[Vegetations associated with infective endocarditis in children]. / Narosla w przebiegu infekcyjnego zapalenia wsierdzia u dzieci.

OBJECTIVE: The purpose of this study were clinical analysis of vegetations associated with infective endocarditis. MATERIAL AND METHODS: Between 1990-1999 years 7 children (aged 2-17 years) with infective endocarditis were study in the Cardiology Department Children's Memorial Health Institute. Analysed clinical features of vegetations associated with endocarditis. MAIN OBSERVATIONS AND RESULTS: The most of them vegetations were localized on the mitral valve and in children without congenital heart disease (CHD). Remaining patients were: girl with bicuspidal aortic valve-vegetation on the aortic valve, boy with simple ventricle, pulmonary stenosis and atrial septal defect-vegetation on the pulmonary valve, boy with double outlet right ventricle, pulmonary stenosis and atrial septal defect-vegetation on the tricuspid valve, boy with patent ductus arteriosus-vegetation on the pulmonary valve. In all patients were regurgitations of this valves (> II degree). 71% patients had fever, 57% another murmur in the heart, 43% hepatosplenomegalia. Positive result of the blood sowing was in 72% patients. After medical treatment of vegetations good result was in 4 children. Chirurgical treatment were performance in 3 children. CONCLUSIONS: 1. Vegetations in the echocardiographic examination were in 21.8% children associated with infective endocarditis. 2. The most of them vegetations were localized on the mitral valve and in children without CHD. 3. Good result after medical treatment of vegetations was in 57% patients.

The assessment of value of transvaginal ultrasound for monitoring of gestational trophoblastic disease treatment.

Thirtysix patients with persistent gestational trophoblastic disease were analysed in The Clinic of Cancer of Female Reproductive System. Using transvaginal USG, the volume of pathological foci within myometrium, diametre of theca lutein ovarian cysts and uterus length before, during and after the treatment were registred. In order to check the effectiveness of USG examination in the monitoring of GTD treatment particular USG factors were compared with hCG level. On 28 patients (77.7%) in USG examination pathological changes in uterus and ovaries were seen. The relation between hCG level and tumor volume, uterus length and theca lutein ovarian cysts was stated. That proves the usefulness of transvaginal USG examination in the monitoring of treatment of patients with persistent gestational trophoblastic disease.

Recruitment experience in the full-scale phase of the Modification of Diet in Renal Disease Study.

The Modification of Diet in Renal Disease (MDRD) Study is a randomized, multicenter clinical trial testing the effects of three different levels of dietary protein and phosphorus intake and two levels of blood pressure control on the rate of loss of kidney function in persons with various chronic kidney diseases. During a 27-month recruitment period, 2507 persons who had objective evidence of impaired kidney function were screened at 15 centers. Eight hundred and forty men and women aged 18-70 with a glomerular filtration rate between 13 and 55 ml/min/1.73 m2 were randomized. Medical record review was the primary means of identifying study participants at the beginning of recruitment. Later, use of mass media was instrumental in alerting both the public and the medical community of the need for MDRD Study participants. Overall, the most important sources of randomized participants were referral by personal physician (45.4%) and relative/friend (5.6%), and self-referral after hearing about the trial from newspapers (23.9%) and television (5.2%). Review of medical records from defined patient populations was the source of 22.3% of the randomized study participants. A total of 9.4% of the randomized participants called a toll-free (800) telephone number before contacting the centers.

The management of granulosa-cell tumors of the ovary based on long-term follow up.

The results of treatment in 130 cases of GCT of the ovary treated in the Institute of Oncology in Warsaw and followed up from 5 to 40 years were analysed with respect to the methods of therapy and age of the patients. The highest 5-year survival rate (86%) was obtained by combination of radical surgery with external irradiation. Such treatment also resulted in the lowest percentage of early and late failures of the treatment (17%). Conservative surgery, applied in the Ist stage of GCT resulted in 69% of 5-year survivals and gave young women a chance of procreation; however, the majority (69%) of patients who underwent this treatment sooner or later developed a recurrence leading, in consequence, to death.

[Gestational trophoblastic disease. Clinical course and results of treatment]. / Ciazowa choroba trofoblastyczna. Przebieg i wyniki leczenia.

Out of 472 patients with gestational trophoblastic disease directed to the Institute of Oncology in Warsaw in the period 1.4.1977-1.4.1987, 145 (30.7%) have been qualified for treatment. Lasting cure was obtained in all of 105 patients with the disease restricted to the uterus, in 13 of 14 (92.8%) with metastatic disease with favourable prognosis and in 20 out of 25 (80.0%) with metastatic disease with poor prognosis. In 102 patients treated exclusively chemically the procreative ability has been preserved, 33 of these women gave birth to a total of 44 healthy children.

