Alveolar soft part sarcoma in a child - a case report.

BACKGROUND: Alveolar soft part sarcoma (ASPS) is a very rare mesenchymal malignancy of uncertain origin. It mostly affects young people, with about a quarter of cases being diagnosed in children. CASE: An 11-year-old girl had a painless subcutaneous "lump" in the left elbow area. Imaging exams revealed a solid soft-tissue intramuscular mass of suspicious appearance. A surgical excision of lesion was performed. The biopsy consisted of a lobular tumor measuring 35 × 20 × 12 mm. Histology revealed an epithelioid-cell population arranged in organoid pseudoalveolar pattern. It immunohistochemically expressed TFE3 and harbored the ASPSCR1:: TFE3 gene fusion. A diagnosis of ASPS was established. Subsequently, a wide re-excision of the scar was performed without microscopic residual tumor. The patient is currently without evidence of local recurrence or metastasis. CONCLUSION: ASPS is considered an aggressive and prognostically unfavorable chemoresistant neoplasm. Children have a better prognosis compared to adults. Early detection of tumor in a localized stage with complete surgical removal remains a mainstay therapeutic option. Due to its tendency to late metastases, a long-term thorough follow-up of the patient is necessary.

Thyroid surgery in children: our experience.

INTRODUCTION: Thyroid surgery in children is a rare operation. The aim of our paper is to point out the specifics of thyroid surgery in children. METHODS: Retrospective analysis of patients hospitalized at the Department of Paediatric Surgery, Faculty of Medicine, Comenius University and National Institute of Childrens Diseases in Bratislava during a 10-year period (20072016) who underwent thyroid surgeries. RESULTS: The retrospective analysis included 81 patients: 66 (81%) girls and 15 (19%) boys. The mean age of the patients was 14 years ±8 months (range 418 years). The most common indications for thyroid surgery were: a nodule in 36 (44.4%) patients, Graves Basedow thyrotoxicosis in 19 (23.5%) patients, and suspected thyroid carcinoma in 11 (13.6%) patients. Cervical lymph node metastases (mts) were diagnosed in 9 (11.1%) patients, and distant pulmonary metastases in 5 (6.17%) patients. Total thyroidectomy (TTE) was performed in 43 (53%) patients, total lobectomy (TL) in 20 (24.7%) patients. Extended surgery on regional lymph nodes was performed in 9 (11.1%) patients. Eight (9.9%) patients underwent reoperation. A total of 12 (14.8%) patients experienced postoperative complications. Unilateral transient recurrent laryngeal nerve (RLN) paralysis occurred in 2 patients, and permanent in one patient. Transient postoperative hypoparathyroidism with hypocalcaemia was reported in 8 (9.9%) patients; no permanent condition of this type was observed. CONCLUSION: Multidisciplinary collaboration ensures that optimal surgical results are achieved in the patients. Experience of the surgeon performing thyroid surgery in children remains crucial.

Sentinel lymph node - historical background and current views on its significance in complex management of breast cancer patients.

Nowadays, breast cancer is the leading oncological diagnosis in women worldwide. On the other hand, breast cancer treatment can be considered one of the most progressive therapeutic approach in the medical field of oncology. The invasive types of breast cancer have a tendency to spread via lymphatic route, what brings in the issue of sentinel lymph node - the first node into which the lymph drains from a given anatomical location. This review paper discusses the historical background of the concept of sentinel lymph node and focuses on clinical significance of the positivity of sentinel lymph node(s) as well. Modern-day conservative therapeutic surgery of breast cancer should be in accordance with diagnostic and preventive interventions in the axilla, whose rate of invasiveness and morbidity must be also attenuated without worsening the patient´s prognosis and survival rate. Formerly, a complete axillary lymph node dissection was routinely performed for prophylactic and cancer staging purposes. The indiscriminate application of this approach was replaced by sentinel lymph node biopsy. Along with common histopathological examination, immunohistochemistry, as well as modern techniques of molecular biology are often employed. These state-of-the-art methods enabled the identification of micrometastases, or even nanometastases, though their real prognostic value is yet to be concluded (Ref. 52). Keywords: sentinel node, breast cancer, biopsy, historical background.

[Functional morphology of recently discovered telocytes inside the female reproductive system]. / Funkcná morfológia novo objavených telocytov v zenskom pohlavnom systéme.

