Integration of DASH and ICS 3000 devices with Hospital Information System and REPACE central registry.

Paper describes the system that is developed by the authors and which allows interconnection of vital signs monitor DASH, implant control system ICS 3000, HIS (Hospital Information System) used at Mestská nemocnice Ostrava and REPACE the central registry of pacemaker implantations. This connection allows users to effectively create, store and visualize operation reports with patient's data. The new system is being developed using C# programming language within .NET environment. The developed application's title is ImplantSys.

[Pregnancy after kidney transplantation]. / Tehotenství po transplantaci ledviny.

In the period 1966-1997 renal allografting was performed in 1746 recipients, 244 of whom were women in fertile age. In 32 of them 45 pregnancies were registered. 29 of them (64%) resulted in abortion, which was spontaneous in 4 and medically advised in 25. There were 16 labours, 4 of them free of any complications; of the latter, hypertension was the most frequent one (8). Of the former, 13 were solved by caesarean section and 3 were vaginal deliveries. Of 15 live babies 7 were immature (one died 1.5 year later of renal failure due to microcystic kidneys). No unfavourable effect of pregnancy on prognosis and on long-term graft function was found.

[Repeat kidney transplantation]. / Opakované transplantace ledviny.

BACKGROUND: The objective of the study was an analysis of results of repeated kidney transplantations (Tx2, Tx3) implemented during the first 29 years of activities of the Transplantation Centre of the Institute of the Clinical and Experimental Medicine in subjects with a different maintenance immunosuppression. METHODS AND RESULTS: The retrospective study pertains to 134 Tx2 and 17 Tx3 in 134 non-diabetic subjects: 43 of them had during Tx1 and Tx2 (1966-1981 and 1966-1985 resp.) immunosuppression on the basis of azathioprin (Aza, sub-group AA), 42 during Tx1 (1972-85), Aza, while during Tx2 (1984-85) immunosuppression on the basis of cyclosporin (CyA, subgroup AC) and 49 both during Tx1 and Tx2 (1985-93 and 1986-95 resp.) CyA (subgroup CC). Compared was survival of grafts by the actuarial method (with regard to all losses regardless of cause) by the end of the 4th year inside the subgroups (Tx2, vs. Tx1 and Tx3 vs. Tx2 in the same subjects) and between subgroups (Tx1 vs. Tx1 and Tx2 vs. Tx2 in different subjects). Moreover in paired investigations the survival of recipients and grafts after Tx2 was compared after immunosuppression on the basis of CyA with the same parameters after Tx1 in different subjects with the same immunosuppression, operated at approximately the same time (n = 81) and survival of subjects with Tx1 + Tx2 on the CC regime regardless whether the second grafts functioned at the time of the last examination, with survival of subjects after Tx1 where after graft failure Tx2 was not performed (n = 34). Prophylaxis with antilymphocyte globulins was not used. Survival of second and first grafts did not differ in any of the subgroups, third grafts survived at the end of the third year more frequently than second grafts (66 vs. 18%, p < 0.01). Second grafts in CC survived more than in AA (55 vs. 28%, p < 0.01). In the paired study Tx2 vs. Tx1 the survival of grafts and recipients was the same (88 vs. 89%, N.S. and 47 vs. 62% resp.), in the paired study Tx1 + Tx2 vs. Tx1 more subjects with Tx1 + Tx2 survived 10 years after Tx1 than subjects who did not have Tx2 (82 vs. 49%, p < 0.05). CONCLUSIONS: A further transplantation of the kidney after functional loss of the first graft is the method of choice: the mortality is low, the probability of several years' function is considerable and the prognosis as regards quality and length of life better than with regular dialysis treatment.

[Immunohistochemistry of a biopsy of an allotransplanted kidney]. / Imunohistochemie biopsií alotransplantované ledviny.

