[Arthrodesis of Interphalangeal Joints of the Hand by an External Fixator in Managing Conditions Resulting from Septic Arthritis]. / Artrodézy interfalangeálních kloubu ruky pomocí zevního fixátoru pri resení stavu po probehlé septické artritide.

PURPOSE OF THE STUDY Arthrodesis of interphalangeal joints of the hand is a method used to treat conditions associated with joint destruction, instability and pain. Our study aims to evaluate the outcomes of the treatment of sequelae of septic arthritis of interphalangeal joints by arthrodesis with external fixation. This topic is hardly covered in literature. Moreover, it compares the outcomes of application of this method in diabetic patients and non-diabetic population. MATERIAL AND METHODS Arthrodesis by means of Stellbrink external fixator was performed in 17 patients who had suffered septic arthritis of interphalangeal joints of the hand. The following parameters were followed in patients in our group: age, sex, etiology of disease, smoking, diabetes, affected fingers and joints of the hand, side, microbial culture finding, wound healing, postoperative ATB therapy and its duration, radiographic signs of the union of arthrodesis and potential complications. RESULTS The group included 8 men and 9 women. The mean age was 66.2 years. 5 patients in the group were diabetic. In 16 patients the wound healed per primam, in 1 case per secundam. The average duration of postoperative ATB therapy was 4.3 weeks. The X-ray showed the union of fused articular surfaces at 6.9 weeks on average. Complications occurred in 3 patients, namely 1 case of secondary wound healing, 1 case of nail bed damage and 1 case of flexor tenosynovitis of the operated finger. The arthrodesis was successfully healed in all the patients and a no difference was detected between diabetic and nondiabetic patients. DISCUSSION When arthrodesis of interphalangeal joints of the hand is performed using an external fixator, the metal material is introduced outside the area of inflammation, or the field potentially at risk of infection, therefore this method is predetermined for surgeries in the terrain changed by inflammation or potentially at risk of inflammation. Compared to the other methods such as arthrodesis by inserting K-wires intramedullary, there is no risk of migration of the metal material and the associated soft tissue irritation. CONCLUSIONS Our study confirms the safety and efficiency of arthrodesis of interphalangeal joints of the hand by means of an external fixator in treating the sequelae of septic arthritis. The union of arthrodesis with no complications was observed even in all the diabetic patients. Ranking among the main advantages of this method are the easy care for the surgical wound, achievement of easy and firm fixation with the possibility to apply an external fixator outside the area of the original infection. Key words:arthrodesis, external fixator, septic arthritis, interphalangeal joint.

Splanchnic vein closures.

Closures in the splanchnic venous system (SVS) represent a broad medical problem. Anatomically, individual or even multiple sections of SVS may be affected at the same time. Main sections of SVS include the venous liver outflow system, the portal vein, and the upper mesenteric vein and its basin. Thrombosis is clearly the predominant cause of closure. The closures can present as acute, subacute, chronic occult or chronic manifest. The main pathological and anatomical units are the Budd-Chiari syndrome (BCS), extrahepatic portal vein obstruction (EHPVO) and mesenteric vein thrombosis (MVT). Advanced laboratory, imaging and intervention methods substantially modify the approach to prevention, diagnosis and treatment; surgical approach also plays a role. The problem of SVS closures is interdisciplinary.

Late postoperative opacification of a hydrophobic acrylic intraocular lens AcryNovaTMPC 610Y.