Discovery of telocytes has become an important and key challenge in past few years. These cells are interstitial cells extending very long cytoplasmic processes named telopodes, by which they create functional networks in the interstitium of different organs. Telocytes are considered to be connective tissue elements that create contacts among each other, but they also function as intercellular structures, functionally connected with cells of the immune system, neurons and smooth muscle cells. Telocytes can be found also in the different parts of female reproductive system with functions and purpose, which is summarized in our overview. Telocytes regulate for example peristaltic movements in fallopian tubes. The decrease of their number (due to inflammatory disease or endometriosis) causes impairment in transport through fallopian tubes which may result in sterility or tubal gravidity. In uterus they regulate contraction of myometrial smooth muscle (blood expulsion in menstrual phase, childbirth) as well as they contribute in immunological care during embryo implantation. Telocytes probably control also the involution of uterus after delivery. Their function in vagina has not been yet clearly defined; they probably take part in slow muscle contraction movement during sexual intercourse. In mammary glands some scientists suppose their function in control of cell proliferation and apoptosis, that is why, they may play a role in carcinogenesis. In placenta they probably monitor and regulate flow of blood in vessels of chorionic villi and they may be responsible also for etiopathogenesis of pre-eclampsy. All these mentioned functions of telocytes are only in the level of hypothesis and have been published recently. New research and studies will try to answer the questions whether telocytes play a key role in these processes. Our review we completed with some original microphotographs of telocytes in different organs of female reproductive system.

[Complications resulting from osteosynthesis in children after supracondylar fractures of the humerus]. / Komplikácie vyplývajúce z osteosyntézy suprakondylických zlomenín humeru u detí

INTRODUCTION: The authors carried out the analysis of the causes for re-operations after percutaneous osteosynthesis of supracondylar fractures of the humerus in children. MATERIALS AND METHODS: The authors evaluated the complications of osteosynthesis of supracondylar fractures in children hospitalized at the Clinic of Pediatric Surgery, University Hospital in Bratislava, for a 5-year period between 2007 and 2011. From the total number (395) of supracondylar fractures, 372 were treated as closed reduction and percutaneous transfixation. RESULTS: 32 (8.6%) of supracondylar fractures that were treated as closed reduction and osteosynthesis were indicated for re-operation - 8 times for signs of lesion n. ulnaris, 7 times for migration of Kirschner wires, 17 times for non-anatomical status or osteosynthesis failure. In case of lesions of nervus ulnaris, Kirschner wires were eliminated from the ulnar side and replaced either with intramedullary descendently introduced Kirschner wire to the ulnar condyle (the first option) or with three divergent Kirschner wires from radial side (the second option). In case of failed osteosynthesis, reosteosynthesis was performed using three Kirschner wires (two parallel or divergent from the radial side and one through the medial epicondyle). CONCLUSION: During the period monitored, the introduction of a differentiated approach in the treatment of supracondylar fractures of the humerus in children according to the type of fracture and the degree of displacement has significantly reduced the number of reoperations. Subsequently, it is important to notice that the decreased number of reosteosynthesis can be also assigned to the fact that the initial operation is not necessarily carried out as an urgent one (e.g. by a surgical team on night duty), but can be postponed and performed by an experienced traumatological team next day.

[Laparoscopy in the management of invagination in pediatric patients]. / Miesto laparoskopie v liecbe invaginácie u detí.

AIM: During the last decade, many articles on indications, contraindications, benefits and risks of laparoscopic desinvagination procedures in children have been presented in scientific literature. However, this therapeutic procedure has become a standard therapeutic option within the range of pediatric laparoscopic precedures. The aim of the authors was to establish this miniinvasive procedure in their clinic. PATIENTS AND METHODS: From January 2006 to December 2009, the authors operated 19 patients with ileocolonic invaginations, in whom prior hydrostatic desinvagination had failed. 11 pediatric patients underwent laparotomic revision. In 9 subjects, idiopatic invagination was detected, while in 2 subjects secondary intususception caused by a Meckel's diverticle was confirmed during the procedure. In 7 subjects aged 8-51 months, desinvagination was achieved using laparoscopic procedures. 3 ports were used during the procedures--one for optic devices, measuring 10 mm, was placed in the infraumbilical incision and 2 working ports of 5 mm were introduced into the left hypogastrium and the left mesogastrium. The desinvagination was achieved using a grasper and gentle traction on the invaginated colon. In two subjects with relapsing invagination, desinvagination was followed by ileo-coecopexy. In one subject, conversion was required during the laparoscopic procedure, because repositioning of the invaginated colon was not feasible. OUTCOMES: The mean duration of these laparoscopic procedures was 68.6 minutes and no intraoperative complications were recorded. Reallimentation was introduced on the first postoperative day, no reinvagination episodes were recorded and the mean duration of hospitalization was 4.3 days. CONCLUSION: Laparoscopic desinvagination has become a part of the algorithm for the management of invaginations in cases, where conservative approach failed, and should be used before open laparoscopic revision is indicated. However, the miniinvasive procedure must be performed by a surgeon with experience in laparoscopy.

