Metabolic profile and sex hormone binding globulin (SHBG) in different reproductive phases of Czech women and their relations to weight, body composition and fat distribution.

In our study, 213 healthy Czech women aged 20 to 65 years were examined and divided into fully reproductive, premenopausal, menopausal and postmenopausal groups. In all subjects body composition was determined by classical anthropometry and metabolic profile was assessed. A total of 146 subjects completed 3-year longitudinal study. Total and LDL cholesterol increased and ratio HDL/total cholesterol decreased with age (p<0.001), most significantly in menopause. Triacylglycerols increased only up to menopause. HDL had a very slight trend to decrease in menopause and postmenopause. Fasting blood glucose level increased progressively (p<0.001), in postmenopause frequently exceeded normal range. Higher BMI, total fat mass and central fat indices were associated with higher total and LDL cholesterol, triacylglycerols, C-peptide, insulin and fasting blood glucose level (p<0.001; fasting blood glucose level to waist-to-hip ratio: p<0.01) and lower HDL cholesterol (p<0.001). Higher C-peptide and insulin were associated with lower HDL cholesterol and higher triacylglycerols (p<0.001). Fasting glucose correlated with LDL cholesterol (p<0.01). Higher SHBG was associated with higher HDL and lower LDL cholesterol (p<0.001). Hormone replacement treatment was related to lower fasting blood glucose level in postmenopausal women (p<0.01). Oral contraception is suggestive of a positive influence on lipid spectrum by increasing the ratio HDL/total cholesterol. Markers of lipid and carbohydrate metabolism are not only age-related, but they are also related to BMI, total fat mass and central fat indices. Therefore, preventive programs should be focused above all on menopausal women.

Weight, body composition and fat distribution of Czech women in relation with reproductive phase: a cross-sectional study.

A sample of 213 healthy Czech women was classified into four groups according to their reproductive phase: fully reproductive, premenopausal, menopausal and postmenopausal women. Changes in body weight, body composition and fat distribution were studied in those four groups using the classical anthropometric method. Body weight rises till the menopause with no further increase. A decrease in relative contribution of muscle and bone mass was observed. The progressive increase in fat mass with age was clearly demonstrated, both the fat mass weight (r = 0.38, p < 0.001) and its percentage contribution (Matiegka r = 0.40, p < 0.001, Parízkovi r = 0.42, p < 0.001). There is a stronger correlation of central fat indices as WHR (r = 0.57, p < 0.001), abdominal (r=0.56, p < 0.001) and waist circumference (r = 0.50, p < 0.001) than for hip circumference (r = 0.27, p < 0.001) to the age. WHR and waist increase most when fully reproductive and premenopausal women were compared (p < 0.001); less when premenopausal to menopausal women are compared (NS) and the least when menopausal to postmenopausal women were compared (NS). The mean values of 14 skinfolds thickness are shown, the skinfold at the abdomen shows the strongest correlation to the age (r = 0.49, p < 0.001). The results are consistent with the hypothesis of progressive fat centralisation.

Weight, body composition and fat distribution changes of Czech women in the different reproductive phases: a longitudinal study.

Women tend to gain weight with age, especially fat mass which shows also regional changes. A cross-sectional study was done on 213 Czech women with the conclusion that there is a progressive weight increase up to the menopause, an increase in absolute and relative fat contribution and fat centralisation up to the postmenopause and these changes seemed to occur even before the weight increase occurs. The same cohort was examined the same way after 3 years for further analysis. The aim was the assessment of weight gain, body composition and fat distribution changes in four age groups representing the reproductive phases in Czech women in 3-year period. 146 healthy Czech women aged 20-65 were classified according to four reproductive phases: fully reproductive women (n=34, mean age 26.96, SD 4.47), pre-menopausal women (n=34, mean age 42.23, SD 2.78), menopausal women (n=45, mean age 51.56, SD 2.61) and postmenopausal women (n=33, mean age 59.55, SD 2.82). Body weight, body composition and fat distribution were determined using classical anthropometric methods in 2000 and 2003. BMI increased significantly in all the groups except for the premenopausal group and was the greatest in the menopausal group. Increase in fat percentage was significant in the fully reproductive (p < 0.001) and menopausal women (p < 0.001), there was no change in the postmenopausal group. Waist, WHR, hip and subgluteal thigh circumference increase significantly in the menopausal group (p < 0.01, p < 0.05, p < 0.05, p < 0.001 respectively). The highest mean values of waist, WHR and even abdominal circumference remain in the postmenopausal group. Changes of all 14 skinfolds and the sum of the peripheral and central skinfolds are shown; the sum of peripheral skinfolds shows the same values at the end of the study while the sum of central skinfolds increases from the fully reproductive to the postmenopausal women. These results permit us to state the following conclusions: the greatest weight gain in the menopausal group suggests weight gain acceleration around menopause. Body fat mass increase terminates in the early postmenopause. Fat centralisation was proved in the menopausal women with still preserved fat deposition in the gluteofemoral area, which was also apparent in the postmenopausal group, however, the postmenopausal women show the highest values of central fat indicators.

