Parathyroid carcinoma in chronic renal disease - a case series of three patients and review of literature.

BACKGROUND: Apart from being a rare endocrine tumor, parathyroid carcinoma is also one of the rarest malignancies in human beings. Parathyroid carcinoma is even more uncommon in haemodialysis patients with end-stage renal disease. The pathogenesis of parathyroid hyperplasia in haemodialysis patients is well known, but the mechanism of development of parathyroid carcinoma in these patients remains unclear. METHODS: Three cases of parathyroid carcinoma in haemodialysis patients are presented in this study: a 69-year-old male patient and two female patients (67 and 61 years old). In all cases parathyroid carcinoma infiltrated the ipsilateral thyroid lobe and in one patient the right laryngeal nerve was involved as well. One patient underwent three surgical procedures. RESULTS: After surgical treatment, all patients were normocalcaemic and showed a significant reduction in PTH levels. CONCLUSION: In patients with secondary hyperparathyroidism, who develop parathyroid carcinoma, surgical resection is the only viable treatment option.

Cardiovascular risk assessment and coronary artery calcification burden in asymptomatic patients in the initial years of hemodialysis.

The specific tool for cardiovascular risk assessment in hemodialysis population has not yet been proposed, despite high prevalence of cardiovascular morbidity, and mortality in clinically asymptomatic patients. Coronary artery calcium score (CACS), as a reliable predictor of future cardiovascular events, might be a valuable approach. We sought to evaluate coronary artery calcification burden and its association with clinical and laboratory parameters in asymptomatic patients who recently initiated hemodialysis. The cross-sectional study included 60 asymptomatic patients receiving chronic hemodialysis for no longer than 48 months. CACS was assessed by cardiac computed tomography. Intima-media thickness (IMT) of both common carotid and femoral arteries were measured using ultrasonography. The mean total CACS was 160.50 (443). Patients' age correlated significantly with CACS (σ = 0.367; P = 0.004), carotid (σ = 0.375; P = 0.004) and femoral IMT (σ = 0.323; P = 0.013). Patients with CACS = 0 were significantly younger than patients with CACS >400: 52.4 ± 7.91 vs. 63.88 ± 8.37 years old, respectively (P = 0.034). In patients receiving dialysis for longer than 24 months CACS, femoral and carotid IMT were higher than in those dialyzed for less than 24 months; however, none has reached significance. There was a significant positive correlation between CACS and right (σ = 0.312; P = 0.018) and left (σ = 0.521; P < 0.001) femoral IMT, while not with carotid. CACS showed significant negative correlation with the serum iron (σ = -0.351; P = 0.007). Calcification burden varies significantly in asymptomatic patients in early years of dialysis. It correlates with patients' age and tends to increase with dialysis vintage. Femoral IMT might be useful for cardiovascular risk stratification in asymptomatic patients who recently initiated hemodialysis.

Predicting anemia using NIR spectrum of spent dialysis fluid in hemodialysis patients.

Anemia is commonly present in hemodialysis (HD) patients and significantly affects their survival and quality of life. NIR spectroscopy and machine learning were used as a method to detect anemia in hemodialysis patients. The aim of this investigation has been to evaluate the near-infrared spectroscopy (NIRS) as a method for non-invasive on-line detection of anemia parameters from HD effluent by assessing the correlation between the spectrum of spent dialysate in the wavelength range of 700-1700 nm and the levels of hemoglobin (Hb), red blood cells (RBC), hematocrit (Hct), iron (Fe), total iron binding capacity (TIBC), ferritin (FER), mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC) in patient blood. The obtained correlation coefficient (R) for RBC was 0.93, for Hb 0.92, for Fe 0.94, for TIBC 0.96, for FER 0.91, for Hct 0.94, for MCV 0.92, for MCHC 0.92 and for MCH 0.93. The observed high correlations between the NIR spectrum of the dialysate fluid and the levels of the studied variables support the use of NIRS as a promising method for on-line monitoring of anemia and iron saturation parameters in HD patients.

Relationship Between Leptin Level, Inflammation, and Volume Status in Maintenance Hemodialysis Patients.