PURPOSE: To report late postoperative opacification of a hydrophobic acrylic intraocular lens (IOL) AcryNovaTMPC 610Y as well as the clinical consequences in patients 10 years after uncomplicated cataract surgery. MATERIALS AND METHODS: Medical records were reviewed of 23 patients (26 eyes) with AcryNovaTMPC 610Y implantated between years 2005 and 2007. Next clinical examination was performed 10 years after surgery. We assessed best corrected distance visual acuity (BCDVA), contrast sensitivity (CSV-1000E) and relative opacity of IOL material, (OCULUS Pentacam HR). Results of BCDVA and Pentacam were analysed statistically. One explanted IOL was analysed using anterior segment OCT in vitro and spectroscopic method EDX (Energy-dispersive X-ray spectroscopy). RESULTS: Opacification led to a statistically significant reduction in the best corrected distance visual acuity (BCDVA) = (0,95 ± 0,10) versus (0,87 ± 0,20) and to increase of IOL opacity only in some lenses but statistically significant in the average (6,37 ± 2,16)% versus value of (14,22 ± 5,87)%. In the explanted IOL we have documented structural changes of primarily hydrophobic raw material leading to property of hydrophilic one. CONCLUSION: Some batches of AcryNovaTMPC 610Y were produced from raw material of poor quality which is the cause of its structural changes and its progressive opacification.

Tobacco smoking strongly modifies the association of prothrombin G20210A with undetermined stroke: consecutive survivors and population-based controls.

OBJECTIVE: Due to contradictory results of previous studies evaluating the association between ischemic stroke (IS) and thrombophilic polymorphisms, their routine screening in IS patients, particularly those older than 60 years, is not recommended. We evaluated the differences in the distribution of rs6025 and rs1799963 polymorphisms according to IS subtypes and their interaction with smoking. METHODS: We conducted a case-control study of 423 hospital-based consecutive survivors of their first-ever IS and 614 population-based controls. Survivors (18-81 years) with IS documented by brain imagining were examined at a median of 16 months after the index event. The stroke subtype was categorized using the Causative Classification of Stroke System. Controls (50-75 years) were free of a history of stroke/TIA, coronary heart disease, and venous thromboembolism. RESULTS: Age- and gender-adjusted prevalence of individuals carrying at least one copy of the rs1799963A minor allele was 5.3% among stroke survivors (by subtypes: 3.1% in large artery atherosclerosis, 2.0% in cardio-aortic embolism, 2.4% in small artery occlusion, and 10.3% in undetermined stroke) vs. 2.4% among controls. In multinomial multivariate adjusted analysis, rs1799963 was exclusively associated with undetermined stroke (OR: 3.67; 95% CI: 1.52-8.85; p = 0.004). There was strong evidence of rs1799963 × smoking synergistic interaction (OR: 5.14; 95% CI: 1.65-16.01; p = 0.005). There was no association of rs6025 with IS in general, or with any subtype. CONCLUSIONS: In our consecutive IS survivors, carriage of the rs1799963A allele is associated with undetermined stroke. This effect appears to be confined to smokers.

A randomised controlled trial of roller versus centrifugal cardiopulmonary bypass pumps in patients undergoing pulmonary endarterectomy.

OBJECTIVES: There is some controversy as to whether there is a benefit from the use of a centrifugal pump compared with a roller pump during cardiopulmonary bypass to facilitate cardiac surgery. We compared the two pumps, with the primary aim of determining any difference in the effects on inflammation after pulmonary endarterectomy surgery which required prolonged cardiopulmonary bypass and deep hypothermic circulatory arrest. METHODS: Between September 2010 and July 2013, 58 elective patients undergoing pulmonary endarterectomy were included in this prospective, randomised, controlled study; 30 patients were randomly allocated to the control group, which used a roller pump, and 28 patients to the treatment group, which used a centrifugal pump. Interleukin-6, procalcitonin, C-reactive protein, thromboelastographic parameters, P-selectin, international normalised ratio, activated prothrombin time, free haemoglobin, haematocrit, red blood cell count, white blood cell count, platelet count and protein S100ß were recorded during and after the procedure. We also recorded the length of intensive care unit stay, blood loss and transfusion, neurological outcomes and respiratory and renal failure. RESULTS: There was a significant difference in the primary outcome measure: Interleukin-6 was significantly higher in the roller pump group (587 ± 38 ng · l(-1) vs. 327 ± 37 ng · l(-1); p<0.001) 24 hours after surgery, which we interpreted as an increased inflammatory response. This was confirmed by a significant rise in the procalcitonin level in the roller pump group 48 hours following surgery (0.79 (0.08-25.25) ng · ml(-1) vs. 0.36 (0.02-5.83) ng · ml(-1); p<0.05). There were, however, no significant differences in clinical outcome data. CONCLUSIONS: We have shown that the use of a centrifugal pump during prolonged cardiopulmonary bypass and deep hypothermic circulatory arrest is associated with a reduced inflammatory response compared to the standard roller pump. Larger multi-centre trials in this area of practice are required.

