Fistuloclysis as a method of nutritional management in a patient with high output enteroatmospheric fistula - a case report.

Enteric fistula is a pathological communication between the small intestine and surrounding tissue. In case of communication with body surface it is called an enterocutaneous or enteroatmospheric fistula. There are many causes of enterocutaneous/enteroatmospheric fistula occurrence. A common result is malnutrition and organ dysfunction which leads to increased morbidity and mortality of the patients. Adequate nutritional support is a very important element in the management of patients with enterocutaneous/enteroatmospheric fistulas. One of the options of nutritional support is fistuloclysis which means administration of enteral nutrition formula to the distal fistula. We present the case of 76-year-old patient with a high-localized and high output enteroatmospheric fistula in whom we were able to reach adequate nutritional status using fistuloclysis, followed by closure of the fistula.

Complications and mortality of surgical therapy for esophageal cancer: 10 years single center experience.

A single-center retrospective study the complication and mortality of surgical treatment of esophageal cancer 2006 to 2015 is presented. A total of 212 patients with esophageal cancer were operated at the First Department of Surgery University Hospital Olomouc, Czech Republic in the period between 2006 and 2015. Adenocarcinoma was histologically described in 127 patients (59.9%), squamous cell carcinoma in 82 patients (38.7%), and other types of carcinoma were described in 3 cases. According to the preoperative staging of esophageal cancer, the patients with early stage disease (T1-2N0M0) had primary surgery, while the patients with advanced stage (T3-4N0-2M0) were indicated for neoadjuvant chemoradiation with the surgery being performed subsequently. Transhiatal laparoscopic esophagectomy was performed in 183 patients, and Orringer esophagectomy in 4 patients. Thoracoscopic esophagectomy was performed in 17 patients and thoracotomy in 30 patients. Respiratory failure with the development of ARDS syndrome accompanied by multiple-organ failure occurred in 21 patients. Statistically significant association between mortality and ASA (p = 0.009) and between respiratory complications and ASA (p = 0.006) was demonstrated. The majority of patients who died were under 60 years of age (p = 0.039). Further, significant association between 30-day mortality and tumor stage (p = 0.021), gender (p = 0.022) and age (p = 0.018) was evident. A significant association between tumor stage and fistula in anastomosis, (p = 0.043) was observed. Esophagectomy is a procedure, which should be performed in specialized high-volume centers experienced in treatment of this serious malignancy and by certified oncology surgeons with long time experience in esophageal surgery.

Esophageal cancer results of surgical treatment at the Department of Surgery I. at the University Hospital Olomouc.

The authors present the results of surgical treatment of esophageal cancer at Department of Surgery I, University Hospital Olomouc between 20062016. The aim of the study was to use retrospective analysis to evaluate the results of patients operated for esophageal cancer and statistically evaluate the results based on the type of surgical approach (transhiatal, transthoracic). Method: A total of 240 patients with esophageal cancer were operated at Department of Surgery I between the beginning of 2006 and the end of 2016. We evaluated respiratory complications, the incidence of anastomotic fistula and complications based on the Clavien-Dindo classification of complications, based on the type of surgical approach selected (transhiatal or transthoracic esophagectomy). Results: The patient set included 207 men (86.3%) and 33 women (13.7%). The mean patient age was 60.4 years. The histological type was adenocarcinoma in 145 (60.4%) and squamous cell carcinoma in 90 (37.5%) patients; another type of carcinoma was observed in 5 cases. Transhiatal esophagectomy was performed in 194 patients (80.2%) (transhiatal laparoscopic in 190 and classic Orringer in 4 patients). Transthoracic approach was used in 46 patients (19.2%), thoracoscopic in 16, and thoracotomic in 30 patients. A gastric conduit was used in 236 patients and coloplasty was performed in 4 patients. The mean duration of surgery was 217 min for the transhiatal approach, 239 min for the thoracoscopic approach and 277 min for the thoracotomic approach. Total blood loss per patient was 562 ml on average for all the operated patients. Peri- or postoperative blood transfusions were administered to 148 patients. Lymphadenectomy was performed as part of the procedure in all patients; the mean of 16.1 lymph nodes were removed. The average hospital stay was 20.7 days. In the patient set, 30-day mortality included 12 patients (respiratory complications 10, MI 1, conduit necrosis 1) and 90-day mortality included 4 (multi organ failure during ARDS). Based on statistical analysis, the incidence of respiratory complications significantly correlated with ASA classification (p=0.0001) and Clavien-Dindo classification (p.

