A comparative analysis of gaseous phase hydration properties of two lichenized fungi: Niebla tigrina (Follman) Rundel & Bowler from Atacama Desert and Umbilicaria antarctica Frey & I. M. Lamb from Robert Island, Southern Shetlands Archipelago, maritime Antarctica.

Gaseous phase hydration properties for thalli of Niebla tigrina from Atacama Desert, and for Umbilicaria antarctica from Isla Robert, maritime Antarctica, were analyzed using 1H-NMR relaxometry, spectroscopy, and sorption isotherm analysis. The molecular dynamics of residual water was monitored to distinguish the sequential binding very tightly, tightly, and loosely bound water fractions. These two species differ in hydration kinetics faster for Desert N. tigrina [A1 = 0.51(4); t1 = 0.51(5) h, t2 = 15.0(1.9) h; total 0.7 for p/p0 = 100%], compared to Antarctic U. antarctica [A1 = 0.082(6), t1 = 2.4(2) h, t2 = [26.9(2.7)] h, total 0.6 for p/p0 = 100%] from humid polar area. The 1H-NMR measurements distinguish signal from tightly bound water, and two signals from loosely bound water, with different chemical shifts higher for U. antarctica than for N. tigrina. Both lichen species contain different amounts of water-soluble solid fraction. For U. antarctica, the saturation concentration of water soluble solid fraction, cs = 0.55(9), and the dissolution effect is detected at least up to Δm/m0 = 0.7, whereas for N. tigrina with the similar saturation concentration, cs = 053(4), this fraction is detected up to the threshold hydration level equal to ΔM/m0 = 0.3 only.

Association of HLA alleles and haplotypes with CYP21A2 gene p. V282L mutation in the Croatian population.

The CYP21A2 mutations that are in linkage disequilibrium with particular HLA-A, -B, -DRB1 alleles/haplotypes, cause deficiency of the 21-hydroxylase enzyme (21-OHD) and account for the majority of congenital adrenal hyperplasia (CAH) cases. The aim of this study was to investigate those associations with the p.V282L mutation linked to the non-classical (NC) form of CAH among Croatians. The study included parents of patients with the NC form of CAH, positive for the p.V282L mutation (N = 55) and cadaveric donor samples (N = 231). All subjects were HLA-A, -B, and -DRB1 typed and tested for the presence of the p.V282L mutation. Among parents of patients, 92.73% of subjects were positive for the B*14:02 allele and almost half of them carried the HLA-A*33:01-B*14:02-DRB1*01:02 haplotype. Among cadaveric samples 77 out of 96 subjects positive for the B*14:02 allele had the p.V282L mutation. Among them, 37 were positive for the HLA-A*33:01-B*14:02-DRB1*01:02 haplotype, 23 had the HLA-A*33:01-B*14:02-DRB1*03:01 haplotype, 8 had the B*14:02-DRB1*01:02 combination and 5 were carrying the HLA-A*68:02-B*14:02-DRB1*13:03 haplotype. Only 4 of these subjects were positive for the B*14:02 allele. HLA-B*14:02 was the only single allele with association that reached statistically significant P value (RR = 12.00; P = 0.0024). Haplotypes B*14:02-DRB1*01:02 (P < 0.001) and HLA-A*68:02-B*14:02-DRB1*13:03 (P < 0.001) as well as HLA-A*33:01-B*14:02-DRB1*01:02 and HLA-A*33:01-B*14:02-DRB1*03:01 showed high relative risks (RR = 45.00, RR = 41.63 and RR = 36.96, respectively). Our data support the previously documented association of the HLA-A*33:01-B*14:02-DRB1*01:02 haplotype with the p.V282L mutation, but also point out a high frequency of the p.V282L mutation among Croatians with HLA-A*33:01-B*14:02-DRB1*03:01 and HLA-A*68:02-B*14:02-DRB1*13:03 haplotypes.