Fructosamine 3-kinase and glyoxalase I polymorphisms and their association with soluble RAGE and adhesion molecules in diabetes.

Advanced glycation end-products (AGEs) are key players in pathogenesis of long-term vascular diabetes complications. Several enzymes such as fructosamine 3-kinase (FN3K) and glyoxalase I (GLO I) are crucial in preventing glycation processes. The aim of our study was to evaluate an association of FN3K (rs1056534, rs3848403) and GLO1 rs4746 polymorphisms with parameters of endothelial dysfunction and soluble receptor for AGEs (sRAGE) in 595 diabetic and non-diabetic subjects. Genotypic and allelic frequencies of mentioned polymorphisms did not differ between subgroups. In diabetic patients significant differences were observed in sRAGE concentrations according to their rs1056534 and rs3848403 genotype. While GG and CG genotypes of rs1056534 with mutated G allele were associated with significant decrease of sRAGE (GG: 1055+/-458 and CG: 983+/-363 vs. CC: 1796+/-987 ng/l, p<0.0001), in rs3848403 polymorphism TT genotype with mutated T allele was related with significant sRAGE increase (TT: 1365+/-852 vs. CT: 1016+/-401 and CC: 1087+/-508 ng/l, p=0.05). Significant differences in adhesion molecules were observed in genotype subgroups of GLO1 rs4746 polymorphism. In conclusion, this is the first study describing significant relationship of FN3K (rs1056534) and (rs3848403) polymorphisms with concentration of sRAGE in patients with diabetes.

The frequencies of six important thrombophilic mutations in a population of the Czech Republic.

The primary aim was to determine frequencies of mutations related to risk of venous thrombosis in healthy Caucasians in Central Bohemia. In a cohort of 1527 healthy individuals the frequency of risk alleles for the mutations FV Leiden and FII 20210G>A was 4.5% and 1.3%, respectively. Frequency of 4G PAI-1 allele was 55.5%. Genotype frequencies were: GG 91.03%, GA 8.91%, and AA 0.07% for FV Leiden; GG 97.45%, GA 2.49%, and AA 0.07% for FII 20210G>A; 4G/4G 30.26%, 4G/5G 50.56%, and 5G/5G 19.19% for PAI-1. Frequency of the risk allele A in polymorphism SERPINC1 (IVS +141G >A) was 11.3%, and frequencies of genotypes were as follows: GG 78.36%, GA 20.66%, and AA 0.98%. Frequency of the risk allele T for polymorphism GP6 13254T>C was 87.7%, and frequencies of genotypes were as follows: TT 77.14%, TC 21.15%, and CC 1.70%. Frequency of the risk allele A in polymorphism CYP4V2 (Lys259Gln) was 65.2%, and frequencies of genotypes were: CC 12.25%, CA 45.12 %, and AA 42.63%. All observed genotypes and alleles frequencies were without gender differences. Their occurrences confirm a relatively high prevalence of hereditary thrombophilia predisposition in the Czech Republic.

Endotelial activation and flow-mediated vasodilation in young patients with breast cancer.

Endothelial activation and dysfunction may play a significant role in the progression of breast cancer. In our study we examined markers of endothelial activation (soluble ICAM-1, P-selectin, E-selectin) in 98 young patients with breast cancer (< 40 years). In 50 of them (and 20 age-matched controls) we also measured flow mediated vasodilation. Patients with breast cancer had significantly higher serum levels of soluble E-selectin, P-selectin and ICAM-1, P-selectin was higher in patients with larger tumors, node involvement and seemed to be apredictor of poor outcome. We were unable to find significant difference in the parameters of flow mediated vasodilation between patients with breast cancer and healthy subjects, although both peak blood flow (PBF) and flow mediated vasodilation (FMD) seemed to be skewed compared to healthy subjects toward mean and lower levels. Cluster analysis enabled us to distinguish several larger groups of patients with different degree of endothelial activation and function and different outcome. Group of patients with high E-selectin, high ICAM-1 (higher endothelial activation) and low VEGF (putative endothelial damage) had more frequently negative estrogen receptors and had worse outcome compared to the group of patients with lower E-selectin, lower ICAM-1 and mostly positive estrogen receptors. Further studies of larger groups of patients should help to identify the panel of endothelial markers which could help in predicting the outcome of young patients with breast cancer.

