Use of handheld computers for assessment of prefrontal cortex function in patients with phenylketonuria.

Assessment of prefrontal brain cortex function can be helpful in treatment monitoring in patients with phenylketonuria. We aimed to assess the usefulness of computerized neuropsychological tests developed for handheld computers for this purpose. We observed worse test performance among persons with blood phenylalanine concentrations exceeding the recommended range. Use of handheld computers was assessed by patients and by doctors as interesting, not time-consuming and convenient. This method can be helpful during routine follow-up visits.

[Umbilical artery lactate level as a marker of the neonatal clinical condition--preliminary results]. / Stezenie mleczanu w krwi tetnicy pepowinowej jako wskaznik stanu klinicznego noworodka--wyniki wstepne.

The paper presents a trial to assess efficacy of cord artery blood lactate level measurement in assessing clinical condition of the newborn and prognosing occurrence of neonatal complications. Prospective study in 400 newborns revealed occurrence of significantly higher lactate levels in the newborns with perinatal asphyxia, complicated labours, Apgar score below 7 in the 1st minute of life as well as in those with neonatal complications, compared to the healthy controls. Routine testing of cord artery blood lactate level seems to be the high specific test in diagnosing distress in the newborn and prognosing pathology of the neonatal period.

Evidence that supramolecular Congo red is the sole ligation form of this dye for L chain lambda derived amyloid proteins.

The mechanism of Congo red binding to amyloid protein was studied in order to establish which of two structural dye versions present in water solutions--unimolecular and supramolecular--represent its actual ligation form. Immunoglobulin L chain lambda of amyloidogenic nature, expressed by Congo red binding and easy gel formation, was used as the model amyloid protein. Congo red was coassembled with rhodamine B, designed to be a marker of the Congo red micellar organisation in complexation with protein. The particular suitability of rhodamine B for this role results from significant difference in its binding affinity to Congo red and to protein. It associates readily with Congo red, becoming incorporated into its micellar organisation, but as homogenous dye it shows an almost complete inability to bind to protein. In view of these properties, Congo red was used as a vehicle to draw rhodamine B into complexation with protein, at the same time supplying evidence of its supramolecular ligation form. The results show that both soluble amyloid precursor L chain and the derived gel material attach rhodamine B coassembled with Congo red but not the homogenous rhodamine B. Despite its dynamic, supramolecular character, Congo red participates in complexation with amyloid proteins as an integral ligand unit.

[Factors influencing prevalence and clinical course of cytomegalovirus (CMV) infection in kidney transplant patients]. / Czynniki wplywajace na wystepowanie i przebieg kliniczny zakazenia wirusem cytomegalii (CMV) u chorych po przeszczepieniu nerki.

In the paper the authors tried to identify factors influencing prevalence and clinical course of cytomegalovirus (CMV) infection in kidney transplant patients. The study was performed in the group of 100 patients after cadaveric kidney transplant followed up in the Chair and Department of Nephrology, Collegium Medicum, Jagiellonian University in Krakow. CMV infection was demonstrated to occur more frequently and significantly earlier in the patients administered prednisone, cyclosporin A and mycophenolate mofetil, compared to the group treated with standard triple-drug-therapy (prednisone, cyclosporin A, azathioprine) or double-drug-therapy (prednisone, cyclosporin A). Higher serum levels of cyclosporin A did not increase prevalence of the infection but urged its onset. Risk for CMV infection was however higher in the group of patients treated for acute rejection episodes, especially with antilymphocyte preparations. No differences were shown in the immunological matching within HLA-A, -B and -DR antigens between the patients without features of CMV Infection and those treated for its active form. The infection occurred significantly more frequently in the recipients with HLA-A1 antigen than in those with HLA-A9 and -DR7. In patients with delayed transplanted kidney functioning, time of the infection onset and a number of its episodes were similar to the remaining population, however severity of the clinical course positively correlated with the duration of acute tubular necrosis (ATN). CMV infection occurred slightly more frequently in patients requiring transfusions compared to those not administered blood preparations. Among patients with AB blood type, active CMV infection occurred statistically less frequently, whereas in those with other blood types percentage of patients with/without CMV infection were comparable.

[Renal osteodystrophy in dialysis patients as estimated by three-point bone densitometry]. / Osteodystrofia nerkowa u chorych dializowanych w ocenie trzypunktowego pomiaru densytometrycznego.

