Tumor markers in pleural effusions.

AIM: The aim of this study was to determine the diagnostic capabilities of tumor markers in pleural effusion and their importance for assessment of the etiology of pleural effusions. PATIENTS AND METHODS: In pleural effusions from 166 patients hospitalized during the period 2003-2005 at the Department of Oncology and Radiotherapy, Faculty Hospital in Pilsen, the following tumor markers were determined: thymidine kinase (TK), neuron-specific enolase (NSE), cytokeratins [tissue polypeptide antigen (TPA), tissue polypeptide-specific antigen (TPS) and cytokeratin fragment 19 (CYFRA 21-1)], carcinoembryonic antigen (CEA) and mucinous markers (CA 15-3, CA 19-9, CA 125). The inflammatory marker procalcitonin-PCT was also assessed. RESULTS: Tumor markers CA 125, TPA, TPS were significantly elevated in exudates, irrespective of the etiology, as a non-specific reaction in mesothelial cells. TK had a sensitivity of over 80% for all the types of cancer examined, while CA 15-3 had a sensitivity of over 90%. CONCLUSION: Significant positivity of PCT and CA 15-3 in pleural effusions indicate a suspicion of inflammatory disease. Positivity of TK and CA 15-3 indicate a strong suspicion of malignant exudates.

[The role of procalcitonin in the patient assessment after surgical procedures]. / Role prokalcitoninu ve sledování nemocných po kardiochirurgických výkonech.

In the group of 450 patients operated in the Cardiosurgical Department of the Faculty Hospital in Plzen during the period from III/2003 till XI/2003, 1451 samples were collected to examine the following-procalcitonin levels (PCT), white blood cell counts (Leu) and C-reactive protein levels (CRP). The findings were assessed with respect to the respective patient's clinical status, and any correlation between procedures with extracorporeal circulation (MO), signs of inflammation, septic and non-septic serious complications and between the above mentioned markers levels, was searched. It was detected, that the PCT levels correlated well with the clinical signs of inflammation and sepsis, as well as with the non-inflammatory complications. The CRP and Leu changes were not statistically significant and their levels are commonly increased by the surgical procedure itself.

[Endothelins and ischemic heart disease]. / Endoteliny a ischemická choroba srdecní.

Endothelins (ET) comprise a group of substances which are produced and have a regulatory function in different systems of the organism. The main cardiovascular ET is ET-1 which is so far the most potent vasoconstrictor substance. ET is important in the early stages of atherosclerosis as it is a strong chemical attractant of monocytes and macrophages and causes endothelial and vasomotor dysfunction. In later stages of atherosclerosis it can affect the firmness and integrity of the fibrous part of the atherosclerotic plaque. During myocardial infarction the ET level rises and this leads to vasoconstriction and reduction of the fibrillation threshold. In coronary angioplasty (PTCA) the ET-1 level rises depending on the applied mechanical stress. ET can participate in the formation of the neointima and the development of restenosis. ET increases also immediately after an aortocoronary bypass (CABG) and after reperfusion. Higher ET levels were found in patients with a positive ECG and echocardiographic loading test. In the latter after CABG normalization of ET was found. Raised ET levels were recorded also in patients where a coronary vasospasm can be provoked, in Prinzmetal's angina pectoris, coronary syndrome X, atrial tachystimulation. In unstable angina pectoris big-ET is elevated, the increase of the ET-1 level is not unequivocal. Stable angina pectoris does not affect ET-1. In the treatment of atherosclerosis for the selective ETA blocker reduction of the number and size of macrophage and foam cells was proved. In acute myocardial infarction a favourable effect for the non-selective ETA/ETB blocker and for the selective ETA blocker was found. In the treatment of restenosis after PTCA blockers of selective ETB receptors and inhibitors of endothelin converting enzyme seem hopeful. Th non-selective ETA/ETB blocker bosentan is in the stage of clinical tests and seems to be safe and perspective.

[Endothelins and chronic cardiac insufficiency]. / Endoteliny a chronická srdecní insuficience.

Endothelins (ET) comprise a group of substances which are produced and have regulatory functions in different systems of the organism. The main cardiovascular ET is ET-1 which is so far the most potent vasoconstrictor substance. In the pathophysiology of cardiac insufficiency ET-1 promotes cardiac hypertrophy, is involved in vasoconstriction, delayed relaxation and reduced left ventricular contractility. The ET-1 level correlates with pulmonary vascular hypertension. By vasoconstriction of renal arteries ET leads to volume retention. Big-ET is a very efficient neurohumoral marker in the diagnosis of developed cardiac failure which can lead to more accurate prognostic stratification. ET-1 is probably important for assessment of the diagnosis of cardiac insufficiency only in severe cardiac failure. The favourable effect of ET block in cardiac insufficiency was proved for the non-selective ETA/ETB blocker and selective ETA blocker. The selective ETB blocker has an adverse haemodynamic effect in treatment of heart failure but by suppression of aldosterone it can prevent fluid retention. In the treatment of cardiac failure blockers of endothelin converting enzyme seem perspective as they reduce adversely activated neurohumoral factors.

