[Von Willebrand factor in hemodialysed patients with chronic renal failure]. / Czynnik von Willebranda u chorych hemodializowanych z powodu przewleklej niewydolnosci nerek.

The aim of the work was to evaluate the von Willebrand factor antigen (vWF Ag) concentration in the blood plasma of hemodialysed patients with chronic renal failure. The study was performed in the group of 43 patients (means aged 42.8 years) with chronic renal failure dialysed means 4 hours 3 times a week. The blood was obtained before and after hemodialyze and in 11 patients additionally after 1 year of systematic hemodialyze. The control group consisted of 51 healthy volunteers means aged 35.6 years. In the citric blood plasma concentration of vWF Ag was determined using immunosorbed enzyme-linked assay (ELISA). In the blood plasma of patients with chronic renal failure significantly higher concentration of vWF Ag than in controls was observed. 4-hours and 1-year dialyze did not influence the level of vWF Ag in patients with chronic renal failure.

Increased plasma glutathione peroxidase activity in patients with acute myocardial infarction.

BACKGROUND: Aim of the study was to determine the concentration of selenium (Se) and the activity of glutathione peroxidase (GSH-Px) in patients with acute myocardial infarction (AMI) and to observe the behavior of these parameters during thrombolysis therapy. MATERIAL AND METHODS: The study comprised two groups of AMI patients and a control group. The first group consisted of 49 patients from whom blood samples were taken after admission to the intensive care unit and subsequently after 3, 7, 14 and 30 days of hospitalization. In the second group of patients (n = 18) blood was taken for measuring only the GSH-Px activity in plasma. In this group blood samples were collected after admission to the hospital, 6, 12, 24, 48 hours, 3, 7, 14 and 30 days later. Control group comprised of 58 healthy subjects. Se levels in whole blood and plasma were measured spectrofluorometrically with 2,3-diaminonaphthalene as a complexing reagent. GSH-Px activity in red cells and plasma was measured spectrofluorometrically with t-butyl hydroperoxide as substrate. RESULTS: In the first group of patients Se concentrations in whole blood and plasma as well as GSH-Px activities in red cells and plasma did not differ significantly from healthy subjects. Both Se levels and GSH-Px activities were stable during the entire period of the study. In the second group of patients, however, plasma GSH-Px activity increased after admission and reached the highest value after 48 hours. This activity was significantly higher compared to healthy subjects (p < 0.004) and to the mean initial activity of this group (p < 0.02). In the later period the activity decreased to the values of healthy subjects. CONCLUSION: We suggest that the increased activity of GSH-Px in plasma of AMI patients is the response of the organism to the increased levels of reactive oxygen species produced during reperfusion and thrombolysis.

Thrombomodulin--endothelial thrombin receptor in blood of patients with unstable angina pectoris.

BACKGROUND: Thrombomodulin (TM) a membrane receptor for thrombin generated in blood in vivo, is present on the surface of vascular endothelium cells. The aim of our work was the determination of thrombomodulin in the blood of patients with unstable angina pectoris. MATERIAL AND METHODS: In the study took part 87 patients with unstable angina pectoris (40 women and 47 men) at age 41-79 years. Thrombomodulin was determined in citrated blood plasma with the use of enzyme immunoassay ELISA with the diagnostic kit manufactured by American Diagnostica. RESULTS: Statistically significant higher thrombomodulin concentration (sTM) was found in the patients when compared with the values recorded in control group. Elevated sTM levels depended on patients age and they were significantly higher in patients over 50 years old. There were no statistically significant differences with respect to patients gender and coexistent risk factors such as arterial hypertension, diabetes or smoking, but significantly higher sTM concentration was observed in patients with high serum cholesterol level. CONCLUSION: Elevated sTM concentrations result from the damage to vascular endothelium cells by the atheromatous process manifested in unstable angina pectoris.

Parathormon, calcium, phosphorus, and left ventricular structure and function in normotensive hemodialysis patients.

