Calcium-phosphorus-magnesium homeostasis in pregnant women after renal transplantation.

OBJECTIVE: The aim of the study was the assessment of calcium-phosphorus-magnesium homeostasis in pregnant women after renal transplantation. METHODS: The study covered 64 pregnant women in the third trimester of gestation including: 33 women after renal transplantation (the study group) and 31 healthy pregnant women (the control group). Women from both groups were at the similar age: 30.8+/-4.7 vs. 31.3+/-5.0 years (NS) and at the same gestational age 34.8+/-2.4 vs. 35.3+/-2.6 weeks (NS). The mean body mass index (BMI) in the women from the study group before pregnancy was 21.49+/-2.81 vs. 22.1+/-3.02 in the control group (NS), BMI before delivery was 25.43+/-3.05 vs. 26.0+/-3.35 (NS), the percentage of the BMI increase during pregnancy was 18.7+/-7.68 vs. 17.65+/-7.13 (NS) and BMI increase during gestation was 3.93+/-1.56 vs. 3.90+/-1.54, respectively (NS). Arterial blood pressure at the time of blood samples collection for biochemical tests was 151.4+/-26.8/92.5+/-16.9 in women from the study group comparing to 115.0+/-6.0/68.0+/-7.0 mmHg (P<0.001) in the patients from the control group. The maximal blood pressure during pregnancy was 169.2+/-20.7/102.7+/-14.0 vs. 118.0+/-7.0/70.0+/-8.0 mmHg (P<0.001), respectively. We estimated serum levels of: total Ca, ionized Ca(2+), inorganic phosphorus (P(i)), Mg, total protein, albumin and blood morphology. Moreover, urine levels of Ca, P(i), Mg and protein were assessed. RESULTS: The pregnant women after renal transplantation presented increases in serum concentrations of total Ca (2.54+/-0.20 vs. 2.16+/-0.10 mmol/l; P<0.001) and ionized Ca(2+) (1.322+/-0.104 vs. 1.12+/-0.07 mmol/l; P<0.001) and the decrease in P(i) level (1.013+/-0.211 vs. 1.10+/-0.16 mmol/l; P<0.05), total protein (59.3+/-7.0 vs. 65+/-5 g/l; P<0.001) and albumin (461.6+/-65.65 vs. 493.2+/-59 micromol/l; P<0.05). Moreover, in the study group drop in red blood cells count to 3.71+/-0.56 vs. 4.01+/-0.35 x 10(12)/l (P<0.02) in the control group was detected. Despite increased volume of 24-h urine collection in the kidney recipients we observed significantly decreased urine 24-h calcium excretion 2.47+/-0.92 vs. 6.72+/-3.49 mmol (P<0.001) and simultaneous increase in urine Mg excretion 3.422+/-1.025 vs. 2.18+/-0.52 mmol/24 h (P<0.001). There was no difference in urine 24-h P(i) excretion between the study and the control group. The pregnant renal transplant recipients presented proteinuria of 1.19+/-1.9 g/24 h. CONCLUSIONS: Women after kidney grafting present vital aberrations in calcium-phosphorus-magnesium homeostasis during pregnancy. The most significant changes are associated with calcium metabolism (high increase in serum Ca levels and impairment of renal elimination of calcium). The observed changes may be influenced by the doses of immunosuppressive agents and disturbed renal function.

[Pseudolymphoma in patients with primary Sjogren's syndrome]. / Pseudochloniak u chorej z pierwotnym zespolem Sjögrena.

Sjögren's syndrome is an inflammatory autoimmune disease affecting primarily the exocrine glands. In the abscence of other autoimmune diseases it is classified as primary Sjögren's syndrome. Patients with primary syndrome have about 40 times higher relative risk of developing lymphoma then normal population, which offers a possibility to study malignant transformation's mechanisms in these patients. In the study we report a case of a woman with pseudolymphoma. The clinical diagnose used to be based on symptoms of proliferate disease, quetionnable histological evaluation and good response to steroids. Nowadays, applying advanced molecular techniques make it possible to diagnose lymphoma in labial salivary biopsy much earlier. It allows recognizing an incipient lymphoma in a group of patients with primary Sjögren's syndrome. Therefore so-called pseudolymphoma can usually be diagnosed as either benign or malignant lymphoproliferative lesions.

[Diagnostic values of lactate dehydrogenase (LDH), creatine kinase (CK) and gamma-glutamyltransferase (gamma-GT) examinations in the course of intrahepatic cholestasis in pregnancy]. / Wartosc diagnostyczna oznaczenia aktywnosci dehydrogenazy mleczanowej (LDH), kinazy kreatynowej (CK) i gamma-glutamylotransferazy (g-GT) podczas wewnatrzwatrobowej cholestazy ciezarnych.