[The stress ergometry test in diabetics and non-diabetics]. / Zátezové ergometrické vysetrení u diabetiku a nediabetiku.

OBJECTIVE: Evaluate risk factors of ischaemic heart disease (IHD) and the importance of burdening on a bicycle ergometer (BE) in the diagnosis of IHD in diabetic and non-diabetic subjects. CHARACTERISTIC OF GROUP: The authors evaluated in a retrospective study all 308 patients subjected to BE during the period 11/98-1/99 in Konstantinovy Lázne. Characteristics of diabetic vs. non-diabetic subjects: number (97 vs. 211), men (70.1 vs. 70.14%) mean age (59.76 vs. 58.01), height (1.71 vs. 1.71 m), body weight (85.91 vs. 81.40 kg), BMI (29.36 vs. 27.68 g/m2), total cholesterol (5.73 vs. 5.51 mmol/l,) triacylglycerols (2.63 vs. 2.08 mmol/l), fasting blood sugar level (7.31 vs. 4.88 mmol/l), hypertension (24.74 vs. 37.44%), hyperuricaemia (40.21 vs. 27.01%), IHD (93.81 vs. 93.84%), ischaemia of the lower extremities (6.19 vs. 13.74%), cerebrovascular episodes (7.22 vs. 5.21%), smokers 10.31 vs. 5.21%), ex-smokers (47.42 vs. 57.82%), non-smokers (42.27 vs. 36.97%). The diabetic patients were treated in 31.96% with PAD, in 5.15% with insulin and in 62.89% by diet only. EVALUATION: BE was used to assess and set the load tolerance, i.e. with regard to the current medication. The conclusion of BE is from the aspect of IHD either positive (ECG signs of coronary insufficiency), negative (without signs of coronary insufficiency at the level of 85% aerobic capacity according to Astrand) or impossible to evaluate (without signs of coronary insufficiency, while not attaining this level of load). Positive ergometric examinations were divided into symptomatic ones (i.e. with stenocardias during BE) and asymptomatic (silent ischaemia). In diabetic vs. non-diabetic subjects there were 0% vs. 6.16% symptomatically positive BE, 27.84% vs. 11.37% positive BE with silent ischaemia, 17.53% vs. 20.85% negative BE and 54.64% vs. 61.61% BE which could not be evaluated. The watt training tolerance was 51.55 vs. 57.26 W. CONCLUSIONS: In diabetics (31.49% of the group) there was a significantly higher body weight, BMI, TG. As to risk factors of IHD and manifestations of atherosclerosis there were among diabetics more patients with a history of a cerebrovascular episode, more smokers and conversely fewer hypertonic subjects and fewer with ischaemia of the lower extremities than in non-diabetic subjects. During BE in diabetics there were more silent ischaemias than in non-diabetics. None of the diabetics with a positive BE suffered from symptomatic ischaemia. The high percentage of BE which cannot be evaluated in both groups is due to the concurrent administration of drugs, in particular beta-blockers and the protocol of the examination (an increasing loading test after 4 min. á 25 W) which is suitable for setting the training load and not for assessment of coronary insufficiency (for this purpose the protocol after 2 min. á 50 W is more suitable). In the conclusion the authors evaluate the importance and informative value of different diagnostic examinations for detection of IHD or its severity in diabetic and non-diabetic subjects.

[Pharmacotherapy in patients after myocardial revascularization surgery 1991-1995]. / Farmakoterapie u nemocných po revaskularizacních operacích myokardu v letech 1991-1995.

The authors discuss in a retrospective study pharmacotherapy administered to 302 patients after revascularization surgery of the heart muscle in 1991-1995 in Konstantinovy Lázne. In the introduction they evaluated the ratio of drugs used in secondary prevention of infarctions incl. trends of their use in individual years between 1991-1995 (antiaggregation treatment-beta-blocking agents, calcium channel blockers, ACE inhibitors, hypolipidaemic agent, rapidly acting and retardes forms of nitrates). They evaluate specially medication with beta-blocking agents from the aspect of cardioselectivity, internal sympathomimetic activity, membrane stabilizing effect and period of action. When evaluating pharmacotherapy they found a satisfactory state of affairs as regards administration of antiaggregants and beta-blocking agents. They found reserves as regards the use of ACE inhibitors and hypolipidaemic agents in indicated patients. A relatively high percentage (20%) of patients with angina pectoris persisting after surgery did not take rapidly acting nitrates.