[Can modern infusion solutions cause serious disruption of inner environment of an organism?]. / Mohou moderní infuzní roztoky zpusobit závazný rozvrat vnitrního prostredí organizmu?

The article brings a description of a patient case when an application of mineral balanced infusion solutions led to a disruption of inner environment, beginning of a combined failure of the acid-base balance with a serious metabolic acidosis. Patient J. was artificially respirated after a CPR. During the therapy the patient was given basically without any changes a combination of mineral solution Plasma-Lyte 148, amino-acid and 20% glucose. During 8 days a serious metabolic alkalosis had developed (caused by a lack of chlorides, phosphates and other reasons), combined with respirational acidosis. Hydrogencarbonate level was increased to 47.2 mmo/l (at norm of 24 mmol/l), base excess level to 21.4 mmol/l (at norm of 0 mmol/l). Metabolic acidosis led to reduction of sensibility of the respiratory centers and therefore it was not possible to restore spontaneous respiration. After the therapy change and reduction of metabolic acidosis the state of the patient got better. Application of acidifying solutions, supplementation of phosphate and potassium levels and replenishment of actual losses of phosphates led to regulation of the inner environment. Together with the application of sufficient amount of basic nutrients was the improvement of acid-base balance the key factor which enabled the restoration of spontaneous respiration and disconnection of the patient from the ventilator. In short summary you can see reasons which cause different effect of identical infusions to acid-base balance of the inmates in different situations. The article points to a necessity of controlling groovy medical procedures according to actual patient's needs.

[Etiopathogenesis of type 2 diabetes mellitus]. / Etiopatogeneze diabetes mellitus 2. typu.

In the genesis and development of type 2 diabetes in the great majority of subjects the contemporary lifestyle characterized by inadequate physical activity and an excessive energy intake is of basic importance. The majority of abnormalities and defects revealed by laboratory tests is probably secondary and caused by the above mentioned factors. Contemporary views of the etiopathogenesis of the disease are demotivating for patients: if the cause of their disease were an inborn disorder at the level of transmission of a signal on membranes then probably nothing else can be done than to take prescribed drugs. If the mistake involves the lifestyle, the latter can be changed and the disease avoided. Any medicamentous treatment is associated with the risk of undesirable effects--the complication of hyperinsulinism in treatment with sulphonyl urea derivatives and insulin or lactate acidosis after treatment with biguanides. This risk is not influenced by early prevention: dietary restraint and adequate physical exercise. Diabetes type 2 and 1--despite the common sign of hyperglycaemia--are characterized by a fundamental difference: (not influenced by treatment) DM type 1 is characterized by enhanced catabolic processes, starvation at the cellular level. Type 2 is characterized by enhanced anabolic processes, excessive amounts of nutrients in cells. The authors submit recommendations which respect the secondary character of deviations for the development of DM 2 which can be detected by laboratory methods: The following are the basic etiopathogenetic mechanism for the development of DM 2: 1. Chronic excessive intake and inadequate output of energy a) increased nutrient supply to the liver with secondary increase of gluconeogenesis in the liver, b) chronic increased supply of glucose to peripheral tissues, in particular muscles and adipose tissue, inadequate physical exercise, with secondary restriction of nutrient supplies to these tissues. 2. Secondary affection of insulin secretion in the islets of Langerhans in the pancreas.

[The paradox of insulin resistance]. / Paradox inzulinové rezistence.