The aim of a study was to estimate the renal osteodystrophy status using bone densitometry in relation to selected biochemical parameters of calcium-phosphate metabolism. The study population consisted of 123 patients with end-stage renal disease, including 24 patients treated with continuous ambulatory peritoneal dialysis (CAPD), aged between 22 and 73 years (mean 49.9 years), on dialysis program for mean period of 14.9 months and 99 patients on maintenance hemodialysis for mean period of 58.8 months, aged between 19 and 72 years (mean 46.6 years). Densitometric measurements using DEXA technique were performed in three different skeletal points: distal ends of both radial bones, lumbar spinal region and femoral neck. Concomitantly, serum concentrations of total and ionized calcium, phosphates and parathormone as well as alkaline phosphatase serum activity were measured. Among male patients treated with CAPD significantly higher BMD values in right forearm were found as compared to women treated with this method (0.769 vs. 0.616; p < 0.001). Higher values of BMD were also found in both forearms in whole CAPD population as compared to those on hemodialysis. However, there was no difference in densitometry results between CAPD and HD patients as well as between men and women within these groups, when measured in femoral neck and lumbar spinal region. Among hemodialysis patients higher levels of phosphates and PTH were found as compared to CAPD, doses of drugs used for treatment of osteodystrophy--calcium carbonate, aluminum hydroxide and active vitamin D were also higher in individuals on HD. In addition, in CAPD patients statistically significant, positive correlations were found between BMD value in lumbar spinal area as well as in femoral neck and amount of ingested calcium carbonate, between BMD in lumbar spinal area and aluminum hydroxide dose taken by patients and between BMD in both forearms and dose of active vitamin D. We failed to demonstrate any relationship between obtained densitometric results as well as biochemical markers of calcium-phosphate metabolism and quantitative parameters of dialysis adequacy in both treatment modes. Obtained results let us to conclude that renal osteodystrophy is less advanced in patients treated with peritoneal dialysis, however this may be related only to markedly shorter renal replacement therapy period in this group. Lack of significant abnormalities in densitometry measurements taken in lumbar spinal area and femoral neck, while they are present in forearms, may suggest that the latter point of skeleton may be most useful for identification of bone mass deficiency in dialyzed patients.

[The impact of changes in levels of calcium, phosphate and magnesium during hemodialysis on autonomic system reactivity as measured by heart rate variability analysis]. / Wplyw zmian stezenia wapnia, fosforanów i magnezu podczas hemodializy na reaktywnosc autonomicznego ukladu nerwowego mierzona parametrem HRV.

The aim of the study was to analyze the response of autonomic nervous system to dialysis related systemic volume reduction using heart rate variability (HRV) analysis. The possible relationship between changes in serum levels of calcium-phosphate balance parameters and HRV measurements results was also analyzed. The study was performed in 32 patients (20 men, 12 women) aged between 27 and 71 years (mean 44 years) treated with maintenance dialysis due to end-stage renal disease from 3 months to 15 years (mean 4.4 years). All parameters mentioned above were analyzed during 4-hour dialysis session. Mean value of LF/HF ratio at the beginning of the procedure was 5.36, with continuous increase in consecutive measurements performed 30-minute intervals to the maximal value 8.2 in 120th minute of HD session (p < 0.05). In the next measurements continuous decrease in the mentioned parameter was noticed, to the mean value 6.99 in minute 240. The values of LF/HF ratio were also lower for the whole HD session in the group of patients with initial predialytic concentration of calcium lower than 2.35 mmol/l as compared to those with initial calcium concentration higher than 2.35 mmol/l. Higher values of LF/HF ratio and bigger oscillation amplitude of this parameter were also noted in those patients, in whom the percentage reduction of magnesium level during dialysis exceeded 20%. In addition, statistically significant relationship between percentage reduction in magnesium ion concentration and LF/HF ratio during HD was found. Obtained results let us to conclude, that hemodialysis leads to important change in the activity of both components of autonomic nervous system. The factors which may adversely influence the quality of this response may be, among others, low total calcium ion concentration as well as low percentage reduction in magnesium level during hemodialysis session.

Cytomegalovirus infection in kidney transplant patients: clinical manifestations and diagnosis.

Cytomegalovirus (CMV) infection is an important cause of morbidity and mortality after solid organ transplantation. CMV infection after kidney transplantation was confirmed in 19 (54.3%) out of 35 patients. 16 of these (84.2%) developed CMV disease. CMV infection was diagnosed based on a fourfold or greater increase of anti-CMV IgG antibody titre, detection of CMV-IgM antibodies and/or virus isolation. Primary infection was observed in 3 patients, reactivation in 9 and an undefined type of infection in 7. In most patients (63%), infection was diagnosed in the first 2 months, and in 3 patients, after 3, 5 and 9 years following kidney transplantation. The most frequent symptoms of CMV disease were fever (58%), pneumonitis (26.3%) and enterocolitis (15.8%). In 53% of the patients, CMV infection co-occurred with other pathogens such as Candida albicans. Cryptococcus neoformans, bacteria or viruses (HBV, HCV, HSV). Treatment with polyvalent globulin (Sandoglobin) or hyperimmune globulin (Cytotect), in combination with ganciclovir in 7 patients, resulted in a regression of CMV disease.

Ethylene glycol acute poisoning treatment results in Kraków in the years 1990-1994.

An analysis of ethylene glycol acute intoxication treatment results was performed in a group of 36 patients hospitalized within a five year period. Mean serum and urine glycol concentrations in the analyzed population ranged from 0-851 mg/dl (mean = 130 mg/dl) and from 12.4 to 930.0 mg/dl (mean 333 mg/dl), respectively. At the time of admission to the clinic 15 of 36 patients were deeply unconscious and mean acid-base balance values were as follows: pH 6.99, pCO2 16.7 mmHg, pO2 140.1 mmHg, HCO3 6.36 mmol/l, BE -29.6 mmol/l. Because of respiratory failure 21/36 patients (58.3%) required controlled ventilation and 24/36 (66.7%) underwent dialysis. Sixteen patients (44.4%) developed acute renal failure. Mean hospitalization period was 16 days (1-53). Eighteen patients (50%) died. The direct death mechanism in 15 patients (83.3%) was asystolia and in the remaining individuals other circulatory disturbances. The main reasons of high mortality rate were multiple organ damages secondary to severe metabolic acidosis.