Implementation and Sustainability of European Training Program on Organ Donation in Poland: Results and the Impact on Donation Indicators.

BACKGROUND: Hospital training called ETPOD-Essentials in Organ Donation-was introduced in Poland in 31 hospitals with under-utilized potential of donation. The aim of this study was to assess the effect in hospitals included and not included in program, before and after trainings. METHODS: The number of potential and effective donors, organs used, and number (%) of family refusals were compared at 10 and in 20 months after the training and in equal periods before. RESULTS: In trained hospitals, the number of potential donors increased (17% in 10 months, 10% in 20 months); in remaining hospitals, donors increased in 5% in both periods. In hospitals included in ETPOD, the number of effective donors increased (2% and 4.5%); in the whole country, donors also increased (5.6% and 2.7%). In ETPOD hospitals, the number of utilized organs increased (14.5% and 8.5%); in the rest, the increase was 3% and 7%. In trained hospitals, family refusals increased from 6.9% to 16.2% and from 8.9% to 10.7%; in the whole country, family refusals decreased from 11.7% to 11% in the short term and increased from 9.6% to 12.1% in the long term. CONCLUSIONS: In hospitals involved in the ETPOD program, the increase in organ donation is greater than in the rest of hospitals. Distinct benefit was observed in consent to organ donation.

Comparative evaluation of gastric ghrelin cells and levels of hormone in the serum of healthy women and men.

Due to difficulties in obtaining human material, most of the data concerning the site of occurrence and synthesis of ghrelin are based on animal studies. There are only few reports describing ghrelin-containing cells in the human digestive tract, based on the limited human material obtained during surgery or biopsy. The aim of this study was to compare and evaluate the distribution and morphology of ghrelin cells in the stomach and the levels of hormone in the serum of healthy men and women. The study included 18 subjects with normal gastric mucosa (12 men and 6 women). Immunohistochemistry was performed using rabbit anti-ghrelin (human) antiserum. Ghrelin level in serum was measured by ELISA. The total number of ghrelin positive cells was greater in the stomach of women than men. Ghrelin-immunoreactive cells were more elongated and larger in the stomach of women. The serum ghrelin level was higher in men than in women. Ghrelin concentration in serum correlates negatively with body mass index and weight in both genders, whereas the correlation between ghrelin level and age was positive in women and negative in men. The number of cells containing ghrelin in the stomach does not reflect the serum hormone levels. The differences in gastric ghrelin cells and ghrelin levels in serum between women and men, indicate that secretion of hormone can be under control sex hormones or other unknown factors.

Cocaine- and amphetamine-regulated transcript : identification and distribution in human gastrointestinal tract.

Cocaine- and amphetamine-regulated transcript (CART) was identified in the central and peripheral nervous system, including the gastrointestinal tract of rodents and pig. CART was also expressed in neuroendocrine cells of the rats stomach antral mucosa. The knowledge of the presence and functional role of CART peptide in the human alimentary tract is very limited due to difficulties in obtaining human samples (especially from healthy individuals). The presence of CART peptide in the gastrointestinal tract of the human was investigated immunohistochemically. CART-immunoreactive (IR) neural structures were observed in all studied fragments of alimentary tract. CART-like immunoreactive nerve fibers were numerous within the muscle in layers of muscularis externa and in the myenteric plexus of all gastrointestinal segments (from esophagus to colon), while they were moderate or few in density in other layers of gastrointestinal tract. The presence of CART peptides in the neuroendocrine cells was demonstrated predominantly in the pyloric, duodenum and fundus, and only few in the rest parts of the small intestine. CART-IR neuroendocrine cells could not be detected in the mucosa of large intestine. The present study reports for the first time a detailed description of the CART distribution pattern within the human alimentary tract. Our findings may hopefully provide some contribution towards a more complete and comprehensive understanding of the function and role of the CART peptide in the alimentary system.

Immunohistochemical identification and localisation of gastrin and somatostatin in endocrine cells of human pyloric gastric mucosa.

The detailed description of the distribution of endocrine cells G and D producing important hormones that regulate activation of other cells in the human stomach may be a valuable source of information for opinions about mucosa changes in different diseases of the alimentary tract. The density and distribution of immunoreactive G and D cells in the pylorus of humans (donors of organs) were evaluated. The pylorus samples were collected after other organs were harvested for transplantation. The number of G cells in the pyloric mucosa of healthy people was higher than the number of D cells. G and D cells were distributed between columnar cells of epithelium mucosa. Multiform endocrine cells generally occurred: gastrin in the middle third of the mucosa and somatostatin cells in the basal half of the pyloric mucosa. The investigation of the pyloric part of the healthy human stomach showed a characteristic distribution of cells that reacted with antisera against gastrin and somatostatin.

