Management of infants with idiopathic dilatation of the right atrium and atrial tachycardia.

Idiopathic dilatation of the right atrium (IDRA) is a rare anomaly defined as isolated enlargement of the right atrium in the absence of other cardiac lesions known to cause right atrial dilatation. IDRA is a congenital anomaly with unknown pathogenesis and highly variable clinical presentation. Optimal management of severe IDRA is controversial and individualized. Literature reports of long-term follow-up have been limited. We describe a child with IDRA with rapid atrial tachycardia (AT) refractory to both medical and surgical management, and we provide long-term follow-up on our two previously reported cases, both of whom had documented AT. For infants with AT, the clinical course is unpredictable, and medical therapy is the first line of treatment. The decision to proceed with surgical resection of a giant right atrium should be made on an individual basis. Atrial resection along with a modified right atrial MAZE procedure could be considered in infants with life-threatening atrial tachyarrhythmia refractory to medical treatment. Surgical scarring of the right atrium may produce substrate for atrial arrhythmia, which may also be refractory to medical therapy. Histological examination of excised atrial tissue remains inconsistent and not contributory to the determination of the etiology of IDRA. Our three infants with IDRA illustrate unique features of their variable clinical courses, as well as continued difficulties with establishing clear guidelines with regard to surgical management of this unusual disorder.

[Influence of Chlamydia pneumoniae and cytomegalovirus infections on prevalence and the course of coronary artery disease]. / Wplyw zakazenia Chlamydia pneumoniae i wirusem cytomegalii na wystepowanie oraz przebieg choroby wiencowej.

Chlamydia pneumoniae (C. pneumoniae) as well as cytomegalovirus (CMV) are common pathogens found in about 50% of healthy western population. Many studies suggest a role of C. pneumoniae in development of coronary artery disease (CAD). CMV infection is also considered to increase risk of developing of CAD as well as restenosis after percutaneous coronary revascularization (PCI). The aim of our study was to evaluate a possible role of C. pneumoniae and CMV infections in both CAD development and course in patients (pts) undergoing PTCA. We enrolled 105 pts (mean age 56.4 years, 83 males) with angiographically documented CAD. Control group consisted of 63 healthy controls (mean age 47.25 years; 31 males). The study subjects were evaluated for presence of C. pneumoniae specific IgG antibodies (MIF test--MRL Diagnostic, USA; seroprevalence assumed when titre > or = 1/8). In 58 random PCI pts CMV specific IgG antibodies (ELISA Eti-Cytok-G PLUS--Dia Sorin) were evaluated. Pts were sampled at the time of PTCA. All PCI pts were assessed by angina questionnaire 5.9 +/- 2.6 months (mo) after the procedure with respect to clinical restenosis. C. pneumoniae IgG antibodies were detected in 37.1% of pts and in 22% of healthy controls (p < 0.05). After logistic regression was applied trend towards more frequent occurrence of C. pneumoniae specific IgG in CAD pts was shown (p = 0.10 OR = 2.4; 95% CI: 0.8-6.8). No significant correlation was found between anti-C. pneumoniae IgG presence or anti-CMV IgG titre and coronary atherosclerosis advancement. There was no significant difference in anti-CMV IgG titre between 9 pts who developed clinical restenosis 5.9 +/- 2.6 mo after PCI and the remaining pts. Our study results suggest a possible significant correlation between C. pneumoniae with CAD prevalence. We did not find a positive association of either infection markers with coronary atherosclerosis advancement. We did not find correlation of clinical restenosis after PCI with markers of CMV infection.

Detection of EBV infection in different etiologic groups of patients.

The ability of two diagnostic tests (ELISA and IF) to detect of EBV infection in etiologically different group of patients was compared: cases of chronic lymphoadenopatis, confirmed mononucleosis or suspected EBV infection, tumors like leukemia or lymphoma. The presence of specific IgM and IgG antibodies for different EBV antigens was studied. The results obtained indicated that as many as 17 out of 32 tested serum samples presented different interpretation of EBV infection in both tests used. High number of discordant results was observed in detection of EA-IgG. The highest number of discordant results was observed in group of patients with tumors, while the lowest in group of cases diagnosed or suspected for EBV infection.

