A comprehensive assessment of potential hazard caused by organic compounds in biochar for agricultural use.

Great attention has been paid to using biochar as soil conditioner and bio-accumulator. Nevertheless, biochar application in agriculture might cause a potential hazard to ecosystems, considering that toxic organic pollutants present in biochar may enter the environment. European Biochar Certificate (EBC) set certain criteria for biochar production. Achieving the EBC established values of the molar ratio of H/Corg <0.7 and O/Corg <0.4, does not ensure that biochar will not cause phytotoxicity. The results of root growth inhibition of Sinapis alba were in the range of 9% (eucalyptus wood biochar) to 82% (maize biochar). Phytotoxicity of biochar was possibly caused by the presence of water-soluble organic compounds. In total, 62 organic compounds were identified in the leachate from noncertified biochar and 35 organic compounds in the leachate from certified biochar. Biochar safety, in terms of the presence of organic compounds, can be recognised by the evaluation of the ratio of organic carbon (OC) and elemental carbon (EC). Biochar with the highest phytotoxicity showed the ratio between OC/EC > 0.1, inhibition of Sinapis alba <30% was observed with OC/EC < 0.02. To achieve Sinapis alba inhibition <20%, these parameters should be met: volatile matter (VM) <30%; concentration of OC < 4%; aromaticity ratio AL/AR < 0.35.

The impact of PET with 18FDG in radiotherapy treatment planning and in the prediction in patients with cervix carcinoma: results of pilot study.

Positron emission tomography (PET) is used to distinguish between benign and malign tumors, to diagnose relapse or post-therapeutic changes. Lately, PET is used to predict the treatment response. and also a complementary method to determine target volumes in radiotherapy. Daily using of PET in the oncology praxis can change treatment strategy and improve its outcome. Results of this pilot study show the role of PET with 8-F-fluorodeoxyglucose ((18)FDG) for staging of cervical carcinoma and in the radiotherapeutic planning. Between March 2005 and May 2007, 51 patients with cervical carcinoma were treated with combination of external beam radiotherapy and HDR brachytherapy, with or without concomitant cisplatin. The lymphatic nodes treatment field size was determined by PET/CT fusion. Treatment results were evaluated by PET 3 and 9 months after treatment. The differences in the results of PET and CT were evaluated in this study. In 32 cases (62.75%) the results of PET and CT were identical, in 14 cases (27.45%) the nodal involvement was more extensive according to PET, in 5 cases (9.8%) the nodal involvement was more extensive according to CT. PET results 3 months after treatment were as follows: in 3 cases (5.88%) stable disease, in 35 cases (68.63 %) negative, in 4 cases (7.84%), progression of disease, in 3 cases (5.88 %) partial regression. There were no false positive results caused by inflammatory reaction persisting 3 months after radiotherapy, as was confirmed by repeating PET 9 months after treatment. The results of this study confirmed the important role of PET in diagnosis and treatment of cervical carcinoma and in determination of target volumes in radiotherapy. PET was found to be a standard staging examination of cervical carcinoma in Masaryk Memorial Cancer Institute. The predictive value of PET has not yet been validated.

[The impact of PET in radiotherapy of the cervical carcinoma--results of pilot study]. / Význam PET v radioterapii karcinomu delozního hrdla--výsledky pilotní studie.

OBJECTIVE: Positron emission tomography (PET) is a complementary method to determine target volumes in radiotherapy. Daily using of PET in the oncology praxis can change treatment strategy and improve its outcome. Results of this pilot study show the role of PET in staging of cervical carcinoma and in the radiotherapeutic planning. METHODS: Between March 2005 and May 2007, 51 patients with cervical carcinoma were treated with combination of external beam radiotherapy and HDR brachytherapy, with or without concomitant cisplatin. The lymphatic nodes treatment field size was determined by PET/CT fusion. RESULTS: The difference in the results of PET and CT was evaluated in this study. In 32 cases (62.75%) the results of PET and CT were identical, in 14 cases (27.45%) the nodal involvement was more extensive according to PET, in 5 cases (9.8%) the nodal involvement was more extensive according to CT. PET results 3 months after treatment were as follows: in 3 cases (5.88%) stable disease, in 35 cases (68.63%) negative, in 4 cases (7.84%), progression of disease, in 3 cases (5.88%) partial regression. CONCLUSION: The results of this study confirmed the important role of PET in diagnosis and treatment of cervical carcinoma and in determination of target volumes in radiotherapy. PET was found to be a standard staging examination of cervical carcinoma in Masaryk Memorial Cancer Institute.