[Long-term results of the treatment of diaphyseal femur fractures in children]. / Dlhodobé výsledky liecby zlomenín diafýzy femuru u detí

PURPOSE OF THE STUDY: Bone overgrowth of the femur after fracture in childhood treated either conservatively or surgically is well documented. The aim of this study was to investigate the frequency of bone overgrowth in childhood fractures treated by elastic stable intramedullary nailing (ESIN), to evaluate it in relation to conservative treatment and to compare its presence in the youngest age categories. MATERIAL AND METHODS: A total of 49 patients, age range 4 to 17 years, with femoral shaft fracture treated in our department by ESIN osteosynthesis between 2001 and 2005 were asked to appear for a follow-up not earlier than one year after the fracture had healed to be examined for the presence of bone overgrowth. The results were statistically analysed and compared with a group of 99 patients treated conservatively (CONS) between 1987 and 1997. RESULTS: In the ESIN group, femoral overgrowth ranging from 5 to 22 mm was found in 15 out of 49 patients. It was most frequent in children up to 6 years of age; with an increasing age overgrowth frequency decreased. In the CONS group, overgrowth was recorded in 30 out of 99 patients and ranged from 4 to 20 mm. Similarly to the ESIN group, it was most frequent in the youngest age category (up to 6 years). In relation to age categories, there were no significant differences in overgrowth values between surgical and conservative treatment. DISCUSSION: ESIN osteosynthesis is currently the most universal method of surgical treatment for long-bone fracture. Although it has undisputable benefits, it may also be associated with longitudinal femoral overgrowth. Children in youngest age categories are often not indicated for ESIN for the fear of bone overgrowth. CONCLUSIONS: The use of ESIN for treatment of femoral fractures in childhood is not associated with a higher risk of long-bone over- growth, as compared with conservative therapy. Moreover, the authors' experience shows that the method of retrograde insertion of osteosynthetic material is safe even in distal diaphyseal fractures and does not increase risk of bone over- growth.

[Acute scrotum is a condition requiring surgical intervention]. / Akútne skrótum je stav vyzadujúci chirurgickú intervenciu.

UNLABELLED: Acute scrotum (AS) is a clinical syndrome, in which authors indicate a surgical exploration of the scrotum. We retrospectively analyzed the group of 354 patients in 10 years (1997-2006) to compare the preoperative findings with the diagnosis of surgical exploration. The aim was to actualize diagnostics and therapeutic management. PATIENTS AND METHODS: We focused on the age of patients, incidence of nosological units of AS and preoperative and surgical diagnosis. RESULTS: 334 boys were operated on from the whole group - 354 patients. Most frequent incidence of AS was in the age group 8-12 (55%). Torsion of testicular appendix or epididymis is the most frequent cause of AS in our group - 204, 59%. In this group of patients ultrasound confirmed the diagnosis only in 120 patients, 65%. Testicular torsion was managed in 74 boys (30 neonates), in 40 of them we decided, mostly at the second look operation after 48-72 hours, for testicle ablation caused by the organ avitality. In all patients with testicular torsion ultrasound confirmed the diagnosis, 100%. In 10 boys we found testicular tumor. In the group of 334 patients operated on, there were no serious complications. DISCUSSION: Testicular torsion and tumor are the units in which the surgical exploration is performed without discussion. Beside that, torsion of the testicular or epididymic appendix is the most frequent occurring diagnosis. There is a group of surgeons, who performed in this unit conservative management. CONCLUSIONS: after the analysis of the group of our patients we actualized the guidelines used in the management of AS in children. Urgent surgical exploration in boys with AS still seems to be the method of choice.

[Use of allogenous material in the management of spina bifida aperta]. / Pouzitie alogénneho materiálu pri riesení spina bifida aperta.

