[When to start the long-term anticoagulation if antiphospholipid antibodies are present in high concentration--case report of the twin brothers]. / Czy i kiedy rozpoczynac leczenie przeciwzakrzepowe przy stwierdzeniu wysokiego miana przeciwcial antyfosfolipidowych--opis przypadku braci blizniaków.

The authors describe the observation of twin brothers with high concentrations of antiphospholipid anibodies in both of them, and the clinical manifestation of antiphospholipid syndrome (APS) and later systemic lupus erythematosus in first, without any clinical signs and symptoms in the other. The literature reports of twins with APS were analyzed and the discussion about long-term anticoagulation beginning proposed.

[Conditions contributing to late diagnosis of Wegener's granulomatosis--own experience]. / Uwarunkowania opóznien w rozpoznawaniu ziarniniaka wegenera--doswiadczenia wlasne.

The paper presents two cases of Wegener's granulomatosis, diagnosed in the phase of advanced renal failure, requiring dialysis therapy. Analysis of factors resulting in delayed diagnosis was performed.

[Analysis of the clinical course of disease and subsequent dialysis therapy in a group of patients with rheumatoid arthritis and end-stage renal disease]. / Analiza klinicznego przebiegu choroby oraz leczenia nerko- zastepczego grupy chorych na reumatoidalne zapalenie stawów.

The chronic nephropathy is often present in pts with rheumatoid arthritis (RA). In the study the authors retrospectively analyzed the clinical course of the disease and outcomes of subsequent dialysotherapy in a group of pts with RA and end-stage renal disease ESRD. During last 5 years ESRD connected with RA was found in 10 (8 F, 2 M) pts out of 325 chronically dialyzed pts (peritoneal dialysis and hemodialysis) representing 3,1% of pts. The mean age at the initiation of dialysotherapy in these pts was 62,8 +/- 10,2 (range 46-76) years. Mean time from the diagnosis of RA to the start of dialysotherapy was 18,8 +/- 11,6 (range 5-40) years. Earlier the patients were treated with many disease modifying antirheumatic drugs (DMARDS) also with glucocorticosteroids and many nonsteroidal anti-inflammatory drugs. It means that they had rather aggressive type of RA. Amyloidosis was histological confirmed in 6 pts (4 F, 2 M). Peritoneal dialysis (PD) was the first choice therapy in 8 pts (2 on APD, 6 on CAPD). The main complication was increased incidence of peritonitis. 3 pts died on PD after 5, 9, 24 months (respectively) of CAPD treatment. 3 pts were transferred to HD after 5, 15, 18 (respectively) months of CAPD because of recurrent peritonitis. 2 pts up to date continue PD (one 12 months, the second 46 months on CAPD). In 5 pts who needed hemodialysis treatment there have been very serious problems with permanent vascular access formation. All used permanent indwelling catheters (Permcath). We concluded that: occurrence of ESRD in pts with RA was connected with aggressive type of disease. Pts with RA represent a dialysis group that is particularly prone to complications of PD (enteric peritonitis) and HD (vascular access problems). It seems to be connected with secondary vasculitis often found in pts with aggressive type of RA.