Clinical and experimental data suggest that Parathormon (PTH), calcium, and phosphorus participate in left ventricular hypertrophy (LVH) and affect myocardial contractility in end-stage renal disease. Cellular calcium overload and interstitial fibrosis induced by PTH may lead to impairment of left ventricular diastolic function. Hyperphosphatemia is an independent risk of cardiovascular mortality in dialysis patients. The aim of the study was to estimate the influence of PTH and calcium-phosphorus metabolism on left ventricular structure and function in hemodialysis patients, without hypertension and antihypertensive drug therapy (SBP = 126.2 +/- 11.1 DBP = 75.8 +/- 6.5 mmHg). Echocardiographic findings in a group of 22 normotensive HD patients had been compared to 43 hypertensive HD patients. Relationships between PTH, calcium-phosphorus metabolism and echocardiography in normotensive group were then evaluated. Left ventricular mass index (LVMI) was lower in normotensive patients: 128.3 +/- 46.2 versus 165.8 +/- 46.7 (p < 0.01). The prevalence of LVH was 55% in normotensive HD patients compared to 86% in hypertensive group (p < 0.01). In normotensive group we found correlation between PTH and LVMI (r = 0.44; p < 0.05). There were also significant relationships between calcium and posterior wall thickness (r = -0.44; p < 0.05), phosphorus and LVMI (r = 0.47; p < 0.05). A significant correlation was observed between both phosphorus, calcium x phosphorus product and E/A ratio: r = -0.47 and r = -0.43, respectively (p < 0.05 both). Disturbances of calcium-phosphorus metabolism and secondary hyperparathyroidism contributes to left ventricular hypertrophy, and impaired left ventricular diastolic function in normotensive hemodialysis patients.

Selenium and glutathione levels, and glutathione peroxidase activities in blood components of uremic patients on hemodialysis supplemented with selenium and treated with erythropoietin.

Patients with chronic renal failure (CRF) often have reduced concentrations of selenium (Se) and lowered activities of glutathione peroxidase (GSH-Px) in blood components. The kidney is a major source of plasma GSH-Px. We measured Se and glutathione levels in blood components and red cell and plasma GSH-Px activities in 58 uremic patients on regular (3 times a week) hemodialysis (HD). The dialyzed patients were divided in 4 subgroups and were supplemented for 3 months with: 1) placebo (bakers yeast), 2) erythropoietin (EPO; 3 times a week with 2,000 U after each HD session), 3) Se-rich yeast (300 microg 3 times a week after each HD), and 4) Se-rich yeast plus EPO in doses as above. The results were compared with those for 25 healthy subjects. The Se concentrations and GSH-Px activities in the blood components of dialyzed uremic patients were significantly lower compared with the control group. Treatment of the HD patients with placebo and EPO only did not change the parameters studied. The treatment with Se as well as with Se and EPO caused an increase in Se levels and red cell GSH-Px activity. Plasma GSH-Px activity, however, increased only slowly or did not change after treatment with Se and with Se plus EPO. In the group treated with Se plus EPO the element concentration in blood components was higher compared with the group supplemented with Se alone. The weak or absence of response in plasma GSH-Px activity to Se supply indicates that the impaired kidney of uremic HD patients has reduced possibilities to synthesize this enzyme.

Selenium, glutathione peroxidases, and some other antioxidant parameters in blood of patients with chronic renal failure.