Insulin resistance (IR) is a phenomenon which associates several serious "diseases of civilization" within the framework of Reaven's metabolic syndrome. In the submitted paper the authors describe the so-called "paradox of insulin resistance"--a paradoxical finding of inadequate insulin action under laboratory induced conditions while under "common" conditions the finding is reversed. Diabetes mellitus type 2 (with obesity) is characterized by excessive filling of cells by energetically rich substances. A low energy output, inadequate physical activity in these subjects leads to the development of regulatory mechanisms, which restrict further nutrient (glucose) uptake from blood into cells. During subsequent stages of the disease the excessive glucose uptake by adipose tissue cells and muscle is ensured by the high concentration gradient, hyperglycaemia and hyperinsulinaemia. Induction of "comparable" conditions in clamp studies leads to paradoxical results. During relative hypoglycaemia and hypoinsulinaemia (as compared with normal conditions) the tissues of the diabetic patient, due to regulatory mechanisms, take up a smaller amount of glucose than tissues of non-diabetic subjects (although under normal conditions the glucose uptake is higher). This phenomenon is called "Paradox of insulin resistance". In a major proportion of patients IR can be induced by mere maintenance of hyperinsulinaemia, it can be minimalized by reducing the nutrient intake and by increasing physical exertion. Differentiation of patients where IR is a secondary, regulatory phenomenon is one of the basic tasks of the physician. Only patients who suffer from primary disorders of insulin function, primary IR and true insulin deficiency should be treated by administration of hyperinsulinaemia inducing drugs. It is questionable how suitable it is to administer these drugs to patients who suffer from a life-style disorder and are threatened by complications associated with hyperinsulinism.

[Combined disorders of the acid-base equilibrium. Clinical comments]. / Kombinované poruchy acidobazické rovnováhy. Klinické poznámky.

The submitted paper contains comments on the evaluation of combined disorders of the acid-base balance. Some different definitions of the acid-base balance are given as well as their importance for the evaluation of combined conditions. The author discusses parallel and opposite deviations which develop inside and outside the cell, disorders associated with the mere accumulation of some ions and disorders associated with an impaired energy balance. On several examples clinical manifestations of impaired acid-base balance are illustrated where the laboratory finding may be atypical.

[Basic indicators characterizing the acid-base equilibrium and its disorders]. / Základní ukazatele charakterizující acidobazickou rovnováhu organismu a její poruchy.

The author describes and evaluates basic parameters used for evaluation of the acid-base balance: pH, pCO2, BE, BBS, (Na + K)/Cl, (AG) and RA. He compares the theories of two basic schools, the Copenhagen and Boston school and synthesizes the different views of various authors. A combination of modern theories permits to evaluate simple and combined disorders of the acid-base balance, disorders which can potentiate each other but also mask their effect. The author mentions also the importance of oxygen parameters and of other substances essential for obtaining energy, the importance of assessment of the patient's clinical condition, the necessity of retrospective evaluation based on the trend of changes of the acid-base balance in the course of time. In the article mathematical logical terminology of acid-base balance disorders is used, the attached figures and calculations facilitate the understanding of this pretentious problem.

[Determination of serum lactic acid and the acid-base equilibrium in carbon monoxide poisoning]. / Význam vysetrení laktátémie a acidobazické rovnováhy pri otrave oxidem uhelnatým.

The authors present a description of severe accidental carbon monoxide poisoning. They stress the significance of the examination of lactic acid level at this poisoning. In case described the level of carbonyl haemoglobin could not be determined because of device trouble. Patient AA (16-year-old) was admitted in relatively very good condition, without clinical signs of severer affection. Considering the facts that gas-poisoning (over 24 hrs) was found through anamnesis, and simultaneous admission of patient's greatgrandmother in critical condition, the patient AA was treated also with oxygen of high concentration, monitored, kept in absolute rest. High lactate level (18.9 mmol/l) and the evidence of metabolic acidosis (pH 7.16, pO2 8.65, pCO2 2.06, sBE -22.1) made to suspect of severe poisoning. Despite intensive oxygenotherapy it came to severe left-side cardial failure associated with pulmonal edema, anuria, shock after 4 hours, managed successfully within 4 hours. Lactate level correlated very well with condition severity. Septum hypokinesis was demonstrated cardiografically and it disappeared within 6 days. However, symetric inversion of T wave in many leads (I, II, aVF, V 2-6) persisted for 24 days. The authors assume that routine examination of acid base balance and lactate level in addition to the determination of carbonyl haemoglobin level is very important for the consideration of the severity of carbon monoxide poisoning. Lactataemia determination is probably even more significant for the assumption of oxygen deficit and therefore for the total prognosis of the patient.

