Preventive administration of Clopidogrel after restoring patency of acute dialysis fistula with surgical thrombectomy.

Dialysis fistula thrombosis is the most common and dangerous complication which prevents proper dialysis therapy. The aim of this paper was to evaluate the influence of Clopidogrel on the incidence of early secondary thrombosis complications after restoring patency of fistula with surgical thrombectomy. The study included 30 patients. In 24 patients the method of surgical thrombectomy proved to be effective and they received a preventive dose of Clopidogrel [75 mg per 24h] for 28 days. In none of the patients early secondary thrombosis was recorded. Late secondary complications occurred in 11 patients 3 to 14 months after the surgical procedure. Treating acute thrombosis with surgical thrombectomy by means of Fogarthy catheter is still the most available and least expensive therapeutic method. Clopidogrel contributed considerably to the elimination of early secondary thrombosis complications in treated fistula.

Preventive effects of Ticlopidine on the incidence of late A-V fistula thrombosis complications in haemodialyses patients.

Development of dialysis therapy over the last decade caused considerable increase in the number of patients receiving haemodialyses as kidney substitution therapy. However, a wider use resulted in greater number of A-V fistula complications. Uraemia patients were reported to develop plasmatic and platelet haemostasis disorders which provoke dialysis fistula thrombosis. The aim of the paper was to answer how Ticlopidine affected decrease in the number of late thrombosis complications in freshly created A-V fistula. The study included 60 patients, 30 of whom were given Ticlopidine (125 mg twice every 24h). The other 30 patients constituted the control group and did not received the drug. The follow-up lasted 27 months. It was concluded that preventive administration of Ticlopidine significantly reduces the extent of late thrombosis complications.

Chronic dialysis fistula thrombosis treatment by means of endovascular recanalization with surgical exclusion of developed collateral circulation.

Fistula thrombosis is the most common and dangerous complication resulting in vascular access insufficiency. The most "tricky" lesion of dialysis fistula is chronic thrombosis which occurs when only a short section of efferent vein becomes clotted and collateral circulation enabling further, limited in time functioning of dialysis fistula is created. In 7 chronic thrombosis patients subjected to treatment by means of endovascular recanalization, developed collateral vessels were surgically ligated to obtain single-canal blood flow. The recanalization procedure involved making a puncture, inserting a guide wire and performing balloon angioplasty. Simultaneously, 2 or 3 collateral veins were incised and ligated. The result obtained in all the 7 cases was considered successful as all fistulas remained a 100% patent 6 months after the procedure.

The usefulness of thyroid size and TSH receptor antibody (TRAb) determinations in predicting the effectiveness of tiamazole and I-131 treatment for Graves-Basedow's disease.

UNLABELLED: The aim of the study was to assess the usefulness of determining the thyroid size, TRAb level and their correlation as markers for predicting the effectiveness of conservative treatment in Graves-Basedow's disease. The study included 100 patients with Graves-Basedow's disease; group I treated with thiamazole, group II treated with 131I. The biggest thyroid size, x -42.09+/-13.94ml, was found in the group unsuccessfully treated with thiamazole and was statistically significant compared to that in the euthyreosis group, x -31.65+/-11.74ml (p<0.01) and controls x -14.45+/-2.37ml (p<0.001). It is noteworthy that the initial TRAb level in the group with persistent hyperthyroidism was higher (x -54.39+/-31.21 U/I) than that in the euthyreosis group (x -29.13+/-19.44 U/I) and controls (x -2.75+/-2.06 U/l), p<0.001 for both parameters. Elevated antibody levels were also found after 12 and 18 months of treatment. Moreover, in the 131 I patients, the biggest thyroid size before iodine administration was found in the group with persistent hyperthyroidism, x -56.56+/-24.19 ml. It was statistically significantly different compared to the thyroid size in the euthyreosis patients x -37.922+/-20.69 ml (p<0.001) and in the hypothyreosis patients, x -43.47+/-18.09 ml (p<0.05). Before 131I administration, the highest antibody levels were observed in the group with persistent hyperthyroidism, x -103.61+/-43.90 U/I (p<0.001) compared to euthyreosis, hypothyreosis and control groups. The significance of differences in TRAb levels in the examined groups was still observed 18 months after 131I administration. In the groups of patients treated with thyreostatics and radioactive iodine, the positive correlation between the thyroid size and TRAb level was found before as well as 12 and 18 months after the onset of treatment. CONCLUSIONS: 1.The TRAb levels and thyroid sizes are important parameters that should be considered in predicting the effectiveness of treatment. 2. The TRAb level correlates with the thyroid size.

