Two cases of unusual rupture of aortic aneurysm.

Two cases of unusual rupture of aortic aneurysm with extravasation in the bronchus and duodenum are described. The clinical evolution of such aneurysm ruptures is associated with considerable diagnostic difficulties due to the absence of pathognomonic typical features and the short survival time after onset of pain symptoms.

[Results of the treatment of acute renal failure in 3 selected dialysis units in southern Poland 1981-1990]. / Wyniki leczenia ostrej niewydolnosci nerek w 3 wybranych osrodkach dializ Polski poludniowej w latach 1981-1990.

The results of the treatment of patients with acute renal failure (ARF) in dialysis units of Kraków, Nowy Sacz and Tarnów were estimated on the basis of prepared questionnaire. The increased number of patients treated because of ARF was demonstrated in the successive years of the study. The mortality rate in the tested group of patients remained about 27%. It depended on the cause of ARF and equalled to 26.7% in medical, 36.7% in surgical, 8% in obstetrical and 6.7 in urological patients, respectively.

[Effect of recombinant human erythropoietin on the bone marrow picture in patients with chronic renal failure treated by hemodialysis]. / Wplyw rekombinowanej ludzkiej erytropoetyny na obraz szpiku kostnego u chorych z przewlekla niewydolnoscia nerek leczonych hemodializami.

The influence of recombinant human erythropoietin (rHu-EPO) on anaemia and bone marrow cells was investigated in 7 patients with terminal renal failure on maintenance haemodialysis. The examination was performed immediately prior to rHu-EPO treatment (mean hematocrit 20.3%) and after increase of hematocrit to 33%. An increased number of cells from the erythroblastic series and rejuvenation of this population were observed during the treatment. There was no significant influence of the treatment on the myeloblastic cells series. An increase in megakaryocyte activity was observed in 2 studied patients.

Effect of peritoneal macrophages from intermittent peritoneal dialysis patients on lymphocytes in culture.

To investigate the biological activity of peritoneal macrophages, cells isolated from dialysate of 30 patients with end-stage kidney disease treated by intermittent peritoneal dialysis and from ascites of 6 patients with cardiac insufficiency (relative control group) were added to autologous, phytohemagglutinin (PHA)-stimulated lymphocyte cultures. Macrophages of dialyzed patients induced a dose-dependent increase in autologous lymphocyte proliferation, whereas macrophages obtained from control subjects exerted a suppressive effect on those cultures. The enhanced lymphocyte proliferation by macrophages from dialyzed patients was corroborated by the increased metabolic activity of macrophages as evaluated by the increased nitro blue tetrazolium (NBT) reduction test and increased functional expression of Fc receptors (FcR). The subpopulation of macrophages from patients with HLA-DR antigens as determined by HB55 monoclonal antibody, inhibited lymphoproliferation in vitro. We conclude that peritoneal macrophages from dialyzed patients represent a heterogenous population of cells with different phenotypic and functional characteristics.

[Effect of recombinant human erythropoietin (rHu-EPO) on anemia and selected biochemical parameters in patients in the pre-dialysis period]. / Wplyw rekombinowanej ludzkiej erytropoetyny (rHu-EPO) na niedokrwistosc i wybrane parametry biochemiczne u chorych w okresie przeddializacyjnym.

The effect of recombinant human erythropoietin (rHu-EPO) on anaemia and some biochemical parameters was investigated in 7 predialysis patients. A statistically significant increase in erythrocyte, haematocrit and haemoglobin levels was observed after 3 weeks of treatment and such changes were constant during the 6 month maintenance therapy. The mean urea and creatinine levels were comparable during the tested period in 4 of the studied patients. The other 3 patients did not completed the planed period and started the dialytic therapy because of progression of renal insufficiency. The latter group had more advanced renal failure and higher blood pressure prior to rHu-EPO treatment as compared with the patients who completed the study.