[Proximal gastrectomy for adenocarcinoma of the gastroesophageal junction in a selected set of patients immediate and long-term results]. / Proximální gastrektomie u selektovaných pacientu s adenokarcinomem gastroezofageální junkce, bezprostrední a dlouhodobé výsledky operacní terapie.

INTRODUCTION: The authors present the results of surgical resection in the form of proximal gastrectomy in a selected set of patients with adenocarcinoma of the gastroesophageal junction. The selection criteria included: ASA III-IV, internal comorbidities and elderly patients. METHODS: Between 2007 and 2015, 28 patients with adenocarcinoma of the gastroesophageal junction underwent proximal gastrectomy at the 1st Department of Surgery. The patient set consisted of 19 (67.8%) men and 9 (32.3%) women aged 5289 years with the median age of 72.5 years. Endoscopic examination revealed a tumour of the gastroesophageal junction, which was evaluated according to the Siewert classification: type I was present in 4 (16.7%) cases, type II in 12 (42.3%), and type III in 12 (42.3%). Histological analysis revealed adenocarcinoma in all cases. Proximal gastrectomy with lymphadenectomy was performed in all patients. Splenectomy was performed in eleven patients. The continuity of the gastrointestinal tract was ensured by esophagogastroanastomosis, and pyloromyotomy was performed as a standard procedure. Cryostatic examination revealed positive resection margins in the esophagus in five patients, which led to the resection of the distal esophagus from the right-sided thoracotomy. RESULTS: Injury to the biliary tract was observed in one case in the perioperative period, which was treated by hepaticojejunoanastomosis onto an excluded jejunal loop. The following complications were observed postoperatively: bleeding, respiratory complications, anastomotic dehiscence, laparotomy wound dehiscence, and inflammatory infiltration in the abdominal cavity. Thirty-day mortality was 10.7% in our patient set. CONCLUSION: Proximal gastrectomy with lymphadenectomy is an appropriate alternative for polymorbid patients with adenocarcinoma of the gastroesophageal junction and provides good short- and long-term results.Key words: cancer of gastroesophageal junction proximal gastrectomy complications of therapy.

Prevalence of mutations in thiopurine S-methyltransferase gene among Slovak IBD patients.

BACKGROUND: Thiopurine S-methyltransferase (TPMT) plays an important role in the metabolism of thiopurines. It has been suggested that TPMT genetic polymorphisms lead to dose-related hematopoietic toxicity. Since there are major ethnic differences in the prevalence of particular TPMT variants, it is important for each country to study their own prevalence in order to estimate the role of TPMT variants-related thiopurines toxicity in population suffering from particular inflammatory bowel disease (IBD). AIMS: The aim of this study was to determine the frequency of the four most common allelic variants of TPMT gene in the population of Slovak IBD patients. METHODS: TPMT genetic polymorphisms (TPMT*2, TPMT*3A, TPMT*3B, TPMT*3C) were amplified using PCR and consequently genotyped with genetic analyzer. The allele frequencies of particular allelic variants were calculated and compared with other Caucasian populations reported so far. RESULTS: Three hundred and thirty IBD patients were included; 196/132/2 cases of Crohn´s disease/ulcerative colitis/unclassified colitis; 180 (55 %) males. Ninety-three percent of patients were homozygous for wild-type TPMT variant. Heterozygous genotype of any of the studied polymorphisms was present in 6 % of patients while only one patient was homozygous for TPMT*3A allele (0.3 %). The most prevalent mutant allele was that of TPMT*3A (3.2 %). The distribution of most common allelic variants of TPMT gene among Slovak IBD patients was in accordance with previously reported prevalence in Caucasian populations. CONCLUSION: This study shows the prevalence of TPMT genetic polymorphisms in population of Slovak IBD patients. As in other Caucasian populations, the most common mutant allelic variant is that of TPMT*3A while the prevalence of homozygosity is relatively low (Tab. 3, Ref. 22).

