[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.

A xanthogranulomatous process encircling large blood vessels (Erdheim-Chester disease?).

The case of a strange type of generalized xanthogranulomatosis, ending by a lethal kidney complication, is described in a woman aged 68. The clinical symptoms of the patient were not characteristic and did not lead to the actual diagnosis. The process was located along the basal brain arteries, it adhered to the adventitia of the descending thoracic aorta and of the coronary arteries. An identical xanthogranulomatous infiltrate was found in the peripelvic adipose tissue of both kidneys, where it led to stenosis of the proximal ends of both ureters; to a lesser extent such infiltrates appeared also in the periportal areas of the liver and in the bone marrow. Histological findings grant the possibility of the Erdheim-Chester disease. Differential diagnosis is subjected to discussion.

[Xanthogranulomatous processes in the area of the large vessels]. / Xantogranulomatózní proces v okolí velkých cév.

A case is described of 68 years old woman suffering from a peculiar xanthogranulomatous process terminated with fatal renal complication. The clinical symptomatology was not characteristic and did not lead to diagnosis during the life. The process was localized around the cerebral basilar arteries, and was also in close connection with the adventitia of the thoracic aorta and of coronary arteries. Identical xanthogranulomatous infiltrate was found in the peripelvic fat of both kidneys where it led to stenosis of proximal parts of both ureters; less extensive infiltrates were present periportally in the liver and in the bone marrow. Histological findings are suggestive of the diagnosis of Erdheim-Chester disease. The differential diagnosis of the process is discussed.

[Atypical forms of IgA nephropathy]. / Atypické formy IgA nefropatie.

Six cases of a IgA nephropathy were presented that were atypical from the morphological point of view and had less favourable prognosis than a classic form. Immune deposits in glomerular basement membranes were found in all of them. Dominant clinical features were common microscopical hematuria and early proteinuria very conspicuous in several cases.

Fluoride metabolism and renal osteodystrophy in regular dialysis treatment.

Fluoride in plasma, urine and bone tissue ash were estimated using a fluoride-ion electrode in 20 control persons (CP), 32 patients with compensated chronic renal failure (CRFP) and 59 patients in RDT (RDTP). The increase in plasma fluoride (CP: 2.4 +/- 1.4, CRFP: 6.5 +/- 2.2, RDTP: 12.3 +/- 4.5 mumol/L) and bone fluoride (CP: 55.1 +/- 31, CRFP: 99.9 +/- 31.2, RDTP: 339.1 +/- 150.6 mumol/g) significantly correlated with the decrease of residual glomerular filtration rate (RGFR), in RDT with the number of haemodialysis, so that the maximum increase in fluoride was found in completely anuric patients (379.7 +/- 153 mumol/g). The increase in fluoride retention was intensified by body retention of considerable amounts of fluoride each dialysis (the fluoridated dialysate increased the post-dialysis plasma fluoride by 195%). Development of bone fluorose known to develop with a bone fluoride greater than 180 mumol/g was not found in any of 40 iliac crest trephine bone biopsy specimens. No correlation was found between laboratory and histological findings of renal osteodystrophy and plasma or bone fluoride. No patient developed spontaneous fractures even after 11 years of using fluoridated dialysate. In conclusion, this report indicates that fluoride might have a protective effect against the progression of renal osteodystrophy in patients with high retention values. The longer the exposure of RDT patients to the fluoridated dialysate, the greater the bone fluoride concentration.

[Multiple endocrine neoplasia syndrome type I - familial occurrence]. / Syndrom mnohotné endokrinní neoplazie, typ I--rodinný výskyt.

Endocrine adenomatosis of Langerhan's islets (gastrinoma), parathyroid, pituitary gland and adrenals manifested itself at a proband by Zollinger-Ellison syndrome and perhaps hyperparathyroidism. Proband late brother's autopsy was reviewed and a similar morphology was found with Cushing's syndrome and peptic ulcer. Both brethren's mother died from a complication of recurring peptic ulcer.

[IgA nephropathy]. / Iga nefropatie.

A series of 150 samples of renal tissue obtained by needle biopsy from patients with haematuria were examined immunohistologically. In 15 cases mesangial deposits of IgA were demonstrated. In most cases they were young patients in whom no hypertension, oedema or laboratory findings indicating renal damage could be detected one year later during a follow-up examination. Electron microscopical examination was carried out in the renal tissue of 7 such cases, and showed dense mesangial deposits and a marked subendothelial rarefaction within the basement membrane. The light microscopical findings were variable. Three cases showed minimal lesions, 5 mesangial proliferative glomerulonephritis and 7 mesangial proliferative glomerulonephritis with focal segmental sclerotic alterations within the glomeruli.

Experimental immune complex glomerulonephritis in the mouse with two types of immune complexes.

Immune complex glomerulonephritis was induced in three groups of mice by long-term immunization. Two antigens of similar molecular weight were used. The first group was immunized with ferritin (mol wt 480,000). In altered glomeruli deposits of immune complexes were seen in the subendothelial and subepithelial spaces of the glomerular basement membrane (GBM) and in the mesangium. The immune complex deposits were formed by amorphous matrix with marked dense molecules of ferritin. The second group was immunized with human fibrinogen (mol wt 450,000). The immune complex deposits were present in the intramembranous, subepithelial and subendothelial spaces of the GBM and in the mesangium. These deposits were relatively less electron-dense and had a fine granular structure. The third group of mice were immunized with both ferritin and fibrinogen simultaneously. Two types of deposits situated subendothelially in the GBM and in the mesangium were seen in one animal of this group. One type of deposit resembled structurally the ferritin-antiferritin complex deposits, the other resembled the fibrinogen-antifibrinogen complex deposits. The individual deposits in the GBM and in the mesangium formed discrete homogeneous masses. The two types of deposit were occassionally in direct contact with one another, but were more often completely separate and were never mixed. It can be assumed that in at least some phase of the experiment both types of complex were present in the circulating blood simultaneously. However, since none of the complexes deposited in the GBM or in the mesangium were mixed, it seems probable that each type of complex is deposited separately in the form of "clusters" composed of a single type of complex. The phagocytic activity of mesangial cells of animals with complex glomerulonephritis was not increased when compared with control animals.

[Malignant nesidioma with 2 types of secretory granules in tumor cells]. / Maligni nesidiom se dvema typy sekrechích granulí vnádorových bunkách

A case has been described of a male aged 38 with a malignant nesidioma. The clinical examination disclosed marked hepatomegaly, variable hypertension associated with cool sweating, agitation and transient hyperglycaemia. The primary tumour as well as the metastases in the liver weighing over 13 kg were histologically of trabecular structure and stained positively with the methods of Bodian and grimelius. The impregnation for D-cells according to Rohoznická and Vortel was positive in isolated cells only. Ultrastructurally, the tumor cells could be divided in two types. The more numerous Type I cells contained rather small secretory granules morphologically resembling A granules of islet cells, and staining positively with impregnation methods for A-cells on the ultrastructural level. Type II cells contained, in addition to the formerly described ones, another type of granules appearing as large, slightly osmiophilic ones characteristic of the D-cells of Langerhan's islets and positive with the impregnation methods for D-cells. The type II tumour cells must be therefore regarded as a mixed cell type containing two types of secretory granules.

Gomori-positive cells in rat thymus: Lack of evidence on endocrine function.

Large Gomori-positive cells were observed in rat thymus after hormonal induction (e. g. after treatment with oxytocin or hydrocortisone). In contrast to some findings by others, no evidence on endocrine function of these cells was found and they were identified as macrophages containing, in their cytoplasm, great amount of phagocytized material.