[Justification of the significance of Pseudomonas aeruginosa index in assessing the quality of drinking water].

The analysis of literature data was carried out and performed research justifying the epidemic value of detection in water P. aeruginosa in drinking and domestic water use. The were revealed features of the vital activity of P aeruginosa in water bodies as opposed to conventional microbiological indicators. It was shown that the coliform group indices can not guarantee the epidemic safety of drinking water use in relation to P aeruginosa. The data obtained justify the need for the introduction of P aeruginosa as an additional index in monitoring the water quality of centralized and decentralized water supply.

[Harmonization of microbiologicaland parasitological indices of epidemic safety of drinking water with the international requirements].

For the purpose of harmonization of microbiological and parasitological indices and benchmarks there was performed the comparative analysis of the requirements for the quality of drinking water in respect of the epidemic safety on the basic regulations of Russia, the Directive Council of the European Union EU, WHO, the United States, Canada, Australia, Finland, Sweden, Brazil, France, Japan and China. As a result, there were revealed the priority bacteriological, virological and parasitological parameters: E. coli--indicator of recent fecal contamination, coliforms, heterotrophic bacteria colony count (Heterotrophic plate count), which is in the water legislation of the Russian Federation is characterized as total bacterial count (TBC), being an integral index of the quality of wastewater treatment technologies and hygienic condition of the water supply systems, coliphages as an indicator of viral contamination. In the Guidelines for drinking-water quality control, WHO and a set of countries there is recommended a more wide range of indicators: enterococci, Clostridium perfringens, Pseudomonas aeruginosa, enteroviruses, parasitological indices. With aim of harmonization of the requirements for the quality of drinking water in the Russian Federation with international approaches to the revision of the Sanitary Regulations and Norms (SanPin) 2.1.4.1074 into the project there are introduced priority indicator parameters of bacterial, viral and parasitic contamination of water, evidence-based guidelines.

[Improvement of effectivity of photo disinfection of water from bacterial contaminants in the presence of heterogeneous sensitizers based on phthalocyanines grafted to aminopropyl silicagel].

The possibility of using 12 heterogeneous sensitizers (HS) based on phthalocyanines covalently grafted to aminopropyl silicagel for disinfection of water from bacteria has been studied. For reliable water quality control the technique of performing bacteriological analysis in the presence of HS beads in the sample has been elaborated. The conditions increasing the efficiency of photo disinfection in the presence of HS were studied. Algorithm for estimation of photo disinfectant effect of HS against bacteria was substantiated. Obtained data confirm the perspective of further studies on the substantiation of the possibility of the application of HS for water disinfection.

Coronary artery calcification, common carotid artery intima-media thickness and aortic pulse wave velocity in patients on peritoneal dialysis.

An increasing body of evidence suggests that atherosclerosis in patients with uremia differs from that found in general population in terms of advancement and localization of vascular lesions. It has also been suggested that different non-invasive techniques of vascular system evaluation are designed to show different types of lesions (i.e. vascular calcification, stiffness or 'classical' atherosclerosis). The aim of the study was to search for possible associations between results obtained with three different non-invasive methods of vascular system assessment in three different vascular sites in patients treated with peritoneal dialysis (PD). 61 patients (28 F, 33 M), mean age of 50.4+/-13.6 years, on maintenance PD for a median period of 10 months (range 1-96 months) were included. Coronary artery disease (CAD) was present in 21 subjects. In all subjects coronary artery calcification score (CaSc) using multi-row spiral computed tomography (MSCT), aortic pulse wave velocity (AoPWV) and ultrasound-based common carotid artery intima-media thickness (CCA-IMT) were performed as methods for assessing coronary calcium burden, arterial stiffness and atherosclerosis, respectively. Median value of CaSc equaled 11.5 Agatston units (range 0-5502.8 units). Median AoPWV was 10.4 m/s (range 7.56-18.1 m/s), and median CCA-IMT-0.6 mm (range 0.3-1.0 mm). In 16 patients (26.2%) at least one plaque in at least one common carotid artery was found on ultrasound. CaSc correlated with AoPWV (R=0.32, p<0.01) and with CCA-IMT (R=0.35, p<0.005), whereas no association was found between AoPWV and CCA-IMT. AoPWV, but not CaSc nor IMT correlated with blood pressure. The values of CCA-IMT and AoPWV increased together with consecutive Agatston categories (with p<0.001 for differences in AoPWV and p<0.05 for CCA-IMT). Patients with at least one plaque found in at least one CCA and patients with CAD were characterized with significantly higher values of CaSc, IMT and PWV, when compared to plaque-free and CAD- negative subjects, respectively. Association between CaSc and both IMT and PWV may suggest that the mechanism of three assessed vascular pathologies may be based, to some extent, on the process of pathologic calcium-phosphate deposition. Lack of correlation found between PWV and IMT may suggest that aortic stiffness and carotid atherosclerosis may partially differ in their pathologic background and/or are dissociated in time.

