[Evaluation of prophylaxis and actual prevalence of HBV infection in twelve hemodialysis centers of Northern Poland]. / Ocena profilaktyki i aktualnej sytuacji epidemiologicznej zakazenia HBV w dwunastu osrodkach hemodializy Polski pólnocnej.

The aim of the study was to estimate the HBV infection preventive measures used in the twelve dialysis centres in north Poland. In all of the centres hepatitis B vaccination and segregation of HBV infected patients (dedicated machines or separate rooms), which are the two basic HBV infection control methods, were introduced. Our results point out that in some of the centres certain modification of these methods would be possible, including universal predialysis vaccination programme, changes in hepatitis B vaccination schedules with most effective routes of vaccination only and dedication for HBV infected patients not only separate rooms but separate dialysis staff as well.

Possible use of excretion of tubular epithelial cells for the study of the nephrotoxic effect of xenobiotics.

The method of determination of the minute excretion of tubular epithelial cells renders it possible to investigate the course of the nephrotoxic effect of the toxin by the influence of which excretion of tubular round epithelial cells is increased. The nephrotoxic effect of repeated administration of amphotericin B (1 mg/kg, i.v.), which produced up to 12-fold increases in the number of excreted epithelial cells, was examined. Repeated administration of cyclosporin A (45 and 56 mg/kg, p.o.) produced up to 23-fold increases in the number of excreted epithelial cells. The degree of excretion of epithelial cells after administration of both drugs was compared with the urinary excretion of alanine aminopeptidase and N-acetyl-beta-D-glucosaminidase, which indicated nephrotoxicity in amphotericin B and cyclosporin A with a lower sensitivity than the increase in the excretion of epithelial cells. In the experiment with cyclosporin A, urinary excretion of epithelial cells was further correlated with renal functional tests (clearance of polyfructosan and hippurate.

[Radical anatomic correction of transposition of great arteries in neonates. A new program of treatment of critical congenital heart defects]. / Radikální anatomická korekce transpozice velkých arterií u novorozencu. Nový program lécby kritické vrozené srdecní vady.

METHODS AND RESULTS: From the group of 110 neonates born with transposition of the great arteries during 1991-1994 that were referred for the treatment to Kardiocentrum, University Hospital Prague-Motol, 46 neonates with simple transposition were operated on according to the criteria for anatomical correction (arterial switch) at the mean age of 9 days (4-20 days). Fourteen infants with transposition and large ventricular septal defect were corrected with arterial switch at the mean age of 2.5 months (5 weeks-9 months). Fifty neonates that did not meet criteria for arterial switch procedure were indicated for correction at the atrial level (Senning procedure) that has been performed at the mean age of 5 months (1-10 months). Out of 46 operated neonates 10 died following the operation and one child died 2 months later after surgery. There were 2 death out of last 20 neonates (10%). Thirty five children surviving 1-4 years after anatomical arterial correction of transposition are without complaints in excellent condition, NYHA class I. CONCLUSIONS: The procedure of the anatomical correction at the level of the great arteries (arterial switch) according to Jatene, that has been successfully introduced at Kardiocentrum, University Hospital Prague-Motol, has been reproducible and became the method of choice for operations of transposition of the great arteries in neonates with the suitable anatomy.

[Heart surgery in neonates (experience with surgery in 420 neonates)]. / Kardiochirurgie novorozencu (zkusenosti s operacemi u 420 novorozencu).

In the child cardiocentre in Prague 5-Motol in 1977-1993 a total of 420 neonates with critical inborn heart disease were operated. Obstructive defects of the left heart were found in 178 children, obstructive defects of the right heart in 87, defects with a left-right shunt with pulmonary hypertension in 75, conotruncal malformations in 73 and various operations were made in 7 children. Complete repair of the defect was achieved in 281 neonates, incl. 104 where extracorporeal circulation was used. Palliative operations were made in 139 children. Early mortality during the entire period was 26%, whereby a decrease from 40% to 16% was recorded during the last three years. At present it is possible to repair permanently critical inborn heart disease in the majority of neonates. This is made possible in particular by early non-invasive diagnosis, treatment with prostaglandins E in duct-dependent critical heart disease, optimal time for and selection of most suitable surgery, microsurgical technique, miniaturization of extracorporeal circulation and the method of deep hypothermia.

