Comparative study of PEP mask and Flutter on expectoration in cystic fibrosis patients.

The objective of the study was to investigate the effect of positive expiratory pressure (PEP) and Flutter on expectoration in cystic fibrosis (CF) patients. Data was gathered through 260 treatments with 10 patients (5 female; 19.2 years; BMI: 18.0). Two methods were used alternately, first the patients started with Flutter and proceeded with PEP, and the next occasion they exercised in the reverse order, starting with PEP then continuing with Flutter. During each phase, 5 sets of 10 exhalations were performed. Sputum weight was measured after the use of the first device, and at the end of the treatment. During sessions starting with Flutter 4.0 ± 4.0 g sputum was expectorated, continuing with PEP, an additional 5.2 ± 5.0 g was produced, altogether 9.2 ± 8.2 g. At sessions starting with PEP 7.4 ± 3.7 g was expectorated, continuing with Flutter an additional 0.8 ± 1.4 g, that is 8.2 ± 4.1 g. Comparing the two devices by themselves, PEP proved to be significantly more efficient then Flutter. Comparing the two treatment types it is statistically not proven, which one is preferable using both devices. Conclusively, PEP is significantly more efficient than the Flutter in sputum expectoration among CF patients. The Flutter is a useful supplementary device.

Results of a multilateral approach to donation-transplantation process in Hungary in the past 2 years.

Hungarotransplant Public Service Corporation, the national organ exchange organization, was established in 2001. The assessment of donation- and transplantation-related data allows the evaluation of the current situation and future trends. The donor reports show involvement of new hospitals and an increase in reported donors. These results are due to a new centralized organ referral system implemented by Hungarotransplant, employment of donation links in donor hospitals, training for key persons in intensive care units, and implementation of a Donor Action program, generating frequent and positive media attention. In 2002 the number of realized cadaveric donors increased by 21% and remained stable in 2003 despite the further increase in referrals. In 2002 the number of heart transplants remained the same, and liver transplant activity declined. In contrast, in 2003 the heart transplant activity rose by 33% and liver transplant activity by 82%. The multiorgan donation rate and the total number of transplanted organs have increased continuously. Our data demonstrate that organized multilateral efforts resulted in an immediate improvement in donation-transplantation activity in Hungary. However, the role of factors other than the shortage of organs, such as capacity problems and limited financial resources, are also highlighted.

[Limiting factors of aerobic capacity]. / Az aerob funkciós rendszer korlátai.

High aerobic capacity is necessary to maintain high intensity, wholebody physical exercise for several minutes. Any steps in the chain of the oxygen delivery and mitochondrial consumption can be a rate-limiting factor of the aerobic functional system. Many examples in the field of the pathology and of the performance physiology demonstrate limiting functions in the elements of this function. Central factors (cardiac output, gas exchange in the lungs, oxygen transport capacity of the blood) and the oxidative capability of the muscle play a probably well integrated role in functioning of the system. A couple of interventions--increase by training, adaptation to the circumstances, medicaments etc are available to restore the failing functions which serve as the physiologic basis of the rehabilitation.

Prediction of early renal graft function by the measurement of donor urinary glutathione S-transferases.

BACKGROUND: We have investigated the possibility of urinary alpha- and pi class glutathione S-transferases (GST-a; GST-pi) serving as a valuable parameter to predict early graft function after transplantation. METHOD: Urinary GST concentrations of 61 donors (DON) and recipients (REC) were analyzed at preoperative, intraoperative, and postoperative periods. We grouped recipients according to the early postoperative graft recovery days. RESULTS: The donor graft function, represented by the donor urinary GST concentration (GST-pi:17,1+/-12 microg/l mmol creatinine (crea); GST-a:14,3+/-10 microg/mmol crea), sustained a loss in comparison to the healthy controls (GST-a; pi< or =1 microg/mmol crea). According to statistical analysis, the donor GST-pi level showed a strong correlation with graft recovery days-pi (r = 0.84; P<0.001). The early graft function cannot be predicted by means of cold ischemia time (22.8+/-3.4 hr), nor handling time (42.4+/-11.1 min), nor even the intraoperative enzyme concentrations. The GST-pi cut off level (12.55 microg/mmol crea) might predict the possible posttransplant graft dysfunction. The discriminative analysis showed that using only DON GST-pi alone could discriminate well between the groups among all grafts in 68%. CONCLUSION: Prognosis is poorer if the donor GST-pi concentration is above 12.55 microg/mmol crea. On the basis of the determination of GST-pi concentration in the donor urine, we can predict graft viability before the surgical procedure with a reliability of 68%.

