The aim of this study was to compare biochemical markers of endothelial activation with microcirculation measured by laser-Doppler flowmetry in Type 1 diabetic patients with or without microangiopathy. A total of 44 Type 1 diabetic patients were subdivided into those with (n=24) and without (n=20) microangiopathy according to ophthalmological findings and the presence or absence of microalbuminuria. The control group consisted of 25 healthy people of comparable age, sex, and body mass index. Postocclusive reactive hyperemia (PORH) and thermal hyperemia (TH, at 44 degrees C) were measured at the forearm. Serum N-acetyl-beta-glucosaminidase (NAG) activity, serum E-selectin, and ICAM-1 concentrations were used as biochemical markers of endothelial dysfunction. A significantly lower velocity of perfusion increase during postocclusive hyperemia (PORH(max) x t(1)(-1)) and during thermal hyperemia (TH(max) x t(2)(-1)) (P<.01) were accompanied by higher serum NAG activity (20.9+/-4.6 vs. 16.3+/-2.5 U l(-1), P<.01) in diabetic patients with microangiopathy as compared to healthy persons. An inverse relationship was found between PORH(max) x t(1)(-1) and NAG (r=-.33) results in diabetic patients. In addition, higher mean values of serum NAG activity, E-selectin, and ICAM-1 concentrations were associated with significantly lower values of microcirculation parameters (PORH(max) x t(2)(-1) and TH(max) x t(2)(-1)) in six patients without microangiopathy who had at least one of the above biochemical markers higher than mean+2 S.D. range. We suggest that serum NAG activity, E-selectin, and ICAM-1 concentrations may be used together with laser-Doppler flowmetry in Type 1 diabetic patients as early indicators of vascular changes in very early stage of diabetic microangiopathy.

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PubMedDate not supplied

Soluble TNF and IL-2 receptors in patients with breast cancer.

INTRODUCTION: Cytokines were shown both to enhance tumour growth and formation of metastases and to inhibit proliferation of tumour cells. TNF alpha may mediate apoptosis and necrosis of cancer cells, while the exact role of IL-2 remains to be elucidated. Plasma levels of TNF alpha and TNF and IL-2 soluble receptors (sTNF-R, sIL-2R) should thus be in some relation to some biological characteristics of the breast cancer. MATERIAL AND METHODS: Plasma levels of TNF alpha, sTNF-R I and II and sIL-2R were measured in 31 women with different stages of breast cancer both before the institution of therapy and after 3 months of the treatment. RESULTS: Plasma levels of both types of sTNF-Rs were higher in patients with breast cancer than in controls (sTNF-R I--2166.6 +/- 568.9 vs. 1121.3 +/- 260.6 pg/ml, p < 0.001, sTNF-R II--3792.8 +/- 958.9 vs. 1996.2 +/- 404.3 pg/ml, p < 0.001) with no significant difference between clinical stages. Plasma levels of both sTNF-R (0.871, p < 0.001) and sIL-2R tightly correlated with each other. Plasma levels of TNF alpha decreased after treatment (from 3.92 +/- 1.86 to 3.40 +/- 1.15 pg/ml, p < 0.01), but plasma levels of sTNF-Rs and sIL-2R were not influenced by the therapy. CONCLUSION: Plasma levels of soluble TNF receptors may thus serve as a non-specific marker of the untreated breast cancer. Their relation to other biologic characteristics of this tumour is not clear. It remains also to be clarified if the long-term treatment leads to the normalization of sTNF-Rs plasma levels.

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PubMedDate not supplied

Massive fetomaternal transplacental hemorrhage as a perinatology problem, role of ABO fetomaternal compatibility--case studies.

BACKGROUND: Massive fetomaternal transplacental hemorrhage is not simply a problem of possible alloimunization in Rh incompatibility but also endangers the fetus (newborn) by massive anemization. Bleeding from placental vessels can occur after small trauma to the gravid uterus with mild or no clinical signs (bleeding or spotting, pain, hypertonus). The rupture of anchoring villi related to early uterine contractions is also possible. In the case of slow blood loss, the fetus reacts by adequate or inadequate compensatory reactions (hydrops fetus). Rapid and massive blood loss is followed by perinatal hypoxic damage and finally death. Our goal was to map out the diagnostic and therapeutic possibilities in regard to specific neonatal care. CASE REPORT: We evaluated four cases of fetomaternal transfusion during a 2-year period with special regard to postpartum adaptation of the newborn and the perinatal outcome. The incidence of adverse outcomes following massive fetomaternal transplacental hemorrhage was 50% (2 of 4). There was one perinatal death and one infant was affected by spastic quadriplegia. CONCLUSIONS: For diagnosis, it is possible to use cardiotocography (decreased variability, sinusoid pattern), ultrasound (biophysical profile) and special hematological tests for quantitative determination of fetal erythrocytes in the maternal blood. For the treatment of such cases one should consider premature termination of pregnancy or intraumbilical transfusion.

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PubMedDate not supplied

Percutaneous laser angioplasty with a pulsed Nd:YAG laser. Initial clinical experience and early follow-up.

Percutaneous laser-assisted balloon angioplasty with a pulsed Nd:YAG laser coupled to sapphire tipped optical fibers was used for the treatment of 22 patients presenting with 30 chronic occlusions of peripheral arteries (mean length 11 cm) during 25 sessions. The procedure was completed by balloon dilatation in 67%. Successful recanalization was achieved in 92%, clinically the procedure was successful in 68% with mean ABPI increase from 0.43 +/- 0.13 to 0.79 +/- 0.21. In 8 cases complications occurred. Two reocclusions were treated by streptokinase infusion, and 2 procedures were repeated 2 months later, one patient was referred to elective bypass surgery, and 3 patients were treated conservatively. Six patients were followed-up for more than 6 months. In 1 patient claudication of 400 m reappeared. These results are encouraging and it is likely that this method could become an important adjunct to balloon angioplasty.

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