AIM: "Conditio sine qua non" in the management of open neural tube defects includes closure of all layers with as minimum as possible tension left within the suture region, in order to prevent early, as well as long-term postoperative complications. In extensive fascial defects, the authors used the Gore-Tex patch as an alternative to myofascial or fasciocutaneous flaps. PATIENTS AND METHODS: From January 2004 to January 2008, 23 patients suffering from open spina bifida underwent surgery in the Bratislava Pediatric Surgery Centre. In 17 subjects, the fascia was sutured following a myofascial release, in 2 subjects the suture was secured with tissue adhesive. In 4 subjects, the Gore-Tex patch was implanted to secure the "tension free" plasty; the Gore-Tex Dual Mesh was used in 2 subjects as well as the Gore-Tex Spinal. RESULTS: Two subjects, who had the Gore-Tex Dual Mesh implanted, developed sequestration of the implant during the late postopertive period. Upon reoperation, the authors removed the Gore-Tex Dual Mesh in the both subjects. However, they found a firm fibrous membrane, which was considered sufficient to protect the dural sac. On the contrary, the both subjects who had the Gore-Tex Spinal implanted, healed with no complications recorded. CONCLUSION: Based on the experience, the Gore-Tex Dual Mesh, although implanted lege artis, does not appear a suitable material for fascia replacements in open spina bifida plastic procedures. Further experience will give more evidence, whether Gore-Tex Spinal would be a suitable alternative, however, the courses in the 2 subjects have hitherto been encouraging.

Perinatal traumatism with gastroschisis.

Authors analyse 11 cases of perinatal traumatism in a group of 110 patients with gastroschisis during a period of 25 years. They point out its causes and consequences. To minimize perinatal traumatism, it is necessary to conduct suitable prenatal and perinatal management. In spite of preferring Caesarean section there are no differences between vaginal and Caesarean delivery when the delivery is properly managed (Tab. 1, Fig. 3, Ref. 12). Full Text (Free, PDF) www.bmj.sk.

Ischemia-reperfusion injury--antiarrhythmic effect of melatonin associated with reduced recovering of contractility.

The effect of melatonin on reperfusion arrhythmias and postischemic contractile dysfunction was studied in the isolated rat heart. 25 min global ischemia was induced and followed by 30 min of reperfusion. Melatonin (10 micromol/l) was present in the perfusion solution during the whole experiment. Experiment revealed protective effect of melatonin on reperfusion-induced arrhythmias--arrhythmia score was significantly lower as well as the total time of arrhythmias duration was significantly shorter in melatonin group than in controls. On the other hand, post-ischemic recovering of contractility was significantly reduced in melatonin group.

2,3-diphosphoglycerate and oxygen supply of tissues in cardiosurgical diabetics.

THE MAIN AIM OF THE STUDY: The oxygen supply of tissues was studied under haemodilution in cardiosurgical diabetic and non-diabetic patients. METHODS: There were 30 cardiosurgery patients examined, 9 were patients with diabetes mellitus.and 21 were non-diabetic patients. Venous blood samples were examined preoperatively, intraoperatively and for 10 days after operation. RESULTS: Haemodilution caused a decrease in haematocrit values in both groups, as well as in the erythrocyte count and haemoglobin concentration. Postoperatively, an increase was recorded in haematological values in both groups, the values had not reached the baseline even by 10th day. Increased values of blood oxygen saturation and partial oxygen pressure during the operation returned to baseline in both groups in the postoperative days. Values of p50 did not change in both groups for the period of observation. CONCLUSION: The obtained data suggest that sufficient oxygen supply to tissues was ensured under haemodilution in cardiosurgery patients in both groups. These results confirm multifactorial dependence of blood oxygen transport to tissues (Tab. 1, Fig. 3, Ref. 13).

[Melatonin and the heart]. / Melatonín a srdce.

Evidence gathered during the last years shows that the pineal hormone melatonin participates in the regulation of the heart. Melatoninergic receptors were found in the heart and vessels and also in the higher centers involved in the regulation of cardiovascular system. Melatonin protects the heart against ischaemia-reperfusion injury and also against cardiotoxic effects of adriamycin and alloxan. Lack of melatonin was repeatedly reported in patients with coronary heart disease. Intake of this hormone leads to decrease of blood pressure in normotensive and hypertensive subjects, while pinealectomy induces hypertension. In addition melatonin can probably influence the levels of intracellular calcium in cardiomyocytes. The aim of this review is to summarize available evidence about effects of melatonin on the heart. Mechanisms involved in these effects are also suggested.

The assessment of erythrocyte deformability by filtration rate.