BACKGROUND: Cellular rejection infiltration of the interstitium is the basic histological finding in biopsies of transplanted kidneys, and leukostasis in the muscular arteries and glomeruli is an important sign of exacerbating rejection. For better understanding and more accurate interpretation the authors used immunohistochemistry. METHODS AND RESULTS: The authors examined 282 tissue specimens from 208 grafts using the two- or three-step immunoenzyme method with 28 mono- or polyclonal antibodies specific for a series of differentiation and activation leukocytic antigens, adhesion molecules and selected cytokines. In the compact component of the rejection infiltrate CD4+ lymphocytes with expression of CD 45 RA antigen predominated while in the disperse component there were mostly macrophages (CD68, 14, 11b); their number correlated significantly with the parenchymatous damage, similarly as intraarterial and glomerular accumulation. The disperse infiltrate and adherent cells expressed CD45 RO (rarely CD25) and integrin molecules of the series CD11 and CD49 CD57+ lymphocytes penetrated into the tubules but did not accumulate in the blood vessels. As to adhesive molecules of the "Ig superfamily", CD106 (VCAM-1) was more important than CD54 (ICAM-1) and its arterial and mesangial expression correlated with the rejection damage. Evidence of cytokines (IL1, IL2, TNF alpha, beta) did provide neither unequivocal results nor correlations. CONCLUSIONS: Immunohistochemistry improves considerably the accuracy of bioptic evaluation of rejection nephropathy and some antigens (e.g., CD68, CD14, CD45 RO., CD57, CD106) are suitable for diagnostic practice. With their aid it is easier to evaluate the activity of rejection, assess the probability of vascular lesions in specimens without affected vessels and detect more sensitively intravascular stasis and adhesion of leukocytes.

Loneliness and social support in infertile couples.

OBJECTIVE: To determine differences between infertile wives' and husbands' levels of loneliness and perception of social support and to determine if there is a relationship between loneliness and social support. DESIGN: Comparative descriptive. SETTING: University infertility clinic and RESOLVE, an infertility support group. PARTICIPANTS: Convenience sample of 62 couples diagnosed as experiencing either primary or secondary infertility. OUTCOME MEASURES: Loneliness was measured using the Revised UCLA Loneliness Scale; social support was measured using the Interpersonal Relationship Inventory with subscales of Social Support, Reciprocity, and Conflict. RESULTS: Wives were significantly more lonely than husbands (t = 2.053, p = 0.04). There was no significant group difference on the social support total score or three subscale scores. Loneliness was inversely related to social support and reciprocity both for wives (r = -0.62, p = 0.001, and r = -0.50, p = 0.002, respectively) and husbands (r = -0.74, p = 0.001, and r = -0.56, p = 0.001, respectively); loneliness correlated with conflict for wives only (r = 0.48, p = 0.007). CONCLUSIONS: Although wives and husbands differed in loneliness, they were similar in perceived social support. Greater social support and reciprocity lessened feelings of loneliness for both groups. Wives who perceived increased conflict in their social relationships were more lonely.

[Early changes in vascular graft rejection in transplanted kidneys: the past and the present]. / Casné cévní rejekcní zmeny transplantované ledviny: minulost a soucasný stav.

BACKGROUND: With maintenance azathioprine+prednisone and in biopsies performed exceptionally earlier than in the 4th week (1966-1984, 476 cadaveric kidney transplantations), prevalence of obliterative arteriopathy (OA, transmural arteritis, 4/III/v3 Banff classif.) was 22.1%, with graft loss by rejection within 6 mos. in 89.4%. The aim of this analysis was to study prevalence and prognostic importance of the former and of further early vascular lesions in subjects with maintenance cyclosporin A using biopsies performed as early as in the 1st week. METHODS AND RESULTS: In a retrospective study on 449 transplantation (1987-92, cyclosporin A+prednisone+azathioprine, 64.7% grafts histologically--mostly repeatedly--examined), prevalence and prognostic classification (A-good, B-uncertain, C-poor prognosis) in recipients with OA, with cellular arteriopathy (CA, intimal arteritis, 4/II-III/v2-v3 Banff classif.) and with minimal arterial lesions (MZ) were assessed. Prevalence of OA was found to be 7.1% transplantations, with graft loss by rejection within 6 mos. in 71.9%, and with A:C proportion 25.0%: 62.5%. CA was found in 5.1% and showed A:C proportion 34.7%: 34.7%; in 6/13 cases with repeated histology, OA was later encountered, which is a strong point against its humoral pathogenesis. Prevalence of MZ was 10.9%, with A:C proportion 40.8: 4.1%. CONCLUSIONS: Both OA and CA are related to rejection, while the etiology of MZ remains to be clarified. With cyclosporine, prevalence of OA markedly decreased and its prognosis somewhat improved; secondary prevention is possible when an early diagnosis (early and repeated biopsies) is done and immediate treatment (antilymphocyte globulins) started.