Skin autofluorescence relates to soluble receptor for advanced glycation end-products and albuminuria in diabetes mellitus.

The aim of this study was to compare skin autofluorescence caused by advanced glycation end-products (AGEs) with biochemical markers of endothelial dysfunction and soluble receptor for AGEs (sRAGE) in patients with diabetes. Skin autofluorescence (AF) assessed by AGE-Reader was evaluated with sRAGE and other biochemical parameters in 88 patients with diabetes (47 Type 1/T1DM/ and 41 Type 2/T2DM/) and 20 controls. Skin AF was significantly higher in T1DM and T2DM in comparison to controls (2.39 ± 0.54, 2.63 ± 0.73 versus 1.96 ± 0.33 AU; P < 0.0001). Positive correlation of AF with sRAGE was detected in T1DM and T2DM (r = 0.37, P < 0.02 and r = 0.60, P < 0.0001), but not in controls. Significantly higher AF values were found in patients with positive albuminuria as compared to those with normal albuminuria. Similarly, higher AF was detected in patients with endothelial dysfunction expressed by vWF, ICAM-1, and VCAM-1. Multiple regression analysis revealed independent association of skin AF with age, sRAGE, and albumin-creatinine ratio in patients with diabetes (R (2) = 0.38). Our study confirms that AF is elevated in patients with diabetes, especially with positive albuminuria and endothelial dysfunction. The strong and independent relationship between AF and sRAGE supports the idea that AF may reflect AGEs/RAGE interactions. The exact mechanism remains to be established.

[Acute myocardial infarction in young patients--severe failures in the system of acute and secondary care]. / Akutní infarkt myokardu u mladých nemocných - závazné nedostatky v systému akutní a následné péce.

INTRODUCTION: The incidence of cardiovascular (CV) diseases and acute myocardial infarction (AMI) in Czech Republic is de-clining. In spite of this in a proportion of patients AMI occurs in young age. The aim of our project was to assess the character of risk factors, precipitating diseases and the quality of care in young AMI survivors. METHODS: We included 132 patients (97 men and 35 women) in whom AIM with ST elevations occurred before age of 45 years in men and age of 50 years in women. Several results were compared to a control group composed of 84 healthy volunteers of comparable age. We assessed the course of the disease, extent of coronary involvement, subsequent therapy and control of risk factors after 3 years from the index event. RESULTS: Smoking represented the main risk factor - 85% patents were active smokers at the time of AMI and 9% were former smokers, 64% patients had a positive family history of CV disease. We found a higher prevalence of dyslipidemia history in men. In spite of high rate of statin use, laboratory examination during follow-up revealed higher triglyceride values and low levels of HDL-cholesterol in both genders. All together 23% of patients had a history of provoking underlying disease or precipitating factors (inflammatory diseases, malignancies, combined thrombophilias, drug abuse). In total 95% of patients underwent coronary angiography during the acute phase of AMI, the median time from pain onset to intervention was 9 hours. Most patients had single vessel disease, 14% had even coronary angiogram without clinically significant stenosis. The subsequent care was satisfactory concerning the rate of drug prescriptions. However, target lipid values were not reached in 78% patients and blood pressure targets in 37%. CONCLUSIONS: In patients who suffered AMI in young age, risk factors are dominated by smoking and positive family history of CV diseases. One fifth of patients suffer from other underlying disease (inflammatory disease, malignancies, combined thrombophilia) or have another precipitating factor (febrile disease, drug abuse). The acute care seems unsatisfactory due to late arrival of most patients to catheterization laboratories (underestimation of the disease, incorrect initial diagnosis). Subsequent therapy is well composed but lacks in intensity.

