Comparison of narrow-band imaging with autofluorescence imaging for endoscopic detection of squamous cell carcinoma of the tonsil.

PURPOSE: Early detection of mucosal neoplastic lesions is crucial for a patient's prognosis. This has led to the development of effective optical endoscopic diagnostic methods such as narrow band imaging (NBI) and autofluorescence (AFI). Independent of each other, both of these methods were proven useful in the detection of mucosal neoplasias. There are limited reported data comparing both methods for oropharyngeal cancer diagnostics. The aim of the study was to compare NBI and AFI endoscopic visualization of signs in identifying tonsillar squamous cell carcinoma (SCC) and assessing its extent and to determine whether the score was related to the evaluator's experience. METHODS: Patients with tonsillar SCC underwent endoscopic pharyngeal examination using NBI and AFI. Fiftyseven video sequences of examinations of lesions proven to be SCC were evaluated by three reviewers. The accuracy of determination of lesion extent and visualization of its endoscopic signs of malignancy were evaluated. RESULTS: Endoscopic visualization of tumour spread was significantly better using AFI than NBI (p = 0.0003). No significant difference was found between NBI and AFI in the visualization of endoscopic malignancy determining signs (p = 0.1405). No significant difference was found among the three reviewers in the visualization of tumour spread and for identifying malignancy-determining signs in NBI endoscopy or AFI endoscopy. CONCLUSIONS: The results show that AFI obtained better results for assessing the extent of tonsillar cancers than NBI. Both methods were proven to be equal in the visualization of endoscopic malignancy-determining signs. Both are useful even for less experienced evaluators.

[S-100B protein elevation in patients with the acute coronary syndrome after resuscitation is a predictor of adverse neurological prognosis]. / Elevace proteinu S-100B u pacientu s akutním koronárním syndromem po resuscitaci je prediktorem nepríznivé neurologické prognózy.

INTRODUCTION: The annual incidence of out-of-hospital cardiac arrest is around 90-190 cases per 100 000 inhabitants. The limiting factor for further prognosis of patients after out-of-hospital arrest is their neurological status. The S100B protein is mainly the nervous system cells product, its glial-specific and mostly expressed by astrocytes. It has been shown that after circulatory arrest its increased level correlates with the prognosis of patients. Work aims to determine the level of protein S100B in the group of patients with acute myocardial infarction without circulatory arrest, and compare it to the value in patients with acute myocardial infarction after out-of-hospital resuscitation. METHODS: 24 patients were evaluated after out-of-hospital resuscitation for the malignant arrhythmias during acute coronary syndrome (ACS). All patients were treated with mild therapeutic hypothermia. The control group consisted of 19 patients with ACS. The sample for the determination of S-100B was taken immediately on admission. Neurological status was evaluated according to the CPC scores (Cerebral Performance Categories) at discharge, patients were divided into 3 groups: CPC1 - good condition, CPC2 - moderate neurological disability, CPC3-5 - serious neurological impairment, coma or death. RESULTS: The values of protein S-100B fluctuated, in patients with no resuscitation, in range between 0.038 to 0.204 pg/ml. In patients after resuscitation without subsequent neurological disability (CPC 1) was range 0.077 to 0.817 pg/ml, in patients with moderate to severe neurological disability (CPC 2) was range 0.132-2.59 pg/ml, patients with severe neurological disabilities or deaths had S-100B levels from 0.70 to 8.53 pg/ml. According to ROC analysis we found the cut-off value for the S-100B. Cut-off value for probably a good neurological condition is < 0.23 pg/ml (specificity 93%, sensitivity 70%), and value testify for supposed severe neurological disability or death is > 1.64 pg/ml (specificity 95%, sensitivity 83%). CONCLUSION: Protein S-100B is one of the early and sensitive markers of severe brain damage in patients after cardiac arrest. Its early determination can help in prediction of patient neurological condition and help doctors to decide further action.

[Coronary artery disease with premature manifestation in young patients]. / Ischemická choroba srdecní s predcasnou manifestací u mladých pacientu.

INTRODUCTION: Coronary artery disease (CAD) affects in lower percentage even younger individuals. This paper describes group of young patients aged 40 years or less with premature manifestation of CAD, including analysis of risk factors, severity of coronary arteries affection, management and follow-up lasting up to 7 years. PATIENTS AND METHODS: There were 98 patients included retrospectively, in whom macroscopic affection of coronary arteries was diagnosed by coronary angiography within the years 2000-2007. 68 of the patients were indicated to coronary angiography urgently due to acute coronary syndrome (ACS), 44 of them due to acute myocardial infarction with ST elevations. The patients were called for further co-operation and 45 of them (45.9%) were re-examined completely and they will be observed prospectively. The results show overall good short-term prognosis of these patients and confirm importance of early invasive management and revascularisation. One-year mortality of the patients with ACS was 1.9%. 80% out of 45 completely re-examined patients have ejection fraction of left ventricle better than 50% and 84% ofthem is without any anginal symptoms. However, our results show inadequate secondary prevention in these patients. 15 patients (33%) still smoke, 20 (44%) is over-weighted. Only 22 patients (49%) had LDL-cholesterol level bellow 2.5 mmol/l and even only 15 patients (33%) had blood pressure below 130/80 mm Hg. CONCLUSIONS: Management of these basic risk factors should improve even the long-term prognosis of our patients.

