Increased mRNA expression of transforming growth factor beta in the arterial wall of chronically rejected renal allografts in humans.

INTRODUCTION: Transforming growth factor beta (TGF-beta) has an established role in interstitial damage of renal transplants during chronic rejection (CR). However, its involvement in transplant vasculopathy is not clear. The aim of the study was to assess TGF-beta gene expression in the walls of large-caliber arteries within chronically rejecting renal allografts. We evaluated associations between gene expression of this factor and intimal thickness or clinical data. MATERIAL AND METHODS: Renal artery samples of kidney allografts were obtained from 20 hemodialysis patients with end-stage renal graft disease due to CR, who were undergoing graftectomy. The control group included 32 hemodialysis patients with end-stage renal disease, undergoing nephrectomy due to autosomal dominant polycystic kidney disease (n = 12), chronic pyelonephritis (n = 13), or kidney limited tumor (n = 7). Gene expression of TGF-beta was measured using real-time PCR. RESULTS: TGF-beta mRNA expression was 3.25-fold higher in CR than in control patients (P < .001). Expression of mRNA for this cytokine was not influenced by the following factors: intimal thickness; age; serum cholesterol, triglycerides and glucose; BMI; graft survival; time of dialysis before transplantation; total ischemic time; immunosuppressive regimen; incidence of acute rejection episode; panel reactive antibodies; and period of dialysis before graftectomy. TGF-beta is involved in neointimal formation in CR.

Liver transplantation in hepatitis C virus-related cirrhosis.

End-stage liver disease associated with HCV infection has become one of the leading indications for liver transplantation and it is the most common disease recurring after liver transplantation. The aim of this retrospective study was to asses factors potentially affecting outcome in patients transplanted for HCV-related liver disease. Among 164 adult patients who underwent orthotopic liver transplantation from December 1994 to December 2002, 134 survived >2 months, including 25 with HCV-related liver disease. Mean follow-up after LTx was 24.8 months (range, 2.1-99.4). Anti-HCV was negative in all donors. The parameters considered in our analysis were: the course, outcome, and liver function tests at 1-year follow-up after HCV reinfection: the potential impact of maintenance and induction immunosuppressive regimens; and episodes of acute rejection. Deterioration of graft function because of HCV reinfection occurred in 16 patients (64%). Mean time for deterioration of liver function related to reinfection was 4.5 months (range, 0.83-23). Induction and maintenance immunosuppression did not affect outcome of HCV-infected liver transplant recipients. Aminotransferases were significantly higher among HCV-infected recipients than among the other patients in our series. There was a slight tendency for earlier recurrence of HCV hepatitis among patients treated with high-dose steroids because of acute rejection.

Comparison of bacterial flora found in the peritoneal cavity and drains after intraabdominal surgery.

The aim of this study was to evaluate bacterial flora infecting during the surgical procedures the peritoneal cavity and drains which were used after the surgery in 40 patients who underwent surgery for colon and rectum tumors. Smears from the peritoneal cavity, liquid removed from the drain taken at 3-4 days after the surgery and smears from the drain taken at the end of drainage of each patient were examined for bacterial content. The comparison of bacterial flora found in the peritoneal cavity with bacteria found in drains showed that the frequency of isolation of anaerobes decreased in contrast to aerobes which were more often cultured over the time of drainage (p < 0.05). Bacteroides spp, enterococci, and strains of Enterobacteriaceae were most often isolated from the peritoneal cavity, but over the time of drainage the frequency of isolation of coagulase-negative staphylococci including MRCNS increased as well as the number of patients infected with enterococci, whereas anaerobes and strains of Enterobacteriaceae were rarely isolated.

[Typing of methicillin resistant strains of S. haemolyticus isolated from patients and from the hospital ward environment]. / Typowanie metycylinoopornych szczepów S. haemolyticus izolowanych od chorych oraz ze srodowiska oddzialu.

Biotyping, antibiograms and fingerprinting were used to determine the relation of 16 methicillin-resistant S. haemolyticus isolated from drains in patients who underwent intraabdominal surgery to 9 methicillin-resistant strains of S. haemolyticus isolated at the same time from hospital environment. The comparison of biochemical properties of the examined strains showed a large variety of biochemical profiles as well as antibiotic patterns of susceptibility. The differences in sensitivity to the antibiotics used were not distinct. Biotyping and antibiograms did not permit determination of the relation of the investigated strains. Only the results of fingerprinting allowed for the division of the 25 examined strains into three genotypes demonstrating three main patterns of PCR products. 16 strains of 25 showed the same pattern of PCR products. This results suggests the presence of a source of infection on the clinical ward. A nurse may have been the source of infection because the same genotype of S. haemolyticus was isolated from her nasal anterior as from the majority of patients.