[Lactate acidosis: a rare or common disease?]. / Laktátová acidóza: vzácné ci casté onemocnení?

The authors present a survey of 50 documented cases of metabolic lactic acidosis (MLAC) recorded in the course of 5 years. To this study cases of severe hyperlactataemia (determined minimum lactate level of concentration 4 mmol/l) have been included. The sample consists of patients hospitalized at the Department of Internal Medicine Litomerice (hinterland of about 110,000 inhabitants). Liver involvement in 5 cases, cardiogenous shock in 6 cases, sepsis in 2 cases were the cause of lactic acidosis. The administration of biguanids (Adebit, Silubin R, Diformin) seems to be the probable cause in 21 cases, other cases were triggered by rarer causes. Dehydratation (16), vomiting (9), diarrhoea (11) dominate often in the clinical picture. The patients were admitted to the hospital often unconscious, with diagnose of vasculo-cerebral incidence, transitory ischaemic incidence... Quit rarely the typical Kussmaul's respiratory (only 9 cases) was recorded. Hyperlactatemia was usually associated with decrease of blood pH (theta = 7.12, pH less than 7.35 was recorded in 49 cases, pH less than 6.8 in 5 cases) and with decrease of BE value (= Ccoase, theta = -15.3 mmol/l). When the hypochloremia and/or hypocapnia was simultaneously more severe, only in these cases the value of pH was within physiological limits or even increased (10). The conclusions show that MLAC is not a rare disorder, however, its occurrence is depended rather on the clinician's capacity to diagnose this disorder and to indicate lactate examination. Usual signs of acidosis (Kussmaul's respiratory, decrease of pH, decrease of BE) can be missing in many cases.(ABSTRACT TRUNCATED AT 250 WORDS)

The usefulness of the lactate dehydrogenase macroreaction in autopsy practice.

The detection of recent myocardial damage by means of the macroscopic lactate dehydrogenase reaction (LDHr) linked to nicotinamide adenine dinucleotide diaphorase (NADHd), conducted in a liquid medium is greatly insensitive to postmortal autolysis. In 10 heart cones (i.e., cardiac ventricles severed underneath the coronary sulcus) stored at 6 degrees C for up to 114 h after death, no autolytic artifacts appeared on freshly cut apical surfaces of transverse myocardial slices. In 10 cones kept at room temperature for up to 95 h after death, no artifacts appeared in eight cases; in two cases the LDHr was impaired by postmortal bacterial spread and decomposition of the myocardium. Intravital perfusion of injured myocardium increases the sensitivity of the LDHr. Postmortal stand-still of circulation is decisive in preserving dehydrogenase activities in undamaged myocardium. An artificial decrease in enzyme activity always appeared on the nonrecent, basally facing cut surfaces of slices exposed to air and fluid oozing out of the myocardium for long periods, even if the exposed surface of the cone was kept at 6 degrees C and wrapped in plastic. In normal practice, when bodies are stored in a refrigerating unit, the LDHr may still indicate myocardial damage more than 114 h after death.

Prevention of adhesion formation around the internal mammary artery pedicle by Gore-Tex surgical membrane. An experimental study in goats.

The effects of wrapping the internal mammary artery in Gore-Tex surgical membrane on the formation of adhesions were investigated. In seven goats both internal mammary arteries were dissected free from the thoracic wall. In six goats the internal mammary arteries were wrapped in Gore-Tex surgical membrane. In the remaining animal both arteries were removed and used as controls. After 6 months the goats were reoperated and it was found that the wrapped segments of all arteries were completely free of adhesions, whereas the non-wrapped segments showed severe adhesion formation. Histologic examination could not detect differences between the wrapped arteries and the controls. One of the 12 wrapped arteries was occluded by a longer existing thrombus, which is attributed to the surgical technique and the fact that postoperatively no anticoagulation was given. The beneficial effect of the use of Gore-Tex surgical membrane on the prevention of adhesion formation is excellent and this implies that it could be used in coronary artery bypass operations, thus reducing the chance of damage to the bypass in case of reoperation.

