Biomedical subjects

J Kvasnicka

Publications and source records attributed to J Kvasnicka.

At least 37 records · Page 2Linked to original sources

PubMed1998

Haemostasis, cytoadhesive molecules (sE-selectin and sICAM-1) and inflammatory markers in non-insulin dependent diabetes mellitus (NIDDM).

Non-insulin dependent diabetes mellitus (NIDDM) is connected with a higher incidence of macrovascular atherosclerotic disorders. The aim of the study was to detect any difference in levels of "cardiovascular risk factors"--fibrinogen, PAI-1 and inflammation response (documented by an increase of protein of acute phase orosomucoid) and of soluble cytoadhesive molecule sE-selectin and sICAM-1 (as markers of endothelial dysfunction) in blood plasma of 118 patients with NIDDM in comparison to the levels in blood plasma of 59 healthy persons as a control group. We observed higher levels of fibrinogen (fibrinogen level was 3.44 +/- 1.02 g/l in NIDDM pts versus 2.44 +/- 0.55 g/l in control group, p < 0.01) and PAI-1 Ag concentration was 159.7 +/- 110.3 ng/ml in NIDDM pts versus 51.43 +/- 24.64 ng/ml in control group, p < 0.01) together with an increase of acute phase protein orosomucoid as a "inflammatory response marker" (orosomucoid concentration was 0.85 +/- 0.23 g/l in NIDDM pts versus 0.54 +/- 0.18 g/l in control group, p < 0.01) in patients with NIDDM. The increase of these "cardiovascular risk factors" levels will be probably induced by higher activity of inflammatory cytokines IL-1 beta and/or TNF alpha in NIDDM patients, because both are inducers of orosomucoid fibrinogen and PAI-1 synthesis. This hypothesis is also supported by observation of higher levels of soluble cytoadhesive molecules sE-selectin (sE-selectin level was 64.25 +/- 26.8 ng/ml in NIDDM pts versus 46.64 +/- 29.57 ng/ml in control group, p < 0.01) and sICAM-1 (sICAM-1 level was 307.71 +/- 86.2 ng/ml in NIDDM pts versus 255.6 +/- 58.0 ng/ml in control group, p < 0.01) in patients with NIDDM. Both cytoadhesive molecules are produced by endothelial cells which are influenced by IL-1 beta and/or TNF alpha. According to these findings we suppose that an "inflammation" plays an important role in the evolution of atherosclerotic process at NIDDM together with the known influence of glucose and lipid metabolism pathology.

Cardiovascular Diseases↗

PubMed1998

The effect of glycosaminoglycan sulodexide on oxidative stress and fibrinolysis in diabetes mellitus.

Glycosaminoglycan sulodexide may influence morphology and functional properties of the basement membranes in microvessels. The aim of this study was to evaluate the effect of sulodexide administration on albuminuria and on different biochemical variables indicating endothelial dysfunction, oxidative stress and fibrinolysis in diabetic patients. Twenty diabetic patients of both types with micro- or macroalbuminuria were selected for sulodexide treatment. Daily dose of 600 U (60 mg) was injected intramuscularly five days a week. Fifteen doses were applied during 3 weeks. The patients were examined before and after treatment as well as 6 months later. No changes of diabetes control were observed during the study and after 6 months of wash-out period. Significant decrease of albuminuria (p < 0.001) was observed during the sulodexide administration with the following increase to pretreated values during the wash-out period. A decrease of serum N-acetyl-beta-glucosaminidase (NAG) activity (p < 0.03) at the end of treatment as compared to pretreated values was found in the whole group of diabetic patients. Slight reduction of oxidative stress expressed by malondialdehyde and superoxide dismutase was apparent after treatment but no simultaneous change in fibrinolysis was observed. Sulodexide may have some protective effects influencing functional properties of the basement membrane as manifested by lowered albuminuria. In addition, it may slightly decrease oxidative stress in diabetic patients and it could stabilize endothelial cells.

Acetylglucosaminidase↗

PubMed1998

[Complications of prevention and treatment of erythrocyte alloimmunization (case reports)].