OBJECTIVE: The activity of LDH, CK and gamma-GT in blood serum of women with intrahepatic cholestasis in pregnancy was investigated. Diagnosis of intrahepatic cholestasis was based on anamnesis, clinical examination and laboratory tests. METHODS: 41 women with intrahepatic cholestasis (the study group) and 30 healthy women (the control group) entered the study. All women were in the third trimester of pregnancy. The prevalence rate of intrahepatic cholestasis in pregnancy in our Department is 1%. All women of the study group presented an intensive pruritus and had negative hepatitis B antigen. They also presented negative results of laboratory tests, clinical examination and anamnesis concerning other hepatitis. RESULTS: There was no significant difference in mean gestational age between study and control group (35.1 +/- 2.8 vs 36.0 +/- 3.0 weeks). The results of biochemical tests in study vs control group: 1) total bilirubin 33.3 +/- 18.8 vs 8.55 +/- 3.4 mumol/L; p < 0.001, 2) direct bilirubin 25.6 +/- 14.2 vs 1.7 +/- 1.7 mumol/L; p < 0.001, 3) indirect bilirubin 7.7 +/- 2.22 vs 8.5 +/- 3.4 mumol/L; NS, 4) alkaline phosphatase (AP) 168.4 +/- 61.2 vs 96.8 +/- 14.9 IU/L; p < 0.001, 5) heat-stable AP 99.8 +/- 38.7 vs 64.1 +/- 20.9 IU/L; p < 0.001, 6) bile acid 28.6 +/- 20.0 vs 4.5 +/- 1.5 mumol/L; p < 0.001, 7) AlAT 158 +/- 00 vs 5 +/- 3 IU/L; p < 0.001, 8) AspAT 97 +/- 31 vs 8 +/- 3 IU/L; p < 0.001, 9) de Ritis ratio AspAT/AlAT 0.61 +/- 0.31 vs 1.6 +/- 0.4; p < 0.001, 10) total protein 61.8 +/- 5.6 vs 66.0 +/- 6.0 G/L; p < 0.001, 11) albumine 450 +/- 34.8 vs 484.0 +/- 37.7 mumol/L, 12) Fe++ 26.0 +/- 3.8 vs 12.71 +/- 2.15 mumol/L; p < 0.001, 13) total cholesterol 8.81 +/- 1.87 vs 6.68 +/- 1.04 mmol/L; p < 0.001, total LDL 6.80 +/- 1.57 vs 4.80 +/- 0.81 G/L; p < 0.001, 15) LDH 211 +/- 48 vs 134 +/- 33 UI/L; p < 0.001, 16) CK 51.0 +/- 33 vs 45 +/- 14 UI/L; NS, 17) gamma-GT 49 +/- 22 vs 23 +/- 8 UI/L; p < 0.001. CONCLUSIONS: An increase of LDH is related to the significant impairment of hepatocytes. An increase of gamma-GT confirms the retention of bile in intrahepatic ducts. CK does not present prognostic value in intrahepatic cholestasis in pregnancy.

[Septic-toxic shock due to rhabdomyolysis in a patient treated with fenofibrate]. / Wstrzas toksyczno-septyczny w przebiegu rabdomiolizy u chorej leczonej fenofibratem.

Lipid disorders have been treated with fibrates for many years. Rhabdomyolysis is one of the side effects of these drugs. We report a case of a septic-toxic shock due to rhabdomyolysis in a 75-year old patient, who had been treated with fenofibrate for 2 years. This case shows necessity of the standard monitoring of aminotransferase, phosphocreatine kinase and creatinine levels during treatment with fibrates.

[A probe using isotretinoin for treatment of poorly differentiated leukemia]. / Próba zastosowania izotretynoiny w leczeniu bialaczki niskozróznicowanokomórkowej.

Isotretinoin (Roaccutane) was used in a patient with low differentiated cell leukemia. Poor general condition, very low blood cell count as well patient's lack of consent made chemotherapy impossible. The effect of isotretinoin treatment was full hematological and clinical remission. The general patient's condition did not require additional medication.

A randomized study comparing low dose ciprofloxacin and ofloxacin in the treatment of lower respiratory tract infections.

An open, randomized study was carried out to compare the efficacy of ciprofloxacin, 250 mg twice daily, and ofloxacin, 200 mg twice daily, in hospitalized patients with lower respiratory tract infections such as bacterial exacerbation of chronic bronchitis or community-acquired pneumonia. Fifty patients were treated in each group. The duration of treatment was 10 to 12 days. Microbiological examinations were carried out on sputum samples taken before, during and after treatment. In both groups, the clinical results were considered to be excellent, with clinical cure in 98% of the patients treated with ciprofloxacin and in 90% of patients treated with ofloxacin. Eradication of the initial sputum isolate was achieved in 98% of the patients of the ciprofloxacin group and in 82% of the patients of the ofloxacin group.

