Thrombotic microangiopathy and pregnancy.

OBJECTIVE: The aim of this study is to draw attention to a nosological unit called thrombotic microangiopathy (TMA). This syndrome represents a serious pathological condition characterized by microangiopathic haemolytic anemia (MAHA), thrombocytopenia and various organ dysfunction. Patients are most often presented with symptoms of the HELLP syndrome but if the clinical picture is not restituted within 48-72 hours after delivery, other TMAs should be considered. SETTING: Department of Obstetrics and Gynecology, 1st Medical Faculty and General Teaching Hospital Prague; Clinic of Nephrology, 1st Medical Faculty and General Teaching Hospital Prague; Department of Obstetrics and Gynecology, Regional Hospital Kolín. DESIGN: Review article and case reports. METHODS: Review of the literature and description of two cases of TMA. CONCLUSION: The authors present a basic overview of the issue of TMA, which requires interdisciplinary cooperation of obstetricians, anesthesiologists, nephrologists and hematologists. In the second part of the article, we present two TMA case reports and finally show the differential diagnostic and therapeutic scheme as agreed by the authorities in the field.

[Intrauterine system (Mirena) and ectopic pregnancy--case report]. / Ektopická gravidita pri IUS (Mirena) - kazuistika.

An ectopic pregnancy are most common gynaecological emergencies. The large majority (95%) of ectopic pregnancies occur in Fallopian tube. Although pregnancy is rare in women who use intrauterine system Mirena, women who do become pregnant while using Mirena have a high risk of ectopic pregnancy. These pregnancies can be watchful for any signs of an ectopic pregnancy, such a severe abdominal pain accompanied by unusual vaginal bleeding.

[The surgical procedure of mini-sling antiincontinence procedure AJUST, recommendations and ways of solution of possible special situations]. / Operacní postup mini-páskové antiinkontinentní operace AJUST, doporucení a zpusoby resení mozných nestandardních situací

The objective of our work was to present and summarize the course of a joint meeting of surgeons with experience with AJUST in SUI anti-incontinence treatment. We would like to discuss the operation procedure and its individual steps. Further aim was to determine the optimal operation procedure, step by step, avoiding possible complications in the course of the procedure; simplifying the technique and publishing the recommendations how to solve possible complications in the course of, or after, the operation procedure, was important outcome of the meeting.

Stoichiometry of potassium channel opener action.

Potassium channel openers (KCOs; e.g., P1075, pinacidil) exert their effects on excitable cells by opening ATP-sensitive potassium channels. These channels are heteromultimers composed with a 4:4 stoichiometry of an inwardly rectifying K(+) channel subunit plus a regulatory subunit comprising the receptor sites for hypoglycemic sulfonylureas and KCOs (a sulfonylurea receptor). To elucidate stoichiometry of KCO action, we analyzed P1075 sensitivity of channels coassembled from sulfonylurea receptor isoforms with high or low P1075 affinity. Concentration activation curves for cDNA ratios of 1:1 or 1:10 resembled those for channel opening resulting from interaction with a single site, whereas models for activation requiring occupation of two, three, or four sites were incongruous. We conclude KCO-induced channel activation to be mediated by interaction with a single binding site per tetradimeric complex.

Identification of the potassium channel opener site on sulfonylurea receptors.

Diversity of sulfonylurea receptor (SUR) subunits underlies tissue specific pharmacology of K(ATP) channels, which represent critical regulators of electrical activity in numerous cells. Notably, the neuronal/pancreatic beta-cell receptor, SUR1, imparts high sensitivity to hypoglycemic sulfonylureas (SUs; e.g. glibenclamide) and low to potassium channel openers (KCOs; e.g. P1075), whereas the opposite drug sensitivities are conferred by cardiovascular receptors, SUR2A and SUR2B. By exchanging domains between SUR1 and SUR2B, we identify two regions (KCO I: Thr(1059)-Leu(1087) and KCO II: Arg(1218)-Asn(1320); rat SUR2 numbering) within the second set of transmembrane domains (TMDII) as critical for KCO binding. Swapping both regions reconstitutes KCO affinities and sensitivities of the donor SUR isoform. High glibenclamide affinity of SUR1 is not reduced by transfer of KCO I plus II from SUR2B, demonstrating that high SU and KCO affinity can coexist in the same SUR molecule. Consistently, high SU affinity was imparted on SUR2B by substituting the region separating KCO I and II (Ile(1088)-Val(1217)) with the corresponding domain of SUR1. We infer the receptor sites for KCOs and SUs to be closely associated within a regulatory domain (Thr(1059)-Asn(1320)) in TMDII of SURs.