OBJECTIVES: The treatment of late recognized alloimunization with intraumbilical transfusions is more difficult and more often connected with complications. MATERIAL AND METHOD: Between 1991-1997 we performed 70 intraumbilical transfusions in 25 fetuses for erythrocyte alloimunization. Six fetuses (24%) were hydropic in the beginning of the treatment. Eleven fetuses were delivered before 36 weeks of pregnancy. Two immature neonates (660 g and 1320 g) had intraventricular hemorrhage with neurologic complications. In six cases the transfusion was complicated by severe bradycardia of the fetus, but only twice the pregnancy was to be terminated by cesarean sectio during 24 hours after the procedure. Two of the 25 fetuses died antenataly and one postnataly, all of them primary hydropic. Two neonates had severe late onset anemia. CONCLUSION: Fetal alloimune anemia should be treated before onset of hydrops. The study was supported by the grant of IGA Ministry of Health CR No. 3200-3.

Adult↗

PubMed1998

[Splenectomy--an analysis of problems].

The authors discuss problematic of splenectomy on the historical view and also on the problematic indication to splenectomy. They compare two different periods in the small lapse of time. In the last period was the mowe in the indication spectrum to the splenectomy in the continuity with the application of new hematological medicaments in the practice. The number of "traumatological" splenectomy is constant.

Hematologic Diseases↗

PubMed1998

Prenatal determination of fetal RhD (rhesus positive) type by an amplification of DNA.

Examination of RhD genotype (Rhesus D gene) from amniotic cells (or chorionic villi cells) by PCR amplification of DNA can be done at early stage of pregnancy. Due to some missing exons in the Rh partial D variant (e.g. DVI), it is necessary to use different PCR systems to get relevant results. The localization of primers in our three PCR systems is on the different exons (10, 7, and 4 + 5). The advantage of PCR technique is prenatal detection of RhD of fetus from nonerythrocytes suspension (e.g. from an amnion fluid cell sediment) in comparison to a "standard" haemagglutination serological technique which uses blood erythrocytes only. The possibility of this technique to distinguished the heterozygous (D/d) or homozygous (D/D) fathers can help the clinicians in decisions about the management of further prevention of the hemolytic disease of newborn.

Amniotic Fluid↗

PubMed1998

[Diagnosis and therapy of erythrocyte alloimmunization in pregnancy].

INTRODUCTION: By preventive administration of anti-D globulin the number of cases of Rh isoimmunization declines steadily. Severe untreated isoimmunization may lead via foetal hydrops to intrauterine death, sometimes already during the 18th-19th week of gestation. The purpose of prenatal diagnosis in pregnant women with isoimmunization is to assess the danger or affection of the foetus, its prognosis and the mode of monitoring of the foetus. It is necessary to decide in time on intrauterine therapy by transfusion of erythrocyte mass and to assess the optimal time of delivery with regard to the risk of prematurity and foetal erythroblastosis, as well as with regard to intrauterine therapy. The objective of the present work was to test the protocol in the treatment of erythrocytic isoimmunization of the foetus. METHOD: During the period between January 1991 and October 1997 the authors investigated two groups of pregnant women: with a hydropic (n = 5) and non-hydropic (n = 20) foetus at the onset of treatment. In both groups amniocentesis and umbilical puncture were indicated. The authors investigated the number of cordocenteses and the volume of transfused blood per pregnancy, the number of complications and their type, gestation age of the foetuses on delivery, their birth weight, the condition of the neonates after delivery and on discharge to home care. RESULTS: During the mentioned period the authors administered 70 intraumbilical transfusions to 25 foetuses. The transfusion was not repeated more than eight times. The baseline haematocrit of non-hydropic foetuses was 26 (14-34), treatment was started on average during the 28th week (23rd-33rd). Pregnancy in women with a non-hydropic foetus was terminated during the 35th (27th-40th) week, with a mean weight of the foetuses of 2439 g (870-3520). Of 25 treated foetuses 6 were hydropic (24%) at the onset of treatment. The initial haematocrit of hydropic foetuses was 10.7 (4-19.8), treatment was started on average during the 28th (23rd-33rd) week. Pregnancy of women with hydropic foetuses was terminated during the 30th (25th-36th) week, the mean birth weight being 1838 g (660-3500). DISCUSSION: The very favourable therapeutic results in non-hydropic foetuses are in great contrast with the therapeutic results of moribund hydropic foetuses. CONCLUSION: The basic prerequisite of successful treatment by intraumbilical transfusion is to concentrate risk pregnancies in specialized centres with a high standard neonatological team for intensive care of pathological neonates.