[Kidney transplantation and tumors]. / Transplantace ledviny a nádorová onemocnení.

BACKGROUND: In conjunction with organ transplantation and subsequent treatment there is a number of influences which potentiate the development and possibly the growth of tumours. This applies naturally also to transplantations of the kidneys. The objective of the present study was to assess the frequency and type of tumours in patients after renal transplantation and compare these results with data of the at present most extensive worldwide register in Cincinnati (CTTR). METHODS AND RESULTS: The authors analyzed a group of 879 patients where within the period between March 21, 1966 and Sept. 29, 1992 a total of 989 renal transplantations were performed from dead relations-934 or from living relations (55); in 38 patients combined transplantations of kidney and pancreas were performed. The group comprised 59% men and 41% women. In the course of years the pattern of prophylactic immunosuppression changed: up to 1984 the basic drug was azathioprin combined with prednisone, during the same year cyclosporin A was introduced as a rule in a triple combination with azathioprin and prednisone; less frequent was the combination of cyclosporin A and prednisone. For antirejection treatment corticoids were used, later supplemented with polyclonal or monoclonal antibodies. During the period 1966-1992 tumourous diseases were diagnosed in 32 patients (3.64%); in two of these patients; combined transplantation of the kidney and pancreas was performed (5.3%). There was no difference in the frequency of tumours in patients with immunosuppressive medication (azathioprin with prednisone-3.80%) and cyclosporin A (3.51%). The mean age of the patients at the time of diagnosis of the tumour was 50.2 years, the interval after transplantation was 42.2 months (in patients treated with azathioprin 57 months, in the group treated with cyclosporin A 29.2 months). As far as the location of tumours is concerned, tumours of the skin predominated 25% (as compared with CTTR where it was 30%), tumours of the patient's own kidneys 21.9% and of the urinary pathways 15.6%, tumours of the gastrointestinal tract 12.5%, lymphomas in 9% (as compared with 15-20% in CTTR), tumours of the lungs 6.25% and other localizations also 6.25%. Some tumours frequently encountered in the population (lung cancer, cancer of the prostate, breast, colorectal carcinoma) are less frequent in patients after transplantation (CTTR); however, this fact was not confirmed by the authors. In renal tumours and tumours of the efferent urinary pathways data on analgetic nephropathy were encountered very frequently. CONCLUSIONS: The prevalence of tumours of various organs in patients after transplantations of the kidneys are not a frequent but a very serious complication. Its causes are multifactorial. The group after renal transplantations in the Czech Repubic has some deviations as compared with CTTR as regards affection of organs.

[Etiopathogenesis of insudative vasculopathy in transplanted kidneys]. / Príspevek k etiopatogenezi insudativní vaskulopatie transplantované ledviny.

In 99 renal allograft recipients with insudative vasculopathy of graft, mean serum cholesterol levels, prevalence of subjects with hypercholesterolaemia, mean cumulative doses of methylprednisolone, prevalence of subjects with methylprednisolone doses > or = 6,000 mg and prevalence of patients with hypertension, all in the period between transplantation and the first diagnostic biopsy, were compared between 51 those with conventional and 48 with cyclosporine maintenance immunosuppression. In subjects treated with cyclosporine the lesion was found in biopsies performed sooner and was present more frequently, prevalence of hypercholesterolaemia and of hypertension was similar and that of subjects with both hypercholesterolaemia and hypertension lower than in subjects treated with azathioprine. A positive correlation was present between high doses of methylprednisolone and prevalence of hypertension, regardless of the type of immunosuppression and of severity of vasculopathy. In etiopathogenesis of insudative vasculopathy atherogenic factors are most probably involved, more markedly when azathioprine is used for maintenance immunosuppression. With cyclosporine, changes of graft haemodynamics and possibly also toxic damage to the vessels involved seem to be more important.

[Therapy in kidney transplant rejection using murine monoclonal IgG2a A1CD3 (Cedetrin)]. / Lécba rejekce transplantované ledviny mysím monoklonálním IgG2a A1CD3 (Cedetrin).

