[Polymorphism of gene p53 and apoptosis in patients with malignant lung disease--our observation]. / Polymorfizmus génu p 53 a apoptóza u pacientov s nádormi pl'úc--nase sledovanie.

BACKGROUND: Many proved alterations in genoms of cells are said to be related to tumorigenesis. Apoptosis--a "programmed" death of cell, which has different morphology from necrosis, is one of the control mechanisms of cell division and participates in tumorigenesis. METHODS AND MATERIAL: The authors present their results of analysis of the relation between genetic polymorphism of the p53 gene and the level of apopotosis in patients with confirmed malignant lung disease. Comparison of genetic polymorphism of the p53 gene in patients with the healthy group showed that allocation of BstUI A2 and MspI A1 alleles was significantly related to lung cancer. The apoptosis of peripheral lymphocytes was significantly increased in lung cancer patients. The highest increase of apoptosis in non-small cell lung cancer (NSCLC) group was found in adenocarcinomas. The level of apoptosis was also studied in correlation to polymorphism of the p53 gen. Substantially higher percentage of apoptotic cells was detected in BstUI 2/2 and MspI 2/2 homozygotes. In response to operation a distinctive increase of apoptosis in the first and second postoperative day was recorded. Therefore a lymphocyte count in peripheral blood was also monitored. The lymphocyte count in patients that underwent the operation proved a decrease in absolute and relative values. CONCLUSION: Observation of known genetic polymorphisms indicates the risk of malignant disease. Together with the analysis of level of apoptosis it may add to complexity of the nature of malignant disease or serve as determinants of its prognosis.

[Surgery in patients with organ transplants]. / Operácie chorých s transplantovanými orgánmi.

Patients after successful transplantation with immunosuppressive therapy form a "new circle of surgical patients" who can develop various surgical diseases, or injuries which bring about an inevitable urgent or planned surgical treatment. The authors present the results in three patients with transplanted organs (1993-1995) who were subdued to various surgical treatments. The first patient underwent a classical cholecystectomy, choledochotomy, and extraction of concrement from the choledochus after orthotopic transplantation of the heart. The second patient underwent transplantation of the kidneys precedingly to bilateral subtotal resection of both lobes of the thyroid gland due to marked bilateral nodal goitre intervening deeply retrosternally with a severe pressure syndrome on trachea and oesophagus. The immediate and long-term results were excellent. Orthotopic transplantation of the heart in the third patient preceded to intercostal drainage of the thorax and evacuation of pus due to an extensive empyema of the thorax and septic state, and later thoracotomy and decortication with extirpation of the substantial part of the empyema sack was performed with an excellent immediate and long-term effect. The authors present the principles which must be inevitably fulfilled in coincidence with successive surgical treatment in patients with transplanted organs in a permanent immunocomplex regime. (Fig 2, Ref. 11.)

[Aggressive angiomyxoma--a new clinico-pathologic entity]. / Agresívny angiomyxóm--nová klinicko patologická jednotka.

The authors present a report on a new clinical and pathological entity--aggressive angiomyxoma which was described in 1983. They draw attention to the genesis of this tumour and its macro- and microscopic picture. They emphasize that treatment of this tumour involves its complete surgical extirpation and frequent local relapses without secondaries. The authors describe in detail two of their observations of aggressive angiomyxoma in a 32- an 38-year-old woman where the tumour started in the lesser pelvis. In both instances, despite radical extirpation of the tumour, within a relatively short time a local relapse developed detected by USG and CT without clinical symptoms.

Panmyelic epidural cooling protects against ischemic spinal cord damage.

The neuroprotective effect of epidural cooling before and during spinal cord ischemia on the neurological, neurophysiological, and histopathological outcome was evaluated after 40 min of proximal and distal thoracic aorta crossclamping in dogs. In the normothermic group (n = 12), no attempt was made to change the spinal cord temperature. Four of eight animals showed complete paraplegia and four had partial recovery. The N3 component of spinal somatosensory-evoked potentials recovered to only 11.7 +/- 1.4% after 2 hr of recirculation and to 45% of control value after 2 days of survival. In the transverse sections taken from L1-L7 segments, apparent interneuronal damage in the intermediate zone was found after 2 hr of reperfusion followed by a heavy loss of interneurons after 2 days of survival and functionally defined as fully developed paraplegia. In the hypothermic group (n = 12), the spinal cord temperature was lowered 3 min before aortic crossclamping with a bolus of epidurally administered 0.9 N saline solution (8 ml/kg at 5 degrees C) to 28.5 +/- 1.3 degrees C and was maintained throughout the crossclamping time with the additional infusion of the same solution (20 ml/kg/40 min) using a peristaltic pump. Seven of eight animals had no neurological deficit and one animal showed partial recovery, which was significantly better than the motor score for the normothermic group (P < 0.05). The SSEP revealed 55% of postsynaptic (N3) wave recovery after 2 hr of recirculation and 92% recovery after 2 days survival, which was significantly higher than those for the normothermic animals (P < 0.05). Histological analysis showed almost full protection of interneurons and A-motoneurons verified after 2 hr and 2 days, respectively. We conclude that spinal cord epidural cooling has a highly protective effect against ischemic spinal cord damage under experimental conditions of high thoracic aorta crossclamping in dogs.

[Vascular care in devastating injuries of the extremities]. / Osetrenie ciev pri devastacných poraneniach koncatín.

The authors present an account on the treatment of blood vessels in 15 patients with serious devastating injuries of the extremities in 1982-1989. In 10 patients the injury was on the upper and in 5 on the lower extremity. In the majority of patients for reconstruction of arteries and veins venous grafts were used. In 8 patients, i.e. in 53.3%, the result was good, in 2, i.e. 13.3%, it was satisfactory and in 5, i.e. 33.3% patients, a secondary amputation had to be performed. The authors describe the surgical procedure and emphasize the necessity of team work of the vascular surgeon, traumatic surgeon and possibly plastic surgeon in the treatment of devastating injuries of the extremities. The authors draw attention to the importance of compartment and reperfusion syndrome which may complicate these injuries, as well as to the role of free oxygen radicals and the necessity to influence their noxious effect during treatment of these injuries during the per- and postoperative period.

Effect of axotomy on cholinergic enzyme activities in the spinal cord and sciatic nerve of the dog.

Choline acetyltransferase (ChAT) and acetylcholinesterase (AChE) activity measured in the ventral and dorsal part of the dog spinal cord (L6-S2) and in the stumps of the sciatic nerve 5, 10, 15 and 21 days after its transection were compared with the corresponding activities in the intact contralateral nerve and in sham-operated animals. AChE was also examined histochemically. Changes in the enzyme activities in the central nerve stump were correlated with activity changes in the spinal cord. In the central nerve stump, a marked (25%) increase in AChE activity was found on the fifth day after transection, but by the 21st day it fell below control value levels; up to the 15th day it showed good correlation with AChE activity in the ventral spinal cord. Histochemically, pronounced reduction of enzymatic activity was found in the ipsilateral part of the spinal cord. On the 15th day, ChAT activity in the ventral spinal cord was also significantly decreased and the accumulation of the enzyme in the central nerve stump was negligible. On the contrary, at the last 21-day interval examined, a significant increase in ChAT activity and a nonsignificant increase in AChE activity was found in the spinal cord, but their activities in the central nerve stump were decreased. In the degenerated peripheral nerve stump ChAT activity dropped by an average of 99% and AChE activity by 48% during the first 15 days after transection but, on the 21st day, AChE activity was 22% higher than at the preceding interval.