[Keratin fragments as a serological indicator in patients with a liver disease]. / Keratinové fragmenty jako sérologický ukazatel u nemocných s jaterní chorobou.

INTRODUCTION: Determination of M30 antigen appears to be a sensitive method for evaluation of hepatocyte apoptosis. The aim of the present project was to implement this technique, compare M30 values in patients with a liver disease and healthy controls and to identify potential relationships between M30 values and other parameters. METHODS: M30 antigen was assessed in 25 patients with a liver disease and 30 healthy controls. These results were compared between patients with a liver disease and the controls and correlated to a range of clinical and laboratory values, including tissue polypeptide-specific antigen (TPS), in patients with a liver disease. RESULTS: We found significant differences in M30 values between controls and patients with a liver disease. The only significant correlations were the correlation between M30 and ALT, highly significant correlation between M30 and AST and highly significant correlation between M30 and TPS. CONCLUSION: The M30 antigen is a sensitive indicator of liver damage. Considering the highly significant correlation with TPS, it can be assumed that in some liver diseases, TPS could serve as a clinically useful indicator of apoptosis.

[Parental smoking and exposure of pre-school children to tobacco smoke]. / Kourení rodicu a expozice predskolních detí tabákovému kouri.

BACKGROUND: During studies on the health of children aged 3 or 4.5 years in Teplice and Prachatice districts of the Czech Republic, we focused also on the extent of smoking in the families and exposure of children to environmental tobacco smoke. METHODS AND RESULTS: In 1128 questionnaires administered to mothers of children born in 1994-1998, 35.6% of mothers indicated that they smoked and 48.9% of fathers/partners (N = 1075) were smokers. Including other family members, there were 41.6% families without any smoker, 30.1% of families with one smoker and 24% families with two smokers (out of 1061 households). Urine samples of 523 pairs of mothers and children (aged 4.5 years) were assayed for cotinine using a RIA radioimmunoassay. Concentration of cotinine was higher than 500 ng cotinine/mg creatinine (the cut-off value for smoking) in 199 of 523 mothers (38%). Exposure of children to environmental tobacco smoke (cotinine levels over 20ng/mg creatinine) was detected in 48.2% of 523 children. There were more children with cotinine levels over 20 ng in Teplice (59.2% of 287 children) than in Prachatice district (34.7% of 236 children). CONCLUSIONS: Cotinine levels in child's urine were significantly positively associated with maternal cotinine levels as well as with smoking of mother and father, and were lower in children visiting kindergarten.

[Pigmented hepatocellular adenoma of the liver caused by long-term use of phenobarbital]. / Pigmentované hepatocelulární adenomy jater vzniklé na podklade dlouhodobého uzívání fenobarbitalu?

A 28-year-old female patient was operated on account of symptomatic hepatocellular adenomas of the liver. Tumours with a diameter of 10 x 11 cm in the left lobe and 9 x 7 cm in the right lober were extirpated. In the adenomas non-ferric pigment resembling the pigment in Dubin-Johnson's syndrome was detected. The patient did not use contraceptives and was treated for more than 10 years for epilepsy. The size, pigmentation, frequency of adenomas and absence of contraceptives in the case-history made the authors consider another aetiology of these adenomas. The authors discuss the possible development of adenomas of the liver as a result of long-term use of phenobarbital. As a basis they use experimental observations where this drug acts as a strong promotor of DNA synthesis and leads to the development of multiple adenomas and carcinomas in the liver of rats and mice.

[Pathomorphology of the transjugular portosystemic shunt]. / Patomorfologie transjugulárního portosystémového zkratu.

An interventional radiological procedure TIPS (transjugular portosystemic shunt) assists in the decrease of portal hypertension. Portal blood is conducted via the hepatic vein into the lower vena cava. Blood drainage is performed via non-vascular formation, i.e. by the channel created within the liver parenchyma (shunt). Histological changes (maturation) within the wall of an artificially formed blood conducting channel were studied on the base of examination of the set of 38 autopsy cases with the placed TIPS (25 males and 13 females, ages ranging from 22-81 years). Maturation course can be divided into three periods. The first stage is characterised by the presence of alternative changes mainly within the liver parenchyma surrounding the shunt. Reparative changes pass through the second stage with the predominance of liver cell debris removal and organisation of fibrin remnants. Consolidation changes dominate the third stage with the development of so-called neointima and giant-cell reaction around the stent struts. In three cases of the acute period of stent placement a new, so far not described specific phenomenon of compressive fusiform hepatocellular remodellation was found within the nodules of hepatocytes exposed to the pressure of resilient stent struts. Neointima is a non-thrombogenous structure participating on the shunt patency. It is possible to judge approximately the time of stent placement according to the histologically estimated level of shunt wall maturation. TIPS is a long-lasting supplement conduit between the portal and systemic blood circulation. Contrary to the easily reconstructable formal pathogenesis of histological changes, the problems of causal pathogenesis of the neointima challenge mainly the interest of laboratories involved in basic science.