The impact of thiopurine-S-methyltransferase genotype on the adverse drug reactions to azathioprine in patients with inflammatory bowel diseases.

BACKGROUND AND AIMS: The thiopurine drugs, azathioprine (AZA) and 6-mercaptopurine, are established in the treatment of inflammatory bowel diseases (IBD). Polymorphisms in thiopurine S-methyltransferase (TPMT) gene have been associated with adverse drug reactions (ADRs) to AZA. METHODS: The aim of this study was to evaluate TPMT polymorphisms and AZA-related toxicity in a Slovak cohort of 220 IBD patients treated with AZA. In every patient, the dose and duration of AZA therapy, concomitant 5-aminosalicylate (5-ASA) medication, frequency, type, time to onset, dose of ADR and concomitant 5-ASA at the onset of ADR were recorded. Each patient was also genotyped for the presence of variant TPMT alleles (*2,*3A,*3B,*3C). Frequency, type and circumstances of ADRs were compared according to TPMT status. RESULTS: Of the 220 patients, 205 (93.2 %) were wild-type (TPMT*1/*1), one (0.5%) carried a TPMT*1/*3C allele, 13 (5.9 %) carried TPMT *1/*3A allele and one was homozygous for TMPT *3A allele. No TPMT *2 mutation was found. The incidence of adverse drug reactions was 62/205 (30.2 %) in the wild-type group as compared to 13/15 (86.7 %) in the TPMT mutation group, p=2.10-5. Leukopenia (WBC< 3.0*10^9/L) occurred in 21/205 (10.2 %) patients with wild type TPMT versus 11/15 (73.3 %) patients with TPMT mutations, p=0.000001. There was no significant difference between TMPT groups in gastrointestinal or other ADRs. No impact of 5-ASA on the incidence and severity of AZA adverse drug reactions was observed. CONCLUSION: The incidence of leukopenia in TPMT mutant patients was significantly higher and more severe as compared to TPMT wild type patients. We observed no impact of concomitant 5-ASA therapy on AZA induced toxicity (Tab. 4, Fig. 2, Ref. 37).

Prevalence of mutations in thiopurine S-methyltransferase gene among Slovak IBD patients.

BACKGROUND: Thiopurine S-methyltransferase (TPMT) plays an important role in the metabolism of thiopurines. It has been suggested that TPMT genetic polymorphisms lead to dose-related hematopoetic toxicity. Since there are major ethnic differences in the prevalence of particular TPMT variants, it is important for each country to study their own prevalence in order to estimate the role of TPMT variants-related thiopurines toxicity in the particular inflammatory bowel disease (IBD) population. AIMS: The aim of this study was to determine the frequency of the four most common allelic variants of TPMT gene in the population of Slovak IBD patients. METHODS: TPMT genetic polymorphisms (TPMT*2, TPMT*3A, TPMT*3B, TPMT*3C) were amplified using PCR and consequently genotyped on genetic analyzer. The allele frequencies of particular allelic variants were calculated and compared with other Caucasian populations reported so far. RESULTS: Three hundred and thirty IBD patients were included; 196/132/2 Crohn´s disease/ulcerative colitis/unclassified colitis, 180 (55 %) males. Ninety-three percent of patients were homozygous for wild type TPMT variant. Heterozygous genotype of any of the studied polymorphisms was present in 6 % of patients, only one patient was homozygous for TPMT*3A allele (0.3 %). The most prevalent mutant allele was TPMT*3A (3.2 %). The distribution of the most common allelic variants of TPMT gene among Slovak IBD patients were in accordance with previously reported prevalence in Caucasian populations. CONCLUSION: This study shows the prevalence of TPMT genetic polymorphisms in the Slovak IBD patient`s population. As in other Caucasian populations, the most common mutant allelic variant is TPMT*3A, and the prevalence of homozygosity is relatively low (Tab. 3, Ref. 16).

Consideration of endoscopic retrograde cholangiopancreatography in cases of acute biliary pancreatitis.

