[Heparin-Induced Thrombocytopenia after Total Knee Replacement]. / Heparinem indukovaná trombocytopenie po totální endoprotéze kolenního kloubu.

Heparin-induced thrombocytopenia is a rare complication of treatment with both unfractionated heparin (UFH) and low molecular weight heparin (LMWH). Antibodies against the complex heparin-platelet factor 4 are the main cause of pathogenesis, resulting in the activation of thrombocytes, coagulation, endothelium, monocytes, neutrophils and subsequent highly prothrombotic state. The prothrombotic state can result not only in venous but also in arterial thrombosis at different locations (which is manifested apart from venous thromboembolic disease also by acute limb ischemia, acute myocardial infarction, ischemic stroke, skin necrotizing lesion exanthema). If HIT is not adequately treated, it may be fatal in up to 10% of patients. For early diagnosis, a combination of 4T scores and diagnostic lab tests for HIT is required. Immediate discontinuation of heparin therapy (UFH, LMWH) and switching to non-heparin anticoagulants (fondaparinux, bivalirudin, argatroban or in some situations DOACs) are essential in HIT treatment. The case report describes the patient after primary knee replacement, complicated by the development of HIT with no evidence of venous thromboembolic disease. Preoperatively, the patient was administrated nadroparin due to paroxysmal atrial fibrillation, after the development of HIT, anticoagulation was modified to fondaparinux and subsequently to warfarin after the platelet count normalization. Key words: unfractioned heparin, low molecular weight heparin, thrombocytopenia, total knee replacement.

[Monitoring of haemocoagulative changes during long-term doses of low molecular weight heparin during pregnancy]. / Sledování hemokoagulacních zmen v prubehu tehotenství zen s opakovaným potrácením v závislosti na podávání nízkomolekulárního heparinu.

OBJECTIVE: The aim of study was to compare plasma levels of selected coagulation parameters in pregnant women with long-term administration of low molecular weight heparin (LMWH) versus cohort of healthy women LMWHs untreated. DESIGN: Prospective study. SETTING: Department of Haematology, Institute of Clinical Biochemistry and Haematology, Charles University and University Hospital, Plzen. METHODS: We examined 67 pregnant women with recurrent fetal loss in previous pregnant history treated by long-term prophylactic administration of LMWH. Blood samples were collected before gestation and at 10th, 20th, 30th gestational weeks. RESULTS: Pregnant women with own history of recurrent fetal loss treated by the long-term prophylactic dose of LMWHs during pregnancy have the same values of the coagulation parameters as the control cohort in spite of fact that the clinical efficacy of administered LMWHs is high. CONCLUSION: Our results suggest that heparin may act by many unknown different mechanisms, such as inhibition of complement binding or secretion of prostaglandins.

[Long-term low molecular weight heparin protection during pregnancy for the recurrent fetal loss]. / Prubeh tehotenství pri dlouhodobém podávání nízkomolekulárního heparinu pro opakované tehotenské ztráty.

Recurrent fetal loss affects 1 to 5% women of the fertile age all over the world. Pathogenesis of recurrent early or late fetal loss remains unclear and therefore the LMHW administration during pregnancy has not been sorted out so far. Our trial deals with a cohort of 51 pregnant women with recurrent fetal loss in their personal history treated by long-term administration of LMWHs which was compared with a cohort of healthy women LMWHs untreated. 91% effectiveness of a long-term LMWH protection means in fact 43 liveborn babies delivered without any complications during pregnancy and delivery to 47 women - 30 of these women were primiparas.

[Serious congenital deficiency of FVII and acquired idiopathic thrombocytopenic purpura--the rare combination of two bleeding disorders]. / Vrozený tezký deficit FVII a získaná idiopaticá trombocytopenická purpura--vzácná kombinace dvou krvácivých stavu.

