[The experience with the use of neuromedin preparations for the treatment of sensorineural impairment of hearing].

The objective of the present study was to evaluate the effectiveness of the application of neuromedin for the treatment of sensorineural loss of hearing of different etiology. A total of 230 patients at the age varying from 20 to 60 years presenting with sensorineural impairment of hearing were available for the observation. Neuromedin was administered intramuscularly at 15 mg/day (1.5% solution at a dose of 1.0 ml) for 10 day; thereafter, the patients took 20 mg neuromedin tablets thrice daily during one month. The majority of the patients reported an improvement of hearing and speech intelligibility. Complete restoration of hearing was documented in certain patients presenting with acute sensorineural impairment of hearing.

[Encapsulating peritoneal sclerosis]. / Enkapsulující peritoneální skleróza.

Encapsulating peritoneal sclerosis (EPS) is a rare complication of peritoneal dialysis (PD) characterized by extensive peritoneal fibrosis and bowel obstruction. Opinions on its etiopathogenesis diverge. It appears that the performance of peritoneal dialysis itself and the exposition of the peritoneum to non-physiological influences (the incidence increases in proportion to the length of peritoneal dialysis treatment) is an important factor. Yet there is also patients' individual sensitiveness, which apparently depends on individual immunological response. EPS causes severe changes in peritoneal anatomy and functions, resulting both in the loss of the transport function of the peritoneum, and in bowel malfunction and serious malnutrition. Imaging methods (ultrasound, computer tomography) are very important in diagnosing EPS; the diagnosis is confirmed histologically. No laboratory markers have been discovered yet to allow for timely indication of EPS development. There are different treatment strategies, including different surgical interventions (liberation of bowel loops, peritoneum resection) and the effort to influence the immune process. Corticosteroids remain the medication of choice; also promising is Tamoxifen. In spite of that, EPS mortality is still very high, ranging between 56 and 93%. The disease often progresses even after peritoneal dialysis has finished. The article summarises the existing knowledge about encapsulating peritoneal sclerosis, its diagnosis and therapy.

WO3 nanorolls self-assembled as thin films by hydrothermal synthesis.

We report a novel type of WO3 nanostructure, i.e. nanorolls obtained as a self-assembled thin film on a transparent conductive substrate. The mild conditions of preparation, avoiding the use of HCl, result in an eco-friendly hydrothermal method with reduced crystallization time. FESEM and HR-TEM show that WO3 nanocrystals are made of rolled nanoflakes with a telescope-like appearance at their tip. For their nano-porosity, electrochemical accessibility, good adhesion to substrates and the envisaged presence of nanocavities between the WO3 layers, these materials hold tremendous promise in nano-electronics, electrochromic devices, water photo-splitting cells, Li-ion batteries and nano-templated filters for UV radiation.

Ketamine blocks cortical epileptic afterdischarges but not paired-pulse and frequency potentiation.

Cortical epileptiform afterdischarges (spike-and-wave rhythm) induced by low-frequency stimulation of the sensorimotor cortex were dose-dependently shortened by ketamine (10, 20 and 40 mg/kg, i.p.). Myoclonic jerking during stimulation was unaffected by ketamine whereas the same motor pattern accompanying afterdischarges was markedly suppressed by this drug. Paired-pulse as well as frequency potentiation of the cortical interhemispheric (transcallosal) responses were not significantly altered by the 40 mg/kg dose of ketamine. The two simple potentiation phenomena studied probably did not play a role in initiation of cortical epileptic afterdischarges.

The inverse Nehb J lead increases the sensitivity of Holter electrocardiographic monitoring for detecting myocardial ischemia.

