[Myocardial infarction in the young - our results and experience]. / Infarkt myokardu v mladom veku - nase výsledky a skúsenosti.

AIMS: Coronary artery disease in young adults is important task of contemporary cardiology. Presented our results experience and opinion were obtained by our long term investigation of myocardial infarction in young patients under 40 years. METHODS: Two sets of patients were examined - 78 patients (74 men, 4 women) hospitalised in pretrombolytic era in prospective 8 years follow up (1984-1992) and 39 patients (35 men, 4 women) admitted during period 2000-2010 analysed retrospective. RESULTS: Myocardial infarction in young age belongs roughly to two different groups with considerable overlap in pathogenetic mechanisms: 1. angiographycally normal coronary arteries or unilocular nonsignificant atherosclerotic stenosis (less 50%) in 25-30% with thrombotic occlusion of one infarct related artery probably with substantial vasospastic component. Patients were younger (average 31.7 ± 3.7 years), dominant risk factors smoking, hyperlipidemia, excessive physical and emotional stress. Disease course and prognosis are favourable. 2. premature accelerated atherosclerosis with significant (more 50%) in 70-75 % often multivessel affection. Pts were significantly older (average 35.8 ± 2.6 years; < 0.001) bad risk factors profile, worse clinical course and poor long-term prognosis. CONCLUSIONS: Study of myocardial infarction in young adults indicates: great role of risk factors, mainly smoking, hyperlipidemia, family history and type A behaviour, hostility with participation of low education level and social inequality (unemployment). Noticeable are hypercoagulable states and trauma. Dominancy of men (90-95%). Prognosis depends on age, extend of coronary atherosclerosis and residual cardiac function. Disease picture has not been changed during last 30 years. Aggressive control over risk factors is unavoidable. Current requirement is to evaluate impact of modern treatment strategy on long-term survival. Key words: coronary artery disease - myocardial infarction at young age.

Expression pattern of anti-apoptotic protein survivin in dysplastic nevi.

UNLABELLED: The anti-apoptotic protein survivin was detected in a panel of 27 dysplastic nevi. From each representative paraffin block 4 mm sections were cut and stained with anti-survivin antibody (DAKO, Clone 12C4). In each section, the labeling intensity, the subcellular location of survivin antigen, the percentage of labeled cells and the degree of dysplasia were assessed. Survivin was present in 23 out of 27 cases (85.2%), but absent in 4/27 cases (14.8%). Positive staining was confined to the cytoplasm (C) of nevus cells only in 18 cases (66.7%), while cytoplasmic as well as nuclear positivity (NC) was found in 5 cases (18.5%). In no case solely nuclear staining could be seen. Furthermore, in 4 out of 5 cases (80%) with NC staining, severe dysplasia was found. Our data point at usefulness of survivin staining, otherwise rarely performed in dysplastic nevi. We confirm the importance of nuclear location of the survivin antigen, which may be helpful for assessing the possible progression to melanoma. KEYWORDS: survivin, immunohistochemistry, nevi, dysplasia, melanoma.

Effects of Mg-ATP on the flavonoid production in the Scutellaria baicalensis Georgii suspension cultures.

This work focused on the cultivation of S. baicalensis Georgii in vitro cultures and on the possibilities of increasing the production of secondary metabolites in these cultures. The aim of the Sstudy was to determine whether the baicalin transport through vacuolar membrane is dependent on the presence of Mg-ATP. Our results showed that Mg-ATP had a significant effect on the ratio of baicalin and baicalein content and on the transport speed of these flavonoids. Therefore, the transport mechanism for baicalin are probably some of the MRP proteins which are the subfamily of the ABC transporte

Cough sensitivity in atopic dermatitis.

