[The ankle brachial index in type 2 diabetes]. / Kotníko-pazni index u nemocných s diabetes mellitus 2. typu.

INTRODUCTION: The ankle brachial index (ABI), i.e. the ratio of systolic blood pressure (SBP) on the ankle and on the arm, is diagnostic for peripheral occlusive artery disease and a marker of cardiovascular (CV) risk. The association between the low ABI < 0.9 and the CV risk in type 2 diabetes (T2DM) subjects was investigated. METHODS: We examined 253 T2DM subjects (135 males, 118 females, aged 66 +/- 9 years). The blood pressures were measured in the supine position with the 2 mm Hg accuracy; Doppler ultrasound was used for the ankle SBP and the mercury sphygnomanometer for the arm SBP. The high CV risk was defined as manifest CV diseases, elevated coronary calcium score (CAC) by Agatston (> 101) or according to the global CV Risk Score > or = 5% (SCORE). STATISTICAL METHOD: Wilcoxon's unpaired test, chi2 test, multiple logistic regression. RESULTS: The ABI < 0.9 was found unilateral in 23 T2DM (8%), bilateral in 24 (9%), in older males (71 +/- 8 years) with higher CAC (600 +/- 707) (p < 0.01), higher total cholesterol (5.4 +/- 1.3 mmol/L) and total homocystein (17.2 +/- 7.1 micromol/L) (p <0.05) in comparison to those with the ABI > or = 0.9 (age 66 +/- 9 years, CAC 234 +/- 458, total cholesterol 5.0 +/- 0.9, total homocystein 14.3 +/- 78). Many CV risk factors correlated positively with the low ABI < 0.9; it was significantly independently associated with age (p < 0.001), smoking (p < 0.01), LDL-cholesterol, total homocystein and CAC (p < 0.05). Low ABI < 0.9 predicted ischemic stroke in subjects with T2DM and manifest CV diseases in the further 3 years. There was no correlation between the ABI and the ultrasensitive C-reactive protein. CONCLUSION: Low ABI < 0.9 was in a strong association with the CV risk. The ABI measurement is a simple, noninvasive, time-nonconsuming and inexpensive method for subclinical atherosclerosis detection; the ABI can supply standard methods for the CV risk prediction.

[Monitoring of cardiovascular risk factors in patients with diabetes type 2]. / Kontrola kardiovaskulárních rizikových faktoru u diabetiku 2. typu.

The control of basic cardiovascular risk factors was examined in a sample of 415 diabetes type 2 patients, aged 66 +/- 10 years, with a 9.4 +/- 8 years long history of diabetes, both genders represented proportionally; 95% of the sample were hypertensive. The recommended blood pressure value was achieved by 13% males and 17% females. Antihypertensive monotherapy was indicated in 40% of the sample. Renin-angiotensin-aldosteron system inhibitors were prescibed to 90% of the sample. The fasting glycaemia < or = 6 mmol/L were achieved in 10% males and 11% females; glycosilated hemoglobin < 4.5% in 20% males and 24% females; 60% of the sample had antidiabetic pharmacotherapy--44% males and 48% females used metformin. Total fasting plasma cholesterol < 4.5 mmol/L was achieved in 31% males and 23% females; LDL-cholesterol < 2.5 mmol/L was achieved in 31% males and 41% females. The target values for diabetics in secondary prevention of cardiovascular diseases or with subclinical atherosclerosis was achieved in 13% of the sample. Statins were prescribed in 60% of the sample, fibrates in 4%. Only 2 females achieved all the target values. Hypolipidemic and antihypertensive drug therapy is unsatisfactory; there is certainly a big potential in life style changes among the diabetic patients.

Negative association between plasma levels of adiponectin and polychlorinated biphenyl 153 in obese women under non-energy-restrictive regime.