AIM: The important question to be answered in all cases of ABP is whether or not a calculous biliary obstruction is still present. Answering this question conditions subsequent management, including the need for endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to determine the relationship between persistent common bile duct stone (CBDS) and laboratory values, and dilation of bile duct in order to find possible significant associations in patients with acute biliary pancreatitis (ABP). METHODS: Retrospectively, statistical evaluation of a group of 76 patients with ABP who had received early ERCP. RESULTS: The prevalence of choledocholithiasis in patients > 70 years old was 54.2%, in patients < or = 70 years old it was 36.5%. Following cholecystectomy, CBDS was present in 81.8% of patients, p = 0.005. The probability of CBDS occurrence in patients > 70 years old with bile duct dilation was 81.3%; in the absence of bile duct dilation CBDS was not present, p < 0.001. The probability of CBDS occurrence in patients 70 years old with bile duct dilation was 57.7%, in the absence of bile duct dilation CBDS was present in 15.4%, p = 0.002. In patients with bile duct dilation predictive factors are as follows: bilirubin (Bi), after excluding patients with acute cholecystitis and cholangitis, p = 0.05; alanine aminotransferase (ALT) in patients 70 years old, p = 0.004; gamma-glutamyl transferase (GMT) in patients > 70 years old, p = 0.02. CONCLUSIONS: ERCP is indicated in patients with ABP if biliary obstruction is present and the presence of a ductal stone is suspected. From our results it is clear that the predictive parameter for choledocholithiasis is the dilation of the bile duct and previous cholecystectomy. In patients with bile duct dilation possible predictive factors are Bi, ALT, and GMT (Tab. 1, Fig. 8, Ref. 20).

[Postoperative monitoring of the esophageal gastroplasty perfusion rate]. / Pooperacní sledování perfuze gastroplastiky jícnu.

AIM: Quality assessment of perfusion of the gastric tube after esophagectomy by using the intramucosal pH measurements. Determination, if these measurements may have an early prediction for an anastomotic insufficiency. STUDY: Prospective observational study. SETTING PLACE: Department of surgery (surgical branches) intensive care unit and 1st surgical clinic, University hospital Olomouc. MATERIAL AND METHOD: 11 patients with the esophageal cancer who underwent esopgagectomy with the replacement by the gastric tube were divided into two groups (leakage+ and leakage- anastomosis). The intramucosal pH (pHi) was measured by a gastric tonometry. RESULTS: Patients with anastomotic leakage on early post-operative period (n = 3) had significantly lower values of pHi than patients without anastomotic leakage (n = 8). CONCLUSION: Gastric tonometry is an useful method to evaluate gastric tube perfusion after esophagectomy. The intramucosal pH values significantly correlated with viability of gastric tube. Measurements of pHi is high predictionable of the risk of anastomotic insufficiency on early stage after surgery.

[Comparison of the two methods, LASIK and ICL in mild and high hyperopia correction--part one]. / Srovnání metody LASIK a implantace ICL pri korekci strední a vysoké hyperopie. I. cást.

The problems of hyperopia surgical correction are complicated. The most used methods are corneal laser treatments (PRK and LASIK), phakic intraocular lenses or clear lens extraction (CLE). The aim of the study was to evaluate and to compare long-term postoperative results of two types of refractive procedures in mild and high hyperopia correction: LASIK and ICL (phakic intraocular posterior chamber contact lens) implantation. The authors evaluated a group of 37 eyes of 20 patients; the average age was 36.3 years +/- 11.8 (SD) and the follow-up period 28.1 months +/- 10.2 (SD) after LASIK procedure, and group of 21 eyes of 13 patients; the average age was 28.6 years +/- 6.1 (SD) and the follow-up period 30.4 months +/- 20.9 (SD) after the ICL implantation. The final uncorrected (UCVA) and best-corrected visual acuity (BCVA) and postoperative refractive error (for far and near) and their development in time were compared. They found statistically significant improvement of the UCVA postoperatively comparing to the preoperative values in both methods (LASIK and ICL) (p < 0.05). Better UCVA was achieved by means of ICL implantation (p < 0.05). The BCVA improved after the ICL implantation only (p > 0.05). In hyperopic LASIK, the final BCVA worsened comparing to this before treatment (p > 0.05). The BCVA changes were not statistically significant. The authors also proved better final spherical refraction for far (p < 0.05 in the first and second year) and for the near as well (p < 0.05 in the first and second year) in the ICL method comparing to the hyperopic LASIK. The stableness of the postoperative refraction was better after the ICL implantation during the whole follow up period. In the laser treatment, the continuous regression of the postoperative refraction was evident. The final cylindrical refraction value was also lower in the ICL group (p > 0.05). The stableness of the postoperative cylindrical refraction was also higher in the ICL method during the whole follow up period. Comparing the intraocular procedure (ICL) to the laser method (LASIK), the ICL implantation demonstrates better final BCVA and UCVA and the postoperative refraction is more stable.