Blood Transfusion, Intrauterine↗

PubMed1998

[Levels of lymphocyte subpopulations in peripheral fetal blood in Rh(D) erythrocyte isoimmunization in pregnancy].

INTRODUCTION: In the foetus in utero predominates a considerable percentage of immunologically so-called naive lymphocytes of the T and B series. The objective of the presented work was to assess by means of flow cytometry and labelled monoclonal antibodies quantitative changes in cell sub-populations of the foetal immune system before the foetus is altered by severe heamolysis as a result of Rh(D) isoimmunization. METHOD: The authors obtained by intrauterine puncture of the umbilical cord peripheral blood from 10 foetuses with isoimmunization during the 23rd-35th week of gestation, confirmed by the direct Coombs test and with a mean haematocrit value of 30.8% +/- 8.02. These findings were compared with values in the peripheral blood stream in a control group of 35 foetuses during the 18th-39th week of pregnancy with normal intrauterine development (haematocrit 34.2% +/- 5.87). The authors assessed the haemogram and CD signs in the lymphocyte population. RESULTS: In the peripheral bloodstream of foetuses with erythrocyte isoimmunization the authors did not detect, as compared with the control group (p > 0.01), a lower haemoglobin level (10.6 +/- 2.77 g/dl vs. 11.9 +/- 2.03 g/dl) a lower haematocrit (30.8% +/- 8.02 vs. 34.2% +/- 5.87) and fewer leucocytes 5.1 +/- 2.39 x 10(9)/l versus 6.97 +/- 3.29 x 10(9)/l. In foetuses with Rh(D) isoimmunization the authors found a higher percentage of T(CD3+) lymphocytes (79.0% +/- 11.23 vs. 73.7% +/- 12.79, but did not prove an increase of activated T lymphocytes (%DR+ from CD3+) (1.0% +/- 0.52 vs. 1.3 +/- 0.58). The percentage ratio of T helper cells (CD+) was higher than in the control group (61.0% +/- 10.25 vs. 56.1% +/- 12.45). In foetuses with Rh(D) isoimmunization there was no difference in the ratio of CD8 positive cells (24.1% +/- 8.23 vs. 23.6% +/- 7.26). Suppressor T cells (CD8+CD11b+) were fewer (4.1% +/- 1.24 vs. 7.5 +/- 11.23) than in the control group. The number of NK cells in foetuses with Rh(D) isoimmunization was 5.1% +/- 3.26 vs. 6.9% +/- 3.86, in isoimmunized foetuses there is a higher ratio of so-called naive T helper cells Th1 (CD4+ CD45 RA+) 49.3% +/- 12.71 vs. 43.0% +/- 12.88. When assessing naive B1 cells (CD19+CD5+), the authors did not find a difference between the two groups (10.4% +/- 6.20 vs. 9.06% +/- 12.1). The ratio of CD4: CD8 in the group with isoimmunization was higher than in the control group (3.1 +/- 1.39 vs. 2.5 +/- 1.13). CONCLUSION: In isoimmunized foetuses in the initial stages of haemolysis no detactable immune response with significant changes in the lymphocyte sub-populations was found.

Female↗

PubMed1998

A new method of estimation of the optimal AV delay by using pulse oximetry in DDD paced patients.