[Peripartal life-threatening hemorrhage - interdisciplinary consensus opinion]. / Peripartální zivot ohrozující krvácení - mezioborové konsenzuální stanovisko.

22 experts from the fields of gynecology and obstetrics, anesthesiology and resuscitation, intensive care, hematology and transfusion medicine has developed recommendations for diagnosis and procedure for life-threatening peripartum haemorrhage, which is still one of the most common causes of maternal mortality in childbirth. This guidelines, which is valid for the Czech Republic, supported by a total of 10 professional medical societies. There are based on new knowledge applicable at this time and is focused mainly on eliminating the most common causes of bleeding during delivery and prevention of haemorrhagic shock.

Relationship of soluble RAGE and RAGE ligands HMGB1 and EN-RAGE to endothelial dysfunction in type 1 and type 2 diabetes mellitus.

Receptor for advanced glycation end-products (RAGE) plays the essential role in the pathogenesis of diabetic vascular complications. The aim of the study was to compare concentration of soluble RAGE and its ligands (EN-RAGE and HMGB1) with different biochemical parameters in Type 1 (T1DM) and Type 2 (T2DM) diabetes mellitus.Total number of 154 persons (45 T1DM, 68 T2DM, 41 controls) was examined and concentrations of sRAGE, EN-RAGE and HMGB1 were measured and compared to diabetes control, albuminuria, cell adhesion molecules and metalloproteinases (MMPs).Mean serum sRAGE concentration was higher in T1DM as compared to controls (1137±532 ng/l vs. 824±309 ng/l, p<0.01). Similarly, EN-RAGE was significantly higher in both diabetic groups (p<0.001) and HMGB1 concentrations were elevated in T2DM patients (p<0.01). Significant relationship was found between MMP9 and HMGB1 and EN-RAGE in diabetic patients. Inverse relationship was observed between MMP2 and MMP9 in both types of diabetic patients (r= - 0.602, p<0.002 and r= - 0.771, p<0.001). Significant positive correlation was found between sRAGE and ICAM-1, VCAM-1 or vWF (p<0.01 to p<0.001).We conclude that serum sRAGE and RAGE ligands concentrations reflect endothelial dysfunction developing in diabetes.

Reduced thrombin generation and soluble P-selectin after intravenous enoxaparin during PCI.

PURPOSE: The objective of our study was to identify changes in the coagulation and serum concentration of soluble P-selectin (sP-sel) after i.v. bolus of 0.75 mg/kg enoxaparin in a group of 33 patients during PCI. METHODS AND RESULTS: As compared to baseline, i.v. enoxaparin increased anti -Xa activity and FIIa inhibition together with APTT and thrombin time tests within 20 min, that persisted for 60 min. At 6 h, the results of all tests had returned to baseline. In contrast, the level of prothrombin fragments (F1 + 2) decreased persistingly for a period of 6 h (baseline 1.19 ± 0.42 nmol/l, after 20 min 1.03 ± 0.46 nmol/l, after 60 min 1.06 ± 0.43 nmol/l, after 6 h 0.95 ± 0.40 nmol/l, p < 0.001 vs. baseline for all values). In addition, i.v. enoxaparin decreased serum sP-sel level (baseline 111.80 ± 37.05 ng/ml, after 20 min 87.80 ± 33.17 ng/ml, after 60 min 86.45 ± 29.15 ng/ml, after 6 h 92.24 ± 31.34 ng/ml, p < 0.001 vs. baseline value for all). sP-sel level mildly correlated with both F Xa inhibition (r = -0.275, p < 0.05) and F1 + 2 level (r = 0.274, p < 0.05). CONCLUSION: Intravenous enoxaparin induced target F Xa inhibition (>0.6 IU/ml) for 60 min in 82% of study patients. During the 6 h of monitoring, a decrease of thrombin generation (F1 + 2) and sP-selectin levels were observed.