[Peritonitis determined by the site of intra-abdominal surgery]. / Zakazenie jamy otrzewnowej zaleznie od miejsca operacji brzusznej.

The aim of this study was to determine bacterial flora infecting the peritoneal cavity during intraabdominal surgery by site of operation. Three groups of patients were examined. 29 patients who underwent surgery on the stomach, duodenum, biliary tract or pancreas, 15 patients operated on because of acute appendicitis and 63 patients operated on because of colon or rectum tumours. At the end of the operation but before closure cultures were obtained by swab from the completed anastomosis site. Samples were placed into transport medium and transported promptly to the laboratory. The results of the bacteriological examinations showed that the peritoneal cavity of all patients operated on were infected with bacteria characteristic for the digestive tract, especially by Enterobacteriaceae spp., Enterococcus spp. and Bacteroides spp. From patients operated on because of rectum or colon tumours 3 or 4 bacterial species were isolated most often and they were often infected with P. aeruginosa and C. albicans. This was in contrast to patients from the other groups. In patients infected with polymicrobial flora, B. fragilis and E. coli or enterococci and E. coli and enterococci were most often seen.

[Analysis of aerobic and anaerobic bacterial flora colonizing drains after surgical abdominal incisions]. / Analiza tlenowej i beztlenowej flory bakteryjnej kolonizujacej dreny po zabiegach na jamie brzusznej.

Aerobic and anaerobic bacterial flora of post-operative incisions with drainage were examined. From each of 28 patients three specimens were taken; during operation (smear from peritoneal cavity), liquid from drain (taken at 3-th day after operation) and smear from drain taken at the end of drainage. Enterococci, Enterobacteriaceae spp. and anaerobes, especially Bacteroides spp. were most often isolated from specimens taken during operation. Enterococci and coagulase negative Staphylococci-often resistant to methicillin, were most often isolated from specimens taken at the end of drainage.

[Evaluation of bacterial flora in patients after intraabdominal surgical procedures throughout a 12 year period]. / Ocena flory bakteryjnej u chorych po zabiegach na jamie brzusznej w okresie 12 lat.

UNLABELLED: The aim of this study was to analyse the composition of the bacterial flora in 295 patients who underwent surgical treatment in our clinic throughout the period of 12 years. 448 specimens were bacteriologically examined. Bacterial pathogens were isolated from 390 (87.1%). Among aerobic bacteria, Enterococcus faecalis was the most often isolated (35.6% - from the peritoneum, 17.8% from the wound). Among anaerobic bacteria, Bacteroides fragilis - 44.9% were the most often isolated. 530 aerobic bacterial strains from Enterococcus, Enterobacteriaceae, Staphylococcus and the nonfermentable rods were carefully analysed. Special attention was paid to the development of the resistance to 3 antibiotics (cefoperazone, ciprofloxacin and gentamycin) in 3 time periods: from 1984 to 1987, from 1988 to 1992 and from 1993 to 1996. Resistance of the bacterial strains to cefoperazone was 38.7% in the first time period; 39.5% in the second; and later increased to 53.8%. Resistance to ciprofloxacin was identical in the first two periods - 10.3%; and subsequently, it increased to 22.6%. The increase of resistance to gentamycin was the most significant--it went up from 24.5% to 44.8 and then dropped to 40.3%. CONCLUSION: Constant monitoring of the bacterial flora enables rational antibiotic application, which is essential due to the observed increase of bacteria strain resistance.

[The study of drug resistance in aerobic and anaerobic bacterial flora to selected antibacterial drugs]. / Badania lekoopornosci tlenowej i beztlenowej flory bakteryjnej na wybrane leki antybaktryjne.

The aim of the study to determine the resistance to certain antibacterial drugs of the aerobic and anaerobic bacterial flora isolated from patients operated on for acute abdominal infections. The resistance was investigated by the disc diffusion method. Among the isolated aerobes Enterobacteriaceae, Enterococcus spp, Pseudomonas spp. Staphylococcus spp were most frequent, and in the group of anaerobes the most frequent were Bacteroides spp, Peptostreptococcus spp and Peptococcus spp. The sensitivity to ciprofloxacin, gentamicin and cefoperazone was tested in 492 aerobic strains, and the sensitivity of cefuroxime was tested in 387 strains. In the group of anaerobes the sensitivity to ciprofloxacin and cefoperazone was tested in 239 strains, and in 187 and 176 strains the sensitivity to cefuroxime and metronidazole respectively was tested. Only 94 aerobic strains and 32 anaerobic strains were additionally tested for augmentin, ceftriaxone, ceftazidime, imipenem, clindamycin and doxycycline. Imipenem was found to be the most active drug against aerobic and anaerobic bacteria. Clindamycin showed a very high activity against anaerobes but was significantly less active against aerobes. Only a small proportion of the tested aerobic strain (11.2%) were resistant to ciprofloxacin, while most anaerobic strains (66.5) were resistant to this antibiotic. Metronidazole was active against about 100% of anaerobes. Augmentin had a high activity against gram-positive cocci and was less active against gram-negative rods and anaerobes. A high proportion of aerobic and anaerobic strains were resistant to ceftriaxone, ceftazidime, cefuroxime and doxycycline. Gentamicin showed a sufficient activity against the tested aerobic strains (33.9% were resistant).