The paper gives a detailed description of a new method for estimating the optimal AV delay in dual chamber paced patients, which is non-invasive, not dependent on the examinator, not time consuming and inexpensive. In principle, the pulse oximetry signal obtained by common finger probe was used to measure the change in its time course after changes in pacemaker stimulation. The Eagle 4000 monitor, manufactured by Marquette USA, was used for measurements and digitizing the data and then this data was analyzed using a portable personal computer with original programs developed in Famulus v. 3.5. Our results were compared to the standard method for optimizing AV delay which uses the direct measurement of blood pressure in the ascending aorta. Twenty-four patients with Physios pacemakers were enrolled in the pilot study. Measurements showed a positive correlation (r = 0.982, N = 432) between the changes in the pulse oximetry amplitude and changes in the pressure pulse amplitude measured in the ascending aorta by a catheter-tip manometer. These results indicated that this new method could be a possible alternative to the currently used techniques for AV interval optimization.

Cardiac Pacing, Artificial↗

PubMed1997

[Effect of estrogens on cell adhesion molecules in thrombophilic states associated with high blood estrogen levels].

BACKGROUND: Incidence of thromboembolism in pregnancy is relatively low regarding to many predisposing factors, inclusively the thrombophilia induced changes in coagulation. To evaluate this contradiction we presumed: 1. still not adequately evaluated role of the fibrinolytic system, 2. possible suppression of cytoadhesive molecules in bloodstream and consequently decreased activation of vascular endothelia by high levels of estrogens in the course of pregnancy. METHODS AND RESULTS: The tests of fibrinolysis (serum levels of fibrinogen, D-dimers, tissue plasminogen activator (tPA) and plasminogen inhibitor 1 (PAI-1) and circulating cytoadhesive molecules (sE-selectin, sP-selectin and ICAM-1) were followed in a group of 66 pregnant women and compared with the unpaired Student's t-test with a group of 16 women after uncomplicated ovarectomy for benign disease. Results were compared with the serum 17 beta-estradiol levels. In pregnancy, significantly decreased levels of both selectins were found: sP-selectin: 159 +/- 39 micrograms/l (SD) vs. 205 +/- 69 micrograms/l (p < 0.05), sE-selectin: 33 +/- 12 micrograms/l (SD) vs. 43 +/- 17 micrograms/l (p < 0.05), meanwhile no significant difference in the concentration of ICAM-1 was found: 248 +/- 80 micrograms/l (SD) vs 285 +/- 101 micrograms/l (SD) (p > 0.05). In concordance, there were found significant negative correlations between serum levels of 17 beta-estradiol and sP selectin (r = -0.35, p < 0.01) and between serum levels of 17 beta-estradiol and sE-selectin (r = -0.21, p < 0.05) but not between 17 beta-estradiol and ICAM-1 (r = -0.1, p > 0.05). There were significant correlations between serum levels of 17 beta-estradiol fibrinogen (r = 0.46, p < 0.01), plasminogen activator I (PAI-1) (r = 0.38) and tissue plasminogen activator I (tPA) (r = 0.22, p < 0.05). No difference was found in serum levels of lipoprotein Lp(a) and naturally occurring inhibitor of the receptor for interleukin 1 (IL-Ira). CONCLUSIONS: This data supports the concept that the decreased serum levels of cytoadhesive molecules of sP-selectin and sE-selectin are dependent on serum estrogen levels and together with a new, estrogen induced, equilibrium of the fibrinolytic system suggest an explanation for the relatively low incidence of thromboembolic events in pregnancy. Decrease of cytoadhesive molecules may be one of explanations of favourable effects of estrogens on the development of atherosclerotic vascular changes.

Adolescent↗

PubMed1997

Angioscopy variables predictive of early angiographic outcome after excimer laser-assisted coronary angioplasty.

