[Current knowledge on the functional morphology of the human spleen]. / Súcasný stav poznatkov o funkcnej morfológii l'udskej sleziny.

The knowledge on the functional structure of the spleen is gained from the analysis of diseases, and immunological studies. Significant information is gained from model tests and isolated cells. The latter is advantageous in coincidence with the studies of intercellular relations. The main function of the spleen resides in "purification" of the blood. The vascular system, white pulp, red pulp and the marginal zone participate in this process. T-dependent zones of the white pulp are restricted by the circumference reticulum (CR) of periarterial lymphatic sheaths. CR is a morphologic substrate of retro-directional flow of lymphocytes. In addition to T lymphocytes and a certain amount of B lymphocytes, the T-dependent zones contain interdigitizing cells. The B-dependent zones, in addition to lymphocytes, contain dendrite reticular cells. The cords are constituted by varied cellular and extracellular compartments, especially macrophages, fibroblastic reticular cells and various fibrous components. The latest filtration barrier is formed by the wall of sinuses of the red pulp. The achievement of new functional knowledge resides prospectively in the use of lectins, anti-collagen antibodies, fibronectins, proteoglycanes and other various molecules participating in intercellular relations, or morphometric studies, they can provide information on the newest subpopulations of cells in both red and white pulp, that are so far inaccurately defined.

[The spleen in hereditary spherocytosis]. / Slezina pri hereditárnej sférocytóze.

Hereditary spherocytosis is the most common inherent, autosomal dominant hemolytic anemia. Mild splenomegaly, venostasis and common decrease of while pulp is characteristic for hereditary spherocytosis. Cords are filled with spherocytes, sinuses can be empty or squeezed. Both sinuses and veins include ghost erythrocytes that lost haemoglobin. They are seen light-microscopically in differential interferent contrast. Macrophages are numerous, sinus lining cells are hypertrophic. Erythrophagocytosis is hardly seen by electron microscope. Not all red blood cells are spherocytes. Spherocytes are seen well in electronmicroscopy. We did not observed transition of erythrocytes through sinus walls. In certain circumstances lots of ferritin is seen both intra and extracytoplasmically. Iron accumulation in cords can result in their fibrosis.

[Congenital atransferrinemia]. / Kongenitale Atransferrinämie.

Congenital atransferrinemia was first diagnosed at the age of 11 months in a now 27-year-old woman. Until she was aged 14 years treatment with human transferrin was irregular and, as it turned out, inadequate. But since then she has regularly received human transferrin (1 g monthly) and deferoxamine (500 mg twice weekly). Despite this she developed haemosiderosis affecting heart, liver, hypophysis, thyroid and the locomotor apparatus. This case report demonstrates the need of early diagnosis and treatment of congenital atransferrinemia to prevent the mentioned complications.

[Changes in hemostasis in ischemic heart disease]. / Zmeny hemostázy pri ischemickej chorobe srdca.

The relationship between changes in blood coagulation, the occurrence and severity of risk factors of ischemic heart disease and the clinical condition of the patient was investigated. The at risk group of patients 42.2% had more than 3 pathological parameters. Intravascular blood coagulation was not activated in any of the patients. In patients with acute myocardial infarction (MI), 62.2% had more than 3 pathological parameters on the first day of MI development. Demonstrable activation of intravascular blood coagulation was found in 28.2% of these patients. On day 5 of MI, activation of intravascular blood coagulation was recorded in 57.7% of the patients treated by classical approach and in 15.4-30.8% of the patients on thrombolytic treatment. In the at risk group, primary hemostasis and the fibrinolytic system were more affected, in patients with MI the whole hemostatic mechanism was involved. On day 5 of MI, in patients with classical therapy pathological laboratory findings still persisted or were even more deteriorated, particularly increases in fibrinogen level. At that time, in patients on thrombolytic therapy no substantial changes of initial values were recorded. No correlation was found to exist between changes in hemostasis and the risk profile or between changes in hemostasis and the clinical severity of MI. The obtained results justify the administration of antithrombotic substances, especially in patients with unstable angina pectoris. On observing time constraints, administration of thrombolytics is justified in MI. (Fig. 9, Ref. 25.)

[Changes in hemostasis as one of the paraneoplastic manifestations]. / Zmeny hemostázy ako jeden z paraneoplastických prejavov.

Derangements of hemostasis and hemocoagulation in patients with malignancies are known as paraneoplastic syndrome. Their origin, however, has not been unequivocally established and explained, and data on their occurrence are controversial. Examination of 157 patients with different malignant tumor diseases yielded pathological laboratory findings in 94.2%. The most frequent finding was the state of hypercoagulation in 41.0%; hypercompensated syndrome of disseminated intravascular blood clotting (DIC) was found in 10.9%, compensated DIC syndrome in 18.0%, consumptive coagulopathy in 3.8%, and in 19.2% hypocoagulation state caused by other abnormalities. The laboratory finding was normal only in 5.8% of the patients. In the light of the high occurrence rate of hemostatic and hemocoagulation changes in malignant diseases, established by laboratory analysis, the use of anticoagulants and antiaggregation substances appears to be justified in the majority of cases, both to prevent the development of these changes which may complicate the course of the malignant condition, and in preoperative care to reduce the rate of postoperative thromboses in patients with tumors.