The aim of the study was to monitor the erythrocyte deformability as one of important factors securing the appropriate tissues perfusion in healthy subjects and diabetic patients with insulin dependent diabetes mellitus. Erythrocyte deformability was determined by the method of filtration and centrifugation, and the erythrocyte filtrability was calculated as a percentage of filtered erythrocytes out of the number of erythrocytes counted before centrifugation. Diluted blood suspensions were filtered by centrifugation through membrane filters with pores of 5 microm in diameter. The speed and duration of centrifugation of 1400 rpm and 5 min respectively were selected as the best ones for filtration due to the lowest value of the coefficient of variance. The values of the arithmetic mean and standard deviation of erythrocyte filtrability were 72.2 +/- 7.9% in normal subjects. In the group of diabetic patients with the long history of insulin therapy the values amounted to 69.1 +/- 4.4%. In diabetic patients, the average value of blood glucose was 11.7 mmol x L(-1), and the glycated haemoglobin concentration reached 9.04%. From the viewpoint of reference values, these facts indicate good compensation of diabetes mellitus. Other haematological values, namely erythrocyte count, haematocrit value, haemoglobin concentration and mean cell volume were within normal reference ranges. No difference between the groups of healthy subjects and diabetic patients was found. (Fig. 4, Ref. 18.)

Effect of melatonin on the isolated heart in the standard perfusion conditions and in the conditions of calcium paradox.

UNLABELLED: The effect of melatonin (MLT) on the isolated rat heart was studied using the standard perfusion conditions (Langendorff preparation) and model of calcium paradox (Ca(2+)-paradox). Ca(2+)-paradox was induced by 1 minute perfusion with Ca(2+)-free Krebs-Henseleit (KH) solution and subsequent 20 minutes perfusion with a normal Ca(2+)-containing KH solution. In MLT group, MLT (10 micromol/l) was in the perfusion solution throughout the experiment. In controls, there was no MLT. VARIABLES: heart rate, coronary flow, systolic and diastolic pressure, +dP/dt max (index of contractility) and -dP/dt max (index of relaxation) were measured at the end of stabilization, i.e. after 30 minutes of standard perfusion and then in the 5th, 10th, 15th, 20th minute after perfusion with Ca(2+)-free KH solution. RESULTS: There was no difference between MLT group and controls in the standard perfusion conditions at the end of stabilization. After perfusion with Ca(2+)-free KH solution, systolic-diastolic difference (in the 10th, 15th, 20th minute), +dP/dt max (in the 5th, l0th, 15th, 20th minute) and -dP/dt max (in the 15th minute) were significantly decreased in MLT group in comparison to controls. CONCLUSION: Melatonin didn't influence rat isolated heart in standard perfusion conditions but it made the heart more susceptible to Ca(2+)-paradox.

The effect of selected membrane active substances on erythrocyte deformability.

Aminoguanidine improved the erythrocyte filterability by 4%, pyridoxyliden-aminoguanidine by 11% and pyridoxal by 13% in healthy subjects. In diabetic patients the aminoguanidine effect on erythrocyte filterability was improved by 7%, PAG effect by 9% and pyridoxal effect by 15% in comparison to the control group. The other investigated haematological variables in both groups were within the range of the physiological standard. All of the tested substances demonstrated a mild protective influence on erythrocyte elasticity both in healthy subjects and diabetic patients. Significant elasticity improvement was obtained only by pyridoxal (p<0.01) in patients with diabetes mellitus. (Fig. 4, Ref. 18.).

[The founding and beginnings of the Institute of Physiology at the Medical School of Comenius University in Bratislava (1924-1939)]. / Vznik a zaciatky Fyziologického ústavu LF UK v Bratislave (1924-1939).

The article deals with the history of foundation and beginnings of the Institute of Physiology of the Medical Faculty of Comenius University in Bratislava. In the school year 1924/25, after the Czechoslovak state university had been founded, the Physiological Institute began its work. The first director was prof. MUDr. Antonín Hanák. Under his leadership the basis of pedagogical and scientific activities in the Institute was established. In the school year 1926/27, Institute moved into the newly built rooms in Sasinková street No 2, where it has been located ever since. Professor Hanák had been working in Bratislava since 1924 till 1930. After his walk-off to Praha, professor MUDr. Vilém Hons became the head of the Institute. In the school year 1936/37 he was elected the dean of the Medical Faculty of Comenius University. He worked in Bratislava till 1939, when he was suspended from the service in the Slovak schools. Both Czech professors founded firm basis of physiology as a subject matter and as a scientific discipline in Slovakia.

Correlation of carnitine levels to methionine and lysine intake.

