Arteriovenous fistula of the kidney: a case report of 47-year-old female patient treated by embolisation.

Arteriovenous fistulas of the kidney are rare. They may be acquired, idiopathic or arise in congenital arteriovenous malformations. There are only few reports in the current literature describing the successful embolisation of idiopathic arteriovenous fistulas. We report a 47-year-old hypertensive female patient with a successfully embolised arteriovenous fistula. Diagnosis was made on the basis of colour duplex Doppler examination and this method enabled further successful embolisation of the fistula.

Oral heparin in the treatment of rheumatoid arthritis.

Heparin was administered orally in 10 patients with rheumatoid arthritis. The treatment resulted in clinical improvement in all cases (significant reduction in the number of tender and swollen joints and morning stiffness). This was associated with a decrease in erythrocyte sedimentation rate (8/10 patients) and cholesterol in all patients, although the differences were not significant. Recent data indicate that heparin can bind cytokines with potent immune modulatory action (e.g. TNF-alpha, interferon gamma etc.). Thus, neutralization of their action on target cells could be partially responsible for the beneficial effects reported. Moreover, heparin inhibits T cell traffic to a site of antigen by blocking enzymes digesting the extracellular matrix and interfering with selection activity. The results of our preliminary study suggest that heparin, given per os, may have immunomodulatory properties with potential application in human disease.

Disturbances of T-cell interactions with endothelium and the extracellular matrix proteins in a patient with Takayasu arteritis.

T-cell interactions with endothelium and the extracellular matrix proteins were studied in vitro in a patient with Takayasu arteritis. Markedly enhanced spontaneous adhesiveness to cultured endothelium and collagen IV and fibronectin were found to be paralleled by abolished responses to the costimulating action of collagens I and IV and fibronectin. Those abnormalities were partly corrected by immunosuppressive therapy. Aberrant interactions of T cells with endothelium and the extracellular matrix proteins may underlay the pathogenesis of some forms of vasculitis.

[Calcitonin in treatment of diabetic foot syndrome]. / Kalcytonia w leczeniu zespolu stopy cukrzycowej.

A case of a 36-year patient with persistent diabetes mellitus of type I and gangrene of the foot is presented. Calcitonin has been used to treat osteitis and inflammation of the adjacent soft tissues. Despite performed surgery and conservative treatment, destruction of the bones has been progressing, and could lead to the high amputation of the extremity. Calcitonin produced an increase in bone, massive calcification around bone stumps, and anastomosis within one year. An acceleration of the wound healing has also been noted. Taking calcitonin mechanism of action and the clinical course of this case into consideration, it seems justified to use calcitonin in the treatment of gangrene of the foot in diabetes.

[Scribner's shunt as a first step in creation of a Brescia type fistula]. / Przetoka Scribnera jako pierwszy krok w dwuetapowym wytworzeniu zespolenia typu Brescia.

The aim of this paper is to present the advantages of performing a vascular access in two steps in uremic patients requiring urgent hemodialysis. In 15 patients age 28-68 yrs. (mean 50 yrs.) with end stage renal disease the Quinton-Scribner shunt linking radial artery with cephalic vein was placed on a forearm, and dialysis was started on the same day. After 18-35 days (mean 26 day) in 12 patients depending on efferent vein arterialization the second step operation of creating Cimino-Brescia fistula was performed on the same vessels. The fistula was immediately good for punction with standard needles. In 3 patients, due to low arterial output the vein condition did not allow for the second step operation. The results of our observations show an efficiency of the proposed method in establishing an acute and chronic vascular access which was as effective as routinely constructed shunts. Our patients avoided complications of central vein cannulation and the hospitalization period was shortened.

[Tuberculosis in patients chronically treated with hemodialysis]. / Gruzlica u chorych przewlekle leczonych hemodializami.

UNLABELLED: Tuberculosis (tbc) is a significant problem in view of diagnosis and therapy in patients on hemodialysis (HD). The object of this study was to analyse cases of tbc found among patients treated by HD at the 1st Dept. of Internal Medicine, Central Railway Hospital in the years 1971-91. Tuberculosis was found in 10 out of 182 patients eligible for analysis (5.5%), 7 of whom were men. Mean HD treatment time before diagnosis was 17 months (for the majority--less than 1 year). One patient had pulmonary tbc 6 had pulmonary tbc with extrapulmonary involvement and 3 had extrapulmonary TB only. Six patients had pericardial involvement. Clinical examination revealed malaise, lack of appetite, weight loss, fever, cough. All cultures were negative. Tuberculin test were positive in only 2 cases. In 4 cases tbc was diagnosed on necropsy. In remaining cases tbc diagnosis was based on clinical grounds, X-ray films and ineffectiveness of broad spectrum antibacterial chemotherapy in conjunction with effective antimycobacterial chemotherapy. Agents used were: rifampicin, isoniazide, ethambutol. Out of 6 treated patients 5 showed improvement. Two patients had a tbc relapse. Mean yearly incidence in our material is 33 times higher than the mean yearly incidence in the general Polish population in the years 1971-91. CONCLUSIONS: Patients on HD have a high incidence of tbc which presents diagnostic difficulties; extrapulmonary organ involvement is the rule in dialysed patients; tbc in such a setting may lead to death if untreated; effect of antimycobacterial therapy confirms diagnosis.