In the present study several parameters associated with oxidative stress were examined in the blood of 25 chronic renal failure (CRF) patients and the results were compared with 18 healthy subjects. Mean creatinine concentration in patients was 1,216 +/- 292 micromol/l. Selenium (Se) concentration in red cells, whole blood and in plasma of CRF patients (106 +/- 32.5, 59.0 +/- 16.7 and 42.4 +/- 13.8 ng/ml, respectively) was significantly (0.0001 < P 0.01) lower (by 20-42%) compared with the controls. Red cell and plasma glutathione peroxidase (GSH-Px) activities (16.6 +/- 3.4 U/g Hb and 93.7 +/- 32.9 U/l plasma) were lower by 12 and 53% (P < 0.05 and < 0.0001, respectively) in patients than in healthy subjects. GSH concentration in red cells of patients (2.81 +/- 0.45 mmol/l) was significantly (P < 0.001) higher (by 20%) than in control group. Malonyldialdehyde (MDA) concentration (expressed as thiobarbituric acid-reactive substances) in red cells of patients (725 +/- 155 nmol/g Hb) was significantly (P < 0.001) higher (by 28%) than in control group. No significant difference was observed in the activity of superoxide dismutase in pLasma between the two groups. In conclusion, our results confirm that the aLterations in Se levels in blood components and in GSH-Px activity in plasma show that the kidney plays an important role in Se homeostasis and in plasma GSH-Px synthesis.

[Infective endocarditis in adults]. / Infekcje zapalne wsierdzia u doroslych.

OBJECTIVE: The aim of the research was to demonstrate that the early diagnosis of infective endocarditis influences significantly the results of treatment. METHODS: The following clinical analysis covered 56 patients, aged 18 to 81 (the average age--50 years) with infective endocarditis treated in the years 1998-2000. Data from patient history, physical examination, laboratory investigations and treatment were analysed. Apart from clinical symptoms for infective endocarditis diagnosis, also blood cultures and echocardiography were important. MAIN OBSERVATIONS: Infective endocarditis was present in 24 patients (42.8%) with heart defects, 7 (12.5%) with prosthetic heart valves, and 4 (7.1%) treated with haemodialysis. RESULTS: In 38 (67.8%) individuals, the echocardiography showed vegetations, and in 14 (25.0%) other abnormalities. Blood cultures were positive in 33 (58.9%) patients. Fever was present in 47 (83.9%) patients. The progression of heart failure appeared in 26 (46.4%) individuals. The average time of antibiotic therapy was 34 days. 11 (19.6%) patients died. 9 (16.1%) individuals had cardiosurgery operations. CONCLUSIONS: Early diagnosis of infective endocarditis is substantial as it improves patients' prognosis as to health and life.

[Taking history in diagnosing coronary artery disease in the 21st century--wasting time or a valuable diagnostic tool?]. / Badanie podmiotowe w rozpoznawaniu choroby wiencowej w XXI wieku--strata czasu czy tez moze wartosciowa metoda diagnostyczna?

UNLABELLED: The relation of chest pain characteristics and other features of the history of disease to coronary angiograms was assessed in 551 patients with chest pain regarded as definite or probable stable angina pectoris. A standardised questionnaire was used to record demographic details and chest pain characteristics of interviewed patients. The differentiation between typical, atypical or nonanginal pain was based on classification proposed by Diamond. The indications for catheterization in each patient were determined at the discretion of the attending physician. All patients underwent diagnostic coronary angiography (clinically important coronary artery disease was defined as > 50 per cent narrowing of the diameter of at least one major vessel or > or = 50 per cent of the left main coronary artery). CONCLUSION: Chest pain characteristics remains an effective tool for estimating probability of coronary artery disease.

[Retrospective analysis of prognostic factors for annual mortality in 97 patients with chronic congestive heart failure]. / Analiza retrospektywna czynników prognostycznych jednorocznej umieralnosci u 97 chorych z przewlekla niewydolnoscia serca.

The aim of our study was to find clinical and biochemical factors, which are prognostically important for the annual mortality in patients with chronic congestive heart failure (CHF). The studied group consisted of 97 people with CHF (31 females and 66 males, mean age--61). The causes of the heart failure were: coronary artery disease or/and hypertension (80 patients), valvular mitral heart disease--(12 patients), dilated cardiomyopathy--(5 patients). On the first day of the hospitalization patients were classified as functional class II-IV according to NYHA classification. Patients were divided into: group 'A'--34 patients, who had died during the 1st year of observation, and group 'B'--63 patients who have survived the 1st year of observation. According to the results of our study patients from group A had lower concentration of plasma sodium, lower left ventricular ejection fraction, lower mean heart rate, higher frequency of ventricular arrhythmias (according to 3&4 Lown class).