Maintenance hemodialysis (HD) patients often experience fluctuations of volume status. Although hypervolemia possibly induces systemic inflammation, the relationship between volume status and leptin has not yet been well defined. The aims of this study were to determine the levels of leptin, C-reactive protein (CRP), and ferritin in relation to volume status and to assess the relationship between leptin and volume and inflammatory status in chronic HD patients. This prospective study included 93 HD patients divided, based on evaluation using the body composition monitor, into normovolemic and hypervolemic groups (overhydration/extracellular water [OH/ECW] ≤ 15% and OH/ECW > 15%, respectively). The levels of leptin and inflammatory markers (CRP, ferritin) were determined during a mid-week dialysis session in all patients. There were more hypervolemic patients after 12 months of follow up than at baseline (41% vs. 38%). Hypervolemic patients had significantly lower leptin levels (11.42 ± 19.24 ng/mL vs. 34.53 ± 40.32 ng/mL at baseline and 13.41 ± 22.04 ng/mL vs. 41.54 ± 21.78 ng/mL at 12 months), longer time on dialysis, and poorer nutritional status than normovolemic patients. Inflammation was present regardless of the volume status, but hypervolemic patients had significantly higher CRP and ferritin than normovolemic patients. A statistically significant reverse correlation was found between leptin level, hyperhydration index, and OH/ECW. No significant correlation was found between leptin and inflammatory markers CRP and ferritin.

Estimation of angiotensin-converting enzyme inhibitors protein binding degree using chromatographic hydrophobicity data.

INTRODUCTION: Angiotensin-converting enzyme (ACE) inhibitors represent a significant group of drugs primarily used in the treatment of hypertension and congestive heart failure. OBJECTIVE: Selected ACE inhibitors (enalapril, quinapril, fosinopril, lisinopril, cilazapril) were studied in order to establish a fast and easy estimation method of their plasma protein binding degree based on their lipophilicity data. METHODS: Chromatographic hydrophobicity data (parameter C0) were obtained on cellulose layers under conditions of normal-phase thin-layer chromatography (NPTLC), using different binary solvent systems. The ACE inhibitors lipophilicity descriptors (logP) values were calculated using the software package Virtual Computational Chemistry Laboratory.The ACE inhibitors plasma protein binding data were collected from relevant literature. RESULTS: ACE inhibitors protein binding data varied from negligible (lisinopril) to 99% (fosinopril). The calculated lipophilicity descriptors, logP(KOWWIN) values ranged from -0.94 (lisinopril) to 6.61 (fosinopril). Good correlations were established between plasma protein binding values and calculated logP(KOWWIN) values (R2 = 0.8026) as well as chromatographic hydrophobicity data, C0 parameters (R2 = 0.7662). Even though good correlation coefficients (R2) were obtained in both relations, unacceptable probability value with p > 0.05 was found in relation between protein binding data and calculated logP(KOWWIN) values. Subsequently, taking into consideration the request for probability value lower than 0.05, a better relationship was observed between protein binding data and chromatographically obtained hydrophobicity parameters C0 values. CONCLUSION: Cellulose layers are easily available and cost effective sorbent to assess hydrophobicity. Experimentally obtained data on ACE inhibitors hydrophobicity and plasma protein binding estimation are important parameters in evaluating bioavailability of these drugs.

Levels of transforming growth factor ß1 during first six months of peritoneal dialysis.

Transforming-growth factor ß1 (TGF-ß1) is a powerful cytokine involved in physiological processes of growth, differentiation, gene expression, embryogenesis, tissue remodelling, wound healing as well as tumorigenesis, immunosuppression and fibrosis, like peritoneal membrane fibrosis on long-term peritoneal dialysis (PD) treatment. The aims of this study were to determine TGF-ß1 levels in serum (s) and drained dialysate (dd), to assess their relations to sex, age, diabetes, dialysis modality, peritonitis and use of erythropoiesis stimulating agents (ESAs), inhibitors of angiotensin-converting enzyme (ACEi) and/or statins in 20 patients, 11 men and 9 women, mean age 62.90 ± 12.69 years, free of peritonitis during the first 6 months of PD treatment. There was no statistically significant difference in TGF-ß1 concentrations in serum and drained dialysate at the beginning and after first 6 months of chronic PD, in patients of different sex, age and diabetic patients versus non-diabetic. The significant positive correlations between sTGF-ß1 levels and glycemia at the beginning and cholesterolemia after 6 months of PD treatment suggest higher TGF-ß1 concentrations in patients with unfavorable metabolic profile. Expression of TGF-ß1 in effluent dialysate was significantly lower in patients on chronic PD using ACEi therapy, suggesting ACEi to have a protective effect on peritoneal membrane. Patients on ESA had slightly lower sTGF-ß1 concentrations after the first 6 months of PD treatment.