Renal parenchyma perfusion spectrum and resistive index (RI) in ultrasound examinations with contrast medium in the early period after kidney transplantation.

The main diagnostic method for renal graft dysfunction is color Doppler ultrasound with the use of spectrae evaluation of blood flow within the main and intrarenal arteries. Ultrasound with contrast medium (US-CM) enhances the possibilities of this tool. The aim of this study was to evaluate the efficacy of US-CM to assess renal graft perfusion among 18 kidney allograft recipients at 5 to 10 days after transplantation. Patients underwent pulse inversion sonography of the graft during intravenous injections of 2.4 mL SonoVue (Bracco-Altana, Italy). Images were quantitatively assessed using computer software to compare the time to peak contrast enhancement effect in the renal cortex and renal pyramids. The results were compared to Doppler ultrasonography of the renal arteries and estimated glomerular filtration rate (eGFR; Modification of Diet in Renal Disease [MDRD]). A correlation was observed between eGFR and blood flow parameters within the renal arteries, as well between the flow time of contrast medium from the artery within the renal hilus to the renal cortex. Increased eGFR correlated with subsequent improvement in graft function (r = -.806; P = .001), and resistive index (RI) of the renal artery was inversely related to subsequent delayed graft function (r = .544; P = .029). Negative correlations were observed between eGFR and renal artery RI, as well as between eGFR and time from renal artery contrast to maximal contrast enhancement of the renal pyramids. A negative correlation was found as well between eGFR and time difference of contrast enhancement of the cortex and pyramids. In conclusion, US-CM enhanced the efficacy of ultrasound diagnostics of the renal graft and may be used as a predictor of graft function in the early posttransplantation period.

Neutrophil gelatinase-associated lipocalin and cystatin C could predict renal outcome in patients undergoing kidney allograft transplantation: a prospective study.

Urinary neutrophil gelatinase-associated lipocalin (NGAL) may represent an early, predictive biomarker of delayed graft function due to ischemia-reperfusion injury. Unfortunately, creatinine is an unreliable indicator of acute changes in kidney function. NGAL was proposed as a novel early marker for detection of acute renal failure. Therefore, the aim of the study was to assess whether NGAL and cystatin C predicted outcomes among 41 consecutive patients undergoing kidney transplantation. Serum NGAL and cystatin C were evaluated before, as well as 1, 3, 6, and 10 days after kidney transplantation using commercially available kits. Serum creatinine was assessed at each time. We observed a significant fall in serum NGAL as early as 1 day following kidney transplantation. Serum cystatin C decreased significantly 3 days after transplantation. Before transplantation, serum NGAL was related to creatinine and cystatin C. At each time point, serum NGAL was related positively to serum creatinine, cystatin C, and negatively to urine volume. In patients with delayed graft function, there was no fall in serum NGAL or cystatin C. Our findings may have important implications for the clinical management of patients undergoing kidney transplantation. The "window of opportunity" to distinguish between acute rejection and calcineurin inhibitor nephrotoxicity is narrow in delayed graft function. Time is limited to introduce proper treatment after the initiating insult. Therefore, NGAL needs to be investigated as a potential early marker for delayed graft function, especially in the settings of early dialysis treatment or antirejection therapy.

The predictive value of arterial renal blood flow parameters in renal graft survival.

BACKGROUND: Renal allograft survival depends on a number of factors, however, no reliable simple parameter has been shown to predict long-term outcome after transplantation. Ultrasound is recognized and relatively inexpensive, providing information about renal location, contour, and size. Doppler ultrasonography shows kidney morphology and hemodynamics. The aim of this study was the evaluation of whether Doppler ultrasound of renal arteries performed in the early stage after transplantation was a valuable predictor for long-term-outcomes. MATERIAL AND METHODS: The study included 17 female and 24 male patients, aged 17-69 years with stable graft function. The Doppler ultrasound of renal flow was done on the 1st and 3rd day after transplantaion, and estimated glomerular filtration rate (eGFR) on the 20th day. The measured indices were as follows: maximum blood flow velocity (V(max)), minimum blood flow velocity (V(min)), resistive index (RI), and pulsatile index (PI). The creatinine concentration was evaluated, and eGFR calculated. RESULTS: Mean renal and intrarenal artery RI increased to day 3 after transplantation, and then reduced. The mean renal and intrarenal V(max) at day 3 correlated positively with eGFR (r = 0.38; P = .015); (r = 0.45; P = .003, respectively). Mean renal and intrarenal V(min) correlated positively with eGFR (r = 0.50; P = .001; r = 0.41; P = .008, respectively). The mean renal and intrarenal V(max) and V(min) on day 1 did not correlate with eGFR. CONCLUSIONS: Early Doppler Ultrasonography of renal graft hemodynamics may be a valuable predictor of graft survival and long-term outcomes. Blood flow velocity within renal arteries seemed to be an important factor.