The aim of this study was to reveal whether accumulation of the persistent organic pollutants (POPs), especially polychlorinated biphenyl (2,2',4,4',5,5'-hexachlorobiphenyl, PCB 153), affects plasma levels of adiponectin in obese patients. The study was designed as a longitudinal intervention trial with a control group, where 27 obese women (body mass index (BMI)>30 kg/m(2); age 21-74 years) were studied before (OB) and after (OB-LCD) a 3-month low-calorie-diet intervention (LCD; 5 MJ daily). As the control group, 9 female volunteers without LCD intervention were used (C; BMI=19-25 kg/m(2); age 21-64 years). Plasma levels of PCB 153 were measured by high-resolution gas chromatography with electron capture detection; total adiponectin and insulin plasma levels were quantified by immunoassays; and adiponectin multimeric complexes were quantified by immunoblotting. Plasma levels of total adiponectin, high and medium molecular weight multimers significantly negatively correlated with plasma levels of PCB 153 in OB, but not in C or in OB-LCD, whereas the LCD intervention lowered BMI by 3.3+/-3.0 kg/m(2). Our results may suggest suppression of adiponectin by PCB 153 in obese women under non-energy-restrictive regime, which may contribute to the known association of PCB 153 and other POPs with type 2 diabetes.

[Macrovascular and microvascular complications in type 2 diabetes patients]. / Makrovaskulární a mikrovaskulární komplikace u diabetiku 2. typu.

The prevalence of chronic vascular complications is higher in patients with type 2 diabetes mellitus (DM2). The objective of our cross-sectional study was to assess the incidence and types of macrovascular (MVC) and microvascular (mvc) complications and to analyse their relation to the different risk factors and biomarkers in order to improve their prevention. SET OF PATIENTS AND METHODOLOGY: 415 patients (219 men and 196 women) with an average age of 66 +/- 9 years enrolled in the study. A total of 95% of patients with DM2 had a history of hypertension, 27% had MVC (of which 55% had ischaemic heart disease), and 54% had mvc (ofwhich 95% had diabetic nephropathy). RESULTS: The patients with vascular complications were significantly older and had a longer history of DM2; they did not differ for their systolic blood pressure, but had a higher pulse pressure and took more antihypertensives. They did not differ for their lipid levels or the respective therapy. Diabetic patients with MVC and mvc had higher insulin resistance, higher plasmatic levels of total homocysteine and a higher incidence ofalbuminuria or proteinuria. The factors which significantly and independently associated with MVC were male gender, age over 60 years, higher hs-C-reactive protein (hs-CRP) exceeding 1 mg/l, glycaemia over 5.6 mmol/l, lower diastolic blood pressure and lower HDL-cholesterol; mvc associated with higher age over 60 years, a history of DM2 exceeding 8 years, and hs-CRP above 1 mg/l. CONCLUSION: Our results show that patients with DM2 have a high incidence ofvascular complications significantly associated with age, DM2 history and higher hs-CRP, irrespective of the other monitored parametres.

[Treatment of hypertension in diabetics with trandolapril, an angiotensin converting enzyme inhibitor--a multicenter study]. / Lécba hypertenze u diabetiku inhibitorem angiotenzin konvertujícího enzymu trandolaprilem--multicentrická studie.

Subjects with diabetes mellitus (DM) are high-risk patients because of the cardiovascular morbidity and mortality. A one-year open clinical prospective study took place in 7 centres in the Czech and Slovak Republic in 1996-1997. Aim of the study was treatment of hypertension in patients with DM of both types by the ACE inhibitor trandolapril in dose of 2-4 mg, possibly in combination with the calcium channel blocker verapamil--240 mg. The investigation was completed by 79 patients (60 patients with DM type 2 and 19 with DM type 1). All patients achieved the target blood pressure which in 1997 was also for patients with DM less than 140/90 mm Hg. As good as 20% of the patients achieved these values when treated with 2 mg trandolapril, 52% on a dose of 4 mg and 23% after combined treatment. Only 25% of the patients achieved values lower than 130/85 mm Hg, as recommended in the contemporary recommendations "Prevention of ischaemic heart disease in adult age" published in 1998. On comparison of other risk factors in groups of patients with a BP below 130/85 mm Hg and higher than this borderlimit line it was revealed that one-year treatment of hypertension with trandolapril--4 mg alone or combined with verapamil 240 mg led to a greater reduction of the pulse rate, fasting insulin level, hematicrit and triglycerides and to an increase of HDL-cholesterol. This study revealed that systematic treatment of hypertension by the above mentioned drugs in patients with DM is effective and well tolerated. In addition to reduction of the blood pressure the activity of the sympathetic nervous system was reduced and some metabolic parameters improved.