[Gene expression profiling in prediction of tumor response to neoadjuvant concomitant chemoradiotherapy in patients with locally advanced rectal carcinoma: pilot study]. / Vyuzitie profilov génovej expresie k stanoveniu odpovedi k neoadjuvantnej konkomitantnej chemorádioterapii u pacientov s karcinómom rekta: pilotná stúdia.

BACKGROUND: Neoadjuvant concomitant chemoradiotherapy has become a standard treatment of locally advanced rectal adenocarcinomas (LARA). It can reduce tumor volume, thus increases a feasibility of sphincter-sparing surgery, shows less acute toxicity, improves local control rate. It is based on fluoropyrimidines (5-fluorouracil, capecitabine) with concurrent radiotherapy. The aim of the study was to evaluate the capability of gene expression method to identify nonresponders (NR) pretherapeutically. METHODS AND RESULTS: 17 patients with LARA, clinical stage II, III according to IUCC were enrolled into our pilot study. Response to therapy was determined clinically by transrectal ultrasonography and CT/MRI before and after therapy and histopathologically by TRG (tumor regression grade) according to Mandard. Patients with TRG 1-2 were included to responders group (R) and patients with TRG 4-5 composed NR group. Gene expression levels of 440 genes were obtained by low-density oligonucleotide microarrays. Gene expression data analysis based on SAM (Significance Analysis of Microarrays) and t-test methods identified 8 genes (RB1, RBBP4, HYOUI, JUNB, MDM4, CANX, MMP2, TCF7L2) significantly upregulated in NR. CONCLUSIONS: Validation of identified changes on the mRNA level (Real-Time PCR) and on protein level (immunohistochemistry) is ongoing. We suggest that low-density oligonucleotide microarray technology could contribute to individualize the therapy of patients with LARA.

[Immediate breast reconstruction and radiotherapy]. / Okamzitá rekonstrukce prsu a radioterapie.

Immediate breast reconstruction has become widespread in breast cancer patients since the eighties of the last century. Now the criteria for adjuvant chest wall radiotherapy are changing as the problem of interference between reconstruction and radiotherapy appears. The irradiation of a reconstructed breast increases complication rate and worsens long-term cosmetic results. If radiotherapy is needed, it should be given regardless of reconstruction and delayed, instead immediate, breast reconstruction is preferable. However, the necessity of radiotherapy is rather difficult to predict before surgery as the criteria arise from the definitive histopathologic examination. Consequently, the former reconstruction enthusiasm has been moderated. Oncologists should be familiar with immediate reconstruction issues in order to provide their patients with realistic information and not hinder reduction of negative esthetic side effects of oncological treatment. A survey of the most important literature concerning this issue is presented in the article.

[Therapeutic approaches for breast carcinoma]. / Lécebné postupy u karcinomu prsu.

With increasing incidence of breast cancer its prevalence also increases. Improvement of therapeutic approaches recently introduced led to improved treatment outcomes. The introduction of taxanes into the adjuvant treatment prolongs the overall survival (OS) of the patients. Third generation of aromatase inhibitors appear better than tamoxifen in the adjuvant treatment of postmenopausal women. New anticancer drugs in combination with bevacizumab and trastuzumab have brought new possibilities in treatment of patients with metastatic breast cancer: their use apparently increases the rate of treatment response and overall survival.

[The role of PET in the diagnosis and prediction of the treatment response in patients with cervical carcinoma treated with radiotherapy--results of pilot study]. / Význam PET v diagnostice a predikci lécebné odpovedi karcinomu cervixu u pacientek lécených radioterapií--výsledky pilotní studie.