[Conversion from Consupren sol. to Consupren S capsules in kidney transplant patients]. / Prevod z Consuprenu sol. na Consupren S kapsle u nemocných po transplantaci ledviny.

In a group of patients after transplantation of the kidney with stabilized graft function treated by Consupren sol. combined with prednisone and azathioprin in 20 patients (group A) Consupren sol. was replaced by Consupren S capsules, in 17 patients (group B) Consupren sol. therapy proceeded without any change. To maintain the cyclosporin blood concentration within the therapeutic range it was necessary after the change of drug form in group A to adjust the dosage of the drug in 12 patients of group A while in group B only in one patient (p<0.01). The mean doses and levels of Cy-A however did not change significantly during the three-month investigation period in the two groups and and the bioequivalence of the two preparations was evident. Conversion from Consupren sol. to Consupren S capsules is not associated with the risk of rejection or undesirable effects. It can be implemented at a ratio of 1:1 or 1: the closest dose divisible by 25 (the smallest capsules are 25 mg) and after conversion a check-up or possible modification of the dose is necessary.

[Metabolic sequelae of pancreatic transplantation using two different surgical techniques]. / Metabolické dusledky transplantace pankreatu pri pouzití dvou ruzných chirurgických technik.

BACKGROUND: By transplantation of the pancreas in diabetics type 1 long-term-term independence on exogenous insulin can be achieved. The extent of normalization of the carbohydrate metabolism can depend on the applied surgical technique. The objective of the submitted work was to compare indicators of compensation of diabetes one year after combined transplantation of the kidney and pancreas, using the method of transplantation of a segment of the pancreas with obliteration of the pancreatic duct by a polymer and the method of transplantation of the whole pancreas with drainage of the pancreatic duct into the urinary bladder. METHODS AND RESULTS: The authors examined two groups of recipients, 13 subjects each with full function of the pancreatic graft one year after transplantation where a combined transplantation of the kidney and pancreatic segment (group SP) had been performed or of the kidney and whole pancreas (group CP). The authors investigated the blood sugar level, glycated haemoglobin, intravenous glucose tolerance test, free insulin level and C-peptide as well as some indicators of the lipid metabolism and acid base balance. In both groups normal blood sugar levels were achieved, though the mean values in the course of the day were higher in group SP than in group CP (mean +/- SE 5.48 +/- 0.11 as compared with 4.98 +/- 0.09; p < 0.01). Glycated haemoglobin declined in group SP from the pretransplantation value of 9.31 +/- 0.09 to 6.40 +/- 0.10% and in group CP from 9.49 +/- 0.15 to 4.92 +/- 0.08%. In group CP the glycated haemoglobin after transplantation was significantly lower (p < 0.01), similarly as the coefficient of glucose assimilation (1.83 +/- 0.03 as compared with 1.25 +/- 0.15; p < 0.05). Indicators of the acid base balance did not differ. Recipients in group CP were however permanently treated with bicarbonate. CONCLUSIONS: With both transplantation method it is possible to achieve compensation of diabetes close to normal. The carbohydrate tolerance is however better after transplantation of the whole pancreas.

[Pulsed doses of calcitriol in the treatment of secondary hyperparathyroidism in patients on hemodialysis]. / Nárazové dávky kalcitriolu pri lécení sekundární hyperparatyreózy u hemodialyzovaných nemocných.