[Repolarization homogeneity in patients after acute myocardial infarction assessed from long-term 12-lead electrocardiographic recordings]. / Homogenita repolarizace u patientu po akutním infarktu myokardu hodnocená z dlouhodobých 12svodových elektrokardiografických záznamu.

BACKGROUND: Abnormal heterogeneity of myocardial electrophysiologic processes increases the risk of malignant arrhythmias. The aim of the studywas to assess changes ofrepolarization homogeneity in patients after acute myocardial infarction (MI) using morphological parameters obtained from long-term 12-lead electrocardiographic recordings. METHODS: In the group of 200 patients (45 females, 155 males) a long-term (10 minutes supine) 12-lead electrocardiographic recording (SEER MC, GE Medical) was performed 48-72 hours after acute myocardial infarction. The following parameters were calculated using experimental software: total cosine R to T (TCRT) and Twave residuum (TWR). The results were correlated with Q wave evolution and left ventricular ejection fraction (LVEF). RESULTS: Distinguishing the MI type (Q vs nonQ) the following values were obtained: TCRT: 0.17 +/- 0.61 vs 0.16 +/- 0.49, p = 0.52, absolute TWR: 21,200 +/- 21,700 vs 25,700 +/- 29,300, p = 0.3, relative TWR: 0.0012 +/- 0.0017 vs 0.0017 +/- 0.0026, p = 0.28. Stratification according to LVEF (< or = 40% vs > 40%) led to: TCRT: -0.03 +/- 0.66 vs 0.25 +/- 0.54, p = 0.01, absolute TWR: 29,700 +/- 32,400 vs 21,300 +/- 21,500, p = 0.14, relative TWR: 0.0021 +/- 0.0047 vs 0.0013 +/- 0.0021, p = 0.48. CONCLUSION: TCRT is a robust measurement of the spatial angle between the QRS complex and T wave loops which is related to LVEF. The results concerning TWR might indicate that this parameter is independent of LVEF, which needs to be confirmed in further analyses in a larger population.

[QT dynamicity in risk stratification in patients after myocardial infarction]. / QT dynamicita v rizikové stratifikaci u pacientu po infarktu myokardu.

BACKGROUND: Ventricular repolarization abnormalities are associated with increased risk of sudden cardiac death in patients after myocardial infarction. The aim of this study is to assess QT dynamicity - QT/RR relationship - in patients after myocardial infarction and its contribution to risk stratification of sudden cardiac death. METHODS: In a group of patients with diagnosis of acute myocardial infarction a long term ECG recording was performed 48-72 hours after myocardial infarction (MARS Unity Workstation, GE Medical Information Technologies). Patients with unstable circulation, artificial pulmonary ventilation, left bundle brach block, atrial fibrillation and paced rhythm were excluded. Analysis of QT dynamicity was performed by QT Guard software (GE Medical Information Technologies). QT/RR relationship is expressed by linear regression as QT = = aRR + b where "a" is termed "slope". RESULTS: Assessment of QT dynamicity was possible in 215 ECG recordings. In 6-month follow-up 2 patients died and another was successfully resuscitated for primary ventricular fibrillation. Six-month mortality resp. mortality + resuscitation was 0.9 %, resp. 1.4 %. Therefore statistical evaluation was not possible. In the 3 mentioned individuals the slope values were 0.333, 0.249 and 0.342. CONCLUSIONS: Mortality of up-to-date-treated patients after myocardial infarction is low. Therefore, in such patients it is not possible to assess QT dynamicity as a risk factor in midterm follow-up. Limitation of the method is the necessity of substantial selection of patients elegible for analysis and dependance on necessary equipment.

Antioxidant micronutrients and childhood malignancy during oncological treatment.