[Temperature sensitive mutant of Herpes simplex virus type 1. I. Pathogenicity and immunogenicity]. / Temperaturowrazliwy mutant wirusa Herpes simplex typu 1. I. Patogennosc i immunogennosc.

The aim of the study was to characterize biological features of the sensitive mutant of HSV-1, derived from McIntyre strain by numerous virus passages at lowered replication temperature (28 degrees C). Pathogenicity of obtained ts mutant for inbred mice lines, CFW/Pzh and BALB/cPzh, was determined. Statistically significant decrease in virulence of the mutant for these mouse lines was demonstrated, as compared with the native virus strain, propagated at 37 degrees C. Immunogenic activity of ts mutant of HSV-1 defined by the possibility of mouse protection against infection with high virulent was determined. Mice, which at the time of immunization with ts mutant received Depo-Medrol--an immunosuppressive agent--were also found to be capable of inducing defense mechanisms to infection with the native strain.

[Temperature sensitive mutant of Herpes simplex virus type 1. II. Neurovirulence and latency]. / Temperaturowrazliwy mutant wirusa Herpes simplex typu 1. II. Neurowirulencja, i latencja.

The course of acute infection of mice with ts mutant or the native strain DNA and the antigens of HSV in brain nerve cells were determined. Virus DNA was detected in brains of all mice in both animal groups while the virus antigens--only in cells of mice infected with the native strain. It can be suggested, therefore, that the ability of ts mutant to replicate in central nervous system of the infected mice is lacking or much lower. The detection of virus nucleic acid 3-5 months after virus infection might indicate a possibility of establishing latent infection. However, ts mutant showed a significantly lower possibility of latency induction, as compared with highly virulent strains. It was found that the mutant ability to induce latent infection was markedly increased when mice were treated with both ts mutant and Depo-Medrol as immunosuppressive agent. This finding shows both a possibility of increase of frequency of latent infections in the state of immunosuppression, and of activation of the latent infection (recurrence of acute form of infection).

Immunogenic activity of HSV-1 temperature sensitive mutant's proteins in mono- and polyvalent systems of immunization.

Immunogenic activity of herpes simplex type 1 temperature sensitive mutant's (ts HSV-1 mutant) proteins was tested in two systems: monovalent and polyvalent with other attenuated virus strains (measles and mumps). The guinea pigs were used as animal model. In monovalent system the humoral response in animals infected with ts HSV-1 mutant (1 or 2 doses) was studied and compared to results received for HSV-1 native strain. In polyvalent system the immunological response induced by ts HSV-1 mutant in the presence of RNA virus strains was tested.

Usefulness of hybridization and PCR methods in monitoring of CMV infection in renal transplant recipients.

The purpose of this work was to compare hybridization and PCR methods as diagnostic tests in diagnosing and monitoring CMV infection. The investigation was performed in a group of 24 renal transplant recipients treated with ATG. The results we obtained suggest that quantitative variant of hybridization is more useful in diagnosing the infection than PCR, because it enables to monitor the infection. DNA CMV level of about 60 pg/ml or the increasing level in the subsequent samples should be a sign to start antiviral therapy.

[Evaluation of the usefulness of various PCR method variations and nucleic acid hybridization for CMV infection in immunosuppressed patients]. / Ocena przydatnosci róznych wariantów metody PCR oraz metody hybrydyzacji kwasów nukleinowych w wykrywaniu zakazenia CMV u pacjentów z immunosupresja.