[Environmental pollution and childhood morbidity]. / Znecistené ovzdusí a nemocnost detí.

BACKGROUND: A study of morbidity of children aged 0 to 3 years was organized in two districts in the Czech Republic. Comparisons were drawn between children living in district Teplice, known for its high air pollution, and those living in Practice, the district with consistently lower particulate and SO2 exposures. METHODS AND RESULTS: 452 children of the follow up study were born between May 1994 and December 1996. Childhood morbidity during the first three years of life was obtained from their pediatric records. Diagnoses were coded using the International Classification of Diseases--the 10th edition, and categorized into broad groups. Children born in Teplice experienced a significantly higher rate of otitis media (and otalgia), gastrointestinal infections, upper respiratory infections, and pneumonia, but they did not differ in the risk of bronchitis or that of viral infections such as varicella. These findings remained valid after the multiple linear regression models were calculated and adjusted for education, maternal age, maternal smoking, and other smokers in the household, breastfeeding, and attendance at the day care. CONCLUSIONS: Air pollution may alter early childhood susceptibility to infection, but other differences between the districts have to be considered: systematic diagnostic differences for several health outcomes between pediatricians in Teplice and Practice, differences in health-care seeking approach of parents, and some hitherto unidentified factors.

Childhood morbidity and air pollution in the Teplice program.

BACKGROUND: A study of morbidity of children aged 0 to 3 years was conducted in two districts in the Czech Republic. Comparisons were made between children living in Teplice district, known for its high air pollution, and children living in Practice, a district with consistently lower particulate and SO2 exposures. METHODS AND RESULTS: The children were selected for the follow up based on deliveries from May 1994 to December 1966. Childhood morbidity during the first three years of life of 452 children was extracted from their pediatric records. Diagnoses were coded using the International Classification of Diseases--10th edition, and categorized into broad groupings. Children born in Teplice experienced a significantly higher rate of otitis media and otalgia, gastrointestinal infections, upper respiratory infections, and pneumonia, but did not differ in their risk for bronchitis or for viral infections such as varicella. These findings remained after multiple linear regression models adjusted for education, maternal age, maternal smoking, and other smokers in the household, breastfeeding, and attendance at day care. CONCLUSIONS: Air pollution may alter early childhood susceptibility to infection, but other differences between the districts must be considered: systematic diagnostic differences for several health outcomes comparing pediatricians in Teplice vs. Practice, differences in health-care seeking behavior by the parents, and inadequate control for confounding.

The differences in selected biochemical markers and histological findings after bile duct ligation in male and female rats.

To study the correlation between the degree of histopathological changes in the liver and selected biochemical tests after bile duct ligation (BDL) in male and female Wistar rats. Rats were divided into 4 groups. Laparotomized male rats (M-LAP), male rats with BDL (M-BDL), laparotomized female rats (F-LAP) and female rats with BDL (F-BDL). Liver bioptic samples were taken 7 and 14 days after operations and were cultivated 24 hours under standard conditions. TNF-alpha and IL-6 (pg/ml) concentrations were estimated in cell culture supernatants. Rats were sacrificed 14 days after operations, histological evaluation of liver tissue was performed, and serum activity of alanine-transaminase (ALT) and gamma-glutamyl transferase (GMT) (microkat/l) and estradiol concentration (EST) (pmol/1) were estimated. Results are presented as median (cytokines, estradiol) or mean +/- SEM. IL-6 concentration in cell culture supernatants was 7 days after the operation 1495 pg/ml in M-BDL and 1050 pg /ml in F-BDL, but were not detected in M-LAP and F-LAP. TNF-alpha concentration in supernatants was detected in all groups and was not significantly higher in male rats in comparison with female rats. M-BDL group had higher activity of ALT (1.5+/-0.1) and GMT (1.24+/-0.38) in comparison with F-BDL (ALT - 1.24+/-0.38, GMT - 0.98+/-0.38). Estradiol concentrations were detected in BDL groups, male rats 175 pmol/l and female rats 543 pmol/l. Although ALT and GMT activities and TNF-alpha and IL-6 concentrations were higher in male rats histopathological findings have shown slightly more advanced fibrotic and inflammatory changes in female rats.

[Preservation of venous grafts]. / Príspevek ke konzervaci zilních stepu.

