Bone biopsy results and serum bone turnover parameters in uremic children.

UNLABELLED: The aim of the study was to evaluate the prevalence of renal osteodystrophy types in children undergoing haemodialysis and continuous ambulatory peritoneal dialysis and to assess the usefulness of biochemical parameters in diagnosis of renal osteodystrophy. Bone biopsy and measurements of serum parathormone (iPTH) level, alkaline phosphatase (AP), osteocalcin (OC), procollagen 1C, calcium and phosphorus levels were performed in 51 children aged 11.5 +/- 2.9 y with end-stage renal failure. Renal osteodystrophy (ROD) was diagnosed as follows: adynamic bone disease (ABD) in 14 (27%); normal bone histology (NB) in 19 (37%), osteomalacia (OM) in 1 (2%), mixed lesion (Mix) in 5 (10%) and hyperparathyroidism (HP) in 12 (24%) children. There was no difference in prevalence of ROD types between children on CAPD and HD. We found significant differences in the mean value of iPTH, OC levels and AP activity in HP vs NB and HP vs ABD. The prevalence of ABD was significantly higher in patients with PTH below 50 pg/ml than in patients with PTH above 50 pg/ml (p < 0.05). In 69% of children with NB the iPTH level was between 50 and 150 pg/ml. Most HP cases (75%) were diagnosed in patients with iPTH above 200 pg/ml. A high correlation between BFR and iPTH, BFR and OC, AP levels was found. CONCLUSION: The biochemical markers of bone turnover have only limited value in the differentiation of renal osteodystrophy types.

[Effect of large doses of nifedipine on pulmonary hypertension in patients with recurrent pulmonary thromboembolism]. / Wplyw duzych dawek nifedypiny na nadcisnienie plucne u chorych z nawracajaca zatorowoscia plucna.

Thromboembolic pulmonary hypertension is an uncommon condition with poor prognosis. Vasodilators may be effective in some patients with that disease. The effect of nifedipine on hemodynamics was investigated in two patients with thromboembolic pulmonary hypertension treated with acenocoumarol. Nifedipine was administered in 20 mg doses hourly during right cardiac catheterization and was repeated after 1 hour until a decrease in systemic pressure occurred. Patients received 80 mg and 120 mg of nifedipine. Pulmonary artery pressures decreased in both cases. An increase of cardiac output and decrease of pulmonary vascular resistance were observed after 60-80 mg of nifedipine and continued to the end of the investigation. No effect on heart rate was observed. We suggest that high doses of nifedipine may be--in some patients--effective in reducing thromboembolic pulmonary hypertension.

[Evaluation of agreement between clinical and pathomorphologic diagnosis of pulmonary embolism]. / Ocena zgodnosci rozpoznania klinicznego i patomorfologicznego zatoru tetnicy plucnej.

The rate of both: false-positive and false-negative diagnoses of pulmonary embolism (PE) is high. To determine the accuracy of the ante-mortem diagnosis of PE we reviewed 78 autopsies and compared the clinical and pathological diagnoses in that group. In 64 cases PE was diagnosed clinically: in 43 it was confirmed by autopsy (67%). In 21 cases (33%) the clinical diagnoses were false-positive. There were 57 pathological diagnoses altogether: in 14 cases (25%) the clinical diagnoses were false-negative. Among falsely diagnosed patients, the diagnoses of myocardial infarction, pneumonia and malignancy were most frequent. We tried to find some distinctive features separating the cases in the subgroups. Among them venous diseases were more frequent in PE than in falsely diagnosed patients.

[Pericarditis during the course of pulmonary embolism]. / Zapalenie osierdzia w przebiegu zatoru tetnicy plucnej.

Among 121 patients with pulmonary embolism (PE) five (4%) developed pericardial syndrome, connected with PE. Other known causes of pericarditis were ruled out. In 3 cases corticosteroids were administered with anticoagulants and/or fibrinolytic agents without complications. We believe that the clinician considering in similar situations the risk-benefit ratio of anticoagulant or/and fibrinolytic therapy should certainly use corticosteroids and not abstain from the use of anticoagulants and/or fibrinolytic agents in presence of pericardial syndrome after PE. In cases with huge pericardial effusion catheter should be inserted into pericardial space, because of high probability of cardiac tamponade.

