Direct ostioplasty of the left main coronary artery using the right internal thoracic artery as patch material.

Three female patients underwent operations for nonatherosclerotic isolated left main coronary artery stenosis. Transaortic patch angioplasty was performed via an anterior approach using the most proximal segment of the right internal thoracic artery as patch material. Six months after surgery coronary angiography revealed good results in all three cases. The internal thoracic artery can be used to enlarge the left coronary ostium safely, if heavy calcification is not present.

[Open-heart surgery in Jehovah's witnesses]. / Szívmútétek jehova tanúinál.

The religious community Jehovah's Witnesses was founded in 1870. They hold that blood transfusion is against God's law. Surgical treatment of a Jehova witness is a great challenge for every surgeon, especially for cardiac surgeons because blood transfusion is frequently needed during such operations. Authors have been trying to reduce the utilization of preserved blood for ten years. This study is about the experience with Jehovah's Witnesses who have undergone open heart surgery in Debrecen. Twenty-four patients underwent open heart surgery from 1989 till May 1999. 7 of them were males and 17 were females. The mean age was 53 years (40-70 yrs). Three patients had congenital heart disease, 11 had acquired valve disease and 7 had coronary stenosis. In 3 cases the patients had combined coronary and valve disease. Authors used a complete procedure for reducing blood loss during the operations. Two patients (8.3%) died during the early postoperative period. Preoperative mean haemoglobin level was 134.2 g/l (112-166) and haematocrit value varied between 36-50% (mean 38%). On the first postoperative day significant decrease was registrated in these values. From the second day a slow but significant increase of haemoglobin and haematocrit levels were detected. The mean follow up time was 37.6 months (2-144), and the NYHA classification of 21 longtime survivors improved from 3.06 to 1.62. At the Department of Cardiac Surgery in Debrecen as well as worldwide more and more operations are done without blood or preserved blood products, so it could be said that nowadays surgical treatment of Jehovah's Witnesses has lower risk than before.

The effect of adrenalectomy on the proteinuria of spontaneously hypertensive rats and normotensive controls.

Urinary proteins were studied by quantitative and electrophoretic methods in 6-month-old spontaneously hypertensive rats and normotensive controls. Protein analysis was carried out before and after adrenalectomy and during gluco- or mineralocorticoid treatment. Urinary protein excretion was significantly diminished after adrenalectomy both in the hypertensive and control groups. The original level of protein excretion was restored only by glycocorticoid treatment. Normal or pathologic electrophoretic pattern of urinary proteins was not influenced by the experimental procedure. Moderately non-selective glomerular proteinuria persisted in the spontaneously hypertensive rats referring to a definitely damaged glomerular barrier. One protein fraction of about 130,000 dalton molecular weight disappeared from the urine of hypertensive animals after adrenalectomy and reappeared after glucocorticoid treatment only. This fraction probably represents the dimeric form of albumin. Quantitative changes of urinary protein excretion can be explained by haemodynamic factors.

Simultaneous occurrence of Graves' disease with endocrine ophthalmopathy. Thyroiditis and thyroid carcinoma.

The simultaneous occurrence of Graves' disease with ophthalmopathy lymphocytic and subacute de Quervains' thyroiditis has been observed in two male patients suffering from follicular-type thyroid carcinoma. In one of them Sjögren syndrome and a mild form of diabetes were also diagnosed. It is assumed, on the basis of indirect evidence, that the humoral and cellular lesions determined by genetic factors and influenced by prolonged thyrostatic and steroid treatment are jointly responsible for tumour genesis.

Fluid and salt intake during the development of renal hypertension in rats.

1. In Sprague-Dawley rats, two-kidney, one-clip renal hypertension was induced, and the drinking behaviour as well as total fluid and sodium intake were studied before and for 16 days after the operation. 2. When water alone was offered as drinking fluid, the blood pressure reached values that were by about 20 mmHg higher than those in the rats which had free choice of drinking water or 2% saline. 3. In those rats which had water and 2% saline to drink, the total sodium and fluid intake rose transiently for three days, as compared with that of the sham-operated controls, and increased steeply starting from the 7th and 10th day, respectively. When a tighter stenosis of the renal artery was induced, the pressure rose more rapidly, and the total fluid and sodium intake increased continuously after the operation until the end of the experiment. 4. A positive correlation was demonstrable between the height of blood pressure and the total daily intake of fluid and sodium, respectively. 5. The relation between the total daily fluid and the total daily sodium intake followed a straight regression line. 6. The hypertensive rats which had a high total sodium intake responded to the withdrawal of the 2% saline solution, within 2 days, with increased water intake, decreased food intake, and loss of body weight, whereas the blood pressure remained high. 7. In the two-kidney, one-clip hypertension, no 'critical level of blood pressure' can be defined, beyond which the contralateral kidney starts to lose sodium.

Glomerular alterations and proteinuria in the "two-kidney" Goldblatt hypertensive rats.

Quantitative and qualitative analyses of urinary proteins were carried out in order to follow permeability changes of the glomeruli during the course of hypertension. Benign and malignant hypertensive cases were separated by the presence of "salt-loosing-syndrome" in the latters. Six hours urinary protein excretion increased significantly from the 2nd postoperative week only in the malignant hypertensive group. Using sodium dodecyl sulfate gel electrophoresis glomerular proteinuria of selective type was commonly found in the benign, moderately unselective type in the malignant hypertensive group respectively. The findings are in accordance with the "double filter" theory of glomerular barrier.