Plasma carnitine levels were measured in two alternative nutrition groups--strict vegetarians (vegans) and lactoovovegetarians (vegetarians consuming limited amounts of animal products such as milk products and eggs). The results were compared to an average sample of probands on mixed nutrition (omnivores). Carnitine levels were correlated with the intake of essential amino acids, methionine and lysine (as substrates of its endogenous synthesis), since the intake of carnitine in food is negligible in the alternative nutrition groups (the highest carnitine content is in meat, lower is in milk products, while fruit, cereals and vegetables contain low or no carnitine at all). An average carnitine level in vegans was significantly reduced with hypocarnitinemia present in 52.9% of probands. Similarly, the intake of methionine and lysine was significantly lower in this group due to the exclusive consumption of plant proteins with reduced content of these amino acids. Carnitine level in lactoovovegetarians was also significantly reduced, but the incidence of values below 30 micromol/l was lower than in vegans representing 17.8% vs. 3.3% in omnivores. Intake of methionine and lysine was also significantly reduced in this group, but still higher compared to vegans (73% of protein intake covered by plant proteins). Significant positive correlation of carnitine levels with methionine and lysine intake in alternative nutrition groups indicates that a significant portion of carnitine requirement is covered by endogenous synthesis. Approximately two thirds of carnitine requirement in omnivores comes from exogenous sources. The results demonstrate the risks of alternative nutrition with respect to the intake of essential amino acids, methionine and lysine, and with respect to the intake and biosynthesis of carnitine.

[Oxygen transport values in patients with surgery performed under extracorporeal blood circulation]. / Hodnoty parametrov transportu kyslíka u pacientov operovaných v podmienkach mimotelového krvného obehu.

The aim of the work was to study the O2-transport changes to tissues in cardio-surgical patients suffering from CAD and operated during extra-corporeal blood circulation (ECC). The changes of selected haematologic variables, 2,3-diphosphoglycerate (2,3-DPG) and ATP concentration, acid-base balance parameters with p50 calculation were measured in the venous blood samples taken before the operation, during the operation and on the 1st, 2nd, 3d, 5th, 7th and 10th day after the operation. From the obtained results follows, that extreme haemodilution causes significant decrease of the haematocrit value (Htc) by 35%, the value of haemoglobin (Hb) by 37% and the count of erythrocytes (Er) by 37% from the initial values. The count of reticulocytes (Ret) was increased by 52%. In the days after operation the increase in Htc values, the values of Hb and count of erythrocytes was observed, whereby the initial values were not reach even on the 10th day after the operation. The increase of the reticulocytes count by 33% prevailed to the 10th day after the operation in comparison with the initial values. 2,3-DPG concentration was increased between 3d and 10th day after the operation by 30% and ATP concentration between 5th and 10th day was increased by 23% from the initial values. Hb-O2 saturation (SpO2) and pO2 were increased already during the operation, the increase prevailed until the 7th day by 27%, pO2 until the 3d day by 39% from the initial values. Calculated values p50 did not change in the course of this study--they fluctuated in range +/- 0.04 kPa from the initial value 3.55 kPa. Supposing multifactorial character of Hb oxygenation and deoxygenation process it is possible to conclude, that the determined changes of observed parameters did not significantly influence O2-transport to tissues during ECC. (Fig. 3, Ref. 12.)

[Hemodynamics, lymphatic circulation and ultrastructure of the lungs during hemodilution with blood substitutes]. / Hemodynamické pomery, lymfatická cirkulácia a ultrastruktúra pl'úc pocas substitucnej hemodilúcie.

The effect of substitution hemodilution on transcapillary fluid exchange in the lung was studied in experiments on 30 dogs. After administration of Ringer's solution and of oncotic solutions (3.4% and 10% Rheodextran), the lymph flow through the right lymphatic trunk was measured and the protein content in the lymph was determined. The obtained results were compared with electron micrographs of the lung. Ringer's solution was found to escape rapidly from the vascular bed. A 3.9-fold increase in lymph flow was recorded and edematous changes were observed in the interstitial space. Administration of 10% Rheodextran induced an 8.3-fold increase of lymph flow and enhanced also the protein transport in the lymph. The permeability of pulmonary endothelial vascular walls was deranged. Isooncotic 3.4% Rheodextran provided adequate transcapillary exchange of fluids in the lungs and proved to be the suitable solution for substitution of blood losses. In the ultrastructure of the lungs no pathological changes were observed. (Fig. 8, Ref. 33).