This study attempted to determine whether anatomic findings at angioscopy were associated with adverse early angiographic outcomes following excimer laser-assisted coronary angioplasty. Predictive factors of either coronary abrupt vessel closure or early (< or =24 hours) restenosis after percutaneous coronary angioplasty, including clinical and angiographic variables, have been widely evaluated. The role of angioscopic findings may contribute to identification of patients at risk for early poor outcome. Thirty-seven patients with severe lesions, including 23 total occlusions which underwent successful percutaneous transluminal coronary angioplasty (PTCA) with laser irradiation and adjunctive balloon dilatation (n = 35), or stand alone laser (n = 2), had concomitant angioscopic imaging of the target vessel. All patients had a 24-hour angiographic follow up. Early unfavorable outcome (n = 15) was defined as abrupt vessel closure or restenosis (> or = 50% stenosis) at 24 hours. By multivariate logistic regression analysis, immediate post-PTCA residual percent stenosis was associated with a poor outcome (restenosis: 33 +/- 22% vs no restenosis: 21 +/- 14%, p = 0.05). Angioscopic red thrombus aspect was the most significant correlate for early closure or restenosis (7 of 15 patients with unfavorable outcome vs 2 of 22 patients with favorable outcome, odds ratio, 22.9; p < 0.01) and was associated with a significantly higher early minimal lumen diameter loss (1 +/- 0.8 mm in the presence of a red thrombus vs 0.3 +/- 0.5 mm without thrombus, p < 0.005). Red thrombus appearance is associated with an unfavorable early angiographic outcome in patients who undergo laser-assisted coronary angioplasty.

Aged↗

PubMed1997

Immunocytochemical detection of estrogen receptors in bone cells using flow cytometry.

A sensitive method for immunocytochemical detection of estrogen receptors using flow cytometry is reported. Using this method, estrogen receptors were detected in several osteoblastic cell lines with established expression of estrogen receptors, and for the first time, estrogen receptors were also demonstrated in murine fibroblasts and in human primary marrow stromal cells. The distribution of estrogen receptors within all cell lines was unimodal. The method enables for studies of estrogen receptors in the cell types which express low to moderate levels of the receptors, for studies of heterogeneity of the receptors' expression and for simultaneous detection of several parameters on a single-cell level.

Animals↗

PubMed1997

[Changes in levels of cell adhesion molecules, acute phase proteins, lipids and hemostasis in relation to levels of endogenous estrogens during pregnancy and after ovariectomy].

The protective effect of oestrogens is probably caused also by the active inhibition of the inflammatory reaction of the acute phase and release of inflammatory cytokines type IL-1 beta or TNF-alpha by this hormone. We formulated this hypothesis because we recorded a drop of the protein of the acute stage, orosomucoid, in relation to the rising oestrogen level during pregnancy (r = -0.511, p < 0.0001). It ensues also from the finding of a lower level of cytoadhesive molecules of sE-selectins in a group of 66 pregnant women (sE-sel.: 32.95 +/- 12.5 ng/ml) with a higher level of 17-beta estradiol (17-beta E2: 9.34 +/- 7.8 nmol/l), as compared with the sE-selectin level in a group of 14 women after ovariectomy (sE-sel.: 43.97 +/- 8.174 ng/ml, p < 0.016) who lacked oestrogen (17-beta E2 0.14 +/- 0.13 nmol/l) and in a group of pregnant women (n 19) in the first trimester with level of 17-beta E2: 1.89 +/- 0.711 nmol/l where the sE-selectin concentrations at the onset pregnancy was higher (sE-sel.: 35.59 +/- 9.5 ng/ml) than in a group of pregnant women (n 38) during the second and third trimester (sE-sel.: 30.58 +/- 13.3 ng/ml, p < 0.05) with 17-beta E2 concentration 11.96 +/- 7.18 ng/ml. The finding of lower sE-selectin levels which is a sign that the endothelium is not exposed to the action of inflammatory cytokines IL-1 or TNF may thus be associated with the active "control" of thrombophilia in pregnancy. When during pregnancy in conjunction with oestrogen levels changes in the lipid concentration were investigated a compensating mechanism could be observed. Hypercholesterolaemia and hypertriglyceridaemia in pregnant women was associated with a rise of oestrogen levels as well as of "cardioprotective" HDL-cholesterol (the HDL level was during the first trimester 1.31 +/- 0.26 nmol/l, in the second and third trimester 1.69 +/- 0.48 nmol/l, p < 0.0167).