Non-invasive diagnosis of coronary-subclavian steal: role of the Doppler ultrasound.

Coronary subclavian steal syndrome (CSSS) is a well documented cause of graft function failure in patients after left internal mammary artery (LIMA)--left anterior descending (LAD) coronary artery grafting. We present a case of the CSSS in a patient with cardiac arrest due to ventricular fibrillation. To our knowledge such a case has not yet been described. Patient with a history of LIMA-LAD grafting, complaining only of a mild chronic exertional dyspnoea developed ventricular fibrillation while walking outdoor. After successful resuscitation, blood pressure difference between both arms and abnormal LIMA flow with systolic reversal flow on the Doppler ultrasonography were suggestive of CSSS. Angiography proved the left subclavian artery (LSA) occlusion and coronary angiography confirmed reversal flow in the LIMA graft. Successful percutaneous transluminal angioplasty of the LSA re-established normal LIMA flow and improved the left ventricular hypokinesis and systolic function.

[Prolonged prophylaxis of thromboembolic disease in patients with colorectal surgical resections for malignancy]. / Prodlouzená profylaxe tromboembolické nemoci u pacientu po chirurgické resekci kolorekta pro malignitu.

UNLABELLED: Cancer patients have 6-fold higher risk of venous thromboembolism compared with patients without malignancy. This risk of VTE is further increased by cancer surgery. AIM OF THE STUDY: The aim of our pilot study was to examine the changes in inflammatory reaction, changes of coagulation parameters and inhibition of FXa in patients with new diagnosed colorectal cancer. During 30 days of observation prophylactic dose of dalteparin 5000 UI subcutaneously once daily was administrated. PATIENTS AND METHODS: Patients who underwent surgical resection of the colon for new diagnosed colorectal cancer were included in the study. Laboratory tests (blood count, acute phase proteins--alpfa-1-antitrypsin, transferin, prealbumin, alpfa-2-makroglobulin, orosomukoid and C reactive protein and coagulation laboratory tests--PT in INR, aPTT, TT, fibrinogen concentration, activity of antithrombinu and concentration of D-dimer) were performed before surgery and on day 3, 10 and 30 after surgery. RESULTS: Inflammatory response reached highest level on day 3, lasted until day 10 after surgery than parameters returned to normal values (p < 0.05). Hypercoagulable tendency was already seen before surgery, highest value of D-dimer was measured on day 10 after surgery and after decrease it lasted until the day 30 after surgery (p < 0.05). Inhibition of FXa varied between 0.02-0.7 IU/ml. The prophylactic range of FXa inhibition 0.2-0.4 IU/ml was reached in 48.1% of the samples, 20.4% of the samples were over the range and 31.5% were under the prophylactic range. During 30 day of observation deep vein thrombosis was not detected in any patient as well as bleeding complication. CONCLUSION: The pilot study shows that prolonged prophylaxis of VTE is advisable in patients after cancer surgery. Variation of FXa inhibition will be in our study further examined.

Microvascular Reactivity and Endothelial Function in Type 2 Diabetic Patients with Hyperlipidemia Treated with Simvastatin: 3-year Follow-up.

Aim of this study was to evaluate microvascular reactivity (MVR) by laser Doppler flowmetry in Type 2 diabetes mellitus (T2DM) with hyperlipidemia during three years of simvastatin treatment. Additionally, markers of endothelium and fibrinolysis were evaluated. Twenty patients with T2DM and hyperlipidemia were treated with 20 mg of simvastatin daily for 3 months, treatment was then interrupted for 3 months (wash-out) and again started and maintained continually up to total of 36 months of follow-up. Maximal perfusion (max), velocity of perfusion increase (max/t) and percent increase of perfusion compared to baseline (%) was measured during post-occlusive reactive hyperemia (PORH) and thermal hyperemia (TH). VCAM-1, ICAM-1, E-selectin and P-selectin were used as markers of endothelium, tissue plasminogen activator (tPA) and its inhibitor (PAI-1) as markers of fibrinolysis. Baseline MVR in diabetic patients was comparable to controls. MVR decreased at months 3, 12, and 36 compared to baseline (PORHmax 26+/-12, 35+/-17, 26+/-11 vs. 56+/-30 PU, p<0.05, THmax 67+/-19, 81+/-37, 58+/-24 vs. 134+/-70 PU, p<0.01, PORHmax/t 2.0+/-1.4, 2.8+/-1.7, 1.9+/-1.3 vs. 7.7+/-7.4 PU/s, p<0.05, THmax/t 1.1+/-0.6, 1.0+/-0.4, 0.7+/-0.4 vs. 1.5+/-0.7 PU/s, p<0.05.