Association of kinesin with microtubules in diverse cytoskeletal systems in the outer segments of rods and cones.

The membranous outer segments of vertebrate photoreceptors are supported by cytoskeletons consisting of microtubules and associated proteins, which occur as the ciliary axoneme in rods and cones, and as a separate cytoskeletal system at the incisures of rod outer segments. We performed an immunocytochemical study of the cytoskeleton in photoreceptors isolated from amphibian retinas and found that immunoreactivity to the heavy chain of the motor protein kinesin was closely associated with the microtubules in each of these outer segment cytoskeletal systems. In the outer segments of cones, kinesin heavy chain immunoreactivity was confined to a streak at the axoneme that extended to the outer segment tip. In the outer segments of rods, kinesin heavy chain immunoreactivity was found as both a short streak at the axoneme and a series of long parallel lines that coincided with the microtubules at rod outer segment incisures. Our findings constitute the first report of kinesin in the axoneme of cones and at the incisures of rods. Closely associated with microtubules, kinesin in photoreceptor outer segment axonemes and at rod outer segment incisures can transport materials longitudinally along the microtubules and/or connect these with each other and/or with other components. Because these cytoskeletal systems differ in fundamental ways, kinesin can play different roles in each case, e.g., kinesin at rod outer segment incisures can have structural and functional roles that are unique to rods. These findings may have clinical relevance because similar cytoskeletal systems are expected to occur in the outer segments of human photoreceptors; thus, a disturbance involving kinesin in the cytoskeletal systems at photoreceptor axonemes and/or at rod outer segment incisures could interfere with the normal structure and function of photoreceptors and contribute to human photoreceptor degenerations.

[201Thallium reinjection after exertion-redistribution myocardial scintigraphy. A new method for distinguishing between scars and vital myocardium]. / 201Thallium-Re-Injektion nach Belastungs-Redistributionsmyokardszintigraphie. Eine neue Methode zur Unterscheidung zwischen Narbe und vitalem Myokard.

In a prospective study 38 patients (35 men, 3 women; median age 56 [37-71] years) with known coronary heart disease in whom conventional thallium-201 exercise-redistribution myocardial scintigraphy (ERMS) had demonstrated segments with diminished activity, thallium-201 was again injected ("reinjection scintigraphy"). Its purpose was to test whether in myocardial segments with persisting diminished radioactivity improved activity after reinjection provided evidence for still viable myocardium. Seven myocardial segments were evaluated in each patient, i.e. a total of 266 segments. Activity in the conventional ERMS was diminished in 94 of the 166 abnormal segments, but improved on reinjection in 21 of the 94 segments (22.3%). Nine of the 38 patients (23.7%) benefitted from the reinjection: only scar tissue without any viable myocardium would have been diagnosed by conventional ERMS in four patients, while extent and spread of ischaemic myocardium was better visualized in five.

Variability of histochemical and morphometric data from needle biopsy specimens of human quadriceps femoris muscle.

Duplicate needle biopsies from the lateral portion of quadriceps femoris muscle from 20 young, healthy males were investigated morphometrically and histochemically. Mean results showed both the size and occurrence of the three main fibre types present to be similar to values obtained from a survey of the literature. However, considerable variations in the proportions of fibre types (coefficients of variation 30-40%) and significant (P less than 0.001) differences in fibre size between individuals were common. Within individuals, comparisons of samples taken at a reference site in the right thigh with samples obtained from deeper, more proximal or contralateral sites also often showed significant differences in fibre size. These results suggest caution is necessary when interpreting apparent changes in such values derived from subsequent biopsies of individuals.