Dialysis headache in patients undergoing peritoneal dialysis and hemodialysis.

OBJECTIVES: Headache is among most frequently encountered neurological symptom during hemodialysis (HD), but still under investigated in peritoneal dialysis (PD) patients. The aim of this study was to assess the incidence and clinical characteristics of dialysis headache (DH) in HD and PD patients. MATERIAL AND METHODS: A total of 409 patients (91 on PD and 318 on HD) were interviewed using a structured questionnaire, designed according to the diagnostic criteria of the International Headache Classification of Headache Disorders from 2004. Patients with DH underwent a thorough neurological examination. RESULTS: DH was reported by 21 (6.6%) HD patients and 0 PD patients. PD patients had significantly lower serum sodium, potassium, calcium, phosphate, urea and creatinine, calcium-phosphate product, and diastolic blood pressure than HD patients. HD patients had significantly lower hemoglobin compared to PD patients. Primary renal disease was mostly parenchymal in HD patients, and vascular in PD patients. DH appeared more frequently in men, mostly during the third hour of HD. It lasted less than four hours, was bilateral, non-pulsating and without associated symptoms. CONCLUSION: Biochemical alterations may be implicated in the pathophysiology of DH. Specific features of DH might contribute to better understanding of this secondary headache disorder.

Levels of Vascular Endothelial Growth Factor during First Six Months of Peritoneal Dialysis.

INTRODUCTION: Chronic peritoneal dialysis (PD) up-regulates vascular endothelial growth factor (VEGF) synthesis and VEGF is found in drained dialysate (dd). OBJECTIVE: Aims of this prospective study were to evaluate serum (s) and ddVEGF concentration during the first six months of PD, relationships between these concentrations and demographic and biochemical parameters, presence of diabetes, peritonitis, and the use of medications. METHODS: The study included 20 patients, with the mean age of 62.9±12.69, 11 of whom were affected by diabetes mellitus. Fasting venous blood samples were taken at the beginning and after six months of PD, in tri-potassium ethylenediaminetetraacetic acid (K3EDTA) vacutainer. RESULTS: After six months of PD, sVEGF concentrations increased significantly, without significant change in ddVEGF. Concentrations of sVEGF at the beginning of chronic PD treatment directly significantly correlated with serum fibrinogen, and after six months with fibrinogen and glycemia. In patients receiving erythropoiesis-stimulating agent (ESA), levels of sVEGF and ddVEGF were lower at baseline, while after six months of PD ddVEGF increased. in patients not receiving ESA, sVEGF increased more prominently, while ddVEGF decreased.The changes were not statistically significant. Patients receiving angiotensin-converting-enzyme inhibitor (ACEi) had sVEGF and ddVEGF levels insignificantly lower than those not using ACEi, however sVEGF significantly increased during six months of PD. After six months of PD, ddVEGF was significantly higher compared to those not using ACEi. Treatment with statins did not significantly influence levels of sVEGF and ddVEGF during the follow-up. Concentrations of sVEGF were continually lower than those of ddVEGF and increased more, while concentrations of ddVEGF were higher in patients using statins. CONCLUSION: Serum and drained dialysate concentrations of VEGF in PD patients were connected with poorer metabolic profile, while the role of inflammation and treatment agents should be studied further.

Work-Related Factors as Predictors of Burnout in Serbian Nurses Working in Hemodialysis.

Nurses who work in hemodialysis (HD) are considered highly susceptible to burnout due to their close relationship with incurable patients and handling sophisticated machinery. A total of 210 nurses from 12 state-owned HD centers in the Republic of Serbia anonymously completed a background information questionnaire providingfactual data on nurses' sociodemographic characteristics and working conditions using the Maslach Burnout Inventory--Health Services Survey. Almost half of the nurses (42.9%) were experiencing burnout High emotional exhaustion, high depersonalization, and low level of personal accomplishment were present in 40.9%, 8.6%, and 31.3% of nurses, respectively. The number of children, involuntary choice of current position, and unwillingness to choose the same type of job again were significant predictors of burnout. Our population of nurses working in HD was more affected by emotional exhaustion than their colleagues in other countries, but maintained high level of empathy and feeling ofpersonal accomplishment.