Serum antioxidant vitamins A (retinol) and E (alpha-tocopherol), beta-carotene, zinc, and selenium, and cholesterol and related proteins for 170 children with newly diagnosed malignancy were measured at diagnosis and 6 months after initiation of treatment, and compared with those of 632 cancer-free controls. Incident cancer cases and controls were 1-16 years old and recruited between 1986 and 1989. At diagnosis, age- and sex-adjusted serum concentrations of retinol, beta-carotene, zinc, and alpha-tocopherol were significantly inversely associated with cancer. No significant decreases in mean values were observed at 6 month, except for the alpha-tocopherol-to-cholesterol ratio in patients with bone tumors and serum zinc in bone tumors and central nervous system malignancies. An increase during the period of treatment was found for retinol and selenium in leukemia patients. beta-carotene was maintained at the initial concentrations determined prior to therapy. These findings provide further information about micronutrient requirements in children with cancer.

Assessment of serum antioxidant micronutrients and biochemical indicators of nutritional status in children with cancer in search of prognostic factors.

Serum vitamins A (retinol) and E (alpha-tocopherol), beta-carotene, zinc and selenium, and related proteins for 157 children with newly diagnosed and histologically proven malignancy were compared with those of 632 cancer-free controls. Incident cancer cases and controls were 1-16 years of age and recruited in 1986-1989. Age and sex-adjusted serum concentrations of beta-carotene and alpha-tocopherol were significantly inversely associated with cancer. No significant association with cancer was observed for serum values of selenium. Although low levels of antioxidants might in part be involved through a causality link, the reported decreased peripheral nutrient levels are considered rather as an impairment of the body's defence system, occurring during the cancer-related metabolic and nutritional disturbances and inflammation processes. The cancer cases group was followed-up and examined 6 months after diagnosis. Among the 157 subjects, 24 had died and 133 were reported to be alive. No substantial difference for any antioxidant or chemistry variable at onset was observed as a function of clinical outcome and health status.

Serum beta-carotene and antioxidant micronutrients in children with cancer. The 'Cancer in Children and Antioxidant Micronutrients' French Study Group.

Serum antioxidant vitamins A (retinol) and E (alpha-tocopherol), beta-carotene, zinc and selenium for 418 children with newly diagnosed malignancy were compared with those of 632 cancer-free controls. Incident cancer cases and controls were 1-16 years old and recruited in 1986-1989. Age- and sex-adjusted serum concentrations of retinol, beta-carotene and alpha-tocopherol were significantly inversely associated with cancer. In similar models, the odds ratio (OR) comparing the highest with the lowest quintile was 2.06 (95% confidence interval [CI] 1.40-3.02) for retinol, 3.87 (95% CI: 2.54-5.90) for beta-carotene, 2.15 (95% CI: 1.48-3.10) for alpha-tocopherol, 1.29 (95% CI: 0.75-2.23) for selenium, and 1.94 (95% CI: 1.17-2.23) for zinc. The cancer sites that were associated with serum beta-carotene were, in general, leukaemia, lymphoma, central nervous system, bone and renal tumours. Moreover, leukaemia was associated with low mean serum levels of retinol, selenium and zinc. Subjects with lymphoma, bone and renal tumours also had lower mean retinol and alpha-tocopherol levels than controls. Brain tumour patients had low vitamin E levels. Low serum values of antioxidant vitamins were associated with childhood neoplasm occurrence. Some site-specific effect was reported. Low peripheral nutrient levels are not considered as cancer promoters but rather as an impairment of the body's defence mechanism occurring during the cancer-related metabolic and nutritional disturbances and inflammation processes.

Serum retinol, beta-carotene, alpha-tocopherol and cholesterol in healthy French children.

Age- and sex-specific reference intervals of data derived from a healthy paediatric population are presented for retinol, beta-carotene, alpha-tocopherol, cholesterol and related proteins in serum. Age was an important covariate for the micronutrient concentration values. Retinol was highly correlated with alpha-tocopherol and cholesterol. Strong correlation was found with both beta-carotene and cholesterol. Serum levels were considered for their appropriateness as indicators of micronutrient status.

Immunonephelometry and radial immunodiffusion compared for measuring serum retinol-binding protein.

We compared a nephelometric method and a radial immunodiffusion (RID) assay for the measurement of retinol-binding protein in samples of serum from children with malignancies. The mean (+/- standard deviation) retinol-binding protein concentration as measured by the Behring Nephelometer was 31.0 +/- 15.6 mg/l; the mean by RID was 31.2 +/- 15.7 mg/l. This difference was not statistically significant by Student's t test (P = 0.6), and the correlation coefficient (r) was 0.87. Thus, the Behring Nephelometer method measures retinol-binding protein rapidly and as accurately as radial immunodiffusion.

Changes in hepatic vitamin K1 levels after prophylactic administration to the newborn.