Adult↗

PubMed1997

The invasive prenatal diagnosis in perinatal centre.

Three main methods of prenatal diagnosis (Amniocentesis AMC, Chorionic villi sampling CVS and Cordocentesis FBS) have been used in Perinatal Centre of Central Bohemia. The chromosomal abnormalities in a group of 3,098 patients have been detected in 1.4% of fetuses. The inherited disorders were diagnosed using DNA analysis and biochemical examination of amniotic fluid. X-linked diseases in a group of 68 patients in 30.8% of fetuses have been diagnosed and inborn error of metabolism in a group of 29 indicated patients in 17.2% of fetuses were diagnosed. The incidence of fetal losses before 28th week of gestation was 0.4%.

Chromosome Aberrations↗

PubMed1997

[The role of the atrium and optimal values of AV intervals in sequentially paced patients].

In 1995, 2249 dual chamber pacemakers were implanted in the Czech Republic. These pacemakers make it possible to set an optimal AV delay between the atrial and ventricular impulse. Although the optimization of the AV interval has its well defined physiologic advantages, it does not seem to be necessary in otherwise healthy individuals with a good atrial and ventricular function. In these patients the default value, usually about 170 ms, is acceptable. However, AV interval optimization--i.e. finding the interval at which the atrial contribution to ventricular filling is maximal--should be done in all patients with left ventricular dysfunction, indicated for pacing because of bradyarrhthmia. In this subset of patients, even a small improvement in ventricular filling is believed to be clinically useful. Moreover, it has been documented, that in some types of ventricular dysfunction the so-called "primary optimization" (i.e. optimization of the AV interval in patients, in whom the pacemaker is not indicated for bradyarrhthmia but for ventricular dysfunction that might be improved by AV interval optimization) may be clinically useful. It is the case in patients with hypertrophic obstructive cardiomyopathy, dilated cardiomyopathy with presystolic regurgitation and AV interval prolongation, and perhaps even in some patients with impairment of ventricular systolic function and substantial prolongation of the AV interval. Despite all that, optimization of the AV interval is not routinely performed because even the best available optimization procedures (stroke volume measurements at different AV intervals by aortic Doppler echography) is observer dependent, time-consuming and costly.

Arrhythmias, Cardiac↗

PubMed1996

[The effect of micronized fenofibrate on lipid parameters and fibrinogen in heterozygous familial hypercholesterolemia and familial combined hyperlipidemia].

BACKGROUND: The aim of the study was to approve the hypolipidemic potency of the new drug from the group of fibrate derivates Lipanthyl 200 M(R) (micronized fenofibrate, cps a 200 mg, Laboratoires Fournier, France) in patients with familial hyperlipoproteinemias. The drug has been administered in constant dose of 200 mg daily with the evening meal for three months. Clinical examinations and monitoring of safety laboratory have been performed in addition to complete analysis of lipids, lipoproteins and apolipoproteins during the study. METHODS AND RESULTS: The group of 30 patients consisted from 14 heterozygotes of familial hypercholesterolemia and 16 patients affected by familial combined hyperlipidemia. Levels of total, HDL- and LDL-cholesterol, triglycerides, apolipoproteins A-I and B and Lp(a) have been measured and concentrations of fibrinogen in plasma as well. Concentration of total cholesterol 8.29 +/- 1.3 mmol/l on the beginning of the study decreased after one and three months of the treatment to 6.94 +/- 1.19 resp. 6.98 +/- 1.21 mmol/l, concentration of triglycerides has been reduced from 2.86 +/- 1.29 mmol/l to 1.70 +/- 0.86 and 1.74 +/- 0.99 mmol/l respectively HDL-cholesterol raised from 1.14 +/- 0.32 mmol/l to 1.27 +/- 0.36 and to 1.34 +/- 0.37 mmol/l in contrast to decrease of LDL-cholesterol 5.88 +/- 1.53 mmol/l on the beginning of the study to 4.87 +/- 1.49 and 4.79 +/- 1.60. Apo B in plasma fall after three month period of the treatment from 1.83 +/- 0.43 g/l to 1.46 +/- 0.47 g/l. On the other hand the concentration of apolipoprotein apo A-I1.20 +/- 0.35 g/l increased to 1.40 +/- 0.32 g/l. Fibrinogen in plasma was reduced from 3.63 +/- 0.69 g/l to 2.77 +/- 0.50 g/l. Also this decrease was statistically significant. CONCLUSIONS: Micronized fenofibrate is a potent hypolipidemic drug with only rare side effects. It is very good tolerated by the patients. Micronized fenofibrate is particularly prescribed for combined hyperlipidemia, however we can use it also in some patients with familial hypercholesterolemia. For to the treatment very resistant hyperlipoproteinemias we should consider combined drug therapy.