[Diagnosis value of lipid content in prostatic cancer]. / A lipidtartalom diagnosztikus jelentosége prostatarákokban.

Authors have demonstrated presence of lipide droplets in the tumour cells in 16 cases out of 22 of the carcinoma of prostata. In 8 cases the tumour was of the xanthomatous variant of Kinoshita. Metastases were examined in 4 cases. Cells of the metastatic tumours contained lipide alike the primaer ones. Authors believe, that lipide content of the metastatic carcinoma may help in recognition of the original tumour, i.e. prostatic carcinoma.

Lysosomal enzymes in the juxtaglomerular cell granules.

In addition to the already known acid phosphatase and beta-glucuronidase, 2 other lysosomal enzymes: aryl sulphatase and N-acetyl-beta-glucosaminidase were localized by histochemical methods in the renin-containing granules of the mouse juxtaglomerular cells.

Renal tubular ferritin-uptake, a consequence of the increased glomerular permeability, during the benign and malignant course of renal hypertension in rats.

Tubular uptake of ferritin given intravenously was studied in the right and left kidneys of 74 Goldblatt-hypertensive rats. Previous observations pointed out the pathologically enhanced permeability of glomerular barrier as the cause of the phenomenon. It was assumed, that the extent of tubular areas taking up ferritin, refers to the number of damaged glomeruli. The process was characterized semiquantitatively by planimetric measurements and determination of the non-hemin iron concentration in the renal cortical tissue. A more frequent and extensive tubular ferritin-uptake (and glomerular damage) was bilaterally recorded in the kidneys of malignant hypertensive rats in comparison to the benign ones. The development of the phenomenon in the clamped kidneys, being defended from high blood pressure, suggests a humoral factor behind the enhanced glomerular permeability. Saline intake has a beneficial effect on the glomerular damage similar to the hypertensive angiopathy.

Ultrastructural changes of the rat renal glomeruli in the early phase of renovascular hypertension.

Electron microscopic studies were carried out on rat kidneys during the early phase of "two-kidney" Goldblatt hypertension. Pathologic ultrastructural changes (confluence of foot processes of the podocytes, formation of intercellular juctions between them, etc.) and an enhanced permeability to ferritin were found in the glomeruli of both the ischaemic and the contralateral kidneys. Signs of activation and exhaustion of the lysosomal system appeared in the glomerular epithelial cells of the untouched kidneys. These signs were absent in the kidneys with constricted arteries. The possible significance and pathogenesis of the alteration are discussed in comparison with other pathological conditions showing a similar ultrastructural picture.

On the lipid granularity of renomedullary interstitial cells in benign and malignant courses of renal hypertension.

The number of lipid droplets of the renal medullary interstitial cells was registered in 40 rats with "two-kidney Goldblatt hypertension" and in 27 sham operated normotensive controls. A strong degranulation in the unclaimed kidneys was always associated with the malignant course of hypertension, characterized by a disturbance in the sodium and water balance. Giving 2 per cent saline in addition to demineralized water as a drinking fluid the decrease in the number of granules was prevented in most of the malignant cases. Significant changes in the granule count were never registered at a benign course of hypertension. Degranulation of the medullary interstitial cells in the unclamped kidneys does not unequivocally represent the loss of medullary antihypertensive function. It seems to be directly determined by the disturbance of sodium and water balance and indirectly by the hypertension.

Studies on the tubular ferritin-uptake in the kidneys of Goldblatt-hypertensive rats.

Ferritin deposition in the tubular epithelial cells developing after intravenous ferritin injection was investigated in the kidneys of 25 Goldblatt hypertensive rats and of 10 normotensive controls. The phenomenon was detected only in the hypertensive animals. Light microscopic and planimetric data indicate an increased permeability of the glomerular filter and contradict a degenerative damage of the tubular epithelial cells as a primary cause. Ferritin after having crossed the glomerular filter is partly reabsorbed by the tubular epithelium and partly excreted by the urine. The high iron content of the urine and the ferritin detected electrophoretically in it also proves this explanation.

The effect of unilateral papillectomy on the juxtaglomerular granulated cells.

The changes of the juxtaglomerular index values in the superficial, deep and whole cortical areas of rat kidneys after unilateral papillectomy were analyzed. On the papillectomized side the JGI values showed an increase in the deep, and a decrease in the superficial cortical zone. The changes proved to be significant during the whole experimental period in the juxtamedullary index and between the 4--14 postoperative days in the superficial index values. The tendency of the changes of JGI in the contralateral kidneys was similar to those of the papillectomized kidneys, but significant differences were registered less constantly. These changes are probably the consequences of haemodynamic factors. Papillectomy is considered an incompetent model for studying the regulatory function of macula densa in the synthesis of renin.

Gonadal malignancy and 46, XY karyotype in a true hermaphrodite.

A case of true hermaphroditism associated with gonadoblastoma and dysgerminoma is reported. The patient had a 46, XY karyotype. The possible significance of the Y chromosome in the development of gonadal tumors and the histogenetic problems of gonadoblastoma are also discussed.

Does the renin-angiotensin system contribute to the vascular lesions in renal hypertensive rats?

1. Renal hypertensive rats with a normal or suppressed activity of the renin-angiotensin system develop vascular lesions which are similar to those observed in spontaneously hypertensive rats on high sodium diet. 2. Exposure of a vascular bed to high blood pressure results in a rapid damage of the vascular wall, irrespective of the state of the renin-angiotensin system.