The aim of study was to investigate the cough sensitivity (C2) to capsaicin (CAPS) in patients with atopic dermatitis without clinical respiratory symptoms. Cough sensitivity (C2) is defined as the lowest CAPS concentration, which evokes two or more coughs. Forty eight dermatological patients (21 M, 27 F; mean age 44 yr) and 24 healthy volunteers (14 M, 10 F; mean age 37 yr) inhaled deep breath (2 l) of CAPS aerosol in doubled concentrations (from 0.02 to 200 micromol/l) (Pari Provokationstest I, PARI WERK; mass median diameter 1.2 microm). Cough sensitivity (C2) expressed as geometric mean (95% CI) of CAPS concentration was 0.13 micromol/l (0.06-0.31) in 26 patients with atopic dermatitis (10 M, 16 F; mean age 41 yr), 5.51 micromol/l (1.33-22.90) in 22 patients with psoriasis (11 M, 11 F; mean age 46 yr) and 4.29 micromol/l (2.54-7.26) in 24 controls. There is significant difference of cough sensitivity (C2) between patients with atopic dermatitis and healthy volunteers (p<0.001) and also between patients with atopic dermatitis and psoriasis (p<0.001). Cough sensitivity (C2) in atopic dermatitis patients without clinical respiratory symptoms is significantly increased. In patients with psoriasis cough sensitivity (C2) is not significantly changed.

Kaposi's sarcoma - still an enigma.

Kaposi's sarcoma (KS) is an unusual neoplasm that has proved to be an enigma in many ways since its original description in 1872. KS, a vascular tumour that is otherwise rare, is at present the most common neoplasm in patients with AIDS. The lesions contain spindle cells that share features with endothelial cells and smooth muscle cells and are in all likelihood primitive mesenchymal cells that can form vascular channels. These cells are monoclonal in origin indicating therefore that KS is a neoplasm. The presence of a novel type of human herpes virus, KS herpesvirus (KSHV) also called human herpesvirus type 8 (HHV8) in KS lesions support a viral ethiology. KS may be mistaken in the skin for an inflammatory or other lesion, thus skin biopsy is important for correct diagnosis, with the use of immunohistochemistry or molecular biology if needed. Radiation or interferon alpha dominate in the therapeutic approaches.

Cough sensitivity in localized scleroderma with no clinical symptoms from lower airways.

Cough sensitivity is increased in patients with atopic dermatitis, although they have no clinical symptoms from the lower airways. In the present study we examined the cough sensitivity to capsaicin in patients, who had no clinical respiratory symptoms, with sclerodermia localized to the skin. Cough sensitivity was defined as the lowest capsaicin concentration, which evokes 2 or more coughs. Twelve patients and 12 healthy matched volunteers, as a comparison group, inhaled deep breaths (2 L) of a capsaicin aerosol in doubled concentrations (from 0.02 to 200 micromol/L). Cough sensitivity, expressed as a geometric mean (95% CI) of capsaicin concentration, was 0.15 micromol/L (0.04 to 0.56) in the patients with localized sclerodermia and 4.96 micromol/L (2.50 to 9.85) in controls, which made a significant difference towards higher cough sensitivity in sclerodermia, respiratory symptom-free patients. Thus, disease processes localized outside the respiratory tract may have surreptitious pulmonary manifestation that is brought to light by the capsaicin cough test.

[Quantitative changes in CD4+ and CD8+ T-lymphocytes in the skin of patients with psoriasis treated with cyclosporin A]. / Numerické zmeny T-lymfocytov CD4+ a CD8+ v kozi psoriatikov liecených cyklosporínom A.

Many things are still not clear in the etiopathogenesis of psoriasis. Health workers in various branches of medicine and even those working in other professions linked with medicine can contribute to gaining more knowledge about its etiology, pathogenesis, diagnosis or treatment. This work presents results from observations of 19 patients with a severe form of psoriasis. Material for immunohistopathological examinations was taken from the margins of chronic psoriatic sites twice from each patient: before treatment and after a 4-week treatment by cyclosporin A. Numeric value of CD4+ T lymphocytes, CD8+ T lymphocytes, their ratios and the values of PASI score were followed. Significant decrease in CD4 T lymphocytes and slight decrease in CD8+ T lymphocytes where observed after treatment. The CD4+:CD8+ ratio dropped from the values of 2.10 to 1.68. A dramatic decrease in PASI score was observed--from the average value of 23.34 to the average value of 11.97. The authors compare and discuss the results of similar cytophotometric studies found in the works of other researchers, but this type of results (CD4+ and CD8+ T lymphocytes subpopulations) is very rare in available literature. The decreases found in all studied parametres correspond with clinically well-known treatment effect of cyclosporin A whose immunomodulating effect is targeted mainly at the T lymphocyte inflammatory population.