In diagnosis of CMV infection various laboratory methods are used. The methods based on detection of viral nucleic acids have been introduced routinely in many laboratories. The aim of this study was to compare nucleic acid hybridisation method and various variants of PCR methods with respect to their ability to detect CMV DNA. The studied material comprised 60 blood samples from 19 patients including 13 renal transplant recipients and 6 with acute leukaemia. The samples were subjected to hybridisation (Murex Hybrid Capture System CMV DNA) and PCR carried out in 3 variants: with one pair of primers (single PCR), nested PCR and Digene SHARP System with detection of PCR product using a genetic probe in ELISA system. The sensitivity of the variants ranged from 10(0) particles of viral DNA in nested PCR to 10(2) in single PCR. The producer claimed the sensitivity of the hybridisation test to be 3 x 10(5) and it seems to be sufficient for detection of CMV infection. The obtained results show that sensitivity of hybridisation was comparable to that of single PCR and the possibility of obtaining quantitative results makes it superior, on efficacy of antiviral therapy, especially in monitoring CMV infection in immunossuppressed patients and in following the efficacy of antiviral treatment.

Quantitative detection of CMV DNA by PCR and hybridizaton methods in renal transplant recipients.

The comparison of two quantitative tests: hybridization (Murex Hybrid Capture System) and PCR (COBAS AMPLICOR CMV Monitor) detected CMV DNA was made. Investigation of viral load in serum by PCR gave better correlation with clinical manifestation in renal transplant recipients.

Identification of cytomegalovirus (CMV) infection by different laboratory methods in renal transplant recipients undergoing triple-drug immunosupressive treatment.

Early diagnosis of CMV infection is very important mainly in transplant recipients because CMV infection is a frequent complication after transplantation. In this work we compared different laboratory methods: ELISA (IgG, IgM), Western blot,shell vial, antigenemia assay (pp65), the immunofluorescent method with epithelial cells from urine (IF), DNA in leukocytes by PCR and DNA in leukocytes by hybridization (HCS) to estimate the most proper method for diagnosis of CMV in renal transplant recipients. This preliminary study showed that HCS, PCR and Western blot are sensitive methods for detecting CMV infection. Using HCS in quantitative variant we obtained a very good correlation between DNA load and clinical symptoms.

[Papillomaviruses and herpesviruses as selected risk factors in the etiopathogenesis of cervix neck cancer. I. Use of nucleic acid hybridization for diagnosing HPV infections]. / Wirusy papilloma i herpes oraz wybrane czynniki ryzyka w etiopatogenezie raka szyjki macicy. I. Zastosowanie hybrydyzacji kwasów nukleinowych do wykrywania zakazen HPV.

HPV infections are regarded as the main etiological factor responsible for the presence of cytological abnormalities and the primary risk factor for cervical cancer development. Diagnostic materials were collected between 1995 and 1997 in the Gynecologic Cancer Prevention, Cancer Center Institute of Oncology, Memorial Hospital Maria Sklodowska-Curie, Warsaw. The patients were divided into three groups: group C--women suspected for viral infection during clinical or cytological examination and two comparative groups A and B--women invited for routine cytological examination. Cytological smears for nucleic acid hybridisation collected before cytological smear sampling with a dacron swab (groups A and C) or collected after cytological smear sampling with a cervical brush (group B) were used. Cytological and clinical data was also used in the investigation. In 52% of the 236 samples tested by nucleic acid hybridisation HPV DNA was found to be present. DNA from the high/intermediate HPV risk group was also present in 36% of the samples and in 11% of the samples from the low risk HPV group. In 5% of the samples we confirmed the presence of mixed infections from both HPV risk groups. The results obtained from nucleic acid hybridisation with pap smear results were compared. It was observed that HPV infections from the high risk group occurred more frequently in pap 3 and pap 4 test results; HPV infections from the low risk group occurred more frequently in pap 1 and pap 2 results, while mixed infections from both risk groups occurred particularly in pap 4 and pap 5 results. Women in the 35-45 age groups suffered more frequently from infections from the high/intermediate risk group. In the 25-35 and 55-65 age groups HPV infections from the low risk group occurred more frequently. In the comparative groups only 2.6% of the women were infected with HPV.