Immunomodulatory action of human recombinant erythropoietin in man.

Recent findings suggest that recombinant human erythropoietin (rhEpo) may have an immunomodulating action. We have studied the in vitro and in vivo effects of rhEpo on immune functions in man. Low pharmacological concentrations of the hormone inhibit T-cell activation and proliferation, while higher ones are without that effect. The same Epo concentrations inhibit mitogen- and alloantigen-driven B-cell differentiation and immunoglobulin synthesis and, to a lesser extent, B-cell proliferation. In vivo treatment with rhEpo causes an initial inhibition of T- and B-cell proliferation, but with prolonged administration improved responsiveness is observed. Our data support the notion that rhEpo can regulate immune functions, a fact of potential clinical application.

[Successful nitrogranulogen treatment of severe nephrotic syndrome in glomerulonephritis--case report]. / Skuteczne leczenie nitrogranulogenem ciezkiego zespolu nerczycowego w przebiegu klebkowego zapalenia nerek--opis przypadku.

A patient with mesangio-proliferative glomerulopathy with advanced nephrotic syndrome (proteinuria 20 g/day) received bolus doses of corticosteroids (5 x 1.0 g iv) but renal function continued to deteriorate. A 11-day course of nitrogranulogen (0.01 mg/kg/day) with prednisone (0.5 mg/kg) caused complete disappearance of proteinuria with improvement in renal function. This observation supports our earlier findings indicating that treatment with low dose nitrogranulogen may be efficacious in some forms of glomerulopathies.

[Subcutaneous emphysema of the anterior chest wall as the only symptom of spontaneous rupture of the esophagus]. / Odma podskórna przedniej sciany klatki piersiowej jako jedyny objaw samoistnego pekniecia przelyku.

A diagnostically difficult case of Boerhaave's syndrome is reported. The patient gave a history of subcutaneous emphysema of the anterior chest wall as the only sign. Aspiration drainage through thoracotomy opening and artificial alimentation through jejunostomy were used with success.

[The immunobiological effects of nitrogranulogen. I. Effect of nitrogranulogen on laboratory and clinical parameters in patients with primary glomerulopathies]. / Badania nad immunobiologicznym dzialaniem nitrogranulogenu. Czesc II. Wplyw nitrogranulogenu na parametry laboratoryjne i kliniczne u chorych z pierwotnymi glomerulopatiami.

The administration of nitrogranulogen in a dose of 0.01 mg/kg in patients with primary glomerulopathies caused a significant reduction in proteinuria in 10 out of 12 cases. In one patient the effects was striking (fall of proteinuria from 10 g/24 hrs to trace amounts). A trend towards the normalization of helper T lymphocytes (CD4+) was noted as well as a significant drop in NK lymphocytes. No side effects or drug-related complications were observed.

[Peritoneal dialysis and leukopheresis in psoriasis: indications and contraindications]. / Peritonealdialyse und Leukopherese bei Psoriasis: Indikation und Kontraindikation.

Twenty-four patients with severe psoriasis were treated with continuous peritoneal dialysis and ten patients with repeated leukopheresis, with comparable clinical results: about 20%-30% of the patients had complete remission of the lesions during the therapy, about 40% showed spontaneous regression of above 50% of psoriatic lesions, and the remaining patients had some improvement. However, despite partial improvement during treatment, the psoriatic lesions of the patients that were previously unresponsive to any external and internal treatment disappeared within 2-3 weeks, after discontinuation of dialysis or leukopheresis, with the use of anthralin or tar ointments. Peritoneal dialysis and leukopheresis seem to be useful methods of treatment for especially resistent and widespread psoriasis in patients having contraindications to other methods, i.e., PUVA and/or aromatic retinoids.

The activity of polymorphonuclear leukocyte neutral proteinases and their inhibitors in patients with psoriasis treated with a continuous peritoneal dialysis.

3 of 16 patients with extensive psoriasis have been completely cleared of skin lesions within 2-3 weeks of continuous peritoneal dialysis, and 2 of them up to 2 mo after termination of therapy. In 5 cases there was a great improvement of psoriatic lesions and in 6 remaining cases only a slight improvement was found. The remission of psoriasis was correlated with extremely high polymorphonuclear leukocyte depletion through the peritoneal cavity in a short time. Neutral serine proteinases were extracted from polymorphonuclear leukocytes and quantitated. The quantity of enzymes in the cells recovered from peritoneal dialysates was found to decrease with duration of treatment, and it was 2-5 times lower than amounts of neutral proteinases extracted from peripheral blood polymorphonuclear leukocytes of psoriatics and normals. The enzyme content per polymorphonuclear leukocyte of patients with active psoriasis was significantly higher (2-fold) than that in inactive psoriasis and in normal controls. Proteinase activity was also found in the sera of psoriatics and normals, as well as in the peritoneal dialysates. However, this activity appeared to be about 30-50 times lower than serum inhibitory activity against neutral proteinases. The concentration of neutral proteinase inhibitors in 5 of 17 sera of patients with psoriasis was significantly lower than that in normal sera. These data indicate that the depletion of activated PMNL with increased amounts of neutral proteinases may account for the beneficial effect of peritoneal dialysis in the clearing of psoriatic lesions.