[The latest trends in the treatment peritonitis of the patients on peritoneal dialysis]. / Soucasné trendy v lécbe peritonitid u nemocných lécených peritoneální dialýzou.

Peritonitis is still one of the major complications ambulatory peritoneal dialysis (CAPD). The initial empiric therapy for peritonitis should be effective against most grampositive organisms as well as gramnegative organisms. Intraperitoneal administration antibiotics has the advantage of a high concentration of the antibiotics at the site of infection. The treatment should provide broad coverage of all organisms, without side-effects or risk for the patient and should not provoke the emergence of resistant germs. The present guidelines of the ad hoc advisory committee are of great value in this regard. The ISPD guidelines for treatment of peritonitis recommended an empirical therapy based on the association of a first-generation cephalosporin with an aminoglycoside or ceftazidime.

[Calciphylaxis in a patient on long-term dialysis]. / Kalcifylaxe u dlouhodobe dialyzované nemocné.

Calciphylaxis is a special form of soft tissue calcification (in particular blood vessels), affecting specially patients with chronic renal insufficiency and associated secondary hyperparathyroidism. Most severely affected are small arteries with a diameter of 0.2-0.5 mm at the interface of the corium and subcutaneous layer. Calcification of the vascular media with subsequent narrowing of the lumen causes ischaemic changes manifested by the development of painful reddish-violet spots on the skin with necrosis and ulcerations. The authors describe the case of a 73-year-old diabetic female patient with regular dialyzation treatment. The patient developed reddish-violet spots on the lower extremities shortly before admission to hospital. At the site of the spots rapidly progressing necroses developed. The cause of these ischaemic changes were calciphylactic changes confirmed on post-mortem examination and by histological examination.

Kinetics of phenols in body fluid compartments during hemodialysis.

On the basis of direct quantification of hemodialysis (HD), the kinetics of phenols (Ph) were followed in 13 patients on regular HD treatment. The average plasma levels of Ph before and after HD were 627 +/- 109 mumol/L and 416 +/- 81 mumol/L, respectively. The total amount of Ph removed during 5-h HD was 7,481 +/- 1,894 mumol. For calculation of the generation rate (G), a new formula has been derived not requiring knowledge of the corresponding volume of distribution. The G of Ph was 2.9 +/- 0.7 mumol/min on average. The mean dialysis clearance (K) of Ph was 48.2 +/- 10.2 ml/min.

[Changes in amino acids in a regular dialysis program]. / Aktuální zmeny aminokyselin v pravidelném dialyzacním programu.

BACKGROUND: Dialyzed patients are chronically in a state of negative nitrogen balance, and amino acids, their building stones, are also significantly affected by dialysis. The purpose of the present investigation was to assess whether they should be supplied, how frequently and for how long and how they are influenced by the usual diet of patients. METHODS AND RESULTS: The examination was made in a group of 13 patients included in a regular haemodialysis programme. Their mean age was 53.2 +/- 12.4 years, they were dialyzed for an average period of 55 months, maximum 163 months. The patients were dialyzed three times per week for four hours, bicarbonate dialysate was used. The patients' diet was not modified in any way. A total of 52 haemodialysis were examined: losses of alpha-amino nitrogen were monitored as well as changes of serum concentrations of different amino acids. Their mean losses were 119 +/- 54.69 mmol/4 h: this corresponds to 10.5 +/- 4.8 mg amino acids. The dialysis clearance was on average 122.7 +/- 63.2 ml/min. This value did not differ significantly from the dialysis clearance of urea, but it was significantly higher than creatinine clearance (p < 0.05). During dialysis a significant drop (p < 0.001) of the plasma concentration of amino nitrogen occurred, however, the changes of serum concentrations of amino acids differed. A significant drop was recorded in serum concentrations of histamine, lysine, cysteine, methionine, tyrosine, glycine, asparagine, citrullin, glutamine, taurine. Before the beginning of dialysis the values of valine, lysine, threonine, serine, alanine and asparagine were lower than corresponds to the reference interval in healthy subjects. CONCLUSIONS: Changes of serum concentrations of individual amino acids are significantly influenced not only by their losses into the dialysate but also by their shift from cells into the extracellular fluid and by resorption from the digestive tract during protein intake in the course of dialysis. An adequate supply of high quality protein can compensate for these losses. Investigation of serum concentration of individual amino acids does not record their kinetic changes but can give an idea on the effectiveness of the dietary regime.