[Effect of a dialysis solution with icodextrin on ultrafiltration and selected metabolic parameters in patients treated with peritoneal dialysis]. / Vliv podání dialyzacního roztoku s icodextrinem na ultrafiltraci a vybrané metabolické parametry nemocných lécených peritoneální dialýzou.

BACKGROUND: To date, peritoneal dialysis has been performed almost exclusively using dialysis solutions containing glucose as the osmotic agent. Use of these solutions is fraught with problems regarding adequate fluid removal from the body and is also associated with undesirable metabolic effects; hence the search for alternative osmotic agents. A dialysis solution with the glucose polymer icodextrin generates ultrafiltration on the principle of colloidal osmosis. The aim of the study was to establish the effect of icodextrin-base dialysis solution on the magnitude of ultrafiltration and evaluate selected metabolic parameters of patients treated by ambulatory peritoneal dialysis. METHODS AND RESULTS: A total of 9 patients whose glucose-based solution was replaced by an icodextrin-based solution during the night-time exchange were evaluated. A control group of 9 patients used glucose-solution during all exchanges. Night-time bag ultrafiltration, blood pressure, and the serum levels of lipids, insulin, leptin, maltose, and amylase were determined before icodextrin administration (time 0), at one-month intervals (time 1, 2, 3), and one month after study completion (time 4). In icodextrin-treated patients, ultrafiltration rose from 246.5 +/- 60.5 ml (mean +/- SEM) at time 0 to 593.1 +/- 87.4 ml; p < 0.01, at time 1, to 547 +/- 67 ml; p < 0.05, at time 2, and to 586.7 +/- 58.8 ml; p < 0.01, at time 3, the icodextrin administration led to a rise in maltose from 0.02 +/- 0.01 g/l at time 0 to 0.1 +/- 0.1 g/l; p < 0.01, at time 1, to 1.0 +/- 0.09 g/l; p < 0.01, at time 2, and to 1.1 +/- 0.09 g/l; p < 0.01, at time 3, with a fall to zero values at time 4 (NS). Icodextrin administration was followed by a decrease in leptinemia from 34.6 +/- 17.2 ng/ml at time 0 to 21.7 +/- 8.9 ng/ml; p < 0.05, at time 1, to 21.4 +/- 9.5 ng/ml; p < 0.05, at time 2, and to 15.9 +/- 24.1 ng/ml; p < 0.05 at time 4. Insulin and lipid levels were not affected. There was no change in the above parameters in the control group. Icodextrin-treated patients reduced their antihypertensive medication, but not statistically significantly. CONCLUSION: Icodextrin administration significantly increase ultrafiltration thus providing for effective control of hydration status without the need for high-level glucose-based dialysis solutions. The use of a glucose polymer-based dialysis solution is associated with a significant yet reversible rise in serum maltose. The decrease in leptin may signal a reduction in body weight after replacing glucose in dialysis solutions with icodextrin, or enhanced rates of leptin elimination as a result of ultrafiltration-induced convective transport.

[Effectiveness and tolerance of fosinopril in the treatment of arterial hypertension of mild and medium severity]. / Ucinnost a snásenlivost fosinoprilu v lécbe mírné a stredne tezké arteriální hypertenze (multicentrická prospektivní otevrená klinická studie).