[Some clinical aspects of erythropoietin action used at doses not affecting erythropoiesis in hemodialysed patients]. / Niektóre kliniczne aspekty dzialania erytropoetyny stosowanej w dawkach nie pobudzajacych erytropoezy u pacjentów przewlekle dializowanych.

Erythropoietin has become a crucial point in treatment of anaemia in patients with chronic renal failure. Recently a very important point of concern are the non hematological aspects of its action. The aim of presented study was to evaluate the biochemical and clinical effects of using erythropoietin at doses not influence hemopoiesis. 10 hemodialysis patients with stable hemoglobin and hematocrit levels, were given erythropoietin at dose of 7-10U/kg.b.w./d--the dose not affecting erythropoiesis. Erythropoietin was administered subcutaneously, 3 times a week, for 12 weeks. In this way, we tried to evaluate the direct effects of erythropoietin action, not associated with a correction of anemia. After the therapy a statistically significant decrease was seen of total cholesterol (p < 0.01), LDL-cholesterol (p < 0.01) in serum of these patients. The concentration of triglycerides, HDL-cholesterol, glucose and insulin changed in a variable mode. We did not find any significant changes in hemoglobin and hematocrit levels, but despite of that we observed a significant decrease of lactate (p < 0.01). It seems that the global result of all mentioned changes was a great improvement in the "quality of life" of this group of patients.

[Correction of double-outlet right ventricle using the Kawashima intraventricular tunnel procedure]. / Korekce dvojvýtokové pravé komory intraventrikulárním tunelem podle Kawashimy.

Anatomical correction with an intraventricular tunnel, as suggested by Kawashima, was performed in 14 children with a double-outlet right ventricle and a subpulmonary (4) or non-committed (10) defect of the ventricular septum with one early and one late death. Nine children had previous palliative operations. Complications after radical surgery were residual ventricular defects (4), infectious endocarditis (2) and impaired rhythm (one sudden death). Twelve patients are after medium- term or long-term follow-up free from subjective complaints, ten children report good performance, in two the performance is slightly reduced. Anatomical intraventricular correction of double-outlet right ventricle restores the mitral valve and left ventricle to the systemic circulation. The prognosis of children with double-outlet right ventricle and subpulmonary or remote ventricular defect improves substantially.

[Anatomic correction of a double outlet right ventricle using the Taussig-Bing arterial switch]. / Anatomická korekce dvojvýtokové pravé komory typu Taussig-Bing arteriální switch.

Four children with double outlet right ventricle type Taussig-Bing were operated in 1988-1990 by anatomical correction-arterial switch. Primary correction of the defect was performed in one infant at the age of three months. Three children had a previous palliative operation (banding of the pulmonary artery, resection of coarctation of the aorta and ductus arteriosus). Anatomical correction of the defect was performed in a second stage at the age of 14, 15 and 19 months. One child died from Gram-negative septicaemia on the 8th day after operation. Three children are completely free from complaints and develop normally. The authors discuss some technical aspects of the arterial switch operation in infants with double outlet right ventricle.

Results of radical surgical correction of ventricular septal defect.

This study evaluates results of radical correction of simple and complex ventricular septal defect in 85 children. 35 children were under 3 years of age. Two babies operated at the age of 6 and 8 months in a critical condition died after surgery. Total operation mortality was 2.3%. In 51 patients examined one year and more after surgery, the long-term results are in 90% of the cases excellent and in 10% favourable. In none of the patients did the authors find an unfavourable result of the operation. The authors regard radical surgical correction of ventricular septal defect as a method of choice regardless of the patient's age and weight.