Renal artery resistance index, thyroid hormones, and thyroid volume in the early kidney transplants recipients.

BACKGROUND: Thyroid hormones could affect renal function, and, on the other hand, renal dysfunction may affect thyroid function. Disturbances of concentrations of thyroid hormones are often associated with thyroid gland enlargement. The aim of the study was to assess the function and morphology of the thyroid (volume and hormones concentration) and kidney function after transplantation (creatinine concentration and resistance index [RI] of transplant artery). MATERIAL AND METHODS: The group included 13 females, 19 males; aged 19-69 years, mean 44.75 +/- 14.8 years after transplantation with stable graft function. Thyroid volume, renal artery RI, creatinine concentration, and concentrations of T3, rT3, FT3, FT4, and TSH were estimated the day before surgery, and at 1, 3, 6, and 10 days after transplantation. RESULTS: The statistical analysis revealed a negative correlation between delta RI (difference between RI at 3 and 6 days after transplantation) and serum creatinine concentration, 10 days after transplantation (r = -0.63; P < 0.01). We also observed a negative correlation between creatinine serum concentration at 10 days after transplantation and delta thyroid volume (Delta Vol; r = - 0.48; p < .05), a positive correlation between delta FT4 (Delta FT4) serum concentration, and delta creatinine (Delta Crea; r = 0.73; P < .001). CONCLUSIONS: The dynamics of RI changes in the transplant kidney artery between 3 and 6 days after transplantation may predict graft function. Together with improved kidney function at 10 days after transplantation, we observed a regression of goiter.

Is there any relation between thyroid gland function and kidney transplant function?

INTRODUCTION: Patients with chronic renal failure exhibit abnormalities of thyroid function. Reports regarding thyroid function in kidney transplant recipients (TX) are rare, particularly those individuals on long-term immunosuppression. The aim of this study was to investigate correlations between FT3, FT4, TSH concentrations, thyroid volume, and graft function. MATERIAL AND METHODS: The study enrolled 46 kidney allograft recipients (aged 27-67 years,) engrafted between years 1994 and 2000 and clinically stable. The mean time after TX was 45.3 +/- 37.4 months. Transplanted patients received prednisone, cyclosporine, and azathioprine. The control group included 22 patients with normal renal function. In addition to serum creatinine, TSH, FT3, and FT4 concentrations, thyroid examinations were performed with a 7.5-MHz linear probe to calculated the thyroid volume. RESULTS: Thyroid volume in TX patients was 25.3 +/- 13.3 mL. A positive correlation existed between thyroid volume and serum creatinine (P <.05), and a negative one between thyroid volume and TSH (P <.05). No correlation was observed between TSH, FT4, and serum creatinine. The time after TX was negatively related to TSH (P <.05). A negative correlation existed also between FT3 and creatinine in TX patients (P <.05). In the control group the concentrations of TSH and FT3 were within normal ranges. CONCLUSION: The FT3 concentration correlates with function of the renal graft. In TX patients the supplementary thyroid hormone therapy should be considered.

Brain abscess as a rare complication in a hemodialysed patient.