Administration of pulse doses of calcitriol is a better way of conservative treatment of secondary hyperparathyroidism (2HPT), making use of the direct suppression of parathormone (PTH) secretion. In a group of 29 haemodialyzed patients the authors evaluated during a six-month follow-up the effect of intravenous Calcijex in 12 and of oral Rocaltrol in 8 subjects. In responders of the calcijex group the PTH level declined by 67.6%, the mean baseline PTH value being 787.8 pg/ml, as compared with non-responders where the decline of PTH at the end of the investigation was 7.5%, the baseline PTH being 1296.4 pg/ml. The difference was significant (p < 0.05). In patients treated with Rocaltrol the therapeutic effect was apparent also in subjects with a lower baseline PTH. An associated phenomenon of treatment are as a rule parallel changes of kALP and ACP levels with those of PTH. It was however revealed that the drop of serum activities can occur also without a concurrent drop of PTH which indicates a dissociation between the level of bone metabolism and PTH secretion. The therapeutic effect can be influenced not only by the stage of 2HPT but also by the route of administration and quantity of calcitriol doses, as ensues from a long-term follow up of one patient. Moreover, the morphological substrate of the hyperplastic tissue of the parathyroid gland and their receptors for 1,25(OH)2D3 must be taken into account. Successfully performed parathyroidectomy, a still justified therapeutic step, is associated as a rule with rapid restoration of PTH levels. TO CONCLUDE: Pulse doses of calcitriol seem to be at present the effective treatment of diagnosed 2HPT, conventional oral calcitriol doses are useful in 2HPT prophylaxis. 2. The i.v. form should be the last resort of conservative treatment before parathyroidectomy. 3. Calcitriol treatment should attempt to maintain slightly raised PTH levels. 4. The limiting indicators of treatment are hypercalcaemia, hyperphosphataemia and the development of extraosseous calcifications. 5. In order to adhere to these criteria it is necessary to use dietary provisions, the dialyzation technique and check biochemical indicators of bone metabolism and possibly change doses of pharmaceutical preparations.

[Nephrotoxicity of Sandimmune and Consupren in an experiment]. / Nefrotoxicita Sandimmunu a Consuprenu v experimentu.

Cyclosporin A is a basic immunosuppresive drug after organ transplantation. Morphological and functional features of Cyclosporin A nephrotoxicity caused by Sandimmune (Sandoz) and Consupren (of the Czech origin) were investigated in male Wistar rats. Rats were subjected to a right side nephrectomy followed by 45-minute- ischemia of remaining left kidney. Sandimmune was administered to one group of animals, Consupren to another group, both in the amount of 10 mg/kg/day. The second part of the experiment was performed in animals with right side nephrectomy only (without ischemia of the left side kidney) followed by the same administration of drugs. Changes were checked the 3rd and 21st day after nephrectomy. Ischemic arterial insudation lasted in the 3rd day set of animals with nephrectomy and left kidney ischemia treated by Consupren and was lacking after Sandimmune. Microvascularization of tubular epithelial cells was observed in significant frequency in the 21st day set of animals with unilateral nephrectomy without ischemia after Consupren and not after Sandimmune. The finding correlated with significantly higher blood level of Consupren and higher creatinine concentrations in serum than those of Sandimmune in rats with unilateral nephrectomy only.

[An experimental model of the effect of uremia on cyclosporin A availability]. / Experimentální modelování vlivu urémie na dostupnost cyklosporinu A.

BACKGROUND: The aim of the study was to determine whether or not uraemia has an effect on cyclosporine A intestinal resorption. METHODS AND RESULTS: Model experiments were conducted in rats to monitor the effect of acute uraemia (bilateral nephrectomy) on the kinetics of cyclosporine A. Using intragastric tube, Cyclosporine A was administered to one group of rats in the form of Consupren (Galena, Czech Republic) and to another group in the form of Sandimmune (Sandoz, Switzerland), at a dose of 10 mg/kg/24 h either case. Blood levels of cyclosporine A were determined using RIA and specific and non-specific antibodies (cyclosporine and its metabolites). Cyclosporine A kinetics in nephrectomized rats was compared with that in control rats and in rats undergoing sham nephrectomy. The blood levels of cyclosporine A were significantly lower, and the area under the curve (AUC) of blood cyclosporine A in nephrectomized rats significantly smaller than in control rats. No significant differences in the evaluated parameters after Consupren or Sandimmune were observed. CONCLUSIONS: Our findings support the hypothesis that uraemia decreases cyclosporine A availability. The results suggest that the changes in cyclosporine A kinetics in nephrectomized rats following Consupren and Sandimmune administration are of the same character.

[Comparison of functional and morphologic changes after administration of Consupren and Sandimmune in rats with a 5/6 nephrectomy]. / Srovnání funckcních a morfologických zmen po podávání Consuprenu a Sandimmunu u krys s 5/6 nefrektomií.