A major reason for the relatively low sensitivity of Holter electrocardiography (ECG) for detecting ischemia is that the sensitivity of bipolar leads used for Holter ischemia monitoring has not been systematically evaluated, making lead selection difficult. Therefore, this study evaluated the sensitivity of 6 bipolar Holter leads for detecting ischemia during percutaneous transluminal coronary angioplasty. Seventy-five patients, each of whom had > 1 mm ST-segment elevation on an intracoronary electrocardiogram from the myocardium distal to the stenosis during balloon occlusion, were studied for the occurrence of > or = 1 mm ST-segment elevation or depression on the simultaneously recorded Holter leads II, III, aVF, CM5, CR4, and inverse Nehb J. The study found that the inverse lead Nehb J provided a significantly higher overall sensitivity for detecting myocardial ischemia than Holter leads II, III, aVF, CM5, and CR4. Also, the use of inverse lead Nehb J significantly increased the sensitivity of 2- and 3-lead Holter ischemia monitoring. These findings were based on a significantly higher sensitivity of inverse lead Nehb J for detecting ischemia induced by transient occlusion of the left anterior descending coronary artery and a slightly higher sensitivity for detecting ischemia induced by occlusion of the left circumflex coronary artery. None of the bipolar leads studied provided a very high sensitivity for detecting ischemia induced by occlusion of the right coronary artery. These findings show that adequate lead selection can increase the sensitivity of Holter ischemia monitoring. Furthermore, the lack of a highly sensitive lead for detection of inferior ischemia indicates that further evaluation of bipolar leads is warranted.

Effects of ketamine on metrazol-induced seizures during ontogenesis in rats.

An anticonvulsant action of ketamine, a noncompetitive NMDA receptor antagonist (1-40 mg/kg IP), on the metrazol-induced seizures was assessed in male Wistar rats aged 7, 12, 18, 25 and 90 days. Ketamine alone caused ataxia even in the lowest dose used. As concerens its interaction with metrazol it exerted a clearcut anticonvulsant effect against generalized tonic-clonic seizures at all developmental stages. On the contrary, the effects on clonic (i.e., minimal) seizures were only moderate or absent. Higher efficacy of ketamine was observed in young animals. Our results suggest a role of excitatory amino acids in the generation of generalized tonic-clonic metrazol seizures, but their share on the induction of clonic (minimal) seizures seems to be very small.

[Correlation of 99mTc-dTPA renal scintigraphy with ACE inhibitor and ultrasound findings in screening for renal artery stenosis]. / Korelace nálezu dynamické scintigrafie ledvin pomocí 99mTc-dTPA s ACE inhibitorem a sonografického vysetrení pri skríninku stenózy renální arterie.

BACKGROUND: ACE inhibitor renal scintigraphy is widely accepted as a useful test in screening of unilateral renal artery stenosis. Another screening examination is ultrasonography, which detects haemodynamic changes with evaluation of resistive index (RI). The aim of the present study was correlation of 99mTc-DTPA captopril renography and duplex ultrasound findings in diagnosis of renal artery stenosis before angiography, that is used as "gold standard". Angiography was performed in 35 patients and their findings were correlated with scintigraphy and ultrasonography. METHODS AND RESULTS: 93 patients (49 male and 44 female) aged 27 to 84 years were examined. Ultrasonography was performed in all patients with evaluation of RI. Estimation of scintigraphy was performed in accordance with interpretative criteria of 99mTc-DTPA captopril renography, which were established at the 9th Symposium of radionuclides in nefro-urology (Santa Fé 1995) and Guideline for diagnosis of renovascular hypertension (1998). 1) Agreement positive and negative findings on scintigraphy and ultrasonography were in 61/93 patients (66%). 2) Within the group of 35 patients with angiography, the correlation between scintigraphy and ultrasonography findings was found in 27 patients (77%). 3) When scintigraphy and angiography were correlated, the correctly diagnosed renal artery stenosis was found in 27 patients with sensitivity (77%). 4) When sonography and angiography were correlated, the correctly sonographicaly diagnosed renal artery stenosis was found in 26 patients with sensitivity (74%). CONCLUSIONS: On the basis of our results and according to our experience with both examinations we can conclude, that screening of unilateral renal artery stenosis with using these nonivasive methods can help to select better the indicated patients for angiography.

[Clinical and economic significance of iron replacement in anemia treated with recombinant human erythropoietin in patients on hemodialysis]. / Klinický a ekonomický význam dusledné náhrady zeleza pri lécbe anémie rekombinantním humánním erytropoetinem u hemodialyzovaných nemocných.