BACKGROUND: Infections remain among the most common morbid events and are an important cause of death in end stage renal disease. They have reduced immune response and increased hazard of infections due to repeated puncture of an arterio-venous fistula, formation of haematoma at the site of cannulation and central vein catheterisation. CASE REPORT: We report a case of brain abscess in chronically haemodialysed patient admitted to our department due to haedache, vomiting, accelerated hypertension and fever. The clinical examination revealed narroving of the right palpebral slit, weeping and right oral angle hanging loose. He had mild microcytic anaemia and high level of g-globulin. Ophtalmologic examination showed normal oculi fundi. The computed tomography revealed heterogenous mass marginally enhanced with contrast agent in the right frontal cerebral lobe. The right fronto-temporal craniotomy was performed and the right frontal lobe abscess was found and totally excised. The postoperative course was uneventful besides of seizures which were effectively treated with carbamazepine. After bilateral nephrectomy the patient undervent succesfull kidney transplantation and is in good condition without any neurological defect. A probable cause of his brain abscess was peridontal abscess recognized 3 month earlier or bilateral vesicoureteral refluxes. CONCLUSIONS: 1. Uremic patients have a reduced immunocapacity and are a high risk group for infections of various etiology. 2. Prompt eradication of all sources of infection is essential in hemodialysed patients.

[Malignant fibrous histiocytoma (fibrohistiocytoma malignum) localized intracranially]. / Wlókniako-miesak zlosliwy (fibrohistiocytoma malignum) o wewnatrzczaszkowej lokalizacji.

Primary intracranial malignant fibrous histiocytoma (MFH) is an extremely rare occurrence, however this kind of neoplasm is observed among the sarcomas. The aim of this report is to present a case of malignant fibrous histiocytoma in a 22 years-old woman. The control examination performed five years after operation revealed only mild exophthalmus and visual disturbances as presented before surgery.

[Concentration of glutathione (GSH), ascorbic acid (Vit. C), and thiobarbiturate acid reacting components (MDA) in brain neoplasms]. / Stezenie glutationu (GSH), kwasu askorbowego (Vit. C) oraz substancji reagujacych z kwasem tiobarbiturowym (MDA) w nowotworach mózgu.

The aim of the study was to evaluate the concentration of glutathione (GSH), ascorbic acid (Vit C), and thiobarbiturate acid reacting components (MDA) in brain neoplasms in specimens from normal brain tissue. The group of 72 individuals treated surgically for brain neoplasm in Department of Neurosurgery Medical Academy of Bialystok (Poland) in the period from 1996 to 1999 was included into the study. The GSH concentration was estimated with GSH-400 method, ascorbic acid by the use of Kyaw method, and MDA by Salaris and Babs method. The statistical analysis revealed diminished concentration of GSH and Vit. C (p < 0.001), and analogous increase of MDA concentration (p < 0.001) in the investigated specimens compared to the mentioned above substances concentration in the specimens obtained from normal brain tissue.

[Magnetic resonance proton spectroscopy in neurooncology--preliminary report]. / Spektroskopia protonowa rezonansu magnetycznego w neuroonkologii--doswiadczenia wstepne.

UNLABELLED: MR proton spectroscopy (1H MRS) has been widely applied in characterisation and differentiation of brain tumors, staging, recurrence of pathologic process, post radiotherapy changes and other lesions mimicking neoplasm like abscesses. Despite of many studies performed over last 3 years in many countries spectroscopic pattern (phenotype) of brain tumors is still not well estimated and the role of each metabolite as an indicator of histopathologic grade and type of the tumor is still unknown. MATERIALS AND METHODS: In vivo 1H MR spectroscopy was prospectively performed in 36 patients with intracranial tumors (low grade gliomas, high grade gliomas, meningiomas and abscesses). Examinations was performed with 1.5 T system, using voxels of 8 cc. RESULTS: In high grade gliomas level of NAA was decreased, and consequently low ratios of NAA to other metabolites were obtained; lactate and choline peaks were markedly increased. In patients with meningiomas signal of NAA was reduced, while in abscesses group peaks of acetate and succinate were observed. Authors analysed ratios of metabolites in above-mentioned tumors. The method is especially useful in differential diagnosis in neoplastic and nonneoplastic cases. CONCLUSIONS: Our study confirms diagnostic value of 1H MRS in doubtful cases of intracranial tumors.

[Activity of glutathione peroxidase (GSH-Px), glutathione reductase (GSSG-R) and superoxide dismutase in the brain tumors]. / Aktywnosc peroksydazy glutationowej (GSH-Px), reduktazy glutationowej (GSSG-R) i dysmutazy nadtlenkowej (SOD-1) w nowotworach mózgu.

The aim of the study was to estimate the activity of glutathione peroxydase, glutathione reductase and superoxide dysmutase in the brain tumours. The activity of GSH-Px was evaluated with the use of spectrophotometry, GSSG-R was evaluated based on the Mize and Langdon method, and SOD-1 with Sykes et al. method. The 55 specimens (45 specimens of neoplasm and 10 specimens of healthy brain tissue) were studied. The statistical analysis revealed significant increase of enzymes within the brain tumours in comparison to the healthy brain tissue.

