[Comparison of diagnostic validity of carbohydrate-deficient transferrin and other laboratory markers in chronic ethanol abuse]. / Srovnání diagnostické validity karbohydrát deficientního transferinu a dalsích laboratorních markeru chronického abúzu etanolu.

BACKGROUND: Carbohydrate-deficient transferrin (CDT) has been reported to be the best laboratory marker of the chronic alcohol abuse, but there are conflicting data on its accuracy and sensitivity ranging from 19% to 96% in various studies. The aim of this study was to compare the diagnostic efficiency of CDT with the other markers of alcohol abuse used in clinical practice with respect to possible sex differences. METHODS AND RESULTS: The serum CDT (using the method of anion-exchange chromatography and TIA), mean corpuscular volume (MCV), gamma-glutamyl-transferase (GMT) values and platelet count were evaluated in 50 alcohol-dependent patients admitted to the Center of Detoxification and in the reference group of 85 healthy teetotallers. The cut-off values for %CDT where established in the level of 2.2% and 2.5% for men and women respectively. In men we proved a comparatively high diagnostic efficiency of CDT (AUC 0.94, sensitivity 82.6%, specificity 96.7%) and GMT, MCV seem to be less accurate marker of chronic alcohol abuse. In contrast there was a lower diagnostic validity of CDT in women in comparison with common markers (AUC 0.83, sensitivity 60%, specificity 88%). CONCLUSIONS: The laboratory diagnosis of chronic alcohol consumption can be improved by using a combination of several markers. The specificity and also the cumulative sensitivity of such a battery of laboratory markers can be elevated by CDT evaluation. In a part of patients, CDT can be the only detectable abnormality.

[Diagnostic value of carbohydrate-deficient transferrin, gamma-glutamyltransferase and mean erythrocyte volume as laboratory markers of chronic alcohol abuse]. / Diagnostická výteznost karbohydrát deficitního transferinu, gama-glutamyltransferázy a stredního objemu erytrocytu jako laboratorních markeru chronického abúzu alkoholu.

INTRODUCTION: Our research aimed at finding out values of carbohydrate-deficient transferin (CDT), gamma-glutamyltransferase (GGT) and mean corpuscular volume (MCV) for the purposes of future etiological diagnostics of alcohol neuropathy in thin fibres. METHODS: We examined the serum of 80 control subjects (50 women and 30 men), and the serum of 33 alcoholics (20 men and 13 women) with the daily consumption of more than 60 g alcohol in the course of the last four weeks. CDT was determined with the use of microcolumn separation after iron saturation followed by turbidimetric immunoassay (ChronoAlcoI. D., Sangui Biotech, Inc.) on Cobas-Mira analyser. CDT is expressed as a percentage of the total transferin. Senzitivity, specificity, positive likelihood ration (+LR), ROC and the area under the ROC curve were determined using statistical program MedCalc. RESULTS: The senzitivity, specificity and positive likelihood ratio (+LR) for CDT-%, respectively, were 82.6, 96.7 and 24.8 for men (cut off 2.2%), and 60.0, 88.0 and 5.0 for women (cut off 2.5%). The respective values for GMT were 95.7, 90.0 and 9.6 for men (cut off 0.64 mu kat/l), and 90.0, 80.0 and 4.5 for women (cut off 0.38 mu kat/l); for MCV 82.6, 96.7 and 24.8 for men (cut off 95.0 fL), and 80.0, 100.0 and 20.0 for women (cut off 97.2 fL). The area under the ROC curve for CDT-%, GMT and MCV, respectively, were 0.940, 0.964 and 0.896 for men, and 0.829, 0.917 and 0.906 for women. CONCLUSION: In men, CDT-% and MCV showed the same values of the statistical parameters studied. GGT was more sensitive and less specific. In women, all the parameters studied presented a lesser diagnostic value, except for MCV with 100% specificity and +LR 20.0.

Developing senior doctors as mentors: a form of continuing professional development. Report Of an initiative to develop a network of senior doctors as mentors: 1994-99.

BACKGROUND: Senior doctors report that mentoring skills are transferable to everyday medical practice and managing juniors. An analysis of views from consultants and general practitioners, who had trained together on a regional mentoring scheme, reveals significant potential for personal and professional development in such networks. CONTEXT: The Northern and Yorkshire Region Doctors' Development and Mentoring Network was set up in 1994. Since then there have been six programmes with 116 senior doctors participating. In 1997 there was an evaluation of the first four programmes. METHOD: Focus groups and postal questionnaire. RESULTS: There were responses from 71 senior doctors, giving a response rate of 86%, and responses from 78 professional stakeholders in 49 NHS organizations, a response rate of 54%. Results indicate that the programmes were highly valued by the participants, particularly with regard to: being part of a network of senior doctors; developing mentoring skills, and engaging in personal and professional development. The most difficult part of the programme was setting up mentoring networks for junior doctors, and reasons included: personal factors, such as levels of confidence in providing mentoring; cultural factors, such as juniors not wishing to be seen to need help, and organizational factors, such as lack of time allocated for mentoring. RECOMMENDATIONS AND ISSUES FOR FURTHER DEBATE: The positive benefits from the scheme raise questions about how to develop mentoring training for senior doctors. Issues include: developing mentors; who needs mentoring; mentoring and the organization; transferability of mentoring skills, and widening the network.

[A case of secondary amyloidosis in Hodgkin's disease]. / Przypadek amyloidozy wtórnej w przebiegu ziarnicy zlosliwej.

A case of hepatic and intestinal secondary amyloidosis in 43 years old patient with Hodgkin's disease is presented. Diagnostic difficulties due to atypical localization of Hodgkin's disease were discussed. Therapeutic problems were caused by severe hepatic insufficiency.