[Effects of specific cycloxygenase-2 inhibition on the renal functions of ederly patients with renal function impairment]. / Vliv specifické inhibice cyklooxygenázy 2 na ledvinové funkce u starsích pacientu s poruchou ledvinové funkce.

BACKGROUND: Elderly patients suffering from nociceptive pain of locomotive organs and concomitantly from renal impairment represent a target population for painkilling drugs. That is why they are predisposed to nephrotoxic effects non-steroidal anti-inflammatory drugs. The aim of our study was to evaluate cycloxygenase-2 (COX-2) inhibition effect on renal function in elderly with moderate impairment of renal function. METHODS AND RESULTS: Based on 24-h urine collection we assessed creatinine clearance (C(Cr), fractional excretion of sodium (FE(Na)), potassium (FE(K)), chloride (FE(Cl)), osmotic active solutes (FE(OSM)) and 24h urinary excretion of prostaglandin PGE2 and PGF(2 alpha). Under conditions of sub-maximal water load fractional excretion of electrolytes, inulin clearance (C(in)), serum cystatin C (S(cyst)) were assessed. In addition basal and stimulated plasma renin activity (PRA) and plasma aldosteron (P(aldo)) were examined. Using comparison of parameters before and at the end of 7-days rofecoxib treatment we found out C(in) 0,82 +/- 0,34 vs 0,74 +/- 0,18 ml/s/l,73 m2, FE(Na) 1,0 +/- 0,3 vs 1,2 +/- 0.4 (p=0,02), FE(OSM) 2.9 +/- 0,7 vs 3,7 +/- 1,2% (p=0,03), U(PGE2 alpha),V 663 +/- 528 vs 414 +/- 195 (p=0,059), U(PGD2) V (559 +/- 625) vs 205 +/- 174 eta g/24h (p=0,02), stimulated PRA 0.94 +/- 0,73 vs 0,4 +/- 0,27 +/- pg/l/h (p=0,019), P(aldo) 104,56 +/- 50,15 vs 56,94 +/- 27,08 eta g/l/h (p=0,008). CONCLUSIONS: Short-term COX-2 inhibition in patients with moderate renal impairment was associated with significant decrease of tubular transport of sodium, without changing GFR and water excretion.

[Chronic nephropathies and disorders of renal function--is it sufficiently diagnosed in patients hospitalised on department of internal medicine and cardiology?]. / Jsou chronická onemocnení ledvin a poruchy ledvinné funkce na standardním luzku interních oboru dostatecne diagnostikovány?

We have found out that nephropathies and renal dysfunctions are diagnosed insufficiently. At the same time, it has been observed that patients are sent to nephrology out-patient clinics too late. The aim of our study was to identify how nephropathy and renal dysfunction are diagnosed and how these diagnoses are recorded in diagnostic summary of hospital discharge report in patients hospitalized in department of internal medicine and cardiology of a big teaching hospital. Also, we studied the incidence of risk diseases (arterial hypertension and diabetes mellitus) and serious cardiovascular complications in individual stages of renal dysfunction. We analysed 325 medical records of patients hospitalized and discharged in the course of one month. Renal dysfunction was classified according to Kidney Disease Outcomes Quality Initiative. Glomerulal filtration rate was calculated via simplified Levey's formula. Nephropathy and renal dysfunction were diagnosed, and properly recorded in diagnostic summary, only in 5 % of patients in the Stage I of renal dysfunction (Stage II = 2%, Stage III = 28%, Stage IV = 88% and Stage V = 88%). The incidence of risk diseases and cardiovascular complications increased linearly with progression of renal insufficiency. The results of our study prove that nephropathy and renal dysfunction are diagnosed insufficiently, particularly in early stages when it is still possible to use targeted therapy and early control of specific complications of renal insufficiency.