The congenital deficiency of FVII is an autosomal recessive rare disorder. We have observed 15 patients with this deficiency in our haematology department including the only one patient with the FVII level < 1%. The deficiency with the FVII level < 2% is associated with serious bleeding complications including the joint bleeding, bleeding in the retroperitoneum, gastrointestinal system and in central nervous system (CNS). Serious acquired thrombocytopenia can originate from the impairment of platelets production, from their higher sequestration in the spleen but even from the elevated thrombocytes disintegration. The raised thrombocytes disintegration caused by the autoantibodies is the most frequent source of the acute life threatening thrombocytopenia with the massive bleeding in tissues, gastrointestinal system or CNS. We list the case report of a young patient with congenital FVII deficiency (FVII level < 1%) and acute idiopathic thrombocytopenic purpura with yet unknown aetiology of which has not been fully clarified although the very favourable effect of prednisone therapy indicates the autoimmune mechanism.

[Placenta and annexin V receptors, antibodies against annexin V and against other phospholipids in patients with recurrent pregnancy loss]. / Placenta a annexin V receptory, protilátky proti annexinu V a proti ostatním fosfolipidum u zen opakovane potrácejících.

THE AIM: To study placenta annexin V receptors, and serum antibodies against ph-acid, ph-ethanolamine, ph-glycerol, ph-inositol, ph-serine, cardiolipin, beta2-glycoprotein I, prothrombin a annexin V in patients with recurrent pregnancy loss. SETTING: Department of Gynecology and Obstetrics and Faculty Hospital of Charles University, Plzen. METHODS: We examined sera and placenta tissue from 156 patients in reproductive age with unexplained repeated pregnancy loss. Control group of eighty-four fertile healthy women was included. ELISA methods were used for detecting a panel of sera of anti-phospholipid antibodies (aPLs). Immunolocalization of annexin V receptors in 143 trophoblast-placenta specimen of 156 patients was investigated by the immunofluorescence technique using Annexin V-FITC, Apoptosis and Annexin V-CY3 commercial kits. RESULTS: Positivity for anti-phospholipid antibodies mainly against ph-serine, ph-inositol, and ph-ethanolamine was found together in 80.8%, anti-prothrombin antibodies in 12%, and anti-annexin V antibodies in 13.5% women. No significant levels of aPLs were found in 6 controls. Immunohistopathology of placenta also exhibited some changes manifested by the presence of apoptotic and necrotic cells in trophoblast, and very few microtrombotization in some intervillous spaces and in placenta vessels. CONCLUSION: Our detailed study demonstrated the prevalence of majority of antiphospholipid antibodies as one of the high risk factor of repeated reproductive failure. Very low microthrombosis in placenta could be explained by the changes of haemocoagulation properties out of uterus.

[Antiphospholipid syndrome and vascular disease]. / Antifosfolipidový syndrom a vaskulární nemoc.

The antiphospholipid syndrome is a rare disease causing recurring arterial and/or venous thromboses at various sites with the first manifestations at a young age. A case report of a 46-year old man with the first venous system manifestations at the age of 19 before description of the syndrome in literature, is presented. The diagnosis was made when he was 44 years old. Bilateral stenoses in the carotid region and a rare manifestation of renal arteries involvement with renovascular hypertension developed. Critical stenosis of the left renal artery resulted in an afunctional left kidney, significant stenosis of the right renal artery was treated by angioplasty and stent implantation. The patient status stabilized only after intensive anticoagulant treatment with warfarin.

Silicone rubber-hydrogel composites as polymeric biomaterials. IX. Composites containing powdery polyacrylamide hydrogel.

A composite material has been prepared consisting of a silicone rubber matrix and particulate lightly cross-linked polyacrylamide hydrogel. The material, resembling common silicone rubber, is hydrophilic and swells in water like hydrogels. The polyacrylamide has a high specific surface area, a relatively low content of water-soluble low-molecular-weight compounds and, owing to its non-ionogenic character, a pH-independent swelling degree. For the composite material consisting of the silicone rubber and very fine powdery cross-linked polyacrylamide, we have measured the rate of swelling in water, the mechanical properties (tensile strength, break elongation, hardness, resilience), biological properties (implantation test, cytotoxicity, cell cultivation) and UV absorption of its water extracts. The polyacrylamide and polysiloxane purity, as the composite material starting components, has been determined to be satisfactory. As a result, a high swelling rate of the prepared composite material has been observed, resulting in reaching more than 70% wt of water of the equilibrium swelling. The results show that the composite material is suitable for biological and medical use.