The prognostic significance of bone marrow metastases in small cell lung cancer patients.

One-hundred forty-six SCLC patients were classified as localised (56) or extensive (90) using chest X-ray, bronchoscopy, brain CT, bone scintigraphy, ultrasonography of the abdomen and bilateral bone marrow trephine biopsy. Bone marrow metastases were found in 28 cases. Patients with bone marrow metastases had significantly shorter time to progression (median 20 weeks) and significantly shorter survival time (median 31 weeks) than other patients with extensive disease (medians 30 and 46 weeks). Patients with bone marrow involvement had significantly more often metastases in three or more organs than others with extensive disease. The negative prognostic significance of bone marrow involvement was however independent of the negative prognostic significance of the number of organs with metastases.

[Value of bone marrow trephine biopsy in evaluating the extent of small cell lung cancer]. / Wartosc trepanobiopsji szpiku w ocenie rozleglosci drobnokomórkowego raka pluca.

Bone marrow metastases using Jamshidi needle were found before treatment in 28 of 146 small cell lung cancer patients (19.2%). Bone marrow was a sole site of distant metastases in 3.4% of all cases and in 8.2% of those with no metastases in other organs. Patients with bone marrow involvement had more often metastases in 3 or more organs and had significantly more often liver metastases as well. Bone marrow infiltration was more often observed in patients with poor performance status and with disseminated disease, but was also found in 4 of 47 patients with good performance status and without metastases in other organs. Bone marrow trephine biopsy should be included in staging procedure in small cell lung cancer patients with good performance status, without metastases in other organs and with abnormalities in peripheral blood picture.

[Frequency of bone marrow involvement in patients with small cell lung carcinoma before treatment based on selected laboratory parameters]. / Czestosc wykrywania przerzutów do szpiku u chorych na drobnokomórkowego raka pluca przed leczeniem w zaleznosci od wyników wybranych badan laboratoryjnych.

Bone marrow bilateral biopsy was done in 106 small cell lung cancer patients before treatment. Full blood count, serum alkaline phosphatase activity, serum albumin concentration and serum Na+ concentration were compared according to presence or absence of bone marrow metastases. Decreased red cell count and elevated alkaline phosphatase activity were found significantly more often in the group of patients with bone marrow involvement. Thrombocytopenia and "blast" smear occurred only in patients with bone marrow metastases. Although bone marrow was found more often in association with low albumin level, this was not significant. It was impossible to anticipate the presence of bone marrow metastases on the base of total blood count, examination increased serum alkaline phosphatase activity or decreased serum Na+ or albumin levels. However in the presence of thrombocytopenia and "blastic" smear bone marrow metastases are very probable.

[Sinus histiocytosis with generalized lymphadenopathy--Rosai-Dorfman disease]. / Zatokowa histiocytoza z uogólnionym powiekszeniem wezlów chlonnych--choroba Rosai i Dorfmana.

A case of sinus histiocytosis with generalized lymphadenopathy--Rosai-Dorfman disease--in a 54 year old male is presented. The diagnosis was made by biopsy of the lymph nodes and histopathological examination of the affected organ. Treatment with prednisone and cyclophosphamide induced clinical improvement. The diseases clinical advanced stage and organ localization and the immunosuppressive therapy resulted in a opportunistic infection--pneumocystidosis and death of the patient within half a year after starting of therapy.

[Death caused by pulmonary embolism in a body builder taking anabolic steroids (metanabol)]. / Zgon z powodu zatorowosci plucnej kulturysty przyjmujacego sterydy anabolizujace (Metanabol).

A 20-year-old body-builder died from pulmonary embolism. The diagnosis was delayed because he concealed long-term taking of anabolic steroids.