Depression and quality of sleep in maintenance hemodialysis patients.

INTRODUCTION: Sleep disorders and psychological disturbances are common in end-stage renal disease (ESRD) patients. However, despite their frequency and importance, such conditions often go unnoticed, since all patients do not clearly manifest fully expressed symptoms. OBJECTIVE: This study aimed to determine the prevalence of depression and poor sleep quality and to examine the association between these disorders and demographic, clinical and treatment-related characteristics of ESRD patients on hemodialysis (HD). METHODS: The study included 222 patients (132 men and 90 women), mean age 57.3 +/- 11.9 years, from 3 HD centers in Central Serbia, which provided us with biochemical parameters and demographic data. Sleep quality and depression were assessed using the Pittsburgh Sleep Quality Index (PSQI) and Beck Depression Inventory (BDI), respectively. RESULTS: The average BDI was 16.1 +/- 11.3. Depressed patients were significantly older (p=0.041), had a significantly lower dialysis adequacy (p=0.027) and a significantly worse quality of sleep (p < 0.001), while they did not show significant difference as regarding sex, employment, marital status, comorbidities, dialysis type, dialysis vintage, shift and laboratory parameters.The average PSQI was 7.8 +/- 4.5 and 64.2% of patients were poor sleepers. Poor sleepers were significantly older (p = 0.002), they were more often females (p = 0.027) and had a significantly higher BDI (p < 0.001), while other investigated variables were. not correlated with sleep quality. A statistically significant positive correlation was found between BDI and PSQI (r = 0.604; p < 0.001). CONCLUSION: Depression and poor sleep quality are frequent and interrelated among HD patients.

Habitual coffee consumption enhances attention and vigilance in hemodialysis patients.

OBJECTIVE: Coffee drinking is the main source of caffeine intake among adult population in the western world. It has been reported that low to moderate caffeine intake has beneficial effect on alertness and cognitive functions in healthy subjects. The aim of this study is to evaluate the impact of habitual coffee consumption on cognitive function in hemodialysis patients. METHODS: In a cross-sectional study, 86 patients from a single-dialysis centre underwent assessment by the Montreal Cognitive Assessment tool and evaluation for symptoms of fatigue, mood, and sleep disorders by well-validated questionnaires. The habitual coffee use and the average daily caffeine intake were estimated by participants' response to a dietary questionnaire. RESULTS: Sixty-seven subjects (78%) consumed black coffee daily, mostly in low to moderate dose. Cognitive impairment was found in three-quarters of tested patients. Normal mental performance was more often in habitual coffee users (25% versus 16%). Regular coffee drinkers achieved higher mean scores on all tested cognitive domains, but a significant positive correlation was found only for items that measure attention and concentration (P = 0.024). CONCLUSIONS: Moderate caffeine intake by habitual coffee consumption could have beneficial impact on cognitive function in hemodialysis patients due to selective enhancement of attention and vigilance.

The weekend effect in patients hospitalized for upper gastrointestinal bleeding: a single-center 10-year experience.