Exhaled carbon monoxide concentration increases after exercise in children with cystic fibrosis.

Oxidative stress and hypoxia, which may occur in cystic fibrosis patients (CF) at rest and may be worsened by exercise, induce the expression of heme oxygenase (HO)-1, resulting in increased carbon monoxide (CO) formation. We tested that exhaled CO level (eCO) was higher in CF patients than in healthy subjects, and that exercise increased CO production. Exhaled CO was measured electrochemically in 15 CF patients and 15 control subjects at rest (T0), immediately (T1) and 60 minutes after a symptom-limited incremental bicycle exercise test (T60). Arterial oxygen saturation (TcO2) was monitored transcutaneously. Data are given as mean+/-SEM. Baseline eCO was 1.90+/-0.26 ppm in the control and 1.93+/-0.27 ppm in the CF group. In both groups eCO was lower at T1 than at rest. In the control group eCO was also low at T60, but in the CF group it was increased compared to baseline level at this timepoint. Exercise caused oxyhemoglobin desaturation in CF patients which was related to the increase in eCO measured at T60 (r=0.67, p<0.01). Our findings suggest that exercise modulates the level of exhaled CO partly by worsening oxygenation in CF patients.

[Organization of liver transplantation--role of the transplantation coordinator]. / A májtranszplantáció szervezése--a transzplantációs koordinátor feladatai.

The authors give a short overview about the background of the organisation of the liver transplantation and about the process of the "liver alarm". One of the most important work of the coordinator is to increase the number of organ donation. The other part of the preparation of liver transplantation is to create the recipient waiting list. The organisation of the "liver alarm" needs the work of two coordinators. The donor coordinator keeps contact with the donor hospital, harmonizes the travel of different transplant teams and organizes the organ explantation. In the same time, the recipient coordinator prepares the liver recipient for the liver transplantation and keeps contact with the donor coordinator in the donor hospital. If the donor liver macroscopically seems good for transplantation, the patient can be send to the operating room and the work of the anaesthesiologists and the surgeons starts.

Diagnostic value of urinary enzyme determination in renal transplantation.

The measurement of enzyme activity in urine provides a sensitive assessment for renal tubular cell damage. The present study was undertaken to evaluate the clinical value of the determination of tubular brush-border-associated enzymes, alkaline phosphatase (AP), gamma-glutamyl transferase (GGT), leucine aminopeptidase (LAP), and dipeptidyl peptidase IV (DPP), of patients with normal graft function (NOR, n = 20), with acute tubular necrosis (ATN, n = 11), with an acute rejection episode (ARE, n = 17) after transplantation, and of healthy persons (n = 20). The second urine of the morning was collected daily during the patients' stay in hospital. The enzyme activities were measured at 25 degrees C and were expressed as U/mmol creatinine. The enzymuria in NOR is higher than in healthy controls, but is still in the normal range. By 5 days after transplantation the initial increased excretion declines as the graft function improves. Elevated enzymuria (DPP 0.69 +/- 0.56, AP 3.06 +/- 3.24, GGT 4.16 +/- 4.13, and LAP 1.39 +/- 1.27) was observed during the rejection episodes. Two days before clinical diagnosis of rejection, the release of DPP-IV and GGT increases to double, and the AP and LAP increases to 3 times the value on the fourth day before rejection. Successful treatment of rejection coincided with a quick return by the third day of the rejection period to the previous enzyme distribution. In ATN no decrease of enzymuria occurs and the excretion is much higher than in ARE. Our method with the every day monitoring of kidney graft function offers the possibility for the early diagnosis of acute rejection.

Disseminated Kaposi sarcoma in immunosuppressed patients.

UNLABELLED: Tumour incidence was examined in kidney-transplanted patients receiving immunosuppressive therapy. Eight hundred and fifty immunosuppressed patients (mean age: 34.5 years; mean follow-up time: 67 months; men/women = 3/2), were followed up. Two cases of disseminated visceral kaposi sarcoma (K.S.) are reported in detail. RESULTS: long-term immunosuppression significantly raises the risk of tumour development (30/850); one must reckon with the appearance of visceral K.S. (2/850), which is exceptionally rare in the general population. CONCLUSION: the classical lower extremity cutaneous manifestation is fairly benign, it appears later and responds to radiotherapy well. The visceral form appears early (in 3-6 months), it is aggressive, progressing quickly. Only early diagnosis followed by immediate reduction or discontinuation of immunosuppression, helps successful oncological treatment.