Changes in TSH receptor antibody levels (TRAb) as markers of effectiveness of various therapies in Graves-Basedow's disease.

The aim of the study was to evaluate the usefulness of TRAb determinations in predicting and monitoring the effectiveness of various forms of treatment in Graves-Basedow's disease. 144 patients with Graves-Basedow's disease aged 18-76 years, x-44 were studied. Group I--54 patients treated with methizole, group II--45 patients treated with 131 I, group III--45 patients subjected to operative procedures. The TSH receptor antibodies were determined using the radioimmunoassay (TRAK-assay, Henning). The examinations were performed before, 12 and 18 months after treatment. Irrespective of the treatment type, the highest initial TRAb values were observed in the groups of patients with ineffective treatment (thiamazole x- 54.39+/-31.23 U/l, radioiodine x- 103.61+/-43.90 U/l, operative procedures x- 104.00+/- 52.34 U/l). During the 12-month follow-up of the patients subjected to surgery and 18-month follow-up of those undergoing conservative treatment, the level of antibodies did not normalize (x- 40.17+/-33.06, x- 77.18+/-44.92, x- 58.77+/-54.67, respectively). In the groups with effective treatment, the TRAb levels normalized. 1. The level of TSH receptor antibodies is a good marker for monitoring the effectiveness of treatment in Graves-Basedow's disease. 2. The high initial antibody level, irrespective of the kind of treatment instituted, is a bad prognostic feature. 3. The TRAb determinations performed 12 months after the institution of treatment also show some prognostic value. 4. The lack of normalization of antibody levels during treatment is associated with persistent hyperthyroidism, irrespective of the form of therapy.

[Antibodies against TSH receptors (TRAb) as indicators in prognosing the effectiveness of Tiamazol therapy for Grave's Disease]. / Przeciwciala przeciw receptorom TSH (TRAb) jako wskaznik w prognozowaniu skutecznosci leczenia tiamazolem choroby Gravesa-Basedowa.

The aim of the study was to evaluate the usefulness of TRAb determinations in prognosing and monitoring the efficacy of conservative treatment in Graves' disease. The examinations were performed in 54 patients. During the 18-month observation all the patients were treated with Tiamazol. The control group consisted of 20 healthy volunteers. The TRAb levels were determined before as well as 12 and 18 months after thyrostatic treatment. Simultaneously, the levels of TSH and FT4 were analysed. Moreover, all the patients underwent ultrasound examinations to assess the size of the thyroid gland. The findings of the 18-month follow up showed that in 31 patients (57%) the thyroid function became normal (group I--euthyreosis), in 23 patients (43%) hyperactivity persisted (group II--hyperthyreosis). The TRAb levels were analysed in both groups of patients. An increased initial level of TRAb was found in the hyperactivity group mean -54.39 + 31.21 U/l which was statistically significantly different from the TRAb levels in the euthyreosis group mean -29.13 +/- 19.14 U/l and in controls mean -2.75 +/- 2.06 U/l (p < 0.001 for both parameters). After 12-month treatment increased values of antibodies were still observed in this group of patients (mean -39.96 +/- 33.40 U/l) in comparison with the euthyreosis group (mean -9.87 +/- 8.33 U/l) and controls (mean -2.75 +/- 2.06 U/l) (p < 0.001 for both parameters). After 18-month treatment the TRAb levels in group II remained increased (mean -40.17 +/- 33.06) while in group I normal levels were achieved. The sizes of the thyroid gland were compared between the individual groups. In the hyperactivity group after 18-month treatment, the thyroid size was the biggest (mean -41.09 +/- 13.94 ml) and was statistically significantly different when compared to the average size in the euthyreosis group mean -31.65 +/- 11.74 ml (p < 0.01) and in controls mean -14.45 +/- 2.37 ml (p < 0.001). The levels of antibodies against TSH receptors are useful parameters in prognosis and monitoring the treatment effectiveness in Graves' disease. High initial levels of antibodies are the poor prognostic factors. The TRAb determinations are of some prognostic value not only before but also 12 months since the onset of therapy. The lack of antibody level normalization during treatment is connected with persisting hyperactivity. The TRAb concentration correlates with the thyroid size.