BACKGROUND: The standard of hypertension control in the population is not satisfactory, only 20% patients with hypertension achieve target values of blood pressure (BP). Extensive prospective studies revealed that diuretics, beta-blockers as well as the majority of calcium channel blockers and ACE inhibitors can significantly reduce the incidence of complications of hypertension and are therefore considered drugs of first choice in the treatment of hypertension. The additive effects of ACE inhibitors are manifested in particular after larger doses. OBJECTIVE OF TRIAL: To assess the effectiveness and tolerance of the modern long-acting ACE inhibitor--fosinopril--in the treatment of mild and medium severe hypertension and its effect on some anthropometric and laboratory parameters. RESULTS: Fosinopril as monotherapy in amounts of 10, 20 and 40 mg led to normalization of BP in 85% of the group (n = 203) and was very well tolerated. Only 11% of the group needed a combination with hydrochlorothiazide--12.5 g/day--after which normal BP levels were attained. Only 4% of the patients did not complete the study on account of undesirable effects, incl. 3 patients where cough was the reason for discontinuation. After 12 weeks treatment the systolic BP was reduced on average by 31 mm Hg and the diastolic BP by 16 mm Hg. The heart rate (HR) declined on average by 3 beats/min. (p 0.001). After four weeks treatment a significant decline of the blood sugar level occurred which was even more marked after 12 weeks of treatment (on average by 0.27 mmol/l and at the same time a significant drop of sodium occurred (by 2 mmol/l), of total and LDL-cholesterol (by 0.26 and 0.23 mmol/l). An expected increase of the potassium level occurred (by 0.1 mmol/l) and creatinine (by 3.4 mumol/l in plasma). CONCLUSION: Fosinopril treatment with 10-40 mg/day was effective in monotherapy of hypertension in 85% patients and was well tolerated. After 12 weeks treatment a significant decline of the BP, HR occurred as well as the expected decline of the plasma Na/K ratio and improvement of some metabolic parameters.

The anemia in continuous ambulatory peritoneal dialysis patients is related to Kt/V index.

Anemia in chronic renal failure causes a number of serious problems to the patient. As a result, it is imperative to make use of all rational options to alleviate it. The present study addresses the question, the answer to which is not yet known, whether or not the degree of anemia depends on the efficacy of continuous ambulatory peritoneal dialysis (CAPD) and, if so, what the importance of peritoneal clearance and residual renal function is. A significant correlation between the hematocrit (Hct) and the total weekly Kt/V index (tKt/V) (r = 0.61, p<0.01), total weekly creatinine clearance (tCLCR) (r = 0.50, p<0.05), and residual glomerular filtration rate (r = 0.43, p<0.05) was demonstrated in a group of 22 CAPD patients. Stepwise regression analysis showed that of all the variables monitored, Hct depends exclusively on tKt/V (p<0.01, r2 = 0.37). The value of Hct in a group of patients with a tKt/V <2.3 (n = 15) was 28.9+/-1.2% (arithmetic mean +/- SEM) while in a group with a tKt/V > or =2.3 (n = 7), it was 35.1+/-1.9% (p<0.01). On dividing tKt/V and tCLCR into their peritoneal and renal components, a significant correlation between Hct and renal Kt/V (r = 0.47, p<0.05) was found; stepwise regression analysis identified renal Kt/V (p<0.01) and peritoneal Kt/V (p<0.05), with R2 = 0.38 as major variables with an effect on Hct. The authors conclude the efficacy of blood purification is another factor affecting renal anemia in CAPD patients. The relationship between anemia and blood purification is best expressed using the Kt/V index. The Kt/V provided by one's own kidneys seems to be of greater importance for anemia than the Kt/V provided by peritoneal dialysis. The results provide the basis for prospective interventional studies.

[Analysis of mortality trends in the West Bohemian Region in comparison with the entire Czech Republic 1988-1995]. / Analýza trendu mortality v západoceském regionu v letech 1988-1995 ve srovnání s celou Ceskou republikou.