We undertook a study of hepatic concentrations of vitamin K (vitamin K1 or phylloquinone, vitamin K1-epoxide, and menaquinones) in 18 infants, ages 1-8 days, with or without vitamin K1 supplementation. The infants who had no supplementation had a total hepatic storage ranging between 0.1 and 0.9 micrograms. Also, hepatic storage of phylloquinone was poor (< 1 microgram) when compared with daily requirements. Moreover, we did not detect any menaquinone in the livers of these infants in our study. The prophylaxis applied to the other infants was very efficient. Hepatic vitamin K1 concentrations, obtained < 24 h after administration, were very high (62.8-93.5 micrograms/g). Vitamin K1-epoxide concentrations were high, which proved the efficiency of the vitamin K cycle. In contrast, the decrease in vitamin K1 concentrations was also very rapid, since the median value after 48 h was 8.4 micrograms/g and only 2.9 micrograms/g 5 days after administration. However, hepatic total storage after 5 days in one infant with vitamin K1 supplementation was much higher (112 micrograms) than in infants who had not received supplementation. In conclusion, hepatic phylloquinone storage at birth was poor (< 1 microgram). The newborn infant might be in a situation of potential deficiency. After prophylactic oral administration of phylloquinone, uptake by the liver was quite satisfactory, but concentrations dropped quickly. However, phylloquinone hepatic storage remained elevated (112 micrograms) after 5 days.

Vitamin E supplementation in very-low-birth-weight infants: long-term follow-up at two different levels of vitamin E supplementation.

This study evaluates the need of vitamin E supplementation in very-low-birth-weight infants by long-term follow-up of plasma vitamin E status during the first 15 mo of life, with two different levels of supplementation. The subjects were 51 newborn infants with birth weights less than or equal to 1520 g. During hospitalization the infants were fed human milk. On the third day of life oral vitamin E supplementation of less than or equal to 10 mg/d was started in all infants. In addition, 23 infants selected at random were given intramuscular vitamin E (20 mg/kg/d) during the first 3 d. The data indicate that the 10 mg/d supplement resulted in an adequate plasma concentration of vitamin E. After cessation of supplementation at age 3 mo, the risk of low plasma vitamin E levels increased. Although intramuscular administration resulted in long-lasting increments in mean plasma vitamin E values, some later levels in these infants were marginal.

Retinol, beta-carotene and alpha-tocopherol status in a French population of healthy children.

The serum of 392 French healthy children aged 1-16 years was analysed for vitamin A, vitamin E, beta-carotene and cholesterol contents. The study group consisted in 185 females and 207 males, living in the area of Tours, France. The mean serum values are 42.05 +/- 12.0 micrograms/dl for vitamin A, 572 +/- 381 micrograms/l for beta-carotene and 9.5 +/- 2.5 mg/l for vitamin E. According to sex distribution, mean values of studied micronutrients levels are higher in boys than in girls, but not significantly. Vitamin A and vitamin E serum levels increased with age. Vitamin E peripheral level is strongly correlated with total cholesterol serum value. The results are compared to those of underdeveloped countries children groups studies. At least, decreased vitamins levels are observed among five per cent of children and are examined as being at risk to develop a deficiency.

Comparison of blood levels of vitamin A, beta-carotene and vitamin E in abruptio placentae with normal pregnancy.

Levels of vitamin A, beta-carotene and vitamin E in peripheral venous blood of women in abruptio placentae and in normal pregnancy have been compared. Chemical methods were used for the estimation of these compounds. The results show that levels of all three compounds in abruptio placentae are lower than those found in the normal pregnancy. We have earlier shown that levels of ascorbic acid in these subjects are low while other studies have indicated that levels of folic acid in them are also low. Based on our present and earlier published work it is suggested that abruptio placentae is a condition with multiple vitamin deficiency. Whether this is its cause or effect is however not clear.

Vitamin status during puerperium and lactation.

In a total of 22 healthy women, the concentrations of vitamin A, retinol-binding protein (RBP), beta-carotene, vitamin E, pyridoxal-5'-phosphate (PLP), folic acid, vitamin B12, biotin and vitamin C as well as the activities of the erythrocytic enzymes, erythrocyte transketolase (ETK), erythrocyte glutathione reductase (EGR) and erythrocyte glutamate oxalacetate transaminase (EGOT) were measured and compared at delivery, 3-5 days post-partum (pp) and 5-10 weeks pp. The mean values indicated a post-partal increase of vitamin A, RBP and vitamins B12 and C; and a post-partal decrease of PLP, folic acid, biotin, vitamin E and beta-carotene. The basal activities ETK0 rose at the end of puerperium above the values measured at delivery, while EGOT0 were lower than at parturition. None of the women had an adequate biochemical vitamin status for all vitamins measured over all three investigations. The biochemical vitamin deficiency of biotin was found most often, followed by vitamins B12, B6, C, A, folic acid, B2, B1 and beta-carotene; vitamin E status was optimal in all women.