The correlation between endothelin-1 levels and spirometry in dialysis patients compared to healthy subjects.

BACKGROUND AND AIM: Several studies demonstrated a six-fold increase in plasma concentration of endothelin-1 (ET-1) in diaysis patients (hemodialysis and peritoneal dialysis) compared to healthy control subjects. However, the effects of ET-1 on respiratory function in these patients are less known. The aim of this study was to determine the potential differences in spirometric values in relation to ET-1 levels. METHODS: The study included 28 patients (15 male, 13 female, mean age 55.9 +/- 16. 2 years) with end stage renal diseases (ESRD) receiving regular hemodialysis (HD), 23 patients (10 males, 13 females, mean age 55.8 +/- 15.8 years) with ESRD treated with continuous ambulatory peritoneal dialysis (CAPD) without any cardiovascular or respiratory diseases, and 30 healthy volunteers (14 male, 16 female, mean age 51.8 +/- 15.6 years) in control group. In each of the three groups the participants were divided into two additional sub-groups according to the serum levels of ET-1. The spirometry values were recorded before the onset of hemodialysis and prior to emptying the peritoneal cavity in CAPD patients. The results were analyzed using standard statistical methods (Student's t-test). RESULTS: Patients who were treated with HD or CAPD were found to have significant difference in values of most pulmonary function parameters between subjects with ET-1 levels lower than 6.6 pg/ml and subjects with ET-1 levels higher than 6.6 pg/ml. In the control group there was no difference in pulmonary function parameters in correlation with ET-1 levels. ET-1 values in patients of both dialysis groups were significantly higher compared to healthy subjects. CONCLUSIONS: Higher levels of ET-1 in dialysis patients over healthy subjects is associated with lower parameters of lung function tests. A possible pathophysiological mechanism for deterioration of pulmonary function might be explained by progression of inflammation, pulmonary oedema also known as "uraemic lung" or/and the progression of pulmonary hypertension.

Neurophysiological effects of mistletoe (Viscum album L.) on isolated rat intestines.

Mistletoe (Viscum album L.) is well known as a medicine from ancient times and the earliest notes. Today it is used as a remedy. The aim of this research was to examine the effects of mistletoe extracts and their components on some neurophysiological parameters in rat intestines. The tonus and contractile responses of isolated intestinal segments (duodenum, ileum and distal colon) were analysed. The experiment was carried out in three groups. In the first group (control group) different concentrations of acetylcholine were added into the organ bath (10-50 nmol/L). In the second group, mistletoe extracts were added into the organ bath with increasing concentrations and in the third group, atropine, a non-selective muscarinic receptor antagonist, was added into the organ bath (concentration 10(-7) mol/L) and after atropine plant extracts were administered. The results obtained suggest that extracts from different parts of mistletoe have neurophysiological effects and change intestinal contractions. The results also suggest that the effects of mistletoe extracts on intestinal contractility act via cholinergic pathways, activating muscarinic receptors in the intestines. However, in order to establish the subtype of receptors, further investigations are necessary where selective antagonists of muscarinic cholinergic receptors should be used.

[The effect of parathormone on arterial blood pressure in patients on hemodialysis]. / Uticaj parathormona na arterijski pritisak krvi kod bolesnika na hemodijalizi.

We evaluated the effect of PTH on blood pressure in haemodialysed patients. The correlation was found between systolic, diastolic pressure and PTH. The results have shown that PTH might have the influence on regulation of arterial blood pressure in these patients.

[The effect of alphacalcidol on calcium and phosphate metabolism in patients treated with hemodialysis]. / Dejstvo sestomesecne terapije alfakalcidolom na metabolizam kalcijuma i fosfata kod bolesnika lecenih ponavljanihm hemodijalizama.

The purpose of these studies was to assess the effect of 6 month calcidol treatment on Ca and PO4 metabolism in haemodialyzed patients. During 3 and 6 month on alpha calcidol therapy, there was significant increase of total and ionized Ca (p < 0.05; p < 0.01 respectively). After 6 months on alpha calcidol therapy there was significant decrease of alkaline phosphatase level (p < 0.05) and increase in bone density (up to 82%, p < 0.05). The study has shown that appropriate use of alpha calcidol could be effective in treatment of Ca and PO4 disbalance in haemodialyzed patients.

[Anatomic and physiologic characteristics of the peritoneal cavity with reference to peritoneal dialysis]. / Anatomske i fizioloske osobine peritoneumske supljine od znacaja za peritoneumsku dijalizu.

Most common complications of peritoneal dialysis are those related to anatomic defect of the abdominal wall and peritoneum. The aim of this investigation was to examine the frequency of congenital and acquired wall defects in patients on CAPD treatment causing complications. Fifty patients, 32 women and 18 men, on CAPD treatment for more than two years, were investigated. Most common was a defect in the anterior-lateral abdominal wall predisposing to hernias in 14% of patients. Umbilical and pericatheteral hernias were more common than other, with a mean time of 21 months for the appearance. Persistence of vaginal process of peritoneum related to scrotal oedema was documented in 4% of patients. Communication of peritoneal cavity with the abdominal ostium of tuba uterina was found not to be an important factor for peritonitis.

[Our protocol in the treatment of peritonitis in patients on continuous ambulatory peritoneal dialysis]. / Nas protokol za lecenje peritonitisa kod bolesnika na programu kontinuisane ambulatorne peritoneumske dijalize.