BACKGROUND: Positron emission tomography (PET) is used to distinguish between benign and malign tumours, to diagnose relapse or post-therapeutic changes and recentlyto predict treatment response. PET is also a complementary method to determine target volumes in radiotherapy. Using the PET in routine oncology practice can change disease management and improve treatment outcomes of cancer patients. We performed a pilot study to validate the role of PET in staging and in radiotherapy treatment planning of cervical carcinoma. PATIENTS AND METHODS: Between March 2005 and May 2007, 51 patients with cervical carcinoma were treated with combination of external beam radiotherapy and HDR brachytherapy, with or without concomitant cisplatin. The lymphatic nodes treatment field size was determined by PET/CT fusion. Treatment results were evaluated by PET 3 and 9 months after completion of radiotherapy. RESULTS: The difference in the results of PET and CT was evaluated in this study. In 32 cases (62.75%) the results of initial PET and CT were identical, in 14 cases (27.45%) the nodal involvement was more extensive according to PET, in 5 cases (9.8%) the nodal involvement was more extensive according to CT. Comparing the results of PET done before and 3 months after the treatment, we found stable disease in 3 cases (5.88%), progression of disease in 4 cases (7.84%), partial regression in 3 cases (5.88 %) and in 35 cases (68.63 %) both PET scans were negative. There should not occur any false positive results caused by inflammatory reaction persisting 3 months after radiotherapy, as was confirmed by repeating PET 9 months after the treatment. CONCLUSION: The results of this study confirmed the important role of PET in diagnosis and treatment of cervical carcinoma and for determination of target volumes in radiotherapy. The predictive value of PET has not yet been validated in our study. PET was integrated into the standard staging of cervical carcinoma in Masaryk Memorial Cancer Institute.

Pilot study of sole conformal peroperative interstitial brachyradiotherapy of early stage breast carcinoma using high-dose rate afterloading.

In this study of high-dose-rate brachyradiotherapy to the lumpectomy site as the sole radiation are documented a three-dimensional treatment planning and preliminary results of accelerated partial- breast irradiation. From March 2002 to July 2004 25 patients were prospectively included in this study. Six patients were excluded becuase of definitive histology of lobular carcinoma or positive margin. The median age was 63.2 years (range: 44-77 years). Median follow-up of all patients is 11 months (range: 3-25 months) with a minimum follow-up of 3 months. Radiation was delivered using the high-dose-rate remote afterloader VariSource with [192]Ir source. The patients received radiation twice a day at least 6 hours apart for a total of 10 fractions over five days with a single dose of 3.4 Gy. The total dose was 34.0 Gy prescribed as a minimum peripheral dose to match or minimally exceed the volume defined by the surgical clips as seen on CT scans. Freehand technique allows conformal placement of the catheters to the shape of the lumpectomy cavity. We use the method of geometric optimalisation which allows the calculations of dose distribution in relation to target. At a median follow-up of 11 months none of patients developed in-field breast recurrences, one patient had out-of-field recurrences. There were no regional nodal recurrences. At each patient, there was calculated target volume size in cm3 (median 91.3 cm3) dose volume histogram (DVH), dose homogenity index (DHI). Median DHI was 0.42. Median volume of breast tissue getting 100% of the prescription dose, V(100), is 87%; and V(150) 48.5%. We have noticed two treatment complications: hematoma and abscess in the place of tumorous bed after exstirpation. At last follow-up, patients rated the overall cosmetic outcome excellent. This method is suitable just for patients with histologically confirmed small tumors (<3 cm in diameter) without negative prognostic factors for local recurrence (age at least 40 years, negative surgical margins, nodal involvement - maximum three positive nodes without extracapsular extension).

Effect of ACE inhibition and angiotensin AT1 receptor blockade on renal and blood pressure response to L-arginine in humans.