MIB-I as a proliferative activity marker of the multiform glioblastomas.

MIB-I is a proliferative activity marker of multiform glioblastomas which are the most frequent tumors of the central nervous system. They are characterizad by differential rate and prognosis. The aim of the study was to determine the proliferative activity of multiform glioblastomas and estimation of the correlation between tumors' proliferative activity and tumors' localization, size, patients' age and sex. 24 patients (18 females and 6 males) with multiform glioblastomas were analyzed. The mean patients' age was 52.1. The proliferative activity was calculated as a proliferation index: IP for MIB-I. Cells with positive reaction were determined by MIB-I which was compared to all neoplastic cells. The most frequent localization of the tumors were frontal and temporal lobes of the brain. The size of the tumors ranged from 2.5 to 5.3 cm (mean 3.9). Mean IP was 43.2 (SD+/-17.4). We found no correlation between IP MIB-I and localization of the tumor, patients' age and sex. There was a marginal statistically significant correlation between IP MIB-I and size of the tumor (p=0.005).

[Long-term results of surgical treatment of lumbar disk herniation in adults]. / Odlegle wyniki chirurgicznego leczenia przepukliny jadra miazdzystego w ledzwiowej czesci kregoslupa u ludzi doroslych.

The authors present long-term results (10.2 years post-op) of surgical treatment of lumbar disc herniation in 1003 patients operated at the Department of Neurosurgery by the University of Medical Sciences in Bialystok. The operated group comprised 33.1% women (mean age--55.6 years) and 68.7% men (mean age 57.3 years). Ten years post-op 15.9% women and 5.8% men kept the recommended diet, 14% women and 7.0% men continued muscle strengthening exercise. Ten years post-op excellent and good results were noted in respectively 42.4% and 46.5% women and 45.4% and 46.6% men.

[Giant intradural disk herniation]. / Olbrzymia wewnatrzoponowa przepuklina krazka miedzykregowego--opis przypadku.

The authors present a rare case of the total intradural sequester from a prolapsed lumbar disc at the L4 level. This kind of hernations comprise 0.3% of all disc hernations. Surgical treatment resulted in a good outcome.

The superficial skin temperature of low extremities in patients with sciatica.

In some patients with lumbar disc herniation pain of various character and intensity is observed. Besides the pain a number of patients present burning or cold sensations. The superficial temperature of the lower extremities was evaluated in 39 patients with ischialgia, classified for surgical treatment. The differences of skin temperature, however not statistically significant, between the affected and non-affected limbs were found.

[Intradural reconstructive surgery of anterior fossa dural lesions using pedunculated periosteal flaps]. / Wewnatrzoponowa plastyka opony twardej w obrebie przedniego dolu czaszki z zastosowaniem uszypulowanych platów okostnej.

The cranio-cerebral injury could result in cerebro-spinal fluid fistula with serious consequences in form of meningitis. In a number of cases a surgical procedure is needed, however in spite of established standards the controversies are still present concerning approach and reconstruction technique. The author presents his own experience in duroplastic operations with intradural use of pedunculated periostal allograft flaps.

Neoplasms of the central nervous system of lipoid origin.

In general tumours of lipoid origin are benign. A high proportion of cases are mesenchymal neoplasms localised in subcutaneous tissue. Neurological signs related to compression of neural structures by fat within the vertebral canal were first presented in 1975. The lipogenic neoplasms represent 1-4% of spinal tumours, and generally are associated with congenital disorders of the spine. These fatty swellings are usually benign, but penetrating deeply into the spine, and connecting with spinal cord, cauda equina or filium terminale, they produce deficits. The deficits may be present at birth but they may also occur in the middle age. These events are classified as epidural lipomatosis (mostly observed in patients on chronic steroid treatment) or as lipoma, common in spinal disraphism. Intracranial tumours of lipoid origin are very rare (0.06-0.5% of brain tumours), and are probably congenital. They occur anywhere within the cranium, however a high proportion of cases tend to be located around the midline, and approximately 50% of tumours are found in the corpus callosum. Usually they are asymptomatic, and when the symptoms occur, they are frequently a result of general clinical condition. The authors present three cases of lipomatous tumours; one intracranial and two of spinal location.