Inflammatory response in patients undergoing hip surgery due to osteoarthrosis or different types of hip fractures.

OBJECTIVE: Hip surgery represents a major intervention associated with significant inflammatory response. The objective of our study was to compare markers of systemic inflammation and soluble adhesive molecules in patients undergoing elective hip replacement to those with hip fracture either intracapsular (IC) or extracapsular (EC). DESIGN: We included 65 consecutive patients undergoing hip surgery--17 patients with elective hip replacement (EL group), 29 patients with EC fracture (EC group) and 11 patients with IC fracture (IC group). Fibrinogen (FBG), orosomucoid (ORM), C-reactive protein (CRP), transferrin (TRF) and white blood cells count (WBC), sP-selectin, sE-selectin, and soluble intercellular adhesion molecule-1 (sICAM-1) were measured before surgery 4h, 48h, and 7 days after surgery. RESULTS: IC patients had preoperatively highest values of inflammatory markers including FBG, CRP, ORM, WBC and lowest values of TRF, as compared to intermediate values found in EC and lowest values in EL groups. The surgery has led in all three subgroups to significant elevation in CRP, ORM and decrease in TRF. In IC group, the subsequent recovery of inflammatory markers was very slow. We noted a significant suppression of sP-selectin and sE-selectin values in all subgroups after surgery. The decrease of sE-selectin but not of sP-selectin correlated with changes in hemoglobin and blood transfusions' administration. CONCLUSIONS: Hip surgery is associated with significant inflammatory reaction. In patients with hip fractures, inflammatory markers are elevated already preoperatively, more so in IC than in EC fractures. The unexpected observation of a significant postoperative decrease in sE-selectin and sP-selectin will require further research for elucidation.

Impaired microvascular reactivity and endothelial function in patients with Cushing's syndrome: influence of arterial hypertension.

The aim of the study was to evaluate skin microvascular reactivity (MVR) and possible influencing factors (fibrinolysis, oxidative stress, and endothelial function) in patients with Cushing's syndrome. Twenty-nine patients with active Cushing's syndrome (ten of them also examined after a successful operation) and 16 control subjects were studied. Skin MVR was measured by laser Doppler flowmetry during post-occlusive (PORH) and thermal hyperemia (TH). Malondialdehyde and Cu,Zn-superoxide dismutase were used as markers of oxidative stress. Fibrinolysis was estimated by tissue plasminogen activator (tPA) and its inhibitor (PAI-1). N-acetyl-beta-glucosaminidase, E-selectin, P-selectin, and ICAM-1 were used as markers of endothelial function. Oxidative stress and endothelial dysfunction was present in patients with hypercortisolism, however, increased concentration of ICAM-1 was also found in patients after the operation as compared to controls (290.8+/-74.2 vs. 210.9+/-56.3 ng.ml(-1), p<0.05). Maximal perfusion was significantly lower in patients with arterial hypertension during PORH and TH (36.3+/-13.0 vs. 63.3+/-32.4 PU, p<0.01, and 90.4+/-36.6 vs. 159.2+/-95.3 PU, p<0.05, respectively) and similarly the velocity of perfusion increase during PORH and TH was lower (3.2+/-1.5 vs. 5.2+/-3.4 PU.s(-1), p<0.05, and 0.95+/-0.6 vs. 1.8+/-1.1 PU.s(-1), p<0.05, respectively). The most pronounced impairment of microvascular reactivity was present in patients with combination of arterial hypertension and diabetes mellitus.