[Yellow osteoid]. / Zlutý osteoid.

Yellow discoloration of the osteoid seams of the partly demineralised trabecular bone in the site of the osteolytic cancer metastasis was observed. Intralesional hemorrhage with massive breakdown of the red cells and local release of bilirubin caused characteristic colour changes of unmineralised osteoid. Mineralised osteoid had unchanged colour. No morphological changes of bone cells were recognised. Yellow osteoid developed as a result of local high bilirubin concentration in the neighbourhood of bone trabecullae with unmineralised osteoid seams.

[Immunohistochemical differentiation of leiomyocellular tumors and tumors with myogenic differentiation]. / Moznosti imunohistochemického odlisení leiomyocelulárních nádoru a nádoru s myogenní diferenciací.

The expression of alpha smooth muscle actin, muscle specific actin, desmin, h-caldesmon, and calponin was studied immunohistochemically in the following soft tissue and bone tumours and tumour-like lesions: muscle fibromatosis, inflammatory pseudotumours, chondroblastoma, enchondroma, chondrosarcoma, fibrous dysplasia, ossifying myositis, osteoblastoma, convential osteosarcoma, leiomyoma and leiomyosarcoma. Tumours and tumour-like lesions with myofibroblastic cells, osteoblasts and chondroblasts frequently exhibited intensive immunoreactivity for the muscle markers, and therefore, some of them may occasionally be confused with leiomyoma and leiomyosarcoma. Calponin does not help to differentiate various mesenchymal tumours expressing muscle markers, because it also stains intensively myofibroblasts, osteoblasts and chondroblasts. We confirmed that h-caldesmon was expressed intensely in leiomyomas and leiomyosarcomas, and never in the other tumours examined, with the exception of three chondroblastomas. The results have shown that h-caldesmon is a rather specific and sensitive marker for smooth muscle tumours, but it can also stain some actin positive myochondroblasts. It is possible that the positivity of h-caldesmon in some chondroblastomas is due to their complete myogenic transdifferentiation, and so we use the term myochondroblasts and myochondrocytes for designation of such S-100 protein, actin, and h-caldesmon positive cells.

Characterization of telomere-subtelomere junctions in Silene latifolia.

Telomere-associated regions represent boundaries between the relatively homogeneous telomeres and the subtelomeres, which show much greater heterogeneity in chromatin structure and DNA composition. Although a major fraction of subtelomeres is usually formed by a limited number of highly repeated DNA sequence families, their mutual arrangement, attachment to telomeres and the presence of interspersed unique or low-copy-number sequences make these terminal domains chromosome specific. In this study, we describe the structures of junctions between telomeres and a major subtelomeric repeat of the plant Silene latifolia, X43.1. Our results show that on individual chromosome arms, X43.1 is attached to the telomere either directly at sites corresponding to nucleosome boundaries previously mapped in this sequence, or via other spacer sequences, both previously characterized and newly described ones. Sites of telomere junctions are non-random in all the telomere-associated sequences analysed. These data obtained at the molecular level have been verified using in situ hybridization to metaphase chromosomes and extended DNA fibres.

[Prophylactic use of counterpulsation in patients with severe myocardial dysfunction]. / Profylaktické zavedení kontrapulzace u pacientu s tezkou dysfunkcí myokardu.

During the period between 2/2000 and 11/2000 21 patients with severe ventricular dysfunction were investigated (EF less than 30%) where in a planned manner intraaortic balloon counterpulsation was introduced before cardiac surgery. The low mortality (5%), zero incidence of complications caused by the method and the improvement of the contractility of the heart muscle, evaluated from a rise of the ejection fraction (EF) make so-called prophylactic use of contrapulsation possible as a method of first choice in severe myocardial dysfunction.

TAS49--a dispersed repetitive sequence isolated from subtelomeric regions of Nicotiana tomentosiformis chromosomes.