[Recombinant human erythropoietin stimulates synthesis of fetal hemoglobin in patients with renal anemia treated by repeated hemodialysis]. / Rekombinant ludzkiej erytropoetyny pobudza synteze hemoglobiny plodowej u chorych z niedokrwistoscia nerkowo-pochodna leczonych powtarzanymi hemodializami.

Effect of intravenously administered recombinant human erythropoietin (rHu EPO) on haemoglobin (Hb) level, haematocrit (Ht), reticulocyte count and foetal haemoglobin (HbF) concentration was assessed in 10 patients with anaemia, treated by repeated haemodialysis due to end-stage kidney. As compared to the initial values, erythropoietin treatment brought about a significant increase in all the parameters examined. During the subsequent therapy with lower, supporting doses of erythropoietin, the elevated HbF values fell back to normal, whereas the higher level of total Hb and Ht were maintained.

[Activity of selected neutrophil enzymes of patients maintained on hemodialysis and treated with erythropoietin (rHu EPO)]. / Aktywnosc wybranych enzymów neutrofilów chorych przewlekle dializowanych leczonych erytropoetyna (rHu EPO).

The peroxidase, alkaline phosphatase, acid phosphatase, beta-glucuronidase and N-acetyl-beta-D-glucosaminidase activity was assessed using a semiquantitative cytochemical methods in peripheral blood neutrophils from 10 maintenance haemodialysed patients treated with recombinant human erythropoietin (rHu EPO) due to severe anaemia. The examination was performed immediately prior to rHu EPO treatment, after 10 weeks and 32 weeks of therapy. A statistically significant increase in the beta-glucuronidase and N-acetyl-beta-D-glucosaminidase activity was observed after 10 weeks, while all the enzymes studied except peroxidase showed a significant elevation of their activity after 32 weeks of the treatment as compared with the values obtained prior to therapy.

Functional characteristics of peritoneal macrophages of renal failure patients on peritoneal dialysis.

Functional activity of peritoneal macrophages of 50 patients with end-stage renal failure on intermittent peritoneal dialysis (IPD) and of 30 control subjects with normal renal function was determined. Phagocytosis of latex particles by macrophages of dialyzed patients was significantly lower as compared with the controls. Further depression of the phagocytic activity was observed during bacterial peritonitis. Macrophages from the dialyzed patients also showed nonsignificantly decreased functional expression of Fc receptors (FcR) and increased spontaneous nitro blue tetrazolium (NBT) reduction.

Ultrastructural study of human macrophages from peritoneal dialysate.

Peritoneal macrophages obtained from 30 patients with end-stage kidney treated by intermittent peritoneal dialysis and from 30 subjects with normal renal function (relative control) were investigated by light microscopy, transmission electron microscopy (TEM) and scanning electron microscopy (SEM). Two populations of peritoneal macrophages were distinguished in both dialysed and control patients. In the former group, the main population consisted of macrophages similar to monocytes from peripheral blood, while the majority of macrophages in control patients showed larger size, more prominent vacuolization of the cytoplasm and stronger spreading on glass surface.

Peroxidase activity in peritoneal neutrophils of patients with terminal renal failure treated by intermittent peritoneal dialysis.

Peroxidase activity was assessed cytochemically in the peritoneal dialysate neutrophils of 50 patients with terminal renal failure treated by intermittent peritoneal dialysis. In 22 patients cells were harvested for the second time after they developed peritonitis as a complication of the treatment. The results obtained were compared with those in the control group consisting of 30 patients with normal renal function. The patients treated by peritoneal dialysis showed both in the complication-free period and in the course of peritonitis significantly higher peroxidase activity in the neutrophils, as revealed by the semiquantitative score test. In the course of peritonitis, the neutrophils peroxidase activity was significantly lower than in the complication-free period.

Acid phosphatase, beta-glucuronidase and N-acetyl-beta-D-glucosaminidase activity of peritoneal neutrophils in patients with terminal renal failure treated by intermittent peritoneal dialysis.