The objective of the work was to find an optimal preservation medium for short-term preservation of venous grafts which could be subsequently used to line metal stents. The external jugular vein of dogs (n = 15) was removed surgically, divided into portions and immersed into preservation media. For hypothermic preservation (+4 degrees C) solutions of Optisol (Chiron, USA), University of Wisconsin (Baxter, USA), Eurocollins (Fresenius, GFR) and saline (Bieffe Medital, Italy) were used. For normothermic preservation (+37 degrees C) in an atmosphere with 5% CO2 Dulbecc's medium for tissue cultures (Sigma, USA) was used. During hypothermic preservation the specimens were kept for 24 hours, 3 and 7 days, during normothermic preservation in Dulbecc s medium also for 24 hours, 3 and 7 days. The specimens were evaluated by light microscopy and raster electron microscopy. The results revealed that minimal changes on the endothelia of venous grafts occurred during normothermic preservation in Dulbecc's medium where after 7 days the endothelium did not become detached and the vitality of cells did not change. During hypothermic preservation the solution of Wisconsin University proved most suitable. By addition of 5% human albumin to this solution it proved possible moreover to reduce pyknosis of the endothelial cell nuclei. The specimens kept in saline displayed deformities of the nuclei, oedema and loss of endothelia incl. incipient oedema of the cellular wall already after 24 hours of hypothermic preservation. The authors consider the use of this solution unsuitable for preservation.

Autologous vein stent-graft: feasibility study.

PURPOSE: To evaluate expandable stents healed into vein wall as autologous vein stent-grafts for endoluminal grafting. MATERIALS AND METHODS: Balloon expandable stents were placed into external jugular veins of eight dogs. Stent and vein patency was followed by ultrasonography. Five weeks after stent placement, jugular veins with endothelialized stent were harvested. The autologous vein stent-grafts were divided into two groups. In group A, autologous vein stent-grafts (n = 3) were placed immediately into Baker solution for microscopic examination. In group B, autologous vein stent-grafts (n = 3) underwent mechanical manipulation; they were compressed, mounted on angioplasty balloon, pushed through a 9-F sheath and dilated. The autologous vein stent-graft endothelialization and changes after mechanical manipulation were evaluated by light and electron microscopy. RESULTS: Stent placement was successful in seven dogs. One stent migrated into the pulmonary artery. One well placed stent was damaged by compression dressing and thrombosed. At 5 weeks, gross and microscopic examinations revealed the autologous vein stent-grafts were fully covered by a 0.115- +/- 0.036-mm-thick neointimal layer. Small wall thrombus was observed in one autologous vein stent-graft. Repeated manipulations did not result in any intimal damage or stent loosening in the autologous vein stent-grafts. CONCLUSION: Expandable stents healed into a vein have potential to be used as autologous vein stent-grafts for endoluminal grafting without risk of disruption during percutaneous transcatheter introduction.

[Systemic embolization of mucous material]. / Systémová embolizace hlenových hmot.

Systemic embolisation of mucous substance occurs as a rare complication of mucinous carcinomas. A case of primary carcinoma of stomach is described with embolisation of mucus into cerebral, renal, pulmonary and myocardial vessels. Vascular blockade by mucus caused multiple partly haemorrhagic microinfarctions of the brain tissue. Beyond this, investigated tumour samples did not show any signs of angioinvasion and the production of mucus was far from massive.

Radiation pneumonitis: the model of interstitial edema.

We used the measurement of the thickness of alveolar septa in the lungs in (C57BI/6xDBA/2)F1 mice irradiated locally in the area of the thorax with absorbed doses of 14, 16 and 18 Gy of gamma rays. The thickness of alveolar septa of the pulmonary tissue was measured using a computer image analysis. 24 weeks after irradiation we found a significant increase in the thickness of alveolar septa in direct relation to the dose within a range of 14 to 18 Gy. This indicator can be used for observation of the radioprotective and remedial interventions against the inception and the development of radiation pneumonitis.

[In towns there is a higher prevalence of asthmatic symptoms in children than in rural areas]. / Ve mestech je vetsí prevalence príznaku astmatu detí nez ve venkovských oblastech.

The authors assessed the prevalence of symptoms of bronchial asthma by means of a standardized questionnaire used in the international survey PEACE (Pollution Effect on Asthmatic Children in Europe). The questions about complaints were addressed to children aged 6-13 years (the questionnaires were completed with the parents assistance). In urban areas 5669 children participated from Prague 5, i.e. 35% of all elementary school children, in Teplice 2489 (21% children), in rural areas: in the Benesov district 5619, i.e. 61% children, in the Prachatice district 1983, i.e. 37% children. The response rate of questionnaires in the urban areas was 86-88%, in rural areas 93%. In urban areas the annual prevalence of wheezing in the chest or dyspnoea or possibly both symptoms was within the range of 3.8-13.8% and differed significantly from the prevalence in rural areas where it was 2.4-3.6%. The most frequent symptom was nocturnal dry cough without a cold (in urban areas 14.1-36.7%, in rural areas 6.0-10.6%). Rural areas differed from urban ones by a lower contamination of the atmosphere, a lower density of the population as well as some parameters caused by a different lifestyle.