[Aerobic and anaerobic bacterial flora in acute abdominal illnesses]. / Tlenowa i beztlenowa flora bakteryjna w ostrych stanach zapalnych jamy brzusznej.

366 specinmens taken from patients suffering from acute abdominal illnesses who had undergone operations were examined. Bacterial pathogens were isolated from 318 specimens. Aerobic bacteria were isolated from 53.8% specimens. Anaerobic bacteria were isolated from 12.6% specimens. Mixed bacterial flora were isolated from 33.6% specimens. Among aerobic bacteria E. coli and Streptococcus faecalis were most often isolated. Among anaerobic bacteria Bacteroides fragilis, Peptostreptococcus spp. and Peptococcus spp. were most often seen.

[Use of ciprofloxacin and metronidazole in prophylaxis of surgical wound infection in surgical treatment of laryngeal cancer]. / Zastosowanie ciprofloxaciny i metronidazolu w profilaktyce zakazen ran operacyjnych w chirurgicznym leczeniu raka krtani.

The purpose of the work was determination of bacterial flora in laryngeal malignant tissue and postoperative scar in patients who were prophylactically given 2 x 200 mg ciprofloxacine intravenously and 1.5 mg metronidazole for five days starting on the day of the operation. Laryngeal cancer specimens from 55 patients and swabs from postoperative scar from 30 patients were investigated bacteriologically. In the cultures from the malignant tissue and scar numerous micro-organisms were obtained which could be the cause of surgical wound infection. In the cultures from the scar the frequency of isolation of enterococci and Streptococcus viridans was found to be decreased while the frequency of staphylococci and Streptococcus haemolyticys isolation was increased. Despite the presence of pathogens, in none case clinical manifestations of wound infection were observed.

[Etiologic factors in acute inflammatory states of the abdominal cavity]. / Czynniki etiologiczne ostrych stanów zapalnych jamy brzusznej.

Three hundred and two samples of biological material from patients operated because of acute inflammatory states of abdominal cavity were investigated. Both aerobic and anaerobic bacteria were investigated. Among aerobic flora most frequently occurred enterococci, E. coli and Pseudomonas. Bacteroides and Peptostreptococcus were most frequently occurring anaerobes. Mixed flora was seen very often. Isolated microorganisms were tested for susceptibility to ciprofloxacin, cefoperazone, cefotaxime, gentamicin, netilmicin and in cases of anaerobes to metronidazole.

[Bacterial flora in laryngeal carcinoma and in postoperative scars of patients treated prophylactically by ciprofloxacin]. / Flora bakteryjna raka krtani i blizny pooperacyjne w warunkach oslonowego stosowania ciprofloksacyny.

Microbiological investigations regarded samples from diseased tissue in patients with larynx carcinoma and in 53 patients. Samples were also taken two weeks after surgery from postoperative wounds. The patients received after surgery ciprofloxacin and metronidazole for five days. Cultures were incubated in aerobic and anaerobic conditions. Isolated microorganisms were tested by application of the API system susceptibility to ciprofloxacin, netilmicin and gentamycin were determined. Samples from cancerous tissue and postoperative wounds revealed most frequently presence of streptococci, staphylococci, Bacteroides and intestinal bacteria. It was found, however, that in investigated patients different bacterial flora was present when compared with previously tested cancerous tissue. Hemolytic streptococci and Staphylococcus aureus, and less frequently enterococci, were found much more frequently, Isolated strains were susceptible to ciprofloxacin (93%), netilmicin (76%) and gentamycin (39%).

[Characteristics of Salmonella strains isolated from different environments in the years 1982-1993]. / Charakterystyka szczepów paleczek Salmonella izolowanych z róznych srodowisk w latach 1982-1993.

The examination of Salmonella strains isolated from hospital patients and out-patients was performed. The results of sensitivity tests of strains isolated in Poland, and from patients of "Third World countries" were compared. In both groups were the strains caused nosocomial infections, which were resistant to Ampicillin and Chloramphenicol. Eight of the Polish strains of S. Typhimurium were cultured from autopsy specimens which were obtained from the newborn ward. S. Typhimurium isolated from specimens of the patients of the children's, ward of Derna Hospital was the cause of 162 cases on nosocomial infections over the period of four months. The ill children were between the ages of the two days old (newborn child in incubator) and eleven years old. It is important to note that in one case S. Enteritidis was isolated from the blood of a hospital patient in critical condition. A much higher percentage (85%) of the strains isolated from out-patients in Poland showed resistance to Tetracycline in comparison with the strains cultured from out-patients in countries of the Third World (7%). The resistance to Tetracycline may be connected with the addition of this antibiotic to food for farm animals in Poland, and can indicate the circulation of animal strains in the human population. In this research we used the latest classification of Salmonella genus.