BACKGROUND: Unfavourable trends in Czech republic (CR) started in the sixties and peaked in the late eighties i.e. in years when a dramatic mortality fall was observed in most western european countries. So, CR belonged among those Eastern European countries in that total and cardiovascular mortality showed increasing and alarming trends. West Bohemia Region (WB) was characterised by the concentration of heavy industry and high environmental pollution. Because of its geographical position on the western frontier, it was generally restricted in capital investment in the past. We wondered whether these phenomenon were reflected in higher mortality rates than in the rest of CR and which changes occurred after the year 1989. METHODS AND RESULTS: We compared the age standardized mortality data from 1988, 91, 93 and 95 in CR and WB for total mortality, cardiovascular mortality, coronary heart disease, strokes, malignancies and respiratory diseases. Data were age-adjusted for "World Population Standards" and rates were given for 100,000 inhabitants. In the whole CR a significant decrease of total, cardiovascular and cancer mortality was observed from 1988 to 1995. In WB these trends were similar, however in comparison to the whole CR the mortality rates remained in each respective period higher for total, cancer (mainly lung cancer) mortality and for non specific respiratory disease. In contrast, the coronary mortality rates in CR and WB were similar, however in WB after a temporary decrease in 1993 a significant increase in 1995 was observed. On the other hand the stroke mortality rates which were until 1993 in WB higher, significantly decreased in 1995 below the rates for CR. The cause of higher mortality rates in WB are far from being clear. To elucidate this observation epidemiologic studies of environmental pollution, life style of the population and socioeconomic factors are necessary, even as a further monitoring of regional mortality rates and trends.

[Detection of risk of insulin resistance in the population]. / Detekce rizika inzulinové rezistence v populaci.

BACKGROUND: To assess the validity of hyperinsulinemia as a marker of insulin resistance (IR) and to find other common risk factors (RF) associated with IR. METHODS AND RESULTS: Sample of 91 healthy volunteers with normal glucose tolerance (NGT) was selected from the adult Pilsen population. Following examinations according to the standard protocol were done: medical history, physical examination, body mass index-BMI (kg/m2), waist to hip ratio (WHR), casual blood pressure (BP), plasma lipids, 7-point oral glucose tolerance test (oGTT), IRI (immunoreactive insulin) curve, insulin suppression test (IST) for the evaluation of IR. Specificity and sensitivity of IRI levels as markers of IR were tested. Association between IR measured by IST and fasting and postload IRI was evaluated by single correlation. Multiple logistic regression (MLR) was applied for the calculation of IR prediction. Fasting and postload hyperinsulinemia (mU/l) have very good specificity (about 90%) for the discovery of IR, but sensitivity was different: fasting IRI > 20 = 19%, IRI in the 2nd h of oGTT > 90 = 30%, IRI sum (fasting IRI + IRI in the 1st and 2nd h of oGTT) > 150 = 51%. Simple correlation between IRI and IR was better in IRI sum (0.56 p < 0.001) than fasting IRI (0.28, p < 0.05). Using MLR HDL-ch, TG and IRI sum were selected as the significant and independent factors for the prediction of IR in the subjects from the population (prediction accuracy about 68%). CONCLUSIONS: Fasting IRI is not too good marker for IR assessment in the NGT subjects from the Pilsen population. IRI sum was the best marker for IR and together with HDL-ch and TG level were selected as the significant predictive factors for IR.

A clinical study to assess the effect of heparin in dialyzer rinsing solutions.

The solution usually recommended for rinsing the blood side, which is an indispensable step in preparing a dialyzer for hemodialysis (HD), contains saline and heparin. The heparin used for rinsing is said to reduce the thrombogenic properties of the dialysis membrane and, hence, also the need for systemic heparinization during the whole procedure. The aim of our study was to establish whether this postulate also applies to polysulphone steam-sterilized dialyzers. To do so, 16 patients on long-term dialysis were randomized into two groups of eight. One group was subsequently treated with polysulphone low-flux dialyzers (F6HPS), the other with polysulphone high-flux dialyzers (F6OS). Both groups were examined, in a crossover manner during HD using a dialyzer previously rinsed with 1000 ml of saline plus 2,000 IU of heparin, and during HD using a dialyzer previously rinsed with 500 ml of saline without heparin. Except for the rinsing, HD conditions were completely identical. Blood obtained before HD, and at 15, 60 and 240 min of HD at the dialyzer inlet, was used to determine the activated partial thromboplastin time (to test heparinization control), the thrombin-antithrombin III complex (ELISA, to evaluate coagulation system activation), platelet factor 4 (ELISA, a substance with antiheparin activity), and platelet count. None of the above parameters showed, at any of the collecting intervals, a statistically significant difference between HD with and without heparin with a reduced volume of rinsing solution, or between HD using low- and high-flux dialyzers. It is concluded that heparin used to rinse polysulphone dialyzers before HD has no effect on blood coagulation or on the need for heparin during the procedure.

