Lipid and apolipoproteins (ApoAI, ApoB, Apo CIII, ApoE) disturbance in hemodialysis (HD) and renal transplant (Tx) patients.

The aim of the study was to evaluate the serum lipid and apolipoprotein profiles among patients after renal transplantation (Tx) and to compare them with the profiles obtained for permanently hemodialysed patients (HD). The investigations were performed at 15 Tx, 40 HD patients and the control group of 40 healthy subjects. There were significantly increased TG, ApoAIII, ApoE, TC/ HDL-C, ApoCIII non B, ApoCIII:B and decreased HDL-C, ApoAI, HDL-C/ApoAI, ApoAI/ApoCIII, ApoB/ApoCIII ratios comparing HD patients to the control group. There were increased TG, ApoCIII, ApoCIII non B, ApoB/ApoCIII ratios and decreased ApoAI/ApoCIII ratios in Tx patients as compared to the control subjects. Moreover, there were significantly higher HDL, ApoAI, HDL/ApoAI, ApoCIII non B and lower ApoE, ApoE/ApoB, ApoCIII:B ratios in Tx patients as compared to these of HD patients. Significant inverse correlation of the time which passed from executed Tx and ApoCIII:B ratio (r = -0.67; p < 0.01) at renal transplant patients were observed, which means the diminished risk of development of atherosclerosis.

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.

Superior mesenteric artery stenosis treated with percutaneous transluminal angioplasty and stent placement.

We present a case of a man with concentric significant stenoses in the superior mesenteric artery and the celiac trunk, in whom percutaneous transluminal angioplasty did not provide sufficient technical result. We report the successful use of balloon expandable Perflex stent to treat superior mesenteric artery stenosis.

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.