Quality control in fatally injured patients: the value of the necropsy.

OBJECTIVE: To identify the contribution of necropsy results to the audit care of severely injured patients. DESIGN: Retrospective study. SETTING: University Hospital in The Netherlands. SUBJECTS: 56 patients who died of severe trauma or its complications during the 10 year period, 1977 to 1987. MAIN OUTCOME MEASURES: Correlation between clinical and necropsy findings. RESULTS: The clinical and necropsy findings corresponded in 31 patients (55%). The necropsy brought to light errors in diagnosis or treatment that might have affected survival in eight cases (14%). The most common missed diagnoses were bronchopneumonia and severe haemorrhage, and the most common cause of death was sepsis. Age, length of stay in hospital, and time between admission and operation were not correlated with accuracy of diagnosis or adequacy of treatment. CONCLUSION: Necropsies in patients who die after severe injuries make a useful contribution to the audit of the care of patients admitted with such injuries.

Histological study of the internal mammary artery with emphasis on its suitability as a coronary artery bypass graft.

The internal mammary, musculophrenic, and superior epigastric arteries were unilaterally harvested from 11 individuals (aged 49 to 83 years; mean age, 67 years) and were examined histologically at 1-cm intervals. In 2 individuals the media of the entire internal mammary artery was elastic, whereas in the other 9 individuals we observed an alternating histological pattern in the media of the internal mammary artery, that of the proximal and distal segments being elastomuscular and that of the mid segment being elastic. In 4 of the latter 9 individuals the distal 10% to 20% of the media of the internal mammary artery was muscular with rare elastic lamellae. The media of the first 1 to 2 cm of the musculophrenic and superior epigastric arteries was elastomuscular or muscular with rare elastic lamellae, whereas more distally the media was purely muscular. The degree of intimal hyperplasia was significantly greater in arterial segments with a purely muscular media (25.6%) than in those with elastic (16.7%), elastomuscular (15.3%), and muscular (with rare elastic lamellae) (17.5%) types of media (p < 0.01). The mean cross-sectional luminal area of the elastic segment (1.9 mm2) and proximal and distal elastomuscular segments (1.9 and 1.2 mm2, respectively) of the internal mammary artery was significantly greater than that of the muscular segments of the musculophrenic artery (0.9 mm2) and the superior epigastric artery (0.7 mm2) (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Autopsy analysis in surgical patients: a basis for clinical audit.

An autopsy study was performed to quantify diagnostic fallibility in clinical surgery. Autopsy results in 312 surgical patients were compared with clinical findings. The primary clinical diagnosis was correct in 93 per cent of patients; complications had been correctly diagnosed in 60 per cent and error in treatment was found in 16 per cent. Error in treatment had an adverse impact on the course of disease in 11 per cent of patients. Infective complications such as abdominal sepsis and bronchopneumonia were encountered most often. Sensitivity was low for the clinical diagnosis of pulmonary embolism, bronchopneumonia, myocardial infarction and terminal haemorrhage. Statistical analysis showed that sudden unexpected death is the most obvious condition in which a high yield is expected from a post-mortem examination. Autopsy remains a valuable means of quality control in clinical surgery and could be a basis for surgical audit.

The results of autopsy of patients with surgical diseases of the digestive tract.

The results of autopsy of 77 patients who died because of surgical disease of the digestive tract were compared with antemortem findings. An analysis was performed to identify missed diagnoses and incorrect therapy. Primary diagnoses had not been frequently missed, but many complications of the primary disorder or treatment had been overlooked. Many patients died because of septic conditions. Error in treatment, with an adverse impact on the course of the disease as assessed by the postmortem examination, occurred in 9 percent of the patients. The most common error had been failure to reoperate upon patients with an intra-abdominal complication. Unexpected death was significantly associated with incorrect diagnosis; failed or inadequate diagnostic methods were significantly associated with treatment failure (chi-square tests). The autopsy remains a valuable procedure in clinical operation. Selection of patients for autopsy, as indicated by decreasing autopsy rates, is not justified.