Angiotensin-converting enzyme activity and the ACE Alu polymorphism in autosomal dominant polycystic kidney disease.

BACKGROUND: Previous studies concerning Alu I/D polymorphism in the ACE gene and ADPKD severity have used the Alu genotypes as a representative of the true biological variable, namely ACE activity. However, wide individual and ethnic differences in the proportion of variance in ACE activity explained by the I/D genotype may have confounded these studies. This investigation examines the association between ADPKD severity and ACE in terms of plasma enzyme activity and I/D genotypes in individuals from three different countries. METHODS: Blood samples were collected from 307 ADPKD patients (116 Australian, 124 Bulgarian and 67 Polish) for determination of ACE activity levels and I/D genotypes. Chronic renal failure (CRF) was present in 117 patients and end-stage renal failure (ESRF) in 68 patients. RESULTS: ACE activity was related to the I/D genotype, showing a dosage effect of the D allele (P=0.006). The proportion of variance due to the Alu polymorphism was 14%. No difference in ACE activity and I/D genotype distribution was found between patients with CRF versus normal renal function (P=0.494; P=0.576) or between those with ESRF versus those without ESRF (P=0.872; P=0.825). No effect of the I/D genotype on age at development and progression to renal failure (CRF; ESRF) was detected in the overall group, and in subgroups based on ethnic origin, linkage status and sex. CONCLUSION: ACE is not likely to play a role as a determinant of ADPKD phenotype severity.

[Long-term good results of surgical treatment for spontaneous epi- and subdural hematoma in a female patient on maintenance hemodialysis]. / Dlugotrwaly dobry wynik leczenia operacyjnego spontanicznego krwiaka nad- i podtwardówkowego u chorej objetej programem powtarzanych hemodializ.

Spontaneous intracranial hematoma is not rare, but with bad prognosis, complication in patients on maintenance hemodialysis (HD). Diagnostic difficulties result from a fact that symptoms of acute hematoma such as headaches,, nausea, vomitis, apathy, sleepiness, parestesia and seizures may also suggest dysequilibrium syndrome, dialytic dementia as well as hypertensive encephalopathy. We describe a case of female patient with 20-year interview data of hypertension on HD since 1981 because of end-stage renal failure in a course of chronic glomerulonephritis, who developed spontaneous epi- and subdural hematoma four year ago in 47 age of life. Performed CT examination confirmed diagnosis and on the same day the patient underwent right frontoparietotemporal craniotomy and the hematoma was removed. During postoperative period, HD sessions were performed without heparin. After surgery the patient developed transcient hypertonia, epileptic sizures and left-sided paresis. Currently, 48 months after craniotomy the patient is fully rehabilitated, with normal blood pressure, without epileptic sizures or palsy. Gradually we discontinued anticonvulsans and antihypertensives.

[Current opinions on the etiology and pathogenesis of autosomal dominant polycystic kidney disease (ADPKD). II. Factors other than genetic factors which have an influence on disease course and selected clinical problems]. / Aktualne poglady na etiologie i patogeneze zwyrodnienia wielotorbielowatego nerek typu doroslych (ADPKD). Czesc II: inne niz genetyczne czynniki wplywajace na przebieg choroby i wybrane problemy kliniczne.

In the first part of this paper achievements in the genetic investigations of ADPKD and pathomechanism of cyst formation have been presented. Majority of authors acknowledge that first type of the disease (ADPKD1) in comparison with the second (ADPKD2) has more severe clinical course. On the basis of clinical analysis of selected affected families the larger and larger emphasis has been put on the influence of such factors like: presence of arterial hypertension, especially role of RAA system, sex, diet, hyperlipoproteinemia, environmental factors, toxic and infectious agents. It seems that genetic analysis of the RAA system and ADPKD will partially explain differences in the clinical course of the disease in different families. Persons with DD genotype in RAA system have statistically significant, more severe clinical course in comparison with their relatives with DI or II genotype. Decidedly worse course of the disease is observed in patients with positive family history of arterial hypertension and in persons with increased blood pressure. Patients sex play a major role. Men have more severe renal manifestations, when in women symptoms and complications associated with liver cysts are more frequent than in men. Frequency of intracranial aneurysms (ICA) in the population of patients with ADPKD have been presented. CT, MRA and classical angiography are in order screening tests for detection of ICA, especially in persons with family history of their prevalence. Prevalence of liver cysts and selected clinical symptoms and complications associated with extrarenal manifestations have been discussed. Problems associated with infections of the urinary tract and cysts, their etiology, pathomechanisms and treatment have been presented. Ultrasonography seems to be the best diagnostic tool because of it's accessibility, high sensitivity and low cost. It is accepted, that presence of 3 cysts in both kidneys in ADPKD kindreds in significant for diagnosis. Modified Ravine's criteria for diagnosis of ADPKD have also been presented. Employment of modern diagnostic methods in combination with genetic analysis (especially linkage analysis) enable early diagnosis in persons who are at risk of ADPKD.