[A case of gastric lymphoma in the course of Epstein-Barr virus infection]. / Przypadek chloniaka zoladka w przebiegu zakazenia wirusem Epsteina-Barr.

A case of 18 year old patient with Epstein-Barr virus (EBV) infection is presented. Serious organ complications were observed in the course of the disease. Patient's death was a result of the massive gastrointestinal bleeding caused by gastric lymphoma, which was confirmed endoscopically and histopathologically. A possible role of EBV infection in the development of lymphomas is shortly discussed.

Ultrastructural studies of daunorubicin hepatotoxicity in rats including protective effects of tocopherol and ascorbic acid.

The Wistar rats were treated with daunorubicin in the doses corresponding to average doses administered in humans. Analysis under TEM concerned changes in hepatocytes induced by the drug. The changes were compared with those observed in the liver when daunorubicin administration followed protective administration of tocopherol (vitamin E) and ascorbic acid (vitamin C) and when daunorubicin was given simultaneously with tocopherol and ascorbic acid. The results showed nucleus heterochromatin scattering, segregation of nucleolus granular and fibrillar components, swelling of mitochondria and myelin structures in them, segmental degranulation of rough endoplasmic reticulum and decreased number of glycogen granules. The studies led to the conclusion that daunorubicin hepatotoxicity was blunted in animals receiving simultaneously vitamin E and C, which indicates to assume that those antioxidants exert some protective effect on hepatocytes. Normalization of the changes 3 weeks after administration of the last dose suggests that most of the changes are reversible and do not result in chronic liver damage.

The effect of caerulein-induced acute pancreatitis on the levels of serotonin (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA) in various rat tissues.

The effects of caerulein-induced acute pancreatitis (AP) on the levels of 5-HT and 5-HIAA in pancreas, liver, brain, kidney and different parts of the digestive tract in rats have been studied. The acute pancreatitis was induced by the continuous intravenous infusion of caerulein in the doses of 5 x 10(-6) g/kg/h and 7.5 x 10(-6) g/kg/h for 12 hours, and the 5-HT and 5-HIAA concentrations were determined by the method of Curzon and Green. The changes evoked by caerulein varied qualitatively and quantitatively between organs. The significant decrease of both 5-HT and 5-HIAA was observed in pancreas, liver, brain and kidney while in the stomach there was a significant fall of 5-HT level accompanied by the relevant increase of 5-HIAA level. In the duodenum, an opposite effect was noticed, the level of 5-HT was higher than normal whereas the 5-HIAA level was reduced. The significant decrease of the 5-HT and 5-HIAA levels in pancreas observed in the present study suggests the importance of 5-HT in the development of acute pancreatitis.

[Infection with HCV in patients hospitalized for various causes. I. Prevalence of anti-HCV antibodies in selected groups of patients]. / Zakazenia HCV pacjentów hospitalizowanych z róznych przyczyn. CZ. I. wystepowanie przeciwcial anty-HCV w wybranych grupach pacjentów.

Using the third generation ELISA test UBI HCV (Organon Teknika) we studied the prevalence of anti HCV antibodies among 980 patients (hospitalized of various diseases) in 4 hospitals in district Lublin. The results indicated that 22.3% of patients were positive for anti HCV. The presence of anti HCV in the high-risk group was higher, in hemophiliacs-59% and in hemodialysis patients-57%. The prevalence of anti HCV is closely correlated with age (19.2% in children and 24.4% in adults). This difference was statistically significant (p < 0.001). As nosocomial infections was probably 70% of cases.

[Activity of enkephalinase (EC.3.4.24.11). Neutral endopeptidase (NEP)in human digestive tract epithelial cells]. / Aktywnosc enkefalinazy (EC. 3.4. 24. 11). Neutralnej endopeptydazy (NEP) w komórkach nablonka przewodu pokarmowego czlowieka.

The activity was studied of enkephalinase (endopeptidase 24.11, neutral endopeptidase)--a membrane enzyme of epithelial cells within human digestive tract (in the stomach, duodenum, small intestine, ascending, descending and sigmoid colon, and rectum). The enzyme activity was determined by column method using the labelled substrate (H-D-AlaLeu)--enkephalin and the selective enkephalin inhibitor--thiorfan in the presence of bestatin and captopril--inhibitors of aminopeptidases and angiotensin converting enzyme respectively. The highest enkephalinase activity was found in the duodenal epithelium (77.3 8.0 fmol of the substrate/min/mg of protein) and in the small intestine (23.4 0.9 fmol/min/mg of protein) with its gradual decrease when progressing down the gastrointestinal tract. This result confirms the hypothesis of enkephalinase participation in protein hydrolysis processes.

[Long-term clinical observations of chronic active hepatitis HBsAg (+)]. / Wieloletnie kliniczne obserwacje przewleklego aktywnego zapalenia watroby HBsAg (+).

This paper presents results of 3-18 year clinical observation of 48 patients with chronic active hepatitis HBsAg (+). 40 patients had suffered viral hepatitis for a period from 6 months to 3 years (avg. 1.5 year) before chronic active hepatitis manifested. Cirrhosis hepatis was a consequence of chronic active hepatitis in 52.1%, chronic active hepatitis in 45.8%, and chronic persistence in 2.1% of cases, during observation period. The average transition time from chronic active hepatitis to cirrhosis was 3 years. 48% of cirrhosis hepatis occurred within 2 years starting from recognition of chronic active hepatitis and 80% within 5 years. Most cases of cirrhosis were recorded if patients had been treated with penicillamine and prednisone (80% of cases), then with azathioprine and prednisone (48% of cases), while the least with ++non-immunosuppressive therapy (penicillamine, isoprinosine or "+hepatic protectors").