Autopsy analysis in patients with vascular diseases.

An analysis of autopsy findings in 68 patients who died with vascular surgical disorders was performed. Incorrect diagnoses and therapy were evaluated. It was found that complications of the primary disease or its treatment were frequently missed clinically (41%). Septic complications and severe hemorrhage were common in examinations of morbidity and mortality. In 13% of cases a treatment error with adverse impact on survival was detected. It is concluded that postmortem examination is a valuable tool in the final evaluation of patient care in a vascular surgical unit. A repeated plea for the autopsy is supported by this study.

The effect of chemotherapy on osteosarcoma.

The aim of this study was to evaluate the effect of chemotherapy on osteosarcoma by comparing the histologic pattern of primary tumors with that of their metastases. Therefore the primary tumors and metastases in 11 patients were macroscopically and histologically classified according to the Enneking and Broder systems as well as our own method. Three of 11 patients developed metastases with a less malignant pattern, 8 patients developed metastases which were as malignant as the primary tumor. The chemotherapeutics used had either an insubstantial effect or none at all on the differentiation of immature tumorous structures in the metastases and treatment did not lead to the expected improvement. Only the patients in whom, according to our own system, the primary tumors were classified as less malignant, are still alive.

Comparative anatomic studies of various arterial conduits for myocardial revascularization.

Comparison was made between the morphologic condition of the left anterior descending artery and four arterial conduits: the internal mammary, right gastroepiploic, inferior epigastric, and radial arteries, harvested from 17 patients (aged 15 to 85 years, mean 64 years) who had died of nonvascular diseases. Proximal, mid, and distal segments were examined microscopically. The internal mammary artery was elastic, but the others were muscular. In all four conduits, atherosclerosis was absent to mild, the internal elastic lamina showed only minimal defects, and the vasa vasorum were confined to the adventitia. In all cases the left anterior descending artery showed mild to severe atherosclerosis and substantial defects in the internal elastic lamina with penetration of the vasa vasorum into the media and intima. Comparison of the mean distance (+/- standard deviation) from the lumen to the outermost portion of the media for the left anterior descending artery (320 +/- 63 microns) with the four conduits gave comparable values for the internal mammary artery (350 +/- 92 microns); p = not significant) and the right gastroepiploic artery (291 +/- 109 microns; p = not significant), versus 529 +/- 52 microns; p less than 0.002) for the radial artery and 249 microns (+/- 87 microns) (p less than 0.04) for the inferior epigastric artery (Kruskal-Wallis and Mann-Whitney U tests). The relatively scanty presence of smooth muscle cells in the thin-walled media of the internal mammary artery combined with a well-formed internal elastic lamina, even at advanced age, may be an important cause for its low susceptibility to atherosclerosis and a major determinant in its superior long-term patency as a coronary artery bypass graft. This finding emphasizes the justification of continued use of the ideally matching internal mammary artery, either as in situ or free graft, in coronary artery bypass grafting. In contrast to the thick-walled radial artery, which may be relatively prone to ischemia, an acceptable long-term patency of the inferior epigastric artery and right gastroepiploic artery, if harvested as pedicled grafts, is anticipated.

Chylopericardium and chylothorax, resulting from a catheter to the left subclavian vein: an autopsy report.

A 47-year-old woman with long-standing myelofibrosis and thrombocytosis whose spleen was removed 9 days prior to death, died of a heart tamponade. Subsequent autopsy revealed the development of chylothorax and chylopericardium due to the existence of a thrombus obstructing the ostium of the left thoracic duct, as a consequence of the particular location of a central venous catheter in the left subclavian vein in the proximity of the confluence of the left thoracic duct in the afore-mentioned vein.