BACKGROUND: One of the substances used in recent years to suppress immune reactions after organ and tissue transplantations is mouse IgG2a globulin which acts selectively on CD3 lymphocytes; it is known under the name of Orthoclone (Ortho Co.) An analogous preparation was developed in the Institute of Molecular Genetics, Academy of Sciences, Czech Republic, although the idiotype is different. The authors submit a report on the experience with treatment of rejection of transplanted kidneys. METHODS RESULTS: Monoclonal mouse globulin IgG2a (Cedetrin) was administered to 20 patients after renal transplantation on account of a rejection episode or progressing rejection; the mean interval after transplantation was 16.1 (range 0.25-96) months; the rejection episode or progressing rejection responded little in the majority of patients to 6-alpha-methyl prednisolone (Urbason, Hoechst, Solu-Medrol, Upjohn). For prophylactic immunosuppression the following combinations were used: cyclosporin + azathioprine + prednisone (17x) or azathioprine + prednisone (3x). Cedetrin was administered by the i.v. route in two to 11 doses a 3 mg substance. Of 20 patients in 6 Cedetrin administration had to be discontinued (allergy, infection, leucopenia, hyperhydration). In 14 the tolerance was satisfactory, the type and frequency of side-effects was similar as after Orthoclone; the antibody formation was less frequent. The specificity of Cedetrin as regards its action on T lymphocytes was confirmed. The effect was good to very good in 6 of 8 patients where the rejection filtrate was histologically active. In 9 patients treated during the first year after renal transplantation the cumulative survival of the graft at the end of the 12th, 24th and 36th month following transplantation was 89%, 67% and 56% resp. Because the therapeutic effect depended on histologically proved rejection activity, the authors consider biopsy of the graft before Cedetrin treatment essential. CONCLUSIONS: The therapeutic administration of monoclonal mouse globulin IgG2a A1CD3 (Cedetrin), developed in the Institute of Molecular Genetics, Academy of Sciences, Czech Republic, produced by Exbio Co., CR) has a favourable effect on rejection episodes or progressing rejection of transplanted kidneys. Treatment is indicated in confirmed histologically active rejection.

[Consupren in prophylactic therapy after kidney transplantation]. / Consupren v profylaktické lécbe po transplantaci ledviny.

Thirty patients after a first transplantation of the kidney from a dead donor were treated with Consupren Galena combined with azathioprine and prednisone for a period of at least one year. As control served a comparable historical group of 50 patients treated with a combination of three immunosuppressive drugs using Sandimmune, Sandoz. No significant differences were found between the two groups as regards the functional development of the grafts, the number of lost grafts, the cumulative survival of grafts, the number of rejections and the number of deaths. As to undesirable effects there were insignificantly more patients with a nephrotoxic episode in group CS where also repeated nephrotoxic episodes were recorded. The most frequent undesirable effect in group CS was hirsutism in half the patients. Consupren used in prophylactic treatment in combination with a azathioprine and prednisone appears to be a comparable immunosuppressive regime as that which comprises Sandimmune, Sandoz.

[Graft rejection after changing from cyclosporin A therapy to conventional treatment in kidney transplant patients]. / Rejekce stepu po prevodu z lécby cyklosporinem A na konvencní lécbu u nemocných po transplantaci ledviny.

Hundred and twenty live patients after the first transplantation of the kidney from a decreased donor with satisfactory graft function, treated with cyclosporine A combined with prednisone or combined with prednisone or combined with prednisone and azathioprine were divided into three groups: A--20 patients changed during the 6th-9th month after transplantation to conventional azathioprine-prednisone treatment. B--68 patients switched to this treatment during the 10h-15th month following transplantation. K--37 patients who were not switched to other treatment during the mentioned period. Within 3 months after the switched rejection develop in 21% of the patients in group A and 20% patients in group B. The incidence of rejections during a comparable period in group K was significantly lower (3%), as compared with group A and insignificantly lower (14%), as compared with group B. The majority of rejections was documented by biopsy but no morphological difference was found between rejections which developed in patients switched and not switched to other treatment. It was striking that there was a difference, though insignificant, in the sensitivity of rejections to antirejection treatment with methylprednisolone after switch to a different preparation: in group A 25%, in group B 37% and in group K 80%. Patients in group A with rejection after the switch had developed a rejection even before the switch significantly more frequently (in 75%) than in group B (in 7%) and these rejections led significantly more frequently to loss of the graft.