[Determination of urea distribution space on the basis of hemodialysis quantification]. / Stanovení distribucního prostoru mocoviny na podklade kvantifikace hemodialýzy.

By using direct dialysis quantification--DDQ--in 124 haemodialyses made in 14 patients the authors assessed the urea output in mmol in the dialyzation fluid collected after every dialysis. The evaluation of total body fluids, which accounts roughly for 60% of the total body weight, was replaced by a calculated distribution space of urea (Vu) according to the Du/Ppre--Ppost formula. This equation was modified with regard to the degree of ultrafiltration and urea formation. The authors found a 5% difference between the values of the modified Vu equation and total body fluids corresponding to 60% of the body weight.

[Hemorrhage into the digestive tract as a cause of death in patients after kidney transplantation]. / Krvácení do zazívacího traktu jako prícina úmrtí u nemocných po transplantaci ledvin.

The authors investigated the prevalence, cause and possible prevention of haemorrhage into the gastrointestinal tract in 218 patients after transplantation of the kidney (TK). 1. Haemorrhage into the gastrointestinal tract after TK occurred in 32 patients incl. 53.1% who died. In the total mortality after TK haemorrhage into the gastrointestinal tract account for 15.7%. 2. The danger of haemorrhage into the gastrointestinal tract is increased in particular: in the early postoperative period (within one month after transplantation of the kidney), during acute rejection with declining function of the graft, in infectious complications, after graftectomy, in preexisting peptic ulcers. 3. The most frequent cause of haemorrhage were duodenal ulcers. The authors elaborated a system of preventive provisions which involve: a) medicamentous prophylaxis by administration of H2 blockers and antacids not only at the time of transplantation of the kidney and during the early postoperative period but also when there is an increased risk, b) detailed gastroenterological examination before transplantation of the kidney, c) in case of relapsing peptic ulceration in the case-history or haemorrhage into the gastrointestinal tract, subject patients on the waiting list for transplantation of the kidneys during the dialyzation period to proximal gastric vagotomy, or so-called highly selective vagotomy.

[Complications of subclavian and femoral cannulas]. / Komplikace podklíckových a femorálních kanyl.

In the course of 15 years in the author's department some 15,000 cannulas were inserted into the subclavian or femoral vein. This number included cca 2300 cannulas inserted to dialyzed patients. 213 patients (inl. 28 dialyzed) died with the inserted cannula. In these patients the incidence of complications was evaluated. A parietal thrombosis was the most frequent complication and was recorded in 119 cases, i.e. in 56% (in non-dialyzed in 57% and in dialyzed in 50%). In two non-dialyzed patients it was the cause of embolization into the lungs. In the incidence of complications there is no significant difference in dialyzed and non-dialyzed patients. For completeness the authors present a preliminary calculation per approximate number of inserted cannulas during this period. From the total number of 15,000 inserted cannulas fatal complications occurred in 0.06% (in dialyzed in 0.13% and non-dialyzed in 0.047%).

[Early acute tubulointerstitial nephropathy in transplanted kidneys]. / Casná akutní tubulointersticiální nefropatie transplantované ledviny.

The authors investigated in a group of 124 patients the effect of acute tubular nephropathy and rejection on the period of functional persistence of transplanted kidneys. Transplants which developed tubulointerstitial nephropathy during the first two weeks after transplantation of the kidney had significantly lower cumulative indexes of survival for as long as the second year after transplantation. Grafts which were rejected during the first two weeks after transplantation had a significantly lower cumulative survival index only during the first and second year. The statistical significance was always tested in comparison with grafts where the postoperative course was uneventful. It is better to evaluate the functional prognosis of transplanted kidneys from the maximal achieved glomerular filtration after a load; it did not matter whether tubulointerstitial nephropathy or rejection was involved.

[Bone metabolism in patients after kidney transplantation]. / Kostní metabolismus u nemocných po transplantaci ledviny.