Acid phoshatase (AcP), beta-glucuronidase (GR) and N-acetyl-beta-D-glucosaminidase (NAG) activity in neutrophils obtained from the peritoneal fluid of 50 patients with terminal renal failure treated by intermittent peritoneal dialysis, and of 30 control subjects with normal renal function was semiquantitatively scored using a cytochemical method. This study was repeated in 22 dialyzed patients during the course of bacterial peritonitis. A significant decrease in the AcP score and an increase in the GR score were found in the neutrophils from dialyzed patients. In dialyzed patients with peritonitis, the GR and NAG scores were higher that in those without this complication.

Effect of heparin and prostacyclin/heparin infusion on platelet aggregation in hemodialyzed patients.

The number of circulating platelet aggregates determined according to the method of Wu and Hoak and the platelet morphology revealed by scanning electron microscopy were investigated in 10 patients (8 males, 2 females) age 28-58 years) with end-stage renal failure treated by repeated hemodialysis. The examination was carried out twice: during a 4-hour hemodialysis session with the use of heparin alone and 1 week later during the course of another dialysis in the presence of both heparin and prostacyclin. During each dialysis session the platelet system was examined three times: prior to, after 90 min, and at the end of the procedure. As compared with the situation prior to dialysis, the number of platelet aggregates assessed after 90 min of dialysis and after its termination insignificantly rose following the treatment with heparin, but significantly fell after the use of the prostacyclin/heparin combination. The differences were also significant when the effects of both treatment types were compared. As revealed by scanning electron microscopy, during the course of hemodialysis with the use of heparin alone, the platelets showed signs of activation manifested by increases in number and length of cytoplasmic processes and by a tendency to aggregate. When both prostacyclin and heparin were used during dialysis, platelet activation was minimal or absent. Thus, the combined treatment with prostacyclin and heparin protects platelets from activation induced by their contact with artificial surfaces and may lower the risk of microthrombosis, making thereby hemodialysis safer and more effective.

Peroxidase activity in peritoneal macrophages of patients with terminal renal failure treated by intermittent peritoneal dialysis.

Peroxidase activity was assessed cytochemically in macrophages from peritoneal dialysate of 50 patients with terminal renal failure treated by intermittent peritoneal dialysis. In 22 patients cells were harvested for the second time after development of peritonitis as the complication of the treatment. The obtained results were compared with those of the control group consisting of 30 patients with normal renal function. Patients treated with peritoneal dialysis showed both in complication-free period and during the course of peritonitis significantly higher peroxidase activity in macrophages as revealed by the semiquantitative score test. In the course of peritonitis, peroxidase activity in macrophages was significantly lower than in complication-free period. Electron-microscopic cytochemistry demonstrated that in macrophages obtained from both control and dialyzed patients the peroxidase activity was located exclusively in cytoplasmic granules, suggesting a similarity of the studied cells and exudative macrophages.

Changes in activity of selected lysosomal enzymes in peritoneal macrophages of renal failure patients on peritoneal dialysis.

Activity of acid phosphatase (AP), beta-glucuronidase (GR), N-acetyl-beta-D-glucosaminidase (GZ), and peroxidase (P) was assessed using a semiquantitative cytochemical method in peritoneal macrophages of 30 patients with end-stage renal failure treated by intermittent peritoneal dialysis and of 30 control patients with normal renal function. The dialysed patients showed a significantly higher activity of GR and P at the beginning of the treatment as compared with the respective activities observed in the control group and a further significant rise of these activities after 4 months of dialysis. Activity of AP at the beginning of the treatment was insignificantly lower than in the control group and the difference became significant at the end of the investigated period. There was no significant difference between the dialysed patients and the control group in the activity of GZ assessed at the beginning of the dialytic treatment and after 4 months of dialysis. A significant decrease in that activity was, however, observed in the course of dialysis.