OBJECTIVE: This study was conducted to assess the possible weekend effect in patients with upper gastrointestinal bleeding (UGIB) on the basis of a 10-year single-center experience in Serbia. MATERIALS AND METHODS: A retrospective analysis of hospital records in the University Clinic 'Dr Dragisa Misovic-Dedinje', Belgrade, Serbia, from 2002 to 2012 was conducted. Patients admitted for UGIB were identified, and data on demographic characteristics, symptoms, drug use, alcohol abuse, diagnosis and treatment were collected. Univariate and multivariate logistic regression were used to assess the association between weekend admission and the occurrence of rebleeding and in-hospital mortality. RESULTS: Analyses included 493 patients. Rebleeding occurred significantly more frequently on weekends (45.7 vs. 32.7%, P=0.004). Weekend admission [odds ratio (OR)=1.78; 95% confidence interval (CI): 1.15-2.74], older age (OR=1.02; 95% CI: 1.00-1.03), and the presence of both melaena and hematemesis (OR=2.29; 95% CI: 1.29-4.07) were associated with the occurrence of rebleeding. No difference between weekend and weekday admissions was observed for the in-hospital mortality rate (6.9% vs. 6.0%, P=0.70). Older age (OR=1.14; 95% CI: 1.08-1.20), presentation with melaena and hematemesis (OR=4.12; 95% CI: 1.56-10.90) and need for surgical treatment (OR=5.16; 95% CI: 1.61-16.53) were significant predictors of all-cause mortality. Patients with nonvariceal bleeding had significantly higher rebleeding rates on weekends (44 vs. 32.3%, P=0.013). CONCLUSION: There was no significant weekend effect in the mortality of patients admitted for UGIB, irrespective of the source of bleeding. Increased attention to older patients presenting with a more severe clinical picture is needed to prolong survival and prevent rebleeding.

Vascular endothelial growth factor in peritoneal dialysis patients.

BACKGROUND: Vascular endothelial growth factor (VEGF) is a glycoprotein which exerts mitogenic effects on endo thelial cells, enhances neoangiogenesis and microvascular permeability, influences leukocyte kinetics when upreg ulated by hypoxia and high-glucose concentration in experimental conditions and in human pathology. Peritoneal synthesis of VEGF has been demonstrated in patients on peritoneal dialysis (PD) treated with glucose-based dialy sate solutions. METHODS: The aim of the study was to determine the serum and peritoneal effluent VEGF concentrations in patients on chronic PD and to assess the relationship between age, gender, comorbidities, dialysis modality and vintage, therapy with erythropoiesis stimulating agents (ESA), angiotensin-converting enzyme inhibitors (ACEi) and statins and VEGF concentrations. Data on the use of ACEi, ESA, and statins were collected from patients' medical histories. VEGF was measured in serum and peritoneal effluent using the quantitative sandwich enzyme immunoassay (ELISA) kits (Quantikine® Human VEGF, R&D Systems, USA & Canada). Complete blood count and standard biochemical analyses (serum glucose, urea, creatinine, total protein, albumin, cholesterol, triglycerides, sodium, potassium, chloride, iron, total iron-binding capacity, ferritin, fibrinogen, C-reactive protein, and intact parathyroid hormone) were performed in fasting venous blood samples. Dialysis and residual components of Kt/V and normalized weekly creatinine clearance were calculated based on 24-hour urine and effluent collections. Peritoneal transport type was determined using the peritoneal equilibration test. RESULTS: Samples from 63 PD patients (39 males and 24 females, average age 61.97 ± 11.01 years) were analyzed. The average serum and effluent VEGF concentrations (231.84 ± 173.91 pg/mL and 38.39 ± 49.38 pg/mL, respectively) correlated significantly (p = 0.002). No significant difference was found in serum and effluent VEGF concentrations in relation to demographic characteristics, comorbidities, dialysis modality, therapy with ESA, ACEi, and statins. Patients treated with PD longer than 5 years had significantly higher serum VEGF levels (p < 0.05). Correlation analysis showed a statistically significant relationship between statin therapy and lower effluent VEGF concentration (p = 0.030). Serum VEGF concentration significantly correlated with fibrinogen serum concentration (p = 0.034) and glycemia (p = 0.004). Effluent VEGF concentration significantly correlated with cholesterolemia (p = 0.004). CONCLUSIONS: Serum VEGF concentrations were significantly higher in long term PD patients, and peritoneal effluent VEGF concentrations were significantly lower in patients receiving statins, suggesting a protective effect of those drugs on peritoneal membrane.

Ultrastructural changes of the peritoneum in a rabbit model of peritoneal dialysis.