We have isolated and characterized a new repetitive sequence, TAS49, from terminal restriction fragments of Nicotiana tomentosiformis genomic DNA by means of a modified vectorette approach. The TAS49 was found directly attached to telomeres of N. tabacum and one of its ancestors, N. tomentosiformis, and also at inner chromosome locations. No association with telomeres was detected neither in N. otophora nor in the second tobacco ancestor, N. sylvestris. PCR and Southern hybridization reveal similarities in the arrangement of TAS49 on the chromosomes of 9 species of the genus Nicotiana, implying its occurrence as a subunit of a conserved complex DNA repeat. TAS49 belongs to the family of dispersed repetitive sequences without features of transposons. The copy number of TAS49 varies widely in the genomes of 8 species analyzed being lowest in N. sylvestris, with 3300 copies per diploid genome. In N. tomentosiformis, TAS49 forms about 0.56% of the diploid genome, corresponding to 17400 copies. TAS49 units are about 460 bp long and show about 90% of mutual homology, but no significant homology to DNA sequences deposited in GenBank and EMBL. Although genomic clones of TAS49 contain an open reading frame encoding a proline-rich protein similar to plant extensins, no mRNA transcript was detected. TAS49 is extensively methylated at CpG and CpNpG sites and its chromatin forms nucleosomes phased with a 170 +/- 8 bp periodicity.

Transgenic UCP1 in white adipocytes modulates mitochondrial membrane potential.

To test if mitochondrial uncoupling in white adipocytes is responsible for obesity resistance of the aP2-Ucp transgenic mice expressing ectopic uncoupling protein 1 (UCPI) in white fat, mitochondrial membrane potential (delta psi(m)) was estimated by flow cytometry in adipocytes isolated from gonadal fat. Ectopic UCP1 (approximately 0.8 mol UCP1/mol respiratory chain) decreased the delta psi(m) and rendered the potential sensitive to GDP and fatty acids. These ligands of UCP1 had no effect on delta psi(m) in white adipocytes from non-transgenic mice, suggesting that the function of endogenous UCP2 in adipocytes was not affected. The results support the hypothesis that mitochondrial uncoupling in white fat may prevent development of obesity.

[Ultrasonography study of the mammary-coronary bypass]. / Ultrazvukové vysetrení mammarokoronárního bypassu.

The authors present the case of a 49-year-old female patient who was admitted with the diagnosis of ischaemic heart disease and the syndrome of angina pectoris grade IV for selective coronarography. For assessment of the affection of one artery, significant stenosis of the insertion of the ramus interventricularis anterior the authors indicated a bypass of the left mammary artery to the ramus interventricularis anterior. During the postoperative course the patient did not have any anginous symptoms or any other clinical signs suggesting ischaemia or necrosis of the heart muscle. During the ultrasonographic check-up examination of the mammarocoronary bypass the suspicion of occlusion of the graft was expressed and this was confirmed on angiography. An angiographically successful percutaneous transluminal angioplasty of occlusion of the bypass was made. During the subsequent ultrasonographic examination the authors suspected again graft occlusion and angiography confirmed a 90% stenosis. Therefore the patient was re-operated. It appears that ultrasonographic examination of the mammacoronary bypass may prove useful in the diagnosis of occlusion or critical stenosis of a graft.

Brown fat is essential for cold-induced thermogenesis but not for obesity resistance in aP2-Ucp mice.

The role of brown adipose tissue in total energy balance and cold-induced thermogenesis was studied. Mice expressing mitochondrial uncoupling protein 1 (UCP-1) from the fat-specific aP2 gene promoter (heterozygous and homozygous aP2-Ucp transgenic mice) and their nontransgenic C57BL6/J littermates were used. The transgenic animals are resistant to obesity induced by a high-fat diet, presumably due to ectopic synthesis of UCP-1 in white fat. These animals exhibited atrophy of brown adipose tissue, as indicated by smaller size of brown fat and reduction of its total UCP-1 and DNA contents. Norepinephrine-induced respiration (measured in pentobarbital sodium-anesthetized animals) was decreased proportionally to the dosage of the transgene, and the homozygous (but not heterozygous) transgenic mice exhibited a reduction in their capacity to maintain body temperature in the cold. Our results indicate that the role of brown fat in cold-induced thermogenesis cannot be substituted by increased energy expenditure in other tissues.