[Central venous sepsis in long-term catheterization of patients during intensive treatment of acute leukemia]. / Centrální zilní sepse u dlouhodobe katetrizovaných nemocných v prubehu intenzívní lécby akutních leukémií.

The authors evaluate the prevalence of central venous catheter sepsis and possible catheter sepsis in granulocytopenic patients with acute leukaemia after intensive treatment with cytostatics. The group comprises 42 patients subjected to 57 catheterizations of a central vein. The period of catheterizations was 18-89 days, the average period 43 days. Catheter sepsis was revealed in 15 patients, i.e. 26.3% of all performed catheterizations, possible catheter sepsis was recorded in four patients, i. e. 7.0%. In almost half of the catheter sepses (42.1%) the same microbiological finding was recorded in the haemoculture and skin smear at the site of insertion of the catheter. Twelve patients were cured (21.0%), seven patients (16.7%) from the group of 42 died. To reduce the incidence of catheter sepsis it is important in the authors' opinion to make available high quality protective materials (Tegaderm plasters) and the entire infusion line should be changed daily.

[Development of therapy of acute myeloid leukemia at the First Internal Medicine Clinic in Plzen]. / Vývoj lécby akutních myeloidních leukémií na I. interní klinice v Plzni.

The authors summarize the development of diagnosis and treatment of acute myeloid leukaemias (AML) at the First Medical Clinic in Plzen in a (group) of 102 patients treated during 1966-1990. On their own results they demonstrate the importance of intensive post-remission treatment with large doses of cytosine arabinoside (ara-c) which makes possible long survival or complete recovery of some patients, and at the same time the necessity and pretentious character of comprehensive supportive treatment is emphasized.

[Cardiotoxicity of anthracycline cytostatic agents--a proposal for routine monitoring and supportive therapy]. / Sledování kardiotoxicity antracyklinových cytostatik--návrh rutinního monitorování a podpurné lécby.

The authors investigated a group of 57 patients with acute leukaemia and 30 patients with malignant lymphomas, who were treated by combinations of cytostatics containing the anthracycline antibiotics daunorubicin and adriamycin. Using examination methods which are widely available they tried to find indicators which detect early manifestations of cardiac damage during this treatment. The most valuable indicators of incipient anthracycline cardiomyopathy were the heart rate at rest and the QTc interval on the ECG tracing. The validity of polygraphy and echocardiography could not be assessed in the present work. The authors suggest a procedure of routine monitoring of patients treated with anthracycline cytostatics and methods of supportive therapy to ensure safe treatment.

[Pure red cell aplasia in chronic lymphatic leukemia. Successful treatment using immunosuppression]. / Cistá aplázie erythropoézy u chronické lymfatické leukémie. Uspesná lécba imunosupresí.

The authors describe two cases of chronic lympocytic leukaemia complicated by pure red cell aplasia of autoimmune origin. The first patient achieved complete recovery of erythropoiesis after short-term immunosuppression by means of cyclophosphamide and prednisone. The second patient did not respond to the same combination of immunosuppressive drugs and remission was achieved by administration of antithymocyte globulin. In the discussion the authors deal with contemporary knowledge of the pathogenesis of autoimmune erythroblastopenia and mechanismus of action of antithymocyte globulin.

[Intensive post-remission therapy of acute myeloid leukemia with high doses of cytosine arabinoside]. / Intenzívní postremisní terapie akutních myeloidních leukémií vysokými dávkami cytosin arabinosidu.

The results are estimated of treatment for acute myeloid leukaemia using intensive post-remission therapy with high doses of cytosine arabinoside (HiDAC). Two women and four men aged 18-34 years were treated with HiDAC. None of them had been given maintenance or boost chemotherapy any more at the time. The patients were rated for the duration of granulocytopenia and thrombocytopenia for the incidence of non-haematological complications and for the duration and quality of survival. The preliminary results are promising and in keeping with those reported by similar clinical centres abroad, namely that maintenance therapy should be phased out in the presence of intensive post-remission treatment.