OBJECTIVE: Nitric oxide (NO) may contribute to the actions of angiotensin converting enzyme (ACE) inhibitors. In contrast, angiotensin type 1 (AT1) receptor blockers (AT1B) have been considered to act exclusively by inhibiting angiotensin II actions. However, recent experimental findings suggest that AT1B actions may be also partly mediated by NO. In this study, we explored whether ACE inhibitors and AT1B modulate hemodynamic responses to L-arginine (L-arg), a NO precursor. METHODS: Systemic (Finapres) and renal hemodynamic responses to L-arg (200 mg/kg body weight), associated with markers of systemic and renal NO production, were assessed before (control) and after 3 weeks of randomized pretreatment with the ACE inhibitor ramipril (5 mg/day for 3 weeks) or the AT1B losartan (50 mg/day for 3 weeks) in nine healthy male subjects (33 +/- 2 years; body mass index 25.5 +/- 0.5 kg/m2). RESULTS: Control L-arg did not influence mean arterial pressure (MAP) (92 +/- 5 versus 90 +/- 5 mmHg; not significant). In contrast, L-arg decreased MAP when administered after pretreatment with ramipril (89 +/- 5 versus 83 +/- 4 mmHg; P< 0.01) or losartan (90 +/- 44 versus 86 +/- 4; P< 0.05). Control L-arg infusion had no effect on renal plasma flow (RPF) (paraminohippuric acid clearance) and renal vascular resistance (RVR), whereas the glomerular filtration rate (GFR) (inulin clearance) decreased (98 +/- 4 versus 89 +/- 5 ml/min; P< 0.05), resulting in a decrease in filtration fraction (P< 0.05). After ramipril, L-arg induced renal vasodilation as indicated by significant changes in RPF (576 +/- 41 versus 669 +/- 21 ml/min; P< 0.01) and RVR (P< 0.05). The GFR did not change statistically after ramipril pretreatment (91 +/- 3 versus 97 +/- 4 ml/min; not significant); however, the trend was different as compared with control (F= 5.7, P < 0.05). L-Arg-induced renal vasodilation was also observed after losartan (RPF, 637 +/- 34 versus 706 +/- 40 ml/min; P< 0.05). Enhanced renal and systemic responses to L-arg after ACE inhibitor and AT1B were associated with a rise in plasma L-citrulline levels, which was greater than after control L-arg (P < 0.05). However, other indicators of NO activity such as plasma and urinary cyclic guanosine 3',5'-monophosphate, and nitrates, remained unchanged throughout all experiments. CONCLUSION: The results indicate that ACE inhibitors and AT1B have a potential to enhance L-arg-induced vasodilation both in systemic and renal vascular beds. However, these hemodynamic responses were not associated with convincing changes in indicators of systemic or renal NO activity, suggesting a contribution of NO-independent vasodilator mechanisms.

Energy metabolism of adipose tissue--physiological aspects and target in obesity treatment.

Body fat content is controlled, at least in part, by energy charge of adipocytes. In vitro studies indicated that lipogenesis as well as lipolysis depend on cellular ATP levels. Respiratory uncoupling may, through the depression of ATP synthesis, control lipid metabolism of adipose cells. Expression of some uncoupling proteins (UCP2 and UCP5) as well as other protonophoric transporters can be detected in the adipose tissue. Expression of other UCPs (UCP1 and UCP3) can be induced by pharmacological treatments that reduce adiposity. A negative correlation between the accumulation of fat and the expression of UCP2 in adipocytes was also found. Ectopic expression of UCP1 in the white fat of aP2-Ucp1 transgenic mice mitigated obesity induced by genetic or dietary factors. In these mice, changes in lipid metabolism of adipocytes were associated with the depression of intracellular energy charge. Recent data show that AMP-activated protein kinase may be involved in the complex changes elicited by respiratory uncoupling in adipocytes. Changes in energy metabolism of adipose tissue may mediate effects of treatments directed against adiposity, dyslipidemia, and insulin resistance.

[Adjuvant radiotherapy in the therapy of uterine cancer in the first clinical stage]. / Adjuvantní radioterapie v lécbe karcinomu delozního tela 1. klinického stadia.

OBJECTIVE: The aim of our study was to find the influence of the postoperative radiotherapy on local control and overall survival in patients with carcinoma of the uterus. Endometrial carcinoma is the most frequent gynecologic malignity. Surgery, radiotherapy, chemotherapy and hormonal therapy are used in the treatment of this disease. The optimal cure strategy has not been established yet. DESIGN: Retrospective study. SETTING: Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno. METHODS: We followed up 246 patients with the diagnosis of endometrial carcinoma. All patients were in clinical stage 1. Median of the age was 60 years. Every patient underwent radical hysterectomy and adnexectomy. Most of them had adjuvant radiotherapy. Combined radiotherapy was used (external beam radiotherapy and brachyradiotherapy). Some of patients underwent only external beam radiotherapy, other had only brachytherapy. We used Kaplan-Meier survival function and methods of Statistica. RESULTS: The median of the follow up was 8.3 years. Local recurrence was proved in 16 cases. The time to the local relapse was 3.2 years. Dissemination occurred in 12 patients. The time to the progression was 5.9 years. Five-year DFS was 80.9%, five-year overall survival was 82.9%. Patients, who had risk factors, were proved to suffer from worse overall survival. The adjuvant radiotherapy improved the local, and the distant control in the group of patients with risk factors. CONCLUSION: The influence of the radiotherapy on the local control was proved in many studies, the influence on the overall survival was not statistically significant. Temporally there is the option not to apply adjuvant radiotherapy. Our study shows the important benefit of the adjuvant treatment in cases of endometrial carcinoma and risk factors.