[Effect of treatment with autologous staphylococcal vaccine on the course of the immunologic process]. / Wplyw leczenia autoszczepionka gronkowcowa na przebieg procesów odpornosciowych.

In 18 patients with furunculosis and in 9 with chronic inflammation of upper respiratory tract, some cellular immunity parameters were tested. These were: phagocytosis index and bactericidal activity against leukocytes. Humoral immunity was also investigated by measurement of serum gammaglobulins. All test were performed before treatment and 30 days after application of the last dose of autologous vaccine. In 12 patients with furunculosis, improvement of the clinical status (disappearance of furunculosis) was appearing together with an increase of phagocytosis index and bactericidal activity of leukocytes without changes in gamma-globulin levels. No such changes were found in remaining patients in whom no clinical improvement was found. The authors suggest that cellular immunity factors studied in this investigation permit for evaluation of the immunity status in patients receiving autologous staphylococcal vaccine.

Epidemiological estimation of Pseudomonas aeruginosa strains isolated from different environments.

117 P. aeruginosa strains have been isolated from hospital material (vascular ward), from ambulatory patients, from lake water samples and from animal environment. The serological characters of the above strains, their phage--typing patterns, their capability of producing ONPG hydrolase were compared in order to find out the strain with identical features responsible for nosocomial infections and also to find endemic infections. There were eleven polyagglutinable strains (isolated from sinks in the vascular ward) which agglutinated with two sera and one strain isolated from lake water. Apart from one exception there were no confirmations of the occurrence of the strains of identical features in different environments. Possible variability within the scope of somatic antigen and the phage typing of microorganism confirm the necessity to use several techniques to carry out studies of epidemiological significance.

[Azoles. 34. Nitroimidazole derivatives and their antibacterial and fungicidal action]. / Azole. 34. Mitteilung4: Uber Nitroimidazolderivate und ihre antibakterielle und fungizide Wirkung.

Nitroimidazole derivatives 4a-4c, 5a-5c, 8a-8c and 9a-9c were synthesized by treating 4,5-dinitro- and 2-methyl-4,5-dinitroimidazole (1,2) or their silver salts [1.Ag,, 2.Ag) with chlorosubtituted phenacyl bromides 3a-3c, diethyl sulphate or ethyl iodide, allyl iodide and ethyl chloro-, azo- or bromoacetate. 2,4(5)-dinitroimidazole (10) has been converted to the 2,4-dinitroimidazole derivative 10a by the action of ethyl bromoacetate in the presence of sodium ethylate. A modified method for the synthesis of 6a and 6b has been described. 7a and 7b have been obtained by a known method. Some of the newly synthesized nitroimidazole derivatives show antibacterial and fungicidal activity.

[Perioperative preventive use of ciprofloxacin in patients with cancer of the larynx]. / Profilaktyka okolooperacyjna z zastosowaniem ciprofloksacyny u chorych na raka krtani.

In comparative study of patients with laryngeal cancer, perioperative prophylaxis with ciprofloxacin was estimated. The drug was administered intravenously 200 mg twice daily, for five days to groups of 95 patients. Bacteriological examinations performed intraoperatively mostly revealed Gram-positive germs. The intravenous form of ciprofloxacin was very effective, resulting in complete healing of the operative wound in shorter time than in control groups. The drug has been well tolerated and no side effects were observed.

[Azoles. 27. Nitroimidazole derivatives, their antibacterial and fungicidal activity and electron affinity]. / Azole. 27. Mitteilung5: Uber Nitroimidazolderivate, ihre antibakterielle und fungizide Wirkung und Elektronen-affinität.

Nitroimidazole derivatives 3a-3g, 4a-4g and 5-8 were synthesized by treating 4,5-dinitro- and 2-methyl-4,5-dinitroimidazole (1,2) with phenacyl bromide, its p-substituted derivatives or epichlorohydrin. 1-(3-Chloro-2-hydroxypropyl)-4,5-dinitroimidazole (5) and its 2-methyl derivative 6 have been converted to imidazo-oxazoles 7 and 8 or amino imidazole derivatives 9-14 by the action of potassium carbonate or cyclic amines (pyrrolidine, piperidine, morpholine and N-methylpiperazine). Some of the newly synthesized nitroimidazole derivatives show antibacterial and fungicidal activity. The electron affinity of the nitroimidazole derivatives 1-24 is discussed on the basis of their half-wave potentials and in the connection with their eventual radiosensitizing properties.