Necrotizing enterocolitis.

In summary, NEC is the most common gastrointestinal emergency in the newborn. Premature infants are the most likely affected. Although progress has been made in elucidating some of the factors responsible for NEC, the exact etiology is still unclear. Aggressive medical management is required, but indications for surgical intervention differ from institution to institution. Overall mortality remains about 20% to 40%. About one half of survivors seem to have no sequelae, but the remaining infants may have significant ones which require additional surgical intervention or produce life long problems. Efforts at prevention have not been very successful. The single most important prophylactic measure would be to prevent prematurity. Until the exact pathogenesis of NEC is better understood, effective preventive measures are unlikely to be developed.

[Initial clinical experience with Consupren, a new preparation manufactured in Czechoslovakia (Galena), in patients after liver transplantation]. / První klinické zkusenosti s novým cs. prípravkem Consupren (Galena) u nemocných po transplantaci ledviny.

Fourteen patients on average 10 months after transplantation of the kidney treated with Sandimmune were changed to a new Czechoslovak preparation Consupren, Galena (Cyclosporine A), while maintaining the other components of immunosuppressive treatment (azathioprine, prednisone). The patients were followed up for 6-12 months on the new drug. The tolerance of Consupren was in all patients satisfactory. Two weeks after the change the mean cyclosporine A level was significantly higher and called for a reduced dosage. No significant changes in the clinical condition and laboratory indicators were observed, the serum creatinine values did not change during the investigation and within 6 months after the change no rejection was recorded, despite the fact that during the first six weeks after the change an insignificant rise of mean absolute number of lymphocytes, CD4 lymphocytes and the regulatory index and a significant rise of CD3 lymphocytes was observed.

[Preventive administration of antithymocyte globulin in combined immunosuppressive therapy with cyclosporin A, azathioprine and prednisone in kidney transplantation]. / Profylaktické podávání antithymocytárního globulinu v kombinované imunosupresívní lécbe s cyklosporinem A, azathioprinem a prednisonem u transplantací ledvin.

Forty-five patients after transplantation of the kidney from a dead donor were treated by a triple combination of cyclosporin A, azathioprine and prednisone. In patients where during the first two days after transplantation the function of the graft was not restored, cyclosporin A was reduced and treatment supplemented by a combination of four by prophylactic administration of ATG for a period of 7 days. A total of 18 patients had a complete prophylactic dose of ATG. The results in this group were compared with a historical comparable group of 27 subjects treated only with the triple combination of drugs without reduction of cyclosporin A. In patients treated with ATG the mean initial function of the graft was reduced only insignificantly and the one-year survival of the graft was only insignificantly better than in the control group. During the first two months after transplantation there were significantly more leucopenic episodes in patients treated with ATG, however, no direct relationship with the latter was proved. The number of infectious complications in these patients was lower than in the control group.

Arteriolosclerosis of the human renal allograft: morphology, origin, life history and relationship to cyclosporine therapy.

In the decade 1979-1988, 658 biopsies were collected from 568 cadaveric renal allografts. In 118 grafts a non-proliferative insudative vasculopathy (IVA) was found in afferent vessels. Immunosuppression was based on azathioprine (AZA) or on cyclosporin A (CsA), from 1983. The prevalence and extent of IVA has increased significantly since 1984. Light microscopy showed fibrinoid and hyaline masses of varying extent; transmural insudative "knobs", intimal oedema with metachromasia, and microthrombosis were also seen with CsA. The ultrastructure of the insudates was unremarkable but CsA grafts displayed early oedema and hypergranulation of endothelial cells with a disarray of smooth muscle cell (SMC) microfibrils, and pronounced degenerative changes of SMC. Rebiopsy showed stationary IVA in AZA grafts and progression in one-half of CsA-treated patients. Nephrectomy specimens revealed, however, a marked predominance of late rejection endarteritis; in only 3 cases was IVA and/or microthrombosis the possible cause of nephrectomy. The mean donor age was higher in severe IVA in CsA grafts and the mean post-transplantation interval at the time of diagnosis of IVA was significantly shorter in CsA-treated patients. No important differences in cumulative graft survival were seen between grafts with absent, moderate or severe IVA. Unused cadaveric donors' kidneys of comparable age exhibited normal arterioles or a slight focal insudative or hyaline lesion.