Extrahepatic portal venous laceration in TIPS treated with stent graft placement.

Three cases of intraperitoneal bleeding from extrahepatic portal vein laceration were observed in a series of 104 patients with TIPS. In one patient, bleeding continued after Wallstent placement and the patient died during an emergency laparotomy. Bleeding was stopped in the other two patients by using a stent graft rather than a regular stent. One shunt remained patent and outflow stenosis developed in 3 months. The other shunt thrombosed in 5 months. Both shunts were fully reopened.

Pulmonary functions of school children in highly polluted northern Bohemia.

The purpose of this study was to ascertain whether pulmonary function in children who were lifetime residents of the highly polluted district of Teplice in northern Bohemia was lower than that for children who were lifetime residents of the cleaner district of Prachatice in southern Bohemia. Forced expiratory spirometry was measured twice (February/March and April) in approximately 235 eighth-grade students in each district. On both testing occasions, height-adjusted forced expiratory volume in 1 s and forced expiratory flow between 25% and 75% forced vital capacity were significantly lower (p < .001) in children from Teplice than in those from Prachatice. These differences were not associated with parental smoking habits, presence of pets, heating/cooking fuels, private home/apartment residency, or rural/urban residency. In Teplice, no differences were observed between lung functions measured at the end of the high pollution season (February/March) and those measured after the children breathed much cleaner air for a 4-wk period (April). This result was suggestive of a condition of chronically depressed lung function. No differences across times were observed in Prachatice, indicating that our measurements were reliable.

[Transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of symptomatic portal hypertension]. / Transjugulární intrahepatální portosystémový zkrat (TIPS) pri lécbe symptomatické portálni hypertenze.

BACKGROUND: A transjugular intrahepatic portosystemic shunt (TIPS) is the creation of a percutaneous portosystemic anastomosis which is used as an alternative method of surgical portosystemic shunts and endoscopic treatment in the therapy of complications of portal hypertension. The objective of the present work was to summarize experience with TIPS in 100 patients. METHODS AND RESULTS: In 1992-1995 the authors treated 100 patients with symptomatic portal hypertension by TIPS. To create the shunt in 84% patients a spiral Z stent was used, in the remainder a Wallstent. In 86% patients the indication for TIPS was haemorrhage associated with portal hypertension and in 14% refractory ascites. TIPS was implemented in 98% patients. The pressure in the portal vela was not reduced on average to 58% of the original value. Haemorrhage was not stopped in one of 7 patients. Haemorrhage from varices reappeared in 7% patients indicated on account of repeated haemorrhage and was always associated with the finding of chronic stenosis of the shunt. The mortality in conjunction with the procedure was 4%, the mortality within 30 days after operation was 8%. Uncontrollable encephalopathy developed in 3% of the patients. Primary patency of the shunt created by the spiral Z stent was 85% after 6 months, after 12 months 72% and thus does not differ from primary patency when Wallstents are used, as reported in the literature. CONCLUSIONS: TIPS is an effective method to reduce the pressure in the portal vein in portal hypertension. The main limiting factor of the method is stenosis of the shunt due to hyperplasia of the neointima. Stenoses of the shunt can be effectively dilated by percutaneous balloon angioplasty.

[Comprehensive care of patients with dysgnathic defects at the dental department of the regional hospital with polyclinic in Ceské Budejovice]. / Kompliexní péce o pacienty dysgnátní vadou na stomatologickém oddelení KNsP Ceské Budejovice.

The authors describe in the form of case- histories the comprehensive care of patients with dysgnatic defects at the dental department of the hospital with policlinic in Ceské Budejovice. The collaboration of orthodontists, surgeons and prosthetists is involved in different combinations. As an example the mention the collaboration during the therapeutic procedure used in a 25-year-old female patient with a protrusion defect, deep occlusion and crowding in the upper frontal section.

[Problems concerning material for root inlays and their solution]. / Materiálová problematika korenových inlejí a její resení.

The author discusses the reduced mechanical resistance of root inlays made from low-melting Koldan silver alloy combined with wire support. The problem is resolved by the use of a chromium-cobalt alloy without a wire nucleus. As modelling material Spofacryl 0 is used which is administered by injection.