Rats with 5/6 nephrectomy were used to compare the nephrotoxic effects of Consupren (cyclosporine A by Galena, Czech Republic) and Sandimmun (Sandoz, Switzerland). Twenty-one days after the administration of the same dosage, 10 mg/kg 24 hr, the blood levels of cyclosporine A were statistically significantly higher (P < 0.025) in rats given Consupren than in rats receiving Sandimmun. The serum concentrations of creatinine, urea, electrolytes, and osmolality did not differ after Consupren and Sandimmun. No significant difference between the two drugs was found in urinary excretion or proteinuria. The increase in the weight of residual renal parenchyma at 21 days after 5/6 nephrectomy did not differ significantly between rats administered Consupren or Sandimmun. Histology revealed gross hypergranularities in the juxtaglomerular apparatus equally present in both studied groups. Results show no significant differences in any of the evaluated parameters of the functional capacity of residual renal parenchyma or in the nephrotoxic effect as demonstrated in the histologic picture.

[Cranial and thoracic circumference as criteria of body development]. / Kopf- und Brustumfang als Kriterium der körperlichen Entwicklung.

The growth of thoracic and neurocranial circumference was studied in 47,099 Czech and Slovak children and adolescents of both sexes, ranging in age from 1 1/2 to 18 years. The data were obtained during our nation-wide studies on the territory of the CSFR in 1987-1988. At the end of the second year of life the values of thoracic circumference were already markedly higher than the values of neurocranial circumference. The characteristics studied show different growth dynamics: The neurocranial circumference increased markedly up to the age of four years, while thoracic circumference showed an onset on intense growth dynamics only at the beginning of the prepubertal period. Throughout the investigated period girls had lower values of neurocranial circumference than boys, yet during the period of puberty their values of thoracic circumference temporarily exceeded the values recorded in boys. After the age of 14 years boys generally had permanently a larger thoracic circumference. Similar to body height and weight both investigated circumferences show an increase in connection with the secular trend. The values of both circumferences are very similar in Czech and Slovak children of the same sex.

[Consupren in prophylactic therapy after kidney transplantation]. / Consupren v profylaktické lécbe po transplantaci ledviny.

Thirty patients after a first transplantation of the kidney from a dead donor were treated with Consupren Galena combined with azathioprine and prednisone for a period of at least one year. As control served a comparable historical group of 50 patients treated with a combination of three immunosuppressive drugs using Sandimmune, Sandoz. No significant differences were found between the two groups as regards the functional development of the grafts, the number of lost grafts, the cumulative survival of grafts, the number of rejections and the number of deaths. As to undesirable effects there were insignificantly more patients with a nephrotoxic episode in group CS where also repeated nephrotoxic episodes were recorded. The most frequent undesirable effect in group CS was hirsutism in half the patients. Consupren used in prophylactic treatment in combination with a azathioprine and prednisone appears to be a comparable immunosuppressive regime as that which comprises Sandimmune, Sandoz.

[Hyperparathyroidism and parathyroidectomy in dialyzed patients]. / Hyperparatyreóza a paratyroidektomie u dialyzovaných nemocných.

The authors present older and more recent views regarding the pathogenesis of hypocalcaemia and secondary hyperparathyroidism in patients with chronic renal failure with emphasis on the impact of inorganic phosphate retention and lack of 1,25-dihydroxyvitamin D3 in body fluids. As regards therapeutic procedures the initial problem is to control hyperphosphataemia and to suppress the increased parathormone secretion in particular in dialyzed patients. When treating hyperphosphataemia it is necessary with regard to the severity of the finding to use concurrently several procedures and avoid aluminium phosphate binders. Aimed reduction of high parathormone levels in the blood stream can be achieved by medicamentous--pharmacological means, using 1,25 (OH)2 D3 or surgery of the hypertrophic parathyroid glands. The term parathyroidectomy can comprise also percutaneous infiltration of the parathyroid glands with ethanol. From this aspect under certain circumstances a combination of different therapeutic procedures may prove useful. In the conclusion the authors mention basic data on para-thyroidectomies performed in their department: the favourable long-term results of operations amounted to 80.4%.

[Membrane transport of cations in erythrocytes during treatment of essential hypertension with angiotensin-converting enzyme inhibitors]. / Membránový transport kationtu v erytrocytech pri lécbe esenciální hypertenze inhibitorem angiotensin konvertujícího enzymu.

The authors investigated in ten patients with essential hypertension changes in the membrane transport of sodium in red blood cells and the intracellular calcium content of thrombocytes during the control period during treatment of hypertension with central sympatholytics and after three-week treatment with an inhibitor of the angiotensin converting enzyme (ACE), enalapril. The effect of enalapril in hypertonic patients was manifested by a rise of the renin plasma activity and the potassium concentration and a reduction of the sodium plasma concentration which corresponds to the inhibition of angiotensin II. The intracellular calcium and sodium content was unaltered. In 8 of 10 patients after enalapril treatment increased values of Vmax for Na(+)-K+ cotransport occurred, incl. 6 patients where at the same time a rise of Vmax Na(+)-Li+ countertransport was recorded.