[Concomitant chemoradiotherapy of tumors of the head and neck]. / Konkomitantní chemoradioterapie nádoru hlavy a krku.

Head and neck carcinomas represent a histopathologically variable group of tumors with different location. Treatment strategy is similar for most of them. Surgery followed with radiotherapy or chemotherapy is a standard treatment. Radiotherapy becomes the main treatment modality in locally progressive or inoperable tumors. Prognostic outcome is rather poor. Use of different fractionation radiotherapy schemes combined with chemotherapy is aimed to improve the treatment results. Results of recent metaanalyses have shown that concomitant chemoradiotherapy can improve overall survival of patients with locally progressive or inoperable disease.

[Role of concomitant chemoradiotherapy in the treatment algorithm for rectal carcinoma]. / Postavení konkomitantní chemoradioterapie v lécebném algoritmu u rektálního karcinomu.

The article summarizes practical guidelines for the management of rectal cancer. Colorectal cancer alone accounts for about 100,000 death in Europe and 75,000 in the US each year. The current cornerstones of treatment are surgery, radiotherapy (for rectal cancer only) and chemotherapy. At diagnosis the most important factor predicting treatment outcome is the stage of disease. Patients with rectal carcinoma should be classified according to the stage of the disease, including endorectal ultrasound and biopsy of the lesion. Five years after diagnosis, survival reaches about 50%. For early stage disease, surgery remains the standard treatment, but patients with lymph node-negative T3 or T4 lesions or with any lymph node-positive cancer should receive adjuvant radiotherapy and chemotherapy following the surgery. Pelvic radiation therapy decreases local recurrence; the addition of systemic chemotherapy further enhances local control and improves the survival. In patients with T3 or T4 rectal carcinoma the pre-operative therapy (radiation therapy combined with systemic chemotherapy) has potential advantages, including the decreased tumor, less acute toxicity compared with postoperative therapy, increased radio sensitivity due to more oxygenated cells, and enhanced sphincter preservation.

[Adverse effects of concomitant chemoradiotherapy and their prevention and treatment]. / Nezádoucí úcinky konkomitantn chemoradioterapie a moznosti jejich ovlivnení.

Concomitant chemoradiotherapy plays an important role in the treatment of malignancies. Concomitant chemoradiotherapy improves the local control and overall survival compare to separate treatment modalities. Combined treatment leads to higher toxicity. Most frequent side effects during concomitant chemoradiotherapy are diarrhoea, mucositis, skin reactions and haematologic toxicity. Optimal combination of treatment modalities, fractionation and dosage of radiotherapy, modern planning techniques and use of radioprotective drugs could decrease the treatment toxicity.

[Concomitant radiochemotherapy in rectal tumors]. / Konkomitantní radiochemoterapie nádoru konecníku.

Requirements for improved cancer control led to the testing of the combined-modality therapy for many types of cancer. This review attempts to analyse possibilities of the simultaneous application of both strategies in the treatment of rectal cancer. Postoperative radiochemotherapy has been shown to be effective in rectum carcinomas. Preoperative combined-modality therapy can ensure downstaging (T3, T4). Operation was carried out 4 to 6 weeks after the end of preoperative therapy.

[Conservative treatment for the penis carcinoma]. / Konzervativní lécba karcinomu penisu.

No explicit recommendation has been determined in a treatment for the verified squamous cell penis carcinoma till now. The application of ionizing radiation is included in traditional treatment methods for this disease, in addition to surgical operations and chemotherapy cure. It is possible to apply external radiotherapy or brachy-radiotherapy (a moulage or an intersticial application) as well as their combination. In individual cases it is possible to use chemo-radiotherapy. In the case of the localized tumor a curative radiotherapy can be used as it is more save towards this organ. Radiotherapy has its place in the neoadjuvans treatment with the goal to reduce the disease extent. It can be also used as an adjuvans--postoperatively and paliatively. This review is describing principles of the radiotherapy treatment for this disease.

[A nutritionally defined liquid diet for hemodialyzed patients]. / Nutricne definovaná tekutá výziva pro hemodialyzované nemocné.