Low-dose glucose-insulin-potassium is ineffective in acute myocardial infarction: results of a randomized multicenter Pol-GIK trial.

We aimed to assess the clinical efficacy of glucose-insulin-potassium (GIK) in acute myocardial infarction. Experimental data provided evidence of the beneficial effects of GIK on ischemic myocardium. The clinical trials, mostly uncontrolled and conducted mainly before the thrombolytic era, were inconclusive due to the small number of patients and discrepancies in protocols. In order to evaluate the efficacy of this intervention, we have performed a prospective multicenter randomized study. The study consisted of 954 patients with acute myocardial infarction (MI) randomized within 24 hours from the onset of symptoms to low-dose GIK (n = 494), which consisted of 1000 mL 10% dextrose, 32-20 U insulin, and 80 mEq K-, or to the control group (n = 460), which was given 1000 mL 0.89% sodium chloride, by intravenous 24-hour infusion at a rate of 42 mL/h. Cardiac mortality and the occurrence of cardiac events at 35 days did not differ between GIK and control-allocated patients (32 (6.5%) vs. 21 (4.6%), respectively; OR 1.45, 95% CI 0.79-2.68, P = 0.20; and 214 (43.3%) vs. 192 (41.7%), OR 1.07, 95% CI 0.82-1.38, P = 0.62). Total mortality at 35 days was significantly higher in the GIK than in the control group (44 (8.9%) vs. 22 (4.8%), respectively, OR 1.95, 95% CI 1.12-3.47, P = 0.01). The excess of non-cardiac deaths in the GIK group may have occurred by chance. Low-dose GIK treatment does not improve the survival and clinical course in acute MI.

Multicenter randomized trial and a systematic overview of lidocaine in acute myocardial infarction.

BACKGROUND: More than 20 randomized trials and 4 meta-analyses have been conducted on the use of prophylactic lidocaine in acute myocardial infarction (MI). The results suggest that lidocaine reduces ventricular fibrillation (VF) but increases mortality rates in acute MI. METHODS AND RESULTS: Patients with ST-elevation MI who were examined <6 hours after symptom onset (n = 903) were randomly assigned to either lidocaine or no lidocaine and to either streptokinase and heparin or heparin alone. Lidocaine was given as 4 boluses of 50 mg each every 2 minutes, then an infusion of 3 mg/min for 12 hours, then 2 mg/min for 36 hours. We compared the incidence of in-hospital death and ventricular arrhythmias. We then performed a meta-analysis of prophylactic lidocaine in acute MI that included these and prior trial results. The rates of VF and death with and without lidocaine were calculated for each trial, then odds ratios (OR) with confidence intervals (CI) were calculated for the risk of these events overall with and without lidocaine. Patients given lidocaine in the randomized study had significantly less VF (2.0% vs 5.7% without lidocaine, P =.004) and a trend toward increased mortality rates (9.7% vs 7.0%, P =.145). Meta-analysis revealed nonsignificant trends toward reduced VF (OR 0.71, 95% CI 0.47 to 1. 09) and increased mortality rates (OR 1.12, 95% CI 0.91 to 1.36) with lidocaine. CONCLUSIONS: Lidocaine reduces VF but may adversely affect mortality rates. The routine use of prophylactic lidocaine in acute MI is not recommended.

[The diagnostic value of resting electrocardiography in stable coronary artery disease]. / Wartosc diagnostyczna spoczynkowego badania elektrokardiograficznego w rozpoznawaniu stabilnej choroby wiencowej.