[The effect of acetate-free biofiltration on anemia and use of erythropoietin]. / Vliv bezacetátové biofiltrace na anémii a spotrebu erytropoetinu.

BACKGROUND: Chronic renal failure is associated with anaemia and a large percentage of patients is indicated for erythropoietin (rHuEPO) treatment. The degree of anaemia depends also on the quality of substitution of renal function. The objective of the present study was to assess whether transfer of patients from haemodialysis (HD) to acetate-free biofiltration (AFB) will influence the anaemia and rHuEPO consumption. METHODS AND RESULTS: Anaemia and rHuEPO consumption were investigated in 10 patients in a stabilized condition with regular dialyzation treatment. The patients suffered from corrected anaemia on a maintenance dose of rHuEPO. During AFB (follow-up period one year) the rHuEPO consumption declined as compared with the condition during HD, while the target haemoglobin level (95-110 g/l) was maintained. The easier control of anaemia during AFB was not due to a change of iron saturation, the aluminium level or a change of the residual blood volume in the dialyzer. During AFB metabolic acidosis was controlled more effectively, the elimination of urea and beta-2-microglobulin increased. CONCLUSIONS: During AFB, as compared with HD, the rHuEPO consumption declines sufficiently to correct anaemia. The authors conclude that one of the reasons may be the more effective control of metabolic acidosis and elimination of uraemic toxins with a low or medium molecular weight. The authors discuss also other factors which affect anaemia during treatment of renal failure by extracorporcal clearing methods.

[Compartment syndrome]. / Compartment syndrom.

Compartment syndrome most commonly occurs following revascularization of an acutely ischemic extremity. It is not only a danger for patient's extremity but also for his or her life if it is not detected and treated in time. The authors present 37 patients treated during 10-years period at the Department of Surgery, University Hospital in Pilsen for compartment syndrome after acute extremity ischemia due to arterial occlusion or trauma. Twenty-five (67.6%) patients healed without complication. Amputation and mortality rate was 16.2%. The main cause of patient's death was reperfusion injury. The length of ischemia and time of fasciotomy were statistically significant factors for the result of treatment. The authors emphasize the significance of early diagnosis and treatment of compartment syndrome.

[Effectiveness of conservative and surgical treatment of lumboischiadic syndrome]. / Efektivita konzervativní a operacní lécby lumboischiadického syndromu.

BACKGROUND: Hitherto performed retrospective studies of conservative and surgical treatment of compressive radicular lumboischiadic syndrome did not provide a clear answer to the question which procedure cures the disease more effectively. The reason is that severe types of the disease treated by surgery were compared with therapeutic results of milder forms treated conservatively. The authors compared therefore the effectiveness of both therapeutic procedures in a prospective study with a random selection of patients as regards the therapeutic procedure. METHODS AND RESULTS: In two groups--first group comprising 100 patients with the global syndrome and second group comprising 64 patients with the pure syndrome--the authors enlisted the patients by random selection for conservative or surgical treatment. Early results were assessed three months after treatment. Satisfactory results (cure) were achieved in 50% of the operated patients with the global syndrome, compared with 23.81% treated conservatively (p < 0.01), and improvement was recorded in 77.77% operated patients as compared with 58.69% conservatively treated patients (p < 0.05). In the group with the pure syndrome satisfactory results were achieved in 68.75% operated patients as compared with 21.87% conservatively treated patients (p < 0.001) and improvement in 81.25% patients as compared with 53.12% conservatively treated patients (p < 0.01). CONCLUSIONS: The investigation proved a statistically significantly greater effectiveness of the surgical method of treatment of compressive radicular lumboischiadic syndrome as compared with conservative treatment. The second finding was that both methods have a relatively low effectiveness as regards, complete recovery. It is necessary to seek methods to increase the effectiveness of both therapeutic procedures, in particular clearly more effective surgical treatment.