The bone metabolism was evaluated in 20 patients after successful transplantation of the kidneys. In case of a functional graft within 22 months after transplantation of the kidneys complete regression of histological signs of secondary hyperparathyroidism was found, i.e. of fibrous osteodystrophy with a decline of the osteoclastic absorption and in 50% of the patients bone histology revealed osteomalacia. On the X-ray of the skeleton in 65% signs of osteoporosis were found, incl. 10% where the results were in discrepancy with the histological finding. The normal plasma calcium level before and after transplantation of the kidney was not affected. Other basic indicators of bone metabolism--phosphates, alkaline phosphatase, the bone isoenzyme of alkaline phosphatase and parathormone attained normal levels within 22 months after transplantation. Bone fluorides remain elevated also after 22 months following successful transplantation of the kidneys, although significantly less than before.

The effect of cortisol on gamma-glutamyl transpeptidase activity in the glycogen body and lumbosacral segments of developing chick spinal cord.

Gamma-glutamyl transpeptidase (GGT) activity is heterogeneously distributed between the lumbosacral chick spinal cord and the adjacent glycogen body during late embryonic and early posthatch development and displays hormonal sensitivity. As GGT activity may reflect the cellular transport of some amino acids, the transiently high activity of this enzyme in the glycogen body suggests that these cells play an important role in amino acid transport and metabolism at a time coincident with the initial phase of myelination in the embryonic chick spinal cord.

Inhibitory effect of tunicamycin on the adhesivity and aggregation of embryonic brain cells.

Tunicamycin (TM) - (0.1, 1.0 and 10 micrograms/ml) inhibits insignificantly the adhesivity of embryonic mice brain cells during the first 120 min of incubation. The effect is not dose dependent. The concentration of 10 micrograms/ml added at the onset of experiments has a drastic effect during the time period in which cell regeneration, cell movement and formation of aggregates occurs. Up to the 5th day in vitro (DIV), aggregation is completely inhibited and disrupted parts of cells are mostly present in the medium. The concentration of 1 microgram/ml is less effective, and 0.1 microgram/ml is practically without effect. EM analysis shows that tunicamycin (10 micrograms and 1 microgram/ml) diminish the regeneration and integrity of plasmatic membranes, 10 micrograms/ml of tunicamycin destroys cytoplasmatic organelles which is probably the cause of the decline of cellular regeneration and of aggregate formation. Tunicamycin (10 micrograms/ml), if added to the already formed aggregates evokes their disintegration and lower doses (1 microgram/ml) liberated cells from aggregates into the medium.

Glutamate uptake into cerebral cortex slices is reduced in the presence of a gamma-glutamyl transpeptidase inhibitor.

The uptake of L-glutamic acid into brain cortex slices of mice of different age was studied. The results suggest that GGT contributes to the transport of L-glutamic acid into the brain.

Reaggregation of human, chick, and human embryonic brain cells. Factors influencing the formation of a histiotypic unit.

1. Aggregation of embryo human, mouse, and chick brain cells was studied. The optimum age interval of donors from different species was determined. 2. The significance of different dissociation procedures (mild trypsinisation followed by sieving, trypsinisation + DNA digestion, mechanical dissociation in 1 or 2 steps, and Ca2+ chelation by EGTA) for the rate of aggregation was estimated. A significant reduction of aggregation was observed after one step mechanical dissociation. Nonspecific adhesion of cells on DNA molecules was found only during the first stages of aggregation. 3. The curve of aggregation kinetics follows the curve of floculation kinetics. 90% free cells disappear from the medium after 2 h of aggregation and a large number of microaggregates are formed which condense after 20 to 24 h into compact aggregates. The time course of aggregation was similar for all cells dissociated by different means. Small differences in the rate of aggregation, caused by dissociation procedures, were apparent only during the first stages of aggregation. 4. The histiotypic unit formed by aggregation of human, mouse, and chick embryo brain cells exhibits some common and some specific features. During aggregation a multiple structural reconstruction takes place and a limited number of cells are exchanged or sorted out from aggregates into the medium. 5. The structural organisation of aggregates from differently dissociated cells differs in several aspects. This indicates that membrane surface structures are influenced differently by dissociation and behave differently during distinct stages of aggregation.