[Intensive treatment of respiratory failure--personal experiences]. / Intensywne leczenie niewydolnosci oddychania--doswiadczenia wlasne.

Controlled oxygen-therapy was used in 30 out of 49 patients (61%) with the acute respiratory failure or exacerbations of the chronic respiratory failure treated at ICU (Group Y), while artificial ventilation in the remaining 19 patients (39%; Group B). An improvement was achieved in 70% of patients of Group A and 42% in Group B. Overall improvement was achieved in 59% of the treated patients. There were 69% of treated patients with infections. Totally 41% of the treated patients died (30% of Group A and 58% of Group B). An analysis of the results has been carried out in various subgroups of the treated patients, i.e. the acute and exacerbated respiratory failure as well as partial and complete respiratory insufficiency. The result of high risk patients have also been analysed. This subgroup included sudden cardiac arrest, shock and non-compensated acidosis. Favourable effects of the intensive care of patients with infections have been discussed with particular reference to the life hazard in case of septic complications. Emphasis is on the unfavorable effects of therapy in patients with respiratory failure complicated with pulmonary embolism. Indications to the use of respirator and complications of the artificial ventilation have been discussed.

[Respiratory failure treated at the intensive care unit "R" of the Internal Disease Clinic of the Institute of Tuberculosis and Pulmonary Diseases (1986-1987)]. / Niewydolnosc oddychania w materiale Sali "R" Kliniki Chorób Wewnetrznych Instytutu Gruzlicy i Chorób Pluc (1986-1987).

A picture and clinical course of the acute and exacerbated chronic respiratory failure have been analysed. An analysis embraced a group of 49 patients, i.e. 16 percent of all patients treated at the Intensive Care Unit. Four subgroups were distinguished depending on the etiology of the disease in which infectious, thrombo-embolic, circulatory or toxic factors caused respiratory failure. An emphasis is on the prevalence of the infectious etiology of disease being noted in 65% of patients. Acute respiratory failure was observed in 37% of patients whereas exacerbation of the chronic respiratory failure in 63%. Complete respiration distress was noted in 55% of cases and partial respiratory failure in the remaining 45%. Gasometric differences characteristic for each subgroup of the patients have also been analysed. 41% of the patients died. The highest mortality rate was seen in pulmonary embolism complicating various pulmonary diseases. Sudden cardiac arrest, shock and not compensated acidosis have been most unfavourable factors in the prognosis.

The effect of alkylating agents on the reproductive and hormonal testicular function in patients with rheumatoid arthritis.

An evaluation of testicular function was undertaken in 11 boys and young men aged 14-26 years suffering from rheumatoid arthritis complicated by amyloidosis and treated with cyclophosphamide and chlorambucil. 7 cases were studied during life and 4 at autopsy. Semen analysis showed azoospermia in 4 cases; in one, cryptozoospermia; in one, oligoasthenotheratozoospermia; and in one, asthenoteratozoospermia. In 4 patients with azoospermia and in one with cryptozoospermia, testicular biopsy was done for histo-pathological examination. In patients with azoospermia, only Sertoli cells were present in the seminiferous tubules. In one patient with cryptozoospermia, normal spermato- and spermiogenesis was found only in occasional seminiferous tubules. Microscopic examination of the testis failed to show any changes in the structure of the interstitial gland in any of the patients. Amyloid deposits were found in the vascular walls of the interstitial gland in one patient only. The serum testosterone level was depressed in 3 patients of the 9 examined. The LH level was elevated in 2 patients. The mean value of testosterone-LH ratio was significantly lower in patients treated with alkylating agents as compared with patients not so treated. Serum FSH level was elevated in 6 patients. Post-mortem examination of the testis in 4 patients showed complete absence of the germinal epithelium and only the presence of Sertoli cells. In 2 cases, amyloid deposits were found in the vascular walls in the rete testis. It was concluded that alkylating agents, besides damaging the testicular germinal epithelium, also affect the function of Leydig cells.