BACKGROUND: Anaemia is a common phenomenon encountered in patients on hemodialysis. Although treatment with rHuEPO therapy is effective, it may fail even at high doses. As rHuEPO efficacy depends on the bioavailability of iron, we monitored the effect of consistent iron supplementation on hematocrit levels and rHuEPO dosage. METHODS AND RESULTS: 24 patients of our outpatient dialysis centre were included in this study. The mean age was 59 years. The age group over 60 included 14 patients. The mean duration of dialysis treatment was 23.8 months. The patients were followed for 6 months according to the NKF-DOQI (National Kidney Foundation Dialysis Outcomes Quality Initiative) recommendations for the treatment of anaemia. Following values were examined monthly: hematocrit, transferin saturation (TSAT) and ferritin. Iron and rHuEPO dosage was adjusted accordingly. Genetic tests for haemochromatosis were conducted in 4 patients with the highest value of TSAT and ferritin. TSAT increased from a mean of 15.9% to 35.9% (p < 0.001). In 23 patients (96%) TSAT levels were within the recommended range after the treatment. Hematocrit increased from 27.7% to 35.7% (p < 0.001). The recommended value of 33% was achieved in 18 patients (75%). The weekly dose of eHuEPO fell from 3958 IU (International Unit) to 2042 IU (p < 0.001), i.e. 1857 IU of rHuEPO were saved per week, per patient. The average dose of iron administered was 157 mg per week. The average level of ferritin rose from 457 micrograms/k to 1387 micrograms/l (p < 0.001). All results were comparable, even in the group of the senior's selected cases. Genetic testing for haemochromatosis showed mutation H63D in heterozygous state of HFE gene in 2 of 4 patients with the highest value of TSAT and ferritin. Sufficient iron supplementation leads to a significant rise in hematocrit and a concomitant decrease of required rHuEPO doses. TSAT, and not ferritin, is a good marker of iron bioavailability. CONDITIONS: The financial savings due to decreased rHuEPO requirements are 20 times higher than the costs related to iron supplementation, calculated in relation to prices valid for the Czech Republic in 1999. Cause and effect of increased level of ferritin should be carefully studied.

[Central salt-wasting diuresis syndrome as a cause of hyponatremia in patients at the internal medicine department]. / Syndrom centrálne navozené solné diurézy jako prícina hyponatrémie u nemocných na interním pracovisti.

Hyponatremia is a common electrolyte disorder related to central nervous system diseases and is often attributed to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and on the other hand to the cerebral salt wasting syndrome (CSWS). This syndrome is characterized by hyponatremia due to excessive renal sodium excretion resulting from a centrally mediated process. Given the divergent nature of the treatment it is of paramount importance for a clinician to be able to recognize and differentiate between these two entities. Thus the monitoring of renal function tests, which are needed for earlier diagnosis of effective osmolality disorders, is important to do in intensive care units, which are caring for patients with central nervous system lesons. Two patients successfully treated for CSW due to ischemic stroke caused by arterial embolism from heart cavities are described.

[Pharmacologic insult as a cause of acute kidney failure with a need for acute hemodialysis therapy]. / Farmakologický inzult jako prícina "akutního" selhání ledvin s nutností akutní hemodialyzacní lécby.

Acute renal failure is a heterogeneous disease. In advanced countries the incidence of acute renal failure is rising steadily in the elderly population. One of the serious causes of renal failure in this age group are pharmacological preparations and iodine radiocontrast diagnostic substances. It was revealed that also commonly used drugs may have a nephrotoxic potency in subjects with pre-existing renal disease and/or in certain clinical risk situations. In a group of 133 acutely haermodialyzed patients at the medical department we made a detailed clinical and economic analysis of treatment in a group of patients haemodialyzed on account of acute drug induced renal failure. These patients accounted for 28% of all acutely haemodialyzed patients and 65% of them were older than 65 years. The drugs which were involved as the cause or partial cause of renal failure had a negative effect on intrarenal haemodynamics. They comprised in the first place inhibitors of the angiotensin converting enzyme and non-steroid antirheumatic drugs, frequently in combination with diuretics or an iodine contrast substance. A risk factor was preexisting nephropathy defined by the presence of renal perfusion depending on increased formation of angiotensin II and renal vasodialatating prostaglandins. Risk is ascribed also to pathological conditions associated with systemic hypotension and a reduced effective circulating volume. Costs of treatment per patient with drug induced renal failure were calculated as 127,000 Czech crowns. The sum was calculated as the cost of the diagnosis related group.

