financial viability of physician practices in under-served areas of Wisconsin is threatened more by the low reimbursement rates of Medicaid and Medicare than by the provision of charity care. Though few are limiting the number of Medicare and uninsured patients they will treat, many have begun implementing cost containment measures, including more strict collection policies. There are also indications of restricted access for Medicaid patients.

An overview of a study on the financial viability of clinics and physician practices in medically under-served areas of Wisconsin.

A survey of 21 physicians and clinic managers located in Health Professional Shortage Areas (HPSAs) and other under-served areas in Wisconsin found that to combat increasing costs, Medicare and Medicaid discounts, charity care demands and physician recruitment difficulty, several practices rely on outside sources of funding to remain financially viable. Also, the financial viability of physician practices in under-served areas of Wisconsin is threatened more by the reimbursement rates of Medicaid and Medicare than by the provision of charity care. Though few are limiting the number of Medicare and uninsured patients they will treat, many have begun implementing cost-containment measures, including more strict collection policies. There are also indications of restricted access for Medicaid patients at some sites.

The effects of Medicare and Medicaid reimbursement on the financial viability of clinics and physician practices in medically under-served areas of Wisconsin.

A survey of 21 physicians and clinic managers located in Health Professional Shortage Areas (HPSAs) and other under-served areas in Wisconsin found that to combat increasing costs, Medicare and Medicaid discounts, charity care demands and physician recruitment difficulty, several practices rely on outside sources of funding to remain financially viable. Also, the financial viability of physician practices in under-served areas of Wisconsin is threatened more by the reimbursement rates of Medicaid and Medicare than by the provision of charity care. Though few are limiting the number of Medicare and uninsured patients they will treat, many practices have begun implementing cost-containment measures, including more strict collection policies. There are also indications of restricted access for Medicaid patients at some sites.

A study on financial viability of clinics and physician practices in under-served areas of Wisconsin: the primary care physician shortage problem and collection issues.

A survey of 21 physicians and clinic managers in Health Professional Shortage Areas (HPSAs) and other under-served areas in Wisconsin found that to combat increasing costs, low reimbursement rates and increasing charity care demands, several practices rely on outside sources of funding. Also, the financial viability of physician practices in underserved areas of Wisconsin is threatened more by the low reimbursement rates of Medicaid and Medicare than by the provision of charity care. Though few are limiting the number of Medicare and uninsured patients they will treat, many have begun implementing cost containment measures, including more strict collection policies. There are also indications of restricted access for Medicaid patients.

Analysis of hepatitis G virus infection markers in blood donors and patients with hepatitis.

The incidence and clinical significance of hepatitis G virus (HGV) is still not fully known. The aim of our study was to assess the frequency of HGV RNA and antibody to HGV E2 protein (anti-E2) in Polish blood donors and patients with hepatitis, and to compare the sequence of HGV clones with those reported by others. Two-hundred and nineteen blood donors and 83 patients with hepatitis were studied. HGV was detected in 3.2% and anti-E2 in 24.2% of blood donors and in 26.5% and 8.4% of patients with hepatitis, respectively. HGV was detected as a co-infection with HCV in four of 18 patients with chronic hepatitis, in four of 16 patients with acute hepatitis and in one of six patients with fulminant liver failure (FLF), and as a co-infection with HBV in one of six patients with FLF and in three of 10 patients with chronic hepatitis. In non-A-C hepatitis, eight of 23 patients with acute hepatitis and one of four patients with FLF were positive for HGV but all 10 patients with chronic cryptogenic hepatitis were negative. In the follow-up studies of patients with HGV alone, a correlation with viraemia and clinical symptoms was observed in two patients, but in three others HGV RNA was detected in spite of clinical resolution. Two HGV clones were sequenced, and the sequence of the HGV helicase region of the HGV isolates from donor and patient were homologous to those described by others. Hence, the frequency of HGV RNA in blood donors is similar to that obtained in other countries but the anti-E2 (marker of a past infection) frequency is higher. The incidence of HGV RNA and anti-E2 in hepatitis patients suggests that HGV plays a role in liver pathology, but careful analysis of individual cases does not confirm this.

Synoviorthesis with 198Au colloid gold in haemophilia patients. A preliminary report.

In 1988-1989 fifteen patients with severe haemophilia A and recurrent bleedings into the knee joint, aged from 19 to 44 years were treated by an intraarticular injection of 198Au colloid gold. So far 10 of them were assessed after 6 months follow-up. In 6 cases cesseation and in 2 cases reduction in number and volume of bleedings were observed. Only in 2 patients the frequency of haemarthroses remained unchanged. No significant difference in tracer uptake was observed between pretreatment 99mTc-pertechnate gamma scans of the knee joints and controls completed 6 months after the radiogold injections. It is worthy to stress the lower costs of the 198Au synoviorthesis as compared with surgical synovectomy of the knee joint. The radioisotope method is also much less traumatic to the patient than the surgical one.

Hazards of thrombolytic therapy in deep vein thrombosis.

From 1965 to 1985, 64 deep vein thrombosis (DVT) patients were treated with streptokinase (SK). In 26 cases 'high-dose SK' (IV 100,000 units/h for 4 days) was used and in 38 patients a 'low-dose SK' regime (IV 250,000 units every 12 h for 4 days) was employed. The clinical signs of DVT subsided in 78 per cent of treated patients within 30 days of completing SK treatment. A repeat phlebography was performed immediately after SK therapy in 29 patients (45 per cent) and a total recanalization or partial thrombolysis was achieved in 80 per cent of the studied cases. In 15 patients minor and major haemorrhagic complications occurred. There were five fatalities, all in the high-dose SK group (three intracranial haemorrhages and two major bleeds). Three patients developed pulmonary embolism and none of them died. The post-treatment clinical and phlebographic evaluation did not reveal any significant difference between the two methods of SK administration, but more haemorrhagic complications (P less than 0.02, chi=5.50825) occurred in the high-dose SK patients. This report emphasizes the risk of bleeding complications during thrombolytic therapy. If SK is to be used, therefore, careful selection of patients and meticulous monitoring are mandatory.