[Current opinions about the etiology and pathogenesis of autosomal dominant polycystic kidney disease (ADPKD). I. Selected genetic aspects and mechanisms of cyst formation]. / Aktualne poglady na etiologie i patogeneze zwyrodnienia wielotorbielowatego nerek typu doroslych (ADPKD). Czesc I: Wybrane aspekty genetyczne i mechanizmy powstawania cyst.

The aim of this study is to present in the chronological order evolution of opinions about the etiopathogenesis of Autosomal Dominant Polycystic Kidney Disease (ADPKD), with the special regard to the newest genetic investigations. Prevalence of this disease is estimated at 1:1000, and patients with ADPKD compose up to 10% patients, who need renal replacement therapy. Since 1957, when inheritance was defined by Daalgard as autosomal dominant, a rapid progression in investigations of genetic aspects of this disease has been done. Actually three genes responsible for the development of the disease are known: PKD1 gene located on the short arm of the chromosome 16 (isolated and described in 1994-1995), PKD2 gene, which is located on the long arm of the chromosome 4 (isolated in 1996) and exceptionally occurs PKD3 gene which is not mapped by linkage analysis neither on the PKD1 nor the PKD2. Loci for PKD3 gene is unknown up to now. Investigations, which have been done indicate dependence between genetic type of ADPKD and clinical picture of the disease. Majority of authors consider ADPKD1 as the severe form of the disease, although it is not a rule. The biggest emphasis has been also lay on the influence of other factors. Pathomechanisms of cyst formation in kidneys, the presence of which is pathognomonic for this disease has been better and better understood. Employment of modern diagnostic methods with combinations of the genetic analysis (especially linkage analysis) afford possibilities for early diagnosis of the disease among persons, who are kindreds of ADPKD family members and are at risk of the disease.

Two cases of unusual rupture of aortic aneurysm.

Two cases of unusual rupture of aortic aneurysm with extravasation in the bronchus and duodenum are described. The clinical evolution of such aneurysm ruptures is associated with considerable diagnostic difficulties due to the absence of pathognomonic typical features and the short survival time after onset of pain symptoms.

[Effect of recombinant human erythropoietin (rHu-EPO) on anemia and selected biochemical parameters in patients in the pre-dialysis period]. / Wplyw rekombinowanej ludzkiej erytropoetyny (rHu-EPO) na niedokrwistosc i wybrane parametry biochemiczne u chorych w okresie przeddializacyjnym.

The effect of recombinant human erythropoietin (rHu-EPO) on anaemia and some biochemical parameters was investigated in 7 predialysis patients. A statistically significant increase in erythrocyte, haematocrit and haemoglobin levels was observed after 3 weeks of treatment and such changes were constant during the 6 month maintenance therapy. The mean urea and creatinine levels were comparable during the tested period in 4 of the studied patients. The other 3 patients did not completed the planed period and started the dialytic therapy because of progression of renal insufficiency. The latter group had more advanced renal failure and higher blood pressure prior to rHu-EPO treatment as compared with the patients who completed the study.

[Recombinant human erythropoietin stimulates synthesis of fetal hemoglobin in patients with renal anemia treated by repeated hemodialysis]. / Rekombinant ludzkiej erytropoetyny pobudza synteze hemoglobiny plodowej u chorych z niedokrwistoscia nerkowo-pochodna leczonych powtarzanymi hemodializami.

Effect of intravenously administered recombinant human erythropoietin (rHu EPO) on haemoglobin (Hb) level, haematocrit (Ht), reticulocyte count and foetal haemoglobin (HbF) concentration was assessed in 10 patients with anaemia, treated by repeated haemodialysis due to end-stage kidney. As compared to the initial values, erythropoietin treatment brought about a significant increase in all the parameters examined. During the subsequent therapy with lower, supporting doses of erythropoietin, the elevated HbF values fell back to normal, whereas the higher level of total Hb and Ht were maintained.

[Activity of selected neutrophil enzymes of patients maintained on hemodialysis and treated with erythropoietin (rHu EPO)]. / Aktywnosc wybranych enzymów neutrofilów chorych przewlekle dializowanych leczonych erytropoetyna (rHu EPO).

The peroxidase, alkaline phosphatase, acid phosphatase, beta-glucuronidase and N-acetyl-beta-D-glucosaminidase activity was assessed using a semiquantitative cytochemical methods in peripheral blood neutrophils from 10 maintenance haemodialysed patients treated with recombinant human erythropoietin (rHu EPO) due to severe anaemia. The examination was performed immediately prior to rHu EPO treatment, after 10 weeks and 32 weeks of therapy. A statistically significant increase in the beta-glucuronidase and N-acetyl-beta-D-glucosaminidase activity was observed after 10 weeks, while all the enzymes studied except peroxidase showed a significant elevation of their activity after 32 weeks of the treatment as compared with the values obtained prior to therapy.