Toxicity of chromium to activated sludge.

The work deals with the toxicity of hexavalent and trivalent chromium to activated sludge. Cr(VI) was added as K2Cr2O7, and Cr(III) as Cr2(SO4)3. Toxicity is expressed as the inhibition of respiratory activity of microorganisms present in activated sludge. Respiration was measured by two methods, by means of an oximeter with an oxygen electrode and by means of a manometric apparatus permitting continuous observation of biological oxygen demand (BOD). The equation of the normal distribution function was used to construct inhibition curves and to calculate effective concentration (EC50). The influence of exposure time was observed as was the influence of concentration of activated sludge on the value of EC50. The 1-h EC50 for Cr(VI) by the ISO method was determined to be in the range of 40-90 mg/liter. A greater scatter of measured values, 46-201mg/liter, was found for the first hour of exposure by the manometric method. In the case of Cr(III) only combined inhibition by chromium ions and pH was determined. The 0.5-h EC50 was 49 mg/liter.

Influence of clonazepam on cortical epileptic afterdischarges in rats.

Epileptic afterdischarges were induced by low frequency stimulation of the sensorimotor cortex in rats with implanted electrodes. Stimulations were repeated 4 times with 10 min intervals. Stimulation was always accompanied by clonic jerkings of the forepaws and frequently also by rearing and falling of the animals even in cases when no afterdischarge followed. Afterdischarges formed by a spike-and-wave rhythm prevailed, but a transition to spikes superimposed on delta waves ("slow waves superimposed with spikes") as well as a "slow waves superimposed with spikes" type since the very beginning of afterdischarges were recorded. Spike-and-wave afterdischarges were accompanied by the same motor pattern as stimulation, i.e., by minimal clonic seizures. During the "slow waves superimposed with spikes" type of afterdischarges, the rats sat motionless; wet dog shakes appeared towards the end. Mixed types of afterdischarges were accompanied by both motor patterns closely correlated to the actual EEG pattern. Clonazepam (0.02, 0.1 or 1 mg/kg, i.p.) was injected 5 min after the first afterdischarge. The second afterdischarge was shortened in a dose-dependent manner. The shortening was also observed in the third and fourth afterdischarge. Both pure afterdischarge types (spike-and-wave and "slow waves superimposed with spikes") could be induced after clonazepam, whereas a mixed type of afterdischarges was abolished. Motor pattern accompanying stimulation was attenuated but never abolished by clonazepam, whereas the same clonic seizures during spike-and-wave afterdischarges were blocked by the highest dose of clonazepam. Dissociation of EEG and motor epileptic phenomena suggests a preferential action of clonazepam on generalization of epileptic activity.

Effect of exercise on muscle fibre composition and enzyme activities of skeletal muscles in young rats.

Young Wistar rats underwent dynamic (D) or static (S) exercise from the 5th to 35th day after birth. Histochemical and biochemical analysis were performed in the extensor digitorum longus (EDL) and the soleus muscle (SOL). Lactate dehydrogenase (LDH) (regulating anaerobic metabolism) and citrate synthase (CS) and hydroxyacyl-CoA dehydrogenase (HAD) (both regulating aerobic metabolism) activities were determined spectrophotometrically. An increase of the fast oxidative-glycolytic (FOG) muscle fibres was found in the slow SOL muscle in both trained groups, i.e. by 10% in group D and by 7% in group S in comparison with the C group. The EDL muscle fibre distribution did not differ from those of control animals in respect to the slow oxidative (SO) fibre type. A higher percentage of FOG fibres by 19% was found in group D contrary to a decreased number of the fast glycolytic (FG) muscle fibres in this trained group. The greatest increase of CS (EDL 185%, SOL 176%) and HAD (EDL 83%, SOL 178%) activities were found in group D as compared with control group (C). Only small differences were observed in LDH activity. The values of characteristic enzyme activity ratios show that dynamic training resulted in an elevation of oxidative capacity of skeletal muscle, while the static load led preferentially along the glycolytic pathway. It may be concluded that an adaptive response to the training load during early postnatal development is different due to the type of exercise (dynamic or static) and/or the type of skeletal muscle (fast or slow).