Adult↗

PubMed1996

[Levels of tissue-type plasminogen activator (T-PA), its inhibitor (PAI-1) and fibrinogen in the blood of patients with type 1 and 2 diabetes mellitus].

BACKGROUND: Fibrinogen (Fgb), the tissue activator of plasminogen (t-PA) and its inhibitor (PAI-1) are described as so-called cardiovascular risk factors. The objective of the present investigation was to assess the occurrence of the mentioned risk factors (Fbg, t-PA and PAI-1) in diabetes mellitus (DM) type 1 and 2, compare them with findings in a healthy control group and the two types of diabetes mutually. METHODS AND RESULTS: Fifty patients with type 1 DM were examined (mean BMI 23.8), 59 patients with type 2 DM (mean BMI 28) and 33 healthy subjects as controls (mean BMI 24.6). Both groups of diabetics were compensated. To assess the t-PA and PAI-1 concentration the ELISA test was used, Fbg was assessed by Clauss' method. The euglobulin fibrinolysis time (ECLT) was also examined. In both groups of patients with DM higher concentration of t-PA were found (DM type 7.06 +/- 2.4 ng/ml, p < 0.05, DM type 2 15.15 +/- 6.07 ng/mg, control 4.67 +/- 2.87 ng/ml, p < 0.05). In patients with DM type 1 a higher concentration of t-PA was found in patients with retinopathy (8.2 +/- 1.7 ng/ml than in patients with DM type 1 without retinopathy (6.9 +/- 1.3 ng/ml), p < 0.05). The PA-1 concentration was, as compared with controls, raised only in type 2 diabetics (DM type 2 124.57 +/- 47.22 ng/ml, control 88.57 +/- 15.7 ng/ml p < 0.05). Between the two groups also a difference in the PAI-1 level was found (DM type 179.25 +/- 17.95 ng/ml, vs. DM type 2, p < 0.05). With these findings corresponded the ECLT activation in DM type 1 (203.4 +/- 76.8 min. vs. ECLT in the control group 276.08 +/- 84.87 min., p < 0.05) and conversely a reduction of the euglobulin fibrinolysis in type 2 DM (448 +/- 117 min.), as compared with the controls (p < 0.05), as well as compared with DM type 1 (p < 0.05). The fibrinogen level was also elevated only in DM type 2 (3.619 +/- 0.69 g/l) as compared with the control group (2.42 +/- 0.42 g/l, p < 0.05) as well as compared with DM type 1 (2.53 +/- 0.47 g/l, p < 0.05). No difference was found in the fibrinogen level between DM type 1 and the control group. CONCLUSIONS: In both groups of patients with diabetes mellitus type 1 and 2 among the mentioned cardiovascular risk factors only a raised t-PA concentration was recorded. Concurrent elevation of PAI-1 and fibrinogen was found only in diabetes mellitus type 2.

Adult↗

PubMed1996

[Changes in hemostasis and fibrinolysis in gestational diabetes].

