Glutamine and other amino acid losses during continuous venovenous hemodiafiltration.

Serum amino grams and daily losses of glutamine (Gln) and other amino acids (AAs) into diafiltrate were measured during the first 5 days of continuous venovenous hemodiafiltration (CVVHDF) in 6 ICU patients with acute renal failure (ARF). Four patients had ARF as a part of multiple organ failure (MOF) of septic origin, and 2 patients had isolated ARF because of primary renal disease. During the study, all the patients received defined total parenteral nutrition (TPN). The mean daily AA losses into dialysate were relatively low (0.61 +/- 0.1 gN) and reached 4.5% of the daily AA substitution. Gln represented 32.7 +/- 5.9% of the total AA losses (0.19 +/- 0.04 gN). Serum levels of Gln (p = 0.002) and of most other AAs were significantly lower in the patients than in the control subjects (AA analysis in 16 healthy volunteers). Phenylalanine (Phe) was the only AA that was increased significantly (p < 0.01) in the patients. The mean patient serum concentrations of Phe and tyrosine were significantly higher (p < 0.03) than the correspondent concentrations in dialysate, but the lysine concentration was higher in dialysate (p < 0.03). The serum and dialysate concentrations of other AAs did not differ. Gln in serum decreased significantly (p < 0.03) on the second day of CVVHDF but returned to the baseline levels subsequently. Serum concentrations of Phe increased on the second day of CVVHDF (p < 0.05). Serum concentrations of other AAs remained stable during the whole study. We conclude that Gln losses into dialysate during CVVHDF are relatively low, but CVVHDF itself may induce changes in Gln metabolism and distribution that are reflected by a decrease of serum Gln levels at the institution of this treatment. Therefore, the need for Gln supplementation in ICU patients is even greater in the first days of CVVHDF.

A clinical study to assess the effect of heparin in dialyzer rinsing solutions.

The solution usually recommended for rinsing the blood side, which is an indispensable step in preparing a dialyzer for hemodialysis (HD), contains saline and heparin. The heparin used for rinsing is said to reduce the thrombogenic properties of the dialysis membrane and, hence, also the need for systemic heparinization during the whole procedure. The aim of our study was to establish whether this postulate also applies to polysulphone steam-sterilized dialyzers. To do so, 16 patients on long-term dialysis were randomized into two groups of eight. One group was subsequently treated with polysulphone low-flux dialyzers (F6HPS), the other with polysulphone high-flux dialyzers (F6OS). Both groups were examined, in a crossover manner during HD using a dialyzer previously rinsed with 1000 ml of saline plus 2,000 IU of heparin, and during HD using a dialyzer previously rinsed with 500 ml of saline without heparin. Except for the rinsing, HD conditions were completely identical. Blood obtained before HD, and at 15, 60 and 240 min of HD at the dialyzer inlet, was used to determine the activated partial thromboplastin time (to test heparinization control), the thrombin-antithrombin III complex (ELISA, to evaluate coagulation system activation), platelet factor 4 (ELISA, a substance with antiheparin activity), and platelet count. None of the above parameters showed, at any of the collecting intervals, a statistically significant difference between HD with and without heparin with a reduced volume of rinsing solution, or between HD using low- and high-flux dialyzers. It is concluded that heparin used to rinse polysulphone dialyzers before HD has no effect on blood coagulation or on the need for heparin during the procedure.

[Adjuvant therapy of lung cancer]. / Adjuvantní lécba rakoviny plic.

The authors evaluated in a retrospective investigation the effectiveness of adjuvant postoperative chemotherapy (ChT) and radiotherapy (RT), as compared with surgery alone, according to morphological types and stages of cancer lung (CaP). In a group of 321 patients 143 were treated by operation alone, 36 by operation and RT and 53 by operation and ChT. ChT involved administration of Cyclophosphamide, 30 mg/kg, at three-week intervals, some of the patients were also given vincaalkaloids. Therapy was repeated after 6-month intervals. According to the gross mortality data the probability of survival (PP) was compared by Kaplan-Meier's method. Improved PP was proved in patients with small cell lung cancer (MbCa) treated by operation and ChT and in third-stage disease treated by adjuvant ChT. In stage I of CaP adjuvant ChT and RT cause deterioration of the perspective of survival, as compared with operation alone and in stage II adjuvant ChT and RT are no advantage. The authors recommend adjuvant ChT in patients with surgically treated small-cell carcinoma and in stage III of operated CaP. They draw attention to the different response of tumours to adjuvant ChT and RT according to types and stages of CaP, to the fact that RT does not prolong the survival and to the possibility of preoperative ChT and RT in some types and stages of CaP.

[Effectiveness and reliability of preoperative studies in patients with lung cancer]. / Effektivität und Zuverlässigkeit präoperativer Untersuchungen bei Patienten mit Lungenkrebs.

The data of documentation of 267 operatively treated patients with lung cancer are shown in a retrospective study. The patients were treated in the clinic for tuberculosis and respiratory diseases of the faculty hospital Plzen. In 50% of the cases the results of histological and cytological examinations correspond with the surgical observations. Results of the pneumomediastinography and the computed tomography of the lung and mediastinum correspond with findings through the operation in 71% and 73% respectively. Through out the last three years the reliability of the cytological diagnosis was increased significantly (p less than 0.01).