[Initial clinical experience with Consupren, a new preparation manufactured in Czechoslovakia (Galena), in patients after liver transplantation]. / První klinické zkusenosti s novým cs. prípravkem Consupren (Galena) u nemocných po transplantaci ledviny.

Fourteen patients on average 10 months after transplantation of the kidney treated with Sandimmune were changed to a new Czechoslovak preparation Consupren, Galena (Cyclosporine A), while maintaining the other components of immunosuppressive treatment (azathioprine, prednisone). The patients were followed up for 6-12 months on the new drug. The tolerance of Consupren was in all patients satisfactory. Two weeks after the change the mean cyclosporine A level was significantly higher and called for a reduced dosage. No significant changes in the clinical condition and laboratory indicators were observed, the serum creatinine values did not change during the investigation and within 6 months after the change no rejection was recorded, despite the fact that during the first six weeks after the change an insignificant rise of mean absolute number of lymphocytes, CD4 lymphocytes and the regulatory index and a significant rise of CD3 lymphocytes was observed.

[Arteriosclerosis risk factors in the offspring and siblings of type 2 diabetics]. / Rizikové faktory aterosklerózy u potomku a sourozencu diabetiku 2. typu.

Risk factors of atherosclerosis were examined in 63 offspring and 30 siblings of type 2 diabetics and in 22 controls. Clinical complications of atherosclerosis were not found very frequently in direct relatives of diabetic patients. Diabetes was detected in 17% siblings, an impaired glucose tolerance in 11% of the offspring and in 33% siblings. The offspring of diabetics had higher blood sugar values and serum insulin levels on fasting and after stimulation, as compared with controls; as to other metabolic parameters lipids and apolipoproteins, body mass indexes, uricaemia, glycated proteins, C-peptide), the two groups did not differ significantly. In middle age, i.e. in siblings of diabetic patients, the incidence of obesity rose significantly as well as hyperlipoproteinaemia type IV and hypertension, while smoking was less common than in offspring. The glucose tolerance deteriorated further, although the insulin levels did not increase substantially. The mentioned findings indicate the orientation for preventive provisions in families of type 2 diabetics.

Endocrine pancreatic secretion in patients after acute pancreatitis.

In 14 nonobese patients after acute pancreatitis and with normal oral glucose tolerance, the response of insulin, C-peptide, and pancreatic glucagon after 100 g of oral glucose was assessed. The curves of insulin and C-peptide were significantly raised compared with those of controls, and no difference was found between the response of patients with a negative (n = 8) and a positive (n = 6) family history of type II diabetes. The curves of pancreatic glucagon did not differ from those found in controls. Our results indicate that a normal response to glucose after recovery from an attack of acute pancreatitis is maintained at the cost of increased insulin secretion.

[Cyclosporin A in preventive therapy after kidney transplantation: a double combination versus a triple combination. I. Therapeutic effectiveness]. / Cyklosporin A v profylaktické lécbe po transplantaci ledviny: dvojkombinace versus trojkombinace. I. Ucinnost lécby.

Two groups of patient after a first renal transplantation from a dead donor were treated by a double combination of cyclosporin A and prednisone (group A) and triple combination cyclosporin A and azathioprin and prednisone (group B). The groups were similar as regards effectiveness of treatment (evaluated with regard to the survival of recipients and grafts and the number of rejection episodes); they did not differ as to the losses of grafts for other than immunity reasons, which predominated in both groups over losses caused by rejection. Discontinuation of prednisone after four months in group A was complicated by rejection in 54%. Discontinuation of cyclosporin A after one year's treatment and a change to azothioprin and prednisone treatment was in both groups complicated by rejection in cca one fifth of the patients.

[Cyclosporin A in preventive therapy after kidney transplantation: a double combination versus a triple combination. II. Adverse effects of cyclosporin A and therapeutic complications]. / Cyklosporin A v profylaktické lécbe po transplantaci ledviny: dvojkombinace versus trojkombinace. II. Nezádoucí úcinky cyklosporinu A a komplikace lécby.

The incidence of irreversibly afunctional grafts, late functional development and period of the initial temporary lack of function did not differ in the two groups. The total number of nephrotoxic episodes was significantly (p less than 0.05) lower in the triple combination, chronic nephrotoxicity developed with equal frequency. Infectious complications were present in 54% of the patients in group A and in 60% in group B, viral complications in 15% patients in group A and in 16% in group B. Serious bacterial infections were the cause of death in one of three patients in group A and in five of six patients in group B.