Soluble adhesion molecules and cytokines in patients with myasthenia gravis treated by plasma exchange.

Plasma exchange (PE) is an effective therapeutic method used in patients with myasthenia gravis (MG) refractory to common therapy and/or with life-threatening respiratory complications. Except for acetylcholine receptor antibodies (AChRAbs), some other inflammatory mediators possibly activated in MG may also be removed during PE. Serum levels of soluble adhesion molecules (sICAM-1 and sVCAM-1), IL-6 and soluble receptors for IL-2 (sIL-2R), IL-6 (sIL-6R) and TNF alpha (sTNF-R II) were measured in 20 MG patients assigned to treatment with PE. On the basis of the serum levels of AChRAb the patients were subdivided into 2 groups (8 patients with low AChRAb, 12 patients with high AChRAb). Soluble adhesion molecules and cytokines were measured before the first and last PE, at the end of the first PE and in the samples of plasma filtrate obtained during the first PE. Before the first PE patients with MG had higher serum levels of sICAM-1, sVCAM-1, sIL-2R and sTNF-R II than controls. Both after the first PE and during the course of PE, a substantial decrease in serum levels of AChRAb, sICAM-1 and sVCAM-1 was recorded. However, serum levels of sIL-2R and sTNF-R II were not significantly influenced by either a single treatment or during the course of PE. There were high levels of AChRAb, soluble adhesion molecules and soluble cytokine receptors in plasma filtrates too. Patients with high circulating AChRAb had higher serum levels of sICAM-1 and sVCAM-1 than patients with low AChRAb. Increased serum levels of soluble adhesion molecules and soluble cytokine receptors in patients with MG suggest some systemic activation of the immune response which is more pronounced in patients with high circulating AChRAb. PE led to the decrease in serum AChRAb and soluble adhesion molecules due to their effective filtration but, on the other hand, serum levels of soluble cytokine receptors were not influenced by PE, in spite of their effective filtration which is probably counteracted by their increased production, possibly stimulated by the contact of the blood with the synthetic membrane.

[Unexpected major perioperative blood loss (case analysis)]. / Neocekávané velké perioperacní krevní ztráty (Rozbor kazuistik).

In this study we are discussing a necessity of sufficient monitoring and therapy of unexpected perioperative massive blood loss, which a case of 4 of our patients. Cell saver system wasn't available. Complete monitoring system maximum intensive care and a broad substitution is essential in these cases. We have pronounced the influence of massive blood loss on multiorganic postoperative failure as well as a necessity of sufficient time of an intensive care.

Remodeling in myocardial infarction and body surface potential maps.

This study deals with the capabilities of body surface integral and departure maps to evaluate the chronic stage of myocardial infarction based on dividing the left ventricle into 12 segments. The effects of ventricular remodeling on electrocardiographic potential distributions are considered. A 61-year-old male patient was examined five times by body surface potential mapping during a period of 9 months after acute myocardial infarction. Integral maps were calculated for 60 ms after QRS onset and compared with mean data from a control group using departure maps. Integral maps showed a continual reduction of negative potentials in the lower half of the torso with time. The negative area covered the lower torso in the departure maps during the whole study, but its form and value changed. According to the location of the departure area, the surface projection of the scar moved from a position corresponding to inferior segments to a position corresponding to posterior segments. Its size also decreased. Echocardiographic examinations showed progressive enlargement of both ventricles with time. Therefore, the authors postulate that the changing pattern of body surface potential maps was mainly influenced by ventricular remodeling after myocardial infarction.

Body surface isochrone maps of peak R in normal adolescent girls.

The aim of our study was to evaluate the adequacy of a new mapping device for obtaining a reliable set of normal maps characteristic for this approach. We studied body surface isochrone maps of peak R in four healthy adolescent girls using the mapping system CARDIAG 128.1 with 80 unipolar leads placed in a regular grid. The constructed maps were compared with published data using 10 criteria. None of the maps obtained could be regarded as normal. After evaluating the reasons for the "abnormality", we assume that they could be caused mostly by the processing of signals. This fact can be eliminated by improving the existing software.

[Possibilities of measurement of obstruction in status asthmaticus]. / Moznosti merení obstrukce u status asthmaticus.

Basic treatment of status asthmaticus comprises among others the use of artificial pulmonary ventilation with all advantages and risks. The authors tried to express objectively the extent of obstruction of the airways from the relationship of ventilation parameters obtained from a display unit of Siemens Elema 900C ventilator and the period of intubation. Based on the investigated parameters, the inspiration pressure, the median intrathoracic pressure and pulmonary compliance, they assessed the correlation coefficient, using a computer. The value of the coefficient is postulated as the extent of obstruction. It can be also used for evaluation of the therapeutic effect and as a prognostic factor.

[The effect of corticoids on bone tissue in myasthenia gravis]. / Vliv kortikoidu na kostní tkán u myasthenia gravis.

Myasthenia gravis is an autoimmune disease where corticoids are the basis of therapy. They are taken for short periods in large amounts, as well as for prolonged periods in medium or small doses. The authors investigated in the described groups the effect of corticoids on bone tissue. They provided evidence of a significant effect on the diffraction pattern, geometrical arrangement of the apatite grid and ion changes in relation to the period of corticoid administration without significant clinical manifestations of osteoporosis, when respecting therapeutic principles.

[Myasthenia gravis treated with plasmapheresis]. / Myasthenia gravis lécená plazmaferézou.

Therapeutic plasmapheresis is nowadays the method of choice in severe cases of myasthenia gravis. The authors confirm the therapeutic effect of this method and emphasize its importance in the differential diagnosis of severe cases where myasthenia gravis is suspected only from clinical symptoms, and electromyographic, roentgenological and laboratory evidence (antibodies against acetylcholine receptors) is lacking. The mentioned procedure led to thymectomy with the finding of a tumour of the thymus within three and a half months after the development of the first symptoms of the disease.

[Desmoid fibromatosis in absorption infrared spectroscopy, emission spectral analysis and roentgen diffraction recording]. / Desmoidní fibromatóza v absorpcní infracervené spektroskopii, emisní spektrální analýze a v rentgenovém difrakcním záznamu.

The authors present results of serial quality and quantity microanalyses of bone patterns and dental tissue patterns in patient with desmoid fibromatosis. Methods of absorption spectroscopy, emission spectral analysis and X-ray diffraction analysis with follow-up to x-ray examination are tested. The above mentioned methods function in a on-line system by means of specially adjusted monitor unit which is controlled centrally by the computer processor system. The whole process of measurement is fully automated and the data obtained are recorded processed in the unit data structure classified into index sequence blocks of data. Serial microanalyses offer exact data for the study of structural changes of dental and bone tissues which manifest themselves in order of crystal grid shifts. They prove the fact that microanalyses give new possibilities in detection and interpretation of chemical and structural changes of apatite cell.

[Mechanical irrigation and selective decontamination in critically ill patients]. / Mechanická irigace a selektivní dekontaminace u kriticky nemocných.

The authors debugged and launched into routine operation an automated monitoring system using computer techniques. Working off-line, they monitored microbiological, immunologic and biochemical parameters of mechanical irrigation of the mouth and selective decontamination of the gastro-intestinal tract. They ran and classified the data concerned into two index-sequence subsets defined on a set of patients treated with artificial pulmonary ventilation and patients with reduced defenses, and/or corticoid-dependent patients with myasthenia gravis. At present, they study basic sets, representative enough to permit the statistically significant examination of all the parameters under study as well as their exact interpretation with regard to the efficiency of the therapeutical strategy chosen.