Hemocompatibility in hemodialysis and erythropoietin therapy.

Two studies designed to investigate the effect of recombinant human erythropoietin (rHuEPO) treatment of anemia in chronic dialysis patients on hemocompatibility were conducted. Study 1, whose main aim was to establish whether treatment with rHuEPO enhances coagulation activation during dialysis, included 15 patients before rHuEPO therapy at a mean hematocrit (HCT) of 22.3% and then during therapy at a HCT of 29.3%. The plasma concentrations of the thrombin-antithrombin III complex were not higher during rHuEPO therapy than before it when performing hemodialysis with a Cuprophan membrane. No significant difference was demonstrated either in the values of activated clotting times (Hemochron), thrombocyte or white blood cell counts (Coulter S+II), or in plasma C5a concentrations (ELISA) established during dialysis sessions before and during rHuEPO therapy. In Study 2, which focused primarily on the question of whether or not rHuEPO therapy increases thrombocyte activation during hemodialysis, 8 patients on chronic dialysis were examined both before therapy at a mean HCT value of 22.1% and during rHuEPO therapy at a HCT of 31.5%, invariably during dialysis with either a Cuprophan or polyacrylonitrile (AN69HF) membrane. The plasma concentrations of beta-thromboglobulin (ELISA) did not differ between the examinations made during rHuEPO and before rHuEPO therapy; however, statistically significant differences were found between dialysis sessions involving Cuprophan and AN69HF membranes. No significant difference between examination before and during rHuEPO was demonstrated in activated clotting time nor thrombocyte and white blood cell counts in this study either. The authors conclude that rHuEPO therapy does not enhance coagulation activation during hemodialysis, does not have an effect on thrombocyte activation, and does not influence complement activation and changes in white blood cell counts.

[Continuous ambulatory peritoneal dialysis--an effective method of treatment in chronic renal failure]. / Kontinuální ambulantní peritoneální dialýza--úcinná metoda lécení chronického selhání ledvin.

The authors evaluate the results of treatment of continuous ambulatory peritoneal dialysis (CAPD) in seven patient with chronic renal failure during a 12-month period. The baseline examination was made one month before CAPD was started, one day before insertion of a Tenckhoff catheter and then after 1, 3, 6 and 12 months of treatment. The highest assessed mean serum urea concentrations during treatment were 19.8 +/- 2.3 mmol/l (arithmetic mean +/- SE of the mean), creatinine 815.1 +/- 43.1 mmol/l. The haematocrit improved significantly due to CAPD. From the mean value of 22.5 +/- 1.7% recorded one month before treatment it increased to 32.8 +/- 2.5% after 12 months of therapy. In five patients CAPD made it possible to discontinue and in two to reduce antihypertensive medication. During the investigation period the authors did not detect a drop of total protein and albumin in serum. Serum cholesterol increased significantly during treatment. Peritonitis was recorded four times during the total period of 70 months of treatment, i.e. on average one episode during 17.5 months of treatment. Based on their results the authors conclude that CAPD is at present one of the very effective methods of treatment of chronic renal failure. The incidence of peritonitis was already during the first year when treatment was initiated comparable with the results in departments where it is commonly used and after further experience it declined to one episode per 38.8 months of treatment. The method deserves wider application than hitherto.

Impact of cardiovascular risk factors on morbidity and mortality in Czech middle-aged men: Pilsen Longitudinal Study.