BACKGROUND/AIM: The number of patients with end-stage renal diseases treated with chronic dialysis is increasing over the last years. Long-term peritoneal dialysis is associated with progressive development of structural and functional alterations of peritoneal membrane. The aim of the study was to analyze ultrastructural alterations of mesothelial monolayer and submesothelial tissue in a modified nonuremic experimental model of peritoneal dialysis in rabbits. METHODS: The study was performed on 5 healthy Chinchilla rabbits. Surgical procedures of implantation and removal of peritoneal catheter, prevention of catheter clothing, prevention of infection and dialysate instillation were performed according to previously described protocols. Peritoneal tissue samples were collected upon catheter placement and removal after a 5-week follow-up and processed for transmission electron microscopy (TEM) examination. RESULTS: The rabbits tolerated anesthesia, surgical procedure and the applied regimen of dialysate instillations well. The animals recovered completely and no adverse effects were noted. In the animals treated with peritoneal dialysis instillations, TEM revealed alterations of the mesothelial monolayer and submesothelial tissue. The mesothelial cells in direct contact with dialysis fluid were prone to shrinking. They lost the typical cobblestone morphology and assumed a flattened shape. The mesothelial cells were often detached from the basement membrane. These cells showed euchromatic nuclei, higher number of microvilli in their apical part and very numerous vesicles. A higher quantity of collagen fibers was noticed in the peritoneal lamina propria in close relation to the basement membrane of mesothelium. The nuclei of the fibroblasts were also euchromatic. Numerous mitochondria, granules and vesicles were present in their cytoplasm. CONCLUSION: The used rabbit model of peritoneal dialysis is simple, practical to perform, reproducible, not expensive and not requiring advanced devices. It is suitable for obtaining peritoneal tissue samples for histological examination and can be used to analyze the effects of dialysis solutions on the rabbit peritoneal membrane.

Lipophilicity Examination of Some ACE inhibitors andHydrochlorothiazide on Cellulose in RP Thin-Layer Chromatography.

In this assay, the evaluation of lipophilicity of four ACE-inhibitors and hydrochlorothiazide (HCTZ) with RP-TLC on cellulose layers was described using three binary solvent systems. The selected ACE inhibitors had sufficiently different structures which can indicate the method suitability for their lipophilicity evaluation as the model substances in comparison with HCTZ. In addition, the linear relationship between the RM-values and composition of mobile phases was established in the current study. From the regression data of the plots, the hydrophobicity parameters, R(0) M and m, were determined and C0 parameter was calculated. The correlations between the experimentally obtained hydrophobicity parameters and calculated log p values were studied. Furthermore, the obtained results were compared with those previously obtained on RP-18 modified silica gel. Very good correlation (r = 0.91; water-ethanol solvent system) between the chromatographically obtained hydrophobicity parameters and calculated log p values confirmed the selection of ACE inhibitors since lisinopril and quinapril were on the opposite sites of linear relationship. The results indicate that cellulose as an easily available sorbent can be successfully used for the lipophilicity investigation of examined substances with RP-TLC.

Immunohistochemical study of pathological alterations of peritoneum in patients with terminal renal insufficiency and on peritoneal dialysis.

BACKGROUND/AIM: During peritoneal dialysis (PD) an exchange of substances between blood and dialysate takes place through specific histological structures of peritoneum. Peritoneal double-layered serous membrane has, so far, mostly been studied with electron microscopy on experimental animals. The aim of this study was to assess integrity of peritoneal tissue in end-stage renal disease (ESRD) and PD patients using standard light microscopy and immunohistochemical methods. METHODS: Peritoneal tissue biopsies were performed on 25 persons: 8 healthy donors during nephrectomy, 9 ESRD patients upon insertion of PD catheter, and 8 PD patients upon removal of the catheter for medical indications. The samples were fixed and prepared routinely for immunocytochemical staining by standardized streptavidin biotin AEC method using a LSAB2 HRP kit (Dako, Denmark) for collagen IV and analyzed by light microscopy. RESULTS: We observed mesothelial detachment from lamina propria, duplicated basement membrane and much thicker blood vessel walls in ESRD and PD patients, compared to healthy subjects. Differences in histological structure, emphasized with immunostaining, indicated pathological alterations of peritoneal tissue in the renal patients. CONCLUSIONS: Imunohistochemistry can be used in studying histological alterations of peritoneal tissue in ESRD and PD patients. This method may indicate possible problems in filtration and secretion processes in this tissue.

Kinetics of C-reactive protein, interleukin-6 and -10, and phospholipase A2-II in severely traumatized septic patients.