Peritonitis is a very serious complication in patients treated by CAPD. The frequent and grave episodes are the main cause for CAPD withdrawal. The effective prevention and adequate therapy of peritonitis are very important for a successful CAPD treatment. The aim of this study was to present our results of peritonitis therapy in CAPD patients using the following protocol: Vancomycin 1.0 g.i.p. immediately after the admission to the unit, 250 mg Ceftriaxon (Longaceph) after a bag exchange for seven days, and the 1.0 g Vancomycin. Using this protocol we treated 97 peritonitis episodes; 74 of them (80%) were treated successfully by this antibiotics combination. The clearness of peritoneal fluid was attained 1-3 days within 56.7% of cases, and 4-6 days within the 29.7% peritonitis episodes (86.4%). A common cause of peritonitis was Staphylococcus epidermidis episodes (28.4%), Staphylococcus aureus (13.5%), and in 39.1% episodes the cultures were sterile. Uneffective antibiotic application according to this protocol was found in cases of pseudomonas and fungal peritonitis. The mentioned antibiotic therapy had no effect in a small number of peritonitides provoked by S. epidermidis (8.7%) and S. aureus (13.0%) This required the application of a third antibiotic. It could be concluded that this antibiotic combination in treatment of peritonitis in patients on CAPD was very effective.

[The effect of frequent peritonitis on parameters of efficacy of peritoneal dialysis]. / Uticaj ucestalih peritonitisa na parametre efikasnosti peritoneumske dijalize.

The estimation of CAPD efficacy presents a complex problem in the patients treated by this method. The most important parameters are: clinical indications, biochemical parameters, Kt/v, PCT, PET indexes, and others. Numerous factors may influence CAPD efficacy. Peritonitis, particularly the frequent episodes, significantly affects permeability and ultrafiltration capacity of the peritoneal membrane. The aim of this paper is to investigate the peritonitis incidence and its influence on some parameters of CAPD efficacy. Forty-four CAPD patients of both sexes, aged 55.7 +/- 13.5 yrs, dialysis duration 19.6 +/- 15 months, were studied. The influence of peritonitis incidence was studied using urea, creatinine, hemoglobin, hematocrit parameters and K t/v, PET indexes. Statistically significant low K t/v values were found in the patients who had four or more peritonitis episodes. Our results, as well as those in the literature, indicate that frequent peritonitis episodes significantly decrease the peritoneal membrane permeability.

[Voice frequencies in patients treated with chronic hemodialysis]. / Osnovna frekvencija glasa bolesnika lecenih ponavljanim hemodializama.

Stress effects on respiration and muscle tension are most likely to affect phonation and articulation; the acoustic parameters reflecting vocal indicators of stress are fundamental frequency, duration and intensity. The aim of this study was to explore the link between some psychosomatic states of patients on dialysis and physical parameters of the vowel "e". Fundamental frequency, intensity and duration of the vowel "e" produced before, during and after dialysis were investigated. The results showed that in the period before dialysis the fundamental frequency was greater, duration was longer and intensity was unchanged. This investigation showed that the changes of the parameters of voice were induced with the changes of psychophysiological states of the patients on dialysis. These patients were in the state of chronicle stress, but the period before the treatment was associated with special, anticipatory stress that induced greater fundamental frequency and longer duration of the pronunciation of the vowel "e".

[Multidisciplinary investigations in dead persons suspicious of AIDS]. / Multidisciplinarna istrazivanja kod osoba umrilih pod sumnjom na ejds (AIDS).

The background of AIDS is the deregulation of the cellular immune system caused by HIV infection. AIDS has proved to be entirely different from any previous known diseases. It affects practically all the tissues and organs of the human body. Clinical and autopsy diagnoses are confronted with an incomparable diversity of inflammatory, vascular, degenerative and neoplastic changes. Thanks to clinical and pathological researshes, the medical knowledge of AIDS has rapidly progressed. The Institute of Forensic Medicine is, for now, the unique medical institution organized to perform obligatory autopsies of drug-addicts, to detect the other cases suspect of HIV infection or some AIDS indicative diseases. The aim of this study is to establish the basis for multidisciplinary investigations of AIDS and to solve very important problems such as: a) to accept the diagnostic criteria for correct diagnosis of AIDS, with or without laboratory evidence of HIV infection; b) to recognize the early stadium of clinico-pathological entities associated with HIV infection; c) to improve the "indicator" of AIDS disease for daily medical practice.

[Suicide among narcotic addicts]. / Samoubistvo narkomana.

The majority of deaths occurring from acute or chronic narcotism declined as accidental are often termed as "overdose". But in some cases, the evidence found at the scene or the other data indicate intent of suicide. This report presents an analysis of suicide victims classified as drug or narcotic abusers. The cause and manner of death, the postmortem toxicologic and histopathologic findings are discussed.

[Filicide]. / Filicidium.

Filicide is the term denoting murder of a child by one of his (her) parents. The authors analysed the autopsic material of the Institute of Forensic Medicine in Belgrade related to a sixty-year period (1920-1980) and found 26 cases of filicide. On the basis of this finding, the authors concluded that filicide was not very frequent in this area. The motives of filicide were as follows: conflict between parents, child's disease or anomaly, illegitimate child, social and economic problems, parents' mental disorders. The murderer of a child was mother in 15 cases and father in 11 cases. Thus, mother was more frequently murderer than the father (15:11). However, these data are not in accordance with data from literature where mother is emphasized as "almost the only" murderer of her child.

The area postrema and the hypertensive effect of angiotensin.

The intracerebroventricular administration of angiotensin II in pentobarbital-anesthetized cats produced dose-dependent increases in the arterial blood pressure without significant changes in the heart rate. The ablation of the area postrema significantly reduced, but did not abolish, the pressor effect of angiotensin injected into the cerebral ventricles. It follows, then, that the central pressor effect of angiotensin is dependent on the integrity of the area postrema and that this central site, at least in part, contributes to the pressor action of endogenous angiotensin.