[Papillomaviruses and herpesviruses as selected risk factors in the etiopathogenesis of cervix neck cancer. II. Use of PCR for isolating DNA of human papillomavirus and Herpes simplex]. / Wirusy papilloma i herpes oraz wybrane czynniki ryzyka w etiopatogenezie raka szyjki macicy. II. Zastosowanie PCR do wykrywania DNA wirusów brodawczaka czlowieka i Herpes simplex.

The aims of the study were to compare polymerase chain reaction PCR with nucleic acid hybridisation HC in the routine diagnosis of HPV infections. Smears collected for PCR were digested for 24 hours using proteinase K. After DNA extraction 174 samples were tested by PCR with human bglobin primers PG04-GH20. The PCR products were separated in 2% agarose gel electrophoresis stained with ethidium bromide. In 80.6% of the samples 256 base pair DNA fragments were observed in the gel in UV light. These samples were tested by PCR with HPV primers MY09-MY11. In 40% of the samples the presence of HPV DNA was confirmed. Next we carried out PCR using a mixture of two pairs of primers bglobin PG04-GH20 and HPV MY09-MY11. DNA for this study was extracted from 24 samples in which the presence of human DNA was not confirmed in the first PCR test and from 7 untested samples. In 21 cases HPV DNA was found to be present in gel electrophoresis. The presence of HPV DNA was confirmed in 44.75% of the samples.

The long QT syndrome with impaired atrioventricular conduction: a malignant variant in infants.

INTRODUCTION: The long QT syndrome (LQTS) is occasionally complicated by impaired AV conduction, mostly 2:1 AV block. This form of LQTS can manifest before birth or during neonatal life, and it is more sporadic than familial. It is usually an isolated disorder, although it can be accompanied by a variety of cardiovascular and other anomalies. In spite of different treatment modes, mortality is high. METHODS AND RESULTS: The reported case presented not only with 2:1 AV conduction, but also with Wenckebach episodes with impaired right and left bundle branch conduction, and decremental conduction in the His-Purkinje axis. We also observed sinus pauses and accelerated AV junctional escape beats. CONCLUSION: Our findings, and similar observations by others, suggest involvement of the sinus node and the distal conduction system in this form of the LQTS. Several histologic studies have documented abnormalities within the conduction system, including apoptosis. Because of the rare occurrence and poor prognosis of the LQTS with impaired AV conduction, international guidelines for diagnosis and treatment are needed. Development of an internal cardiac defibrillator for this young age group is necessary.

Risks of intravenous amiodarone in neonates.

The courses of two neonates treated with intravenous amiodarone for supraventricular tachyarrhythmia, both of whom developed significant adverse effects, are reported. A 13-day-old term newborn developed hypothyroidism after 27 days of mostly intravenous amiodarone for atrioventricular reciprocating tachycardia and severe heart failure. A one-day-old, 36 weeks' gestation newborn developed electromechanical dissociation after receiving an intravenous bolus of amiodarone for rapid atrial flutter. Judicious use of amiodarone is recommended.

[Tick-borne encephalitis--etiopathogenesis and implications for public health in Poland]. / Kleszczowe zapalenie mózgu--etiopatogeneza i znaczenie dla zdrowia publiczengo w Polsce.

Tick-borne encephalitis (tbe) belongs to infectious units being under study in Poland since over 40 years: clinical, virological, immunological, epidemiological (see eg. fig. 1 of the review) observations succeeded in developing tbe map of Poland, and organization of satisfactory diagnostic virological control of the disease. This article covers most important data since the early (1952-1953) expeditions to the endemic districts of Poland, studies of human beings, animal reservoir, both wild and domestic animals, biological vectors, migrating and local birds, frequency of virus isolations from man, ticks, mosquitos, wild rodents, with special reference to specific (vaccines, immunoglobulins) prophylaxis and associated unexpected and negative reactions. The article points also on north-east districts as of high tbe exposure, on described milk-associated outbreaks. The problems are discussed in relation with analogical and/or probable reactions related with other viral infections. Because of so meritorically differentiated and long-time performed studies and observations, the tbe is still in center of medical and public interest in Poland.