BACKGROUND/AIM: Injury-induced anergy is one of the key factors contributing to trauma victims' high susceptibility to sepsis. This group of patients is mostly of young age and it is therefore essential to be able to predict as accurately as possible the development of septic complications, so appropriate treatment could be provided. The aim of this study was to assess kinetics of interleukin (IL)-6 and -10, phospholipase A2-II and C-reactive protein (CRP) in severely traumatized patients and explore the possibilities for early detection of potentially septic patients. METHODS: This prospective study included 65 traumatized patients with injury severity score (ISS) > 18, requiring treatment at surgical intensive care units, divided into two groups: 24 patients without sepsis and 41 patients with sepsis. C-reactive protein, IL-6 and -10 and phospholipase A2 group II, were determined within the first 24 hours, and on the second, third and seventh day of hospitalization. RESULTS: Mean values of IL-6 and phospholipase A2-II in the patients with and without sepsis did not show a statistically significant difference on any assessed time points. In the septic patients with ISS 29-35 and > 35 on the days two and seven a statistically significantly lower level of IL-10 was found, compared with those without sepsis and with the same ISS. C-reactive protein levels were significantly higher in septic patients with ISS 18-28 on the first day. On the second, third and seventh day CRP levels were significantly lower in the groups of septic patients with ISS 29-35 and > 35, than in those with the same ISS but without sepsis. CONCLUSION: Mean levels of CRP on the first day after the injury may be useful predictor of sepsis development in traumatized patients with ISS score 18-28. Mean levels of CRP on the days two, three and seven after the injury may be a useful predictor of sepsis development in traumatized patients with ISS score more than 28. Mean levels of IL-10 on the second and seventh day after the injury may be a useful predictor of sepsis development in traumatized patients with ISS score > 28.

Morphometric study of healthy jejunal and ileal mucosa in adult and aged subjects.

Small intestine mucosa is often affected with malabsorptive, autoimmune and inflammatory pathological processes. However, morphometric data on the healthy human small intestine mucosa, especially ileum, are scarce. We aimed to obtain histoquantitative data on the healthy jejunal and ileal mucosa and assess the effects of gender and ageing on these parameters. Computer-aided morphometric analysis was performed on 24 jejunal and 25 ileal biopsy samples collected upon routine endoscopy screening of healthy persons with a family history of intestinal malignancy. Subjects were distributed in four groups according to age and sex: adult (<60 years) and elderly (>60 years) males, and adult (<60 years) and elderly (>60 years) females. Results were statistically analyzed with Mann-Whitney U test. Jejunal mucosal thickness was significantly reduced in elderly subjects (p<0.05), especially in elderly females compared to adult ones (p<0.05). Jejunal villi were significantly wider in adult than in the elderly subjects (p<0.05), whereas ileal villi were significantly wider in elderly compared to adult subjects (p<0.01) and in male compared to female subjects (p<0.05). No statistically significant differences were found in other histoquantitative parameters (mucosa epithelium height, crypt numerical density, villous height, crypts and villous perimeter, diameter and epithelium height) of jejunal and ileal mucosa. This study provides complete morphometric data on the healthy human jejunum and the first relevant data on the healthy ileal mucosa, thus representing a valuable morphometric reference for future histoquantitative studies of human small bowel mucosa in both healthy and disease affected individuals.

Stereologic analysis of tissue compartments of gunshot-injured and blunt-injured spleen.

The spleen is composed of several tissue compartments and the respective histoquantitative data are essential for complete understanding of immune or pathological processes in this organ. The aim of our study was to determine and compare the stereologic parameters of all tissue compartments of the gunshot-injured and blunt-injured human spleen. The model-based stereology with point-counting method was utilized to study the volume densities of red pulp, perifollicular zone, marginal zone, white pulp (follicles and periarteriolar lymphoid sheath), and connective tissue. The areal numerical density (the number of follicles per mm(2) of tissue section), the numerical density (the number of follicles per mm(3) of tissue) of lymphoid follicles and the mean follicle diameter were also determined. Our study provides stereological parameters for all tissue compartments of the human spleen. No morphometric differences were registered between tissue compartments of the blunt-injured and gunshot-injured spleen. As the gunshot-injured spleen was taken as presumably unstimulated in immunological regard, our results suggest that both gunshot-injured and blunt-injured organs may be used as models of the normal human spleen.