BACKGROUND: The most serious complication of diabetes is the progressive development of vascular changes in which impaired hemocoagulation and fibrinolysis participate. The latter were investigated in diabetes type 1 and 2, but les is known about them in gestational diabetes (GDM). The objective of the submitted work was to assess wither these disorders occur also during GDM and to compare the assessed changes of haemostasis and fibrinolysis with findings in a) non-pregnant healthy controls (n = 58), b) healthy pregnant women (n = 41) and c) groups of pregnant women with impaired haemostasis during gestation/gestational hemorrhage (n = 15), preeclampsia (n = 22), varicosities (n = 15) and dead foetus syndrome (n = 16), but normal carbohydrate metabolism. The changes in GDM were moreover compared with changes found in diabetes type 1 and 2. METHODS AND RESULTS: In pregnant women with GDM (n = 29) which was diagnosed according to WHO criteria the following parameters were examined: number of thrombocytes, APTT, fibrinogen-Fbg (according to Clauss), euglobulin fibrinolysis-ECLT, t-PA concentration, PAI-I (Coaliza, Kabi) and by microturbidimetry the concentration of plasma proteins/orosomucoid (ORM), alpha-1-antitrypsin (A1AT), prealbumin (PREA), transferrin (TRF) and alpha-2-macroglobulin (A2M). In patients with GDM a high Fbg level was found (4.51 +/- 0.98 g/l, p<0.01) not only as compared with Fbg in non-pregnant women (2.42 +/- 0.40 g/l), Fbg in healthy pregnant women (3.63 +/- 0.70 g/l) but also Fg in other patient groups with a pathological pregnancy. In pregnant women with GDM a reduced fibrinolytic activity - ECLT (464 +/- 98 min., p<0.01) was observed as compared with the finding in non-pregnant women (273 +/- 98 min.) but also in healthy pregnant women (303 +/- 106 min.). Another important deviation as compared with findings in healthy pregnant women in GDM is the reduced value of two proteinase inhibitors: A2M (2.04 +/- 0.59 g/l vs. 2.89 +/- 0.90 g/l, p < 0.01) and A1AT (2.98 +/- 0.80 g/l vs. 3.96 +/- 0.85 g/l, p < 0.01). The rise of t-PA (Ag), PAI-1 (Ag), fibrinogen and reduction of fibrinolytic activity (longer ECLT) made the changes the haemostasis and fibrinolysis in GDM closer to findings in DM type 2 than type 1. CONCLUSIONS: In GDM a higher thrombophilia was found (higher Fbg, longer ECLT) than in other groups of pregnant women. Another pathological finding is the reduced A2M level (proteinase inhibitor but also of PDGF and interleukins) and A1AT (inhibitor of leucocytic proteinases). The authors assume that these deviations favour the development of possible vascular changes in GDM and possibly also diabetic foetopathy (reduced A2M).

Adult↗

PubMed1996

Relationship of oxidative stress and fibrinolysis in diabetes mellitus.

This study attempted to verify the existence of a relationship between oxidative stress documented by malondialdehyde (MDA) and superoxide dismutase (SOD) and fibrinolysis analysed by tissue plasminogen activator (tPA) and its inhibitor (PAI-1) in diabetes mellitus. Forty-seven patients with Type 1 (n = 27) and Type 2 (n = 20) diabetes were examined together with 20 non-diabetic controls. The following were analysed: plasma MDA concentration, SOD activity in erythrocytes, tPA activity and antigen, PAI-1 activity and antigen, fasting blood glucose, fructosamine, glycated haemoglobin (HbAlc), and urine albumin. SOD activity was decreased in patients with diabetes. This contrasted with an increased plasma MDA concentration especially in Type 2 diabetes as compared with Type 1 or healthy persons (p < 0.001). tPA activity was increased in both groups of patients with diabetes as compared to healthy persons (p < 0.001), PAI-1 activity was higher in Type 2 diabetes with vascular changes than in the remaining subgroups (p < 0.001). Multivariate analysis revealed a significant positive relationship between plasma MDA concentrations and PAI-1 antigen (r = 0.53, p < 0.001) and a negative relationship between SOD and tPA activities (r = -0.53, p < 0.01). We conclude that oxidative stress may modulate fibrinolytic properties in diabetes mellitus.

Adult↗