Evaluation of the antiemetic effect of domperidon in patients treated with cytostatic drugs.

Forty patients with various neoplastic syndromes received domperidon as a drug reducing nausea and vomiting. The drug prevents in the daily dose of 30 mg completely the occurrence of nausea and vomiting in 30% of the patients and in 58% considerably reduces their intensity. The dose of 60 mg abolishes nausea and vomiting in 60% of the patients and alleviates in 35%. The drug had been administered through the whole period of chemotherapy without any side effects which may be attributed to its antagonist action to dopamine.

[Evaluation of anti-emetic action of domperidone in patients treated with cytostatics]. / Ocena przeciwwymiotnego dzialania domperydonu u chorych leczonych cytostatykami.

Domperidone was administered to 40 patients with various neoplastic syndromes to prevent nausea and vomiting observed during previous courses of chemotherapy. It was found, that daily dose of 30 mg completely prevents nausea and vomiting in 30% of patients and significantly lowers such symptoms in further 58% of patients. An increase in a daily dose of 60 mg abolishes nausea and vomiting in 60%, and decrease their intensity in 35% of patients. Domperidone was administered orally during the whole period of chemotherapy without any adverse reactions related to its anti-dopamine actions.

[Results of treatment of breast cancer with tamoxifen]. / Ergebnisse der Behandlung von Brustkrebs mit Tamoxifen.

There were 62 cases of mammary carcinoma treated with the antioestrogen tamoxifen. The age of the patients ranged from 35 to 75 years. Tamoxifen was administered in a daily dosage of 30 mg (3 x 1 tablet). Treatment was carried out as monotherapy or adjuvant therapy. Treatment was carried out for 6 months with a follow-up period of further 6 months. In the group of patients with mammary carcinoma, 23 were premenopausal without metastases after radical mastectomy and sterilisation. The remaining 39 in this group were in the menopause with metastases which were in some cases untreated and in some cases treated by mastectomy, radiation and chemotherapy (CMF-scheme). All Patients were PD in relation to further radiation and/or chemotherapy. Karnofsky-index was 60 minimum. After 4 weeks' treatment with tamoxifen both an improvement in general wellbeing and a regression of the focus of the tumour was achieved. A significant improvement in wellbeing and tumour status could be established for a total of 48 cases of mammary carcinoma. Treatment was well tolerated. Only 1 case of side effects in the form of vomiting occurred.

[A few years of following up results of chronic respiratory infections with broncho-vaxom]. / Kilkuletnia obserwacja dotyczaca wyników leczenia przewleklych zakazen dróg oddechowych preparatem Broncho-Vaxom.

Broncho-Vaxom was administered to 57 patients with chronic respiratory infections. A significant improvement was noted in 70% of the treated patients whereas mild improvement in 21%. Discussing the results of Broncho-Vaxom therapy, the author suggests so-called maintenance therapy with the same preparation to stabilize its effect.

[Results of ciprofloxacin therapy in urinary and respiratory tract infections]. / Wyniki leczenia cyprofloksacyna zakazen dróg moczowych i oddechowych.

Ciprofloxacin was administered to 218 patients with various urinary and respiratory tracts infections, including 142 patients with urinary tract infections and 76 patients with respiratory tract infections. Bacteriological tests and routine laboratory tests were performed thrice (before, during and after therapy) in all patients. Ciprofloxacin was administered orally in daily dose of 500 mg for 10 days. Daily dose was increased to 1000 mg in 23 patients with severe respiratory tract infections. Satisfactory results (recovery or regression of the symptoms of exacerbated chronic disease) were achieved in 185 patients (84.9%) and no effect in 10 patients (4.6%). Significant improvement or transient improvement were noted in 23 patients (10.5%).

Results of the treatment of cardiac arrhythmias with Palpitin.

1) Palpitin has distinguishable antiarrhythmic effect in different type of cardiac arrhythmias of both supraventricular and ventricular origin, and of various ethiopathogeneses. 2) Antiarrhythmic effect is observed in most patients, already 24 hours after initiation of treatment. 3) Untoward effects, although occurring relatively frequently, usually do not cause such severe alterations which lead to a discontinuance of therapy. 4) Palpitin may be used in long-term treatment of outpatients.

Bacterial infections of the lower urinary tract treated with ciprofloxacin or cefalexin--a comparative study.

30/30 patients with lower UTI were enrolled in a randomized study to compare ciprofloxacin (250 mg/b.i.d.) and cefalexin (1 g/t.i.d.). In addition, 59 patients with cefalexin-resistant bacterial strains were treated in an open study arm. Ciprofloxacin showed convincingly better clinical and bacteriological efficacy than cefalexin. Both antibiotics were well tolerated. Ciprofloxacin has proved to be superior to cefalexin in the treatment of lower UTI.