[Thyrotropin receptor antibodies (TRAb) as a test of surgical treatment effectiveness in Graves-Basedow's diseases]. / Przeciwciala przeciw receptorom TSH jako test skutecznosci leczenia operacyjnego w chorobie Gravesa-Basedowa.

The aim of the study was to assess the relations between the concentration of antibodies against TSH receptors (TRAb) and the outcome of the surgical treatment in Graves-Basedow's disease. The studies were performed in 30 patients (age range--18-50, mean -37) operated on for Graves-Basedow's disease and in 20 healthy controls. In control group, the TRAb concentration was mean -2.75 +/- 2.06 U/l, the TSH mean -1.06 +/- 0.53 mlU/l, and FT4 mean -14.71 +/- 2.15 pmol/l. The thyroid volume was mean -14.45 +/- 2.37 ml. In the group operated on antibody concentration was determined before and 12 months after the surgery. The TSH and FT4 concentrations were also determined before and 12 months after the operation. Moreover, the size of the thyroid remnant was assessed ultrasonographically 12 months after the procedure. The results showed the effectiveness of the surgical treatment, i.e. hyperthyroidism was not observed in 22 out of 30 patients. Among these 22 patients, euthyreosis was found in 14 cases (46%) and hypothyreosis was observed in 8 cases (27%). In the euthyreosis group, the pre-operative TRAb concentration was mean -24.00 +/- 11.04 U/l. 12 months after the operation, the decreased levels of antibodies were found in 13 patients (mean -6.14 +/- 5.71 U/l). In the hypothyreosis group, the pre-operative TRAb concentration was mean -24.50 +/- 10.43 U/l. After the surgical procedure, TRAb levels were normal in all patients, the average values being 2.13 +/- 1.34 U/l. In 8 patients with recurrent hyperthyroidism (27%), TRAb concentration before the surgery was higher, mean -107.25 +/- 56.69 U/l. 12 months after subtotal strumectomy, the patients in this group still did not show normal TRAb levels (mean -54.25 +/- 51.61 U/l). Moreover, the relations between the size of the thyroid remnant and the TRAb level were evaluated. In the group with recurrent hyperthyroidism and high TRAb levels, the thyroid size (volume) left was mean -12.10 +/- 6.25 ml, in the euthyreosis group mean -5.54 +/- 2.23 ml, while in the hypothyreosis group it was mean -4.86 +/- 1.14 ml.

Application of scintigraphy MDP 99 mTc in the diagnosis of osteoarticular pains of obscure etiology.

The three-phase scintigraphy of bones is useful in detecting disorders of bone tissue perfusion metabolism in patients with the occult etiology of joint pains. The bone scintigraphy with application of MDP plays the main role in the orthopaedic diagnosis. It is of the greatest importance when radiograms are not normal. In spite of application of the other modern methods it is the technique of choice in the early diagnosis.