Leukocyte endogenous mediator fails to alter protein dynamics in a model of liver dysfunction.

This study examines the effect of a purified leukocyte-derived endogenous mediator (LEM) on protein metabolism during liver dysfunction and after sham surgery and the role of a nonsteroidal, antiinflammatory drug (indomethacin sodium trihydrate) in modifying this response. Febrile response, protein kinetics, urinary end products of protein metabolism, and plasma acute phase protein levels were studied in rats given a pyrogenic dose of LEM or saline solution, and these same indicators were studied after the administration of the same dose of LEM plus 2 mg/kg indomethacin 3 weeks after a portacaval shunt (PCS) or sham operation. In both surgical groups given LEM, a maximum of 1.1 degrees C fever was observed. LEM increased protein turnover and urinary excretion of nitrogen and urea in sham-operated rats but not in the PCS animals. Administration of indomethacin decreased the plasma oxidation of L[1-14C]leucine and prevented the increased excretion of total nitrogen and urea in sham-operated animals treated with LEM. PCS animals showed a constant excretion of nitrogen and urea independent of treatment. alpha 1-Acid glycoprotein levels increased significantly in sham-operated animals treated with LEM but not in the PCS group until indomethacin was added. The coadministration of LEM and indomethacin in shams also enhanced the levels of alpha 2-macroglobulin and alpha 1-acid glycoprotein over values found with LEM alone. These findings confirm the catabolic effect of LEM in normal animals and identify the essential role of the liver in the acute phase response. The data also suggest that indomethacin may modify the acute phase response by reducing plasma amino acid oxidation as well as enhancing the levels of some specific acute phase proteins.

Effect of protein depletion and short-term parenteral refeeding on the host response to interleukin 1 administration.

Previous studies have demonstrated that protein malnutrition adversely affects the synthesis and release of interleukin 1 by monocytic cells. The purpose of this study was to investigate the protein and trace metal metabolism of severely protein-malnourished guinea pigs given exogenous interleukin 1 in the postabsorptive state or while concomitantly receiving total parenteral nutrition (TPN). Protein-depleted guinea pigs in the postabsorptive state failed to exhibit fever, granulocytosis, accelerated amino acid oxidation, or an acute-phase protein response after administration of interleukin 1 or endotoxin. However, a reduction in the serum concentration of zinc (P less than 0.05) and iron (P less than 0.05) was observed in the guinea pigs given interleukin 1, but not in those given endotoxin. The short-term (1 day) administration of TPN restored positive leucine balance (P less than 0.001) and reduced leucine release from protein breakdown (P less than 0.001). No other differences in the protein metabolism or trace metal response to interleukin 1 were observed as a result of short-term TPN feeding. Body temperatures of these malnourished guinea pigs given interleukin 1 and TPN became febrile or hypothermic depending on initial body temperatures. It is concluded that an attenuated capacity to synthesize interleukin 1 and a failure to mount an appropriate acute-phase protein response to exogenously administered interleukin 1 exist in this protein-malnourished animal model. Furthermore, this diminished protein response appears to be independent of short-term substrate provision because TPN for 1 day was unable to restore the full effects of the acute-phase response as mediated by interleukin 1.

Consequences of UMP synthase deficiency in cattle.

Several dairy cows have been identified as partially deficient in UMP synthase. Although erythrocytes of normal cows contained 2.54 units of enzyme per ml, four cows were discovered with only 1.08 units per ml. Cows deficient in UMP synthase secreted milk with abnormally high levels of orotate, 300-1,000 micrograms of orotate per ml compared to 80 micrograms/ml for normal cows. The deficiency also was accompanied by a lactation-induced orotic aciduria. Although bovine urinary orotate was generally less than 10 micrograms/ml, the urine of the deficient cows, when lactating, contained 20-200 micrograms/ml. Their plasma orotate also was elevated. Genetic transmission of the condition was suggested by a common bull in the pedigrees of all deficient animals. Indeed, these cows, with half the normal level of UMP synthase, are probably heterozygotes with a 50% chance of passing the deficient allele to their progeny. For these putative heterozygotes, the condition is apparently benign because longevity and production were unaffected. However, the existence of a gene for UMP synthase deficiency in the dairy cow population poses a hazard with respect to the conception of homozygotic, deficient animals. These, in analogy with a comparable human condition, would be expected to exhibit high perinatal morbidity and mortality.