BACKGROUND: For patients having regular haemodialysis there are no suitable complete preparations for general use in case intensive treatment is needed. Nutrilac renal is a new preparation of a nutritionally defined liquid diet corresponding as to its composition to the needs of haemodialyzed patients. The purpose of the present work was to assess whether this preparation when administered as a supplement will have a favourable effect on the nutritional parameters of haemodialyzed patients. METHODS AND RESULTS: Nutrilac renal was administered to haemodialyzed patients for a period of three weeks as a supplement meeting 20% of the energy requirements. The protein intake rose from 0.87 to 0.95 g/kg body weight (p < 0.05), the energy intake from 109 to 126 kJ/kg body weight (p < 0.05). As to nutritional parameters, the serum albumin values improved (from 25.0 to 29.4 g/l, p < 0.05) and Whitehead's quotient from 1.8 to 1.5, p < 0.05). The favourable effect on the amino acid spectrum was manifested by a significant rise of essential amino acids and those with branched side chains (p < 0.01). The preparation did not lead to a rise of potassium, ura and vitamin A levels. CONCLUSIONS: The newly developed preparation Nutrilac renal exerts a favourable effect on nutritional parameters. Changes in the aminogram characterized by an increase of essential amino acids, in particular threonine, valine, leucine and isoleucine indicate the high biological value of the protein component of the preparation for patients with chronic renal failure.

[Clinical course of recent insulin-dependent diabetes mellitus and possibilities of controlling it therapeutically]. / Klinický prubeh recentního inzulín dependentního diabetu mellitu a moznosti jeho terapeutického ovlivnení.

Intensive insulin treatment in a recent stage of IDDM promotes metabolic compensation of the disease regardless which regime of conventional or unconventional treatment is used. In thus treated patients more frequently complete or partial metabolic remission is achieved. C-peptide in patients in remission is much higher than in other patients, and conversely there are fewer persons without residual B-cell secretion. The manifestation of diabetes has an impact also on the clinical course of the disease. Normoglycaemia with possible metabolic remission associated with easy insulin administration a flexible lifestyle have a favourable effect on the onset of the life-long disease and eliminate to a minimum factors which have a negative psychosomatic impact on the patient.

[Long-term administration of a low-protein diet with keto-analogs of essential amino acids and the metabolic status of patients with chronic kidney failure]. / Dlouhodobé podávání nízkobílkovinné diety s ketoanalogy esenciálních aminokyselin a metabolický stav nemocných s chronickým selháním ledvin.

To 12 patients with chronic renal failure (CHRI) for 12-22 months a diet containing 20 g high quality protein supplemented by keto analogues of essential amino acids (KA)--4.8 g/day--was administered. During the investigation period no significant change of the albumin, prealbumin or transferrin level was recorded, nor of Whitehead's quotient, immunoglobulin levels and haemoglobin concentration, serum iron and its binding capacity. However, there was decline of the C3 complement component (p less than 0.01). The investigated parameters of carbohydrate metabolism (fasting blood sugar, immunoreactive insulin, oral glucose tolerance test) did not change, similarly as total cholesterol and triglyceride levels. The originally reduced HDL-cholesterol level increased (p less than 0.05). The achieved results suggest that the long-term administration of a diet with 20 g protein supplemented by the minimal necessary dose of KA does not produce undesirable changes of the investigated metabolic parameters.

[Individualized supplemented low-protein diet in patients with chronic kidney failure]. / Individualizovaná suplementovaná nízkobílkovinná dieta u nemocných s chronickým selháním ledvin.

The possibility of developing protein-energy malnutrition poses a serious risk associated with long-term administration of a restrictive low-protein diet. We conducted a randomized prospective study designed to evaluate 36 patients with chronic renal failure in initial malnutrition (BMI 22%, albumin 35 milligrams, WQ 2.02). In 20 of these patients (Group I), low-protein diet was supplemented with ketoanalogs of essential amino acids along with a low-phosphate drink from casein-free protein. The diet of another 16 patients (Group II) was supplemented with a mixture of essential and non-essential amino acids of egg white. Three-month follow-up revealed a statistically significant improvement in selected metabolic parameters (Surea, albumin, WQ, valine HDL-CH cholesterol, SP and SCa), particularly in Group I (p < 0.01). In group II, the improvement was either not marked (p < 0.05) or no improvement was seen. Results of the study indicate that patients found to suffer from initial malnutrition require early dietary supplementation including ketoanalogs of essential amino acids and a special protein providing an adequate amount of energy.