The impact of biological and life-style characteristics measured during baseline examination on 12-year morbidity and mortality of coronary heart disease (CHD), stroke (STR), and malignancies was investigated in an urban population of 3,540 middle-aged men initially free of clinical disease. The following factors enhanced significantly (at the 5% level) the adjusted relative risk ratios: for total mortality age, smoking, and elevated systolic blood pressure; for CHD age, smoking, elevated systolic blood pressure, serum cholesterol levels, and body mass index, and family history (father or mother). Myocardial infarction was positively associated with age, smoking and elevated serum cholesterol levels. For STR age and elevation of both systolic and diastolic blood pressure were risk factors. The relative risk for all malignancies was enhanced by age and smoking. Regular alcohol consumption was associated with a significantly lower risk for all CHD; however, with only marginal significance for myocardial infarction. Higher education was associated with a significantly lower risk of total mortality, all CHD, and myocardial infarction and a marginally lower risk of STR. A high leisure physical activity was negatively (but not significantly) associated with the risk of all end points.

[Carcinoma of the lung in patients with pneumoconiosis]. / Karcinom plic u nemocných s pneumokoniózou.

From 614 patients with notified pneumoconiosis who died in 1964-1992 on necropsy carcinoma of the lungs was found in 87, i.e. 14.1% (in 48 it was the cause of death). The incidence in individual years did not differ significantly; on evaluation in relation to the diagnosis of pneumoconiosis an insignificantly more frequent incidence was found in complicated pneumoconiosis of miners. On evaluation by work places miners in black coal mines and workers in quarries were affected more frequently, the difference being at the borderline of statistical significance. As to the histological aspect, most frequently squamous cell carcinoma was involved, the site was most frequently in both upper lobes. The carcinoma was seven times associated with silicotic lesions, with anthracofibrotic lesions six times (a total of 14.9%). In lifetime carcinoma was detected in 55 of the patients who died, i.e. in 63.2%. As to aetiopathogenetic influences, the relationship with smoking is significant. The aetiopathogenesis of carcinoma of the lungs in patients with pneumoconiosis is most probably not uniform-the influence of smoking is beyond doubt, the carcinogenic effect of silica should be considered in patients with carcinoma in the scar. With regard to the repeatedly proved more frequent incidence of carcinoma of the lungs in patients with pneumoconiosis, frequent check-ups of patients with pneumoconiosis focused on possible detection of lung cancer are essential.

[Clinical study of biocompatibility of dialysis membranes made from non-modified and modified cellulose]. / Klinická studie biokompatibility dialyzacních membrán z nesubstituované a substituované celulózy.

Basic biocompatibility parameters of dialysis membranes made of non-substituted regenerated cellulose (NRC) and cellulose membranes with hydroxyl groups substituted, to a higher (H) or lower (L) degree, by dl-ethyl-amino-ethyl groups (DEAE), or by acetate (CA) were investigated in a 16-week clinical study, involving 10 long-term haemodialysis patients. In the 15th minute of dialysis, the decrease in blood leukocyte count, while using NRC (0.24 +/- 0.03 of baseline value, arithmetic mean +/- SEM) was deeper compared with that seen in DEAE-L (0.88 +/- 0.10, p < 0.001), in DEAE-H (0.79 +/- 0.10, p < 0.01), and in CA (0.73 +/- 0.05. p < 0.05). In the 15th minute of the procedure, C5a concentrations, reflecting complement activation, were higher in NRC (4.4 +/- 0.51 micrograms/L) than in DEAE-L (1.41 +/- 0.22, p < 0.001), in DEAE-H (1.68 +/- 0.47, p < 0.01), and in CA (1.68 +/- 0.22, p < 0.01). Activated clotting times were, in the 10th minute of the procedure, significantly longer in NRC (2.94 +/- 0.37 of baseline value) than in DEAE-H (1.74 +/- 0.10, p < 0.05) and, by the end of dialysis, the difference between these membranes (NRC: 1.47 +/- 0.21, DEAE-H: 0.85 +/- 0.08, p = 0.07) was close to the level of statistical significance. The authors conclude: 1. Substitution of the hydroxyl groups of regenerated cellulose reduces the decrease in leukocyte count and complement activation in the initial phase of haemodialysis. 2. At the same time, substitution by DEAE groups may raise thrombogenicity, as indicated by the shorter activated clotting times.(ABSTRACT TRUNCATED AT 250 WORDS)