Multiple cutaneous metastases as the first sign of lung cancer in a patient with well-differentiated papillary transitional cell carcinoma of the urinary bladder.

A case of multiple, cutaneous metastases as the first sign of lung cancer in a patient with well-differentiated, papillary, transitional cell carcinoma of the urinary bladder is presented. In the left clavicular region were two, sharply demarcated, dark red tumors measuring 3 and 2 cm in diameter with a history of rapid growth and intermittent spontaneous bleeding. Thorough examination of the patient revealed 16 additional skin lesions, which were dark red macules and papules, 2-3 mm in diameter, situated on the left side of the chest. The skin biopsy material (tumors, macular and papular lesions) was studied using histological and immunohistochemical techniques and showed intact epidermis and massive dermal and subcutaneous metastatic involvement by a small cell carcinoma with neuroendocrine differentiation most likely originating in the lung.

[Juvenile hyaline fibromatosis]. / Juvenilná hyalínová fibromatóza.

BACKGROUND: Juvenile hyaline fibromatosis is a sporadic hereditary disease with autosomal recessive mode of inheritance, characterized by the presence of nodules and tumours in the skin and soft tissues and gingival hyperplasia. The majority of patients are growth retarded, suffer from joint disorders, contractures, osteolytic lesions and have a positive family history. The disease most frequently occurs in children, but may be diagnosed also in adults. Since 1873, when the disease was described by Murray, only a few cases were introduced in the literature. THE AIM AND THE BASIS OF THE STUDY: To present the clinical pattern of a patient diagnosed at the age of 28 and describe also the histopathological, immunohistological and electron-microscopic findings of excisions from the lesions. METHODS: The pathologist in cooperation with clinicians from several disciplines established the diagnosis on the basis of typical histopathological picture and additional immunohistological tests not yet introduced in the literature. RESULTS: Tumorous lesions contained hyaline structureless matrix often with chondroid or even osteoid metaplasia, calcium salts. The matrix contained numerous fibroblastoid-like cells with eosinophilic cytoplasm, oval nucleus and often pericytoplasmic halo. ELMI investigation revealed dilated cisternae of rough endoplasmic reticulum and hypertrophic Golgi apparatus. Sporadically were particles with calcium salts density detected. Immunohistochemical tests revealed the expression of vimentin, alfa1-antitrypsin and alfa1-antichymotripsin by the tumorous cells. CONCLUSION: The authors presented an extremely sporadic childhood disease in an adult. The results are in accordance with the data from the literature. Immunohistochemical picture of "cementicles" has not yet been introduced in the available literature. (Fig. 12, Ref. 25.)

Phaeohyphomycosis due to Alternaria spp. and Phaeosclera dematioides: a histopathological study.

A case of phaeohyphomycosis caused by strains of both Alternaria spp. and Phaeosclera dematioides is presented. The biopsy material was studied using histological, immunohistochemical and transmission electron microscopy techniques. The agent's dematiaceous mycelia are composed of thick-walled hyphae, branched and unbranched, with terminal vesicular formations. All the described structures occur alone or in chains within multinuclear giant foreign body-type cells or invading an abscess. Also present are budding forms. Immunostaining of histiocytic inflammatory cells in either. diffuse or granulomatous infiltrates revealed cytoplasmic positivity for lysozyme and Ki-MIP antibody. The lymphocytic infiltrates of the upper corium show predominantly small T lymphocytes (CD3 and CD45RO positive) and absence of CD20-positive B cells. Plasma cells occurring within the infiltrates of the deeper parts show polyclonal expression of both Ig light chains.

Phaeohyphomycosis caused by Alternaria species and Phaeosclera dematioides Sigler, Tsuneda and Carmichael.

A case of phaeohyphomycosis caused by strains of both Alternaria spp. and Phaeosclera dematioides is presented. First clinical signs of mycosis appeared on the patient's face, after an injury with a straw stalk during the wheat harvest in Germany in 1942. Further signs developed in 1955 at one forearm, and again in 1968 in the mouth, leading to perforation of the palate. After treatment with amphotericin B (1973-75) she went into a 13-year-long, clinically asymptomatic remission. She relapsed in 1988, when eight foci of the disease developed, mostly on both forearms. Diabetes mellitus and asthma developed at this time. After pulse therapy with itraconazole the patient remains in a good clinical condition.