The relation of resting electrocardiographic (ECG) patterns to angiographic features was assessed in 566 patients with chest pain regarded as definite or probable stable angina pectoris. The indications for catheterization in each patient were determined at the discretion of the attending physician. All patients underwent diagnostic coronary angiography (clinically important coronary artery disease was defined as > or = 70 per cent narrowing of the diameter of at least one major vessel or > or = 50 per cent of the left main coronary artery) and standard 12 lead electrocardiography which was interpreted by 2 cardiologists independently in coordinating centre. The signs of impaired coronary blood flow were assessed by abnormalities of repolarization (among others S-T segment, the T wave), depolarization and presence of disturbances of cardiac rythm. The resting routine electrocardiogram was assigned to one of three categories: normal, nonspecific abnormalities or typical for coronary insufficiency. The typical pattern for ischemia was present in 104 patients (18%), nonspecific abnormalities were present in 185 patients (33%) and electrocardiogram was normal in 277 patients (49%). Sensitivity and specificity of the typical for coronary insufficiency resting ECG was calculated: 23% and 87% respectively for the entire group, 33% and 81% in women, 20% and 93% in men. In the group with normal resting electrocardiographic pattern 55% of patients have significant stenosis in at least one major coronary artery.

[Infections with Chlamydia pneumoniae, Helicobacter pylori or cytomegalovirus and atherosclerosis]. / Zakazenie chlamydia pneumoniae, Helicobacter pylori i wirusem cytomegalii a miazdzyca.

It's known that common risk factors of atherosclerosis can explain only 50% of its etiology. In only 40% patients risk factors modification inhibits progression of atherosclerosis. Therefore looking for new risk factors of atherosclerosis is necessary. In recent years the inflammatory-infectious hypothesis of atherosclerosis has been reevaluated. The discovery of heavy infections load in the serum of patients with acute coronary syndromes might suggest a potential immunological mechanism triggered by bacterial proteins. Chlamydia pneumoniae, Helicobacter pylori and cytomegalovirus infections are very common in human population and therefore they are suspected as the main infectious pathogen in the coronary disease. Clinical studies have demonstrated higher anti-Chlamydia and ani-Helicobacter antibody titres in patients with myocardial infarction (60-70% pts), stable and unstable angina (50-60% pts) than in control groups (12-15% pts). Two studies were performed with antibiotic (azotromycin, roxitromycin) influence on the prevalence of acute coronary syndromes after myocardial infarction and unstable angina. These studies have shown statistically significant reduction of the prevalence of acute coronary episodes in follow-up period.

[Multiple myeloma nephropathy as a cause of renal failure--diagnostic difficulties and prospects for treatment]. / Nefropatia szpiczakowa jako przyczyna niewydolnosci nerek--trudnosci diagnostyczne i mozliwosci leczenia.

We describe two patients admitted to our hospital because of renal failure. We diagnosed multiple myeloma in both. One patient had high peripheral blood eosinophilia, that normalized during therapy. The patients were treated with melphalan and prednisone, hemodialysis and one patient with recombinant human erythropoietin. Both patients responded to that treatment: after 7 months the number of plasma cell in bone marrow decreased from 65 to 10% in the first patient, and from 38 to 4% in the second patient. They returned to work and were on maintenance hemodialysis 2 times weekly. The patients have been observed for 21 months.

[Evaluation of prophylaxis and actual prevalence of HBV infection in twelve hemodialysis centers of Northern Poland]. / Ocena profilaktyki i aktualnej sytuacji epidemiologicznej zakazenia HBV w dwunastu osrodkach hemodializy Polski pólnocnej.

The aim of the study was to estimate the HBV infection preventive measures used in the twelve dialysis centres in north Poland. In all of the centres hepatitis B vaccination and segregation of HBV infected patients (dedicated machines or separate rooms), which are the two basic HBV infection control methods, were introduced. Our results point out that in some of the centres certain modification of these methods would be possible, including universal predialysis vaccination programme, changes in hepatitis B vaccination schedules with most effective routes of vaccination only and dedication for HBV infected patients not only separate rooms but separate dialysis staff as well.